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COUNTWAY LIBRARY

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MEDICINAE
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THE ROENTGEN RAY

AND ALLIED PHENOMENA
(Formerly ARCHIVES OF SKIAGRAPHY).

VOLUME XII.
JUNE, 1907, TO MAY, 1908.

THI
ERM
OTH
ERA London :

REBMAN LIMITED ,
129 SHAFTESBURY AVENUE
1908
 CATALIE

COSTON,MEDIOS
IN 19:08
JUN 16 1908
E. H , B.

LIBRARY, INDEX TO VOLUME XII.

А.
ABDOMINAL diseases, the value of the X rays in diagnosis
of obscure. Professor Edwin E. Goldmann, 335,
pls. cclxxxix ., ccxc.
Absorption of Roentgen rays, the selective. G. W. C. Kaye,
B.Sc., A.R.C.Sc., 314
Action of uviol light on the skin, and its therapeutic use
in dermatology. Dr. Carl Stein and Dr. Hesse, 70
Alexander, Dr. Béla. Plastic Roentgenography, 216,
pls. cclxxxi. , cclxxxii.
B
Base-ball fingers. J. N. Hall, M.D., and G. H. Stover,
M.D., 41, pl. cclxviii.
Batten , George B., M.D. Some practical points regard
ing the X -ray treatment of ringworm of the scalp,
42, pl. cclxix., figs. 1 and 2
Belot, Dr. J. Recent progress in Roentgenology and
Roentgeno-therapy, 344
Belot, Dr. J. Treatment of Paget's disease by radio
therapy , 67
Bergonié, Professor J. , Bordeaux . An electrostatic
voltmeter as a continuous indicator of the penetra
tion of a focus-tube, 225
Bladder, urinary, examination of the, by X rays, after
insufflation with oxygen . David Morgan, M.B.,
271 , pls. cclxxxv. , cclxxxvi.
Bordier, Professor H. Determination of the quantity
of X rays absorbed by the various tissues of the
body, 199
Born , H. H., M.D. A case of supernumerary digits , 148,
pl. cclxxvi.
Born, H. H. , M.D. The localization of foreign bodies in
the eyeball, 228
British Medical Association at Exeter. Report of the
Electrical Section , 91
British Medical Association at Sheffield, the Electrical
Section of the, 335
Burnet, James, M.A. , M.D. The origin of frost- bite, and
its treatment by artificial hyperemia (translation ),
170
Butcher, W. Deane, M.R.C.S. The future of electricity
in medicine, 177
C
Calculi, renal and ureteral, the X-ray diagnosis of.
G. Harrison Orton, M.A. , M.D. , 238, pls. cclxxxiii. ,
cclxxxiv .
Cancer and lupus, radium for the treatment of. William
J. Morton , M.D. , 278
Chest routine examination of the. George A. Pirie,
M.D. , 260
Congenital maliormations. A case of hexadactylia : a
skiagraphic contribution to the study of. Professor
August V. Luzenberger, M.D. , 41 , pl. cclxix., fig. 3
Congress of Electrology and Radiology, fourth Inter
national, at Amsterdam , September, 1908, 270
Congress of Medicine , ninth, at Paris, 1907, 212
Congress of Physio-therapy at Paris, 302
Congress of Physio-therapy , the Second International,
at Rome, 1907 , 2, 58 , 120, 209
Congress of the German Roentgen Society, programme
of the fourth, Berlin , 334
Contribution to the study of high - frequency currents.
Dr. Foveau de Courmelles, 141
Correspondence, 27 , 56, 87, 117, 148, 205, 235, 299, 331,
366
Courmelles, Dr. Foveau de. A contribution to the study
of high-frequency currents, 141
D
Dermatology, the action of uviol light on the skin , and its
therapeutic use in . Dr. Carl Stein and Dr. Hesse, 70
absorbed by
Determination of the quantity of X rays Professor
the various tissues of the body. H.
Bordier , 199
Diagnostic work, some experiments with Roentgen tubes
with respect to the use of tubes for. Vernon J.
Willey , A.M. , 248
Difficulties, some, in the X - ray diagnosis of renal calculus .
C. Thurstan Holland , M.R.C.S. Eng., 61, pls. cclxx. ,
cclxxi ., cclxxii .
Digestive tract, the Roentgen -ray examination of the.
Dr. Franz M. Groedel, 122
Diseases of the hair, on the radio -therapeutic treatment
of. Professor Dr. Robert Kienbock , 12 , pl. cclxvii.
Dislocations and fractures, the use and abuse of skia
graphy in. John Poland, F.R.C.S. , 131
Distributionof Roentgen rays from a focus-tube. Walter
A. Scoble, B.Sc. , 108
E
Editorial, 1 , 29, 57 , 89, 119, 149, 207 , 237, 269 , 301 , 333
Einthoven galvanometer. Professor J. K. A. Wertheim
Salomonson , 157 , pls. cclxxvii . , cclxxviii.
Electric sleep, the . Professor Stéphane Leduc, 46
Electrical radiographic and allied departments at the
London hospitals, 59
Electrical Section of the British Medical Association at
Sheffield , 335
Electricity in medicine, the future of. W. Deane
Butcher, M.R.C.S., 177
Electrology and Radiology, fourth International Congress
of, at Amsterdam , September, 1908, 270
Electroscope, Dr. Milton Franklin's, a test of. Walter
A. Scoble , B.Sc. , 39
Electrostatic voltmeter as a continuous indicator of the
penetration of a focus-tube. Professor J. Bergonié,
Bordeaux , 225
Electro -therapeutical Exhibition, the, 208
Enuresis, note on high -frequency currents in . W. F.
Somerville, M.D. , 199
Epileptiform neuralgia treated with X rays, a case of.
Alex. Gregor, M.D., 169
Epithelioma, treatment of, with Roentgen rays. Dr.
Eduard Schiff, 276
 0 5 0 9
1
INDEX TO VOLUME XII . iii

Eyeball, foreign bodies228in the, the localization of. High-frequency currents in enuresis, note on. W. F.
H. H. Bor , M.
n D., Somerville, M.D., 199
Examination of the heart by the Roentgen rays. High -frequency currents, the treatment of sciatica by.
Dr. Franz M. Groedel, 303 E. S. Worrall, M.R.C.S. , 272
Experiments with Roentgen tubes with respect to the High -frequency devices, some new. Henry G. Piffard,
use of tubes for diagnostic work. Vernon J. Willey, M.D., LL.D., 78
A.M., 248 Holland, C. Thurstan, M.R.C.S. Eng. Some difficulties in
F the X-ray diagnosis of renal calculus, 61 , pls. cclxx .,
Focus-tube, penetration of a, an electrostatic voltmeter cclxxi. , cclxxii.
as a continuous indicator of the. Professor J. Humphris, F. Howard , M.D. Brux. The rationale of
Bergonié, Bordeaux, 225 static currents , 274
Focus-tube, the distribution of Roentgen rays from a. Hyperæmia, artificial, the origin of frost-bite, and its
Walter A. Scoble , B.Sc. , 108 treatment by. Dr. Carl Ritter, 170
Foreign bodies in the eyeball,localization of. H. H. Born,
M.D. , 228 I
Fractures and dislocations, the use and abuse of skia Instrument for high frequency, a new , 291
graphy in. John Poland, F.R.C.S., 131
Fractures only recognizable by theaidof the Roentgen Intensity of the Roentgen rays, on Salomo
the . Profes
themeasurement of
Werthsor Dr. eim nson , 3
rays. Dr. Graessner, 102, pls. cclxxiii. , cclxxiv . Intestines and stomach , diseases of the, on the present
Franklin, Dr. Milton , electroscope, a test of. Walter A. position of Roentgen diagnosis in. Dr. Jollasse,
Scoble, B.Sc., 39
Frost-bite, origin of, and its treatment by artificial Hamburg, 281
hyperemia. Dr. Carl Ritter, 170 Ions, zinc, and tissue chemistry. Dr. Alwin Knauer, 324
Fryett, A. G. , F.R.M.S. Stereoscopic photograph of a Irradiation, intensity of, on the technique of Roentgen
female pelvis, 15, pl . cclxvi. burns and the means of determining the . Dr. R.
Kienbock , 160
G J
Galvanometer, the Einthoven. Professor J. K. A. Wer- Jollasse, Dr. , Hamburg. On the present position of
theim Salomonson , 157, pls. cclxxvii., cclxxviii. Roentgen diagnosis in diseases of the stomach and
Goldmann , Professor Edwin E. The value of the X rays intestines, 281
in diagnosis of obscure abdominal diseases, 335, K
pls. cclxxxix ., ccxc.
Graessner, Dr. Fractures only recognizable by the aid of Kaye, G. W. C., B.Sc. , A.R.C.Sc. The selective absorp
the Roentgen rays, 102 , pls. cclxxiii., cclxxiv. tion of Roentgen rays , 314
Graham, George H. , M.D. Radium and its medical uses, Kienbock , Professor Dr. Robert. A vertical ortho
31 diagraph, 288
Gregor, Alex., M.D. A case of epileptiform neuralgia Kienbock , Professor Dr. Robert. On the radio -thera
treated with X rays, 169 peutic treatment of diseases of the hair, 12,
Groedel, Dr. Franz M. Ortho -Roentgenography, 150, 184 pl. colxvii.
Groedel , Dr. Franz M. The examination of the heart by Kienbock, Dr. R. On the technique of Roentgen burns
the Roentgen rays, 303 and the means of determining the intensity of
Groedel, Dr. Franz M. The Roentgen -ray examination irradiation, 160
of the digestive tract, 122 Knauer, Dr. Alwin. Zinc ions and tissue chemistry ,
324
H Koehler, Dr. Alban. The theory and technique of
Hair, diseases of the, on the radio-therapeutic treatment teleroentgenography , 311
of. Professor Dr. Robert Kienbock, 12 , pl. cclxvii.
Hall, J. N., M.D., and G. H. Stover, M.D. Base-ball
fingers, 41 , pl. cclxviii. L
Hall-Edwards, J., L.R.C.P. Lymphadenoma and the Leduc, Professor Stéphane. The electric sleep, 46
X rays, 10 Localization of foreign bodies in the eyeball. H. H.
Heart, examination of the, by the Roentgen rays. Dr. Born, M.D. , 228
Franz M. Groedel, 303 Long bones, syphilis of the, radiograms of. Martin W.
Hesse, Dr. , and Dr. Carl Stein. The action of uviol Ware, M.D. , 343
light on the skin, and its therapeutic use in Lupus and cancer, radium for the treatment of. W. J.
dermatology, 70 Morton , M.D. , 278
Hexadactylia, a case of : & skiagraphic contribution to Luzenberger , Professor August V., M.D. A case of
the study of congenital malformations. Professor hexadactylia : & skiagraphic contribution to the
August V. Luzenberger, M.D. , 41, pl. cclxix., fig. 3 study of congenital malformations, 41, pl. cclxix . ,
High frequency, a new instrument for, 291 fig. 3
Higb - frequency currents, a contribution to the study of. Lymphadenoma and the X rays . J. Hall- Edwards,
Dr. Foveau de Courmelles, 141 L.R.C.P. , 10
iv INDEX TO
M NOTES AND ABSTRACTS — continued
Measurement of the intensity of the Roentgen rays, on
the. Professor Dr. Wertheim Salomonson, 3
Measurement of X rays, on the use of the Sabouraud
pastille for the Agnes F. Savill, M.A., M.D., 340
Medicine, the future of electricity in. W. Deane
Butcher, M.R.C.S. , 177
Meijers, Dr. R. F. S. The photograph of a Roentgen
tube in action, 130, pl. cclxxv.
Morgan , David, M.B. Examination of the urinary
bladder by X rays, after insufflation with oxygen ,
271 , pls. cclxxxv., cclxxxvi.
Morgan, David, M.B. Plastic Roentgenography, or the
reproduction of X -ray pictures in relief, 195,
pls. cclxxix ., cclxxx.
Morton , W. J., M.D. Radium for the treatment of
cancer and lupus, 278
N Experiences in the treatment of acute articular
Neuralgia, epileptiform , a case of, treated with X rays.
Alex. Gregor, M.D., 169
New Inventions, 327
NOTES AND ABSTRACTS
a rays, scattering of the, 262
Abortion caused by Roentgen rays, 146
Action of the Roentgen rays on prostatic hyper
trophy, 174
Action of the Roentgen rays on the selenium cell, 24
Advantages of radiant baths, 112
Angina pectoris, treatment of, by arc light baths , 329
Application of blue electric light in various diseases,
329
Artificial light, the effect of, on plant life , 361
Bismuth and the X rays in the detection of gastric
ulcer, 83
Bismuth skiagram in gastro -intestinal disorders, 330
Bloodvessels, the action of different currents upon
the, 295
Bronchial asthma , treatment of, by means of the
Roentgen ray, 292
Cancer treated with the X ray, report of 107 cases
of , 362
Chronic bronchitis, the treatment of, by Roentgeni
zation , 51
Coincidence of measles with the defluvium of the
hair in the X -ray treatment of ringworm of the
scalp, 113
Combined treatment for exophthalmic goitre , 23
Conservation of the human arterial pressure after
application of high -frequency currents by auto
conductor, 331
Copper ions in the treatment of suppurating sinuses
and infected wounds, 173
Cure of lupus by the X rays, 174
Diagnosis of lung tumours by means of the Roentgen
rays, 330
Effects of radio -therapy on spastic spinal paralysis,
146
Electrical charge of toxin and antitoxin, 294
Electrical treatment of pruritus of the vulva and
anus , 110
VOLUME XII .
Electricity as an immunizing agent and disinfectant,
363
Electricity in the treatinent of rheumatism , 110
Electro -densimeter, the , 262
Electrolysis, the radical absorption of urethral
strictures by, 51
Electro -therapeutics of rheumatism , 144
Electro - therapy in disorders of the circulation, 24
Epithelioma of the skin, treatment of, by high
frequency currents, 365
Epithelioma, treatment of, with Roentgen rays,
361
Epitheliomata treated by Roentgen rays, 362
Equipment for X -ray work, 82
Examination of the mobility of the stomach after
gastroenterostomy, 330
Exophthalmic goitre treated by radium , 262
rheumatism with Stauung-hyperæmia, 365
Experiences with the quartz lamp, 329
Experiments on the law of the action of the
alternating current on organized structure, 360
Favourable influence of the Roentgen rays in chronic
bronchitis, 145
Favourable influence of X rays in chronic bronchial
affections, 173
Fracture of acetabulum , 330
Galvanometer, the, in the study of mental diseases ,
364
Gas from the glass of X-ray tubes, 360
Glove for electro -massage, 230
Gloves for X-ray workers, 327
Granuloma pudendi tropicum treated by the Roentgen
rays, 146
Growth of fog in unsaturated air, 230
Healing fistulous tracts by metallic cataphoresis, 144
High -frequency currents in chronic pelvic conditions,
144
Hypertrichosis, treatment of, by the X rays, 51
Hypertrophy of the prostate treated by radio
therapy, 362
Induction of local anesthesia by cocaine cata
phoresis, 111
Influence of cholin and of X rays on the course of
pregnancy, 293
Influence of the Roentgen ray on the diagnosis and
treatment of fractures of the elbow - joint, 363
Influence of X rays, in the treatment of leukæmia
and Hodgkin's disease, 146
Injury from electric current of 16,000 volts , 112
Injury to the kidneys due to the X rays, 116
Kromeyer quartz vacuum mercury lamp, 263
Leukæmia treated by the Roentgen rays, 174
Light rays, a new form of, in cystitis and posterior
urethritis, 145
Light treatment of ozæna, 82
Localization of foreign bodies, 231
Lupus of the face and photo -therapy, 262
Lymphadenoma treated by X rays, a case of,
291
Measurement, 261
 INDEX TO VOLUME XII .
NOTES AND ABSTRACTS — continued
Measurement of the radiochromometric penetration
of a focus-tube by means of an electrostatic
voltmeter, 24
Medical quartz lamp for light treatment, a new , 231
N rays, 328
New apparatus for Roentgen-ray examinations
(trochoscope), 230
Esophagoscope, the, 174
On the Roentgen -ray examination of fractures , 330
Ophthalmological experiments made with the aid of
light of mercury vapour, 360
Origin of Roentgen rays, 360
Orthodiascopy of the human heart , 112
Ozone, the production of, 81
Pathological effects of Roentgen rays on animal
tissues, 145
Photo-therapy in nervous disease, 82
Physical measures in the treatment of disease, 22
Protection of the physician and patient against
injury from Roentgen and radium rays, 173
Protection of the Roentgenologist, 327
Protection of the skin in the treatment of leukæmia,
81
Protective gloves, 230
Radiologists, skilled, the importance of, 203
Radioscopy and radiography employed in the
detection of tuberculous meat, 328
Radio-therapy of psoriasis and of eczema, 115
Radio -therapy in syringomyelia, 292
Radium emanation , 262
Radium emanation, the action of, 360
Radium in therapeutics, the specific action of, 359
Radium, the action of, on plants and animals, 230
Red light and iodine paint, 329
Removal of a foreign body from the left bronchus,
363
Removal of needles under the X ray, 82
Removal of the dilated vessels caused by radium
treatment , 329
Respiratory gymnastics in pulmonary tuberculosis,
112
Rhythmical exercises in the treatment of spasmodic
neuroses , the value of, 365
Rodent ulcer, treatment of, by X rays , 293
Roentgen -ray treatment of exophthalmic goitre, 114
Roentgen rays in dermatology , 146
Roentgen rays, selective absorption of the, 360
Roentgen -therapy of tuberculous cystitis, 361
Status, present, of the Roentgen ray , 328
Stomach sound , a new, for X -ray use, 230
Synthesis of precious stones, 231
Theory of metallic conductivity, 294
Tic-douloureux, treatment of, by electrolytic intro-
duction of the salicylic ion , 363
Treatment of effusion into the knee-joint , 23
Treatment of gastro- intestinal diseases with carbon
dioxide massage, 23
Treatment of hæmorrhoids with the constant current,
24
Treatment of leukæmia by means of the Roentgen
rays , 115
NOTES AND ABSTRACTS — continued
Treatment of neuralgia by means of electricity and
radio -therapy, 145
Treatment of posterior urethritis by means of high
frequency currents , 23
Treatment of prostatic hypertrophy by means of the
Roentgen rays, 114
Treatment of Raynaud's disease by high-frequency
currents, 144
Treatment of tuberculous glands of the neck by the
X ray, 22
Ultra - violet ray and high-frequency currents in
phlebitis , 263
Uric acid and purin bodies in the urine and blood ,
the behaviour of, under the influence of the
Roentgen rays, 328
Urticaria pigmentosa treated by X rays, a case of,
113
Uviol lamp, the, in dermatology, 328
Value of Roentgen -ray examination in the diagnosis
of early pulmonary tuberculosis, 113
Value of the high -frequency spark as a local applica
tion , 110
X ray in skin diseases, 146
X -ray treatment of prostatic enlargement, 202
X -ray treatment of tubercular adenitis , 115
X ray versus surgery in sarcoma, 115
X rays and resorcin in treatment of lupus, 116
X rays in a case of inveterate psoriasis of nine years '
duration , 145
X rays in cases of sarcoma, value of the, 293
O
Origin of frost-bite, and its treatment by artificial
hyperæmia. Dr. Carl Ritter, 170
Orthodiagraph, a vertical . Professor Dr. Robert
Kienbock, 288
Ortho-Roentgenography. Dr. Franz M.Groedel, 150, 184
Orton, G. Harrison , M.A., M.D. The X - ray diagnosis
of renal and ureteral calculi, 238, pls. cclxxxiii .,
cclxxxiv .
Osteo-arthritis treated with the X rays, a case of.
Margaret M. Sharpe, L.R.C.P., L.R.C.S., Ed ., 65
P
Paget's disease, treatment of, by radio-therapy. Dr. J.
Belot, 67
Photograph of a Roentgen tube in action. Dr. R. F. S.
Meijers, 130, pl. cclxxv.
Physio-therapy, International Congress of, at Rome, 2,
58, 120, 209
Piffard, Henry G. , M.D. , LL.D. Some new high
frequency devices , 78
Pirie, George A. , M.D. Routine examination of the
chest , 260
Plastic Roentgenography. Dr. Béla Alexander, 216,
pls . cclxxxi., cclxxxii.
Plastic Roentgenography, or the reproduction of X-ray
pictures in , relief . David Morgan, M.B., 195 ,
pls. cclxxix., cclxxx .
vi INDEX TO VOLUME XII .
Practical points regarding the X - ray treatment of
ringworm of the scalp. George B. Batten , M.D.,
42, pl. cclxix ., figs. 1 and 2
Progress, recent, in Roentgenology and Roentgeno-
therapy. Dr. J. Belot, 344
R List of Muscles for Electrical Testing, 147
Radiograms of syphilis of the long bones. Martin W.
Ware, M.D., 343
Radiographic, electrical and allied departments at the
London hospitals , 59
Radio -therapy, treatment of Paget's disease by. Dr. J.
Belot, 67
Radio -therapy , X rays in , on the use of smaller doses of.
Professor H. Rieder, 196
Radio -therapeutic treatment of diseases of the hair.
Professor Dr. Robert Kienböck, 12, pl . cclxvii.
Radium and its medical uses. George H. Graham , M.D. ,
31
Radium for the treatment of cancer and lupus. William
J. Morton , M.D. , 278
Rationale of static currents . F. Howard Humphris,
M.D. Brux., 274
Renal and ureteral calculi , the X-ray diagnosis of.
G. Harrison Orton, M.A. , M.D. 238, pls. cclxxxiii . ,
cclxxxiv
. Prevention of Tuberculosis, 175
Renal calculus, some difficulties in the X-ray diag.
nosis of. C. Thurstan Holland , M.R.C.S. Eng. , 61 ,
pls. cclxx., cclxxi., cclxxii.
REPORTS OF SOCIETIES
British Electro -therapeutic Society, 83
Faraday Society, 25
New York Academy of Medicine, 297
Physical Society, 26
Roentgen Society , 52, 116, 232, 266, 324
Royal Institution, 296
Royal Society of Medicine , 150, 203, 263 , 295, 354
Society of Arts, 232
REVIEWS
American Quarterly of Roentgenology , 26
A System of Radiography, with an Atlas of the
Normal . W. Ironside Bruce, M.D. , 147
Archiv für Physikalische Medizin und Medizinische
Technik, vol. ii. , 87
Archives Internationales de Laryngologie, d'Otologie,
et de Rhinologie, 86
Atlas Chirurgisch - pathologischer Roentgenbilder .
Dr. Rudolf Grashey, 358
Die Anwendung der Elektrizität in der Dermato .
logie. Professor S. Ehrmann , 326
Die Röntgenstrahlen im Dienste der Neurologie.
Dr. W. Fürnrohr, 86
Intensified Induction Coil and Moto - Magnetic
Interrupter , 55
L'Année Électrique. Dr. Foveau de Courmelles, 298
L'Ionothérapie Électrique, Delherm and Laquerrière,
358
Leitfaden des Roentgenverfahrens. F. Dessauer and
B. Wiesner, 35
Les Ions et les Médications Ioniques. Professor
Stéphane Leduc, 175
REVIEWS - continued
Les Ions, et particulièrement l'Ion Iode. Dr. Ray
mond Brillouët, 147
Light and X - Ray Treatment of Skin Diseases. Mal
colm Morris, F.R.C.P., and S. E. Dore, M.D.,
204
Medical Annual, 1907 , 27
Medical Electricity. H. Lewis Jones, M.A. , M.D. ,
267
Mitteilungen aus der Wiener Heilstätte für Lupus
kranke. Professor Dr. Eduard Lang, 267
Roentgen Atlas of Orthopaedic Surgery. Dr. A.
Hoffa and Dr. L. Rauenbusch , 55
Röntgen Kalender. Professor Ernst Sommer, 298
Roentgen Rays and Electro - Therapeutics, with
Chapters on Radium and Photo - Therapy.
M. K. Kassabian, M.D. , 234
Roentgen Rays in Medical Work . David Walsh ,
M.D. , 26
Text-Book of Electro-Chemistry. Max Le Blanc,
233
The Evolution of Matter. Gustave le Bon ; trans
lated by F. Legge, 326
Third Annual Report of the Henry Phipps Institute
of Philadelphia for the Study, Treatment , and
Wellcome's Photographic Exposure Record and
Diary for 1908 , 268
Report of the Electrical Section of the British Medical
Association at Exeter, 91
Rieder, Professor H. On the use of smaller doses of
X rays in radio -therapy, 196
Ringworm of the scalp, some practical points regarding
the X-ray treatment of. George B. Batten, M.D.,
42 , pl. cclxix. , figs. 1 and 2
Ritter, Dr. Carl. The origin of frost-bite, and its treat
ment by artificial hyperæmia , 170
Roentgen burns, on the technique of, and the means of
determining the intensity of irradiation . Dr. R.
Kienbock, 160
Roentgen diagnosis, on the present position of, in dis
eases of the stomach and intestines. Dr. Jollasse,
Hamburg, 281
Roentgenography, ortho-. Dr. Franz M. Groedel , 150, 184
Roentgenography, plastic. Dr. Béla Alexander, 216 ,
pls . cclxxxi . , cclxxxii.
Roentgenography, plastic, or the reproduction of X -ray
pictures in relief. David Morgan, M.B., 195 ,
pls. cclxxix. , cclxxx .
Roentgenology and Roentgeno -therapy, recent progress in .
Dr. J. Belot, 344
Roentgen - ray examination of the digestive tract. Dr.
Franz M. Groedel , 122
Roentgen rays, fractures only recognizable by the aid of
the. Dr. Graessner, 102, pls. cclxxiii. , cclxxiv.
Roentgen rays, on the measurement of the intensity of
the. Professor Dr. Wertheim Salomonson , 3
Roentgen rays, the distribution of, from a focus-tube.
Walter A. Scoble, B.Sc., 108
Roentgen rays, the examination of the heart by the. Dr.
Franz M. Groedel, 303
 INDEX TO VOLUME XII. vii

Roentgen rays, the selective absorption of. G.W.C. Kaye, Stover, G. H. , M.D. , and J. N. Hall, M.D. Base -ball
B.Sc., A.R.C.Sc., 314 fingers, 41, pl. cclxviii.
Roentgen rays, treatment of epithelioma with. Dr. Syphilis of the long bones, radiograms of. Martin W.
Eduard Schiff, 276 Ware, M.D. , 343
Roentgen Society (German ), programme of the fourth
Berlin Congress of the, 334
Roentgen tube in action , the photograph of a. Dr. Technique of Roentgen burns, and the means of deter
R. F. S. Meijers, 130, pl. cclxxv. mining the intensity of irradiation. Dr. R. Kien
Roentgen tubes, some experiments with , with respect to bock, 160ography
the use of tubes for diagnostic work. Vernon J. Telero entgen , the theory and technique of. Dr.
Willey, M.A. , 248 Alban Koehler, 311
Routine examination of the chest. George A. Pirie,
George A. Pirie, Theory and technique of teleroentgenography. Dr.
M.D., 260 Alban Koehler, 311
Tissue chemistry and zinc ions. Dr. Alwin Knauer, 324
s
Sabouraud pastille for the measurement of X rays, on U
the use of the. Agnes F. Savill, M.A. , M.D. ,
340 Ureteral and renal calculi, the X-ray diagnosis of.
G. Harrison Orton , M.A. , M.D., 238, pls. cclxxxiii.,
Salomonson, Professor Dr. Wertheim . On the measure cclxxxiv.
ment of the intensity of the Roentgen rays, 3
Salomonson, Professor Dr. Wertheim . The Einthoven Use and abuse of skiagraphy in fractures and dislocations.
John Poland, F.R.C.S., 131
galvanometer, 157 , pls. cclxxvii . , cclxxviii.
Savill, Agnes F. , M.A., M.D. On the use of the Uviol light, the action of, on the skin , and its therapeutic
Sabouraud pastille for the measurement of X rays, use in dermatology. Dr. Carl Stein and Dr. Hesse,
340 70
V
Scalp, ringworm of the, some practical points regarding
the X - ray treatment of. George B. Batten, M.D., Vertical orthodiagraph, . Professor Dr. Robert
42 , pl . cclxix., figs. 1 and 2
Kienbock, 288
Schiff, Dr. Eduard. Treatment of epithelioma with Voltmeter, an electrostatic, as a continuous indicator of
Roentgen rays, 276
Sciatica, the treatment of, by high -frequency currents. the penetration of a focus-tube. Professor J.
E. S. Worrall, M.R.C.S. , 272 Bergonié, 225
Scoble, Walter A. , B.Sc. A test of Dr. Milton Franklin's W
electroscope, 39
Scoble,WalterA.,B.Sc . The distribution of Roentgen Ware,MartinW.,M.
rays from a focus-tube , 108 long bones, 343
D. Radiograms of syphilis of the
Selective absorption of Roentgen rays. G. W. C. Kaye, Willey, Vernon J., A.M. Some experiments with
B.Sc. , A.R.C.Sc. , 314 Roentgen tubes with respect to the use of tubes for
Sharpe, Margaret M. , L.R.C.P., L.R.C.S., Ed. A case diagnosis work, 248
of osteo -arthritis treated with the X rays, 65 Worrall, E. S. , M.R.C.S. The treatment of sciatica by
Skiagraphy, the use and abuse of, in fractures and dis- high -frequency currents, 272
locations. John Poland, F.R.C.S. , 131
Skin, the action of uviol light on the, and its therapeutic
use in dermatology. Dr. Carl Stein and Dr. Hesse,
70 X-ray diagnosis of renal and ureteral calculi.
Sleep , the electric . Professor Stéphane Leduc, 46 G. Harrison Orton, M.A., M.D. , 238, pls. cclxxxiii.,
Somerville, W. F. , M.D., Note on high-frequency cclxxxiv.
currents in enuresis, 199 X -ray diagnosis of renal calculus, some difficulties in the.
Somerville, W.F. , M.D. The electric sleep (translation ), C. Thurstan Holland, M.R.C.S. , 61 , pls. cclxx .,
46 cclxxi. , cclxxii.
Somerville, W. F., M.D. The International Congress of X -ray treatment of ringworm of the scalp, some practical
Physio-therapy at Rome ( translation ), 209 points regarding the. George B. Batten, M.D. , 42,
Static currents, the rationale of. F. Howard Humphris, pl . cclxix. , figs. 1 and 2
M.D. Brux . , 274 X rays, a case of epileptiform neuralgia treated with.
Stein , Dr. Carl , and Dr. Hesse. The action of uviol light Alex. Gregor, M.D., 169
on the skin , and its therapeutic use in dermatology, X rays, a case of osteo -arthritis, treated with the.
70 Margaret M. Sharpe, L.R.C.P., L.R.C.S., Ed. , 65
Stereoscopic photograph of a female pelvis. A. G. X rays and lymphadenoma. J. Hall-Edwards, L.R.C.P.,
Fryett, F.R.M.S. , 15, pl. cclxvi. 10
Stomach and intestines, diseases of the, on the present X rays, determination of the quantity of, absorbed by the
position of Roentgen diagnosis in. Dr. Jollasse, various tissues of the body. Professor H. Bordier,
Hamburg, 281 199
viii INDEX TO VOLUME XII.
X rays, examination of the urinary bladder by, after
insufflation with oxygen . David Morgan , M.B. , 271,
pls. cclxxxv . , cclxxxvi.
X rays in radio -therapy, on the use of smaller doses of.
Professor H. Rieder, 196
X rays in the diagnosis of obscure abdominal diseases,
the value of the. Professor Edwin E. Goldmann,
335, pls. cclxxxix., ccxc.
PLATES .
Plate CCLXVI. - Stereoscopic photograph of a female
pelvis. A. G. Fryett.
Plate CCLXVII . -To illustrate Professor Dr. R. Kien
bock's article on the radio-therapeutic treatment of
diseases of the hair (p. 12) .
Plate CCLXVIII . -To illustrate article on base-ball
fingers, by Drs. J. N. Hall and G. H. Stover
(p. 41 )
Plate CCLXIX . (Figs 1 and 2 ).- To illustrate Dr. G. B.
Batten's article on the X-ray treatment of ringworm
( p. 42 )
Plate CCLXIX . (Fig. 3). —To illustrate Professor A. V.
Luzenberger's paper on hexadactylia (p . 41 ) .
Plates CCLXX. , CČLXXI., CCLXXII . ( Figs. 1 to 12).
To illustrate Dr. C. Thurstan Holland's paper on
some difficulties in the X -ray diagnosis of renal
calculus (p. 61 )
Plates CCLXXIII. and CCLXXIV. -To illustrate Dr.
Graessner's article on fractures only recognizable
by the aid of the Roentgen rays (p. 102)
Plate CCLXXV .–To illustrate Dr. Meijers' article on
the photograph of a Roentgen tube in action (p. 130)
Plate CCLXXVI. – To illustrate Dr. Born's letter on a
case of supernumerary digits (p. 148)
Plates CCLXXVII. and CČLXXVIII.—To illustrate
Rebman Limited , 129 Shaftesbury Avenue, W.C.
X rays, measurement of, on the use of the Sabouraud
pastille for the . Agnes F. Savill, M.A., M.D.,
340
z
Zinc ions and tissue chemistry. Dr. Alwin Knauer,
324
1
Professor Wertheim Salomonson's article on the
1
Eithoven galvanometer (p. 157)
Plate CCLXXIX . - Normal chest of a youth, to illustrate
the article on plastic Roentgenography by David
Morgan , M.B. (p. 195)
Plate CCLXXX . -Fracture of the lower end of the
femur, to illustrate the article on plastic Roent
genography by David Morgan, M.B. ( p. 195 )
Plates CCLXXXI. and CCLXXXII.--- To illustrate
Dr. Béla Alexander's article on plastic Roent
genography (p. 216)
Plates CCLXXXIII. and CCLXXXIV . - To illustrate
the article on the X-ray diagnosis of renal and
ureteral calculi, by G. Harrison Orton, M.B. (p. 238)
Plates CCLXXXV. and CCLXXXVI. - To illustrate the
article on examination of the urinary bladder by
X rays after insufflation with oxygen, by David
Morgan , M.B. ( p . 271 )
Plates CČLXXXVII. and CCLXXXVIII.—To illustrate
the article on the theory and technique of tele
roentgenography, by Dr. Alban Koehler (p. 311) 1
Plates CCLXXXIX . and CCXC.- To illustrate Pro
fessor Goldmann's article on the value of the X rays
in the diagnosis of obscure abdominal diseases
(p. 335)
1
1
 Annual Subscription, Price 1/6 net (with postage 1/8).
No. 83 . 36 cents (with postage
16/- net ( $ 4 ) , in advance.
40 cents ).
L
VO . XII . No. 1

ER
TH HAND
ED
ARCHIVES A

OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE ( New York ); A. BECLERE ( Paris ); T. P. BEDDOES ( London ); J. BELOT ( Paris) ; F. BISSERIE ( Paris );
H. BORDIER ( Lyons); J. BURNET ( Edinburgh ); R. HIGHAM COOPER (London ); W. COTTON ( Bristol) ; FOVEAU DE
COURMELLES ( Paris); L. DELHERM (Paris); R. W. FELKIN ( London );
L. FREUND ( Vienna ); H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
ELE (Montreal) ; STANLEY GREEN (Lincoln ); H. GUILLEMINOT (Paris) ;
R A
D. GUNZBURG ( Antwerp ) ; J. HALL -EDWARDS ( Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ; T H E
F. H. JACOB ( Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris); 8. LEDUC (Nantes) ;
JU

E.R. MORTON ( London ); G.HARRISON ORTON ( London ); H. G. PIFFARD ( New

07
NE

York ); JNO.C.RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ); 19 .

.

W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM

WILLIAMS ( London ); CLARENCE WRIGHT ( London ).

CONTENTS.
PACE PAGE

EDITORIAL 1 NOTES AND ABSTRACTS ( continued ) :

MEASUREMENT OF THE RADIOCHROMOMETRIC PENETRATION
SECOND INTERNATIONAL CONGRESS OF PHYSIO.
2
OF A Focus-TUBE BY MEANS OF AN ELECTROSTATIC
THERAPY , ROME, 1907 VOLTMETER 24
ORIGINAL ARTICLES : THE ACTION OF THE ROENTGEN RAYS ON THE SELENIUM
ON THE MEASUREMENT OF THE INTENSITY OF THE CELL 24
ROENTGEN RAYS. — By PROFESSOR DR. WERTHEIM ELECTRO-THERAPY IN DISORDERS OF THE CIRCULATION 24
SALOMONSON 3 THE TREATMENT OF HEMORRHOIDS WITH THE CONSTANT
LYMPHADENOMA AND THE X RAYS. - By J. HALL CURRENT 24
EDWARDS, L.R.C.P., F.R.P.8 . 10
ON THE RADIO - THERAPEUTIC TREATMENT OF DISEASES OF REPORTS OF SOCIETIES 25-26
THE HAIR . — By PROFESSOR DR. ROBERT KIENBÖCK,
Vienna 12 REVIEWS :
THE AMERICAN QUARTERLY OF ROENTGENOLOGY 26
NOTES AND ABSTRACTS : THE ROENTGEN RAYS IN MEDICAL WORK . 26
PHYSICAL MEASURES IN THE TREATMENT OF DISEASE 22 THE MEDICAL ANNUAL, 1907 27
THE TREATMENT OF TUBERCULOUS GLANDS OF THE NECK
BY THE X RAY 22 CORRESPONDENCE - 27-28
THE TREATMENT OF EFFUSION INTO THE KNEE -JOINT 23
A COMBINED TREATMENT FOR EXOPHTHALMIC GOITRE .
23 PLATES :
TREATMENT OF POSTERIOR URETHRITIS BY MEANS OF PLATE CCLXVI. -STEREOSCOPIC PHOTOGRAPH OF A

HIGH-FREQUENCY CURRENTS 23 FEMALE PELVIS. — By ALFRED G. Fryett, F.R.M.S. ,

THE TREATMENT OF HYPERTROPHY OF THE PROSTATE BY Melbourne, Victoria 15
THE ROENTGEN RAYS 23 PLATE CCLXVII. -TO ILLUSTRATE PROFESSOR DR. ROBERT
THE TREATMENT OF GASTRO - INTESTINAL DISEASES WITH KIEXBÖCK'S ARTICLE ON THE RADIO-THERAPEUTIC TREAT.
CARBON DIOXIDE MASSAGE 23 MENT OF DISEASES OF THE HAIR . 16

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FOOD AND HYPNOTISM MARRIAGE AND

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An Elementary Treatise upon PSYCHOTHERAPY BEING AN ABRIDGED EDITION OF
Dietetics and Hygienic A Study of the Psychological,
Treatment. Psycho - physiological, and “ Health and Disease in Relation to
BY Therapeutic Aspects of Marriage and the Married State .'
Hypnotism . EDITED BY
WILLIAM TIBBLES, BY
LL.D. ,. L.R.C.P.,M.R.C.S., L.8.A., Medical Professor H. SENATOR 2
Officer of Health, Fellow ofthe
Health .
Royal Institute Dr. (Med .) AUGUST FOREL AND
of Public
Dr. Phil. (h.c. ) et Jur. (h.c. ), Dr. S. KAMINER.
In this volume an attempt is made to Chigny, Switzerland . TRANSLATED BY
give an account of the most particular Translated from the Fifth
points in connection with food , air, and J. DULBERG, M.D.
water,which are of interest to the patient (German ) Edition by
or medical practitioner. The composition At a time when such questions as the
and character of the foods is given from H. W. ARMIT, M.R.C.S. , L.R.C.P. decline of the birth rate, the sterilization
many sources; that of the medicinal waters of the degenerate , the restriction of indis
and the particulars about climates chiefly The British Medical Journal says : " ... It is criminate marriages, the voluntary limita
from the official reports issued from the undeniable thatstudy of hypnotic phenomena tion of families, and so forth , form subjects
respective health resorts. The introductory has added very greatly to our knowledge of of daily debate and newspaper articles, it
chapters give a résumé of the proximate morbid mentality , and that as a guide to the becomes more than ever necessary that the
student of this branch of investigation no more medical profession should be in a position
principles in food and their digestion and fitting book could be chosen than this of the
assimilation. The food required by healthy distinguished exponent of the Nancy School. to give well -considered replies to questions
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circumstances is also considered. his able and painstaking translation ." kindred subjects.

Catalogue and Descriptive Circulars on Application .

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 N MED
BOSTO ICA
L
, !!! V 19 :408

Y.
VOL. XII.-No. 1 . JONER

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY.
EDITED BY

W. DEANE BUTCHER , M.R.C.S., F.P.S.

IN COLLABORATION WITH
ROBERT ABBE (New York) ; T. P. BEDDOES ( London ) ; J. BELOT (Paris) ; A. BÉCLÈRE ( Paris) ; F. BISSERIE (Paris) ;
H. BORDIER (Lyons) ; J. BURNET (Edinburgh ) ; R. HIGHAM COOPER ( London ); W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM (Paris) ; R. W. FELKIN (London ) ; L. FREUND ( Vienna) ; H. E. GAMLEN (West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris); D. GUNZBURG ( Antwerp) ; J. HALL-EDWARDS
( Birmingham ); G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ); F. H. JACOB (Nottingham ) ;
LEWIS JONES ( London ) ; A. C. JORDAN ( London ) ; ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris) ; S. LEDUC ( Nantes) ;
E. R , MORTON ( London ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD ( New York ) ; JNO. C. RANKIN ( Belfast ) ; WERTHEIM
SALOMONSON (Amsterdam ); W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM WILLIAMS ( London );
CLARENCE WRIGHT ( London ).

The office of radiologist dates from a hoary antiquity of At present the position of medical officer in charge of
but ten or twelve years at the most, and the radiologist the electrical department is not in all cases a happy
is himself still in an early stage of evolution. We need one, and it needs a vast amount of goodwill and honest
not, therefore, greatly wonder if he has not as yet com-
enthusiasm to render it tenable. The radiologist is in
pletely shaken down into his final position in the scheme
charge of complicated and valuable apparatus whose
of things. In the early days of Roentgenography he was
fashion is changing yearly. He carries on a trying and
usually an offset from the physical laboratory, a chemist
dangerous occupation, with the aid of a half -trained and
or perhaps an amateur. Some of these early pioneers ever- changing staff. To the training of the physician he
did yeoman service for our art, and were treated, we must add that of the physicist and a large amount of
fear, with but little consideration during the rapid technical knowledge, which up to the present time has
development of the medical radiologist. been but imperfectly taught. He must be an electrical
Even now the relationship of the radiologist to his engineer, a photographer, and a mechanician. If in
medical and surgical colleagues is somewhat uncertain addition he be a man of infinite tact and patience ,
and unsettled, and the rules drawn up for the guidance born teacher with a genius for original research—then,
of our electrical departments are in many instances indeed, he may be said to be an ideal radiologist.
vague and shifting. Our American brethren are at the It is probable that in the future there will be a
present time especially exercised as to the status of tendency for the electrical to interpenetrate the other
the medical electrician in our larger hospitals, and are departments, rather than to develop separately and side
urging him, perhaps somewhat prematurely, to assert by side. This has already occurred in the department
his position as a consultant specialist. In this country, of dermatology, for which there is in many hospitals
at all events, the matter will adjust itself, perhaps not à distinct and separate radio -therapeutic instalment.
very logically, but with that easy -going give-and-take, Similarly, on the Continent the department for neurology
the spirit of compromise, which is the note of our is provided with separate electrical apparatus for
national character. diagnosis and treatment. It is probable that the
As time goes on the practical work of the electrical surgical and medical departments will follow suit. This
department will naturally fall more or less into the would seem to be a better arrangement than crowding
hands of junior members of the staff, and it will be all cases into the electrical department proper, but
found that senior men of position and experience will would necessitate a larger and better trained staff,
occupy a position in no way inferior to that of their familar with electrical methods.
colleagues at the head of other specialist departments. Whether by natural development or interpenetration ,
1-2
2 ARCHIVES OF THE ROENTGEN RAY.

the physical and electrical department of the future willlogo (Verone), Mirselli (Gênes), Murri (Bologne ), Tam.
assuredly become the greatest of all, for it will be the burini (Rome) , Tanzi (Florence ), Tommaselli (Catane).
servant of all. Till then the youngest handmaid of The General Secretary is Prof. Colombo, Via Plinio,
medicine will bear herself with what modesty and patience 1 , Rome.
she may among the older sisters of the craft. National Committees of Propaganda have been formed
in each country, containing some of the principal names
We desire to draw attention to the beautiful anatomical in medical science, who will bring to the Congress of
plate published in this issue — one of a collection of Physio-therapy the authority of their names, as they
stereoscopic skiagrams taken by Mr. A. G. Fryett, of have already given to physical therapy the support of
Melbourne. It is that of a female pelvis showing the their teaching
last two lumbar vertebræ with the innominate bones and The following is the composition of the French Com .
sacrum . The observer is looking into the pelvic cavity. mittee, which represents the leading workers and
The commencement of the common iliacs is seen on teachers of physio-therapy in France :
the left side of the fourth lumbar vertebra. From the Présidents d'honneur : Prof. d'Arsonval, Bouchard ,
termination of the aorta the middle sacral has an almost Armand Gautier, Gariel.
median position on the front of the sacrum and coccyx. Président : Prof. Landouzy .
The iliacs are dividing in front of the intervertebral Vice- Présidents : Prof. Bergonié ( Bordeaux ), Garrigou
disc between the fifth lumbar and sacrum . The external ( Toulouse), Grasset (Montpellier), Lépine (Lyon), Spill
iliac extends along the pelvic brim to Poupart's ligament. mann (Nancy).
On the left side the deep circumflex iliac is seen arising Secrétaires : Dr. Maurice Faure (Lamalou) , Dr. Albert
from its termination, and runs outwards. Weil (Paris).
Two branches are seen coming from the outer side of Membres du Comité : Prof. Albert Robin (Paris), Prof.
the internal iliac, and ramify in the iliac fossa. Arnozan (Bordeaux), Dr. Babinski (Paris ), Dr. Ballet
The obturator is coursing behind and parallel with the (Paris), Dr. Béclère (Paris), Prof. Berger (Paris), Dr.
external iliac below the pelvic brim . The uterus is not Carron de la Carrière ( Paris ), Dr. Cautru ( Paris), Dr.
median in position. The uterine artery does not appear Dagron (Paris) , Dr. Delherm (Paris), Prof. Demény
quite continuously. It is passing forwards, deeper down (Paris) , Dr. Desfosses (Paris), Dr. Deschamps (Rennes) ,
than the obturator, and then takes an abrupt curve. It Prof. Doumer (Lille ), Dr. Durand Fardel (Vichy), Prof.
then passes up in a wavy course along the sides of the Gaucher (Paris), Prof. Gilbert ( Paris), Dr. Gourdon
uterus. A zigzag branch along the fundus uteri connects (Bordeaux) , Prof. Guilloz (Nancy), Prof. Hayem
the arteries of the two sides. Several branches are (Paris), Dr. Heitz (Royat), Dr. Huchard ( Paris),
passing forwards to the bladder, which is lying collapsed Prof. Imbert ( Marseille), Prof. Imbert (Montpellier ),
behind the symphysis pubis. Prof. Kirinisson (Paris), Dr. Lagrange (Vichy), Prof.
The lateral sacral vessels ramify on the sides of the Leduc (Nantes), Prof. Lemoine (Lille), Dr. Lucien-Graux
sacrurn and anastomose with the middle sacral. (Contrexéville), Prof. Maygrier (Paris), Prof. Miraillé
(Nantes), Dr. Oudin (Paris), Dr. Philippe (Paris), Prof.
Pitres ( Bordeaux ), Prof. Raymond ( Paris), Prof. Sigalas
(Bordeaux ), Dr. Stapfer (Paris ), Dr. Sollier (Paris),
SECOND INTERNATIONAL CONGRESS OF PHYSIO Dr. Tissié ( Pau ).
THERAPY, ROME, 1907. The languages permitted for the papers and discus
sions will be English, German, French, and Italian. A
THE Second International Congress of Physio-therapy résumé of all reports and communications will be given
will be held at Rome on October 13, 14 , 15, and 16, in French.
under the patronage of His Majesty the King of Italy The studies of the Congress will be divided into three
and the presidency of Prof. Bacelli, with the concur- classes :
rence of Prof. Belmondo (Padoue), Bianchi (Naples), 1. Medical Electricity, Radio -therapy, Photo -therapy.
Boeri ( Naples), Bozzolo ( Turin ), Casciani ( Rome ), Colella 2. Hydro -therapy , Climato -therapy, Dietetics.
( Palerme), Durante (Rome), Maragliano (Gènes), Masso- 3. The Therapeutics of Movement and Orthopædics.
 ARCHIVES OF THE ROENTGEN RAY. 3

There will be an exhibition of products and apparatus 8. Measurement of the intensity of the current passing
relating to physical therapeutics, including electrical through the focus -tube.
apparatus, dietetics, hydrology, plans, pictures of sana- 9. Measurement of the time-integral of the current
toris, institutes of physio-therapy, and works on physio- passing through the focus-tube.
therapy. 10. Measurement of the energy absorbed by the
The English Secretary is W. Deane Butcher, M.R.C.S., primary circuit.
Holyrood, Ealing. 11. Measurement of the energy of the cathode rays.
12. Measurements of certain other physical constants.
To these various forms of measurement we must add
another, without which all the rest are incomplete
viz., the measurement of the penetration of the rays.
ON THE MEASUREMENT OF THE INTENSITY OF 1. FLUORESCENCE. - In his second communication,
Roentgen himself drew attention to the fact that the
THE ROENTGEN RAYS.
fluorescence produced by the rays bore a definite rela
By Professor Dr. WERTHEIM SALOMONSON . tion to their intensity.
The method of measurement by fluorescence was also
From the very commencement of practical Roentgeno used by him in practice. A leaden screen was arranged
graphy attempts were made to measure the intensity of at right angles to the fluorescent screen so that each
the Roentgen rays, and the necessity of adopting some half of the screen was illuminated by one of two separate
practical means of dosage became still more imperative focus-tubes. ' The equal illumination of both halves of
when the Roentgen rays began to be used for therapeutic the screen was obtained by adjusting the distance of one
purposes. of the two tubes, and thus the observer was enabled to
At the suggestion of the Standards Committee of compare the relative intensity of illumination of the two
the British Roentgen Society and the Intensitäts Com- tubes .
mission of the German Roentgen Society, I have pre- In 1896 Roïti described an instrument for Roentgen
pared a short résumé of the means hitherto employed measurement which depended on the same principle. A
for Roentgen measurement. lead prism was employed , two sides of which were
The methods may be arranged in two categories. covered with a fluorescing substance. The relative
The so-called direct methods measure some one effect strength of two focus - tubes could be compared by
or quality of the X rays in order to determine their illuminating one side of the prism by means of one of
intensity. In the indirect methods, on the contrary, we the two tubes. Moreover, a focus-tube could be com
make use of certain physical phenomena which are sup- pared with a standard source of light. For this purpose
posed to be related to the production of the Roentgen a glow-lamp was used with shade of cobalt glass (see
rays, and on which their intensity depends. Bibliography, 1 ). It is, however, exceedingly difficult to
The direct methods are the following : compare the two tints, since the cobalt glass is not a
1. Measurement of the Roentgen rays by observation perfect match for the Roentgen fluorescence. The
of the fluorescence produced by their impact. result is more satisfactory with very weak illumination
2. Measurement by the phosphorescence produced by --the so -called Purkinje phenomenon.
X rays . This method is, to my mind, susceptible of improve
3. Measurement by the action of the rays on photo- ment by the use of Wood's filter, which is permeable
graphic preparations. only to ultra -violet light.
4. Measurement of some chemical action produced by The utility of this method will depend on the possi
the rays . bility of finding a simple and easily producible standard
5. Measurement of the ionizing action. light. This may, perhaps, be found in one of the modern
6. Measurement of the photo-electric action. glow-lamps, with osmium, wolfram , or tantalum wire.
7. Measurement of the thermal action . All of these are fairly constant, and give a light rich
The indirect methods of measurement are the follow- in ultra-violet radiations.
ing : Contrémoulins made use of an acetylene lamp for this
 1
1

4 ARCHIVES OF THE ROENTGEN RAY . 1

purpose, and Courtade employed a screen rendered photographic method is the most reliable hitherto
luminescent by radium irradiation. devised, and the results of other modes of measurement
An analogous method is the use of the inferior limit of have been controlled by this method. The intensity of
visibility of the fluorescent screen as the zero of the the photographic action of the Roentgen rays is esti
scale. This is not a practical method, however, since mated by the degree of blackening obtained on a sensi.
the readings depend on the degree of adaptation of the tized plate, the transparency being compared photo
retina, which may vary over 200 times. Even when the metrically with the transparency obtained from a
retina has been sensitized by half an hour's rest in abso- standard Hefner lamp in a given time and at a given
lute darkness, the use of the “ threshold of discrimina distance. For this purpose it is indispensable that a
tion ” is about the worst means of measuring the intensity separate scale of comparison should be made for each
of the rays. plate, one half being used for the Roentgen exposure
Gaiffe makes use of the fatigue of a platino -cyanide and the other half for the scale. Afterwards both halves
screen under prolonged irradiation. His very ingenious should be developed at the same time and in the same
method is, however, not reliable, since it depends on the dish. The best instrument for comparing the trans
quality and mode of preparation of the fluorescent salt parencies is Martense's polarization photometer, which
and of the cementing medium . enables us to compare small fields of as little as 5 milli
2. PHOSPHORESCENCE.-- I have made experiments in metres diameter. An accuracy of 1 per cent. may easily
my own laboratory on the possibility of using the phos- be attained with this instrument. It is evident that such
phorescence of various substances as a means of measur- a means of measurement is not of any practical use for
ing the intensity of the Roentgen rays, the fluorescent treatment, but is only adapted for the laboratory.
screen being replaced by some substance which is ren- Kienbock has lately introduced a simplified modifica
dered phosphorescent by the X rays. Balmain's luminous tion for the photographic measurement of the Roentgen
paint is the best for this purpose, since it is fairly con rays in practice. He substituted for the photographic plate
stant in quality and easily procurable. a sensitized paper slip, and the Roentgen impression on
Such a screen
should be kept for a considerable time in the dark in athis is compared with a scale of exposures, which is
moderately cool room until not the slightest trace of manufactured and sold with his apparatus. Kienbock's
phosphorescence is visible . Under these circumstances • quantimeter,' as the instrument is called, is accompanied
the Roentgen rays produce a vivid phosphorescence, and by definite instructions for the development of the sensi
if the irradiation is not too intense or of too long duration tized strips. This instrument has recently been tested
the luminescence is proportional to the integral of the with satisfactory results by Mr. Scoble in Lord Blyths
Roentgen irradiation . The phosphorescence may be wood's laboratory. Kienbock's quantimeter also enables
compared with a ground -glass screen of cobalt glass us to measure the photographic action of the rays after
illuminated by an electric light from behind. The passing through 1, 2, or 3 millimetres of aluminium .
results are not entirely reliable, since the phosphor- In my opinion, this instrument should prove of great
escence is affected by temperature. Better results were practical utility in the dosage of the X rays.
obtained by two phosphorescent screens, one of which 4. CHEMICAL.-A . The action of Holzknecht's well
was irradiated by Roentgen light, and the other by a known chromoradiometer depends on the coloration of
glow-lamp of four-candle power. Readings of the focal certain halogen salts by exposure to the Roentgen rays.
distance and of the duration of the exposure give us the At its first introduction this instrument was received with
necessary data for measurement. The method has not, enthusiasm , but unfortunately it has hardly fulfilled the
however, proved to be of any great practical utility. early expectations. The comparison of the tint of the
3. PHOTOGRAPHIC .- The principle of this method of exposed capsule with the scale is not easy, and is to a
measurement is very simple. The photographic action large extent influenced by the source of light employed .
of a source of light of intensity I during a time of T is The changes in colour are also dependant on the
proportional to the product IT, and we may assume that temperature and the moisture of the atmosphere, which
a similar rule holds good with regard to the Roentgen may introduce errors of 50 per cent. or more. The
rays. Y. Precht has shown that this is only true within instrument, moreover, is not easily procurable at the
certain limits. If carried out with due precautions, the present time. In spite of these drawbacks, Holzknecht's
 ARCHIVES OF THE ROENTGEN RAY . 5

name will always be honoured as the pioneer in the Comparative measurements may be made with a
measurement of the intensity of the Roentgen rays. smaller electroscope of limited capacity by removing the
B. Sabouraud and Noiré were the first to employ the focus-tube to a greater distance — 5 metres or more — and
platinocyanides of potassium and of barium in the measuring the time of discharge of the electroscope
measurement of the X rays. Their pastilles are much ( Hurmureszu, Deane Butcher, and others). The result
less sensitive than those of Holzknecht, and they are is, however, only a rough approximation. Accurate
subject to even more sources of error, the influence on measurements by the ionization method require a well
them of light, temperature, and moisture being even insulated condenser and a very sensitive electrometer,
greater than it is on Holzknecht's pastilles. We are instruments which belong rather to the physical
quite unable to use them here in Amsterdam on account laboratory.
of the excessive moisture of the air, especially in summer, The best instrument for the purpose is a sensitive
which may introduce errors in estimating the intensity mirror galvanometer. Two insulated plates of 10 centi
of the rays of as much as 100 and 200 per cent. metres diameter are connected to an electric source,
Bordier's modification of Sabouraud and Noiré's having a difference of potential of some 100 or 200 volts,
pastilles is subject to the same disadvantages . the galvanometer being included in the circuit. The
C. Freund's method is even less satisfactory. His plates are separated by a distance of 10 centimetres, and
the air between the plates is exposed to the action of the
measurement is based on the decomposition of a solution
X rays, while the plates themselves are carefully screened.
of iodoform in chloroform , and the estimation of the
amount of iodine set free. Unfortunately, iodoform is Under these conditions there passes between the plates
decomposed, not only by the Roentgen rays, but by a current which may be measured by the galvanometer,
the action of ordinary light. This disadvantage might and which is directly proportional to the degree of
be overcome, but there is a more serious one. It has ionization. When the potential is about 100 volts - i.e.,
been shown in my laboratory that the decomposition is not high enough to ensure a saturation current-the
dependent on the presence of moisture. If the materials current varies also with the potential. The leakage
are absolutely pure and free from moisture, and the flask current is about 0 ·05 of a microampère, with the focus
containing the iodoform solution contains some crystals tube at a distance of 1 metre, and of such a hardness
of caustic potash, no decomposition occurs either with that a skiagram of a hand can be taken in twenty
light or with X rays. seconds. I have used two instruments —one made by
D. Schwartz has recently introduced a new method Hartmann and Braun, and another by Siemens and
of measurement, by estimating the amount of calomel Halsk—which are sensible to a current of less than 10–9
deposited from a solution of oxalate of ammonium and ampères.
corrosive sublimate under the influence of the X rays. The ionization method is the one preferred by Lord
The precipitate is collected by means of a centrifuge, and Blythswood and Mr. Scoble, writing in the Journal of
can be measured with great exactitude. In a later form the Roentgen Society, 1907, p. 53. I am not entirely in
the amount of precipitate is estimated by a colorimetric accord with their view. As long as the resistance of the
method. I have had no personal experience of this focus-tube remains constant, the readings of the galvano
method . meter are proportional to the intensity of the rays.
5. IONIZATION . — The simplest means of measuring the The ratio, however, remains constant only as long as the
intensity of the X rays consists in measuring the ioniza- vacuum of the tube remains unaltered. This I have
tion of the air through which they have passed. An found to be invariably the case when measuring the
electrometer of known capacity is charged to a high intensity of the rays by the photographic method.
potential, and when this is irradiated by the X rays it With tubes of very different hardness the ionizing and
gradually loses its charge. The time required for the the fluorescent effects are apparently more nearly
electrometer to lose half its charge, and for the index to parallel than are the ionization and the photographic
fall to one -half its maximum deviation, gives the degree of effects. It is quite certain that radiations of considerable
ionization of the air. The difference of potential should penetration have a greater ionizing power than we should
be high enough to ensure a saturation current during the expect from the photographic power of hard when com
whole course of the experiment. pared with soft rays.
6 ARCHIVES OF THE ROENTGEN RAY.

6. PHOTO-ELECTRIC MEASUREMENT.-It has been found current being cut out by means of a valve -gap or a valve.
that Roentgen irradiation acts on a Becquerel photo tube.
electric cell. Two electrodes are first covered with a There is no fixed ratio between the readings of the
film of chloride of silver or chloride of copper, and then milliamperemeter and the photographic or fluorescent
immersed in a saline solution . If now one of these action of the rays. If the current through the tube and
electrodes be irradiated, there is produced between the the vacuum in the tube are both kept constant, any
two electrodes a difference of potential which may be increase of frequency is accompanied by a fall in the
measured by means of a galvanometer. At the com- photographic and fluorescent action of the rays, amount
mencement of the experiment there is in most cases ing in some cases to 100 per cent. or more.
a " rest current " which must be compensated. With The reading of the milliamperemeter depends & good
irradiation of short duration the deflection of the galvan- deal on the hardness of the tube. It is a simple and
ometer is proportional to the Roentgen rays. The valuable instrument, enabling us to obtain the same
method is, however, not entirely satisfactory, and is intensity of Roentgen rays on different occasions. This,
moreover, a laboratory experiment not at all suitable for however, is only possible when we use the same ap
practical use. paratus, with the same frequency, and the same focus
Forster of Berne has discovered the variations of tube with the same vacuum . A milliamperemeter is
resistance of a selenium cell under the influence of the quite useless for comparing measurements of the X rays
X rays. Ruhmer and Levy have devised a method of obtained with different installations and different focus
measurement on this principle. Though the arrange tubes .
ment is not a complicated one, it appears doubtful if it If we always work with the same installation and the
will ever prove of any great utility in practice . same or similar focus-tubes, we may, by careful pre
Coffin Johnston measures the fluorescence of a liminary experiment , estimate the amount of X rays
Wolfram -calcium screen , and employs a selenium cell as given out by the focus-tube per second. Then , by keep
a photometer. The light from the screen alters the ing the reading of the milliampère constant, we are
resistance of the selenium cell, which is joined up in a enabled to measure a given dose of X rays in seconds.
Wheatstone bridge. The author asserts that the galvano- The milliamperemeter is most useful in installations
meter readings are proportional to the intensity of the where the frequency does not vary, as with the alter
Roentgen light. nating current. Its readings are quite worthless when
7. MEASUREMENT OF THE TOTAL ENERGY OF THE a Wehnelt break is used, or a motor-break with varying
X RAYS.-Theoretically this should be the best measure- frequency
ment of the intensity of the Roentgen rays. Unfor- Another instrument of special interest for indirect
tunately, this does not prove very satisfactory in measurement is the oscillograph , an instrument invented
practice. Dorn has measured the heat produced by by Gehrke. It shows the variations in current intensity
absorption of the " X rays, as also have Schoeps, by the oscillation of the cathodal glow, a violet lumin
Rutherford , and M. Cluny. F. Leiniger has not been escence in a slightly exhausted tube. If properly cali
more successful in this direction, in spite of the beauty brated, it will show the intensity of the secondary circuit
of his instrument. The latest experiments are those of at any given moment, and afford us valuable indications
Angerer, who employs an electric method for estimating as to the instantaneous intensity of the current. The
the total energy sent out by the Roentgen tube in the oscillating light of this violet glow may be observed by
form of Roentgen rays. This is, however, not adapted means of the rotating mirror. An increase in the mean
for practical use. intensity of the secondary current is accompanied by
8. INDIRECT MEASUREMENT. — The most important i
but little alteration in the height of the curve, but there
indirect measurement is that of the intensity of the is a considerable increase in the breadth. The image as
current passing through the focus- tube. A milliampère- seen in the mirror approximates to that of a triangle
meter of the Deprez-d'Arsonval type is usually used. whose height varies principally with the hardness of the
1 tube, and whose breadth varies chiefly with the magni
The
t. tude of the current passing through the focus-tube. We
average unidirectional current is measured, the reverse may therefore read the oscillograph even without the
.
1
 ARCHIVES OF THE ROENTGEN RAY . 7

rotating mirror. An observation of the height of the ness. The photographic effect, however, is not abso
negative glow, the milliampère reading, and the fre- lutely proportional, but increases rather more rapidly
quency will give us all the data required for estimating than the power. So long as the focus-tube does not vary ,
the intensity of the secondary current. and the energy passing through the primary circuit is
In lieu of a milliamperemeter, Curchod and Klingelfus kept constant, the Roentgen intensity remains constant
use a specially constructed voltameter as an integrating within a few per cent., whether measured by the photo
instrument. graphic or the ionization methods.
9. MEASUREMENT OF THE Root MEAN SQUARE VALUE The use of the wattmeter enables us to keep the
OF THE SECONDARY CURRENT. —This consists of the primary current constant, while at the same time the
1 milliamperemeter enables us to keep the current in the
determination of the value of 1(f reatat)
t.
For this
secondary circuit constant. Under these circumstances
purpose we may use a hot wire instrument, a voltmeter, the dosage may be accurately graduated by varying the
a thermopile, a soft iron instrument, an electro -dynamo- time of exposure.
meter, or an electrometer in idiostatic connexion with An English maker, Dean , was the first to introduce
the terminals of a resistance. I have myself only used & method of dosage, regulated by the number of inter
the first and the last of these methods. In every case ruptions, all the other factors being kept constant. In
a valve or spark-gap must be introduced into the circuit . his instrument the current is automatically cut off as
There is considerable advantage in using this method . soon as the prescribed number of interruptions has been
As long as the vacuum remains constant the photo reached, in a similar manner to the automatic time
graphic action of the rays is approximately proportional switch used by Gocht. This method has been lately
to the mean square value of the current—at least reinvented in France .
between 1 and 5 milliampères. Moreover, the result is 11. MEASUREMENT OF THE ENERGY OF THE CATHODE

independent of the frequency. The electrometer I usually Rays . — Walter showed some years since that the heating
employ is an aperodic instrument made by Carpentier. of the anticathode was a measure of the energy of the
An integral measurement may also be obtained by cathode rays. Since a definite proportion of this energy
other methods. For this purpose I have designed my is transformed into X rays, the heating of the cathode is
“ dilatometer," which has been already described in the also a measure of the intensity of the X rays. Alban
Journal of the Roentgen Society. The dilatometer con- Kohler makes use of this principle by introducing a
sists of a slate-rod resistance, enclosed in a glass tube, small thermometer into a diverticulum of the focus-tube.
which is filled with liquid paraffin, the tube being drawn The rise of the mercury is a measurement of the integral
out into a capillary termination. As the slate rod of the intensity of the Roentgen rays. One disadvantage
becomes heated by the passage of the current, the liquid of this method is that the temperature is also dependent
paraffin rises in the capillary tube as in a thermometer. on the time of exposure and the surrounding tempera
The instrument is calibrated by comparing it with a ture. The method is applicable also to water-cooled
calorimetric current-measuring instrument. The dilato- tubes. Only approximate measurements are obtainable
meter is joined up with this first in parallel and then in by this means.
series. This instrument gives fairly accurate results for 12. MISCELLANEOUS METHODS.-Jirotka suggests that
short exposures. For longer exposures the loss of heat the dose should be expressed as the product of the time,
by convection and radiation introduces sources of error, the voltage in the primary, and the milliampérage in
which interfere with its utility in practice. the secondary. The Jirotka unit, to which he has given
10. MEASUREMENT OF THE ENERGY IN THE PRIMARY the name of " vlasts," is nothing but the number of the
CIRCUIT.—This method consists in a measurement of the watt seconds in the secondary circuit divided by the
number of watts absorbed by the primary of the trans- transformation ratio of the coil in question. This ratio ,
former, not including the power dissipated in the resist- however, varies with the resistance in the secondary
ance. The power absorbed, as indicated by the watt- circuit on account of the influence of the capacity.
meter, is roughly proportional to the Roentgen intensity Hence the method is far from a satisfactory one.
as measured by its photographic action, so long as the 13. MEASUREMENTS OF PENETRATION. Since the
focus-tube is maintained at a constant degree of hard- radiations issuing from a Roentgen tube are disturbances
2
 8 ARCHIVES OF THE ROENTGEN RAY .

of the ether of varying equivalent wave-length, we require material of the spark electrodes were properly defined
some means of estimating the constituents of the hetero- and universally accepted.
geneous mixture of radiations. The following are the chief forms in use at the present
Roentgen himself described the earliest apparatus for time :
measuring the hardness of the rays. From a scientific ( a ) Equal spherical electrodes. The usual diameter is
point of view the aluminium-platinum window he em- 2.5 centimetres .
ployed has not hitherto been improved upon. (b) A negative plate with a positive spherical electrode.
Aften Roentgen's aluminium -platinum window came (c) A negative plate and a positive pointed electrode.
the instrument designed by Gardiner,9 with lead and The best diameter for the plate is 5 centimetres. The
aluminium windows of different thickness arranged hori- point should be of platinum -iridium , of conical shape,
zontally, as in Wehnelt's later instrument. with an angle of 30 degrees. Data which give the length
of the spark-gap without mentioning the form and size
In 1901 Benoist constructed his apparatus, an account
of which appeared in the Archives d'Électricité Médicale of the electrodes are quite useless.
for March, 1902.10 (2) Another indirect measurement of the hardness of a
In October, 1902, Walter published the details of his focus-tube is the R.M.S. value of the difference of
measure of penetration. His apparatus with platinum potential between its terminals. Bergonié measures this
window is of great interest, both theoretically and by means of a high-tension electrometer. This is not
practically, although the readings are considerably difficult with a transformer, supplied by an alternating
influenced by the intensity of the current. His second current without interrupter. The method is, however,
apparatus is a modification of Benoist's chromoradi- not to be recommended for use with a coil and break.
ometer, but arranged in a more convenient manner and Bergonié also introduced the use of an alternating
more easy to read. current voltmeter at the terminals of the primary coil.
Wehnelt's modification is still more accurately gradu- (3) The milliamperemeter may also be used as a
ated, but has the disadvantage of being very difficult measure of hardness when the supply of energy to
to reproduce. the inductorium or high - tension transformer is kept
In our opinion, Benoist's instrument is superior to all constant. When this is the case, the intensity of the
others, especially when the aluminium diaphragms are current varies directly with the resistance of the tube.
arranged in a linear direction. It is the only instrument (4) The cathode-glow oscillograph invented by Gehrke
which gives a direct reading without measurement or also gives a fairly accurate measure of the hardness of the
calculation . For instance, a reading of penetration focus-tube. It may be used with or without a revolving
No. 5 means that the rays in question are equally mirror, and its utility is greatly increased when it is
absorbed by 5 millimetres of aluminium and by the properly graduated so as to show the number of milliam
pères passing through the focus-tube. The maximum
standard silver plate. With Walter's instrument it is
necessary to observe or measure what thickness of intensity of the current during each oscillation is read
aluminium corresponds to the number read off on the off, and gives a fairly adequate idea of the hardness of
scale. This is also the case with Wehnelt's apparatus. the tube.
More recently an instrument on the same principle 14. We may now proceed to the inquiry as to what
has been constructed by Haga for measuring the pene methods of measurement are the most trustworthy,
tration of the primary and secondary Roentgen rays. We may dismiss at once the thermal method, the
The action depends on the selective absorption of char- photo-electric cell, and the measurement by phosphor
coal and ebonite for the rays . escence. The various colorimetric measurements are
THE INDIRECT MEASUREMENT OF THE HARDNESS OF put out of court on account of their difficulty and
THE FOCUS- TUBE . — This may be carried out in different unreliability. There remains to consider, then, only
ways. ( 1) The photometric estimation of fluorescence.
(1) The equivalent spark-gap. A spark - gap is in- (2) The photographic method .
troduced into the secondary circuit parallel with the (3) The ionization method.
focus-tube. This gives the initial tension, and would be ( 4) The indirect methods.
a fairly adequate measure of the voltage if the form and It is said that the indirect methods necessitate the
 ARCHIVES OF THE ROENTGEN RAY . 9

simultaneous estimation of the degree of hardness of the shown this most ably in his presidential address before
focus-tube. This, however, is also the case with the the Roentgen Society:11 Our requirements must be kept
direct methods ; under no circumstances can the pene- within more moderate limits —viz . , to choose among the
trating power of the rays be left out of account when we many methods at our disposal the one most practical for
endeavour to measure their intensity. our purpose.
It has already been shown that the fluorescent effect and In my opinion , by far the best is the photographic
the photographic effect are not entirely parallel , although method . It has the advantage that the measurements
in general hard tubes give strong fluorescence and strong of intensity are easily reproducible , and are comparable
photographic effects , whereas the contrary is the case with a standard which is already in existence - viz ., the
with soft tubes . Moreover , the ionization effect does not Hefner candle , the amyl-acetate lamp, which is used as
run entirely parallel with the photographic action , but is the standard of light measurement in Germany . There
more nearly proportional to the fluorescent effect. The is not the slightest difficulty in comparing the light from
physiological action is not exactly proportional to either
a Roentgen tube with that from a Hefner candle by
of the other two effects. All that we know about the photographic means, the distance and the time of
matter is that irradiation with a soft tube has a super- exposure being also given. The result of measurement
ficial effect, while an exposure with a hard tube has a may be read off in second-metre candles. We may thus
much deeper action. speak of a Roentgenographic exposure as being equiva
À priori one of the direct methods of measurement lent to so many second-metre candles. If to this be
would appear to have many advantages, but even then added the degree of hardness on Benoist's scale, we
we cannot dispense with the measurement of hardness. have all the data necessary for the accurate dosage of
With direct measurement we are independent of a the X rays. The intensity of the source of Roentgen
number of transformation constants—the transformation light may be spoken of as of so many candle-power, and
of the energy of the primary into the energy of the the illumination of an exposed surface as equivalent to
secondary, and the transformation of the latter into that so many metre candles. Personally, I should prefer that
of the cathode rays, with the further transformation of the prefix “ Roentgen " should be added to these terms,
the energy of cathode into that of Roentgen rays. We so that a Roentgen dose may be defined as of so many
must, however, remember that even with the so-called Roentgen second-metre candles ( R.S.M.C.) , caused by a
direct measurements we have to take into consideration Roentgen irradiation of so many Roentgen metre candles
certain coefficients of transformation - viz. , the trans- (R.M.C. ) from a source of Roentgen light of so many
formation of the energy of the ether impulses into Roentgen candles (R.C.).
chemical energy , or into ether waves of different length, All of us when using the photographic method of
or into the energy of ionization . The difference between Roentgen measurement already use this terminology,
direct and indirect methods of measurement is , therefore, either consciously or unconsciously.
not so fundamental as it appears. By the indirect For practical use Kienböck's quantimetre is, in my
method we measure the energy before it is transformed opinion, the most suitable. According to Kienböck, the
into X rays ; by the direct method we measure some tint No. 1 on his scale corresponds to an exposure of
form of energy produced by the transformation of part thirty minutes to a standard Scheiner lamp at a distance
of the X -ray energy, the ratio of transformation being of 30 centimetres. As, according to Eder, the Scheiner
equally unknown . lamp is equal to 1
Hefner candles, Kienböck's tint
15. At the present time we have no means of 13.2
measuring the energy of the Roentgen irradiation in 1800 x 1002
No. 1 corresponds to 13.2 x 302
or 1,515 Roentgen
such a way that the results have only one meaning,
and cannot be explained in more than one way, nor is it second - metre candles (R.S.M.K.). Tint No. 2 will,
at all probable that we shall ever be able to do so. Even therefore, correspond to 2 x 1,515, or about 3,000
in the case of light we are unable to give a complete ex- R.S.M.K. If, for example, an irradiation of 8 x is
pression of its energy in C.G.S. units, and with our present applied in ten minutes at a distance of 20 centimetres,
knowledge this would appear to be still more impossible this would correspond to an exposure of 8x1,515, or
in the case of the X rays. Professor Vernon Boys has 12,000 Roentgen second-metre candles, during which
242
10 ARCHIVES OF THE ROENTGEN RAY.

the Roentgen light would be equivalent to 0 :8 Roentgen 7 Archives d'Électr. Med ., No. 15, p. 29 , 1907.
candle, and the exposure would be equivalent to twenty 8 Mitteil. a. d. Akad. f. Wissensch ., May 13, 1897.
Roentgen metre candles. 9 Gardiner : Archives of the Roentgen Ray, 1900, vol. iv. , p. 90.
10 Benoist : Archives d'Élect. Médicale, 1902, p. 129.
We are thus in a position to measure the strength of 11 Professor Vernon Boys : Presidential Address, Roentgen Society,
1906.
the Roentgen rays, the intensity of illumination , and
the exposure, by means of a photo-chemical process, and
to express them in terms which are independent of
variations of sensitiveness in the photographic plate. LYMPHADENOMA AND THE X RAYS.
I have used the photographic method for many years in By J. HALL - EDWARDS, L.R.C.P., F.R.P.S.,
my laboratory with ordinary Cadett plates , which I have Officer in charge of the X-Ray and Light Department at the General
found much the best for this purpose. Hospital, Birmingham , and ex- President of the British Electro
Therapeutic Society.
The photographic method is, however, quite useless
without the accompanying definition of the degree of Dr. LoVELL GULLAND, in the “Encyclopædia Medica,"
hardness of the tube. The penetration of the rays is a says : " The question of the real nature of this disease
necessary factor in every measurement of the intensity and its relation to leucocythæmia on the one side,
of the Roentgen rays. generalized glandular tuberculosis on another, and
If, then, we decide to make use of the photographic lymphosarcoma on a third, is one of the most difficult
method of measurements, it by no means follows that problems in medicine, and one whose solution we are as
the other methods are to be discarded. Many radi- yet very far from obtaining .” The cause of the disease
ologists still hesitate to use Kienböck's method on is unknown. In all diseases showing a chronic enlarge
account of the time and trouble it entails, or because of ment of the lymphatic glands there are present in the
the disadvantages of an integrating measurement. Those blood an abnormally large number of white cells.
who employ one of the indirect methods attain an equal Whilst it is next to impossible to differentiate between
accuracy in dosage. Whatever method is employed, we cases of lymphadenoma and lymphosarcoma, even if
must remember that at the basis of all our measurements there is any difference at all, it is generally admitted
are the watch , a measure of length, and some power or that such cases are incurable—that is to say, that
current - measuring instrument. The photographic or although under treatment all the clinical symptoms
ionization methods serve only as a check on those may subside for a time , the symptoms generally recur,
actually adopted. and the death of the patient sooner or later follows.
In future the ionization measurement or the Gehrke- From a medical point of view there is only one method
oscillo- dograph method may be still further developed, of treatment namely, that of the administration of
and these will necessarily have to be compared with the arsenic in gradually increasing doses. If this fail to
photographic and photometric methods. Many problems bring about a result, from a physician's point of view
will have to be solved before we can hope to obtain a there is nothing more to be done.
perfectly reliable and easily comparable unit of X-ray From the point of view of a surgeon , the removal of a
measurement. As yet I know of no better method than group of glands early in the history of the case appears to
that I have described above. The photometric units delay the progress of the disease somewhat, but never
proposed in this report appear to be the best at our brings about a cure.
disposal in which to express the doses for X -ray treat- The X rays have in all cases of leukæmia submitted to
ment or the exposures in skiagraphy. them produced brilliant results. Indeed, at one time it
appeared that by this means a definite cure could be
BIBLIOGRAPHY.
effected ; but this sanguine view was found to have no
1 Roïti : Eletricista, No. 9 , 1896 ; Electrician , 1896 , p . 670. solid foundation , for we now know that, although the
? Comptes Rendus, 142, p. 447, 1906.
3 Archiv f. Wissenschaftliche Photographie, 1899, vol. i. , p. 260. patients gain respite for a time, which may vary from a
4 Kienböck : Fortschritte a. d . Gebiete d. Rontgenstrahl, 1906, vol. ix. , few days to many months, the disease sooner or later
Part IV. , p. 276 . reappears ; and although it may be kept back by renewed
5 Journal of the Roentgen Society, December, 1906, p. 36. exposures to the rays, it, as a rule, gradually regains the
6 Lord Blythswood and Walter Scoble : Journal of the Roentgen
Society, vol . iii., 1907 , p . 53 . mastery, and ends in a fatal issue.
 ARCHIVES OF THE ROENTGEN RAY . 11

As will be shown in the case which follows, however, emaciated, cachectic, so feeble that he could hardly
the patient may, at any rate for a time, be relieved of his stand. He complained of inability to take food , and was
distressing symptoms, his life be prolonged, and his con- nightly in the habit of taking morphia to produce sleep.
dition be rendered otherwise comfortable. His breathing was laboured , and he was unable to
The use of the X rays in this disease in no way inter- undergo the slightest exertion. There were large masses
feres with the carrying out of the usual method of ad- of glands on the left side of the neck ; the axilla was
ministering arsenic ; indeed, there is no reason why the filled with masses of gland of such a size that he had to
two should not be carried out together. In the present hold his arm at an angle of 45 degrees. There were also
case it will be noticed that the administration of arsenic large masses in the left groin, both the inguinal and
was stopped wben the X-ray treatment was commenced . femoral gland being affected, and he had the greatest
The splendid result secured by the application of the difficulty in moving his leg.
X rays in this case points to the fact that by some The X rays were applied for ten minutes' duration,
alteration of our methods we may, by the outcome of and at a distance of from 8 to 10 inches from a hard
careful observation, be able to treat such cases with tube, no shield of any sort being used during the applica
success and bring about a cure, although at the present tion to the neck and axilla. Between October 29 and
time this may seem impossible . December 4 twenty -four such exposures were given, the
In speaking of the use of the X rays in such cases, greater part to the neck and axilla only. The glands
Belot at the Lyons Congress said : " A medical man who after a few exposures began to diminish in size and the
fails to have recourse to this form of treatment would patient's health to improve. For some weeks no applica
commit as grave an infraction of duty as one who did not tion was made to the groin, yet during this time the
give mercury in syphilis." glands here markedly diminished in size. When the
In acute forms of leukæmia the X rays appear to glands in the neck and axilla had disappeared those in
produce very little result. In chronic forms, however, the groin were still apparent, and the latter treatments
much temporary improvement invariably takes place, were given over this region. Since December 4 and up
and cases have been published in which a clinical cure to date the patient has on various occasions received
has been brought about. The action of the X rays thirteen five -minute exposures. That the patient is
appears to be that of destroying the leucocytes by a peculiarly susceptible to the action of the X rays is
process of histology acting as a caustic. shown by marked pigmentation , which can be seen over
Dr. Vasquez at the before-mentioned Congress drew a the skin .
parallelism between arsenic and the X rays. It has been At the present time (January 15, 1907) the patient's
shown that, after X-ray treatment, leucocytes can be general health is so much improved that he can take
detected in the blood which are undergoing histolysis. long walks, take his food regularly , and sleeps well
The lymphocytes are specially affected , whilst poly- without having to resort to morphia. The glands have
nuclear cells are more resistant, thus explaining the assumed their normal size, and the patient has gained
gradual return to normal (Aubertin and Beaujard). considerably in weight. He breathes normally, and does
Beaujard has also pointed out that the continued im- not complain of shortness of breath even when walking.
provement during the interval between the sittings may Through the kindness of Mr. Lucas, I here append his
possibly be due to the influence of the X rays, leucocytic own notes :
substances being formed in the blood serum.
The X-ray treatment of diseases in which leukæmia is CASE OF LYMPHADENOMA TREATED BY
a prominent symptom yields palpable, unquestionable X RAYS.
results, demonstrable by clinical observation, and capable
NOTES BY MR. A. LUCAS, F.R.C.S.
of confirmation by the microscopic examination of the
blood. In the case under consideration the results may W. W a groom, aged thirty-three years, was
fairly be described as marvellous, admitted to the General Hospital on April 20, 1905,
The patient was sent to me by Mr. Albert Lucas, under my care, suffering from a large mass of enlarged
F.R.C.S. , of the General Hospital, Birmingham , on glands in the left subclavian triangle. The swelling had
October 29, 1906. At this time he was exceedingly been forming for from three to four months.
12 ARCHIVES OF THE ROENTGEN RAY .

On April 27 the glands were excised, and were recog- Differential count :
nized to be lymphadenomatous ; this was confirmed by Polymorphonuclears 86.7 per cent.
microscopic examination . The wound healed well, and Lymphocytes 8 :3
Large mononuclears 2.5
he left the hospital after a stay of fourteen days. Eosinophiles 2 :3
He was seen by me from time to time . Transitional forms 1.2 1)

In the course of the following July the glands in the Third examination , January 11 , 1907 :
left axilla began to enlarge, and subsequently glands in Red blood -corpuscles 3,500,000
the upper part of the left side of the neck, the medias White blood -corpuscles 7,300
tinum mesentery, the left inguinal region, and Scarpa's Slight irregularity in shape and size of reds.
triangle were noticed . Arsenic in large doses was given
from time to time, but without any benefit. He suffered Remarks. — The improvement in the condition of the
considerable pain, and took large quantities of morphia, patient has been accompanied by a rise in the number of
red blood cells and by a fall in the number of leuco
opium, trional , etc.
On October 30, 1906, as he appeared to be rapidly cytes. The leucocytosis at the commencement was due
to a relative preponderance of polymorphonuclear cells,
sinking, Mr. Hall-Edwards was asked to treat him with
the X rays.
accompanied by a relative preponderance of large mono
nuclear forms and relative diminution of small lympho
He was then very emaciated , and could hardly walk
cytes and of eosinophile cells .
to the hospital. There was a large mass of glands in
That the improvement in this case was entirely due to
the left side of the neck and axilla ; the left arm could
the action of the X rays there can be not the slightest
not be approximated nearer to the body than an angle of shadow of doubt. The patient was practically in a
45 degrees. The superficial veins of the chest were
dying condition when the rays were first applied, and,
much dilated ; he had a “ brassy " cough and shortness although all other methods of treatment had been
of breath.
The mesenteric glands were much enlarged, and there entirely discontinued, he commenced to improve after
the fourth application .
were huge masses of glands in his left inguinal region
and Scarpa's triangle ; the liver and spleen were not
enlarged.
ON THE RADIO-THERAPEUTIC TREATMENT OF
REPORT ON BLOOD OF W. W_, BY DR. MILLAR, DISEASES OF THE HAIR.
OF THE UNIVERSITY, BIRMINGHAM.
By Professor Dr. ROBERT KIENBÖCK, Vienna. *
First examination , October 30, 1906 :
3,175,000
The fall of the hair as a sequel of Roentgen irradiation
Red blood-corpuscles was observed as long ago as 1896—an effluvium capil
White blood -corpuscles 12,500
lorum that resulted in baldness, either temporary or
Microscopic examination : Some irregularity in shape permanent, according to the intensity of the irradiation .
and size of red cells, also in their hæmoglobin contents. It was therefore natural that the epilating action of the
Differential count :
X rays was first made use of to procure either a
temporary destruction in cases of disease of the hair, or
Polymorphonuclears 87.2 per cent. a permanent destruction in hypertrichosis.
Lymphocytes (many of them
large) 8 :3 Freund, Schiff, and Goch were the first to carry out
Large mononuclears 2 :3 Roentgen epilation, and these were speedily followed
Eosinophiles 1
1.3
by Albers- Schönberg, Hahn, and others. The technique
Transitional form
of radio-epilation is so difficult, and the number of
Second examination , December 5, 1906 : published articles dealing with the subject so limited ,
that I need make no apology for publishing a report of
Red blood-corpuscles 3,000,000
White blood -corpuscles 7,000
results which I have myself obtained. I propose here
*
Communicated and condensed by Professor Dr. Kienböck from
Slight irregularity in shape and size of reds. Archiv für Dermatologie und Syphilis , lxxxiii. , 1 , 1906.
 ARCHIVES OF THE ROENTGEN RAY. 13

to treat of three affections only–hypertrichosis, alopecia The more energetic treatment of hypertrichosis con
areata, and favus. sists in the production once for all of a Roentgen
HYPERTRICHOSIS. dermatitis of the second degree, with more or less
painful excoriation. This dermatitis may continue for
Abnormal growth of hair, either generalized or in many weeks, and results in permanent alopecia. Here,
patches, may occur on any part which bears lanugo however, we must take into account the danger of
hairs, either on the body, the extremities, the forehead, telangiectases occurring after three months and pro
or face. The case we are oftenest called on to treat is ducing permanent disfiguration . With the more ener
the growth of the beard in women, an anomaly which is getic treatment by a single irradiation this complication
the cause of untold suffering and misery to the unfor- is more frequent and more pronounced, and on this
tunate patients . account, in my opinion, the milder form of treatment
The Roentgen treatment of hypertrichosis faciei is to be preferred.
attempts the complete destruction of the hairy growth The dose to be given varies according to the mode
without the production of any further complications. of treatment adopted. For the energetic treatment, a
We may for this purpose employ one of two methods- maximum dose may be given on different areas, with
a milder or a more energetic one. intervals of a few weeks. For the milder treatment, a
With the milder treatment, the production of any normal dose only should be given on each area, and this
strong reaction is to be studiously avoided . As a result should be modified according to the age of the patient
we obtain a complete effluvium of the hair ; but as a and the position of the area to be irradiated. On the
rule the hairs begin to grow again after a period of face, this dose consists of 6 to 8 of the units , as
about six weeks, and ultimately regain their former measured by Kienböck's quantimeter, corresponding to
quality. Under these circumstances we are compelled 3 H to 4 H. On the back, a dose double the above may
to subject the patient to a new series of irradiations in be given.
order to produce epilation anew, or to commence the For the more energetic treatment — which , however,
irradiations after only a month's interval in order to is not to be recommended -we must produce a derma
prevent the regrowth of hair. According to our expe- titis of the second degree, with blistering and excoriation ,
rience , these irradiations with massive doses must be followed by complete effluvium of the hairs. For this
repeated for some eighteen months before we are able purpose a double normal dose is required : On the face,
to ensure a permanent alopecia of the irradiated areas. 12 x to 16 x in Kienböck units (6 H to 8 H) ; and on
If there only remain a few unpigmented hairs , the treat- the back, 24 x to 32 x.
ment may be regarded as complete . There is a modification of this expeditive method by
In many cases, however, at this period, eighteen which an amount somewhat over the normal dose is
months after the commencement of treatment, a process spread over several successive days, a fractional dose
of atrophy with telangiectases may set in. This process being given at each sitting.
develops during the course of many months. It is the The original method recommended by Schiff and
So -called late reaction , & most unwelcome and durable Freund consisted of a slight irradiation repeated daily
result of the primary inflammatory reaction, which may for many weeks until the first symptoms of reaction
not have been greater in intensity than a Roentgen occurred
occurred . Usually a dosimeter is dispensed with in
dermatitis of the first degree. In these cases not only this treatment, but, roughly, a dose of about one-tenth of
have we produced a definitive atrophy of the hair a normal dose is given on each occasion. The method
papilla, but the bloodvessels and the stroma of the skin is, however, very tedious, and gives no better result than
itself has suffered . This telangiectatic atrophy remains the more expeditive modes of treatment.
for many years, if not permanently . There is no satis- With regard to the magnitude of the dose, the only
factory treatment of the red spots of telangiectasis. The circumstances that influence it are the hardness of the
best available means is the scarification or electro- focus-tube, the distance of the anticathode from the skin ,
puncture of the larger spots, a procedure which should and the duration of the exposure. The dermal effect
not be attempted till the process has quieted down and can be produced with rays of all degrees of penetration,
become stationary. but a medium soft tube is the best . The best focal
 ARCHIVES OF ROENTGEN
14-16 THE RAY .

distance is 16 to 20 centimetres. A longer distance has swelling, with more or less complete effluvium of the
the disadvantage of requiring much longer exposures, hairs, due to acute atrophy of the hair papillæ. This
and a shorter distance is not practicable on account of degree of reaction is accompanied by itching and the
formation of a few pustules. The skin undergoes &
the inequality of the irradiation over the exposed area.
In order to treat the complete beard, four separate brown coloration—a sort of pseudo-pigmentation - pro
areas have to be irradiated. The focus-tube should be duced by the passage of erythrocytes through the vessel
so placed that the normal ray impinges on the centre of walls, and a subsequent transformation of their hæmo
the upper lip, the centre of the chin, and the right and globin into hæmosiderin. This discoloration lasts for
left angle of the jaw respectively. When the chin is many weeks, and may go on to true pigmentation, with
irradiated , the whole head should be well thrown back. increase of the melanoblasts.
A double protection should be used. Attached to the After a period of four to six weeks — that is, after the
tube there should be a localizer of lead glass, with a period of latency of reaction and dermatitis — à second
wide aperture of 8 centimetres, without any application irradiation may be given, with rather less than the
tube. In addition , the surrounding skin should be normal dose. In the subsequent sittings the dose must
protected by lead plaster or baryta plaster. be diminished, since the skin becomes more sensitive
During the irradiation of the chin and lip the cheeks the more it is irradiated .
should not be protected, and, on the other hand, during As already said , the treatment must be continued
irradiation of the cheeks the chin and lips may be for a period of eighteen months before a durable alopecia
exposed. In this way the corners of the mouth and is obtained. It is not in all cases possible, however, to
other situations, which are difficult to irradiate normally, set up a normal reaction corresponding to a normal dose
are exposed twice over to the oblique rays, and therefore (3 H to 4 H), either in consequence of error in measure
get a fair dose of the Roentgen rays. The red borders of ment, or deficient irritability of the skin, or inequality
the lips should be protected by a lead shield moulded for of irradiation . In these cases we may get a milder
the purpose. During the irradiation of the cheeks the reaction , with imperfect or partial effluvium , or, on the
lead screen covering the eyes should be moved from other hand, inflammation and swelling, with redness of
time to time, so as to avoid the sharp line of separation the integument. We have never met with burning of
which sometimes shows on the cheeks and temples. the skin from a normal dose, due to the so -called
idiosyncrasy to the X rays. Moreover, the failure to
R

BIV BI
R
produce effluvium is most often due to faulty technique
and too feeble irradiation , rather than to any supposed
deficiency in the sensitiveness of some patients to the
Roentgen rays.
BI
In the Archiv für Dermatologie und Syphilis, 1906,
vol. lxxxiii., Part I., I have given a detailed report of
twenty -two cases of hypertrichosis treated by the
Roentgen rays.
In many of these cases the growth of the beard was
associated with other masculine characteristics or a
slight degree of pseudo-hermaphrodism . Eleven of the
twenty -two cases were plump in figure, four were
strongly built and bony, with strong musculature, no
waist, ill-developed breasts, and a growth of hair on the
Fig. 1 . breast, abdomen, back, and extremities. One woman
1 , 2, 4 , The normal ray for various positions of the focus-tube ; 3 is on had a man's voice and a masculine appearance . In the
the opposite angle of the jaw ;f, focus ; R , focus-tube ; Bl, screen . remaining eleven individuals of normal appearance, the
After irradiation with a normal dose we get a normal occurrence of a beard was in many cases a family
reaction. This consists of an erythema lasting several characteristic.
days, with, perhaps, a slight degree of inflammatory As these cases show , the radio -therapeutic treatment
 STEREOSCOPIC PHOTOGRAPH OF A FEMALE PELVIS.
By MR . A. G. FRYETT, of Melbourne, Victoria.
Plate CCLXVI.
(“ Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
15
 FIG
2.. Fig
3.
1
.Fig

5
.Fig .6.
Fig
.4
FIG
.12
PAGE
ON
ARTICLE
K IENBÖCK'S
.DR
PROFESSO
ILLUSTRA
TO R
TE
.CCLXVII
PLATE
Cand Allied
Ruy
Roentgen
the
?s frchiv
(" opyright
oA.)”—Phenomena
16
 ARCHIVES OF THE ROENTGEN RAY. 17

of hypertrichosis of the face is both troublesome and producing only the required " normal reaction.” In
tedious. Although every care was taken not to exceed Case 13 , in addition to swelling of the cheeks, the
the required dose, yet in the earlier cases no dosimeter patient developed an attack of gingivitis — a somewhat
was in existence. In the earlier cases (Cases 1 to 10 of rare, but not a serious, complication. The sensitiveness
Table I.) dermatitis of the second degree was produced of the skin appeared not to vary much in individuals of
during the course of treatment by numerous successive the same age , and there was no apparent difference
reactions. In one case (No. 8) a second excoriation was between patients with blonde or dark complexions. In
produced, and in one or two cases the reaction passed , no instance was there any phenomena observed which
on to a dermatitis of the third degree. might be described as due to personal idiosyncrasy.
In the later cases of Table II. we were successful in
TABLE I.

DERMATITIS OF THE SECOND DEGREE, WITA PERMANENT ALOPECIA AND TELANGIECTATIC ATROPHY.
Dermatitis of the Second Degree. Period of
Colour of Months of Incubation of the Years under
Name. Age. Hair, Treatment. Atrophy in Observation .
Period of Incuba Duration in Months.
tion in Days. Weeks.

1. M. S. 25 Black . 8 9 to 13 3 to 4 18 4
2. G. v. G. 40 Dark brown . 22 8 .6 Unknown . 2
3. F. W. 38 Black . 14 3 3 4 4

10.
4. E. S. 39 9 14 2 Unknown.
5. R. G. 46 18 8 Many. 3 11
6. T. P. 23 Blonde . 18 11 to 12 4 4 3
7. A. G. 30 Brown. 12 10 4 Unknown. 1
8. J. B. 28 92 11 10 to 12 5 4
9. R. C. 38 Black . 34 12 2 18 6
10. C. T. 29 38 8 Many . 3 3

TABLE II.

CASES IN WHICH NO EXCORIATION WAS PRODUCED.

Later Complications.
Colour of Months of Years under
Name. Age. Treatment. Observation .
Hair.
Period of Incuba Condition of Condition of Skin .
tion in Months. Hair .

11. E. T. 26 Dark brown. 16 14 4

Definite alopecia . Strong telangiec
tasis.
12. S. D. 25 Blonde. 12 Unknown Alopecia almost 1
complete.
13. L. D. 25 Black . 4 Alopecia almost Cyanosis. 13
complete.
14. L. D. 20 19 18 Definite alopecia . Traces of telangiec 4
tasis.
15 12 2
15. A. S. 34 Blackish. No telangiectasis. 1
16. S. S. 25 Black . 1 Unknown. 'Unknown. 12

17. G. C. 21 15 Almost complete Traces of atrophy.

alopecia .
18. F. W. 55 Brown . 15 24 Definite alopecia. Traces of telangiec 4
tasis.
19. L. B. 35 Dark brown. 9 Unknown . Incomplete alo 1 等3
pecia . !
20. J. K. 17 Black . 8 97 Incomplete alo 3
pecia.
21. H. S. 40 8 Almost complete Cyanosis. 3
1
alopecia .
22. 0. S. 19 Dark brown. 19 Alinost complete Traces of atrophy. 4
alopecia.
3
18 ARCHIVES OF THE ROENTGEN RAY .

The earlier cases have been under observation for a minutes' duration . The time for the production of
period of two or three years, some of them for five or six permanent alopecia varied from one and a half to two
years, so that we are in a position to verify the per- and a quarter years, with 68 to 127 sittings. In one
manent condition of the skin after the termination of case, in which six different regions were irradiated, the
the treatment. Table I. shows the result of dermatitis treatment lasted three years, with 208 sittings, and this
of the second degree in eleven of our cases, while without any permanent complication .
Table II. exhibits the late complications which followed Pusey treated six cases of hypertrichosis with the
the normal reaction . Roentgen rays, and kept them under observation for
In all cases of Table I. in which excoriation occurred, two and a half to three and a half years. In four of
Roentgen -atrophy showed itself three or four months these, although there was no inflammation, the results
afterwards. The atrophy was very marked, and was were satisfactory - complete and permanent epilation,
permanent. Even under these conditions the patients with but little injury to the skin. In two cases severe
expressed themselves as pleased with the result. In dermatitis of the first or second degree occurred during
Case 6 freckles were developed in the atrophic skin by the course of treatment, and the skin remained irritable
exposure to the summer sun . In the cases shown in for many months. The alopecia was complete and
Table II. only eight were kept under observation permanent, " and only accompanied by a slight degree
long enough to give reliable data. Of these, cyanoses of atrophy.” Pusey maintains that durable alopecia is
occurred in two instances, and in one well-marked not obtainable without producing a certain amount of
telangiectases as a consequence of intense inflammatory inflammation of the skin.
swelling. In five cases out of these eight, the cosmetic The indications for the treatment of hypertrichosis
results were very satisfactory — i.e., a complete or nearly are somewhat limited. In young patients, with a growth
complete permanent alopecia was obtained , with but of light -coloured hair and with but slight disfigurement,
slight traces of telangiectases. These were the cases in Roentgen treatment is not to be recommended, on
which , after each repetition of the irradiation , complete account of the difficulty and tediousness of the treat
effluvium of the hair occurred with only moderate ment and the risk of severe reaction and permanent
reaction. In Case 18 a most tormenting irritation and disfigurement from telangiectases and atrophy. In cases
itching of the skin without inflammatory symptoms was where there is a heavy dark beard, radio -epilation may
cured by the irradiation , and in many cases previously be legitimately attempted after warning the patient of
existing acne and folliculitis disappeared with the possible complications from the later skin reaction.
effluvium of the hair. In a series of fifteen cases, the Four years ago I published the above conclusions, and
result in eight cases was a permanent Roentgen -atrophy ; since then have not undertaken any new cases of
in two there was cyanosis, and in four cases there was epilation. Other authors have also given up the practice,
simple alopecia, without any late complications of any and the radio-therapeutic treatment of hypertrichosis, in
moment. Thus, in 33 per cent. of the cases the desired the opinion of most authors, has fallen very much into
cosmetic effect was produced. In the future, with careful disrepute.
employment of dosimetric methods, we may hope for Schiff, however, who has published notes of 137 cases
even a larger proportion of successful cases, but in any-a larger number than all other authors put together
case the radio-therapeutic treatment of hypertrichosis still continues the treatment of hypertrichosis, and
will be a difficult and tedious one. obtains good results with his method of frequent weak
If we compare the percentage of cure of other irradiations with a hard focus -tube.
observers, we find that Freund in 1906 reported thirty
ALOPECIA AREATA .
one completed cases. In twenty-two of these there was
no Roentgen-atrophy, or, at all events, “ the atrophy The radio-therapeutic treatment of alopecia was first
was so slight that the patient was quite satisfied with established by my experiments, which were suggested
the result of treatment.” In the remaining nine cases by G. Noble. It is somewhat in the nature of a paradox
complete and permanent alopecia resulted, complicated to suppose that the Roentgen rays, which produce an
by the occurrence of Roentgen -atrophy. Freund employs effluvium of the hair, are at the same time capable of
the primitive method of weak irradiations, each of six causing its regeneration. The apparent contradiction is,
 ARCHIVES OF THE ROENTGEN RAY . 19

however, easily explained. Even in cases of alopecia March 18.—The fore-part of the scalp is covered with
the Roentgen rays cause an effluvium of the remaining thick, long, black hair. On the back part of the head
down-like hairs. To this acute and temporary atrophy there is a regrowth of normal hair, but thin and poor and
of the hair papilla follows a growth of healthy hair, the pale in colour. On the temples the regrowth is fairly
whole of the hair nidus having undergone profound thick, but poor and thin on the right side (Plate CCLXVII. ,
alteration in consequence of the inflammatory reaction . Fig. 3). The normal growth of hair continued unaltered
In many cases a quite superficial irritation by friction, for four years.
massage, galvanization, or the Finsen light, is quite In September, 1905, he returned with a patch of
sufficient to produce a regrowth of hair. Moreover, it alopecia over the forehead, and one on either side behind
is frequently noticed that, even with normal hair, the the ear. Behind the right ear the skin was atrophic and
regrowth after Roentgen epilation is thicker, darker, and marbled with red telangiectases.
of altered quality . The patches were irradiated from November 11 to 14.
Fig. 1, Plate CCLXVII., shows the case of a young The hair fell out in three weeks..
man, twenty-six years of age, who had suffered for three November 20.—The large frontal patch is covered with
years from alopecia areata of the scalp. For the last a fairly thick growth of thin black adherent hairs. The
two years the head had become almost completely bald. case is still under treatment.
Here and there only there were a few blanched atrophic That the Roentgen exposure was the immediate cause
hairs. There was considerable marble - like reddening of of regrowth in this case is proved by the fact that the
the scalp and exaggerated sweat secretion. The fore- improvement only occurred over the areas that had been
part of the scalp was irradiated between June 20 and 26, irradiated. The result of a single irradiation was in
a medium soft focus -tube being placed above the fore- every instance perfectly satisfactory, with the exception
head at a focal distance of 20 centimetres, for a duration of a patch on the temple which remained bald as the
of fifteen minutes. After fourteen days the hair and the result of overexposure . As will be noticed, the re
lanugo fell out, with a good deal of accompanying currence after four years was equally amenable to treat
redness. Two and a half months afterwards dark hair ment by radio -therapy.
began to grow on the irradiated area . This was at first Since 1900, I have had the opportunity of treating
very weak and atrophic and easily drawn out. On several cases with success . One occasionally, however,
September 2 the hair on the fore-part of the scalp was meets with cases which , contrary to all expectation,
black and fairly long, whereas there was no apparent prove absolutely refractory to the Roentgen rays, and
alteration of the back part of the head. There the this in spite of large doses, energetic reaction, and fall of
lanugo hairs were longer, but there was no alteration of the hair in the neighbourhood of the diseased patches.
the diseased areas ; the red marbling of the scalp was These cases are often apparently slight in young patients,
unchanged, nor was there any alteration in the tendency where the disease has been but of short duration , with
to hypersecretion of sweat. few foci and a plentiful appearance of lanugo on the
October 7.-The hair is growing thickly again on the scalp. In cases where the patches were depressed and
fore-part of the head, and is already bristly. The situa- atrophic, naturally no good result could be expected.
tion of the former diseased islets is clearly indicated by In other cases the response to Roentgen treatment
a thicker growth of hair ( Plate CCLXVII., Fig. 2). seemed to depend on the stage of development of the
November 2. –The patient was shown to the Royal disease, rather than to any great difference in its
Medical Society of Vienna. etiology. The rays appeared to be useless in the pro
November 3 to 8.—The hinder-part of the head and gressive stage of the affection , but were of considerable
temples were irradiated in three exposures each of ten efficacy in the stage of regression. Most cases that
minutes . come under our notice are in the stage of progression.
December 10.-The hair on the back of the head is Cases that are improving do not usually come for treat
falling out ; there is some inflammatory swelling behind ment. It is, however, very difficult to recognize
the ears. accurately the various stages of the disease. It is
January 25.—There is a copious regrowth of hair, therefore impossible to predict if a case will react to the
except on the inflammatory patches behind the ears. Roentgen rays. It is advisable, however, to treat all
342
20 ARCHIVES OF THE ROENTGEN RAY .

obstinate cases with radio -therapy, as the atrophic con- rounding the patches is sometimes found to be more
dition of a patch is most clearly visible after irradiation. resistant than the rest , so that hairy rings may appear
There is no danger of any unfavourable result, for in the round the patches, while the rest of the scalp is totally
very worst cases the remaining islands of hair grow bald. These, however, quickly fall off in their turn .
again after epilation. The hair begins to grow again on the patches after
After the publication of my earlier cases, many other six weeks, and on the healthy skin in about eight
authors—Holzknecht, Spiegler, Ullmann, Müller, Strebel, weeks. Thus, as Holzknecht has pointed out, we
Herdingsfeldt, Morton, and Williams -- have reported may often see about the sixth week after epilation
successful cases.
the previously bald areas appear as hairy patches
The technique in these cases is the same as that for on the otherwise bald scalp, like a negative photo
hypertrichosis. The expeditive method is the best, the graphic impression of the previous condition. Finally
patch being irradiated in a single sitting, with careful the whole head regains its equally distributed normal
screening of the surrounding healthy hair. In cases growth .
where there are a number of small scattered patches, Favus.
these should be treated one after another. Confluent No disease has proved 80 amenable to radio
patches, or those which are close to one another, may be therapeutic treatment as favus, a disease which previous
treated at the same time. Where the foci are very to the discovery of the Roentgen rays was often in
numerous, or in cases of complete baldness, the whole curable, or only curable after long and painful treat
scalp may be treated by means of five or six separate ment, whereas at the present time the disease may
exposures. The position of the focus-tube and the
2
method of screening will be described when we come to
the treatment of favus. It is better, however, to
irradiate one region first, and to await the result of this.
If there is no improvement it is better to wait for a few 4
А
months, since the disease may then have progressed to
a more favourable stage.

‫اررر‬
Each patch should be irradiated with a normal dose
of 8 x to 12 x (4 H to 6 H). The focal distance should be
16 to 20 centimetres, and the focus-tube should be a
moderately soft one .
Accurate dosage is not of such great importance in
these cases as it is with affections of the face, since
there is a much broader margin of safety when the scalp
is being treated. It is easy to keep within the limits Fig . 2 .
of normal reaction, since dermatitis of the second
1 , 2, 3 , 4, Position of the normal ray in the various positions of the
degree, with excoriation and permanent baldness, can focus-tube ; A, B, C, position of the leaden shield for irradiations
1 , 3, and 4 .
only be produced in the scalp by an irradiation three
times that of a normal exposure . be completely and painlessly eradicated by a single
After a normal dose both the lanugo on the diseased exposure. The priority in the employment of this
patches and the hair around the patches fall off after treatment is due to Freund and Schiff, who were
& period of latency of two weeks or thereabouts, followed by Liemssen, Albers-Schönberg, Hahn, Scholtz,
occasionally with signs of erythema. The effluvium Spiegler, and many others. The failure to obtain a
proceeds in a centrifugal direction from the centre of prompt cure in this disease is always due to incomplete
the irradiated area. The shortest period of latency epilation , one or more foci remaining untreated through
is also in the centre, where the skin has received the faulty technique.
largest dose . The action begins much later on those The technique consists in a complete irradiation of
portions which have been irradiated with oblique rays. the whole scalp, divided into five or six separate areas.
During complete epilation of the scalp, the hair sur- Of these, three are in the middle line — the vertex, the
 ARCHIVES OF THE ROENTGEN RAY. 21

fore- part of the head, and the occipital region — and one, TABLE III .
the temporal region, on either side. A medium soft
Favus TREATED BY THE EXPEDITIVE METHOD.
focus-tube should be used, at a focal distance of 16 to
20 centimetres. The dose should be 6 X to 10 x
(3 H to 5 H), a dose which should be reduced in the case Duration of Latency of Under
Name. Age and Sex . the Disease the Reaction Observation
of children. The face and neck should be guarded by lead in Years . in Days . since Cure .
shields, as in the accompanying diagram ( Fig. 2).
Ten days after the exposure dermatitis occurs in the 1. S. B. 13, Female . 1 12 year.
diseased foci. This goes on to excoriation . A few days 2. H. H. 13 , Male. 7 14
3. N. R. 18, 9 13 1
later total effluvium of the hair occurs , with a certain 4. R. S. 15, From child. 10
amount of reddening. It may be mentioned that no hood.
5. A. D. 19, Female . 4 2 years.
appearance of cerebral irritation or stimulation follows 6. J. T. 14, Male. 5 15
this intensive irradiation of the scalp, which for the 7. A. P. 24 , 6 13 year.
treatment of the five separate areas may last as long as 8. E. R. 5, Many. 13 Poor re
growth .
an hour and a half. In the case of children , consider
able fever may set in as the result of dermatitis.
This may last several days, with slight disturbance of Parasitic Eczema of the Scalp . - In conclusion , I may
the general health and an exanthematous eruption, draw attention to a case of a boy, twenty years of age,
due to the absorption of the inflammatory destructive who for the last twelve years had suffered from recurring
products. parasitic eczema of the scalp. The affected region was
The excoriation soon heals, and some six weeks after covered with thick masses of crusts and scales, and the
epilation the hair grows again as strong as ever on the hair had fallen out. On October 31 and November 1
healthy part of the scalp, whereas on the diseased areas and 2 a strong irradiation was given with rays of a
the growth is poor and scanty or altogether absent. moderate degree of penetration. The focal distance
Three or four months after irradiation the head is was 18 centimetres, and the length of exposure fifteen
clothed by a new growth of thick, long hair. The minutes. By the middle of November complete effluvium
excoriations are treated with ointment, and the bare of the hair had taken place, and the crusts had also
scalp is frequently washed with spirit- soap. disappeared ; by the middle of December the new growth
The cure depends on the complete removal of hair, of healthy hair began to appear ; and by the following
together with the sheaths of the hair roots and the February there was a thick growth of long hair. The
achorion fungus, and not, as is sometimes said, on the eczema was completely healed, and there had been no
destruction of the fungus, since the epilation dose is far recurrence up to the end of the month of June.
below the intensity of Roentgen irradiation required to
produce a bactericidal action . ILLUSTRATIONS, PLATE CCLXVII.
If dosimetric precautions are omitted, we are subject
to many errors. Underexposure is followed by imper Case of Alopecia.
fect or partial epilation . Overexposure is followed by Fig. 1. On June 26.
permanent baldness and atrophy of the healthy areas. Fig. 2. On October 8.
We sometimes meet with cases of long-continuing Fig. 3. On May 18.
ulceration and so much thinning of the scalp that the
cranial bones and their sutures appear of a greyish Case of Parasitic Eczema.
tint through the transparent scalp. Fig. 4. On October 30 .
The following table shows a series of eight cases of Fig. 5. On December 19.
favus treated by the expeditive method : Fig. 6. On June 1 .
22 ARCHIVES OF THE ROENTGEN RAY.
Notes and Abstracts.
· MASSAGE.
Physical Measures in the Treatment of Disease ( C. R.
Dickson, Canad. Jour. of Med. and Surg ., November, 1906) .-
Ostrom, in “ Massage and the Original Swedish Movements, "
claims that " ma al treatment for disease has existed to a
certain extent since the Creation. There was a perfect
system of gymnastics among the Chinese three thousand years
before the Christian era. The priests of Egypt used some
manipulation in the form of kneading and friction for rheumatic
pains, neuralgias, and swellings. The Hindoos also had some
knowledge of their therapeutical importance. Even the Persians
used a few movements for different affections. The Greeks
were the first to recognize gymnastics as an institution. .
Although the Romans imitated the Greeks to some extent, they
rather preferred calisthenics."
William Murrell, in “ Masso -therapeutics,” says that in a
primitive form massage was known to the Greeks and Romans,
who resorted to it after the bath—a custom which , under the
name of shampooing, still prevails among the Orientals. After
the struggles of the circus it was employed to dissipate the
resulting contusions and extravasations. Homer tells us that
beautiful women rubbed and anointed war-worn heroes to
refresh them after battle. Hippocrates says : “ A physician
must be experienced in many things, but assuredly also in
rubbing, for things that have the same name have not always
the same effect. For rubbing can bind a joint that is too loose,
and loosen a joint which is too tight. Rubbing can bind and
9 )
loosen , can make flesh and cause parts to waste.”
The late Maurice Pilgrim put the subject of mechanical vibra
tion on a sound basis. He disclaimed any intention of lauding
the treatment as a cure-all, but claimed that vibratory stimula
tion increased the volume of blood and lymph to any given area
or organ, and increased thereby the nutrition, secretion, and
metabolism . - ARCHD, JUBB .
RADIO - THERAPY .
The Treatment of Tuberculous Glands of the Neck by
the X Ray (New York Medical Journal, January, 5, 1907).
Feldstein says that it has been proved beyond doubt that tuber.
culous cervical glands can be successfully treated by the X ray.
Successful cases may be regarded as almost permanent cures,
due to the fact that the histology of the affected part has been
changed. A fibrous tissue formation is the result, and by its
presenceit both retards the growth of the tuberculousglands,and
most probably prevents the enlargement of those in the imme
diate neighbourhood. In glands where softening has already
taken place, however, treatment by X ray is not advisable, for
it gives no positive results, and these patients should be referred
to the surgeon rather than to the radiographer.
The post-operative treatment of the tuberculous cervical
glands is important, and is usually overlooked. After operation,
however thorough, it is often found that in a few weeks or
months a swelling will appear in the region which has been
operated on, and sometimes a discharging sinus will form. This
is undoubtedly due to some glands which have been overlooked
and left behind, and then rapidly grow. In order to prevent
this, X -ray treatment after each operation is to be advised.
This is the more essential because of the fact that many of the
glands in the neck are inaccessible, and are prone to undergo
tuberculous change if some of the more superficial glands are
involved.
Another advantage of the X -ray treatment is that it obviates
an unsightly scar. The size of the gland or glands does not
seem to influence the result of the X-ray treatment. In con
clusion , the writer summarizes the value of this treatment as
follows :
1. Tuberculous cervical glands should be treated by the
X ray when no softening or caseation has taken place.
2. Softened or cascous glands should be referred to the
surgeon , and ought not to have X-ray treatment.
3. Post-operative X-ray treatment is important if there is
any doubt of remaining glands which might be infected.
4. X-ray treatment is of great value for cosmetic reasons.
5. The size of the gland or glands does not influence the
successful result of the treatment . – J. B.
ROENTGEN- THERAPY.
In a lengthy article on Priapism , Blum mentions a case where
the condition was due to leucocythæmia ( Wien. klin . Woch .,
No. 38). The patient was twenty years old, and had never been
addicted to masturbation , nor did he suffer from emissions, but
he had frequent night erections.
The patient was free from venereal disease. Six months prior
to coming under observation he fell from a ladder on the
perinæum , and received a bruise of the testicle, leading to a
traumatic epididymitis, which was quite well in six weeks. A
week before admission he was awakened by a severe erection.
He was unable to work, and the condition did not yield to the
local application of heat or of ice. This state of affairs was still
present, without emission or sexual desire, till he was received
under observation. On admission he was pale and weakly,
without ædema and cyanosis. He had a systolic murmur at
the cardiac apex. The abdomen was somewhat distended, and
on the left side a tumour reaching down to the ilium , and having
the form , consistence, and position of a splenic tumour. In the
groin, axilla, and supraclavicular regions were numerous enlarged
glands. Urine contained a trace of albumin and some uric acid
crystals. White corpuscles 565,000, red corpuscles 5,235,000 ;
proportion, 1 white to a little over 5 red. The priapism affected
the corpora cavernosa on both sides, the corpus spongiosum being
normal.
For twenty-six days after admission no change took place
under all manner of treatment, but after that time it gradually
became less. Besides the local application of heat and cold,
X rays were applied to the spleen, bones, and penis. After the
priapism subsided the spleen was diminished in size by the
effect of the X rays, but the blood condition was unaltered.-
JOHN ORR .
 ARCHIVES OF THE
ELECTRO-THERAPY.
The Treatment of Effusion into the Knee - Joint.
Laquerrière (Bulletin Officiel de la Soc. Fran. d'Électrothér.,
June, 1906) thinks that attention should be given to the state of the
muscles in hydrops of the knee. He believes, with Planet, that
the best treatment is faradization of the quadriceps to restore the
tonicity and nutrition . Further, he recommends active and passive
movements, and condemns all strappings and bandages as likely
to compress and cause atrophy of the muscles which act upon
the joint. One pole of the battery is put on the outer and upper
part of the thigh, the other is moved over the muscles. For the
joint itself one pole is placed in front and one behind the
swelling. Such procedures calm the pain, disperse the swelling,
prevent muscular atrophy, and restore tonicity.-ARCHD. JUBB.
A Combined Treatment for Exophthalmic Goitre.— The
treatment of Graves' disease has been unsatisfactory, and
electricity can claim to be less disappointing than other means
(La Clinique, June, 1906). The faradic and galvanic currents
are borne by the patients much more easily than the static.
The symptoms amend usually in the following order : the size
of the tumour, the tremor, flushings, the sweating, tachycardia,
and, lastly, the exophthalmos. The serum treatment consists
of the exhibition of sera from animals which have been deprived
for some period of time of their thyroid glands.
Dr. Marque of Pau has combined these measures :
1. Galvanization.- Positive pole on neck , negative pole on
the goitre, 50 milliampères for quarter of an hour. Faradization
for ten minutes of the præcordial region, and for five minutes
of the sympathetic on each side.
2. Serum-therapy. - Carrion's fluid (hémato -éthyroïdine), a
teaspoonful with each meal.
The patient was a man , aged sixty-four, who had been affected
for six years. He improved quickly under the combined treat
ment ; the pulse fell from 120 to 96, and the palpitation and
tremor were much reduced. The improvement has been main
tained during six months of observation . -ARCHD. JUBB.
Treatment of Posterior Urethritis by Means of High-
Frequency Currents (Annali di Elettricita Med.e. Therapia
Fisica , February, 1907).-— Blasi calls attention to the antiphlo
gistic properties of electricity, and of the high-frequency currents
in particular. He refers to the work of Doumer in connection
with the treatment of prostatic disease and affections of the
neighbouring organs by means of high -frequency currents. As
an adjunct to internal medication, such as helmitol, the passage
of bougies, and urethral irrigation, the high - frequency current is
of undoubted value. Blasi maintains that further trial of this
mode of treatment ought to be made, as it is certainly deserving of an empty, movable sack in that region. Appetite is improved,
of attention in view of its simplicity.
RADIOGRAPHY.
The Treatment of Hypertrophy of the Prostate by the
Roentgen Rays.—C. Luraschi and C. Carabelli (Annales d'Élec- service in one case of true achylia and in cases of hypersecretion
trobiologie et de Radiologie, January, 1906 ; abstract in the
Archives of Physiological Therapy, May, 1906) report favour-
ably on two cases treated by irradiation through the perinæum.
They consider that in the treatment of prostatic hypertrophy method in quite a number of cases of intestinal disease, and
this method should be used.-C. THURSTAN HOLLAND.
ROENTGEN RAY . 23
MECHANO - THERAPY.
The Treatment of Gastro - intestinal Diseases with
Carbon Dioxide Massage ( Wiener Medizinische Wochenschr.,
No. 51 , 1906 ).- Dr. Walther Nik . Klemm , of Darmstadt, in an
important article refers to his early use of CO, combined with
massage in the treatment of diseases of the large intestine. He
has now extended his observations to include the stomach. Ho
points out that CO, is antimicrobic, and acts as a disinfectant on
the area with which it is brought into contact. Then , again, it
causes dilatation of the bloodvessels of the mucous membrane
of the stomach, which remains for several hours, just as it does
those of the skin . This action of CO, is observed in the
Nauheim bath treatment. Whether this effect is due to a
contraction of the vaso-dilators or to a paralysis of the vaso
constrictors is uncertain. Then , again, CO, stimulates the peri
pheral nerve-endings themselves, and so assists the contractile
power of the vessels. If we, at the same time, massage the
stomach , which is pushed towards the hands by means of the
distension due to the introduced gas, then by virtue of the knead
ing process employed we empty and fill the organ in quick
succession, and thus increase its elasticity, at the same time
heightening its muscular energy.
Klemm's method is as follows : He introduces the gas directly
into the stomach from the generator by means of a stomach
tube, until flatulent distension is observed. Then the gas is shut
off, and he massages the stomach in the direction of the cardiac
end. In the case of the colon he massages downwards, so as to
empty the intestine. On each occasion more gas is introduced,
and more forcible massage employed. The tube is introduced
while the patient is in the sitting posture, then he lies down with
a blanket rolled up under his back. As soon as the gas is shut off
the tube is taken off the bottle , and that end is placed into a
vessel of water. In this way the Co, in the stomach , together
with the natural gastro-intestinal gases, are forced out during
the massage process under higher pressure. Klemm is of
opinion that the use of ordinary air for the distension of the
stomach prior to massage is of no value. Moreover, his method
is disinfectant ; and, besides , no fluids are necessary such as
formerly were introduced to disinfect the gastric organ. His
method he claims to be safer and more easily carried out. The
blood circulation of the stomach walls is increased very materi.
ally, and so the organ is stimulated. This treatment is of great
value in all cases of gastroptosis, atony, and hour -glass con
traction of the stomach.
The immediate effect of a CO, massage is an agreeable feeling
of warmth in the stomach or colon, as the case may be. We lose
the weak , sinking feeling and we find no longer the sensation
and the patient has no longer apprehensions as to fulness and
heaviness after eating. Simple cases may be cured within a
week, after which a bandage may be worn. Even seasickness
may be treated by this method. This method has proved of
and of hyperacidity. He has also found it of use in cases of
gastritis and of bacterial infection of the stomach walls, as also
in some cases of anal fistula . Klemms has also employed his
concludes by referring to the results obtained by Rose, of New
24 ARCHIVES OF THE
York, in the treatment of colitis, proctitis, and dysentery. In
testinal tuberculosis, enteric fever, and intestinal atony are
referred to by the writer as suitable conditions for a trial of his
CO, massage treatment.
MEASUREMENT.
Measurement of the Radiochromometric Penetration of
a Focus - Tube by Means of an Electrostatic Voltmeter
(J. BERGONIÉ, Comptes Rendus de l'Académie des Sciences,
January 7, 1907).-- At the present day the extended use of high
voltage currents bas necessitated the use of electrostatic volt
meters, graduated up to 60,000 volts and more.
For the last six months , both in hospital and in the laboratory,
I have made use of two electrostatic voltmeters, made by Hart
mann and Brann , for measuring the degree of penetration of my
focus-tube. I have thus obtained the following results :
1. Whatever be the intensity of the current passing through
the focus-tube, if the voltage is the same, the penetration of the
rays, as shown by Benoist's radiochromometer, does not vary.
This was found to be the case even when the current varied as
much as from it to 1 milliampère.
2. As the voltage increases, the penetration of the rays
increases. The intensity of current has but little effect on the
penetration. Using Gaiffe's apparatus, the voltage and the
degrees on Benoist's radiochromometer were as follows :
12,000 volts 2° + on Benoist's scale.
20,000 3°
25,000 4°
30,000 5°
35,000 6°
42,000 7°
3. With the same voltage the penetration was the same, even
when using focus-tubes of different models from different makers,
taking different intensities of current.
By means of a milliampèremeter and a voltmeter we may
measure exactly the amount of work expended in a focus-tube,
and in this way obtain an estimate of the quantity of X rays
emitted.
The Action of the Roentgen Rays on the Selenium Cell.
- This was discovered by Foster and developed by Perreau and
Ruhmer. It was asserted by these authors that the action of
the Roentgen rays was similar to that of light, but that the
selenium cell was less sensitive to the action of the X rays, and
that the return to the normal resistance was slower after ex
posure to the X rays than it was after exposure to light.
In opposition to this Dr. Wertheim Salomonson's experiments
show that there is certainly no qualitative, and probably no
quantitative, difference between the action of light and the
action of the Roentgen rays on a selenium cell. In his experi
ments he made use of the new Einthoven string-galvano
meter. After each momentary emission of the Roentgen rays,
at the moment of break, the resistance of the selenium cell
was found to be greatly reduced — just as happens during a
similar momentary exposure to light — i.e., for about one
thousandth of a second.
The ordinary movable - coil galvanometer will not show these
brief alterations in resistance, but registers only the “ net
electrical result."
ROENTGEN RAY.
The spark from a condenser has a precisely similar action on
the selenium cell, giving the same curve , as in the case of the
Roentgen emission.
In previous experiments what has really been observed has
been the elastic deformation and after -effects, and not the true
resistance effect (Third Berlin Congress, 1907 ).
ELECTRO-THERAPY .
Electro - therapy in Disorders of the Circulation (Münchener
med. Wochenschr. , No. 50, 1906 ).— Hornung calls attention to
the value of electrical baths in the treatment of disorders of the
circulation . He finds that after faradic and sinusoidal baths there
is a real heightening of the blood-pressure. Hearts which are
dilated and acting feebly can often be made to diminish in size
by the use of electrical baths. Apparently these, effects are
due to the action of the electrical currents on the vasomotor
apparatus, whereby the diminished pressure in the bloodvessels
is improved and the heart unloaded . Treatment by means of
the sinusoidal and faradic currents should be considered as a
remedy, replacing Co, baths in many heart affections. Thus
they may be used in cases of uncomplicated insufficiency of the
heart muscle, even in those very severe conditions following in
fectious diseases, toxæmias, and over- exertion. They are also
indicated in cases of cardiac defect with commencing failure of
compensation ; in early arterio -sclerosis ; in chronic myocarditis ;
and , lastly, in various neuroses affecting the heart and blood
vessels.
ELECTRO-THERAPEUTICS.
The Treatment of Hæmorrhoids with the Constant
Current ( Journal of Advanced Therapeutics, March, 1907).
Franklin Patterson says that the application of the constant
current has been attended with good results in cases of
hæmorrhoids. It not only removes the hæmorrhoids, but also
restores the diseased mucous membrane to a normal condition
and overcomes the accompanying constipation. In cases where
the hæmorrhoidal mass is indurated much time may be gained
by inserting a platinum needle connected with the negative
pole into each tumour, and using just enough current to blanch
the mass . This method is to be preferred to the injection of
carbolic acid or ergot. If followed by the anodal application of
a covered copper electrode in the rectum with from 10 to
15 milliampères every other day, the ultimate result will be
all that could be desired, and superior to that attained by the
knife or actual cautery.
To overcome some of the objections attending the use of a
solid copper electrode, the writer has devised a special form of
hollow rectal electrode. The copper bulb can be unscrewed from
the shank, and the chamber loosely filled with absorbent cotton
and the bulb replaced. The electrode is then dipped into water
or medicated solution, and the rubber tip squeezed several times
to thoroughly wet the cotton. A covering of gold-beater's skin
is placed over the copper bulb, lubricated, and inserted in the
rectum . The current is then turned on. This thin covering
offers little or no resistance to the passage of the copper salts,
and is kept moist throughout the treatment by the wet cotton
in the chamber.
 ARCHIVES OF THE
Reports of Societies.
THE FARADAY SOCIETY.
Electrode Potentials and "· Supertension.”
A FULL programme, of much chemical interest, was laid
before the members of the Faraday Society at the March
meeting
Two of the four papers read dealt with the subject of electrode
potentials, that by Messrs . H. Nutton and H. D. Law treating
of “ The Potential of Hydrogen liberated from Metallic
Surfaces," and the paper by . Messrs . F. M. G. Johnson and
N. T. M. Wilsmore on “ Electrode Potentials in Liquid
Ammonia . ” The former paper has a close bearing on electro-
lytic methods of reduction at the cathode of an electro - chemical
cell, methods which are now assuming some importance,
particularly in the domain of organic chemistry.
Many years ago Caspari showed that, whereas hydrogen
would separate visibly on a platinized platinum cathode at prac-
tically a zero potential, in the case of many other metals a
considerable excess potential or “ supertension ” had to be
applied before hydrogen bubbles could be caused to evolve. It
was further proved that by means of such electrodes, notably
mercury and zinc, whose supertensions are exceptionally high
(0.78 volt and 0•70 volt respectively), organic reduction produc-
tions, otherwise difficult to prepare, could easily be obtained .
Mr. Law has lately been extending the work of Caspari and
Telcl in various directions, and his results have been published by
the Faraday Society ; the present paper records a further exten.
sion of this work, undertaken with the object of reducing to
some order the somewhat bewildering and conflicting information
at present available on the subject of supertension , and in
particular, to try and distinguish between purely chemical and
physical effects.
The conclusion arrived at is that, contrary to what was
supposed, the supertension is not even a fixed quantity for a
given metal , but varies with the physical condition of its surface
and with small impurities present in the metal, until long
contact with the electrolyte has eliminated the effect of these.
Seeing that the phenomenon of “ supertension ” is probably
caused by the solubility of hydrogen in the metal of the cathode
— there being a direct relation between these two quantities-
it is not surprising that it depends so largely on physical con-
ditions , chemical reactions, surface films, etc. , but some of the
anomalous results given by Messrs. Law and Nutton are
decidedly puzzling. Thus, to quote a single example, if a piece
of platinum is coated with cadmium ,the " supertension ” will be
that of the former, i.e. , almost zero, no matter how well the
platinum appears to be covered, unless the cadmium coating be
exceptionally heavy and dense .
A full investigation of this subject will be of the utmost
value in throwing light on that obscure and complex corner of
electro-chemistry, electrode reactions, and thoughtful and pains-
taking work like that of Mr. Law deserves every encourage
ment, especially on the part of that not insignificant portion of
the chemical world who can see nothing good in a physico-
chemical research unless it hails from over the seas.
ROENTGEN RAY . 25
Messrs. Wilsmore and Johnson's paper is a preliminary
account of a difficult investigation that promises to be of very
great theoretical interest.
Nernst has familiarized us with the conception of the
“ electrolytic potential" of a metal—that is, the contact potential
between a metal and its solution under definite conditions of
temperature and ionic concentration in the solution.
If Nernst's theory of contact potential is correct, this “ electro
lytic potential" should be a fixed and characteristic constant for
every element , one of the great constants of Nature - an
affinity constant of the element, in fact ; and the object of the
authors of this paper was to check the theory by seeing whether
it holds good for solutions other than aqueous, on which are
naturally based at first all theories of this kind. Liquid
ammonia was chosen for the solvent, and after considerable
difficulties had been overcome , the authors succeeded in making
a series of measurements with various metals, which up to the
present show merely the same order of potential as exists with
aqueous solutions, but in no cases actually coinciding with the
latter. But it will be necessary to apply many corrections
notably, for the amount of ionic concentrations in the ammonia
solutions—before the figures can be regarded as final, so the
verdict at present must remain “ not proven , " and Mr. Wilsmore
and Mr. Johnson must be encouraged to proceed with and
complete their difficult and trying investigation.
Mr. Rhodin's paper on the Impedance of Solutes in Solvents
as Manifested by Osmotic Pressure " was an echo of the
symposium on the subject held in January, and it follows the
views outlined by Mr. G. T. Beilby in a recent B.A. address.
In order to overcome the main difficulty of the original
Van t’Hoff's conception of osmotic pressure, which , regarded as
a positive pressure caused by the impacts of solute molecules,
would act in precisely the reverse direction to that actually
observed, the new theory would regard the solvent and not the
solute as the source of the energy manifested in the usual semi
permeable membrane experiments. The presence of a solute in
a solvent, in fact, diminishes the potential energy of the latter ;
there is, therefore, a flow of energy across the semi-permeable
membrane from the solvent to the solution inside the membrane.
The " osmotic pressure " is thus a potential pressure, made
actual by the transformation of the excessive potential energy
of the solvent on the one side of the semi-permeable membrane ,
by absorption of exterior heat energy .
To explain the action of semi -permeable membranes, the
author imagines these—and colloids generally—to be composed
of radial filaments, emanating from a common centre. The
structure is coarse compared with that of the solvent, but the
iliac impede the motion of the molecules of the latter. In an
osmotic experiment the stronger bombardment on the solvent
side pulverizes the filaments into cones, and a kind of “ Bunsen .”
valve is thus produced, which will allow the solvent, but not the
solute molecules, to pass through it.
It is doubtful whether this view of membranes can be
substantiated, because, as Kahlenberg and others have shown,
larger molecules will often pass through a membrane that
4
26 ARCHIVES OF THE ROENTGEN RAY.
impedes the flow of smaller ones. The action of the membrane
is more likely to be caused by either selective chemical affinity
or selective solubility as between the solvent and the solute.
A paper communicated by Dr. T. Slater Price, taken as read
owing to the lateness of the hour, dealt with the best solutions
and best conditions to use for the accurate electrolytic determina-
tion of zinc by depositing it on a rotating cathode.
PHYSICAL SOCIETY.
At the meeting held March 8, 1907, Professor J. Perry , F.R.S.,
President , in the chair, a paper by Professor F. T. Trouton
and Mr. S. Russ on “ The Rate of Recovery of Residual Charge
Reviews
The American Quarterly of Roentgenology, the official
organ of the American Roentgen Ray Society, is to be pub.
lished quarterly instead of yearly as heretofore.
The editor insists at some length on the necessity of emphasiz-
ing the fact that the radiologist is a consultant, and not a mere
19
technical expert. He should use the term “ Roentgenogram ’
or " skiagram " instead of the more familiar photograph, and
retain his Roentgenogram in his own hands, delivering simply
the diagnosis, and thus maintain the position of a consultant,
who gives diagnostic conclusions based upon special lines of
argument.
“ In regard to treatment, he should not allow himself to be
dictated to by the attending physician either as to the number
or the character of his exposures. He should give the profession
and the patient to understand that all the details of his applica-
tion of Roentgen therapeutics are guided by his own judgment
and experience .”
There is an interesting paper by Vernon J. Willey, M.A. , on
“ The Teaching of Roentgenology in Medical Colleges." He
says truly that for the medical student of the future a know-
ledge of the application of Roentgenology to clinical work will be
an absolute necessity, whether the practitioner chooses to do his
own Roentgen work or to refer it to a Roentgenologist. Every
student should be taught to interpret in a general way what he
sees on the screen-not so much as a picture as a record of the
densities of the tissues traversed by the rays. He should also
understand the value of correct interpretation, not only for the
purposes of treatment, but for the weighing of the radiographic
evidence frequently brought forward in medico-legal cases.
In most of the American colleges some attention is already
given to the teaching of this subject. The best means of illus-
trating to a large class would appear to be by means of lantern
slides thrown on the screen . In this way the student sees a
large number of positive Roentgenograms, and may thus in a
comparatively short time obtain a general idea of the scope and
application of X rays to diagnosis.
There is a most comprehensive paper by Dr. Andrew P.
Biddle on The Accumulative Experience of the Profession in
the Use of Roentgen Rays in Acne, Acne Rosacea, Eczema, and
Psoriasis.” This gives the answers to a number of queries as to
in Electric Condensers," was read by Professor Trouton. The
experiments described by the authors were undertaken in order
to examine the rate of recovery of residual charge when the
difference in potential of the plates was kept constant ; previous
experimenters have always allowed the charge to accumulate on
the plates while observing the rate of rise in potential. The
observations when plotted with current against time were found
to lie on a hyperbola. This shows that under the circumstances
of the experiments the quantity of electricity recovered up to any
given time follows a law Qra log (p + t) similar to that found
by Rankine and others for the recovery of stress in overstrained
elastic bodies when the strain is kept constant .
the value of radio-therapeutic treatment addressed to a number
of physicians and radiologists.
With regard to acne a large number of authorities testify to
the value of radio -therapeutic treatment in obstinate cases, but
most observers would limit its use to cases of rebellious , deep
seated, indurated or pustular types due to staphylococcic infec
tion .
In acne rosacea the general consensus of opinion is that the
best results are obtained in cases in which the sebaceous
glandular form predominates, whereas Roentgen -therapeutic
treatment has but little action on the dilated vessels or the
tumefaction of the nose.
In eczema the chronic localized indurated patch, whether on
the palms, the soles, or elsewhere, is best treated by the X rays.
It may sometimes be used in other varieties, but only for the
relief of pruritus.
In psoriasis the Roentgen rays as a routine treatment may
be used when the disease has invaded the nails, or for the treat
ment of large infiltrated plaques, which nothing else seems to
affect permanently.
The paper is of great interest, and contains the opinions of a
number of specialists, American, English, French and German.
The opinions, it is needless to say, differ considerably as to the
efficacy of radio-therapeutic treatment. In the opinion of the
reviewer, cases of acne are habitually overdosed with X rays,
and this overdosage accounts for a large number of apparent
failures in radio -therapeutic treatment.
An article by G. E. Pfahler, M.D., on the author's Roentgen
ray filter, concludes a most interesting number, and we con
gratulate the American Roentgen Ray Society on their new
quarterly issue of valuable original material supplied fresh from
the mint.
The Roentgen Rays in Medical Work. By DAVID WALSH, M.D.
4th Edition . London : Baillière, Tindall and Cox. 1907.
Price 15s. net .
Dr. Walsh was one of the earliest writers on the Roentgen
rays, the first edition of his work appearing as early as 1897,
and the issue of this, the fourth edition , proves that it is still in
demand.
Naturally, the first part of the book, that dealing with apparatus,
 ARCHIVES OF THE
has been almost entirely rewritten, and this was done for the
third edition, and also for the present edition, by Dr. Lewis Jones.
The second part of the book is devoted to diagnosis and treat
ment. The illustrations, of which there are a considerable
number, are very good. We would especially draw attention to
those by Dr. David Morgan, some of which are exceedingly
beautiful.
Of great interest, too, is Dr. Walsh's skiagraphic mapping of
the skin surface, although the practical value of the method
may be doubtful. The result was obtained by kneading fully
into the skin, then working up the surface with glycerine, and
finally gently rubbing with subnitrate of bismuth .
Dr. Walsh also gives two good illustrations showing the
differential diagnosis between gout and rheumatoid arthritis.
In health a skiagram shows clear transparent spails of from
1 to 3 millimetres in breadth between the articular ends of the
bones, and this clear space is maintained to the end of life. In
gout, as shown in the figure, these clear spails are unaffected,
while the existence of tophi are clearly shown as light patches
on the denser bone. In rheumatoid arthritis, on the other hand,
the clear spails have disappeared . This, in addition to the bony
outgrowth and deformity, furnishes a differential diagnostic
indication of great value . This was first pointed out in 1897
by Oudin and Barthélemy.
It is a matter of some surprise that the X rays are not more
used in the study of human and comparative anatomy. The
plate exhibiting the injected bloodvessels of the kidney, by
Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR,—In reply to Dr. H. P. Wells's letter in the May
number of the ARCHIVES, I may state that the patient a skia
gram of whose knee was published in the March issue had all
the symptoms of loose-body in the joint, such as sudden locking
of the joint, with acute pain, etc.; and, moreover, skiagrams
taken at an interval of one year show a change in position of
the body. I cannot agree with Dr. Wells that it is quite the
rule to find a sesamoid bone in the outer head of the gastroc
nemius. Out of many hundreds of skiagrams of knee - joints
taken at St. Bartholomew's Hospital during the last four and a
half years , I have only seen shadows, such as the one published,
in about a dozen instances at the outside, and several out of
these were undoubtedly due to loose-body.
Yours sincerely,
G. HARRISON ORTON, M.D.
29, Upper Berkeley Street, W. ,
April 27 , 1907 .
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
DEAR SIR,-In your issue of March you have published a
radiogram of the knee by Dr. G. Harrison Orton. Allow me
to point out to you that the alleged loose-body is apparently
nothing but the well -known “ fabella ” -a sesamoid in the
caput externum m . gastrocnemii.
ROENTGEN RAY. 27
Dr. Dawson Turner, shows what admirable results may be
obtained by Roentgen-ray dissection, if we may coin the term.
The Medical Annual, 1907. Published by John Wright and
Co. , Bristol. Price 78. 6d . net.
This is the twenty -fifth issue of this admirable year-book of
treatment. The article on Electro - therapeutics and Radio
therapeutics from the pen of Dr. E. R. Morton, of the London
Hospital, is brought well up to date . Points of interest
touched upon are the introduction into practical use of Gehe
recke's oscillograph, and the anomalous alteration in the
resistance of a Chabaud's tube produced by the cardboard guard
of the osmo-regulator. The Roentgenology of the stomach and
intestines is treated at some length , and attention is drawn to
the modern tendency to use more powerful currents of 10 or 15
milliampères through the focus - tube, with a corresponding
reduction in the duration of exposure. The chapter on X-ray
Therapeutics is very complete and yet concise, and gives a good
idea of the general trend of medical opinion and practice in this
new branch of treatment. Indeed, the whole article is well
worthy of special study, although the work in which it is found
is adapted chiefly for speedy reference. The articles on Opsonins
and Vaccine Inoculations, and that on Serum - therapy, are also
of great interest and fully up to date.
The paper by Dr. P. Watson Williams is illustrated by a
number of stereoscopic skiagrams, one of which, by Dr. Mackenzie
Davidson, illustrates very well the advantage of the stereoscopic
method of localization .
Pictures of this sesamoid have already been published in the
Fortschritte auf dem Gebiet der Röntgenstrahle, vol. iii. , p. 188
( 1899 ), by A. Wildt. Also by M. Martens, Deutsche Zeitschrift
für Chirurgie, vol . liii. , pp. 508-510.
In vol. iv. of the Fortschritte auf dem Gebiet der Rönt.
genstrahle, p. 59, W. Pfitzner gives a list of no less than sixty
eight names of persons who have described this bone.
It is nearly always possible to distinguish between a foreign
body and this sesamoid by making also a skiagraph of the sound
knee. As in most cases the sesarnoid exists at both knees , there
should be no difficulty about this. In the exceedingly rare
cases where the other knee does not show a sesamoid , I think
it preferable to inject pure oxygen into the knee-joint before
opening it. A radiograph taken after inflation with pure oxygen
will immediately show whether the shadow lies within or with
out the joint.
I am, dear sir ,
Yours faithfully,
J. WERTHEIM SALOMONSON.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR DOCTOR,—I have read with a great deal of interest
the abstract in your valuable journal of the paper of
H. D. McCulloch , M.B., and am sending you under separate
cover a copy of the Journal of Advanced Therapeutics for
28 ARCHIVES OF THE ROENTGEN RAY .

December, 1906, which contains a paper by one of my associate
editors which I think will interest you.
It seems now that in time we shall come to a more definite
understanding of the action of the Roentgen ray as a therapeutic
agent. Your own conclusion with reference to the action of the
ray upon the tubercular bacilli accords with my own—that the
germs are in reality destroyed in situ with the destruction of
the lowly organized tubercular tissue, and that the bacilli thus
destroyed may become opsonines.
I am also, personally, of the opinion, as stated in a recent
contribution of mine which was published in your valuable
journal, that the X ray sterilizes many types of germs when
present in living tissue, thereby effecting the destruction of
germ life in the tissue.
Very sincerely yours ,
W. BENHAM Snow.
NEW YORK, April 10, 1907.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR,—In Dr. Somerville's interesting article on the
treatment of neurasthenia I find the following sentence :
“ Another method which I have sometimes found of great value
in the later stages of treatment is what are called ' Morton's
waves,' which consist of an uninterrupted unidirectional current."
Dr. Somerville is mistaken in this, for if he will put an
oscilloscope in series with the patient and the machine, he will
find that the negative glow will appear on both terminals of
the oscilloscope, and much stronger on the terminal nearest the
machine, showing that we have an alternating instead of a
unidirectional current, and with the inverse stronger than the
direct. I have elsewhere called attention to this fact (New York
Medical Journal, March 2, 1907 ).
Yours truly ,
HENRY G. PIFFARD , M.D.
New York, April 9, 1907.

PLATE CCLXVI.
STEREOSCOPIC PHOTOGRAPH OF A FEMALE PELVIS, BY ALFRED G. FRYETT , F.R.M.S. , MELBOURNE .
PLATE CCLXVII .
TO ILLUSTRATE PROFESSOR DR. ROBERT KIENBÖCK'S ARTICLE ON THE RADIO - THERAPEUTIC TREATMENT OF DISEASES OF THE HAIR .

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES .
He would be very much obliged if contributors would send, with any prints intended for publication, a full account of the
case and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used, or any other facts of interest.
EDITOR'S AND PUBLISHERS' NOTICES.
THE EDITOR begs to acknowledge communications from Professor Kienböck (Vienna), Dr. Graessner (Cologne),
Dr. Freund (Vienna ), Dr. Sloan (Glasgow ), Dr. Clarence Wright, Professor August Luzenberger (Naples ).
The following Journals and Periodicals have been received : “ Advanced Therapeutics," « The Électrician ,"
“ The Electric Review ,” “ Knowledge, " " The British Journal of Dermatology," " Annals of Physico -therapy,"
“ Medical Times ," “ Medical Electrology and Radiology," “ Archives of Physiological Therapy,” “ Archives
d'Électricité Médicale,” “ Le Radium ," " Annals d'Electrobiologie et de Radiologie,” “ Fortschritte auf dem Gebiete
der Röntgenstrahlen,”.." Münchener Medizinische Wochenschrift," " Zentralblatt für Physikalische Therapie,”
“ Annali di Elettricità Medica," " Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN RAY, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London, W.C.,” or to “ W. Deane Butcher, M.R.C.S. , Holyrood ,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles and radiographs for publication in our columns are always acceptable, and, in the case of
the former, each contributor will be furnished with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view.
Annual Subscription , payable in advance, Sixteen Shillings net (Four Dollars) , including postage ; single
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Communications relating to advertisements should be addressed to the Publishers, REBMAN LTD. ,
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L
VO . XII.

No.
2.
HE
PH RAK

dA de
dhi denn ARCHIVES
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE (New York ); A. BECLERE ( Paris ) ; T. P. BEDDOES ( London ); J. BELOT ( Paris) ; F. BISSERIE ( Paris );
H. BORDIER ( Lyons); J. BURNET ( Edinburgh ); R. HIGHAM COOPER ( London ); W. COTTON ( Bristol) ; FOVEAU DE
COURMELLES (Paris); L. DELHERM (Paris ); R. W. FELKIN (London );
ELEC L. FREUND ( Vienna ); H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
(Montreal) ; STANLEY GREEN ( Lincoln ); H. GUILLEMINOT ( Paris) ;
T D. GUNZBURG ( Antwerp ) ; J. HALL -EDWARDS ( Birmingham ); G. HARET
( Paris ); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna) ;
F. H. JACOB ( Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
ARCH . JUBB (Glasgow ); E. LAQUERRIERE (Paris); S. LEDUC (Nantes) ;
JU

E.R. MORTON ( London ); G. HARRISON ORTON ( London ); H. G. PIFFARD ( New 07

LY

19 .
.

York ); JNO.C.RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ) ;

W. F. SOMERVILLE (Glasgow ); H. WALSHAM (London ); CHISHOLM
WILLIAMS ( London ) ; CLARENCE WRIGHT ( London ).

CONTENTS
PAGE PAGE
EDITORIAL 29 NOTES AND ABSTRACTS (continued ) :
TREATMENT OF HYPERTRICHOSIS BY THE X RAYS 51
ORIGINAL ARTICLES : THE TREATMENT OF CHRONIC BRONCHITIS BY ROENTGENI
RADIUM AND ITS MEDICAL Uses. – By GEORGE H. ZATION .
51
31

GRAHAM , M.D.
REPORTS OF SOCIETIES 52
A TEST OF DR. MILTON FRANKLIN'S ELECTROSCOPE.
By Walter A. ScoBLE, A.R.C.Sc., B.Sc. 39 REVIEWS :
BASE-BALL FINGERS. -- By J. N. Hall, M.D. , and G. H.
ROENTGEN ATLAS OF ORTHOPÆDIC SURGERY 55
STOVER, M.D. 41
INTENSIFIED INDUCTION Coil AND MOTO - MAGNETIC
A CASE OF HEXADACTYLIA : A SKIAGRAPHIC CONTRIBU
INTERRUPTER 55
TION TO THE STUDY OF CONGENITAL MALFORMATIONS.
By PROFESSOR August V. LUZENBERGER, M.D. , . Naples 41 CORRESPONDENCE - 56

PLATES :
SOME PRACTICAL POINTS REGARDING THE X - RAY TREAT
MENT OF RINGWORM OF THE SCALP . - By GEORGE B. PLATE CCLXVIII. - TO ILLUSTRATE ARTICLE ON BASE
BATTEN , M.D. 42 BALL FINGERS BY DRs. J. N. HALL AND G. H. STOVER
THE ELECTRIC SLEEP. -By PROFESSOR STÉPHANE LEDUC, ( PAGE 41 ) - 43
Nantes. Translated and condensed by W. F. SOMER PLATE CCLXIX . ( Figs . 1 AND 2). To ILLUSTRATE
VILLE , M.D. . 46 Dr. George B. BATTEN'S ARTICLE ON THE X - RAY TREAT
MENT OF RINGWORM ( PAGE 42) 44
NOTES AND ABSTRACTS :
PLATE CCLXIX. (Fig . 3 ).--- To ILLUSTRATE PROFESSOR
THE RADICAL ABSORPTION OF URETHRAL STRICTURES BY August V. LUZENBERGER'S PAPER ON HEXADACTYLIA
ELECTROLYSIS 51 (PAGE 41 ) - 44

LONDON
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 VOL. XII.–No. 2. JULY , 1907 .

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY.
EDITED BY

W. DEANE BUTCHER , M.R.C.S. , F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York) ; T. P. BEDDOES ( London ) ; J. BELOT (Paris) ; A. BÉCLÈRE ( Paris ) ; F. BISSERIE ( Paris) ;
H. BORDIER (Lyons) ; J. BURNET ( Ellinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
(Paris) ; L. DELHERM (Paris) ; R. W. FELKIN (London) ; L. FREUND ( Vienna) ; H. E. GAMLEN (West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ; D. GUNZBURG ( Antwerp ) ; J. HALL -EDWARDS
( Birmingham ) ; G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ; F. H. JACOB ( Notlingham ) ;
LEWIS JONES ( London ) ; A. C. JORDAN ( London ) ; ARCH . JUBB ( Glasgow) ; E. LAQUERRIERE ( Paris) ; S. LEDUC (Nantes) ;
E. R. MORTON ( London ) ; G. HARRISON ORTON Gondon) ; H. G. PIFFARD (New York ) ; JNO. RANI ( Belfast) ; WERTHEIM
SALOMONSON ( Amsterdam ) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( Lonilon ) ; CHISHOLM WILLIAMS ( London ) ;
CLARENCE WRIGHT ( London ).

THE article on Electric Sleep which appears in the
present number opens up a far-reaching vista for the
future of physical treatment. In the armamentum of
medicine there is a goodly array of weapons for stimula-
tion, but comparatively few instruments for inhibition .
A notable addition to these latter has been made by
Professor Stéphane Leduc, that of a sleep-compeller,
acting, not by poisoning or counter-irritation or exhaus-
• tion, but by the direct and local inhibition of the brain-
cells themselves.
The inhibition is produced by the electrical stimula-
tion of the nerve-cells, with a rhythmical frequency which
is incompatible with their physiological activity. To potent instrument for producing nervous inhibition, and
produce the inhibitory effect the current oscillations
must be tuned to suit the individual case. In his
experiments on the rabbit, Professor Leduc uses a low-
tension galvanic current with a frequency of 100 per
second, and a current duration of one thousandth of a
second. The current is passed in an antero-posterior
direction through the cranium . The potential is very
gradually raised, in order to avoid excitement. Usually
6 or 8 volts, with an intermittent current of some 2 milli-
ampères, is sufficient. Quietly, without a cry or move-
ment, without the least sign of pain or discomfort, the
animal sinks into a condition of deep narcosis, similar
to that produced by chloroform . On the cessation of
the current, the animal awakens instantly , without any
signs of pain, of fear, or of fatigue.
Professor Leduc has subjected himself to the treat-
ment with no ill effects, although in his case the experi
ment was not carried far enough to produce complete
narcosis.
It will be readily understood that a further increase of
potential will lead to inhibition of respiration, and thus
we have a most merciful and even elegant means of
electrocution.
We have here & method which promises to yield
further interesting developments, since not only can
general anesthesia be produced, but by appropriate
modifications of the process a limited local anesthesia is
also obtainable. We are thus furnished with a most
we may hope ere long to see the electric sleep in use as
a practical remedial agent, replacing or reinforcing the
natural rest. More than this, we have some reason for
supposing that each muscle and nerve is attuned to its
own special period of electric stimulation , and therefore
of electric inhibition, so that in the near future we may
be able to put to sleep a tired member or an injured
organ, without obliterating the general consciousness.
The necessity of finding some safe and simple means
of inducing nerve sleep is becoming ever more important
as the stress of civilization increases, and the prevailing
disease of the present day—a too widely extended and
developed consciousness of our environment–becomes
even more cute. We may live to hear “ two hours'
inhibition " prescribed before an operation, or a week's
electric sleep before an examination . The possibility of
5–2
30 ARCHIVES OF THE ROENTGEN RAY.

thus suspending growth and tissue changes is brought Speaking of vacuum deterioration, he says : “ Up to
forcibly to our notice by the modern methods of forcing date, four methods have been developed and used, and
vegetables and flowers for the market. thousands of experiments have been made concerning
In the vegetable as well as in the animal world the the replenishing of the gas, and thereby overcoming this
axiom holds good that a period of quiescence or inhibi- vital difficulty of the gaseous conductor becoming non
tion must precede a period of stimulated growth. We conducting, due to the peculiar chemical reaction that
have long known that the winter sleep of plants may be must occur when electricity passes from a solid con
induced at any season of the year by placing them in ductor to a gaseous conductor. These methods are as
cold storage. Plants whose growth has thus been re- follows :
tarded will develop much more rapidly on being re- 1. By obtaining a cycle of events through catalytic
awakened by warmth. More recently the ether narcosis action .
of plants has come into use. By this method , a brief 2. By obtaining & cycle by evaporation and con
nap of some couple of hours seems to fulfil all the densation. Probably mercury is the only element that
purposes of a long winter sleep , and the plant can be can ever be used in this way.
forced at once into a new season of growth and activity. 3. By re-supplying the necessary gases automatically
It would be a matter of great importance if some by the action of heat on suitable substances.
similar means were at our disposal for regulating the 4. By automatically feeding gas to the tube when
19

development and activity of the animal organism , and
perchance the electric sleep may enable us to procure the
inhibitory rest required as a prelude to stimulated
growth.
At all events, we may congratulate Professor Leduc
on having opened up a fertile field for research , which
calls for immediate tillage and which promises an
abundant harvest.
It is a constant source of regret to all X-ray workers
that the vacuum of a focus - tube tends to deteriorate with
use .
Not only is the life of the tube thereby materially
reduced , but also the progressive substitution of rays of
greater penetration interferes with our proximate deter-
mination as to what rays are best suited for the treat-
ment of any individual disease or type of disease
submitted to Roentgenization. It is needless here to
recount the various methods proposed to obviate this
difficulty and to ensure the vacuum against deterioration.
One by one they have come and vanished, for each and
all have failed to satisfy the requirements of an ordinary
workaday experience. The invention of a suitable
vacuum control or regulator is therefore still one of the
greatest of radiological problems. We are, however,
within measurable distance of its solution. In the April
issue of the Proceedings of the American Institute of
Electrical Engineers (vol. xxvi . , No. 4) Mr. D. McFarlan
Moore has contributed a most interesting article on
“ Light from Gaseous Conductors within Glass Tubes . ”
needed by means of a “ feeder -valve ."
The description of the apparatus designed by him to
automatically supply fresh gas to the tube is as follows :
" A piece of z -inch glass tubing is supported vertically,
and its lower end is contracted into a -inch glass tube,
which extends to the main discharge tube. At the point
of contraction the tube is closed by a 4 -inch carbon plug
fixed by means of cement. The porosity of the carbon
is not sufficient to allow mercury to percolate through
it, but it will permit gases easily to pass, since there
is the vacuum of the discharge tube on one side of
the plug and atmospheric pressure on the other. This
carbon plug is normally completely covered by about a
thimbleful of mercury, which seals the pores of the
carbon.
The level of the mercury in the tube can be altered
by means of a movable plunger. When this plunger is
withdrawn the mercury sinks, exposing the top of the
carbon plug and allowing a small quantity of air to pass
through it into the focus-tube. When the plunger sinks
the mercury level rises again and reseals the tube.
The plunger, a glass tube containing in its upper end
a bundle of soft iron wire, is actuated by a solenoid
which surrounds the main tube. The solenoid in its
turn is fed by the primary current of the transformer.
It may easily be shown that there is a certain degree
of vacuum at which the conductivity of a vacuum tube
is at its maximum . If, therefore, a tube be used with
the vacuum below this point, any increase of the vacuum
will diminish the resistance of the tube. The con
sequent increase of the current through the tube will
 ARCHIVES OF THE ROENTGEN RAY. 31

react on the primary current, causing that also to RADIUM AND ITS MEDICAL USES .*
increase. When such & discharge tube is in use,, the
By GEORGE H. GRAHAM , M.D.,
vacuum rises, the secondary current increases, the
primary current increases, the solenoid becomes stronger, Medical Officer in Charge of Electrical Department, East London
Hospital for Children, Shadwell.
the plunger is raised, the mercury sinks, and air pene
trates through the carbon into the tube. When sufficient THANKS to the brilliant researches of Mme. and the
air has entered , the secondary current decreases, the late M. Curie, following the discovery of the radio
primary current decreases, the solenoid weakens, the activity of uranium by Becquerel in 1896, we have been
plunger falls, the mercury rises, and the tube is placed in possession of a new element - radium - of
resealed . surpassing interest to the physicist from the many com
This feeder -valve can be adjusted to maintain any plex and surprising phenomena it exhibits, and to us
desired degree of vacuum by altering the relative position as medical men as a therapeutic agent of the greatest
of the solenoid and plunger. The action of the valve is value.
quite automatic. The recurring rise and fall of the tip Before referring to its therapeutic uses, we may
of the carbon plug above the level of the mercury consider some of its physical, chemical , and physio
vividly reminds one of a mud-turtle taking a breath of logical properties, as such a study will enable us to
air in a mill-pond — as others have expressed it, the understand more clearly the uses it can be put to in
apparatus actually breathes . medicine and surgery.
When the tube is not in use there is no leakage of air Radium is one of a class of substances that are radio
or other gas through the carbon ; it will therefore last active, so called from the power they possess of sponta
for an indefinite length of time. The vacuum can be neously emitting radiations capable of penetrating plates
maintained within .01 millimetre of the required value. of metal and other objects opaque to ordinary light.
The automatic feeder-valve can be used for all kinds These radiations have the further characteristic pro
of vacuum -tube apparatus, such as X-ray tubes, vacuum perties of ( 1 ) acting on a photographic plate, (2) dis
oscillographs, wireless telegraphy (or telephony) trans charging electrified bodies by ionization , and (3 ) causing
mitters and receivers, vacuum or vapour rectifiers or certain substances to fluoresce. It was'this power of
lamps. radio -activity which led to the discovery of radium by
Since in radiology the vacuum in the focus-tube is Mme . Curie.
generally required to be kept above the point of Radium is obtained in very minute quantities from
maximum conductivity, it would probably be necessary the mineral pitchblende by elaborate chemical processes,
to use a light floating plunger held down by the solenoid costing much time and labour. Though pitchblende is
instead of lifted by it. In this case it would, of course, obtained in many parts of the world, it varies consider
be necessary to use some form of permanent magnet to ably in the amount of radium contained, that from
keep the tube sealed when the current is turned off. Cornwall producing practically nil ; while even from the
We feel certain that we only voice the sentiments of best, coming from Johanngeorgenstadt, in Saxony, or
the world of Roentgenologists when we congratulate Joachimsthal, in Bohemia , it is possible only to extract
Mr. D. McFarlan Moore on this very important step a few milligrammes of a pure salt from two tong.
towards the solution of the “ vacuum -replenishment ” After the various processes have removed all other
problem. substances, radium is left mixed with barium , to which
it is closely allied in chemical properties ; and from this
it is finally purified by the method known as that of
THE cinematograph has been impressed into the service fractional crystallization frequently repeated,
of radiology. At the Roentgen Congress at Berlin , Dr. When a salt of radium is first prepared , it has only
Koehler of Wiesbaden showed a cinematographic pro- about one-quarter the radio -active value it ultimately
jection of normal and pathological breathing, thus attains . The maximum value is reached in about three
demonstrating in a most beautiful manner the com- to four weeks, and is then constant.
pensatory action of the heart and lungs during inspira * Lecture delivered at the Medical Graduates' College and Polyclinic
tion and expiration . on March 5 .
32 ARCHIVES OF THE ROENTGEN RAY.

Pure radium salts are at first colourless, and only They may be compared to the canal rays of Goldstein ,
assume slowly and gradually a yellow tint ; but should and are positively charged particles, travelling at the
the salt not be well freed from barium , it quickly acquires speed of 20,000 miles per second . To Professor J. J.
a yellow or orange colour. It burns in the Bunsen Thomson , of Cambridge, is due the credit of demon
flame, giving a beautiful carmine colour, a good indica- strating this positive charge.
tion of its purity, as if it has not been freed from barium Mr. Soddy, however, states that the positive charge
the green colour in the flame of the latter would pre- carried by the a particle is an accident of the condition
ponderate. under which it is investigated , and that when first
Mme. Curie has determined the atomic weight to expelled the a particle is not charged at all. The a rays
be 225. A pure radium salt maintains itself some 3º are only slightly deviated in a magnetic field. In &
to 5º above that of the surrounding temperature ; and strong magnetic field of 10,000 C.G.S. units the rays are
Curie and Laborde have shown that the heat evolved shown to describe the arc of a circle of 39 centimetres
amounts to 100 calories per gramme per hour, which is radius
sufficient to raise a weight of water equal to that of the The Beta rays are more deviable, and in a magnetic
radium from freezing point to boiling point every hour. field of the above intensity would probably describe a
One may well hold the opinion I have heard expressed circle having a radius of only yo millimetre. They are
that for medical treatment by radium a patient should analogous in all respects save that of speed with the
be either a millionaire or a pauper, as the element is so cathode rays in an X -ray tube, the B rays having a
scarce and difficult to obtain, and so expensive. The mass one thousand times less than that of hydrogen .
reason for this scarcity has been explained by Professor They are negatively charged particles, moving with a
Soddy and others. Radium is itself a product of uranium speed varying from 0.2 to 0.96 of the velocity of light,
-a transition form in the uranium disintegration series travelling much more rapidly than the cathode rays, and
--with a period of average life of nearly 2,000 years. It thus being able to penetrate much greater thicknesses of
is estimated that one-thousand-millionth part, or 1 milli- matter before they are absorbed. Owing to their larger
gramme per ton, of uranium changes yearly, producing mass, the a rays have an immensely greater ionizing
nearly 1 milligramme of radium . The search for a action than the B particles, but the a rays are so quickly
mineral containing more radium than the known uranium absorbed by the air that their action ceases abruptly at
minerals will, in Professor Soddy's opinion , prove a distance of 7 centimetres from the surface of the
fruitless . radium .
Suppose for a moment we had the power of trans- If a radium salt is placed in a capsule thick enough to
muting elements—à power claimed by alchemists in absorb all the a rays, but thin enough to allow most of
search of the philosopher's stone from the most ancient the B rays to escape, the vessel containing the radium
times—and were able to convert uranium rapidly into will acquire a positive charge. This is the principle on
radium , Professor Soddy has calculated that from one which Strutts' ingenious invention of the radium clock
ton of uranium , costing less than £ 1,000, more energy is founded — the nearest approach we have to perpetual
would be supplied than that of all the electric-supply motion. Owing to the quantity of ß rays emitted falling
stations in London. The energy given off by radium is to half value in about 1,200 years, the movement of the
such that from 1 gramme of the element more than one gold leaves would slow down.
thousand million calories could be evolved, and this, if The Gamma rays are believed to be electro -magnetic
converted into electrical energy, would suffice to keep & pulses or waves , similar to, but far more penetrating,
32 candle -power lamp burning continuously throughout than X rays proceeding from a hard tube. Their ionizing
a year . action is small when compared with that of the B rays.
Radium gives off three kinds of rays and a gas spoken On the other hand , while the a rays have little action on
of as an emanation. The rays are distinguished as a photographic plate, the ß and y rays have a very
Alpha, Beta, and Gamma rays, and are respectively powerful one. No deviation of the y rays takes place in
characterized as being easily absorbed, penetrating, and a magnetic field . These penetrating y rays give rise to
very penetrating. secondary rays, having an intense action on a photo
The Alpha rays have a mass of 1.6, hydrogen being 1. graphic plate, thus causing radium radiographs to
 ARCHIVES OF THE ROENTGEN RAY . 33

lack the sharpness of outline of an X -ray skiagram . of a few minutes on account of the liberation of iodine
The absorption of all three types of rays is approxi- by the B rays.
mately proportional to the density of the substances Hardy made some experiments on the action of radium
traversed. on globulin coagulation. Two solutions of globulin from
The emanation of radium is a radio -active heavy gas, ox serum , one made electro -positive by the addition of
which is given off when radium is heated or dissolved in acetic acid, and the other electro-negative by adding
water. The volume of pure emanation emitted from ammonia, were exposed to the action of radium . A
radium is infinitesimal. Strutt estimates that 50 milli- drop of the positive solution became clearer, showing
grammes of radium would give a volume of emanation more complete solution, whereas the negative drop
at any one time not exceeding a large pin's head. It rapidly became a jelly and opaque, this action being
is an extremely active gas in consequence of its radio- due to the a rays alone . A singular change takes place
activity and its great diffusibility. Experiments point to in glass and quartz vessels containing radium , depending
the emanation being about ninety times as dense as on the degree of activity of the radium . Glass , even
hydrogen, or more than six times as dense as air. It when free from lead, changes colour from violet through
has all the peculiarities of radium in respect to ionization yellow to black.
and photographic action, but emits only a rays. It can Many experiments have been carried out on bacteria
be condensed by cooling in liquid air. It has its uses in with radium , but the results reported by different
therapeutics, as I shall presently show, but its activity observers have shown much discrepancy. Several
is transitory, decaying to half value in 3-7 days. It has reasons may be given for this, for not only has the
the power of exciting radio-activity in bodies in its technique varied with different observers, but the radio
proximity, this “ induced ” activity being due to an activity of the sait used has also varied very largely.
invisible and unweighable deposit of radio -active matter Moreover, the radium in most experiments has been
on the surface of these bodies. The “ induced ” radio- enclosed in some sort of capsule, entirely shutting off
activity, which emits chiefly the B and y rays, with a the a rays, which alone are believed to be bactericidal.
few a rays, comes down to half value in twenty-eight The B rays simply inhibit growth, but do not kill.
minutes, and is lost altogether in a few hours. We Pleiffer and Friedberger have reported the destruction
need not stop to discuss the successive products of the by radium irradiation of the cholera vibrio and the
decomposition of the emanation of radium , named by bacilli of typhoid fever and anthrax, and Hoffmann
Professor Rutherford “ radium A, B, C, D, E, F ,” or of produced a like effect on cultures of staphylococci.
the further product helium. Strebel has pointed out the attenuation of cultures of
One of the peculiar properties possessed by radium is Bacillus prodigiosus exposed to radium . Caspari intro
that of exciting fluorescence and phosphorescence in duced the tubercle bacillus into the anterior chamber of
various bodies, such as zinc sulphide, barium platino- the eye of a guinea-pig, and the diphtheria bacillus into
cyanide , diamonds, willemite (green), kunzite (red), the muscles. When this was followed by injections of a
spartaite (orange). Rubies and sapphires do not fluoresce radio-active solution, the animals were not infected .
under radium . Diamonds after prolonged exposure M. Danys found that the rays kill the larvæ of certain
become affected throughout their whole mass chiefly by butterflies.
the more penetrating B and y rays, and they undergo On the physiological action of radium, omitting for
a change of colour, becoming strongly radio -active, and the moment that on cell- life and the skin, to which I
remaining so even for thirty -five days, notwithstanding shall allude later, several remarkable observations have
prolonged and intense heating. been made. M. Danys, in studying its action on the
The chemical actions of the a and ß rays are many nervous system, irradiated the spinal column of mice,
and varied . Oxygen is changed into ozone by the causing death from acute nervous disturbance in from
energy of the radiations, and white phosphorus is three to eight days. The young mice died sooner,
changed into the red variety. Mercury is said to be showing injection of the spinal cord and meninges, and
changed into the yellow oxide. I have converted the abundant meningeal hæmorrhages. In a dog that had
perchloride of mercury into calomel. A solution of been trephined the application of radium to the brain
iodoform in chloroform is turned purple after an exposure substance caused hemiplegia after a few hours.
34 ARCHIVES OF THE ROENTGEN RAY .

Henri and Mayer found that radium had an action on capsule of thin glass, or in a little ebonite box with a
the blood of dogs and frogs, changing its colour after an metal cover, having a mica window in the centre. The
exposure of three hours, and transforming it as shown glass capsules are liable to explode violently with the
spectroscopically into methæmoglobin. Georges Bohn passage of an electric spark from the accumulation of a
has also shown that the rays diminish the resistance of positive charge. This may be prevented by fusing a
the red blood- cells . platinum wire into the glass. After such an explosion
Its action on the virus of rabies is specially notable. Piffard localized the lost radium in the thick carpet,
Tizzoni and Bongiovanni have shown that after radium where it had fallen , by its action on a photographic
irradiation the spinal cord of an animal that had died of plate. He then cut out the piece of carpet and sent it
rabies will not inoculate other animals, but will act as a to a laboratory, where a good part of the radium was
vaccine. Further, an animal inoculated with rabies and recovered. It is estimated that a pressure of 20 atmo
showing symptoms of the disease may be cured by a spheres is required to cause this explosion in the capsule.
prolonged radium irradiation of the cerebro-spinal axis. Quartz capsules have been used, and have some advan
Sirnov, who has confirmed these experiments, states that tages in allowing more of the B rays to pass, but they
the action is due to the a and B rays. On the other are very liable to split. Celluloid films are also used.
hand, other observers, as Castellane, Ivo Novi, and These are dipped in an alcoholic solution of radium .
Danysz, have not been able to produce all the results The celluloid is softened temporarily by the alcohol, and
claimed by the Italians. Phisalix , in experimenting a coating of radium is left, which, when dry, is protected
with different venoms , found that spake poisons of an by a coating of varnish, which is said to withstand
albuminoid nature lose their toxicity under the influence boiling. M. Danne of Paris, who has kindly given me
of the radiations or the emanation, but that alkaloid much information on the subject, uses metal discs and
venoms, such as that of the salamander, are not affected. pencils coated with a special varnish. The layer of
The measurement of the radio -activity of a salt of radium is dried by exposure to great heat for a long
radium is a matter of importance in its practical use. time, and this stands a temperature of 300 ° C. He
When buying a specimen of radium, you may be told that uses for this purpose the sulphate of radium , which
it has an activity of 1,000,000 or 1,800,000, which means is less soluble than the other salts. The composition of
that the salt is that number of times more active than the varnish is a secret, but it resembles an enamel rather
a similar weight of uranium which is taken as unity. than a varnish. It will stand boiling water, great cold,
The activity is measured by electrical methods, depend- and the more or less prolonged action of various solutions,
ing upon the ionization of the air. A convenient as those of permanganate of potash, bisulphite of soda,
electroscopic meter is made by Danne of Paris, allowing or & 1 per cent. solution of perchloride of mercury. It
anyone using radium to measure easily the radio-activity should not, however, be used with absolute alcohol,
of the salt without the necessity of sending it to a rectified spirit, or ether. The advantage of such a
laboratory. Should, however, the strength not be known method of mounting is that at least 5 per cent. of the
in units—or uranies, as they are called—there are one or bactericidal a rays can be utilized , whereas they are
two simple methods of roughly estimating the strength. completely shut off by glass or ebonite capsules.
One may observe the rate of discharge of a gold-leaf is estimated that with the varnished salt six times
electroscope and the distance at which the radium is greater radiation is obtained than that from an encap
held. The fluorescence of a screen of platino-cyanide suled salt of equal radio- activity .
of barium may be observed, or the number of super- The emanation of radium may be made use of in
imposed pennies through which the rays will penetrate various ways, either in its natural state, or by the
and light up such a screen. It is necessary to be in a induced or imparted activity of other substances, as
dark room for at least ten minutes before trying the last water, cotton-wool, gelatine, bismuth, or vaseline.
test. Another method is to note the time required to One may speak of a dose of radium as one speaks of a
change the colour of a Sabouraud's disc such as is used dose of any other drug. Several factors have to be taken
in the X-ray treatment of ringworm . This, however, is into account, of which the principal are the radio -activity
not accurate as a guide for treatment. For therapeutic and the weight of the salt used. Not less important is
purposes radium is usually enclosed either in a small the nature and thickness of the capsule or film holding
 ARCHIVES OF THE ROENTGEN RAY. 35

the radium. This is shown by the fact that an aluminium bility, rather than pain . A fine vesication occurs early
cover lo millimetre thick absorbs 90 per cent. of original in the reaction, forming later on a thin crust, which soon
radiation . peels off. The acute reaction subsides in a few days, or
It is essential to distinguish between the “ potential” it may last from seven to ten days. If the reaction has
activity of a given specimen of radium and its " effica- been slight, only some redness and pigmentation remain ,
cious” activity. For instance, if we take 5 milligrammes which disappear gradually, occasionally, however, taking
of radium bromide, having an activity of 1,000,000 some months to do so completely. Should the exposure
uranies, the " potential” activity for that weight of have been prolonged, the whole skin may be destroyed
5 milligrammes will be 5,000 times that of a gramme of and slough, leaving an ulcer, which, as in the case of a
uranium ; while its “ effective " activity, if enclosed in a severe X -ray burn, may give much trouble to heal. Even
capsule of aluminium io millimetre thick, would be only after a moderately acute reaction a characteristic scar is
500 times that of a gramme of uranium. It is evident, formed, very white in the centre, with the skin much
therefore, that the essence of the therapeutic dosage of thinned and depressed, showing a red ring of dilated
radium is time, or the duration of exposures to the rays. capillaries at its edge. Telangiectases also appear fre
When radium of high activity is applied to the skin quently in the scar. Some scars I have seen show, even
for ten to thirty minutes, no pain or sensation of heat is after four years, activity in this respect, new vessels
perceived. It is not necessary, as in the Finsen treat- forming and rupturing, causing small hæmorrhages in
ment, to use compression in order to enable the rays to the epidermis, which after a few days flake off in
penetrate the skin ; it is sufficient to hold or to strap the scales .
capsule on to the part to be treated. According to Schwartz and others, the action of
After such an application nothing visible occurs until radium is due to its action on the lecithin of the cell, or,
after the eighth to the fourteenth day, when a small red according to Exner, Zolarek, and Schlacter, to cholin ,
blush is noticed, which quickly gets deeper in colour, which is a disintegration product of lecithin.
In some cases , as in fair, clear skins, and particularly if The rays of radium are destructive to all cells, but
there has been any previous treatment, such as an primarily so to young, newly-formed , and forming cells,
application of Finsen light, the reaction may commence such as are found in inflammatory and morbid tissues.
as early as the third day ; on the other hand, if there is It is fortunate that this is so, as the whole of a diseased
any obstruction to the rays reaching the skin, the reaction area may be cleared up without leaving the slightest
may be long delayed. In July last I carried an ebonite sign of scarring in the healthy tissues. Such a result
box containing 5 milligrammes of radium in my trousers occurred in a case I treated fifteen months ago in a
pocket in a purse with about an inch in thickness of gentleman suffering from a large wart involving the
various coins between it and my skin. AfterAfter using it II whole of the top of the second finger, even showing
replaced it in my purse, and forgot it until the third day, under the remains of the nail, which had been cut down
when I removed it. Nearly six weeks afterwards I almost to the matrix. This had defied treatment for
developed a small red irritable spot on the thigh, the two years, till at last, fearing malignancy, it was proposed
mark of which is still very evident . to remove the finger. I gave him half -hour applications
It is a problem of the highest interest, but as yet on each area till the whole of the wart had been
unsolved, as to what is taking place in the tissues during treated — ten and a half hours in all. In three weeks
this latent period. The same latency occurs in the the whole of the disease had disappeared, even under the
reaction following prolonged X-ray exposure. It is held nail. The finger is now as normal as that of the other
by many that the first action is a constrictive one on the hand. Twelve months after treatment he had forgotten
capillaries and small bloodvessels, followed by throm- and could not tell from the appearance which had been
bosis. Wichman of Hamburg, however, denies that the diseased finger.
there is any early destructive action on the cells of the In deep-seated cancer radium has not had the success
internal tunic of the bloodvessels . The secondary action it was hoped and anticipated , although Wichman has
or reaction is an inflammatory one, with stimulation of shown that the pathological tissue of cancer absorbs the
cell activity and phagocytosis , accompanied by the rays most energetically.
energetically. No authentic case of cure has
usual phenomena of redness, heat, swelling, and irrita- up to the present been reported, as far as I am aware,
6
36 ARCHIVES OF THE
notwithstanding the large numbers of workers in this
field .
Many observations have been reported showing shrink-
ing of growths, relief of pain, stoppage of hæmorrhage,
and the healing of ulcerated surfaces. Max Einhorn
and Braunstein report the destruction of cancerous
tissue in cases of constricted esophagus or rectum , thus
re-establishing the calibre and allowing food and fæces
respectively to pass. These results have tended towards
making the sufferings of the patients more bearable, or
relieving distressing symptoms. Various methods of
application have been employed. Some have simply
applied a glass tube of radium to the surface , while
others have placed a tube of radium in an incision made
in the centre of the growth. Piffard in this way has
inserted needles coated with radium varnish . Braun-
stein injected water rendered radio-active by the emana-
tion into the growth , and dusted radio -active bismuth,
or administered it by the mouth in cases of cancer of the
larynx, esophagus, and stomach. In one case where
he had injected radio-active water the whole tumour
liquefied and became fluctuating, without any alteration
of the skin, and when evacuated the liquid was found to
be yellow, transparent, and quite sterile. It is evident
that these methods are not sufficient. To produce a
really tangible result it is, in my opinion , necessary to
attack the growth over the whole of its growing surface
at one time, by rendering the healthy tissues surround-
ing it radio-active, thus acting alike on the blood-supply
and on the invading diseased cells. But here lies the
difficulty, for, owing to the rapid diffusion , it is impossible
to localize the action of the emanation , which is alone
possible to be used. We can, however, work hand in
hand with the surgeon , and I believe (though I have
not tried it personally) it would tend to better and more
permanent results if the surgeon, after complete removal ,
were to wash the wound with radio- active water, and to
dust it with an antiseptic radio-active powder.
Though little success has attended the treatment of
deep cancer, many cases of small epitheliomata of the
' skin have been apparently cured by radium , no relapse
occurring after prolonged periods. Among those report
ing such cases are Wickman , Schiff, Abbe, and others.
The latter has also reported two cases of apparent cure Strassmann made microscopical examinations of
of sarcoma--one a giant-celled sarcoma of the lower lupoid tissue excised three to four weeks after the
jaw, and the other a round- celled sarcoma of the eyelid. radium reaction, and reports “ thrombosis of the vessels,
Exner and Holzknecht have reported the disappearance proliferation of the internal tunic, and in place of the
of metastatic growths in two cases of melano-sarcoma
ROENTGEN RAY .
after single exposures of twenty to twenty -five minutes
duration ,
In this country Mackenzie Davidson was, I believe,
the first to cure a case of rodent ulcer with radium .
Since this case a brilliant series of successful results
has been recorded by many observers , even in cases
where prolonged X-ray treatment had failed . It is
important to pay particular attention to the thickened
edge of the ulcer. In cases
ca where bone is affected
radium does not seem to be so efficacious.
Two cases of rodent ulcer have recently come under
my care where X rays had been employed unsuccessfully
for four and two years respectively. A rapid improve
ment in the ulcers appeared after a few irradiations with
radium . In both cases great relief of pain was ex
perienced even before any reaction was apparent.
Radium has acted beneficially in some affections of
the nervous system. Darier reports relief, and in some
cases complete cure, of cases of facial paralysis. Ray
mond and Zimmern report the diminution, and some
times the disappearance, of lightning pains in tabetics ;
while Rheus, on the other hand, has found sensation
return to anæsthetic patches in tabetics and lepers.
Oudin quotes a case of chronic pruritus ani cured after
two sittings of ten minutes each , at intervals of ten
days ; and Wickman gives details of the entire relief of
a case of intense cutaneous hyperaesthesia following an
attack of zona in the cervical region , by repeated
applications of ten minutes duration .
It is, however, in dermatological practice that radium
has been found to be of the greatest use , and to give the
greatest number of successes.
In lupus vulgaris a number of observers have reported
most favourably on its action. Either alone or in com
bination with Finsen treatment I have used it in many
cases with satisfaction ; and it is especially useful in
treating the disease in the nose, mouth , or other places
where the light cannot be applied. When combined
with Finsen treatment I generally treat the outlying
nodules-the " satellites ” of Hutchinson — with radium
alone. With larger surfaces I have not found the skin
after radium treatment has been left so soft and pliable
as after Finsen treatment .
vessels strings of connective tissue cells, masses of
 ARCHIVES OF THE ROENTGEN RAY . 37

leucocytes round the giant cells, with encystment of the patches of chronic leucoplaxia of the tongue, a disease
lupus nodules, while some five weeks later there was which is usually considered as a precancerous con
vacuolation and necrosis of the giant and epithelioid dition.
cells, followed by a gradual absorption of the nodules.” Secondary and tertiary syphilitic lesions of the skin
In a case of lupus erythematosus, where Finsen treat- have been successfully treated. Dr. London’s, of St.
ment had only been partially effectual, I obtained a good Petersburg, method of treatment of skin affections is
white scar after a strong reaction following ten -minute that of covering the surface with cotton wool made radio
applications in different places. Many others have active with the emanation, of which it absorbs a large
observed a like benefit. amount. Gelatine charged with the emanation and
In a case of Bazin's disease (erythema induratum) spread on any suitable material acts, perhaps, better, as
I found 5 milligrammes of a very active bromide of it retains the radio-activity for a longer period.
radium enclosed in an ebonite capsule with a mica I have had no opportunity of trying radium on a case
window, and applied for fifteen to twenty minutes, of hard chancre, but I can well believe that it would
cleared up the subcutaneous nodules in a short time, be beneficially influenced. On this point I have been
provided no central necrosis had begun before the favoured with a report by my friend Mr. Deane Butcher,
application. who has treated three such cases , apparently with bene
Nævi of the capillary variety, from those the size of a ficial results. One of these was a chancre of the lip,
small point with radiating vessels up to large port-wine another on the face, and a third on the prepuce. The
stains, are very amenable to applications of radium. primary sores, especially that on the lip, were accom
The smaller ones quickly clear up, but the large stains panied by a good deal of glandular swelling. This was
require time. Polland has given details of an extensive speedily reduced, and in each case the induration rapidly
cavernous angioma involving the right half of the face cleared up, and the sore quickly healed. As it was not
which gradually contracted after long exposures to an thought justifiable to omit mercurial treatment, the
active salt and left a healthy scar. The result, however, experiment as to the possible effect of radium on subse
was not permanent, as three months afterwards a fresh quent systemic infection was not a crucial one. The
angioma formed at the edge of the scar. question is one that would well repay further investigation .
In this country Dr. Hartigan has shown at the Cohn first reported the cure of trachoma with radium ,
Dermatological Society of London two cases of Paget's and his observations have been followed by Telenowski
disease of the nipple cured by the use of radium. and others with varying, but on the whole generally
Warts, as in the progressive and obstinate case I have successful, results.
mentioned, pigmented warts and hairy moles, small Its action in conjunctivitis, uveitis, and central ulcer
sebaceous or dermoid cysts, such as are often seen in or of the cornea has been favourably reported on by
adjacent to the nasal groove, and small fibrous thicken-different observers, as also the relief of pain in rheumatic
In dealing with
ings of the skin, are speedily removed. In dealing with ophthalmia, and choroiditis with orbital neuralgia. In
a lady's face, however, great care must be taken not to a case of ulcer of the cornea with conjunctival congestion
make prolonged exposures, as the resulting scar and I used it tentatively, giving two short exposures of one
possible telangiectases would be very disfiguring. minute each , with an interval of three days between
I have used it successfully in eczema. Rheus, Salmon, them . Though I could not see any very marked action
Wickman, and others report highly of its use in psoriasis , on the ulcer, it had the effect of rapidly clearing the
chiefly of the guttate type. Fortunately, in the treat- congested conjunctiva, and added to the comfort of the
ment of these affections it is only necessary to give patient for the time being.
exposures of from one to five minutes duration on each M. Pochon has detailed a case of actinomycosis in a
place, so that fairly large surfaces can be treated in a girl of fourteen. An ulcerated growth the size of a hazel
reasonable time. In a recent case I sent a gentleman nut had formed on an impetiginous patch due to inocula
suffering from eczema to bed an hour earlier than usual tion, where the lobe of the left ear had been pierced.
for a couple of nights, and was able to treat a large Yellow - coloured granules appeared, which proved micro
surface with a happy result. scopically to be the ray fungus. Several daily applica
Rheus records the disappearance after two sittings of tions of radium were made, and in a month she was
6-2
38 ARCHIVES OF THE ROENTGEN RAY.

considered cured . No recurrence had taken place up to appears to be one of considerable importance. Judging
the time of publication . by analogy from the effect produced by radio-activity on
Within the last few months Drs. Oudin and Verchère, tuberculous nodules of the skin, it is possible that in
in an interesting paper read before the Academy of Addison's disease, where a fibro -caseous lesion of the
Sciences in Paris, have shown the use of radium in suprarenals, due to tuberculosis, is the commonest con
gynæcological practice . The cases treated included two dition, injection of the emanation may be attended with
patients suffering from uterine fibroids, accompanied by beneficial results.
severe hæmorrhages, which had been almost continuous The mineral waters in a large number of health resorts
for many months before treatment, together with pain and spas in this country and on the Continent have been
and serous discharges between the hæmorrhages. All found to be radio -active. The activity is due to the
these symptoms were quickly controlled by three or four emanation given off from radium or thorium , and varies
irradiations. The periods became normal, metrorrhagia very largely in different waters. In the deposits and
ceased, as also did the pain and the serous discharge, mud obtained from some of the springs minute traces of
and the fibroids lessened in size . Other cases were radium have been found .
treated of gonorrhæal urethritis, metritis, and extensive The simple thermal waters, such as Gastein in
erosion and eversion of the cervix . Austria and Plombières in France, seem to have the
In order to utilize
all the three types of rays, they have since made an greatest radio- activity, while those heavily charged with
instrument coated with varnish for special use in such salts have but little . Among some of the chief waters
cases, or in those of gleet, prostatitis, and enlarged that may be mentioned are Bath and Buxton in this
prostate gland. It takes about 3 centigrammes of the country, and on the Continent Carlsbad, Marienbad,
salt to cover the metal part. Dr. Oudin kindly sent me Kreuznach, Baden-Baden, Wiesbaden, and D'Abano.
a message through a mutual friend to say that the The many virtues that were already claimed for these
results disclosed in his paper have been more than and other waters have been added to a hundredfold
confirmed by his experiences since, and one can but look since the discovery of their radio-activity. There may
forward now for further details with the greatest interest . be some truth in the claim that this activity is one of
In July, 1903, Mr. Soddy advocated the use of the the great factors in the efficacy of the waters.
emanations of radium or thorium as an inhalation in While many observations have been made as to the
amount of radio-activity of different waters, few observa
lung diseases, phthisis more especially, and showed how
this might be prepared ; but I can find no record of tions have as yet been made as to any definite or precise
radium emanation ever having been tried, chiefly, I therapeutic action. One or two such observations are
fancy, owing to the expense of the salt, and , notwith- worthy of mention . Gastein water, which, as I have
standing Soddy's statement that no toxic action need be already mentioned, is strongly radio-active, is stated by
feared, possibly also on account of warnings afterwards Dr. Kallmann to be bactericidal in consequence of this
given by one or two medical men, who , I believe, were activity.
unnecessarily timorous, as there are workers who are Bergel, Braunstein, and Bickel have shown that
constantly breathing the emanation without detriment. freshly -drawn water from the Kochbrunnen Spring at
Thorium emanation has been used, but from the cases Wiesbaden when taken into the stomach has, as a result
reported no definite conclusions can be formed. Oudin of the activity of the emanation, a stimulating effect on
amusingly suggests that, as the emanation is plentiful in the secretions, increasing proteolytic pepsin digestion,
mines, one should not despair of the establishment of while this action is retarded if the water is kept for
subterranean sanatoria . some time or deprived of its radio-activity.
Bouchard has quite recently shown by experiments It has been noted that the radio-activity of many of
on small animals that the emanation when inhaled or these waters is lost if they are kept for forty-eight hours
injected is so diffusible that all the tissues of the body after being drawn, and that bottled waters have no such
become at once radio-active. The activity varies in activity. This would seem to bear out an idea one hears
different tissues, but is found to be greatest in the supra- frequently expressed that waters taken directly at the
renal bodies and in the lungs. The discovery that the source have a beneficial effect, but when taken at home
chief radio-activity is found in the suprarenal bodies have no action at all.
 ARCHIVES OF THE ROENTGEN RAY . 39

Let me say just a few words on the comparison charge leaking away in a few seconds. To remedy this,
between radium and the X rays. Radium has been some strong sulphuric acid was put into the small glass
called the pocket edition of X rays. This is only par- dishes supplied for that purpose by the makers, and
tially true ; for, although there is a general similarity in one of these was placed in each of the two chambers.
the nature of the cases suitable for treatment and in After a few hours the leak was reduced so that the leaf
their effects and results, radium has some advantages dropped only one or two degrees per minute-an insula
peculiarly its own. tion quite good enough for the purposes of the test. At
The combination of rays given by radium cannot be the same time this was not at all satisfactory for an
obtained from an X -ray tube , and the advantage of this electroscope, and, as it may easily be remedied, it would
combination is well shown in those cases of rodent ulcer
which have not yielded to X rays, but have afterwards
healed with radium . The energy emitted by radium
when it has attained its maximum state is constant,
whereas that given by an X-ray tube is ever varying.
In addition, the a rays of radium are believed to be
bactericidal, while the X rays are not so. Radium has
further advantages over X rays in its greater applicability,
especially to internal regions and cavities, and in its
portability.
In conclusion, I would say that, with a few notable F

exceptions, the chief therapeutic work with radium has

been carried out on the Continent and in the United
States of America. It seems to me to be a matter for
regret that in England greater use has not been made of
a powerful agent possessing such undoubted value in
many diseases. to

A TEST OF DR . MILTON FRANKLIN'S

ELECTROSCOPE .

By WALTER A. SCOBLE, A.R.C.Sc., B.Sc.

DR. DEANE BUTCHER'S STANDARDIZED ELECTROSCOPE.
The following paper is the result of experiments which
have recently been carried out in the Blythswood be advisable to improve the insulation . In ordinary
laboratory. The instrument tested was Dr. Deane practice, lime or limed asbestos should be preferable to
Butcher's modification of the Milton Franklin electro- sulphuric acid, or the chloride of calcium recommended
scope, kindly lent by Messrs. Newton and Co. It It is
is by the makers. This would render the instrument more
unnecessary to describe this piece of apparatus, as a easily portable.
description has already appeared in the Journal of the During the test the instrument stood on a wooden
Roentgen Society, April, 1906, and in the ARCHIVES OF floor, and it is not necessary to earth the stand. The
THE ROENTGEN Ray, April, 1907. A figure is here given readings of the electroscope were compared with those
to recall the design. of another ionization apparatus, a leakage gap, a battery
It might be well to mention that it was necessary to of small cells, and a galvanometer (see ARCHIVES, May,
mount a new gold leaf, which was slightly larger than 1907). The intensity of the rays was also measured by
that fitted by the makers. a photographic method, Lumière Roentgen photographic
The first point noticed was that, without some means plates being exposed in double envelopes for twenty
of drying the air , the insulation was very imperfect, the seconds at the same time that the rate of fall of the gold
40 ARCHIVES OF THE ROENTGEN RAY.

leaf was being measured. The photographic plates were to make a photographic measurement accurate being
developed by a standard method, being immersed in inadmissible except in a laboratory.
ferrous oxalate at a definite temperature for a constant One point which should be noticed is that the intensity
time, and the transparencies of the developed plates were of the rays is measured in a direction different from that
measured . By referring to a curve, the intensity of the of the rays used for the radiography or dosage ; the
rays could be determined very accurately from the trans- intensities in the two directions will not be equal. If,
parency of the photographic plate. A Müller water- however , the angle between the two positions be always
cooled focus tube was used, the long axis of the tube- the same, the intensities will be proportioned , and the
i.e., the direction of the cathode stream-being vertical . factor introduced may be neglected.
The leakage gap was placed directly in front of the tube, When the unscreened rays from a focus tube are
and the stand for the photographic plates and the electro- measured, since the composition of rays from hard and
scope to one side, the relative positions being the same soft tubes is much the same, both the photographic
throughout. The photographic plate was 20 inches and and ionization methods will give the same value for the
the centre of the electroscope 30 inches from the anti- intensity within the limits of probable error. There is,
cathode. The rays did not affect the rate of fall of the however , a great diversity of opinion as to which method
leaf until the shutter was opened. is most correct when rays of different hardness have to
The table shows the results of a typical test : be measured. On this account many may hesitate to
adopt this instrument, as depending on ionization ; but ,
Electroscope Electroscope Galvano- Intensity of as stated above, for unscreened rays this makes no differ
Time in Galvano meter Rays from
Number
of Test. Seconds for Time in
meter Deflexion Photo ence, and in other cases there is no reliable evidence,
Terms of in Terms of
Leaf to fall Deflexion . graphic
from 50 ° to 20 %. No. 4 . No. 4. Exposure. different authorities being responsible for contradictory
statements .
1 28 0.61 2:4 0.63 0.64 It is impossible to charge the electroscope when the
2 25 0.68 2.8 0.74 0.68
3 20 0.85 3 :1 0.815 0.86 focus tube is running, and this was found to be rather
4 17 1 3.8 1 1
5 14.5 1:17 4.4 1.16 1.24 inconvenient. The first measurement may be uncertain ,
6 11.5 1:48 5 :1 1.5 thus necessitating a repetition ; or it may be desirable to
7 9.5 1.79 5.6 1.83
8 8.5 2 6.2 2:32 check the intensity during a long irradiation to be sure
that it remains constant. As it is inconvenient to sus
pend the dosage while charging the electroscope, the
It will be seen that the results agree exceedingly well , writer has overcome this difficulty by fixing a very small
except for the greatest intensity. In that case, however, condenser inside the top chamber, with an arrangement
the photographic method is not so very reliable, and the enabling it to be charged simultaneously with the gold
electroscope probably gave the more correct value. The leaf. It is then switched out, and retains a charge
time taken for the gold leaf to fall from 50° to 20° varied which may be given to the main part of the instrument
in the above tests from 28 to 8:5 seconds ; this time, after this has leaked across the gap during measure
being short, is best measured by means of a stop -watch. ment .
The instrument is much to be preferred to any other
the writer has seen for measuring the intensity of
Roentgen rays in practice. It should not be expensive, THOSE who are enamoured of the “ cold light of
costs nothing in use, is very accurate, and measurements reason ” cannot do better than call in the aid of the
can be made in a few seconds. It may be worked at a Cooper-Hewitt mercury lamp in the diagnosis of skin
considerable distance from the focus tube, so that it is disease. By how much the rosy light of dawn conceals,
not likely to be in the way. The writer has always pre- by so much does the blue light reveal every imperfection
ferred an ionization method as being more accurate for of the complexion, and throw out every spot and blemish
measurement, and here it is adapted to practical require- into strong relief. It is the ideal light for the dermato
ments. This instrument gives far more accurate values logical department, especially now when the early
of the intensity than photographic or allied methods, recognition of lupus, of rodent ulcer, and of epithelioma
and it is much more convenient, the refinements necessary is assuming such vast importance.
 ARCHIVES OF THE ROENTGEN RAY. 41

BASE -BALL FINGERS. The accompanying illustrations were taken from the
By J. N. HALL , M.D.,
fingers of a man of forty -five years, who played as
Visiting Physician to the Denver City and County Hospital ; and catcher in a professional nine in 1880. Seven of the
eight fingers are deformed, while the right thumb shows
G. H. STOVER , M.D.,
the scar of a “ split," leaving, of course, no shadow in
Radiologist to the Denver City and County Hospital.
the picture. I believe that in general the thumb is most
(For illustrations see Plate CCLXVIII.) likely to escape, with but little choice as to immunity in
In my medical work I have for years been much inter- the fingers. It is most common to find but one or two
ested in the characteristic deformities of the fingers of joints affected .
base-ball players. They are so well marked that one Although similar deformity might easily come from
may detect them at a glance in many cases, but, never- many other sources, I find , as a matter of fact, that
theless, they are not generally recognized by the pro- most of such fingers as I describe are from the cause
fession , nor differentiated from more common lesions. mentioned
The essential feature is a bony deformity due to a From arthritis deformans (see Fig . 6) the injuries from
subluxation of the terminal phalanx of one or more base-ball playing may be distinguished by their limita
fingers. Evidently sufficient injury is done to the joint tion to the terminal joints of the fingers; by the sharp
to prevent complete recovery, for the apposition and localization of the periosteal thickenings ; the entirely
alignment are imperfect in the typical examples. It is normal conditions of other bones and joints ; by the
possible that fracture of the articular surfaces is a factor absence of atrophy and consequent lightening of the
in some cases, but I believe repeated traumatisms from shadow in the Roentgenogram, so characteristic of
continual playing before complete recovery ensues to be atrophic arthritis, or more or less generalized thickening,
of more importance. with darker shadow, in the hypertrophic forms, and by
The deformity is most typically a lateral displacement , the lack of symmetrical deformity in most cases.
as in the first and second fingers of the right hand, and At the time these cases are seen, treatment is not
the second, third, and fourth of the left ( Fig. 1 ), or a generally demanded, and would probably be of no avail.
partial dislocation , as in fingers one and three in Fig. 3.
Fig. No. 4 gives the appearance rather than the reality
of a backward dislocation, and was mistaken for such a A CASE OF HEXADACTYLIA .
condition until I saw the plate .
In some of the joints a proliferating periostitis causes A Skiagraphic Contribution to the Study of
Congenital Malformations.
the thickening apparent in the accompanying Roent
genogram , best seen in the first and fourth fingers of the By Professor AUGUST V. LUZENBERGER , M.D.,
right hand (Fig. 2), and in the second, third , and fourth Naples.
fingers of the left hand in Fig. 3. These fingers AMONG congenital malformations polydactylia has been
remain tender and more or less disabled for years in regarded from various standpoints.
some cases. Comparative anatomy finds in it a support to explain
I saw, when a student, a compound dislocation of the the origin of the human hand from the ichthyosaurus'fore
last joint of the ring finger by a passing ball barely foot, as maintained by Gegenbauer, Goette, Strasser, and
touched by the finger -tips, but this must be rare. The others. According to Bardeleben, the original number of
tip of the thumb is occasionally split, and the flesh of carpal and metacarpal bones was seven , and he finds
the palm ; but of the acute conditions in general I am traces of them still remaining in separate or reduplicated
not qualified to speak from lack of experience, although points of ossification in the scaphoid and pisiform bones.
I have seen many old cases of the bony deformities The latter, which is more than a simple sesamoid bone,
mentioned. represents the carpal support of the vanished sixth
It is notable that the worst examples of this trouble finger.
are seen in players now past middle age , who were This phylogenetic explanation of supernumerary
injured , especially in the catcher's position , before the fingers accords them also an importance as signs of
common use of gloves for protection of the hands. degeneracy. In psychiatry and neurology we no longer
42-44 ARCHIV
ES
OF THE ROENT
GEN RAY .

understand by this term a declension or degradation, as lateral the variation or deviation may be purely em
it was used by Morel, who was the originator of the bryonic, occurring in one of the three stages - blastemal,
term. On the contrary, the somatic marks represent for chondrogenous, or osseogenous . When, however, the
us the result of imperfect evolution, an embryological malformation is bilateral, although it may not be sym
derangement interfering with the development of the metrical , it is evidently an inherited character originating
whole organism , the limbs as well as the brain and other in the germ cell of one or both parents.
internal organs. This interference may suppress or The hand of which the skiagram appears in Fig. 3,
restrain the growth of a single germ cell , as in the case Plate CCLXIX. , was that of a girl thirteen years of age.
of harelip or cleft-palate. It can also perpetuate a The supernumerary thumb had not disturbed her till she
germ cell which in the ordinary course of development found it interfere with her work on entering a manu
would have perished, as in the persistence of the tail, or factory. The left hand , when examined by Roentgen
in the multiplicity of breasts conserved in many quadru- oscopy, appeared perfectly normal. None of her relations
peds, which appears in rare cases also in the human had a similar malformation. This fact supports Pryor's
subject. Polydactylia belongs to this second category. opinion that inherited forms are generally bilateral and
The late Professor Penta, who examined more than symmetrical.
4,000 criminals in the Italian prisons, found super- The skiagraph shows that the thumb has a metatarsal
numerary fingers or toes in 15 per cent. , whereas that bone with a large cartilaginous epiphysis curved like an
deformity is very rare in normal man. He believes in arch. On this articulate two series of phalanges, the
the hereditary transmission of this malformation, having first diverging, the second converging towards one
found it in one case existent in three generations. another, and laterally dislocated from their articulations.
From a surgical point of view Annandale * divides The bones, in accordance with the age of the girl,
polydactylia into four types or categories : (1) An have still distinctly separated epiphyses. Fürnrohr *
imperfect member loosely attached by a narrow pedicle found in the skiagraphic appearance of the metacarpal
to the hand or to another digit. (2) A more or less and phalangeal bones a confirmation of the old idea that
developed organ, free at its extremity, and articulating the thumb should be regarded as without the metacarpal
with the head or side of a metacarpal or phalangeal bone, but with three phalanges like the fingers. This
bone. (3) A fully developed separated digit . (4) A digit figure, however, supports a completely opposite opinion.
intimately united along its whole length with another The whole conformation of the thumb and metacarpal
digit, and having either an additional metacarpal bone of bone is the same as that of the others, and the two
its own, or articulating with the head of one which is series of phalanges resemble exactly those of the normal
common to it and another digit. finger phalanges. The case, therefore, confirms the
Albert, t of Vienna, gives special importance to the conclusions of the more modern anatomists.
duplicity of the thumb, probably on account of the
inconvenience to the workman of a supernumerary
thumb.
All these publications preceded the discovery of the SOME PRACTICAL POINTS REGARDING THE X-RAY
Roentgen rays, and contain , therefore, indications which TREATMENT OF RINGWORM OF THE SCALP.
are derived only from clinical appearance or from the
skeleton. Read before the British Electro-therapeutic Society.
T. W. Pryor | describes cases of congenital poly By GEORGE B. BATTEN, M.D.
dactylism of both hands occurring in a young man and
ALTHOUGH I do not have the large experience that
his sister. The supernumerary finger articulated with workers in connection with large hospitals have with
the metacarpal bone of the thumb, but had three ringworm , yet I have had a comparatively long ex
phalanges, as in & finger. When the condition is uni perience with it in private practice, my first successful
* Annandale , “ Diseases of the Fingers and Toes,” Edinburgh , case with the X-ray treatment having been in November
1865 .
† E. Albert, “ Lehrbuch der Chirurgie und Operationslehre ," Wien and December, 1902, giving me nearly four and a half
und Liepzig , 1881 , Bd. ii., s. 483.
# T. W.Pryor, “ The X Ray in the Study of Congenital Malforma- * S. W. Fürnrohr, " Dic Röntgenstrahlen in Dienste der Neurologie, ”
tions , " Medical Record , New York, November 3, 1906. Berlin, 1906.
 FIG.1.

2 44

L Fig . 2. - FINGERS OF Right HAND OF Fig . 1 .

DE SUER

2802
Fig . 1. - HANDS OF A BASE-BALL PLAYER .

3.

Fig . 3. - FINGERS OF LEFT HAND OF Fig . 1 .

/
3.

Fig . 4. -LEFT HAND, SHOWING DEFORMED FINGERS.

ty
Righ

Fig . 5. - INDEX FINGERS DEFORMED BY PLAYING BASE - BALL. FIG . 6.-ARTHRITIS DEFORMASS,

TO ILLUSTRATE ARTICLE ON BASE - BALL FINGERS ,

By DRS. J. N. HALL and G. H. STOVER (p. 41 ).
PLATE CCLXVIII.
( " Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
43
 Fig . 1 . Fig . 2.

TO ILLUSTRATE ARTICLE ON RINGWORM .

By DR. GEORGE B. BATTEN (p. 42).

Fig . 3.

TO ILLUSTRATE ARTICLE ON HEXADACTYLIA .

By DR. AUGUST V. LUZENBERGER (p. 41 ) .
PLATE CCLXIX .
(“ Archives of the Roentgen Ray and Allied Phenomena.” — Copyright.)
44
 ARCHIVES OF THE ROENTGEN RAY. 45

years' experience. I therefore hope that a few notes I go over the scalp and mark the areas affected with
of mine may be interesting to others . ringworm with an aniline pencil. If there are only a few
I formerly always used the six-exposure method of small areas, I expose them through an appropriately sized
ten minutes each to each portion of the head, and with funnel ; or if there are several areas on the same aspect
this I was uniformly successful. I still think this of the head, I cut holes to correspond in opaque rubber
method the safest from risks. or in thin lead lined with indiarubber sheeting, or more
During the last two years, however, the single-ex- often in boys' caps coated with a layer of white -lead, and
posure method , controlled by the pastilles of Sabouraud then , if possible, use a funnel diaphragm to keep the tube
and Noiré, has come into vogue, and I have of course and head at the right distance. All this is easy, but if
adopted this method . Now, Sabouraud , to epilate the we have to epilate the whole scalp, it is more difficult.
whole scalp, divides it into about twelve smallish areas, I do not consider circular diaphragms placed against the
giving one exposure to each . head suitable for this : they leave areas in between.
At the London Hospital, I understand, they divide the Now, I find there are three main types in the shapes
scalp into about six areas. Now, I hold that practically of heads. Some are fairly ilat on the top, and those are
the whole scalp can be epilated usually by exposure in the most numerous ; others are flatter on the sides than
two, three, or at most four areas, and I wish to describe on the top ; and some are rounded all over, without any
how I do this . flatter part.
The accepted correct distance of the scalp from the With the first kind - fairly flat on the top - I let the
anticathode of the tube during exposure is 6 inches, & child lie on its back, with its chin on its chest , and elevate
distance chiefly imposed by the use of Sabouraud's the back of the head on a cushion (of course , covered with
pastilles , which are placed at half that distance . fresh paper covering for each case), and then put some
For epilating small areas the ordinary apparatus used , thing flexible and opaque against the back of the head,
diaphragms and shields sold, are quite good and efficient; and make a line where this is with an aniline pencil.
but for epilation of large areas not many of these are I tilt up the tube box and put the aperture parallel to
efficient, chiefly because the apertures through the tube the top of the head, so that its nearest point is 6 inches
shields are too small or are placed at incorrect distances from the anticathode, and expose until the Sabouraud's
from the anticathode of the X -ray tubes. I place my pastille is just short of “ teinte B , ” and this usually with
tube inside a rectangular box without a lid, the sides my apparatus takes fourteen to twenty minutes. Also I
and bottom of the box being made of lead-glass, which move the couch on which the child lies a little to and
quite shields the operator from the X rays. The bottom fro, and also tilt the tube box from one side to the other,
has a circular aperture 31 inches in diameter, and so as to favour first one and then the other aspect of the
there are suitable though simple supports inside the box top of the head. Immediately afterwards, or on the next
for the tube ; also there are slides, made of picture- day, I place the child face downwards on the couch ,
framing, for holding glass funnel diaphragms outside the shield the top of the head with a white-lead cap with &

box, and a simple pastille holder. large hole in it for the back of the head, and expose the
This glass box will hold any ordinary tube, and the back of the head in the same way. I do not fix the cap
tube can easily be placed so that the anticathode is over too close to the head, because I find that one gets better
the centre of the 31-inch aperture. The box is placed universal epilation by letting some of the oblique rays
on wooden gimbals , so that it can be put and fixed in from the tube on the second exposure overlap the oblique
any position . The funnel diaphragms I use were made rays of the first exposure. After eighteen to twenty -five
for me by Messrs . Powell , of the Whitefriars Glass days, when the whole top and back are bald , the areas
Works , and all have a 31-inch aperture at the tube end. above the ears may be exposed if there is any ringworm
All but one are 27 inches high, and they have different present in these areas.
sized apertures at the scalp end ; one with 6-inch aperture The accompanying photos show a case treated in this
at the head end is 3} inches high, so as to allow the way—i.e. , the whole top and sides were done in two
most prominent portion of a child's head to be not less exposures, and the small area over the ear was exposed
than 6 inches from the anticathode. So much for the subsequently (Figs . 1 and 2, Plate CCLXIX .).
apparatus ; now for the patient . If the child has a head of the second type-i.e. , with
7
46 ARCHIVES OF THE ROENTGEN RAY .

flatter sides than top -I get the child sideways and I think great care should be taken not to have any
do one side first, then, next day, the other side, again portion of the scalp within 6 inches of the anticathode
letting the oblique rays overlap at the sagittal suture. during the exposure, but a little further away does not
Then , after these two areas are bald, the back of the head matter.
is exposed, covering up the bald areas very carefully. In conclusion, I should like to ask some questions. Is
it safe to use Sabouraud's pastilles more than once ?
If a child has too rounded a head for either of these
methods, then I have to make caps with white-lead Dr. Agnes Savill says five or six times, but I always
coating, with apertures in them with straight edges, and understood they got too sensitive after one * exposure.
expose in four or five areas through such holes ; these Then I should like to ask your opinion as to our legal
are better than many circular holes or circular position if one inadvertently should cause, despite great
diaphragms. The edges of the holes exposed, of care, a patch of permanent baldness .
course, are carefully marked on the scalp.
I prefer treating children lying down, as they keep
more still. I use a soupape and milliampèremeter in “ THE ELECTRIC SLEEP .”
series with my tube, and usually work at 0 :6 to 1 milli
ampère, with Benoist from 41 to 7, and the anticathode By Professor STÉPHANE LEDUC, Nantes.
red hot. Now as to results. Translated and Condensed by W. F. SOMERVILLE, M.D.
I have treated about fifty cases. I have not bad any
case of recurrence . This I attribute to careful watching The condition which I have described under the name
afterwards , and the use all through of a weak antiseptic of " Electrical Sleep ” resembles that produced by
spirit lotion on the whole scalp. chloroform, for the subject exhibits the same tendency
The hair usually begins to fall from the fourteenth to to remain in any set posture, without any attempt at
the seventeenth day, and is complete by the twenty -fifth voluntary movement, and without any effort at resist
to the twenty- eighth day. After all danger of erythema ance to stimulations, even when these are most painful ;
is over, I use a mild stimulant ointment to promote hair all remaining movements, beyond those of the heart and
growth, and later on use a similar stronger ointment. The respiration, being purely reflex in character. This state,
hair commences to grow between the seventh and ninth which results from the action on the brain of a particular
week from the X-raying, and there is a good fine growth form of electrical current, can be maintained for several
by the tenth week, and a strong growth by the fifteenth consecutive hours, to cease instantaneously with the
week. cessation of the current.
I have had two cases of partial baldness remaining- The CURRENT.—The procedure for the production of
one, the first case, in which I treated the whole scalp by " electrical sleep ” is the outcome of an experimental
the old six-exposure method , which was in 1903. This is study of certain conditions attendant upon the electrical
shown in Case A, and the patch over the left ear in photo excitation of nerves. It may best be described as an
No. 4, published in ARCHIVES OF THE ROENTGEN RAY, intermittent uni - directional current of low tension, in
August , 1905, is still rather thin. which the duration of flow and intermission are sharply
The other case was a boy. I treated the whole scalp defined, and follow each other in absolutely regular
by exposure in two areas, on September 2 and 4 , and succession.
did not see him again until last week . Although the In the accompanying diagram of the current curve the
hair is strong over the rest of the head, there is yet a abscisse represent time ; the ordinates, the intensity of
rather bald patch, where the hair is still very weak, on the current ; the period—i.e., the interval between any
the vertex ; but I still think this will recover. two identical and consecutive parts of the curve — is a
These are the only two cases of accident. I have also hundredth of a second. Thus the current is made and
had two cases where exposure of one large area caused broken one hundred times a second. The interval of
a sort of mild folliculitis in the surrounding part of the current flow - i.e ., between make and break-is one
head, which cured the ringworm there without any * One or two members said that they used the pastilles several
further exposure, and where the hair grew very well times, after exposure to daylight (preferably sunlight), to restore them
to their original colour. One member found they becamo 10 per cent.
afterwards . too sensitive after eight exposures to X rays.
 ARCHIVES OF
tenth of the period — i.e., a thousandth of a second . It
will be seen that the establishment and cessation of
current flow are instantaneous, the intensity rising
sharply from zero to a maximum , and falling as quickly
from maximum to zero.
THE INTERRUPTER.—The current may be obtained
from any constant current source, and is best regulated
by a special interrupter which has been made for me
by Messrs. Gaiffe. After a great number of experiments
with currents of different frequencies and of different
periods, I have determined that a frequency of one
Intensity
Current
.
Time.
INTERMITTENT CURRENT FOR ELECTRIC SLEEP .
Period 01 second .
Current
I period.
Pause i'r period.
hundred per second , and a duration of current one- of a rabbit's head, between the eye and ear, the skin
tenth of that of the period , are the most suitable for the
production of electric sleep.
OPINIONS REGARDING CEREBRAL ELECTRO -PHYSIO-
LOGY. Three fallacies, of which the two latter are experiment repeated, the rabbit will fall on the other
contradictory, have hindered the advance of cerebral side, again that of the anode. If we place a large
physiology. The first is that of the electrical non- indifferent electrode on the body, and a small electrode
excitability of the brain ; the second, that of the
non-accessibility of the living brain to electric currents ;
the third , that of the danger of intense currents when
applied to the head. Up to 1870 the inexcitability of the
brain by all known methods of stimulation, and specially CURRENT TO THE BRAIN . – Vertigo occurs similarly in man,
the electric stimulus, was a dogma recognized and
affirmed by Magendie, Flourens, Longet, Matteuci,
Weber, and Schiff, and admitted by all physiologists.
The experiments by which Fritch and Hitzig showed on
the exposed brain the existence of motor centres capable
of being excited by electricity destroyed this dogma
and opened the way for the electric exploration of the
brain. In 1867 , Erb showed on the dead body that
electric currents, both continuous and induced, when
passing through the head also penetrate into the brain.
The electric resistance of the cranium filled with blood
and of organic fluids is much less than is generally
believed. I have found a resistance of 300 to 400 obms
between two electrodes of 10 to 16 centimetres , one
placed on the forehead, the other at the back of the
THE ROENTGEN RAY. 47
neck . A fresh calvarium containing saline solution,
shows a resistance of 150 to 200 ohms, allowing for the
resistance of the liquid. On the other hand, Von
Ziemsen has shown that cerebral substance is the best
conductor in the human body. According to him, the
resistance of muscular tissue is 3: 1657 times greater
than that of cerebral tissue. Consequently the brain is
of all the deep organs the most responsive to electric
currents. The electric current penetrates the brain by
the shortest route, through its thickness, in order to
reach the nerve centres, which are good conducting
tissues. On the other hand, when it is applied to the
back, a large proportion of the current traverses the
masses of muscle, and only a small proportion penetrates
to the spinal cord . The application of the electric
current to the head excites the nerve centres, and
produces sensations of taste and light ; but one of the
chief effects produced by the current as it passes through
the head is vertigo, which reaches its maximum when a
continuous current is passed suddenly from one ear to
the other. If a small electrode be placed on each side
having previously been shaved, so soon as the current is
closed the rabbit falls suddenly on its side—the side
next the anode. If the current be reversed and the
on the side of the head between the eye and the ear, the
fall occurs on the side not excited, whether the active
electrode be cathode or anode.
RULES TO BE OBSERVED WHEN APPLYING THE ELECTRIC
when the electric current is applied to the head, and may
be so severe as to cause the patient to fall. It frightens the
patient, and for this reason I have attempted to discover
the conditions which give rise to it. Electrical vertigo
is always produced by a variation in the intensity of the
current ; the more rapid the variation the more marked
the vertigo. The intensity of the vertigo depends also
on the direction of the current ; the more transverse, the
more intense. When, on the other hand, the direction
of the current is antero -posterior, vertigo does not occur
if the intensity be altered gradually.
I have described in a paper (Les Ions et les Médica
tions Ioniques, Masson, 1907) the effects on the cerebral
functions of a continuous current passing from the neck
to the forehead. Strong electric excitement of the brain
7-2
48 ARCHIVES OF THE ROENTGEN RAY .

for a short period, five seconds, causes an attack of in duration. The addition of one volt in sixty seconds
epilepsy. Later on we shall study how this is produced. will produce sixty times less excitement than if it were
PRODUCTION OF ELECTRIC SLEEP .-In order to pro- done in one second. The excitement immediately pre
duce electric sleep we must have a source of energy, a cedes the sleep. For this reason the raising of the
graduator of potential , an interrupter, a current reverser, potential should be made more slowly as the potential
and & milliamperemeter. A voltmeter is placed in itself increases. Under these circumstances the animal
parallel between the two electrodes. A portion of the is seen quietly, without a cry, without a movement of
hair on the head of the animal, a dog or rabbit, is shaved, resistance , without a sign of pain, to pass into a state of
so as to ensure as little resistance as possible. It is cerebral inhibition , similar to the sleep of chloroform ,
important not to cut the skin of the animal , or the whole except that the reflexes remain unaffected, especially if
current will pass through the wound and produce severe the spinal cord be not included in the circuit. The
pain. The shaved surface should extend in front as far animal does not respond to any excitement ; it appears
as the eyes, so that the current may pass over the whole in a state of gentle and absolute anæsthesia. All sorts
anterior portion of the brain . On the shaved surface we of operations may be performed upon it. In order to
apply a thick piece of absorbent cotton-wool, soaked produce this electric sleep in the rabbit 6 to 8 volts are
in a warm solution of chloride of sodium , 1 in 100. required, giving 1 to 2 milliampères of interrupted
Upon this cotton-wool a inetallic electrode of flexible current, corresponding to 10 or 20 milliampères of a
tin is applied, to which is soldered the conducting wire continuous current . When the necessary voltage has
in connexion with the negative pole . The electrode been ascertained it may be introduced instantaneously
should be applied with gentle and regular pressure. into the circuit , in which case inhibition is sudden , and
The other electrode, connected with the positive pole, the animal falls on its side stiff and motionless. In $

should be of larger size, and may be placed on any consequence of general muscular contraction respiration
portion of the body on the same side. It is of advantage, is suspended. After ten seconds the contraction ceases
however, to place it on the lower part of the back, so and resolution occurs .After fifteen seconds respiration
that the current may pass through the nerve centres, the recurs, and the animal remains in this condition for an
brain, the cerebellum , and the spinal cord in its wholeindefinite period of time.
length . If it be desired to exclude the spinal cord and At any moment the experiment may be stopped by
the cerebellum , then the larger electrode should be suddenly cutting off the current. The awakening is
placed in the front of the body below the thorax. instantaneous, the animal immediately regains its feet ,
The head is connected to the negative pole. In this looks quietly about, showing neither pain, fear, nor
way its potential does not vary. The current depends on fatigue .From the moment that the electrodes are
the alterations of potential of the positive pole on the removed it frisks about and eats readily. We have
body, which is high when the circuit is closed, and falls never met with any untoward effects, no vomiting, rarely
suddenly when the circuit is broken. It is quite possible even a little stupor. The animals, moreover, manifest
to produce electric sleep by connecting the head to the no signs of distrust or fear after having been submitted
positive pole, but a greater voltage is required, greater to the operation .
intensity, greater energy, and the sleep is not so pro- INHIBITION OF RESPIRATION. —After the occurrence of
found. The experiment being arranged, the interrupter electric sleep, if the potential be still further increased ,
put in motion, the current regulated both as regards its there is produced an arrest of respiration , and, later, of
period and frequency, we commence by gradually raising the heart. In order to inhibit the respiration in a rabbit,
the potential, at first more quickly, and afterwards more the voltage must be increased beyond that required for
slowly. All the influences which suppress cerebral electric sleep-to 10 volts, for instance, in lieu of the
functions cause, in the first place , excitement, as is the 6 volts which were sufficient to inhibit mobility and
case with alcohol, chloroform , and opium. Although sensibility. Under the influence of the increased voltage
this period of excitement is unavoidable, we have, in the the respiratory movements are first of all increased in
slow and gradual raising of the potential and current, amplitude and then are accelerated. Later on they
a means of controlling its intensity, as the excitement become more and more irregular, then the movement of
thus produced loses in intensity in proportion as it gains the chest becomes gradually less and less, till the move
 ARCHIVES OF THE ROENTGEN RAY. 49

ments of the thorax are arrested at a point midway respiration in order to cause stoppage of the heart and
between inspiration and expiration, the registering death. This method of causing death contrasts favour
needle describing a practically horizontal line. Inbi- ably in its gentleness with that used in America for
bition of respiration may then be considered as complete. electrocution . In the case of intermittent currents, and
A tracing taken during a period of twenty seconds with the electrodes placed as I recommend, the functions
shows this inhibition of respiration, while the functions of the higher centres are first of all abolished ; following
of the heart remain completely unaltered . When the these, the respiratory and cardiac centres. There is no
current is suddenly cut off a deep inspiration takes reaction, and it is no metaphor to say that the subject
place, and the thorax regains its movements slowly and sleeps the eternal sleep. In the United States, on the
gradually. Respiratory inhibition may last for a minute contrary, there is no direction as to the locality for the
or more without causing the heart to stop. This may application of the electrodes. Visible pain and violent
be produced repeatedly if the animal be permitted to contractions are observed . The voltage and intensity of
rest for some moments during the intervals. When the current employed are far too great, producing violent
current is properly under control, the operation correctly contractions, and also an amount of heat which burns
performed, and the animal carefully observed during the the victim and necessitates the breaking of the current
establishment of sleep, a fatal result does not occur. It in a few seconds . Hence in some cases the victim is
is evident that the production of inhibition of respiration resuscitated , and a second application is required in
is more dangerous, especially when prolonged for the order to produce death. With the intermittent current,
seventy such as I use, a weak potential only is necessary in order
purpose of studying its effect. In aa series of seventy-
four experiments made together with Professor Rouseau to produce stoppage of the heart, and the current may
for the purpose of studying the action of the respiration continue as long as desired without any break..
and circulation, we have had only seven deaths. Of THE TIME DURING WHICH ELECTRIC SLEEP MAY BE
these, five were produced intentionally in order to study MAINTAINED. — Electric sleep may be continued for a
the circumstances in which they were produced ; the very long time without causing animals to suffer, and I
other two cases occurred during the study of respiratory have often kept animals asleep for three consecutive
inhibition. Of all the animals submitted to experiments hours. I have even done so for four hours fifty minutes,
on respiratory inhibition, only one was found dead in its and registered the cardiac movements of a rabbit
cage on the following day ; none of the others appeared electrically asleep. Miss Louise Robinowitch, of New
to be in the least affected . York, has kept in my laboratory a rabbit in a condition
METHOD OF.RESUSCITATING ANIMALS FROM A CONDITION of electric sleep for eight hours twenty minutes con
OF APPARENT DEATH .—When the arrested respiration is secutively. The animal wakened without showing any
not re-established on the cessation of the current, even inconvenience from such a long experiment. Finally,
after the heart has ceased to beat, it is possible to consecutive experiments on the same animal do not seem
resuscitate the animal by means of the same current by to produce any change in its health .
which it has just been nearly killed. For this purpose, BLOOD PRESSURE DURING ELECTRIC SLEEP . - Our
without altering the connexions, we pass the current tracings show the influence of electric sleep on blood
for a second or two, following closely the rhythm of pressure. A rabbit was put to sleep suddenly on the
respiration, and thus produce contractions of all the closing of the circuit with four volts, with an intensity
muscles of the body, comprising those of inspiration ; of 0.75 milliampère, the current having 110 interruptions
artificial respiration is therefore obtained. Among our per second. At the moment of sudden closure of the
experiments on inhibited respiration we have used this circuit the thorax enlarges considerably, then retracts
method fifteen times, and the animals have been resusci- below its normal position, and finally gradually returns
tated eight times. This number would have been greater to the normal. The carotid blood pressure experiences
had we not, for the sake of experiment, delayed our a slight increase on the closing of the current, followed
intervention too late. If cerebral excitability be in- by a marked fall ; then slowly a very great increase is
creased after passing the current the animal is saved. produced , and this pressure remains during the rest of
ELECTROCUTION.-It only requires the addition of the sleep. On the sudden cessation of the current the
1 or 2 volts to those which have produced inhibition of blood pressure returns steadily to its normal amount.
50 ARCHIVES OF THE ROENTGEN RAY.

To sum up, electric sleep, whether produced suddenly

centres are completely inhibited, and there is no reaction
to painful stimulations. There may be some groaning,
or gradually, produces after the initial oscillations a
marked rise of carotid blood pressure, which persists produced by the stimulation of laryngeal muscles, but
during the period of sleep. no facial expression of pain is shown. The pulse
INFLUENCE ON THE INTESTINE AND THE BLADDER . remains unaltered , while respiration is slightly inter
Sudden cerebral inhibition causes in animals evacuation fered with. When the current reached its maximum ,
both of the bowels and the bladder . I heard as in a dream the voices of those around me.
TEMPERATURE AND PUPILS. -Miss Louise Robino- I was aware of my incapability of moving and of con
witch states that the temperature is usually subnormal versing with my colleagues. I felt the contractions,
as long as the rabbit remains motionless. She has also twitchings,and stingings of the upper arm, but the sensa
found the pupils to be contracted, and not dilated as Tno dioxide mere blunted likethose of abenumbed limb. The
epilepsy. Trost painfal experience is to follow the successive dis
REFLEXES — duriqen appearance
in
electric sleep depends on the position of the code- in which one feels in danger, yet is unable to cry out or
i.e., whether or not the spinal cord is in the circuit of the domove. Masterwards regretted that my colleagues did
current. If the large electrode be placed on the thox B Rappress the currentfurther in order to obtain inhibition.
or abdomen , the current does not touch the cord , which , The experiment was again repeated, but my colleagues,
accordingly, is not inhibited , at least, in its lower thinking that inhibition had occurred, again stopped
portion. The reflexes to the face and the upper limbs before unconsciousness was complete.
are therefore abolished, while those to the lower limbs In another experiment the E.M.F. was raised to 35
are exaggerated. On the other hand, if the large volts, and the intensity in the interrupted circuit to 4 milli
electrode be placed on the back , the current passes ampères. In the two consecutive séances I remained for
through the whole length of the cord , which is, accord- twenty minutes under the influence of the current. On
ingly, inhibited. The reflexes of the lower limbs are the opening of the current awakening was immediate,
therefore abolished. and no after- effect was experienced further than
CEREBRAL INHIBITION IN MAN.–Up till now only one sensation of well-being. Immediately after the experi
person has been experimented upon with a view to ment I gave an address to a society of retired workmen,
electric cerebral inhibition , and that was myself, under of which I am an honorary member.
the direction of Professors A. Malherbe and A. Rouseau . LOCAL ELECTRICAL ANÆSTHESIA.—If we place on the
The current was supplied by a generator of small internal median nerve at the wrist a small sponge electrode
resistence and a potential of about 60 volts. The frontal forming the cathode of the intermittent current , a larger
electrode was in direct communication with the negative anode being placed on any part of the body, and gradu
pole, while a larger electrode on the trunk was connected ally raise the intensity of the current, a tingling is
to the positive pole. produced at the finger-tips in the part supplied by this
It is well, as a preliminary, to pass a continuous nerve. Sensation, too, in this region is abolished to
current of 10 to 20 milliampères for five minutes. By such an extent that with the eyes closed the subject
this means the sensibility of the skin and the resistance cannot state whether he is pricked, pinched , or cut.
of the body are considerably diminished, and cerebral Local anesthesia is complete.
inhibition is more easily obtained. In this case we are dealing with a subcutaneous
The sensation produced by the stimulation of super- nerve, having scarcely any motor fibres ; but if we wish
ficial nerves is easily borne. In time it subsides, as in to deal in the same way with other nerves, the muscles
the case of the continuous current, and after reaching contract, and these muscular contractions hinder local
a maximum it becomes less, even though the E.M.F. electrical anesthesia.
be increased. The face reddens and the muscles of the EXPERIMENTAL EPILEPSY. - M. Battelli produced
face, neck, and upper arm twitch slightly, and there are attacks of epilepsy in animals by means of currents from
the electric mains. I have obtained similar results by
fibrilly tremblings, and finally tingling at the extremities
of fingers and hands, toes and feet. The inhibition means of intermittent currents. Hitherto no one has
reaches the centre of speech first of all, then the motor been able to produce epilepsy in the rabbit. It may,
 ARCHIVES OF THE
however, easily be produced by this means. When the
cathode is placed on the head, as for electrical sleep,
and an anode on the abdomen or on the back , the
Notes and Abstracts.
MEASUREMENT.
In using Bordier’s platino-cyanide pastille for X-ray measure.
ment, it is convenient to enclose it in a black paper envelope,
and to remove it from time to time in order to compare it with
the standard scale of tints. The envelope may be 2 centimetres
long by 1} centimetres broad, and is best affixed to the skin by
a little head of beeswax softened by pressure . The pastille
should be gummed on a slip of card, 3 centimetres by 1 centi
metre, and may thus be conveniently removed and replaced, if
necessary, many times during an irradiation.- Dr. J. Bosc,
Archives d'Éléctricité Médicale.
RADIUM-THERAPY.
Bouchard and Balthazard have shown that the emanation of
radium is toxic when introduced into the respiratory tract. All
the tissues of the animal become radio-active, more especially
the suprarenal capsules and the lungs. The emanation is
eliminated by the skin and the lungs, so that after about six
hours the tissues have lost completely all traces of radio-activity.
Beryell, Braunstein, and Butel have shown that the emanation
increases the zymotic action of pepsine, pancreatine, and ferments
in general. This may explain in some measure the stimulant
action of mineral waters when drunk fresh from their source.
It is curious to notice the unequal distribution in the organism
of the emanation , a gas which has been proved to be chemically
inert. In like manner argon has an elective affinity for the
blood . - Académie des Sciences, July 23, 1906.
ELECTRO-THERAPY.
The Radical Absorption of Urethral Strictures by
Electrolysis. — Robert Newman , M.D. ( International Journal
of Therapy, January, 1907), states that every organic stricture
of the urethra can be cured by electrolysis. The electrolysis
causes a galvanic chemical absorption of the pathological neo
plasm in the canal, and particularly of the tissue surrounding
the canal, which absorbs and thereby restores the calibre of the
urethra to its normal size. This process is caused by mild
currents, which never can cauterize, burn, or destroy healthy
tissues ; it is not dilatative, and can only be used in organic
stricture. The technique is as follows : The patient is placed
in a position most comfortable to himself ; the positive pole is
held by the hand or placed on the lower extremity of the abdo
men ; the electrode selected for the séance is attached to the
negative pole, and lubricated with a conductor-the best being
glycerine or white of egg—it is then carefully introduced until
arrested by the first stricture. The galvanic current is then
turned on , and increased very slowly and gradually, one cell at
a time, until the patient feels an increase of warmth, and from
ROENTGEN RAY . 51
passage of the intermittent current will give rise, when
it is cut off, to a complete and typical attack of
epilepsy.
3 to 5 milliampères are registered. Care must be taken to
guide the electrode only, and use no force or pressure of
any kind ; the electrolytic action soon acts as an absorbent,
makes the calibre thereby larger, and the instrument slowly
advances, passes the obstruction, and sometimes jumps through
the stricture. If there be more than one stricture , the electrode
should be guided in the same way until all are passed. Next,
the electrode is slowly withdrawn , and held a little time at each
stricture until all are again passed ; then the current is diminished
slowly, cell by cell, to zero, but not until then is the electrode to
be removed. The time of a séance will vary according to cir
cumstances, and may last from five to twenty minutes. Séances
may be repeated in a week .
RADIO - THERAPY .
Treatment of Hypertrichosis by the X Rays.At the
Lyons Congress, August, 1906, Professor Bordier presented a
patient cured of hypertrichosis by a single irradiation by X rays.
The case was that of a lady, twenty-eight years of age, whose
face and neck were thickly covered with coarse hairs. Various
means of treatment had been attempted without result, in
cluding the thermo-cautery, which had only produced deep
scarring. Bordier divided the affected area into three portions,
and subjected each portion to a single irradiation of 6 or 7 Holz
knecht units, corresponding to the tint No. 3 of his chromo
radiometer .
The ensuing dermatitis continued for six weeks, after which
period the crusts fell off, and the skin remained in a normal
state .
Bordier reported that two other female patients had been
successfully treated by the same method, but were unwilling to
be exhibited.
It was noticed that in all three cases the few remaining hairs,
about twenty in number, were quite white, although the natural
tint was a dark brown. " A strong dose of X rays is thus shown
to have an action opposite to that of a weak dose, the former
causing depigmentation, whereas the latter produces pigmenta
tion . - Annali di Electricità Medica e Terapia Fisica.
The Treatment of Chronic Bronchitis by Roentgenization.
-Immelmann ( Berliner Klinische Wochen ., April 15, 1907 )
records his experience of the Roentgen treatment of the more
chronic types of bronchial asthma and bronchitis. The general
results were excellent, the dyspnea resulting from bronchial
spasm being particularly benefited. Exposures were made over
the anterior, posterior, and lateral aspects of the thorax for ten
minutes per session. A limited number of exposures generally
proved effective. In cardiac and the more purely neurotic types
of asthma no beneficial results accrued.
52 ARCHIVES OF THE ROENTGEN RAY .
Reports of Societies.
THE ROENTGEN SOCIETY .
The Measurement of Radio -Activity and X Rays.
BY CHARLES E. S. PHILLIPS, F.R.S.E.
In his recent paper on the “ Measurement of Radio-Activity and
X Rays ” Mr. C. E. S. Phillips said :
“ It has always appeared to me the better plan to approach the
question of X-ray measurement through the standardization of
radio -activity.
Consider a litre of air enclosed in a metallic vessel which also
contains a suspended gold- leaf system .
The slight ionization due to the radio-activity of the metal ,
and also to the contained gas, as well as the loss of charge owing
to imperfect insulation, will cause the electrified leaf to very
slowly fall. The rate at which it moves under these conditions
indicates the “ natural leak ” of the apparatus.
The approach of a crystal of RaBr, creates ions in the gas, by
the passage of a, b, and y rays through it, and the rate of leaf-
fall may be taken as proportional to the amount of energy
absorbed from the radiation .
The a particles are emitted from radium at the first three
transformations, and also by Ra. C and F.
At each of these exciting episodes in the life -history of a
radium atom an a particle is shot out with a definite but different
velocity ; the a rays , taken as a whole , are therefore hetero-
geneous.
If, however, the emanation be driven off by means of heat,
the q rays which are given out by the active substance remain-
ing behind are sufficiently homogeneous to allow of comparative
tests being made as to the activity of the salt.
The emanation itself, which by heat or solution can be
removed from the radium , may also be used as a measure of
activity .
For obvious reasons neither of these methods is suitable for
the comparison of specimens in sealed containers such as glass
tubes or aluminium capsules.
The emanation test so far impairs the activity of the substance
that it would require about three months in which to regain
radio -active equilibrium .
B Rays.
Owing to their high speed, the negative corpuscles are not
readily stopped by matter, and consequently produce relatively
less ionization.
The co -efficient of absorption for, say, lead is not constant ;
a larger proportion of the rays are absorbed at first than is the
case when subsequent layers are added. The exponential law
is not obeyed, and the rays are therefore heterogeneous. More .
over, for any freshly prepared specimen of Ra Bru, calculation
shows that about forty years must elapse before the number o
B particles emitted per second attains a uniform value . In
spite of this fact, however, it is not uncommon to find the B rays
made use of in determining relative activity.
I do not say that a B- ray test is utterly unreliable ; indeed,
considering the facts of the case, it is surprising to see that the
results agree even approximately with those obtained by a more
accurate method .
Saturation .
Consider for a moment the value of such a test , and suppose
the electroscope to have an antenna projecting into the air of
the room . The specimen of radium is placed , perhaps, 2 feet
away, and the leaf charged to 500 volts. The time is taken
with a stop -watch for the leaf to move over a range correspond.
ing, say, to a fall of 100 volts ; another specimen is similarly
placed, and the process repeated .
Now , it is practically impossible to catch all the ions which
form in the large mass of air surrounding the antenna under
these conditions, nor have we any reason to think that the same
proportion is caught in each case .
And, further, the air is in motion. Whether much confidence
may be placed in tests carried out under these circumstances
depends very largely upon the experience of the operator. By
using a high P.D. and screening from draughts a fairly good
reading may be obtained. It is clearly desirable, however, to
improve the conditions. The air to be ionized must be confined
to a definite small volume - say a litre—and care taken to ensure
a saturation P.D. between the gold leaf and the case of the
electroscope.
The ions will be produced in the gas at a definite rate, and
rapidly disappear by recombination . The electron theory
requires that the number of recombinations shall vary as the
square of the number of ions present and experiment verifies
that relationship.
It is clear, therefore, that the rate of recombination will gain
on the rate of production, until finally equilibrium is established
and the number lost per second exactly equals the number
produced in the same time.
There are two conditions, then , to be considered in reading
the rate of leaf- fall -- viz., saturation , where all the ions are
caught ; and the state of equilibrium , where the rate of com
bination is equal to the rate of production .
In the first place, if we double the number of ions produced
per second , we also double the rate of leaf- fall. The second case
requires more detailed consideration .
If I is the number of ions produced in the gas per second , we
have I = a Na where N is the number of ions after a steady
state is reached , and a is the co- efficient of recombination. In
order to double N the value of I must be quadrupled .
When the condition is far from saturation ( as it easily may
be in testing strongly active specimens), it is therefore erroneous
to say that because one quantity of radium produces twice the
rate of leaf-fall that another does, the former is twice as active
as the latter.
I emphasize this point in order to bring out strongly the
importance of ensuring a condition of saturation in radio - active
measurements.
 ARCHIVES OF THE ROENTGEN RAY .
Any relative test by B rays involves, in reality, the following
considerations :
1. The thickness of the layer of active substance.
2. The proportion of the rays absorbed by the container,
3. The composition of the pencil of raysmi.e., their magnetic
spectrum .
4. The age of the preparation .
These alone will suffice to show the immense difficulties to
be overcome if we base our system of measurement upon the
B ray .
Other Methods.
It has been thought that an indirect method, in which a
volume of air is ionized and then carried rapidly away from the
radium and tested, would offer some advantages. For this
purpose a lead cylinder, with two short side tubes also of lead
cast on to it, was made 3 inches thick and 18 inches long with
a 1 -inch hole through it. The experiments were not, however,
satisfactory. Since my aim has been to try practically, as far
as possible, the various suggestions for measuring radio -activity,
these experiments were persisted in for a longer time than may
seem profitable, in order to see if, though indefinite in themselves,
they might lead to other and more practical means.
The same may be said of an attempt to count by a direct
method the number of B particles emitted during a given time
by a radium salt.
It has been suggested that the strong coloration of a solution
of iodoform in chloroform under the influence of B and y rays
be utilized as a measure of radio -activity. The discoverers
(W. B. Hardy and Miss Willcock ) have themselves recom
mended that a solution of a definite tint be chosen and set aside
as a standard with which to compare the colour of a given
quantity of iodoform in chloroform after radiation for a specified
time.
Bordier and Galimard have also attempted to establish upon
this basis a unit of quantity for Roentgen rays.
Now, in addition to the great difficulty inherent in the match
ing of tints, the scheme appears to be unsatisfactory for many
reasons. A tube containing the solution must be kept abso
lutely dark while radiated, and then only held in dim light for a
short time, in order to compare the colour with that of the
standard.
A darkening begun by the rays goes on for some time even
when the liquid is removed from their influence, and so the
comparison is all the more difficult to make.
The sensitive solution is of great interest, however, and I
have tried to find some other change accompanying the altera
tion in colour.
For this purpose two electrodes—one of platinum , the other
of pure silver - were placed in 4 c.c. of chloroform saturated
with iodoform. They were connected to a very sensitive reflecting
galvanometer, and the cell brought out into the light. It was
expected that the iodine liberated by the action of the radiation
would attack the silver and give rise to a P.D. sufficient to drive
a measurable current through the circuit.
As the solution became purple a deflection was observed,
showing that the silver plate had become negative to the other.
The experiment was repeated, and the result verified by means
of a Dolezalek electrometer.
53
Before venturing to express an opinion as to the possible
development of this and other physico -chemical methods for
our purpose, the feasibility of using a selenium cell may be next
considered.
Five milligrammes of pure RaBr, produced no appreciable
change in the resistance of a very sensitive selenium cell pre
pared by Messrs. Becker and Sons. The action of the rays has,
however, been demonstrated by Haga .' On the other hand,
X rays gave a very marked effect. In spite of the sluggish
behaviour of selenium cells and their slow recovery , it has
already been suggested before the society that they be utilized
for the comparison of X rays from different focus tubes.
But, speaking generally, methods of measurement based upon
these curious actions suffer from one fundamental objection .
The factors quality and quantity are utterly confused . We
are generally asked to measure X rays with a bit of photographic
paper, or the activity of radium by means of the ionization due
to B rays of unknown complexity.
If an X -ray tube on one occasion gives twice the darkening
of the iodoform in chloroform , twice the selenium effect, or
twice the ionization that it does at another time, how are we to
find out whether the average hardness of the rays has changed,
or whether their actual number has altered ? The above tests
do not provide a means of ascertaining what has happened . At
the present time we have no way of accurately measuring the
output of a focus tube . I have tried hard to find one. The
utter heterogeneity of the rays is the only real difficulty. The
speed at which the electron is projected upon the anticathode,
as well as the number of particles which strike it per second,
appear to be the two governing factors of the problem. Since
the speed is a function of the potential gradient along which
the electrons move, it is surprising that Lord Blythswood and
Mr. Scoble found no regular connexion between the potential
difference at the terminals of a focus tube and the photographic
effectiveness of the rays . I think, however, the explanation of
this result may be found in the fact that the emissions of
electrons from the cathode is now known to be modified by the
impact of positive rays. The conditions within the tube are ever
changing.
But I gather that the need for a very precise method of com
paring X rays is not so pressing as some appear to think. At
least one medical practitioner has pointed out that the errors
due to matching the tint of a Sabouraud disc are small relatively
to those arising from the idiosyncrasy of the patient. Cases of
X-ray burn are now happily rare, and it therefore seems that,
added to a good practical experience, the methods of Kienböck
and others are accurate enough so far as they go. While I
agree that more convenient means should be looked for, a
greater degree of accuracy does not appear to be required than
is already attainable at the present time.
Returning to the subject of radio -activity, the question whether
a given weight of pure RaBr, emits a definite quantity of radia
tion of a specific type evidently lies at the very root of this
problem of measurement.
We have decided that the a rays, as well as the emanation ,
cannot be employed except under special circumstances. I
have examined the B rays from several quantities of radium , in
order to see whether the slowly moving particles always bore
8
54 ARCHIVES OF THE
the same proportion to the more penetrating ones. The ratio
of the ionization with no screen over the radium (except the
mica cover) to that observed with a lead screen 5 mm. thick in
position showed that with different specimens the ionization was
not reduced in the same proportion. Except for rough tests
the B rays must also be ruled out on account of their com
plexity. They are generally believed to be the parents of the
y radiation, however, and the change in the emission of the
former with the age of a radium preparation leads to the con
clusion that the latter would also be inconstant over the same
range of time .
The year's work has been largely concerned with researches
which conclusively answer this question , and the latest data
available relating to the transformation products of radium
show that the growth of emanation, as well as the changes to
radium A and B, are accompanied by the emission of a particles
only. Radium B, regarded at first as rayless, has now been
found to emit easily absorbed ß particles, but neither a nor y rays . calculate its amount from the relative ionization it produces ;
On the other hand, the next product in order, radium C , gives
out a, B, and y in great profusion.
We notice also that since a quantity of radium C when
isolated becomes half transformed in nineteen minutes, the
amount of this substance accumulating in a radium salt rapidly
reaches a maximum. It is owing to the reason that the B rays
given out by the amount of C present in radium early acquire a
constant value that they serve as an approximate guide to the
activity. Radium D, thought at first to be rayless, has also
been shown to give out B rays as it changes to E, which emits
the B rays that change with time. Since E is a slow trans
formation product, with a period of about forty years, very much
depends, from our point of view, upon knowing whether it does
or does not give out y rays. Any doubt on this matter has been
dispelled, however, by Stefan Meyer and von Schweidler's
statement, that if these rays are emitted at all from Ra. E it is
only to an excessively small extent. Eve has also come to the
same conclusion from the results of work undertaken in another
direction . All the y rays given out by radium originate, there
fore, in the rapid transformation product C, and their constancy
is in no way affected in the slow change in the emission of
B particles.
With regard to the composition of the rays, the latest figures
show that between a thickness of 0.64 and 3 mm. of lead the
value of x ranges from 0:57 to 0:46 .
Their slight want of homogeneity is, however, no disadvantage
in view of the fact that they were uniformly irregular for all
specimens of radium tested, as well as for Uraninite, Thorium ,
Radio - thorium .
The ionization produced by y rays from a given quantity of
RaBr., clearly depends upon the purity of the salt. As this may
be measured by its calorific value, we may be able to base our
system of measurement ultimately upon a determination as to
the quantity of heat given out by a definite weight of radio
active substance.
The y-ray ionization from a number of distinct specimens of
radium bromide has been compared with their respective weights,
and found to agree. My suggestion, therefore, is that the y-ray
ionization test be generally adopted for radium as a measure of
the quantity of active matter present, and I make it now with
ROENTGEN RAY .
all the more confidence because of the fact that it is becoming
the practice in many laboratories to follow this course.
It may not be clear, perhaps, that such a plan requires the
establishment of a radium standard. If we agree that it is
sufficient to know the weight of pure radium in a given salt, we
may talk in milligrammes instead of units of activity. But
further consideration will show that this involves the know
ledge of the ionization produced by unit weight of the substance.
It would actually necessitate as many empirical standards as
there are radio -active bodies. The simpler way, therefore ,
appears to be to adhere to the original idea, and to measure the
quantities of all active substances in terms of a radium standard.
For instance, let a and b be numbers proportional to the ioniza
tion produced respectively by such a standard, and some specific
ray from another active body. Then , if we know what value
of
a
corresponds to a definite quantity of that substance, we can
b
a
would be a constant for each active body, although in every
b
case a different type of ray might be chosen .
Owing to the infinitesimal amount of active substance required,
the radium standard need not be costly. The above plan has
the advantage that anyone provided with a table of the con
stants may measure against such a standard and by an
ionization test the purity of other radio -active bodies in his
possession .
The question whether it is necessary to standardize apparatus
seems at last to be finally disposed of. No part need be made
to any specified dimensions, except a small lead plate for the pur
pose of stopping all the B rays. This plate should be 1 centimetre
thick. A slight deviation — say of 1 mm. either way - would
not appreciably affect the readings, so that extreme accuracy
here is unnecessary ; but it is easy to make the plate correct to
0:1 mm. The apparatus required to carry out a test consists of
å sensitive electroscope, a plate of lead as large as a penny and
centimetre thick, a reading telescope, a stop -watch , and a
known weight of RaBr., in a sealed container. If the radium to
be tested is in a glass tube it is convenient to have a lead pot
ready to fit over the standard plate, so that while the bottom of
the tube rests upon the disc it lies aslant in the pot.
I have made an attempt to devise a way of setting up a
radium standard. It is difficult to prevent the loss of emana
tion ; every ebonite button containing RaBr, that I tested was
coated with a deposit of active matter due to the escape of
emanation .
The glass cover should not exceed 0 : 0035 inch in thickness.
(Those supplied for use with an oil immersion lens answer per
fectly.) It is cemented to a brass cell by means of shellac, and,
when the radium has been dropped in, the opening is sealed
with a gold-plated steel-bearing ball. A stiff spring holds the
ball firmly in position , and the cap, as well as the holder, are
thickened to enable the apparatus to be safely handled .
For the detection of yrays a sensitive electroscope is required.
With a view to simplifying calculations, its dimensions are
chosen so as to give about one electrostatic unity of capacity,
and the brass cylinder is provided with a removable cover
at either end. The top cap may be fitted with gold-beater's
 ARCHIVES OF THE
skin , aluminium , or whatever is required , and a small door
enables little flat dishes of radio -active material to be placed
actually within the electroscope. The difficulty of accurately
observing the edge of a moving gold leaf (often ragged in spite
of every care) has frequently been drawn attention to. It is
simpler to dispense with the leaf altogether, and to use instead
a fine fibre of electrically conducting glass. My assistant has
much improved the arrangement by attaching the fibre to a
small hinge of gold leaf. The fibre and its mounting are fastened
to a horizontal support by means of a bead of sulphur and
a sliding wire provided for the purpose of charging. The sup-
port may be either kept a constant potential or connected to
earth . I wish also to draw attention to a device for producing
Reviews.
Roentgen Atlas of Orthopedic Surgery. By Dr. A. HOFFA
and Dr. L. RAUENBUSCH. Published by Ferdinand Enke,
Stuttgart.
This is a fine quarto containing some eighty plates of skiagrams
of deformities. Such a work must prove of the utmost import
ance to students and surgeons. As the authors say in their
preface, in no branch of medicine have the Roentgen rays
brought greater assistance than in the study of orthopædic
surgery. They assist the diagnosis, they indicate the treatment,
they demonstrate to the patient the necessity for operation, and
they follow the result of the operation with scientific scrutiny.
The Atlas is, therefore, particularly designed to assist the
diagnosis, the ætiology, and the therapy of deformities.
The authors have directed their attention particularly to
practical illustration of cases suitable for surgical treatment,
tuberculosis of the bones and joints, rhachitis, congenital glenoid cavity, forming an opacity which hides the outline of
dislocation of the hip, and coxa vera. There are also examples
of chronic arthritis, loose bodies in the joint, bone-atrophy, and
also of syphilitic disease of the bone and osteomyelitis. In
most of the illustrations the negative is taken with sagittal
exposure, the patient lying supine on a couch—the photographic dress, for the benefit of the great English -speaking communities,
position therefore appears as if the patient were viewed from
behind. The position is not always clearly indicated in the
text. It should be remembered that, with this disposition of
the patient and of the focus-tube, the joint appears as if the
observer's eye were placed in the same position as the focus-tube,
so that the smaller and more sharply delineated details are
nearer to the eye.
The following are some of the more interesting plates :
Figures 1 and 2 show cases of cervical ribs on both sides. The
figures which follow, illustrating spinal deformities, most of
them in young subjects, are very beautiful examples of Roent-
genological art.
Figure 72 is the skiagram of a normal knee-joint of a patient
sixty years of age . In this figure is shown very clearly the
so -called “ fabella , " the sesamoid bone in the outer head of
ROENTGEN RAY. 55
the slight charges of electricity often required when using an
electroscope. The poor insulating power of celluloid, as well as
the ease with which it may be electrified by friction , are taken
advantage of.
A celluloid rod is charged by the rubbing action of a small
piece of flannel held in a metallic holder. The negative charge
acquired by the rubbed portion slowly spreads to the other end
of the rod, and serves to electrify the fibre of the electroscope.
By direct friction of the projecting portion of the celluloid rod
against the sliding wire support the latter becomes charged
positively. Since celluloid does not readily condense moisture
upon its surface, the apparatus may be used on a damp day, or
in a crowded room , with little or no risk of failure.
the gastrocnemius muscle, which is frequently mistaken for a
loose cartilage in the knee -joint.
Figure 74 is an example of some of the difficulties of nomen.
clature. It is an illustration of a loose body in the joint, and
is described in the text as a view of the right knee from before
(von vorn) . It should be described as a view of the right knee
from behind. Evidently the focus-tube was placed in front of
the knee . The same may be said of Figure 75. Figure 78, on
the other hand, is correctly described as a front view of the
right knee, taking the assumed position of the spectator as the
point of orientation.
Figure 120 is of great interest. It is the shoulder -joint of a
young patient, twenty years of age, who had been treated for
caries of the shoulder by means of iodoform -glycerine injection .
The iodoform has accumulated around the rugosities of the
the glenoid cavity.
The photographs are very good, and the whole style of the
Atlas does great credit to the publishers, F. Enke of Stuttgart.
We only wish there was a probability of seeing it in English
who are, however, apparently less keen than their German
cousins in their determination to know all that there is to know
of Roentgenology.
Messrs. Watson and Son's booklet on the Intensified Induc
tion Coil and Moto -magnetic Interrupter, now to hand, reminds
us that the last word has still to be said upon the subject
of electro -therapeutical apparatus. The interrupter embodies
several novel features, and if it does all that is claimed for
it will reduce some of the drudgery of practice. We note
that Messrs . Watson offer to send it to any member of the
medical profession on a seven-days' trial free of all cost. The
Bauer Air -cooled X-ray Tube, also advertised, is said to pass
10 milliampères of current with safety.
56 ARCHIVES OF THE ROENTGEN RAY .

Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR , -Can any of your readers tell me if there is any
objection to the use of metallic mercury instead of bismuth for
the radioscopic examination of the stomach and bowels ?
believe it was formerly given in large doses for the treatment of
rupture, and that without any ill effects. The liquid mercury
passed through the bowels unoxidized , and was recovered from
the fæces. I should be glad of any information on the subject.
Yours truly,
IGNORAMUS.
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
DEAR SIR ,-A device for the optical intensification of pictures
is described by R. W. Wood in the Scientific American of
February 9, 1907. The painting is photographed , and a lantern
slide is made from the negative. This is projected by an arc
lamp on to the picture, and by this means the details of the
faint and faded painting are emphasized. It is possible that a
I similar device might be used in Roentgenography in order to
emphasize the faint shadow of a kidney stone, or the like. A
lantern -slide of the skiagram would be made in the ordinary
manner. When this is projected on to the skiagram , and the
lantern adjusted until the outlines coincide , the shadows of the
Roentgenogram will be reinforced. If necessary, the reinforced
Roentgenogram might be photographed in its turn .
It would be interesting if some of your readers would make
the experiment.
Believe me , dear sir,
Yours truly ,
WINDSOR.

PLATE CCLXVIII .
TO ILLUSTRATE ARTICLE ON BASE -BALL FINGERS BY DRS. J. N. HALL AND G. H. STOVER (PAGE 41 ).
PLATE CCLXIX. ( Figs. 1 AND 2) .
TO ILLUSTRATE DR. G. B. BATTEN'S ARTICLE ON THE X-RAY TREATMENT OF RINGWORM (PAGE 42).
PLATE CCLXIX. (Fig. 3) .
TO ILLUSTRATE PROFESSOR AUGUST V. LUZENBERGER'S PAPER ON HEXADACTYLIA (PAGE 41 ) .

The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send, with any prints intended for publication, a full account of the
case and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used, or any otherfacts of interest.
EDITOR'S AND PUBLISHERS' NOTICES.
THE EDITOR begs to acknowledge communications from Dr. Herschel Harris ( Sydney), Dr. Cowl (Berlin ),
Professor Colombo (Rome), Dr. Thurstan Holland (Liverpool), Professor Doumer (Lille), Dr. Kienböck (Vienna).
The following Journals and Periodicals have been received : “ Advanced Therapeutics,” “ The Electrician ,”
“ The Electric Review ,” “Knowledge ," " The British Journal of Dermatology ,” “ Annals of Physico -therapy,”
“Medical Times, ” “ Medical Electrology and Radiology," “ Archives of Physiological Therapy,” “ Archives
d'Électricité Médicale ," "Le Radium," " Annals d'Electrobiologie et de Radiologie," " Fortschritte auf dem Gebiete
der Röntgenstrahlen,” “ Münchener Medizinische Wochenschrift,” “ Zentralblatt für Physikalische Therapie,”
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VO . XII.
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de

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RAB
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AND ALLIED PHENOMENA
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AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH
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G.

York ); JNO.C.RANKIN ( Belfast ); WERTHEIM SALOMONSON (Amsterdam );

W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM
WILLIAMS ( London ); CLARENCE WRIGHT ( London ).

CONTENTS
PAGE PAGE

EDITORIAL · 57 NOTES AND ABSTRACTS (continued ) :

THE PRODUCTION OF OZONE 81
SECOND INTERNATIONAL CONGRESS OF PHYSIO -THERAPY,
EQUIPMENT FOR X- RAY WORK 82
ROME 58
REMOVAL OF NEEDLES UNDER THE X RAY 82
THE ELECTRICAL, RADIOGRAPHIC, AND ALLIED DEPART
LIGHT TREATMENT OF OZANA
-

82
MENTS AT THE LONDON HOSPITALS 59
PHOTOTHERAPY IN NERVOUS DISEASE 82
ORIGINAL ARTICLES :
BISMUTH AND THE X RAYS IN THE DETECTION OF GASTRIC
SOME DIFFICULTIES IN THE X- RAY DIAGNOSIS OF RENAL 83
ULCER
CALCULUS . - By C. THURSTA , HOLLAND, M.R.C.S. Eng .,
L.R.C.P. Lond . 61 REPORTS OF SOCIETIES 83
A CASE OF OSTEO -ARTHRITIS TREATED WITH X RAYS.
REVIEWS :
By MARGARET M. SHARPE, L. R.C.P. , S. , and Ed . 65 86
DIE RÖNTGENSTRAHLEN IM DIENTSE DER NEUROLOGIE
TREATMENT OF PAGET'S DISEASE BY RADIO - THERAPY.
By Dr. J. BELOT .
- 67 ARCHIVES INTERNATIONALES DE LARYNGOLOGIE, D'Oro
LOGIE ET DE RHINOLOGIE 86
ARCHIV FÜR PHYSIKALISCHE MEDIZIN UND MEDIZINISCHE
THE ACTION OF Uviol LIGHT ON THE SKIN , AND ITS THERA TECHNIK 87
PEUTIC USE IN DERMATOLOGY. - By Dr. Carl Stein and
70 CORRESPONDENCE - 87
DR . HESSE, Düsseldorf
SOME New High -FREQUENCY DEVICES. — By HENRY G. PLATES :
PIFFARD, M.D. , LL.D., New York 78
Plates CCLXX. , CCLXXI. , CCLXXII. (Figs. 1 to 12).
NOTES AND ABSTRACTS : To ILLUSTRATE DR . C. THURSTAN HOLLAND'S PAPER
PROTECTION OF THE SKIN IN THE TREATMENT OF LEU ON SOME DIFFICULTIES IN THE X-RAY DIAGNOSIS OF
KAMIA .
81 RENAL CALCULUS.

LONDON
REBMAN LTD ., 129 SHAFTESBURY AVENUE, W.C.
-
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There are already over seventy of these interrupters in use.

Write for descriptive and Illustrated Booklet, No. 7c, post free and gratis on application to
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21 , Mincing Lane, London , E.C.

REMOVAL .
OFFICE , SALES - ROOM , FACTORY ,
113 , 115 , 117 , West 31st Street,
NEW YORK CITY.
To Our Friends :
On March 1st we removed to the above address. This removal was necessitated on
account of large increase in business ; more spacious quarters were necessary.
You are most respectfully invited to call and inspect the finest and most complete line of X- Ray,
High-Frequency, and Electro-Medical Apparatus.
Yours very respectfully,
New Telephone No. :
5795 Madison Square . WAITE & BARTLETT MFG. CO.
VOL. XII.-No. 3. AUGUST , 1907 .

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY , PHOTOTHERAPY , THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER , M.R.C.S. , F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York ); T. P. BEDDOES (London); J. BELOT (Paris ); A. BÉCLÈRE (Paris) ; F. BISSERIE (Paris) ;
H. BORDIER ( Lyons) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ); W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
(Paris) ; L. DELHERM (Paris) ; R. W. FELKIN (London) ; L. FREUND (Vienna) ; H. E. GAMLEN (West Hartlepool); G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN (Lincoln) ; H. GUILLEMINOT ( Paris); D. GUNZBURG ( Antwerp ) ; J. HALL-EDWARDS
( Birmingham ) ; G. HARET (Paris) ; C. THURSTAN HOLLAND (Liverpool) ; G. HOLZKNECHT (Vienna) ; F. H. JACOB ( Nottingham ) ;
LEWIS JONES (London ); A. C. JORDAN (London ) ; ARCH . JUBB (Glasgow ) ; E. LAQUERRIERE (Paris ); S. LEDUC (Nantes) ;
E. R. MORTON ( London ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD ( New York) ; JNO. C. RANKIN ( Belfast) ; WERTHEIM
SALOMONSON (Amsterdam ); W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM (London ) ; CHISHOLM WILLIAMS (London) ;
CLARENCE WRIGHT ( London ).

RADIUM-THERAPY, like all novel remedial methods, has influence in any marked degree the evolution of a deep
passed through the usual three stages of evolution . In seated and widespread cancer.
the first stage, the new remedy is good for every ill that From a theoretical point of view , the most interesting
flesh is heir to ; in the second , it is good for nothing at question is that of the physiological action of the
all ; while in the third it is found to be useful in a some- radiations, and their selective action on pathological
what limited number of pathological conditions. tissue. This question will be found intimately bound up
Although only some ten years old , the treatment by with the further question, What is the common factor
radium irradiation is already approaching its third stage, underlying the action of radium, of Roentgen rays, and
and we are now in a position to define its sphere of of ultra-violet light ? Some recent researches on the
action with some degree of certainty . The subject is to action of radium on animal ferments seem to indicate
be discussed at the Exeter meeting of the British Medical that the action is a chemical one, perhaps an oxidation.
Association , and we trust that further light will be At all events, the ether waves set up some motion of the
thrown on its utility and technique. electrons of the tissue which is incompatible with the
Soon after its discovery by Mme. Curie in 1896 development of aberrant, immature, or rapidly growing
radium was impressed into the service of medicine. cells. The subject is one that would well repay inquiry.
Professor H. Becquerel and other early workers suffered For the due development of radium-therapy the dose
from accidental burns from carrying the newly discovered of the irradiation must be accurately defined. This
substance on their persons. This speedily led to its use question of dosage is in a very unsatisfactory state .
in diseases of the skin, for it is in dermatology that is almost impossible, under present conditions, for
radium has gained its greatest triumphs. observers in different countries to compare their results,
According to many careful observers, radium irradia- or for an experimenter to repeat his experiments under
tion is the ideal treatment for a rodent ulcer, a small precisely the same conditions. The quality and quantity
focus of lupus, or a cutaneous epithelioma. Of late its of the salt of radium, its state of aggregation, the radio
use has been extended to the treatment of pruritus, the activity of the specimen, the thickness and quality of the
removal of birthmarks, and of neoplasms or infiltrations cover, the material of the backing, are all subject to
of the skin of doubtful origin. As yet, however, neither variations which are difficult to measure and impossible
the natural radio-activity of radium nor the artificial to define. It is to be hoped that the labours of the
radio -activity of the Roentgen tube has been proved to many eminent workers, both in this country and abroad,
9-2
58 ARCHIVES OF THE ROENTGEN RAY .

who are turning their attention to this subject may Turner, Lauder-Brunton, Butcher, etc., from England ;
furnish us ere long with a practical standard of radio- MM. Winiwarter, Jacques, Gunzburg, Ioteyko, from
activity. Belgium ; MM. Rosenthal , Slomann , Jacobaeus, Reyn,
Another, and perhaps the greatest, drawback to the etc., from Denmark ; MM. Sañudo, Taboada, Decref,
further development of radiuin -therapy is its enormous Perez , etc., from Spain ; MM. Bouchard , Béclère, Ber
cost. The price of radium is a measure of the labour gonié, D'Arsonval, Lagrange, Landouzy, Kirmisson ,
required for its extraction, and this shows no signs of Robin, Raymond, Faure , Weil, etc. , from France ; MM.
decreasing. We recently saw at a public hospital a Savas, Vassilidès, etc., from Greece ; M. Kitasato, from
child with nævus over the whole of one side of the face. Japan ; MM . Wenckebach , Wertheim Salomonson ,
This had been treated with radium with fairly satisfactory Breemen, from Holland ; MM . Ketly, Dollinger, Kor
results. The treatment, however, had lasted over a anyi, Herczel, Donath, etc., from Hungary ; MM . Bom
year, with an expenditure of time and money which is barda, Machado, Neves, etc., from Portugal ; MM. Holst,
only possible in the case of a millionaire - or a pauper. Mellbye, etc. , from Norway ; MM . Marinesco, Gerota,
Sarafidi, etc. , from Roumania ; MM . Bechterew, Turner,
Korolko, Schmiguelsky, etc. , from Russia ; MM . Cur
mann , Wide, Zander, etc., from Sweden ; MM. Berdez,
SECOND INTERNATIONAL CONGRESS OF PHYSIO- Eichorst, Roux, Schulthess, Scholder, etc., from Switzer
THERAPY, ROME. land ; MM . Altamirano, Cicero, etc., from Mexico ;
MM. Baccelli, Bianchi, Bozzolo, De Giovanni, De Renzi,
Special Travelling Facilities.
Durante, Grocco, Maragliano, Murri, Morselli, Tam
The Italian Minister of Public Works has granted special burini , etc. , from Italy.
travelling facilities to all members attending the Second The object of the Italian Government is to offer to all
International Congress of Physio-therapy, to be held at members of the Congress, but more especially to those
Rome from the 13th to the 16th of October. The re- from abroad, a means of visiting the parts of Italy which
duced fares apply to all lines, both on the mainland and may be of special interest to them on account of their
on the islands . natural value as climatic resorts, either at the sea-shore
The Organizing Committee of the Congress is author- or in the mountains, and the principal water- cures and
ized to issue to each member or associate, duly enrolled , thermal stations.
a book of railway coupons. Each coupon entitles the Merchandise intended for the Exhibition can claim
holder to a ticket at from 40 per cent. to 60 per cent. the reduced tariff, both on the outward and also on the
reduction on the ordinary fare. As the book contains return journey
twenty tickets, available for any journey in any part of The different foreign Governments have also been
Italy, it enables members to make an extended tour in approached with a view to obtain similar facilities for
the country at greatly reduced cost . travellers passing through their territory, or travelling
The coupons are valid for forty -five days from by their steamboat services.
October 1 to November 15, 1907. Ladies duly registered Applications for membership should be accompanied
as associate members of the Congress and exhibitors are by the subscription of twenty francs for members, or
also eligible for the reduced fares. fifteen francs for associates, and should be sent to the
These exceptional facilities are granted in view of the General Secretary, Professor Carlo Colombo, Via Plinio 7,
great importance of the Congress, when some of the Roine. The English Secretary is W. Deane Butcher 9

most illustrious savants from all parts of the world will
assemble at Rome. Among those who have already
signified their intention of being present are : MM . von
Leyden , Curschmann, Evald , Hoffa, Krauss, Penzoldt,
Senator, Strümpel, Immelmann, etc., from Germany ;
MM . Bishop, Morton, Snow , from America ; MM. von
Noorden , Jaksch, Bum , Lorenz, Holzknecht, Kienböck ,
Rokitansky, etc. , from Austria ; MM. Lewis Jones,
M.R.C.S., Holyrood, Ealing.
The Exhibition of electrical and other instruments for
physical treatment, in connexion with the second Inter
national Congress of Physio-therapy, will be held at
the Hôpital Policlinico at Rome from October 13 to
October 25, 1907. Books, photographs, and plans of
thermal stations and sanatoria, will also be exhibited.
 ARCHIVES OF THE
Regulations for the admittance of exhibits may be
obtained from the Editor of this Journal.
Among the exhibits at the recent Conversazione at the
Royal Society, the following were of special interest to
radiologists :
Mr. A. A. CAMPBELL Swinton showed some novel
Vacuum Tube Phenomena.
1. The mechanical effects of canal rays in causing the
rotation of mill-wheels in Crookes's tubes .
These rays, which are positive, travel in the opposite
direction to the negative rays that proceed from the
cathode. They can be detected both when they are
approaching the cathode, and also, if the latter is per
forated, after they have passed through the apertures.
2. Photo -micrographs of the bubbles that are developed
by sudden heating of portions of the glass walls of
Crookes's tubes, owing to the occlusion by the glass of
the residual gas during prolonged use.
3. Exhibition in the microscope of a special case of
the above, in which the sudden heating was occasioned
by an electric spark , which has thus impressed its own
image on to the glass. The image is entirely made up
of minute bubbles , and from its form it is clear that the
spark was a positive one.
Mr. C. E. S. PHILLIPS showed a Fibre Electroscope.
In this instrument the gold-leaf is replaced by a fibre physician in charge (Dr. Ironside Bruce).
of electrically conductive glass, which is delicately hinged
so as to move very readily under the influence of a
difference of potential. Other details are introduced to
render the apparatus especially suited for research in
radio -activity
Mr. W. DUDDELL, F.R.S., exhibited a method of in the Dermatological Department by Dr.J. H. Macleod,
obtaining Persistent Electric Oscillations.
The oscillations are produced by the method of the
“ musical arc.” In this method a direct-current arc is
shunted with a circuit consisting of a condenser and a
self-induction in series. The frequency of the oscilla
tions can be varied by altering either the capacity or the
self-induction in the shunt circuit. The oscillograph
records exhibited showed the variations in the potential
difference and current when the oscillations are pro
duced.
To obtain powerful oscillations at very high frequencies Morton), and a medical radiographer (Dr. Alfred Jordan).
the arc may be placed in hydrogen gas as employed by
Paulsen .
ROENTGEN RAY. 59
In the apparatus shown the arc burnt in coal-gas, and
no magnetic field was used to blow out the arc.
Experiments in magnetic induction, tuning, and dis
charge in vacuo, are easily demonstrated with persistent
high- frequency oscillations.
The persistent oscillations are of special use for
energizing the transmitter in wireless telegraphy, as
they permit better syntony or tuning to be obtained.
Mr. J. MACKENZIE DAVIDSON exhibited a series of
Stereoscopic X -ray Photographs.
These showed the great advantage of stereoscopic
methods for determining correctly the relative size and
position of the various portions of the skiagram.
THE ELECTRICAL , RADIOGRAPHIC, AND ALLIED
DEPARTMENTS AT THE LONDON HOSPITALS.
We are indebted for the following notes of the electrical
and allied departments in the London medical schools
and hospitals to the Editors of Medical Electrology and
Radiology.
LONDON HOSPITALS AND MEDICAL SCHOOLS.
Charing Cross Hospital, - The Electro -therapeutic
and Radiographic Departments are combined under a
The departments are open daily. Hours for attend
ance of out- patients : every afternoon at 2.30.
Lay assistance : One male operator, one nurse.
No lectures.
X-rays and light treatment are also applied to patients
physician to that department.
Hours of attendance : Daily at 2 p.m.
One male operator.
Guy's Hospital.--Three separate departments : One
for Electro-therapeutics, one for Light and X-ray Treat
ment, and one for Radiography. The former under
Dr. Hertz ; the second under a medical officer in charge
of the Actino -therapeutic Department ( Mr. Iredale) ; the
third under a senior surgical radiographer ( Mr. E. W.
Shenton ), a second surgical radiographer (Dr. C. J.
Lay assistance : One mechanic, one lady photographer.
Departments open daily.
60 ARCHIVES OF THE ROENTGEN RAY .

No lectures at present. St. George's Hospital. - No Electrical Department at

King's College Hospital. — One department for Electro- present. The radiographic work is done by a non
therapeutics and Radiography under an electrical medical medical operator (Mr. Addyman).
officer (Mr. Archibald Reid ). X-rays and light treatment are carried on in the
Lay assistance : One male attendant, one nurse. Dermatological Department under the direction of Dr.
Department open daily. W. S. Fox.
Hours for attendance of out- patients : 10 to 5. St. Mary's Hospital. — Two departments : One for
No lectures. Electro-therapeutics under an electro-therapeutic officer
London Hospital. - Two departments : One for Electro- (Dr. Wilfrid Harris), and one for Radiography and
therapeutics and Radiography and Clinical Photography, X -ray Treatment under a medical officer in charge of
under a medical officer in charge of the Electrical De- the X-ray Department ( Dr. G. Allpress Simmons) .
partment (Dr. E. R. Morton), who is also lecturer on Lay assistance : One male attendant (part services ),
therapeutic electricity and radiography. There is also a one nurse.

qualified clinical assistant. X -ray Department open daily. Out-patients on Mon

Lay assistance : An operator for the radiographic day, Tuesday, Wednesday, Friday, from 2.30 to 4.30,
work, an assistant operator, and a clinical photographer ; and Saturday from 10 to 12. Electro- therapeutic De
also one male attendant and two nurses, and a man to partment open on Tuesday and Friday at 10 a.m.
help in the photographic dark -room . St. Thomas's Hospital. — One Electrical and X-ray
Hours of attendance for out-patients : Daily in the Department under a physician in charge (Dr. A. H.
afternoon, except Saturdays. Greg) .
There is also a Photo -therapeutic Department under (The electrical examinations of nerve and muscle are
the charge of Dr. Sequeira, with a large staff of nurses. done by Dr. Turney. )
Middlesex Hospital. - A Finsen and Electric Depart- Lay assistance : Two male attendants and three nurses.
ment under the care of a surgeon to the department Department open daily.
(Mr. C. R. C. Lyster ). Hours for attendance of out-patients : Tuesday and
Lay assistance : One male operator, one nurse . Friday afternoons.
Department open daily from 9 till 5. Westminster Hospital.-One Department for Electro
Royal Free Hospital. - One department for Electro- therapeutics and Radiography under a medical officer in
therapeutics and Radiography under a radiographer and charge (Dr. M. D. Sale -Barker).
medical electrician (Dr. G. Harrison Orton). Lay assistance : One male, one female.
Lay assistance : One male operator, one nurse. Department open daily. Out -patients at 2 o'clock.
Department open five days a week at 2.30 o'clock . University College Hospital. - Two departments : One
St. Bartholomew's Hospital. - One department for for Electro-therapeutics under a medical officer in charge
Electro -therapeutics and Radiography under a medical of the Electro - therapeutic Department ( Mr. E. S.
officer in charge of the department, Dr. Lewis Jones, Worrall), and one for Radiography under a inedical
who is also lecturer on medical electricity and electro- officer in charge of the Radiographic and Photographic
therapeutics. Department ( Mr. R. H. Cooper).
Two chief assistants : Dr. Hugh Walsham and Dr. The Electro -therapeutic Department is open five days
J. M. Flavelle, Clinical assistant : Dr. Orton . a week. The Radiographic Department is open daily in
Lay assistance : One male attendant and one special the afternoon from 1.30 to 4.
nurse. Assistance : Two nurses in the Electro -therapeutic
The staff and servants are about to be increased in Department, one nurse in the Radiographic room , with
number by the addition of another medical officer, a a male assistant working in both.
lay photographer, an electrical mechanic, and a second Lectures and practical demonstrations are given by
nurse. Mr. Worrall .
Department open daily from 9 a.m. to 5 p.m. Medical Graduates' College and Polyclinic. - Practical
Hours
for out - patients : 1.30 to 4.30, Monday, Tuesday, classes on the application of the Roentgen rays by
Thursday and Fridays. Dr. Harrison Low.
 ARCHIVES OF
Hospital for Diseases of the Skin, Blackfriars.—
Medical officer in charge of Light Department, T. P.
Hartigan, F.R.C.S.
St. John's Hospital for Diseases of the Skin.—Medical revealed the presence of a stone ; and, vice versa, in all
officer in charge of Electrical Department, Dr. V. H.
Rutherford .
Assistant medical officer to Electrical Department,
Agnes F. Savill, M.D.
Assistance : A clinical assistant and a nurse ; no lay
assistants.
London Skin Hospital.— Medical officer in charge of its shadow may hide those of smaller calculi lying either
Electrical Department, Dr. W. Deane Butcher.
Assistant medical officer to Electrical Department,
Dr. R. H. Johnston.
Assistance : One clinical assistant, one lay assistant.
Every member of the staff is at liberty to use the
electrical installation for the treatment of his own
patients.
SOME DIFFICULTIES IN THE X-RAY DIAGNOSIS
OF RENAL CALCULUS .
C. THURSTAN HOLLAND, M.R.C.S. Eng., L.R.C.P.
Lond. ,
Hon. Medical Officer in charge of the Electrical Department,
Liverpool Royal Infirmary.
( For Illustrations see Plates CCLXX ., CCLXXI.,
and CCLXXII.)
With the great improvement in the technique of the past
two years, with the increased facility with which good
negatives can be obtained, and with the much greater
certainty of results, has arisen a corresponding desire on
the part of physicians and surgeons for an X-ray ex-
amination in all cases of suspected, and indeed of un-
suspected , renal calculus. By the latter I mean that
very many cases are now examined by X rays more for against stone if no shadow suspicion of this is indicated.
the purpose of certainly negativing, rather than from
the point of view of confirming, the presence of stone.
One is able to assert that at the Liverpool Royal In-
firmary, so great is the confidence of the staff in the reports
from the X-ray department, that every case which presents
itself which gives rise to the smallest doubt is referred for
X-ray examination ; and it is not too much to say that
if the department gives a decided positive or negative
opinion, then this opinion is accepted with full con-
fidence ; further, the operations conducted during the
past two years have in each case strengthened their con-
THE ROENTGEN RAY . 61
fidence. In not one case where a decided negative opinion
has been given bas a subsequent operation, or, indeed, the
subsequent history of any case that has been traced,
cases where a decided positive opinion of the presence of
stone has been given, a stone or stones have been found
in all those operated upon .
It is not always possible to decide upon the exact
number of stones present, especially when one or more
is of very large size, as when there is a large calculus
in front of or behind it ; as a rule, though , the exact
number of stones can be foretold .
It is not always easy to obtain plates of the quality
which is necessary in order to be confident in making
a negative diagnosis, but in most cases these can be
obtained, and if from any cause one does not get suffi
ciently diagnostic plates, then this fact is recognized and
a guarded opinion — with an explanation - given. One
interesting point in making the positive diagnosis has in
a large experience of stones become evident; in all our
cases, practically without an exception, if once a shadow
of a stone has been obtained upon a negative, the stone
shadow has always been indicated in all other plates ex
posed on the same region, whatever their density, and
whether good, bad , or indifferent. This point is strongly
suggestive of the fact that negative plates, although not
absolutely reliable unless the edge of the psoas is shown,
are, nevertheless, not altogether valueless, as on very
many of these plates the stone shadow showed quite
plainly even when there was no indication of the edge of
the muscle, and the ribs and transverse processes were
also indistinct. Thus, a fair plate, not too dense,and show
ing a certain amount of tissue differentiation, even if the
last ribs and transverse processes are indistinct, and even
if the psoas edge is not shown, is, nevertheless, strongly
The method of examination adopted has been the same
in all cases examined, and consists essentially in that a
diaphragm compressor is always used with as much pres
sure as can be borne. The lower edge of the compressor
is longer than the upper, so that it can be passed well
into the abdomen without unduly pressing on the ribs ;
the fact that stone shadows appear fairly sharp is proof
that this fixes the kidney under examination. This
method necessitates for complete thoroughness the ex
posure of four or five plates at least, which is no doubt a
drawback in a department where the work is overwhelm
62 ARCHIVES OF THE ROENTGEN RAY.

ingly large, but mistakes will occasionally happen unless
the whole area on both sides is examined .
I do not propose in this paper to deal with the whole
subject exbaustively, but shall restrict my remarks to a
few points in the X -ray diagnosis, and quote some illus-
trative cases, and shall therefore treat each little diffi-
culty separately.
1. Facal Concretions. — This has often been referred to
by surgeons and others as a difficulty ; as a matter of
routine the bowels should be thoroughly evacuated before
this point, is the radiograph of a kidney which was as
large as a fatal head, and only just contained within
the ring of the compressor ; it was found to be a mere
bag full of pus, and in this is clearly shown a stone,
which was also found at the operation.
I only mention this here to express my opinion that,
notwithstanding that so much has been said to the con
trary, the presence of pus makes no difference, and
stones can be shown just as easily as when there is
none .

the X-ray examination is made , and then , should any Tubercular deposits may sometimes be shown, and
doubt exist (and I think the shadow of any fæcal concre- quite possibly these might be the cause of difficulty, or
tion would always be a doubtful one), a further clearing even of error, in certain cases. In most of the cases of
of the bowels and a second examination would always tubercular kidney which have come under my notice no
prevent any mistake being made. I have never met with shadow suggestive of stone has been obtained, unless,
any difficulty of this kind except in one case where what does not appear to be very uncommon, a stone
bismuth was being taken. was present as well.
The case was of a somewhat interesting character : a In one case of practically certain double tubercular
lady who landed from America with an attack of acute kidney of old standing, on the radiograph & blotchy
pain in the right side, and with a history of having on a shadow occupied the whole region of both kidneys.
previous occasion passed a stone. Pus, but no blood . These shadows, as a whole, were the size and shape of
was found in the urine. She was brought into hospital, kidneys, and darker and lighter areas alternated ; the
and immediately X - rayed ; in the right kidney region was darker areas probably represented caseating masses , with
a dark shadow, which might very easily have been mis- possibly some phosphatic deposit, but one felt sure that
taken for a stone, and in the pelvic region was the extra- there was no definite calculus ( Fig. 3).
ordinary condition shown in Fig. 1. A second skiagram , A third case may be mentioned here in which a large
taken the next day, showed very similar appearances in tumour was present in the right side, the nature of which
the pelvis, but it was noted that in the region of the right was doubtful, but which was thought to be renal, and in
ureter was an oblong shadow , about 1 inch long, in which the X ray showed a number of minute shadows
the same position in both the radiographs ; it was also occurring in groups. At an operation it was found that
discovered that the patient was taking bismuth . The the tumour was a large malignant growth which could
bismuth was stopped, the bowels well cleared out, and not be removed, and we considered that the small
then all the shadows, including that in the kidney region, shadows on the X-ray plate were due to calcareous
but excepting the oblong one already referred to , disap- deposits in this growth. In this individual case no
peared. This latter shadow was diagnosed as being due question arose as to these shadows being due to renal
to a ureteral calculus. All symptoms subsided and the calculi , but at the same time it is possible that similar
patient left hospital, but two weeks later, with an attack shadows might in another such case be so arranged as
of colic, a stone was passed which weighed 4 grains and to cause doubt .
corresponded to the shape of the X -ray shadow. 3. Calcareous Glands .-Shadows due to the presence
2. Pus in the Kidney : Tubercular Deposits, etc.—My of calcareous glands are undoubtedly more difficult than
experience of pus in the kidney is that it in no way any others to differentiate from the shadow of renal
affects the reliability of the X-ray examination ; and on or ureteral calculi. These shadows may be single or
many occasions it has been possible to show stones quite multiple, may occur in or about any part of the stone
clearly even in the presence of large quantities of pus. area, and so may simulate kidney stone, or ureteral
In one case , where two stone shadows were shown, the stone in any part of the course of the ureter ; and, what
kidney was found at the operation to be the site of three is still more unfortunate, a kidney stone shadow may
separate abscesses, and the stones were situated in two sometimes by its position and shape and appearance
of the latter. Fig. 2, which exceedingly well illustrates simulate that of a calcareous gland, and then mistakes
 ARCHIVES OF THE ROENTGEN RAY. 63

may happen from both points of view. I have met with It seems to me probable that in both these cases a
cases of all kinds. calcareous gland was the cause of the shadows ; but at
Often the position and shape of the shadows will help the same time the position of the shadow - namely, so
in diagnosing them as being due to calcareous glands; low down-is not diagnostic, and this can be shown by
sometimes we may find a considerable number of these the next case . In this the shadow is opposite the trans
shadows in the abdominal region, and then, as a rule, verse process of the fourth lumbar vertebra (Fig. 6),
there is no doubt about the cause, but it must be on the right side. It was not suspected before the
remembered that it is possible for both renal calculus operation that the kidney was in this position ; never
and calcareous glands to be present at the same time. theless, a stone was removed from the right kidney, and
A case of this kind occurred at the Royal Infirmary its size corresponded with that of the shadow.
last year. A young medical man (Fig. 4) had a septic A further case adds still greater difficulties to the
wound of the finger, and shortly afterwards developed a certain diagnosis. Fig. 7 is the pelvic region of a gentle
kidney abscess ; this abscess was opened and drained, man who for some years had been more or less of an
but the sinus showed no signs of closing, and on going invalid owing to the presence of pus in his urine, and
most carefully into the history of the case it came out to attacks, very sudden and severe, of pain and fever,
that, although for the past year he had been well, followed by an increase in the quantity of pus. Several
previously to that there had been attacks of very severe of these attacks had been serious enough to threaten his
backache following exertion , and that this had continued life. Repeated X -ray examinations at intervals always
for a considerable time. An X -ray examination showed showed the shadow seen in the illustration, and no other
the appearances seen in Fig. 4, and at the operation a abnorinal shadows could be found in any other part of
stone was removed from the kidney-the upper shadow- the stone area. At the operation a calcareous gland was
and a fixed calcareous gland was found, which accounted found adherent to the ureter, and in the ureter at the same
for the lower shadow. spot was found a tiny calculus. The calcareous gland
In two cases large shadows, roughly oval in shape, substance removed weighed 0-70 gramme, the calculus
about 1 inch long and ì inch broad , have been found in 0·022 gramme. It seems certain that the passage of this
patients presenting certain symptoms pointing to kidney calculus was prevented by the pressure of the gland, and
stone ; on each occasion the shadow has appeared on that at times more or less obstruction occurred, with
the negative at about the level of the transverse process of attacks of pyelitis. Since the operation, nearly a year
the third lumbar vertebra, and close to its outer margin, ago, there have been no attacks of illness ; and although
once on the right and once on the left side. In the one microscopically the urine still contains a few pus cells,
case (Fig. 5) the kidney symptoms were very indefinite, which are supposed to be of kidney origin , the patient
and it was not considered that an operation was justified. is perfectly well, and has regained his health and
In the other case, in addition to long- standing backache, strength.
there was intermittent hæmaturia, and with the whole 4. The Necessity of a Complete Examination . - In some
stone area examined this was the only shadow found. of the cases already referred to the necessity of this
Some doubt, chiefly owing to the position, was expressed procedure has been obvious, and mistakes and difficulties
as to this shadow representing a calculus, but as the in diagnosis will frequently result unless great care is
symptoms suggested the latter, an operation was decided taken that th whole stone area is examined .
upon. The kidney was brought out on to the loin , In two cases which have come under my notice
incised , and thoroughly examined ; nothing abnormal kidneys have been removed for pyonephrosis without an
was found, no stone was present, and no cause for the X -ray examination having been made ; no kidney stone
shadow could be discovered. During the few weeks was present in one case, whilst it is not certain in the
the man was in hospital before the operation he was other whether a small stone was found or not. How
examined with X rays on three occasions, the bowels ever, in both cases the real cause of the trouble was
having been cleared out previously, and all the plates undoubtedly ureteral calculi, and this is shown by the
showed the same shadow . He was X -rayed again a following illustrations. Fig. 8 shows the right pelvic
fortnight after the operation, and the shadow was still region of a nurse whose left kidney was a bag of
there. pus. The remains of the kidney were removed, the
10
64 ARCHIVES OF THE
ureter was found to be enormously dilated , and a sound
passed down was felt to grate against a calculus ; an
attempt was made to remove this, but it was not
successful. Later, when the patient had recovered
from the operation , the radiograph (Fig. 8) was taken ,
and shows an extraordinarily large ureteral stone. It
is now nearly two years since the operation ; the stone
is still in situ , and gives rise to no symptoms at all.
In the other case the radiograph (Fig. 9) was taken
three and a half years after the kidney had been
removed because of a return of symptoms -- namely, pain
and hæmaturia. The X -ray examination , in addition to
showing the two large calculi in the left ureter, showed
also several calculi in the right, the only kidney, and it
was deemed advisable not to operate.
The two following cases are also very instructive as quently is not in favour of an exploratory operation the
showing not only the necessity for a thorough examina- result of which is so very doubtful.
tion , but also the difficulty of diagnosis even when this
has been made.
A careful examination of the whole stone area of a
lady who suffered from severe aching pain in the right
side over a period of five years was made. There was
no other symptom , and an operation for the removal
of the appendix one year previously had not done
any good. The X -ray examination is entirely negative,
with the exception that very low down and far out on
the right side of the pelvis, just below and almost
touching the point of the shadow of the ischial spine, is it helped to make certain the diagnosis. Fig. 12 shows
a distinct oval shadow , inch long and inch broad
(Fig. 10). No doubt this shadow is very suspicious of
stone in the ureter, but it is very far out and low down,
and in the absence of acute renal attacks , pus, and
hæmaturia, it is a great responsibility to urge an opera-
tion of the severity entailed in an attempt to remove
this " doubtful shadow,” when one knows that phlebo
liths, calcareous patches on vessels, and especially calca-
reous gland shadows, often show in the pelvic region.
The same remarks apply almost with equal force to the
next case. A gentleman , forty-eight years of age , had , on
and off, at intervals of from eighteen months to two
years, for sixteen years past, attacks of " claret-coloured
urine " for from six to nine days. No pus, no acute
renal attacks, no backache; but during the last attack,
the worst of the series, his doctor noticed that there was
some pain, tenderness, and fullness over the right kidney. in with hospital patients, with private patients cost has
After a very careful and thorough examination , and a
series of good negatives, nothing was found except an
extremely suspicious shadow in the left pelvic region
ROENTGEN RAY.
( Fig. 9) , again rather far out, but a little higher up
than in the preceding case. This shadow is a little
more definitely oval in shape, and on the negative is
slightly “ fenestrated, " and looks exactly like a stone
shadow.
Here, again , we are in a difficulty : all the symptoms
point to the right side, and the only suspicious shadow is
on the left. In this case I am strongly of opinion that a
calculus is present in the left ureter, but in view of the
right-sided symptom, and the knowledge that other
conditions give rise to hæmaturia and pain, it is a great
responsibility to say that this is a ureteral calculus, and
is the cause of the symptoms, and cure will result from
its removal . This patient , again , since the X-ray
examination, has had no further symptoms, and conse
There are, of course, methods by which the diagnosis
may be made more certain. Stereoscopic radiographs
might certainly help one sometimes, although in all the
cases already referred to, owing to the position of the
shadows in the kidney region or along the possible track
of the ureter, they would be useless.
A further method is to have a ureteral bougie opaque
to X rays passed into the ureter, and take radiographs
with it in position. This has been done in several cases
which have come under my notice, and in one case
such a bougie in position, passed into the left ureter of
a female through a speculum in the bladder, and on its
course is seen the shadow of a small ureteral calculus,
which was afterwards removed. In this case the
symptoms were very suggestive, but the shadow was
rather far out in the pelvis in the radiograph taken at
first without a bougie in position, and it was due to this
that it was deemed wiser to X -ray the case with a
bougie in the ureter before proceeding further. However,
although in this case this method was of use, in many
cases it also would serve no purpose, and there are many
difficulties and objections in the way of its employment.
In the first place, it is by no means an easy thing to do
even under an anæsthetic, and in the male it is often
very difficult.
Again, although monetary considerations do not come
often to be considered, and it is by no means a small
matter to arrange for the passage of such a bougie, and
for an X-ray examination whilst it is in situ ; and thus
 ARCHIVES OF THE ROENTGEN RAY. 65

it is a method of examination which is often quite will present less reasons for doubt ; but it is not fair to
impossible. One would very much like to have an ask the X rays to be absolutely diagnostic in all cases,
opportunity of making this examination in the cases and we must recognize that, although they can show
illustrated by Figs. 10 and 11 , but it has not been shadows, they cannot always differentiate the causes of
possible. I think in both these cases that in this manner these shadows.
the differential diagnosis between ureteral calculus and Not only in kidney cases, but in others as well, I
other objects could be made with certainty . would plead that radiography must not altogether stand
One more case is interesting, and points its own moral alone. It is one of the methods of making a diagnosis,
-or, rather, two morals : one, that in these doubtful and in many cases a certain and ultimate method, but
cases an X-ray examination should be made before any in others it is merely an adjunct, and must be treated as
operation is undertaken ; the second, that, whatever is such.
found by X rays, the examination ought to be complete.
This young lady had a very chequered existence for
some years. Pain in the right back and side led to the
appendix being removed in November, 1904 ; it was A CASE OF OSTEO-ARTHRITIS TREATED WITH
found to be long, but healthy. Pain still continuing, led X RAYS .
to the abdomen being opened in November, 1905, to look
By MARGARET M. SHARPE , L.R.C.P., L.R.C.S. Ed.
for adhesions or any other cause ; and in the course of
this operation it was discovered that the kidney was The patient is an unmarried lady, about fifty years of
enlarged, and stone was suspected . On recovery, an age . She gives a history of gout in her mother's family,
X ray was taken of the right kidney, which showed which has also shown itself in her own. She has suffered
clearly a well-marked oval stone shadow 5 inch long, all her life from " tender feet," corns, deformed toe-nails,
inch broad. On January 13 , 1906 , this stone, which etc.
weighed 1.19 grammes, was removed from an otherwise About the age of twenty-one she suffered from “ flat
healthy kidney. This was not the end, however, for in foot, " and wore springs in her boots for many years.
January, 1907, the patient returned, with her old pain Her feet were always worse when she was living in town
unrelieved . We now did what we should have done at than when she was in the country, and always worst in
first, and carefully examined the whole stone area on wet weather ; she was a very good walker, and could
both sides. This showed no stones except three low enjoy a twenty- mile walk in the country when her feet
down in the right ureter. These have been successfully were well .
removed, and we hope that the case is now finally and She first consulted me in the winter of 1904, com
completely closed. plaining of great pain in the ball of the left foot. She
Such are the cases which illustrate some of the described the pain as like walking on hot sand. Indoors
difficulties met with in the X-ray diagnosis of the she walked about quite comfortably in her stockings, but
presence or otherwise of a stone within the stone area, any kind of leather shoe made walking very painful.
and they have been chosen from a considerable number She suffered most in wet weather and least in dry frosty
of others as serving best to illustrate the various points weather, provided she could keep her feet warm, which
brought forward. I think they are sufficiently typical was not easy. I recognized the condition as one
to show in a very marked manner that grave, perhaps of osteo- arthritis of the second and third metatarso
insuperable, difficulties may often arise even with the phalangeal joints.
X -ray diagnosis, and I do not think that this is so well I treated her with static electricity and local applica
understood by medical men as it ought to be. tions of high frequency sparks. Under this treatment
Of course, in by far the greater proportion of cases she improved rapidly.
examined it is possible to give both positive and negative The following winter she turned up again with a return
opinions which can be absolutely relied upon, but at the of the pain, more severe than the year before. I adopted
same time these cases of difficulty are constantly arising the same method of treatment as before, with the same
when large numbers are being dealt with . As we have success, but the treatment had to be continued for a
more and more experience, no doubt some of these cases longer time. That year she had again taken to the
10/2
66 ARCHIVES OF THE ROENTGEN RAY.

spring-sole boots , and had found her walking powers the real nature of the condition were aroused by the fact
greatly improved by their use. that the pain was not evoked by pressure on the sole of
Early in January this year she came to me again. the foot, as by walking in stockinged feet, but by the
Her foot bad given her very little trouble ир till then . side-to-side pressure on the front part of the foot of a
She had been wearing heavy leather shoes all through leather shoe. My patient had always had her shoes
the autumn, she had walked in the snow that fell at the most carefully made to measure, and with, as she
close of the year, and it was not till after the sudden thought, plenty of width of sole to allow for the spread
thaw , which arrived with the New Year, that she ex- of the foot. Nevertheless, she had often noticed that
perienced any fresh discomfort. The present attack was on days that she could walk comfortably in shoes with
far worse than any she had had before. She could only soft brown leather uppers, she often could not walk
walk very slowly , and with a perceptible limp, due to the at all in shoes with stiff calf leather uppers, though the
fact that she could not rise on her toes because of the shoes were exactly the same size and had the same kind
pain. The front part of the foot was slightly swollen of sole . The condition is , of course, very common in the
on both aspects, and she said that on some days the pain finger-joints, and a patient will wince at a too hearty
was continuous, even in the house, unless she was toast- band-shake who still experiences no inconvenience in
ing the foot in front of the fire. A walk of half a mile any movement of the fingers or hand.
or even less made her quite ill from pain and fatigue. With regard to treatment, I have for many years
I began the same treatment as before, wbich improved relied entirely on electricity : general static treatment to
her general condition, but did not greatly relieve the pain. improve the patient's nutrition, and local applications of
We were both feeling very discouraged , when , one day spray and spark discharges to the affected joints. The
that her foot was worse than usual and giving her con- static spark is rather painful, so of late years I generally
tinuous pain, I determined to try X rays. I made her substitute for it the high -frequency spark discharge or
sit down, and, with her left leg crossed over the right the high-frequency vacuum electrode. The spark is very
hold her stockinged foot with the sole about 2 inches efficacious in promoting the reabsorption of calcareous
from the glass of the tube, which was a bard one, deposits . I have frequently reduced disfiguring nodules
fluorescing brilliantly, but without heat. I continued on the hands to quite innocuous dimensions from an
the treatment for ten minutes, and long before the end æsthetic point of view.
of the time she declared the pain was gone. I X -rayed The patient in question derived but slight benefit from
the foot for ten minutes a day for six successive days, all these measures, though, the sole of the foot being
continuing also the general static treatment. At the end very insensitive, she had been able to bear fairly vigorous
of that time she said she could bend her foot, and that sparks.
walking, though not altogether a pleasure, was no longer The following considerations, perhaps, explain the
painful. She then , contrary to my advice, gave up treat more successful action of the X rays. When we employ
ment ; not, however, for long. In three weeks she was static electricity for the relief of pain the procedure
back again with a fresh attack of pain . Again I X-rayed always is to charge the patient from the negative pole,
her, with the same result as before, the pain disappearing and to direct the discharges from the positive electrode
during the first application. I made two more applica- towards the seat of the pain . Now , there are many
tions on successive days, and then gave it up altogether, resemblances between the discharge of the positive pole
but continued the static treatment three or four times a of a static machine and the discharge from an X - ray
week. She is now using her foot with quite free action tube ; but most important in the present connexion is
and only slight pain when the weather is damp. the fact that the air surrounding an excited X -ray tube is
I believe that osteo-arthritis in the sole of the foot is always positively electrified ; it appears to lose its charge
much more common than is generally supposed . Very very suddenly at a certain distance—roughly speaking,
many people, especially dwellers in towns, suffer from about 3 inches from the tube ; but within that area the
“ tender feet,” for which there is no apparent cause. My tube acts like the pole of a magnet, and strongly attracts
patient had often complained of it to doctors, and had a negatively charged object and repels a positively charged
been told that it was a neurotic condition , and that only one . As the rays that come from an X-ray tube, and
nerve tonics would do any good. My suspicions as to which presumably make a path for the escape of this
 ARCHIVES OF THE ROENTGEN RAY. 67

positive charge, are known to be many times more focus it spreads little by little, reaches the areola and
powerful in respect of penetration and of action at a the neighbouring parts of the breast, retaining its
distance than the static current, it is conceivable that original characteristics, and keeping, a more or less oval
they might surpass the latter in therapeutic properties. outline.
It is also probable that if the patient were negatively To this so - called eczematous stage succeeds a second
charged during the X- ray application the result might stage of retraction . The nipple becomes retracted , sinks
be still more emphatic. I did not do this in the case little by little until it is replaced by a depression, which
under consideration , but I always seated the patient on may become an ulcer with irregular edges. Later the
an insulated platform . entire mammary gland may become infiltrated, increase
in size, and thus produce a malignant tumour of the
breast .
According to Brocq, the total duration of the affection
TREATMENT OF PAGET'S DISEASE BY RADIO- varies from a few months to twenty years, and usually
THERAPY. * takes from two to six years to become epitheliomatous.
Paget's disease, although it was originally described ·
By Dr. J. BELOT,
Radiologist to the Hospital St. Antoine, Paris. as occurring on the nipple, is also met with in other
regions of the body. It has been observed by Brocq on
In the year 1874 Sir James Paget described a rare the back, and by Colcott Fox and Macleod on the
affection of the nipple, the areola, and its neighbour- umbilicus.
hood. This disease is usually observed in females of Histologically the lesion is characterized by the
forty years of age and upwards, and, according to Brocq, existence of pseudo-coccidia, which are, in fact, nothing
should be placed in the category of cutaneous epithe- but modified epithelial cells. “ Paget's disease ,” says
liomata.
Darier, “ is a dyskeratotic disease of the epidermis,
It commences as a fissure or as a simple desquamation which is akin to epitheliomatization, and which sooner
of corneous concretions or fine crusts, and is usually or later gives place to a true epitheliomatous proliferation .”
accompanied by redness of the skin and some amount I have gone somewhat fully into the clinical description
of pruritus. Subsequently it spreads gradually over the of Paget's disease because it is but little known in this
whole of the nipple and its areola, and forms a bright country, and the name it bears is apt to mislead. More
red patch, smooth, as if varnished, occasionally papillo- over, in order to apprehend properly the results obtained
matous and finely granulated. An abundant clear by radio -therapy in the treatment of this affection, it
yellow viscous liquid oozes from the diseased area, often is indispensable to be familiar with the lesions which
giving rise to yellow or blackish crusts. characterize it.
At the commencement the skin is slightly infiltrated The failure of all other therapeutic agents in the treat
with whitish lamellar scales on the raw surface. The ment of this disease, and the fact that in its early stages
pruritus, which is almost always present, becomes more it is limited to the integument, turned the attention
accentuated, occasionally becomes intolerable, and is
of radio-therapists to the treatment of this affection .
often accompanied by a pricking and burning sensation. Moreover, the histological formation of the diseased
Here and there excoriations occur, the surface being tissue, with its resemblance to epitheliomatous degene
only slightly moist, of a vivid red colour, and finely ration, warranted us in hoping that it would prove
granular. Accompanying these are veritable ulcers, but amenable to radio-therapeutic treatment.
ill-defined, oozing freely, sometimes bæmorrhagic in In my treatise on “ Radio -therapy in Skin Disease " *
character . At different points may be seen little islets I have alluded to various published observations on this
disseminated over the surface . These are the so -called subject. Many experimenters have, in fact, tried radio
cicatricial epidermic plaques of Darier, and are dry, therapeutic treatment in various stages of Paget's disease
smooth , brilliant, rose - coloured, and uniform in
with varying success.
appearance. One of the more recent reports is that by M. B.
The progress of the disease is slow. From the original
Radio -therapy in Skin Disease,” by Dr.J. Belot. Translated by
* Read before the Third Roentgen Ray Congress at Berlin , 1907. W. Deane Butcher. Rebman Limited, 1905.
68 ARCHIVES OF THE ROENTGEN RAY.

Hartzell, of Philadelphia, reported at the Thirty -ninth slightly adherent. The edge was well marked, but at
Congress of the American Dermatological Association . the junction with the healthy skin there was a zone of
According to his observations, it is possible to ensure lighter colour, not ulcerating, but already decolorized
the complete healing of those lesions which are confined and desquamating. In the centre was the nipple, already
to the surface of the nipple and the areola. The effect, retracted, and projecting but little beyond the surface of
on the contrary, is but slight on the epithelial proliferation the skin. The nipple was of a brighter red colour than
of the deeper glandular canals. This opinion is based the rest of the lesion, and gave vent to an abundant
on microscopical examination of tissues excised after discharge. There was no evidence of enlarged axillary
prolonged irradiation . He concludes that, while radio- or supraclavicular glands. On the other hand, the breast
therapy may be efficacious in the earlier stages, in the was slightly infiltrated, although one could not feel any
later stages we should have recourse to a surgical definite tumour. There was no apparent thickening of
operation . In the discussion which followed many of the integument itself. The patient complained of a good
those present were opposed to all radio-therapeutic deal of pruritus and an occasional attack of pain.
treatment, preferring early removal of the breast by The radio -therapeutic treatment was begun on April 26,
operation. 1906. The integument was protected , but a border &
In presence of such contradictory opinions, it may be centimetre in breadth was left around the ulcerated
region. The dose given was 3 H, with rays of medium
of interest to report two cases of Paget's disease, one
of the nipple and another of the back, both of which penetration, corresponding to Nos. 6 or 7 on Benoist's
were completely healed under radio-therapeutic treat scale . All local treatment was suspended, with the
ment. As far back as 1905 I published an analogous exception of a cold cataplasm of potato starch, which
case , which remained apparently cured after a period was applied night and day.
of two or three months. On May 3 there was no change in the appearance of
CASE 1. -In April, 1906, a woman of forty-seven years the lesion. For the last two or three days, however, the
of age came under my care suffering from Paget's disease patient had complained of increased pain and itching,
of the left breast. with a sensation of burning. A dose of 2 ! H was given..
The disease commenced four or five years ago with On May 10 the lesion was considerably altered in
a slight excoriation , red round the periphery, and having appearance. With the exception of a central portion
a certain amount of itching. The patient, who at that 1 centimetre by 2-the whole of the ulcerated surface
time was in the East, was treated by a simple ointment. was covered by a white epidermis, thin, lamellar, but of
The disease progressed, the redness increased, the skin healthy appearance. The pains had diminished, the
became excoriated, and finally ulcerated , and a discharge discharge was much less, and the general health was
made its appearance, accompanied by a violent sensation excellent.
of burning. On her return to France she was advised On May 22 the amelioration had continued, the pains
to apply a mercurial ointment. This, however, had a had ceased, the discharge had dried up, and the infil
deplorable result : the lesion extended, and the application tration was less. The general appearance was excellent.
was so painful that the patient abandoned the use of the The cold starch poultices were replaced by an application
external medicament . of thin zinc paste.
It was at this stage that she consulted Dr. Brocq , who On June 5 only a few points of excoriation remained .
diagnosed Paget's disease , and placed the patient under A dose of 31 H was given over the whole of the breast .
my care . The lesion was a typical one of Paget's On June 12 the appearance was less favourable. The
disease. Over the whole of the areolar and periareolar breast was red and the epidermis torn in places. This
region there existed an ulceration of a reddish-violet was attributed to the zinc paste, which seemed to irritate
colour. The shape was more or less that of an ellipse , the thin epidermis. A dose of 2 H was given, and we
with its longer transverse axis 6.4 centimetres in length . returned to the starch poultices.
The surface was granular and discharging. There were On June 19 the breast was again completely covered
no crusts, as the lesion was kept moist with dressing with epidermis, the greater part of which was still white.
night and day. Here and there were a few cornified At the periphery, however, a border 1 centimetre in
lamellæ of a pale gray colour, very small, and only breadth had all the appearances of normal skin, and was
 ARCHIVES OF THE ROENTGEN RAY. 69

only distinguishable by its lighter colour. A dose of Here, then, is a woman suffering from Paget's disease,
3 H was given . whose condition was indisputable, in which the disease
On June 27 and July 4 the amelioration continued , had passed the eczematous stage, since retraction of the
the pains, which had recurred, ceasing entirely. nipple, and infiltration of the gland had already set in.
On July 18 cicatrization was complete, and the general The lesion, which had commenced four or five years
aspect of the lesion was excellent. A dose of 3 H was earlier, is completely cured in a period of seven months.
given, and doses of 2 H were repeated on July 30 and This result seems to warrant us in considering radio
August 13. therapy as a most satisfactory method of treatment in
At that date the cicatrization was complete. The this disease.
skin in the neighbourhood of the nipple merely appeared CASE 2.—The second case which has come under my
more rosy than the rest of the body. There was no notice is that of a woman seventy -one years of age, who
pain, no infiltration of the breast , and the nipple was no had on the back, between the shoulders , a reddish
longer retracted , but was as prominent as normal. patch , ellipsoid in form , with the long axis vertical .
The patient returned about the middle of October in The lesion was 7 centimetres in length by 5 in breadth .
excellent health. The cure was apparently complete, According to the patient's story, it appeared six years ago,
the skin covering the breast being soft and supple. after the application of tincture of iodine. The position
In November, 1906, and again in the following of the lesion , however, on a level with the lower border
January, I gave an irradiation of 3 H over the whole of the scapulæ leads one to doubt if this apparent origin
breast in order to prevent recurrence, and I propose to is the correct one . The diseased surface was of a vinous
repeat this every three
three or
or four
four months.
months. At the present red colour with fine lamellar squamæ. There was no
time the patient is in good health and apparently com- tendency to discharge, the edges were clearly defined,
pletely cured . the integument was partially thickened , and the patient
The accompanying table shows the succession of complained of great irritation .
irradiations . This woman was sent to Dr. Béclère's laboratory at
TABLE I. the Hospital of St. Antoine, of which I am assistant
surgeon . The diagnosis was at first doubtful. It was
Date . Quantity of Quality of Remarks.
suspected to be a case of Paget's disease. But the
X Rays. Rays.
position led one to hesitate, localization otherwise than
on the nipple being exceedingly rare. A histological
1906 .
April 26 ... 3 H 6 to 7 B examination, however , carried out by M. Rist confirmed
May 3 2} H the diagnosis of Paget's disease. The patient was con
10 2 H Commencement of fided to the care of Dr. Jaugeas for radio -therapeutic
amelioration . treatment.
22 24 H
June 5 31 H The irradiations were commenced on December 18,
12 2 H 1905, the patient receiving a dose of 5 H , with rays of
19 3 H
27
penetration Nos. 5 or 6 on Benoist's sale. A similar
31 H
July 4 séance was given a fortnight later. From January 8,
:

31 H
18 31 H 1906, the patient received regularly a dose of 3 H each
:

30 2 H
:

Complete cicatriza week. On February 26 the lesion had completely dis

:

tion,
Aug. 13 2 H Apparently cured. appeared, leaving in its place epidermis of completely
Oct. 3 normal appearance, only distinguishable from the neigh
:::

Nov. 29 3 H To prevent recur- bouring skin by a difference in pigmentation. The

rence,
1907 . patient had received ten exposures, representing a total
Jan. 24 3 H irradiation of 34 H. I have seen the patient within the
March Local condition last few days, and the lesion is still in a perfectly satis
1:

completely satis factory state.

factory.
These cases are not isolated ones. One of my col
70 ARCHIVES OF THE ROENTGEN RAY.

leagues, Dr. Darbois, has also had two or three cases of there is any ulceration or discharge, one should begin
cure by radio -therapeutic treatment. with a dose of 5 or 6 H , and then reduce the dose to
The interest of these observations consists in the fact 3 H once a week, or, better, once in ten or twelve days,
that one concerns a case of Paget's disease in an advanced according to the local reaction.
stage, with retraction of the nipple, while the other was In a later stage, with ulceration , discharge and re
in an earlier stage and in a very rare position. The traction of the nipple, one must proceed more carefully,
result in both cases was equally rapid and complete, and on account of the sensibility of the diseased tissues. A
this with relatively feeble doses of the X rays. dose of 4 I should not be exceeded , and I usually
From the observation of cases under my own care and employ a dose of 3 to 4 H every week or fortnight,
others, I can affirm that radio-therapy is a most potent according to the evolution of the local disease.
remedy in Paget's disease, so long as there is no invasion All inflammatory reaction is to be studiously avoided,
of the mammary gland or the deeper tissues. and I often think that the failure one hears of is often
There is nothing very astonishing in this. We all due to the excessive doses given.
know the selective destructive action of the X rays on The local applications are of great importance, and
neoplastic tissue elements . Paget's disease, according cataplasms of potato starch have in my hands resulted
to Darier, consists of a degeneration of the epidermis better than applications of zinc pastes.
akin to epithelioma, and tending ultimately towards In conclusion I would repeat that radio-therapy is
epitheliomatous proliferation. The result of X-ray the treatment par excellence of Paget's disease, rapidly
treatment would be of the same nature as that which modifying the appearance of the lesion, arresting pain
we constantly meet with in cutaneous epithelioma. and itching, and causing cicatrization , with all the signs
This affection, moreover, has a number of character- of a durable and permanent cure .
istics which render it most suitable for radio-therapeutic
treatment. To begin with , it develops very slowly, and
we all know how favourable a condition this is for X-ray
treatment. Moreover — at least, in its early stages --the THE ACTION OF UVIOL LIGHT ON THE SKIN,
disease is limited to the superficial layer of the integu AND ITS THERAPEUTIC USE IN DERMATOLOGY. *
ment. Its superficial position , therefore, exposes it very By Dr. CARL STEIN and Dr. HESSE , Düsseldorf.
easily to the destructive action of the X rays. Even
in a somewhat later stage , as in the first of our cases, The following is the result of a series of experiments on
the action of the rays is still efficacious, the slowness of the action of the uviol light on the normal skin , and also
development compensating in some measure for the as regards its use as a therapeutic agent.
deeper and less favourable situation of the disease . It is evident that the production of a light erythema
When , however, the breast itself is involved, and the is necessary in order to produce a therapeutic action .
localized Paget's disease develops into a malignant By experiments on our own persons, we found that the
tumour, radio -therapy is powerless, and we must have uviol light would produce a slight erythema, with an
recourse to a surgical operation . irradiation of fifteen minutes' duration, at a distance of
It may be objected that the results are not as yet 5 centimetres. After a lapse of five hours a patch of
proved to be permanent, in spite of the fact that the redness appeared over the area of irradiation. This
patients have been under observation in one case for increased during the next few hours to a uniform redness,
seven months, and in the other case for thirteen months. which disappeared on pressure. For two days the red
It is, of course, possible that recurrence may occur after ness increased ; it remained one day at its height, and
radio-therapeutic as after every other treatment. In any on the fourth day died down to a brownish discoloration,
case, we may say that the radio -therapeutic treatment which did not disappear under pressure. This was

has cured in a few months cases which, in spite of other succeeded in from four to six days by a lamelliform
treatment, have been progressing slowly for years—and desquamation. After desquamation a slight discoloration
that without pain or mutilation . remained, which , however, disappeared after some time.
As regards the prescription for X-ray treatment, we The reaction to uviol light is more intense with blonde
may say that in the first stage of Paget's disease, before * Condensed from the Muenchener Mediz . Woch ., February 12, 1907.
 Stone
right
ureter
the
in

.
Stone .
ke

.1.ISMUTH
BOWELS
THE
Fig
-
BIN

Calcareous
gland.

Fig . 4. – STONE IN KIDNEY AND CALCAREOL'S GLANI).

Fig . 2. - STONE IN CENTRE OF A PYONEPHROTIC KIDNEY AS LARGE FIG . 3. –TUBERCULAR KIDNEY ON THE LEFT SIDE.
AS A FETAL HEAD.

TO ILLUSTRATE ARTICLE ON SOME DIFFICULTIES IN THE X - RAY DIAGNOSIS OF RENAL CALCULUS ( p . 61 ) .

By DR. C. THURSTAN HOLLAND.
PLATE CCLXX.
(“ Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.) 71
 Fig . 5. - SHADOW OF CALCAREOUS GLAND IN RIGHT ABDOMES . Fig . 6. - STONE IN KIDNEY.

Fig . 7. - STONE IN Right URETER , AND ADHERENT CALCAREOUS Fig. 8. -STONES IN URETER.
GLAND AT SAME SPOT.

TO ILLUSTRATE ARTICLE ON SOME DIFFICULTIES IN THE X - RAY DIAGNOSIS OF RENAL CALCULUS ( p. 61 ).

By DR. C. THURSTAN HOLLAND.
PLATE CCLXXI .
(" Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
73
 Fig. 9. – STONES IN LEFT URETER . Fio . 10. - Shadow Low Do : X IN Right PELVIC REGION .

Fig . 11. - STONE IN LEFT URETER ( ?). FIG . 12. - STONE IN LEFT URETER .
Ureteral bougie in the ureter through a speculum passed into the bladder.

TO ILLUSTRATE ARTICLE ON SOME DIFFICULTIES IN THE X -RAY DIAGNOSIS OF RENAL CALCULUS ( p. 61 ) .

By DR . C. THURSTAN HOLLAND .
PLATE CCLXXII.
(" Archives of the Roentgen Ray and Allied Phenomena.” — Copyright.)
75
 ARCHIVES OF THE
and less with dark complexions . Ten minutes may
suffice to raise a blister on the cheek of a young girl,
while forty -five minutes will barely cause an evanescent
redness on the shaven scalp of a dark-complexioned boy
of similar age. In one case, that of an indurated eczema
of the palm , there was no apparent result from prolonged
irradiation of half an hour to an hour repeated every day tricophytes and other deep -seated parasites appear to be
for a week.
A series of histological observations were made on
portions of human skin which were excised by means of
Dreuw's instrument, after uviol irradiation for periods of
three, twelve, thirty-six, and seventy hours respectively.
When the specimen was excised twelve hours after
irradiation, nothing was noticeable under the microscope
except some slight swelling and opacity of the cells of
the rete mucosum .
In specimens excised thirty- six hours after irradiation
there were signs of further alteration. Evidence of com-
mencing cell destruction was observed, more especially in
the stratum mucosum , and the ædema of the cells of the
rete mucosum was accentuated.
In portions of skin excised three days after uviol
irradiation the middle layers of the epidermis showed a
number of hollow spaces containing cell debris. Here,
as also in the upper layers of the rete, a few wandering
leucocytes were found .
It would seem , therefore, that an exposure of fifteen
minutes produces only a condition of hyperæmia without
any histological change. The appearance was that of
severe solar erythema, but there was no deep-seated single irradiation will often dry up the skin, with subse
effect as occurs after exposure to the Finsen light.
The results of our observations showed that uviol
light produces a superficial dermatitis , with long- con-
tinued dilatation of the bloodvessels , followed by supe r- light failed entirely . In another of universal pruriginous
ficial desquamation of the skin .
It may be readily understood how the hyperæmia several irradiations.
conduces to an improved nutrition of the skin. Hence
we may consider that the uviol light is a useful addition
to our therapeutic agents for the treatment of superficial
dermatoses. That hyperæmia is a powerful therapeutic
agent is proved by the well -known fact that the eczema
of children is often cured by an attack of measles. Unna
supposes that the febrile condition alters in some way
the condition of the integument, thus rendering it a less
favourable soil for the growth of bacteria. We are
rather disposed to explain the results in accordance with
Bier's hypothesis - viz ., the direct therapeutic action of
hyperæmia.
ROENTGEN RAY . 77
Uviol light has but little influence on bacteria.
Cultures of staphylococci on agar were not influenced
by an irradiation of twenty minutes' duration.
In the therapeutic treatment by uviol light the
resulting desquamation may remove micro-organisms in
the superficial layers of the skin, and in certain cases
influenced.
As regards the therapeutic action of uviol light, our
experience was varied. We treated by uviol irradiation
cases of eczema, psoriasis, alopecia areata, trichophyton,
favus, sycosis, phagedænic ulcer, and lupus.
In each case we endeavoured to produce an erythema.
The area to be irradiated was cleared from scales and
crusts. Impetiginous crusts were removed by oil com
presses, and scales were removed by means of spirit
soap or benzine. To protect the neighbouring skin, it
was covered by a paper shield or with zinc paste. It
was found that a few long exposures were more effica
cious than a larger number of shorter irradiations.
Well-marked redness was produced in every case, the
resulting desquamation being removed by gentle friction
with benzine, and afterwards treated with 5 per cent.
salicylic ointment. After the complete arrest of all
desquamation a second irradiation was usually given.
In many cases , however, a single exposure was sufficient
to produce complete cure.
Uviol-light treatment is contra -indicated in the acute
stage of eczema. In the subacute stage, however, a
quent desquamation and a complete cure after two or
three exposures.
In one case of inveterate papulous eczema the uviol
eczema, great improvement set in after a course of
In seborrheic eczema of the face and head we obtained
most excellent results. In nine cases of chronic recur
ring seborrheic eczema we obtained a complete cure,
and in four of these there was no recurrence after many
months.
The treatment is not well adapted for psoriasis, since
the treatment is long and tedious where there are many
diseased foci. In two cases of general psoriasis, how
ever, we treated the head with uviol light, after removal
of the thickened crusts. The treatment was completely
successful after three irradiations, each of half an hour,
at intervals of five days.
11
78 ARCHIVES OF THE ROENTGEN RAY.

In alopecia areata the treatment was also successful treatment, and both yielded to short uviol irradiation on
in two out of three cases treated by us. In one case of alternate days, with application of perhydrol.
seven years' duration the head was irradiated for twenty It is not probable that lupus will be affected by uviol
minutes every fourth day for six weeks. After four light—at all events , without the aid of pressure. The
weeks the hair began to regrow . light is too weak , and its action too superficial. We
In three cases of herpes tonsurans the duration of have not had an opportunity of using Axmann's concen
treatment was from six to seven weeks, with absolute trator, which focuses the light by repeated reflection..
destruction of the fungus and regrowth of healthy hair We have, however, used the light in private practice
-this without the use of any external application. One for superficial lupus with good results, after the lupus
case was cured by four exposures, each of thirty minutes nodules have been destroyed by acids or cautery. By
at intervals of a fortnight. an irradiation of twenty to thirty minutes, the desqua
Precautions should be taken to guard against staphy- mating infiltrated skin is rendered smooth and supple,
lococcic infection . In several cases , after intensive with a marked improvement in appearance.
irradiation , a number of small blisters made their Our best results were obtained in eczema, especially
appearance. Some of these became impetiginous in in seborrheic eczema of the scalp, psoriasis of the scalp,
consequence of scratching or by other means. It is well, alopecia areata, and herpes tonsurans.
therefore, to protect the irradiated areas by an aseptic The advantages of the treatment consist in its sim
dressing or bandage, in order to guard against accidental plicity, its safety, and the ease with which the dose may
inoculation . be adjusted. For the patient the cleanliness and painless
In a case of favus, the left side of the head was treated ness of the treatment is of great importance. In our
with X rays and the right side with uviol light. After hands, there have been no drawbacks except the
three weeks the uviol treatment was found to be useless, occasional formation of pustules.
and we had recourse to the X rays over the whole scalp . The uviol lamp is a valuable addition to the instru
In a case of non -parasitic sycosis the uviol light was mentarium of the dermatologist. It does not , however,
proved equally inefficacious, whereas X-ray treatment replace the Finsen lamp. It remains to be proved
produced satisfactory results. In a second slighter case whether better results will be obtained by the new
of sycosis we obtained good results after a number of quartz lamp, which, like the uviol lamp, depends in
irradiations. In this case sharp inflammation of the hair great measure on the therapeutic action of ultra - violet
follicle with desquamation followed each irradiation. vibrations.
We next tried the uviol light on ulcers of the leg. In
these cases the action of the light as a stimulus of the
oxidation power of the living animal cell was well shown SOME NEW HIGH-FREQUENCY DEVICES .*
in the bright red flushing of the tissues around the By HENRY G. PIFFARD, M.D., LL.D. , New York.
wound . In three cases of chronic torpid ulcers with
thickened , callous edges, good results were obtained by The use of vacuum electrodes in connexion with high
frequent short irradiations of ten minutes' duration. tension , and more particularly with high-frequency
The results, however, did not differ greatly from those currents, originated, I believe, with Dr. F. F. Strong, of
produced by other therapeutic agents. Boston . They may be connected directly to one pole of
In one case of varicose ulcer, after ten minutes' irradia- a static machine or coil, and applied directly to the skin
tion, blisters, followed by ulceration, appeared in several or held at a little distance from it, according to the
places on the neighbouring integument, which had not effect desired. The effect will vary with the intensity of
been shielded from the light. the exciting current and the degree to which the tube
We have to report two cases of venereal ulcer treated has been exhausted . If the vacuum is low (the so-called
by uviol light. In the first case a large phagedænic Geissler vacuum ), the tube will glow with a pinkish
ulcer extended on to the abdomen, and a second one radiance, while if the vacuum is very high , the glow
existed on the thigh. The second case was that of a will be whitish, with sometimes a tinge of green .
large, soft ulcer of the inguinal region, following a Examined with a prism , this radiance will be found to
chancrous bubo. Both had resisted other methods of • Condensed from New York Medical Journal, March 2, 1907.
 ARCHIVES OF THE ROENTGEN RAY . 79

cover a considerable proportion of the visible spectrum , necessary to apply the tube to a considerable extent of
and is in nowise to be spoken of as distinctively violet. In surface ; and where this is done with the tube directly
fact, its intensity, as well as that of the other colours, is on the skin, it is found that it does not pass freely, but
vastly inferior to that from an ordinary Welsbach burner. tends to stick. To overeome this tendency I have
The effects obtained from & vacuum -tube properly devised an egg-shaped vacuum -tube that, held in an appro
actuated is an electrical one, and is in nowise to be priate handle, readily rolls over the surface.
confounded with any form of phototherapy. Professor When a vacuum-tube is used in connection with a coil
Minin, of St. Petersburg, introduced the use of an instead of a static machine, either directly connected or
incandescent electric light, having a blue bulb and through the medium of a solenoid or a transformer, the
backed by a reflector. The use of this is sometimes exciting current is of lower voltage, but much higher
spoken of as blue light or violet light treatment. ampèrage, and the sensations of the patient and the
That such a lamp has its uses is unquestioned, but its local effect will be somewhat different. The heating
efficiency is impaired rather than promoted by the effects will be more pronounced and the sparks more
coloured bulb . painful.
The standard Finsen lamp demands about 8,000 watts This matter is very readily regulated by increasing
( more than 10 horse-power of energy), while a 16 candle- or diminishing the spark -gap between the secondary
power incandescent requires only 55 or 60 watts. The terminals of the coil and proper adjustment of the
output of blue and violet rays is also much greater in the rheostat and the interrupter .
Fingen arc, per unit of energy expended, than in the Vacuum -tube applications have proved of the highest
incandescent, and it would therefore require, approxi service in the treatment of many cutaneous lesions, a
mately, 150 or more of these incandescents to equal the fact to which I have elsewhere called attention (Medical
Finsen in short -wave efficacy. Record, October 20, 1900 ), and also have been found
A high -frequency current may be obtained by means useful by many physicians for purposes of counter-irrita
of a condenser discharge. If the outer armatures of a tion in neuralgia, neuritis, and other painful con
pair of Leyden jars be connected through a d'Arsonval ditions. I am not aware that these applications have
small solenoid or other device of similar construction a any effect on the general system other than may result
high-frequency current is developed, and can be applied from relief of the local conditions for which they may
by connecting a vacuum electrode to one of the terminals have been employed.
of the solenoid , the other terminal being free or con- The high-frequency currents which do affect the
nected with some indifferent part of the patient's body. general system , and do so in a most decided manner,
If, instead of connecting the vacuum-tube to the are the three d'Arsonval currents, and probably also the
primary of the transformer, it be connected to one of “ effluve, " first developed therapeutically by Oudin.
the terminals of the secondary winding, we have a high- The currents chiefly associated with d’Arsonval's name
frequency current of much higher voltage ; and if the are the shunt or " derived," the auto -conduction , and the
patient be connected with the other secondary terminal, auto-condensation. These have been described in more
the effect will be still more intense. In fact, by using or less detail and with more or less accuracy in most of
unipolar or bipolar connection and varying the length of the recent text-books on electro-therapy, as well as in
the spark-gap, the intensity of the effect may vary from journal articles by myself and others. The auto -conduc
a gentle and pleasurable stimulation to one that will tion current I exclude from present consideration,
severely try the nerve of the most resolute . Before The auto -condensation current is usually administered
using any of these currents, the physician should first with the patient reclining on a special condenser couch.
“ try it on the dog," and the “ dog " should be himself. This, however, is a somewhat cumbrous article, and not
The benefit to be derived from the vacuum -tube elec- altogether satisfactory in use ; and for a long time I
trode in certain cutaneous affections, neuralgias, and have substituted a special condenser cushion in connexion
sundry rheumatic pains is now so thoroughly estab- with an ordinary arm -chair (ARCHIVES OF THE ROENTGEN
lished that it is unnecessary to dwell on the matter Ray, October, 1904 ).
here. The arms of the chair are ornamented with brass balls
In some cutaneous and other conditions it may be about 21 inches in diameter, and these are connected
11—2
80 ARCHIVES OF THE ROENTGEN RAY,

together by a brass chain in such manner that the chain to me to produce a more profound impression on the
can be readily detached if desired. system .
When in use the cushion is attached to one of the The manner in which the high -frequency currents
terminals of the d’Arsonval solenoid, the author's spiral traverse the tissues is a problem that still awaits &
or the primary of his transformer, and the balls on the definite solution. Various explanations have been given ,
arms of the chair to the other terminal . With the but none of these bas as yet received universal accep
patient sitting on the chair with his hands on the balls tance. The laws which govern the behaviour of the
and the apparatus (static machine or coil) in action and direct galvanic current do not in all cases appear to be
with Leyden jars in position, he will receive the auto . applicable to the currents here considered. Is the
condensation current. There is a barely perceptible transfer of the current from one terminal to the other
sensation even with a cựrrent of several hundred milli- through the tissues in accordance with the laws of
ampères. Ohmic resistance , or, on the other hand , does the body
It will be noted , however, that with this arrangement act as a capacity ( condenser) which presupposes an
the current circulates through the upper part of the body internal and an external armature ? Some writers
( from the buttocks to the arms) . maintain that the high -frequency current simply flows
As it is sometimes desirable to bring the lower part of over the surface of the body without penetrating it, but the
the body within the circuit, I have devised a little observed facts as regards the effects of the current would
insulated footstool that I find exceedingly convenient for appear to negative this view. If a person is placed in
this, as well as some other purposes. It is 16 inches the chair and connected for either the auto -condensation
square, and raised on glass legs about 5 inches above the or the shunt current, with a standard 16 candle - power
floor. The wooden top is covered with a thin metal lamp in series, the current can be adjusted so that the
plate. lamp filament will glow with a bright cherry- red . Now ,
With the patient sitting on the cushion, and his feet if a second person be added to the circuit, the filament
bare or in stockings resting on the stool connected to the will brighten ; and if still another be added, it may bring
free terminal of the solenoid, the direct action of the the lamp up to full incandescence, a fact not in harmony
current will be confined to the lower part of the body, with the idea of Ohmic resistance-so far, at least, as
that is, from the feet to the buttocks. regards the human portion of the chain .
Again, if one terminal be connected to the balls on the In the foreign literature of the high -frequency currents,
chair (the cushion being discarded ), and the other frequent reference is made to the beneficial results of
terminal to the footstool, on which a sheet of plate-glass the use of the effluve from the Oudin resonator. With
has been laid , the entire body except the head will be this in view I have tested resonators made in France,
subjected to the influence of the auto-condensation England, and America, but without finding one that I
current. cared to permanently install. Disappointed in this, I
The third of the d’Arsonval currents—namely, the sought to obtain an efficient effluve by other means, and
one in which the patient is placed in shunt to the solenoid have succeeded in doing so. Taking my transformer as
( courant en dérivation)-is described in the text-books, the starting point, I altered the primary so as to obtain
but curiously little information is given as to its phyeio- an increased inductive effect, and in connexion therewith
logical effects or the special technique of its application . used jars having foil surfaces of not less than 8 by
One convenient method of using it is to connect the 12 inches. The apparatus is completed by an intensify.
terminals directly to the brass balls on the chair, detach. ing electrode. This latter is virtually a resonator, and
ing the chain that connects them and discarding the weighs about 8 ounces.
condenser cushion. With this arrangement the current When the apparatus is properly actuated by either a
oscillates from hand to hand across the body at, or near, static machine or coil , the effluve is superior in length
the upper part of the spine. and fullness to any that I have seen from a resonator of
As a rule, however, I prefer to connect one terminal the Oudin type.
to the footstool and the other to the balls connected The strongest effect is obtained when the subject
together by the chain . In this way one obtains a stands in bare or stockinged feet upon the insulated
wider distribution of the current, and it has appeared footstool attached to one of the secondary terminals of
 ARCHIVES OF THE ROENTGEN RAY . 81

the transformer. To the other terminal the electrode is culosis and some other affections has been so thoroughly
attached through the medium of a flexible but well attested by competent clinicians at home and abroad ,
insulated cord . The effluve from the static installation that there remains no doubt in the writer's mind as to
is longer and coarser than that from the coil , and is the efficacy of this agent in connexion with other
absolutely painless, there being simply a slight and appropriate measures of relief.
pleasurable sensation of warmth. The effluve must in no sense be regarded as a purely
If the effluve be at its maximum intensity and the local application , for if the patient stands on the in
electrode approached to within 3 or 4 inches of the sulated footstool connected to the other pole of the
patient standing on the footstool, the underlying muscles machine, he becomes a part of what, in this connexion,
will contract in a peculiar manner, differing from any other might be termed a short circuit. If not so connected,
form of contraction produced by electric currents. The he becomes part of a longer circuit through the ground.
muscles do not contract in bulk, but only in the regions In either case the oscilloscope shows that we are dealing
on which the effluve impinges, the separate fibres with an oscillating current, with, however, a preponder
apparently contracting independently of each other. ance of effect in one direction .
The contractions are painless. If the electrode is Under the influence of the transresonator effluve I
brought within sparking distance, the clear white single have seen tuberculous cervical glands diminish, pleuritic
sparks are painful. The effluve bere described differs pains accompanying pulmonary tuberculosis subside, and
from the Oudin in being longer and of higher voltage, neuralgic or neuritic troubles yield to its influence.
and may be conveniently designated as the transresonator My personal use of the effluve has been chiefly in
efiluve or current . connexion with cutaneous affections, and I have found
Accompanying the effluve there is an intense develop- it specially useful in acute fluent eczemata, in pruritus,
ment of ozone, with, of course, some nitrogen oxides, and as a capillary stimulant. I have found it extremely
sufficient sometimes to prove disagreeable to both the useful in these conditions, and I believe, moreover, that
patient and the physician. This is more marked with its sphere of useful activity will be further extended to
the coil than with the static machine. conditions that have not as yet been brought to public
The value of a powerful effluve in pulmonary tuber- notice .

Notes and Abstracts.

RADIOTHERAPY . states that the earliest mechanism for the production of ozone
Protection of the Skin in the Treatment of Leukæmia was a static machine. It is, however, the alternating current
( Semaine Médicale, December 5, 1906 ).— Dr. Maragliano recom from a dynamo of high periodicity, stepped up to several
mends the use of several thicknesses of ordinary diachylon thousand volts, which offers the best means of obtaining the
plaister in the treatment of myeloid leukæmia by the X rays. silent or ozone-making discharge. Such an apparatus, however,
With this precaution no dermatitis other than a slight may give any one of three kinds of discharge. Thus the arc dis
pigmentation should occur. In this way we may filter out charge destroys the apparatus, owing to its intense heat ; while the
the softer rays which otherwise would be absorbed by the 3park discharge transforms the nitrogen of the air, mixes it with
integument without reaching the spleen. A thin leaf of tin. the transformed oxygen, and gives impure ozone. Means must,
foil or aluminium will do equally well, but the diachylon therefore , be taken to prevent these undesirable forms of dis
plaister is more convenient. In this way the author has been charge, and to limit apparatus to the production of the silent
able to use somewhat stronger doses than usual. In one effluvium which transforms the oxygen of the air into its
case of leukæmia he obtained good results with the return allotropic condition . The inventive faculties of investigators
of the blood to normal without any radiodermatitis, in a case of have been directed to this problem for many years . Bridge
leukæmia which at the beginning of treatment showed a pro himself has devised a perforated electrode , and so arranged the
portion of 80,000 leucocytes and only 1,800,000 red corpuscles. air-supply that it passes through the perforations in fine streams
directly into the hollow cores of the discharges taking place on
INSTRUMENTATION. its surface . In this way the air is forced to travel first upwards
The Production of Ozone ( Journal of the Franklin Insti with the discharge, while completely surrounded by it, and then
tute, May, 1907 ).-J. H. Bridge, in a very elaborate paper, forced through the lurninous walls of the discharge. This brings
82 ARCHIVES OF THE
every particle of the air into intimate contact with the discharge.
The first tests of this apparatus gave 80 grammes of ozone of a
high concentration. An extension of this principle, which
logically follows, is that by which the treated air is instantly led
away from the de-ozonizing effects of the heat of contiguous forceps, and pull out the needle by the end of its long axis.
discharges by withdrawal through the perforations of an opposing
electrode. In this way the air first passes directly into the core
of a discharge taking place from one electrode, which, for con
venience, may be called the anode, and is thence led directly
into the core of a second discharge taking place from the
opposing electrode, or cathode, and so passes at once out of the
influence of the discharges through the cathodicperforations. recently reviewed his results, and produced some of his old
Of course,this can only be done when no dielectric is placed patients before the Royal Academy of Turin. Two of the
between the discharges, and arcing and sparking must then be
prevented by employing the usual resistance in the circuit
between the source of energy and the discharge.
Equipment for X - ray Work.– Wells, of St. Louis, writing
in the Lancet Clinic, May 11 , 1907, says that he employs as
his source of energy an 18- inch coil of standard winding with
mercury break run on a 220-volt direct lighting circuit. His
tubes are of several makes, including Gundlach , Friedlander,
and Müller types. The light he endeavours to produce is
divided into hard and soft, according to the degree of vacuum
in the tube. By the hard light is meant that from a tube with
an equivalent spark of 3 inches or more, whereas the soft light
is from a tube of lower resistance than this. In superficial
lesions, whether sarcoma or epithelioma, he uses the soft light
with tube from 2 to 3 inches from the surface to be treated , and
produces a reaction as soon as possible. By reaction is meant
a zone of active leucoplakia and erythema about the lesion, with
possibly superficial necrosis of the ulcerated area . This can be
done quickly in a few treatments, or slowly after weeks of
tentative applications, according to the aggressiveness of the
operator. The writer intends in future to have all excrescences
and protruding masses ablated by the knife or curette, as it is
a waste of time and energy to wait for the ray to do what can
be done more efficiently and more rapidly by the surgeon or
even by the application of a suitable paste.
RADIOSCOPY .
Removal of Needles under the X Ray .-- Dr. F. Wullyamoz,
of Lausanne, offers suggestions for the removal of needles buried
in the tissues when once their position has been definitely ascer
tained. The iris diaphragm of Béclère or some similar arrange-
ment should be used, so as to exclude all rays which do not
fall perpendicularly on the screen . The tube should be fairly
high ( Nos. 5-10 Benoist). The part in which the needle is em-
bedded is placed between the tube and the fluorescent screen.
Now, by means of a dermographic pencil provided with a metal
sheath, mark out on the skin the length and direction of the
needle. Freeze the skin over the length of the needle, and then
incise in the middle of the drawn line to a distance of 5 millimetres.
Inject 1 cubic centimetre of a 1 per cent. solution of cocaine.
Introduce a pair of forceps with a ribbed surface. Now switch
off the light, and, with the hand behind the screen, seize the
needle at its centre with the forceps. After switching on the
light, alter the position of the needle by means of the pliers, so
that the near end will move towards the surface of the body
ROENTGEN RAY.
as a rule, it is the broken end. At the point where the needle
projects, make an incision of 2 millimetres. Press the needle
through this incision, and lay hold of the end of the needle with
a flat pair of Pean's forceps. Disengage the other pair of
PHOTOTHERAPY.
Light Treatment of Ozæna .-Ignazio Dionisio (Gazz. Med.
Ital. , February 21, 1907 ), who has previously published accounts
of his treatment of ozæna by a modification of Finsen's method,
patients, a boy and girl, each aged seventeen years, were shown
to the Academy as cured in 1904. The nasal secretion is almost
normal in quantity and quality. The respiratory function is
very good. The atrophy of the mucosa has disappeared. In
one patient the sense of smell has returned . The cures, there
fore, have been permanent. The cases were originally typical
cases of ozæna, with atrophy of the mucosa, crusty secretion,
and fetor, in spite of frequently repeated douching. In each
case the treatment was carried on for many months, and included
more than 200 sittings of two hours each. The other two
patients—a girl of nine years and a man aged twenty-two years
-were shown to the Academy in December, 1905, to exhibit the
gravity of the disease before treatment began. They now have
no disturbance of any sort. The man has given up douching
altogether, and the girl washes her nose out once or twice a
week with salt and water. Treatment in each case lasted three
months, and involved 120 sittings of one hour each . The
shorter period of treatment necessary is not due to the less
intense nature of the disease, but to the professor's improved
technique. Since treatment was begun in 1901, it has been
applied to fifty -four severe cases. Not all of these underwent a
complete course . Three of the patients obtained no benefit, the
others were very greatly improved or were completely cured.
In some cases counted as cured, and enabled for a long time to
do without the douche, it occasionally happened that a severe
coryza caused very free discharge, with some fetor, which dis
appeared rapidly with douching and the disappearance of the
coryza. In a few cases there was true relapse, quickly cured by
a few radio-therapeutic sittings. The improvement in methods
has been so great that 100 hours suffice to produce the effects
which a few years ago needed 600 hours.-- British Medical
Journal.
Phototherapy in Nervous Disease. - A . D. Rockwell (Med .
Record , March 23 ) deals with the effects of incandescent
(leucodescent) lamp light on nervous conditions. Although
manifestly inferior to sunlight and the arc light in chemical
effects, its superiority in heat rays renders this form of treatment
more valuable for its general constitutional influence and
analgesic action. Stimulation of the peripheral circulation
results in a sort of circulatory drainage in congested areas,
which helps to dissipate local hyperæmias. In toxæmias and
toxic neuroses the stimulation by primary irritants of vital cell
energy produces a therapeutic effect beyond question.
The basic factors in light treatmentare : bactericidal influence,
action on tissue metabolism , stimulus to hæmogenesis, and the
 ARCHIVES OF THE ROENTGEN RAY.
analgesic effect produced by the relief of congestion and the
rapid vibration of the radiations upon the nerve units of the
body.
RADIO-DIAGNOSIS,
Bismuth and the X Rays in the Detection of Gastric
Ulcer. – Hemmeter (Archiv f. Verd -Krank, 1906, Bd. xii.,
p. 357), as a result of experiments on rabbits and cats, recom
mends that a large teaspoonful of bismuth subnitrate in a
cup of water be given on an empty stomach . The patient is
then placed for half an hour in a position with that surface of
the stomach downwards where the ulcer is probably situated.
A screen examination is then made, and, if necessary , a skiagram
Reports of Societies.
BRITISH ELECTRO - THERAPEUTIC SOCIETY,
April, 1907 .
The Physiological Action of High -Frequency Electric
Currents in Disease.
By SAMUEL SLOAN , M.D. (Glasgow ).
PROFESSOR D'ARSONVAL's experiments on the physiological
effects of high -frequency electric currents showed that no harm
resulted from such currents ; that by their use the blood-
pressure fell and then rose, remaining at a higher level ; that
the quantity of urine became greater ; that the relation of the
purin bases to the urea more nearly approached to the normal ;
that the amount of exhaled carbonic acid was higher ; and that
the muscular system was invigorated.
In my opinion , we are now justified in looking towards the
future of electro -therapeutics with more confidence than ever,
and with the conviction that we are only now on the fringe of
great possibilities.
The early part of my investigations seemed to promise labour
only. I seemed to be merely recording, and to be unable to see
any useful results from these records. They seemed either to
disprove my previous assumptions or to contradict each other ;
but further experiment has since led to some very interesting
results .
As regards the cardio-vascular system , few subjects have
occupied the time and attention of medical scientists during the
past few years more than that of blood pressure. What has
impressed me most of all in my study of blood-pressure
literature is the almost universal dread, expressed or implied, of
high blood pressure. It has seemed to me to be something of a
bogey. Only a few writers have mentioned the importance of
having in certain cases a high blood-pressure. One of these, in
speaking of high blood pressure in cases of nephritis, says : “ I
do not consider high blood - pressure in itself a good thing, but I
prefer to see it in the subjects of this disease . ” Ewart writes :
“High blood pressure is possibly in old age a necessity, for the
purpose of permeating the less patent channels and stimulating
more torpid cells. We must not forget that a low or even , in
some cases, a moderately high blood pressure may mean
9
deficient cardiac force ."
83
taken . A diffuse shadow should then be seen, with a darker,
smaller patch, which corresponds to the ulcer, should one be
present ; the bisinuth causing the diffuse shadow in the stomach
disappears in an hour or so, but the shadow of the ulcer should,
if no food be taken , be visible for twenty - four hours or so. In
view of the fact that the hinder surface and pyloric end of the
stomach are the most frequent sites of an ulcer, it is best, as a
routine, for the patient to lie first on the back and then on the
right side. The shadow of the bismuth in the colon renders
examinations on successive days impracticable. The same
method may be employed in the examination of carcinomatous
ulcers .
The more I have considered this question, the more I have
come to feel the danger of this universal desire to have a low
bloodpressure. We are apt to forget that blood pressure is the
product of peripheral resistance and systolic force. With a
given peripheral resistance, the greater the systolic force the
higher the blood-pressure. A reduced blood-pressure may there
fore mean either a reduction of the resistance or a diminution of
the force . While the former result may sometimes be desirable,
the latter can hardly be advantageous, unless temporarily and
for a special purpose . The danger in cases of high blood
pressure - high, that is, relative to the age of the individual—is
not in the bloodpressure itself, but in the cause of this high
pressure, and in the fact that there are apt to be weak points
in the arterioles of the brain, where a sudden increase of the
vis a tergo may determine a fatal result. On the other hand, a
sudden decrease of bloodpressure due to diminished systolic
force might cause death by heart failure, especially after
influenza . It will thus be seen that I do not consider high
frequency currents an unmixed good, because they are said to
cause a fall in the blood-pressure, any more than I consider the
rise in the blood - pressure which they occasionally produce
necessarily an advantage, since this rise may be due to increase
of resistance. Moreover, I have reason to doubt the statement
that these currents do always, in therapeutic doses , produce a
primary fall of blood -pressure. Frequently, indeed, they do the
reverse , and with much advantage to the patient.
My observations have been taken with the Riva-Rocci
sphygmomanometer as modified by Martin . It is a systolic
pressure instrument, and will register the height of the column
of mercury at the instant of the cessation of the pulse in the
radial artery to within 2 millimetres.
Physiologists teach us that a fall of blood pressure is ac
companied by a quickening of the pulse. In diseased condi.
tions, however, I find that such quickening, if it does occur, is
only temporary. Under the influence of high-frequency
currents , the cardio -vascular mechanism adjusts itself, not only
according to the individual, but according to the then condition
of the individual. As Haig points out, when the heart becomes
seriously disabled, high blood pressure causes a rapid pulse
rapid in proportion to the peripheral resistance, and to the
84 ARCHIVES OF THE
degree in which the heart is unable to meet the demand made
upon it. I might explain how the pulse-rate is affected by the
following analogy : Let us suppose that three men are required
to walk a certain distance in the same time, each being at liberty
to choose his own length of step , one taking short and frequent
steps, those of another being longer and less frequent, but all
going at the same pace. Suppose one of these men to be of
great strength, with abundant neuro-muscular reserve, the
second a man of only moderate strength, and the third
distinctly below the average in staying power. They are
walking against a moderate head -wind , when suddenly the wind
abates. The first man is hardly conscious of any difference in
his pace, and an onlooker would probably observe no change in
it. The second man , when the wind abates, has to step out
somewhat more quickly till he recovers himself, when he
resumes his ordinary pace ; whilst the third man, unless he has
been warned of the coming change in the force of the wind, has
to run for some steps, and almost falls for rd, on account of
the difficulty of at once adjusting himself to the sudden change.
Let the head -wind as suddenly increase, and whilst no effect is
apparently produced on the pace of the first man , the second one
will take longer and less frequent steps for a few seconds till he
finds what pace will enable him progress at the required rate
with least fatigue. The third man , again , may even miss a step
before he recovers himself. In the same way the heart acts
against a varying peripheral resistance, and the pulse-rate will
depend upon the condition of the cardiac force when the resist
ance varies—at least, for a shorter or longer interval after the
change of resistance. If the peripheral relaxation is sudden,
and the asthenia severe or increased by previous undue exertion,
the heart may be even seriously hampered . The blood-pressure
will, under these circumstances, give an indication of the amount
of cardiac reserve. If the heart's energy is only slightly
diminished , it will maintain the blood -pressure at its initial
height, in virtue of the tonic effect of the current upon it, if the
dose has not been so strong as to cause excessive relaxation of
the arterioles, the relaxation of the peripheral resistance being
exactly counterbalanced by the increase of the cardiac force.
Should the blood-pressure have been previously low, it may rise
under the influence of the current, but only if the current is
suited to the case, and the cardiac force is increased more than
the resistance is diminished,
The following are my conclusions as to the action of high-
frequency currents on pulse and blood-pressure :
1. These currents at first cause diminished peripheral resis-
tance in all cases.
2. This is followed, sooner or later, by increased cardiac force,
when the currents are given in therapeutic doses.
3. The effects on the blood-pressure and the pulse -rate of this
double action will depend on the cardio-vascular stability.
4. Should this be normal, there may be no change whatever
in either the blood-pressure or the pulse-rate ; only an increase
of blood -flow , giving rise to slight elevation of the temperature
of the blood.
5. Should there be slight cardio -vascular instability, then the
diminished peripheral resistance is only in part compensated by
the heart, and so the blood-pressure falls slightly, and there
may be no change in the pulse-rate.
ROENTGEN RAY .
6. On the other hand, should the heart be in a state of asthenia,
and the blood-pressure already low, then, if the patient on
reaching the couch is fairly fresh, there having been nothing to
depress or fatigue just before the treatment, the increase of the
cardiac force obtained from the current may so overpower the
tendency to peripheral relaxation that the blood-pressure rises
whilst the pulse-rate falls.
7. Again , should matters be as in the last case with the
oxception that the patient has recently been fatigued or unduly
excited, the heart may be unable to respond to the action of the
current. Just as the breeze which will fan a steady flame may
extinguish a flickering one, the heart may be at first staggered,
the cardiac force failing to rise to the occasion ; the result will
then be a dangerous fall of the blood-pressure with a relatively
high pulse- rate.
8. The after -effects are, in low blood-pressure, due to diminished
cardiac force prior to the treatment.
9. If the blood -pressure be already high, due to the high
peripheral resistance of albuminuria , with somewhat weakened
cardiac action, the current will probably have the effect of
raising the blood-pressure without raising the rate of the pulse.
Where the above is the case, and, from long illness, the cardiac
asthenia is great, as shown by a high pulse-rate, which no
medicine is able to reduce, the effect in the pulse is sometimes
striking .
10. When the blood pressure has been high for the individual's
age, and there is no apparent disease to account for it , I have
observed that after several applications of the current the
blood-pressure is diminished, and there a corresponding
improvement in the pulse -rate.
11. In some instances of intermittent pulse- radial only, or
cardiac as well—the intermissions may diminish or disappear.
Should the intermission have existed for a short period only, as
from temporary gastro -intestina Jisorder, the intermissions of
the pulse may cease after two or three applications of the
current, probably from the beneficial effects of the current on
the gastro -intestinal canal.
Thermic Effects. — Dr. Somerville, of Glasgow , has done some
good work on surface heat production as a result of high
frequency currents. The results obtained by him are , however,
I believe, purely electro -physical effects.
The difficulty of determining the physiological production of
heat is stated very clearly by Waller. He says : “ By the
thermometer we ascertain the temperature of the body, not the
amount of heat that it produces or loses. The thermometer
gives no measure of the activity of heat production , nor even
any positive indication that it is above or below the normal.
We are thus left in great part to infer a heat production in the
blood by these currents rather than to test it by the thermometer.
Here let me state that whilst the rectal temperature is the
internal temperature proper, being that of the large splanchnic
storehouse of heat, that of the mouth , as pointed out by Haig,
is a peripheral temperature. On starting my investigations
I allowed too little time for heat distribution, consequent
on the recumbent position of the patient. When at the
end of the séance the mouth temperature had risen on an
average 1 degree, and the rectal had fallen 1 degree, I came to
the conclusion that this was the effect of the current, by
 ARCHIVES OF THE
relaxation of the peripheral vessels. I discovered that the
transfer of heat from the internal to the peripheral circulation
was purely physiological, and in no sense electro- physiological.
A considerable amount of time, I find, is required to bring about
this state of heat equilibrium—something like thirty to forty
minutes. This gives time also for determining to what extent
heat reduction is taking place . This latter will depend on
previous exercise, and the time of the patient's last meal.
Physiologists are evidently agreed that the greatly reduced
morning temperature, internal and peripheral, is wholly due to
diminished heat production, consequent upon long rest. If the
blood temperature , as ascertained in the mouth and rectum ,
has been diminishing before the current was applied, and is
found to be stationary during the time of the current, the
natural inference is that the current has had some share in this
by causing increased heat production. My researches have
pointed in this direction , but I have little of definite proof to
bring forward in support of it. Waller's statement may explain
this. It will be a natural inference, also, that the heat distribu.
tion I have spoken of will account for the rise in the surface
temperature throughout, as well as that of the mouth.
It will be noticed that the greatest increase of heat is near the
electrodes, and this increase of heat diminishes in amount in
proportion, as a rule, to the distance of the parts tested from the
electrodes. It is plainly not blood heat, but only surface or
superficial tissue heat. In some of my observations the tempera-
ture in the axilla was actually higher than that of the mouth.
Now, how are these increased surface temperatures caused ?
They are greater the nearer the parts tested are to the electrodes ;
this is just what might be expected, since the current to earth
is greatest there, and the local heat will be directly proportioned
to the square of the current. It must be borne in mind that the
quantity of the electricity in the case of the static form of high
frequency is proportioned only to the capacity of the part,
whereas in the auto-condensation it decreases in proportion to
the distance of the parts from the electrodes and to the differ-
ence of the potential.
The heat production is the product of the resistance into the
square of the current, and the steeper the potential gradient, the
greater will be the heat concentration. Considering the enormous
resistance of dry skin, the resistance between the hand and the
forearm might quite equal a spark-gap of 1 to 2 millimetres.
The points from which the potential difference is to be
measured should have a metallic connexion to either side of a
spinthermeter. The current to zero is measured by making a
metallic connexion from any part to earth with a milliam-
pèremeter in series. With both hands on the ordinary electrodes,
it would be seen that the largest amount of current is, as might
be expected , from the hands. The next in amount of current is
from the forearm, and the potential difference between the
hand and the forearm is quite considerable, varying from
1 millimetre to 2 millimetres, so that nearly the full amount of
the current from the hand must act on the wrist and lower
forearm.
I have no doubt that some of the rise of temperature in the
mouth and in the rectum must be electro - physical , but how
much it would be difficult to say. I should expect, however,
that this would tell more on the mouth temperature than on
ROENTGEN RAY. 85
that of the rectum, when the electrodes are grasped by both
hands. Like Dr. Somerville, I have noticed that the increase
of heat on the left forearm is less than that on the right. The
cause of this, I find, is that the resistance is usually greater, and
the current to zero less, in the left than in the right forearm .
For obvious reasons the reverse would be the case in left-handed
people .
Deeper Tissues . — It has been generally assumed that high
frequency currents are confined practically, if not wholly, to
the surface ; and that their physiological effects arise from their
action on the peripheral nerves and the peripheral circulation.
I have, however, made two experiments which prove that they
also penetrate to the deeper tissues.
To prove that the high-frequency currents stimulate the
neuro -muscular system, place one electrode in the hand and the
other on the upper portion of the sterno -mastoid muscle. If
the two electrodes be now connected by a wire with a spark - gap
in it, the disturbances of potential when the spark passes will
cause muscular contraction . That this is not due merely to the
spark can be shown by dropping the hand electrode, when no
contraction occurs, although the connexion through the spark
gap is still intact.
A measurement of the potential difference between different
parts of the body, by the length of spark-gap which can be
introduced between any given point and the electrode, shows
that the difference of potential between the neck and the groin
is five times as great as that between the mouth and the rectum.
This low resistance between mouth and rectum proves that the
current cannot pass merely via chin, neck, breast, and abdominal
walls, but must also pass by the gastro-intestinal tract. Similarly
the resistance between axilla and groin is less than between
axilla and waist , because in the former case the current passes
also through the gastro - intestinal canul, and probably also
through the viscera.
Since the current is thus seen to be acting on the whole
lining membrane of the alimentary canal, there is no wonder
that this electric energy has an influence on the appetite and on
the general health.
Renal Excretion . - In one case of kidney disease I have been
able to watch and gauge the progress under high - frequency
treatment with exceptional care and accuracy. It was one of
& very slow convalescence from uræmic convulsions. Coma
had lasted for about a week ; general blood-letting had been
resorted to, and for some days it seemed impossible for the
patient to recover. Convalescence was very protracted, and
after ten weeks no appreciable progress was being made, the
pulse remaining between 96 and 102. At this stage I suggested
high -frequency treatment. We decided to stop all medicines,
and simply to note the condition of the patient from day to day,
allowing ten days for this before beginning the electric treatment,
in order that we might be able to eliminate any source of error
in the final result. The effect on the pulse-rate was all that
could be desired. It came down to about 85, and remained at
about this rate after three applications of the current. The
blood-pressure at the period of convalescence indicated was
about 180 to 200 ; and the high pulse-rate at that time was
probably caused by the blood-pressure plus the cardiac failure,
especially the latter.
12
86 ARCHIVES OF THE ROENTGEN RAY.
Into the question of purins in the blood, and their effect on
the circulation and on the general health, this is not the occasion
to enter. Whilst in many cases it is advisable to withhold a
diet rich in uric acid, I have come to the conclusion that, if only
the diet is suited to the individual in quantity, attempts should
be made to improve the cardiac force, and to set right the
gastro-intestinal digestion, leaving the purins to take care of
themselves, rather than to try to rectify faults of metabolism
by washing out the purins or taking special steps to avoid their
intake.
In many of my cases I have obtained great improvement of
the general condition and absence of rheumatism without any
appreciable diminution in the purin ratio ; indeed, in one case
of obesity this ratio even increased during treatment.
Retino-Cerebral Mechanism . — None of the physiological
effects just described will, however, account for all the various
signs and symptoms following high -frequency treatment. They
give no explanation of certain sensations remarked upon
by patients when undergoing auto-condensation treatment : of
the “ comfortable weariness in contrast to fatigue or faintness,
and sensation of freedom from care so often experienced.” Some
action on the central nervous system evidently takes place under
the therapeutic use of these currents. We cannot see what is
Reviews.
Die Röntgenstrahlen im Dienste der Neurologie. By Dr. W.
FÜRNROHR . Berlin : S. Karger.
This work of some 350 pages is prefaced by an introduction
by Professor H. Oppenheim , who, at the first Berlin Congress ,
showed , by means of the X rays, an enlargement of the sella
turcica in the living subject, a patient affected with acromegaly .
Since then the connexion between neurology and Roentgeno
logy has become still more intimate, so that an X-ray installa-
tion is found to be a necessary addendum to the neurological
department in many Continental hospitals.
The first chapter of Dr. Fürnrohr's book deals with bullet-
wounds of the cranium, tumours of the brain, hydrocephalus,
and various malformations of the skull.
The chapter on the spinal cord treats very fully of the patho-
logical changes of the joints due to disease of the cord. It is
interesting to notice that the X rays occasionally show some
affection of the joints accompanying psoriasis, thus bringing
additional evidence to bear on the supposed nervous origin of
this disease.
The neuralgias of peripheral nerves as a consequence of
cervical ribs is very fully treated, as also is skoliosis due to the
same cause .
The chapter on acromegaly is of great interest, and is illus-
trated by two radiograms of the sella turcica taken from the
living subject .
The X rays have greatly added to our knowledge of the
development of the osseous system, and the abnormalities
pertaining thereto. They also have enabled us to examine with
going on in the brain, but we can measure what is going on in
the retina, which, after all, is a prolongation of the brain . What
is called the “ after -image " may by the measurements of its
duration give us some indication of the condition of the retino
cerebral mechanism . Physiologists declare that the duration
of this after-image is proportional to the cerebral fatigue. I
tried to measure the duration of the positive after -image on
myself, but gave this up, for several reasons. I then decided to
measure the duration of the negative after -image as an index of
the cerebral fatigue. My experience has led me to the following
conclusions :
That the duration of the negative after-image is different in
different individuals. That in the same individual it differs
according to the state of the health, being longer when the
person is well and fresh than when ill and fatigued, and
according to the time of day. I could, indeed, tell with a fair
amount of certainty how fit or unfit I was going to be during
the day by taking my negative after-image in the morning . A
considerable amount of experience is necessary, however, to be
able to measure with sufficient scientific accuracy the duration
of even one's own after- image. Accordingly, I have not been
very successful with other people, but I recommend the matter
to your consideration as interesting and as of scientific value.
greater precision the alterations in the joints which accompany
nervous diseases.
The work is so thorough , and bears evidence of such careful
labour-a list of the literature alone occupies sixty pages--that
we feel sure it will for a long time to come remain the standard
work on the subject.
Archives Internationales de Laryngologie, d'Otologie, et de
Rhinologie. May to June, 1907. Paris : 99, Boulevard
Saint-Germain . Price 3 francs 50 cents.
The current issue of this journal is a particularly interesting
number, embracing, as it does, quite a number of practical
subjects connected with the special branches of which it treats.
We would specially mention a very good article by Jackson, of
Pittsburg, on gastroscopy. In this paper the writer recounts
that by means of the gastroscope he has diagnosed cases of
gastritis, gastroptosis, cancer of the pylorus, gastric ulcer,
and cancer of the cardiac end of the stomach. He maintains
that by this means cancer will be diagnosed sufficiently early to
enable a successful operation to be performed. A coloured
plate of beautiful gastroscopic views accompanies this paper.
Another valuable paper is from the pen of Salamo, of Paris.
The title is “ Some Particulars regarding Mastoiditis in Infants,"
of which he has seen 150 cases. Rhodes, of Chicago, contributes
a suggestive article on the treatment of sarcoma of the naso
pharynx by means of injections of adrenalin . He mentions
that this method is well worthy of trial in cases of cancer of the
pharynx or nose. It will replace morphine as an analgesic in
those cases, and certainly palliates the condition.
.
 ARCHIVES OF THE
Royet, of Lyons, writes regarding the relation between
menstrual affections and diseases of the naso-pharynx. Tan
turri, of Naples, has a contribution on the treatment of foreign
bodies in the larynx, trachea, and bronchi. The other articles
are of exceptional value both to the specialist and to the general
practitioner. The rest of this number is taken up with a record
of the proceedings of the various societies, European and
American . These reports show that a large amount of impor
tant work is being carried on in these particular fields of
medical science, both in this country and abroad. As a supple
ment to this number there is issued a special report of the
Congress of the French Society of Laryngology, Otology, and
Rhinology, held in Paris from May 13 to 16 last. We most
heartily commend these archives to the notice of those of our
readers who are interested in this department of medicine .
Archiv für Physikalische Medizin und Medizinische Technik.
Vol. II. Leipzig : Otto Nemlich . 1907.
We are pleased to welcome the second volume of this very
valuable periodical issued at Leipzig under the editorship of
Drs. Kraft and Weisner. It is a quarterly review of convenient
size, well printed , and with very fine illustrations. The pro
Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR,—The attention which has recently been directed
to the procedure of Roentgen epilation for ringworm tends to
overshadow the undoubted benefit to be derived from other
electrical methods of treatment. At the London Skin Hospital
it has been the custom for several years to irradiate cases of
tinea tonsurans, not with a view to epilation, but for the direct
action of the rays on the tricophyton. The dose given is a small
one , not exceeding five minutes' exposure with a soft tube once a
week. The action of the rays is apparently a direct one, or it may
possibly be due to the transport of the copper ions into the deeper
tissues of the skin, since most of the cases have been previously
treated with ointment of oleate of copper. These small doses,
repeated once a week, seem to be of undoubted benefit in many
cases . The procedure in its present form was originated by the
radiologist of the hospital, Dr. Deane Butcher, who has now
carried out the treatment for some years.
That the X rays have a direct action on the fungus itself is
proved by the cure of onychomycosis by irradiation . Quite
recently Pellizxari showed three cases to the Academy of
Florence cured by Roentgenotherapy, and that without any
avulsion of the nail .
The cases were cured by seven irradiations with a dose of
about 4H on each occasion . The cure was painless, and without
any visible reaction. The nails did not fall off, but continued
to grow without deformity and without opacity.
I feel sure that the treatment of ringworm by what I may
call the gentler means of radiotherapy will well repay further
investigation. Many parents object , and I think with reason,
to the long and severe exposures required for complete epilation.
ROENTGEN RAY . 87
duction is worthy of German Roentgenology, and will take its
place on a par with the older Fortschritte auf dem Gebiete der
Röntgenstrahlen .
This second volume commences with an article by Professor
Rieder of Munich on the “ Orthorontgenography of the Heart,"
which is profusely illustrated by orthodiagrams and photographs.
A paper by Dr. Paul Wichmann on the “ Treatment of Lupus
by Radium is also of great interest. In the June number
Professor Stephane Leduc contributes articles on the “ Physical
Basis of Life and Biogenesis," and on the “ Culture, Germina
tion, and Growth of Artificial Cells." There are also articles
on the “ X -ray Examination of Joints after Oxygen Insuffla
tion ," by Dr. G. A. Wollenberg ; on the “ Radiotherapeutic
Treatment of Arthritis Deformans,” by Dr. J. Wetterer ; and
on the Kromayer Quartz Lamp.
The abstracts from foreign journals are particularly good .
Among these we notice numerous abstracts from articles which
have appeared in the ARCHIVES OF THE ROENTGEN RAY.
The reproductions of the photographic plates are very beauti
ful, and on the whole we congratulate the editors and publishers
on a very welcome addition to the literature of Roentgenology,
The treatment by means of copper ions carried into the deeper
layers of the scalp by the constant current is also worthy of
consideration. It has, however, the disadvantage of being some
what painful to the little patients.
I am, dear sir,
Yours truly ,
DAVID SOMMERVILLE .
The London Skin Hospital.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR ,-Since I have unwittingly called forth a contro
versy in connexion with the case of a supposed foreign body in
the knee -joint, reported in the April number of the ARCHIVES, I
will ask Dr. Orton's pardon for offering a little more evidence on
my side of the case.
In the last number of the ARCHIVES Dr. Orton states that he
cannot admit my contention that sesamoids occur with com
parative frequency (compared to the other inconstant sesamoids)
in the outer head of the gastrocnemius .
In reply to this I quote from Gray's " Anatomy,” p. 295,
edition of 1887 , seventh line from the bottom of the page .
Speaking of the sesamoids that occur in the tendons of the leg ,
the author says : “ One is found in the outer head of the gastroc
nemius, behind the outer condyle of the femur."
In addition to this quotation I wish to make good my point by
offering to send prints of a number of cases in which these
sesamoids were discovered accidentally while radiographing for
various purposes. If either the journal or Dr. Orton will be
interested in seeing these prints, I shall be glad send them .
I believe this question is of sufficient importance to merit the
88 ARCHIVES OF THE ROENTGEN RAY .

attention I am giving it, for it is more than possible that some knee-joint. I have seen none that did not follow this descrip
misguided individual might mistake this normal finding for an tion, and Dr. Orton's case is identical with this rule .
operable condition, and commit the terrible blunder of cutting The writor feels quite sure that Dr. Orton enters this little
into a knee-joint to remove an obnoxious foreign body that did tilt with the same friendly feeling that he himself indulges, and
not exist. consequently there is no hesitancy on his part in continuing the
The reason why I am entirely certain that my contention is discussion .
correct in this particular case of Dr. Orton's is that the object Thanking you for the courtesies of the ARCHIVES,
shown is not within the limits of the knee -joint at all, but, on I am, sir,
the contrary, it does lie within the region of the hamstring Yours very respectfully,
tendons, and exactly where I have always found the sesamoids. H. P. WELLS.
Another fact I may mention is that these little bones always St. Louis, Mo.,
occur as plano -convex bodies with the plane side toward the June 17 , 1907.

Description of Plates.

PLATES CCLXX. , CCLXXI., CCLXXII. ( Figs. 1 To 12 ).

To illustrate Dr. C. Thurstan Holland's paper on “ Some Difficulties in the X-Ray Diagnosis of Renal Calculus."

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send , with any prints intended for publication, a full account of the
case and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used , or any otherfacts of interest.
EDITOR'S AND PUBLISHERS' NOTICES.
THE EDITOR begs to acknowledge communications from Dr. Herschel Harris ( Sydney ), Dr. Henry G. Piffard
( New York), the American Roentgen Ray Society (Pittsburgh , Pa. ), Dr. H. P. Wells ( St. Louis, U.S.A.), Professor
C. Colombo (Rome), Professor Kienböck (Vienna) , Dr. Groedel (Bad Nauheim), Dr. H. H. Born ( St. Louis, U.S.A.),
Dr. Dawson Williams (London).
The following Journals and Periodicals have been received : “ Advanced Therapeutics,” “ The Electrician ,"
“ The Electric Review ,” “ Knowledge," “" The
The British Journal of Dermatology,"
Dermatology,” “ Annals of Physico -therapy,"
“ Medical Times,” “ Medical Electrology and Radiology ," " Archives of Physiological Therapy," “ Archives
d'Électricité Médicale,” “ Le Radium ," " Annals d'Electrobiologie et de Radiologie," " Fortschritte auf dem Gebiete
der Röntgenstrahlen ," “ Münchener Medizinische Wochenschrift,” “ Zentralblatt für Physikalische Therapie,”
“ Annali di Elettricità Medica," “ Rivista Internazionale di Terapia Fisica .”
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN RAY, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London, W.C., " or to “ W. Deane Butcher, M.R.C.S., Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles and radiographs for publication in our columns are always acceptable, and, in the case of
the former, each contributor will be furnished with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published .
The plates are guaranteedtobe faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view.
Annual Subscription , payable in advance, Sixteen Shillings net (Four Dollars) , including postage; single
numbers, One Shilling and Sixpence net ( Thirty -six Cents) , twopence extra for postage (Four Cents ). Back
numbers can be supplied ; prices on application .
RATES FOR ADVERTISEMENTS IN THIS JOURNAL.—Whole page, £5 net ; half page , £2 155. net ; quarter page,
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Communications relating to advertisements should be addressed to the Publishers, REBMAN Ltd.,
129 Shaftesbury Avenue, London, W.C. (Publishers of the " Archives of the Roentgen Ray and Allied Pheno
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L
VO . XII .

No.
E

4.
O T H
ADI
Va
R ARCHIVES
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
(Formerly ARCHIVES OF SKIAGRAPHY).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE (New York ); A. BECLERE (Paris ); T. P. BEDDOES ( London ); J. BELOT (Paris); F. BISSERIE ( Paris);

ELEC
H. BORDIER (Lyons) ; J. BURNET ( Edinburgh) ; R. AIGHAM COOPER ( London ); W. COTTON ( Bristol) ; FOVEAU DE
COURMELLES ( Paris); L. DELHERM (Paris); R. W. FELKIN ( London ); A P I
TRO L. FREUND ( Vienna ); H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
(Montreal) ; STANLEY GREEN ( Lincoln) ; H. GUILLEMINOT ( Paris ) ;
T HER
D. GUNZBURG ( Antwerp ); J. HALL-EDWARDS ( Birmingham ); G. HARET
( Paris ); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna) ; ERMO
THE

F. H. JACOB ( Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );

ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris ) ; 8. LEDUC ( Nantes) ;
SE

E.R. MORTON ( London ); G. HARRISON ORTON ( London ); H. G. PIFFARD ( New 07

PT

York ) ; JNO.C.RANKIN (Belfast); WERTHEIM SALOMONSON ( Amsterdam ) ; 9

.

1 .
W. F. SOMERVILLE (Glasgow ); H. WALSHAM ( London ) ; CHISHOLM
WILLIAMS ( London ) : CLARENCE WRIGHT ( London ).

CONTENTS .
PAOR PAGE

EDITORIAL • 89 NOTES AND ABSTRACTS ( continued ) :

A CASE OF URTICARIA PIGMENTOSA TREATED BY X Rays 113
REPORT OF THE ELECTRICAL SECTION OF THE BRITISH COINCIDENCE OF MEASLES WITH THE DEFLUVIUM OF THE
MEDICAL ASSOCIATION AT EXETER - .
91 HAIR IN THE X- RAY TREATMENT OF RINGWORM OF
THE SCALP - 113 -

ORIGINAL ARTICLES : THE TREATMENT OF PROSTATIC HYPERTROPHY BY MEANS

OF THE ROENTGEN RAYS . 114
FRACTURES ONLY RECOGNIZABLE BY THE AID OF THE
THE ROENTGEN - RAY TREATMENT OF EXOPHTHALMIC
ROENTGEN RAYS . - By DR. GRAESSNER 102
GOITRE 114
THE DISTRIBUTION OF ROENTGEN RAYS FROM A Focus
THE X RAY VERSUS SURGERY IN SARCOMA . 115
TUBE . - By WALTER A. SCOBLE, A.R.C.Sc. , B.Sc. - 108
THE RADIO - THERAPY OF PSORIASIS AND OF ECZEMA 115
ON THE TREATMENT OF LEUKEMIA BY MEANS OF THE
NOTES AND ABSTRACTS : 115
ROENTGEN RAYS
VALUE OF THE HIGH-FREQUENCY SPARK AS A LOCAL .
115
APPLICATION X- RAY TREATMENT OF TUBERCULAR ADENITIS
- 110
X RAYS AND RESORCIN IN TREATMENT OF LUPUS - 116
THE ELECTRICAL TREATMENT OF PRURITUS OF THE VULVA - 116
INJURY TO THE KIDNEYS DUE TO THE X Rays
AND ANUS - · 110
ELECTRICITY IN THE TREATMENT OF RHEUMATISM · 110 · 116
REPORTS OF SOCIETIES
INDUCTION OF LOCAL ANÆSTHESIA BY COCAINE CATA
PHORESIS .
111
CORRESPONDENCE - · 117
INJURY FROM ELECTRIC CURRENT OF 16,000 Volts - 112
RESPIRATORY GYMNASTICS IN PULMONARY TUBERCULOSIS 112
THE ADVANTAGES OF RADIANT BATHS 112 PLATES :
ORTHODIASCOPY OF THE HUMAN HEART - 112 PLATES CCLXXIII . AND CCLXXIV . - To ILLUSTRATE
THE VALUE OF ROENTGEN -RAY EXAMINATION IN THE DR. GRAESSNER'S ARTICLE
ON “ FRACTURES ONLY
DIAGNOSIS OF EARLY PULMONARY TUBERCULOSIS 113 RECOGNIZABLE BY THE AID OF THE ROENTGEN RAYs ” 118

LONDON
REBMAN LTD ., 129 SHAFTESBURY AVENUE, W.C.
A NEW METHOD OF MEASURING EXPOSURE ,

DR. HOWARD PIRIE'S QUANTIMETER.. ( Patent applied for .)

Descriptive Leaflet post free on application .

IMPROVED RADIOGRAPHIC COUCH (After Dr. Ironside Bruce).

THE INTENSIFIED INDUCTION COIL

FOR SHORT EXPOSURES.

THE MOTO - MAGNETIC INTERRUPTER.

There are already over seventy of these interrupters in use.

Write for descriptive and Illustrated Booklet, No. 7c, post free and gratis on application to
313, HIGH HOLBORN ,
W. WATSON & SONS, LONDON, W.C.
EDINBURGH : 16 , Forrest Road . BIRMINGHAM : 2, Easy Row.

FLUORESCENT SCREENS
( BARIUM PLATINO CYANIDE )
OF SUPERIOR QUALITY AND GREAT BRILLIANCY,
Supplied by Electricians, Opticians, Photographic and Surgical Warehouses
OR BY THE MANUFACTURERS ,

JOHNSON, MATTHEY & CO., Ltd.,

74 to 81 , HATTON GARDEN , LONDON ,
OLD or DAMAGED SCREENS ( if Platino Cyanide of Barium) bought or allowed for in part exchange at best prices.

1
VOL . XII.-No. 4. SEPTEMBER , 1907.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER , M.R.C.S. , F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York ); T. P. BEDDOES (London) ; J. BELOT ( Paris) ; A. BÉCLÈRE ( Paris) ; F. BISSERIE (Paris) ;
H. BORDIER ( Lyons) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER (London) ; W. COTTON ( Bristol ); FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris ) ; R. W. FELKIN (London) ; L. FREUND (Vienna) ; H. E. GAMLEN (West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT ( Paris) ; D. GUNZBURG (Antwerp ); J. HALL-EDWARDS
( Birmingham ); G. HARET (Paris) ; C. THURSTAN HOLLAND (Liverpool); G. HOLZKNECHT ( Vienna ) ; F. H. JACOB (Nottingham ) ;
LEWIS JONES ( London ); A. C. JORDAN (London ) ; ARCH . JUBB ( Glasgow) ; E. LAQUERRIERE (Paris ) ; S. LEDUC (Nantes );
E. R. MORTON ( London ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD (New York ); JNO. C. RANKIN ( Belfast); WERTHEIM
SALOMONSON (Amsterdam ) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM WILLIAMS ( London );
CLARENCE WRIGHT ( London ).

The meeting of the British Medical Association at greatest utility, and should be adopted where considera
Exeter was both in its social and its scientific aspect a tions of expense need not be taken into account. A
great success. There was a separate electrical section, comparison of the different X-ray plates on the market
which will, we hope, form a permanent feature of future showed that the Lumière plate still holds an important
meetings of the Association. As physical therapeutists position.
we may congratulate ourselves on having won , though The discussion on dosage of X rays was opened by
somewhat tardily, an assured position in the Witenage- Dr. Sequeira, in a paper based on the experience of many
mot of medicine. years in the radio -therapeutic treatment of skin diseases
The discussions of the electro -therapeutic section were at the London Hospital. In his opinion the Sabouraud
rendered exceptionally interesting by the presence of and Noiré disc still remains the best direct instrument of
our foreign brethren . The opening address by Professor measurement at our disposal, although it admittedly
Leduc was delivered with that mastery of detail and leaves much to be desired. A record of many thousand
charm of manner which renders him inimitable as an exposures made under its control shows that, with the
exponent of our art. Professor Wertheim Salomonson conditions obtainable at the London Hospital, this
communicated a most interesting paper on his adapta- method is fairly reliable. Dr. Lewis Jones drew atten
tion of Einthoven's galvanometer, an instrument which tion to the new " Fallungs radiometer ,” which is based
will doubtless prove a most powerful weapon of research on the precipitation of calomel from a solution of corro
in the analysis of current curves and in the interpreta- sive sublimate. This method promises to be a useful
tion of physiological reaction. one, as it is simple, easily read, and independent of the
A discussion on X rays and sensitive plates was climatic conditions, which militate so greatly against the
opened by Mr. Mackenzie Davidson, who gave the results reliability of platinocyanide discs. The new form of
of his long and varied experience in the technique of voltameter introduced by Dr. Howard Pirie bids fair to
Roentgen photography. This paper dealt principally furnish reliable means for the estimation of X rays, and
with the quality of the X -ray tube necessary for the will be of use more especially when we desire to give a
production of a good skiagram , and the plate best suited fractional portion of the Sabouraud and Noiré dose .
to X rays. In the discussion which followed there We are glad to welcome an atlas of skiagraphy by an
seemed to be a general consensus of opinion that the English author, Dr. Ironside Bruce, who has brought
stereographic method of X-ray photography was of the out “ An Atlas of Systematic Radiography." Up to the
13–2
90 ARCHIVES OF THE ROENTGEN RAY .

present time, we have been greatly behindhand in unless we assume that it was veritably produced from
the reproduction of the exceedingly good work done the copper .
by English skiagraphers. The plates represent the Such a suggestion of the transmutation of metals
appearance in health of the various joints, with the would have been laughed to scorn if brought forward at
focus-tube in the optimum position for bringing out the a meeting of a scientific society ten years ago ; but we
anatomical details. The work is one of great importance now know for a fact that radium does produce helium ,
and indispensable to workers in practical skiagraphy. and we have thus been in some measure prepared for
Dr. Reginald Morton drew attention to a new method this further step.
of treatment he had introduced at the London Hospital, The explanation offered by Sir William Ramsay is
This consists of the use of slowly alternating continuousthat the enormous amount of energy released when the
currents in lieu of currents of high frequency. The radiun emanation breaks up is used up in the degrada
former are found to be particularly useful in the treat- tion of the product to helium. If the evolution of energy
ment of atonic conditions of muscular organs, especially occurs when the emanation is in solution, the energy is
those containing unstriped muscle. expended in doing other work , the degradation does not
There was a good demonstration of lantern -slides, proceed so far, and the result is argon or neon instead of
among which were some beautiful skiagrams of the helium. Should this be the case, we should expect
hip-joint taken by Dr. Shenton . Dr. Lewis Jones that when it is given still more work to do — c.g., when
showed tracings of the currents of an ordinary medical dissolved in a solution of gold or platinum—the emanation
coil taken with Duddell's oscillograph. Dr. Wertheim should give the next higher member of the series1.e.,
Salomonson showed the current curves of the primary crypton. Unfortunately, experiment in this direction is
of a large induction coil taken with Einthoven's galvano- much hampered by the small amount of radium at our
meter. He also showed a most interesting series of disposal, there being only three or four laboratories in
cardiograms, both normal and pathological, taken by his the world where there is a sufficient quantity to allow of
modification of the same instrument. a repetition of Sir W. Ramsay's experiments.
This discovery is of considerable interest from a
Many of our readers will have felt regret that the medical point of view. We have already heard from
meeting of the British Association should have taken various quarters of an attempt to secure for deep -seated
place at Leicester in the same week as that of the tumours the beneficial result that radium-therapy un
British Medical Association at Exeter. At the former doubtedly exercises on superficial lesions, by giving a
meeting there was, as usual, much discussion in the solution of the radium emanation internally. It is only
Physical Section as to the exact nature and properties the extreme difficulty of procuring a sufficient supply of
of radium. The great sensation was the announcement the medicament which has prevented a more systematic
by Sir William Ramsay that he had succeeded in con- inquiry into this mode of treatment.
verting radium , not into helium only, but also into A paper of special interest to radiologists was that by
other members of the same series—viz. , argon and Professor Soddy on what he terms “ pseudo -high vacua."
neon . He found that, whilst the emanation of radium If a vacuum-tube is filled with a monatomic gas instead
when kept gradually produced helium , a solution of the of those more usually employed, we get all the
emanation in water after a time showed distinct traces of phenomena of a high vacuum at a pressure much below
argon, whilst if a concentrated solution of copper sulphate that usually required, whereas at the ordinary vacuum
or copper nitrate was used instead of water, the gas tube pressure no such effect is obtained. For example,
obtained was neon .This was not all, for on evapora a hydrogen vacuum-tube gives X rays at a pressure of
tion of the copper solution the residue showed the about 0:04 millimetre of mercury. When helium is
presence of both sodium and lithium . The presence of substituted for the hydrogen the X rays are obtained at
sodium might possibly be explained by accidental con- a pressure of 0.2 millimetre , and in the case of mercury
tamination, since it is present almost everywhere. The vapour 0.5 millimetre is sufficiently low. It would be
conditions of the experiment, however, which was of great interest to know what effect these different
repeated several times with all possible precautions, left gases had on the penetration of the X rays given oft
no means of accounting for the presence of lithium , from the anticathode.
 ARCHIVES OF THE ROENTGEN RAY. 91

The subject is one which would well repay investiga- co-workers felt at the presence of these gentlemen found
tion, and we may, perhaps, hope that Roentgen tubes expression in a complimentary resolution at the close of
filled with different monatomic gases may solve the the session. Yet a further factor in the success of the
problem of obtaining rays of a definite, constant degree meetings was the presence of local practitioners, who
of penetration, so desirable for therapeutic purposes. supported the section in considerable numbers.

The President's Address : Electro - ionic

Medication .
REPORT OF THE ELECTRICAL SECTION OF THE
Professor Leduc's address on the opening of the section
BRITISH MEDICAL ASSOCIATION AT EXETER .
was a dignified apologia for medical electricity. He
The seventy -fifth annual meeting of the British Medical began with a graceful recognition of British genius in
Association, which was held at Exeter during the last the realm of electrical science, and pointed out that the
week of July, was of special interest to radiographers first electrochemical reaction — the oxidation of azote by
and electro-therapeutists, owing to the fact that the means of the electrical discharge-was obtained by a
claims of electro -therapy were recognized by the creation British worker, Dr. Priestley ; that electrolysis took its
of a special section . It should be said that the birth in England with the discovery of the decomposition
influence of the Association's President, Dr. Henry of water by Nicholson and Carlisle ; that the laws of
Davy, was no small factor in bringing about this result. electrolysis were given to the world by our own Michael
There was evidently a determination on the part of the Faraday ; and that from England the world has learned
workers in this branch of medical science to make the the electrical nature of light, the theory of the electrons,
meeting one worthy of the occasion , and to ensure for and the laws of radiant matter,
electro-therapeutics a permanent place in future gather- In recent years much had been learned about the
ings. The meetings of the section were held daily in action of currents upon living beings. The faculty of
the Albert Memorial, and were most successful, both in introducing electrolytic bodies into the organism through
point of attendance and of fruitful discussion . The the skin or through a wound had increased in large
measure the resources of the therapeutist and the
papers were, perhaps, somewhat too numerous, so that
on several occasions communications of value were read power of medicine. The main obstacle to electro-ionic
when it was impossible to devote to the discussion of medication was the burning of the skin, produced by
them the time which they deserved . During the three the more or less caustic ions which had their birth at
days of the meetings about twenty papers were read, the surface of the metallic electrodes. These ions had
and there were also two set discussions, one dealing a speed much greater than that which was commonly
with the therapeutic side and the other with the photo attributed to them, because they were driven , not only
graphic aspect of X -ray work. Among the factors which by the electro -motive force, but also by a high osmotic
contributed to the success of the section was the presence pressure. The ions, which had their origin at the surface
in the chair of Dr. Lewis Jones, who conducted the dis- of the plates, raised and maintained a high osmotic
cussion with great tact and energy, and allowed no time pressure, and were thus rapidly diffused away towards
to be wasted. Another factor was the visit of several the skin.

distinguished Continental workers. Among these was
Professor Stéphane Leduc, who occupies the Chair of
Medical Physics in the Medical School of Nantes, and
than whom no one has done more for electro -therapeutics,
both by putting it on a scientific basis of experiment and
by advancing it into fresh fields. Another visitor was
Professor Wertheim Salomonson, of Amsterdam , who is ,
perhaps, one of the most distinguished physicists who
have turned their attention to this branch of medicine.
He read two papers, and took the keenest interest in
the proceedings. The gratification which their British
Professor Leduc then devoted himself to the question
of preventing these caustic ions from reaching the skin.
This result, he said, would be best obtained by a radical
alteration in the usual fashion of the electrodes. The
old cover of chamois-leather over an electrode of carbon
or metal must entirely disappear. Ordinary washing
was not sufficient to remove the caustic ions from it.
The single layer of chamois-leather should be replaced
by fifteen to twenty layers of absorbent tissue well
soaked in the electrolytic solution. Under these condi
tions the caustic ions would not have time to penetrate
92 ARCHIVES OF
the fabric during a single sitting, and after every sitting
the fabric should be renewed or thoroughly washed to
remove the last traces of the metallic and other caustic
ions.
The Professor went on to show that the caustic action
of the ions depended not only on their nature, but on
their number or surface density. If the electrodes were
applied loosely, the current passed at only a few points,
and at these points the surface density became so great
that the skin was damaged or destroyed. This was
best prevented by the more perfect adaptation of the
electrodes to the surface of the skin . The tissues
covering the electrode should be carefully stretched ,
without folds, the metallic plate should be soft and
flexible, and the whole should be fastened to the patient
by means of an elastic band, so as to produce a gentle
and uniform pressure over the whole surface of the
electrode. One precaution , on which he laid special
stress, was the use of pure distilled water in the pre-
paration of the electrolytic solution , so as to avoid the length of time, the result would vary according to which
introduction of foreign and undesirable ions. form of exposure had taken place first. A reversed
Professor Leduc closed his paper with a description X -ray negative could be produced by carrying out the
of the results obtainable when due care was exercised
so as to eliminate this caustic action on the skin . The
high-current intensities necessary both for superficial
and for deep action could then be employed with safety
By this means thoracic diseases came within the reach
of medical electricity. The introduction of iodine ions
over the whole surface of one side of the thorax gave
most excellent results in chronic pleurisy, even of the
suppurative form . With a current of 60 to 100 milli-
ampères and a solution of potassium iodide as the
cathode, iodine appeared in the saliva in from ten to
fifteen minutes. If, however, the iodine solution was
used as the anode, no iodine appeared in the saliva, even
with a strong current passed for a considerable time .
The iodine in the saliva was best detected by electrolysis,
tbe saliva being spread on a strip of starch paper and
the current passed between two platinum needles.
X Rays and Sensitive Plates.
Mr. Mackenzie Davidson opened a discussion on the
subject of X rays and sensitive plates. He dealt first
with the main essential qualities that an X -ray tube
ought to possess. It is important to ascertain the
position and sharpness of the focus of the Roentgen
tube. His method consists in placing in front of the
X-ray tube a thick sheet of lead in which is a small pin-
THE ROENTGEN RAY.
hole aperture. The distance of the pin -hole from the
anode is measured, and a photographic plate is placed
at an equal distance on the other side of the lead. In
this way an image is obtained the actual size of the
X - ray producing surface .
Mr. Mackenzie Davidson also pointed out the deteriora
tion of the image resulting from the X rays given off by
the glass bulb itself, which fogged the plate and blurred
the shadow . He advised enclosing the tube in a box
lined with a thick layer of red or white lead, so as to cut
off the X rays proceeding from the surface of the focus
tube.
Turning to the question of X-ray plates, he detailed a
series of experiments which he had undertaken with the
view of determining the difference of the speed of photo
graphic plates to ordinary light and to X rays. Not only
was there a great difference of penetrative power, but
there were other differences. For instance , if a plate
were exposed to both X rays and light for the same
exposure and development in daylight.
On the question of hard versus soft tubes Mr.
Mackenzie Davidson was non -committal ; he left the
members to discuss the question. He considered that
a tube with an alternative spark-gap of 2.5 centi
metres produced the maximum actinic effect. The nega
tive produced by a high -vacuum tube had a greyish
colour when compared with the velvety black of a nega
tive produced by a soft tube.
This question of hard versus soft focus-tubes was
strenuously debated. Chief among the advocates of
low tubes was Dr. G. H. Orton, who was convinced of
the greater action on the photographic plate of rays
of low penetration . He had lately quite discarded the
use of high tubes for skiagraphy, with marked improve
ment in the result. He worked with a spark.gap of not
more than 3. to 4 inches, even when photographing an
abdomen of considerable thickness. In his opinion
excellent results would be obtained with tubes even
lower than this, if only one could get a focus-tube that
would stand the necessary intensity of current. A tube
so soft that with a current of 1 milliampere the bones of
the hand cannot be seen on the screen will give a good
skiagram when 8 milliampères are sent through it. In
such a tube the resistance increased to a certain extent
with the amount of current employed . As to the ques
 ARCHIVES OF THE ROENTGEN RAY . 93

tion whether a plate can be overexposed, Dr. Orton is of Dr. Howlett thought that it was not possible to over
opinion that this is certainly possible when using a low expose an X-ray plate. The exposure could be prolonged
tube and a heavy current. In such cases, if development indefinitely and development would still give a good
be carried far, the image appears as a positive on the result. He suggested that it might be possible to incor
back of the plate. On fixing such a plate it was found porate in the emulsion of the plate some non-actinic
that practically nothing could be seen through it in material, and thus obtain an X-ray plate which could be
strong daylight, but the positive image was distinctly handled in daylight, doing away with the dark-room .
visible on the back of the plate. He also referred to the Professor Wertheim Salomonson made an interesting
intense blackening of the plate produced by a very low speech on the theoretical side of the question.
tube. The lower the tube -- provided, of course, that pointed out that the electrons impinging upon the
X rays are given off — the more intense is the action on cathode did not lose their velocity all at once, but in
à plate . a series of successive- possibly four or five - oscillations.
Dr. Lewis Jones thought that the photographic results The impulse was thus entirely stopped only after four or
obtainable with very low tubes had been underestimated . five waves . These gave rise to what might be called
It was possible that the appearance on the fluorescent secondary Roentgen rays from the anticathode. These
screen was not in all respects parallel with the influence rays were not so penetrative as the primary rays. In
of the X rays on the sensitive plate. this manner were produced rays of different penetra
Dr. Shenton questioned whether the greater density tive properties. Moreover, when the electrons started
obtainable by the use of low tubes was really required. from the anticathode its potential was lowered, and
He pointed out that, while a negative taken with a high thus during the time of a single discharge not one elec
tube might be bad photographically, it might be more tron was emitted, but possibly twenty or thirty. These
useful to the surgeon than a good negative from a photo- were emitted with different velocities, thus producing
graphic point of view. It was possible, by careful print different degrees of impact on the anticathode, and hence
ing, to get a brilliant result, from the surgical point of X rays of different penetration. During the life of a tube
view, from a comparatively poor negative . The average as the vacuum increased the band of cathode rays became
print taken by a relatively high tube often showed very much more narrow . This meant that the focus, as
details which the denser negative might obscure . photographed with a pin -hole camera, became smaller.
Dr. Morton referred with admiration , not unmixed Hence a new tube became better as its vacuum was
with envy, to the excellence of American radiography. raised by use, and it was sometimes advisable to use a
During a visit to the American Roentgen Ray Society new tube first for therapeutic work and afterwards for
last year he had an opportunity of seeing the results photography.
obtainable by the use of low tubes and intense currents.
Some of the radiographs were of such density that the The Dosage of X Rays.
outline of the kidney could be clearly made out. Per- Dr. J. H. Sequeira's paper on the subject of X -ray
sonally he had failed to obtain these results, for with the dosage also led to a full discussion, in which many well
increase of the current the anode began 'to melt away. known radio -therapeutists took part. Dr. Sequeira gave
He believed strongly in the value of a low tube. the results of his experience of many years at the
Dr. David Arthur also bore witness to the value of low London Hospital, and we hope to publish his paper
tubes. In the West London Hospital the tubes were in extenso in a future issue. In dealing with the
used as low as possible. In a case of renal calculi the question of reaction following upon X-ray treatment,
rays from a hard tube go right through the stone without he pointed out how important it was to observe the
producing a shadow. He never used a tube with an period of latency intervening between the application
alternative spark -gap longer than 3 inches. of the rays and the appearance of the reaction .
On the question of plates, Dr. Lewis Jones appealed The true X-ray reaction is not the evanescent erythema
for a more unanimous opinion among X -ray workers as frequently seen a few hours after exposure, but the
to the essential qualities of a good X -ray plate. It was inflammation, or the effluvium of the hair, which
obvious that they could not instruct the plate -makers appears after this has subsided, possibly two or three
until they were fully persuaded in their own minds. weeks after the irradiation . The varying degrees of
94 . ARCHIVES OF THE ROENTGEN RAY .

reaction complicate the question of dosage and render the patient. The action on the skin is excluded , while
exactness of measurement essential. In considering the the effect upon the blood shows that the deeper action
various instruments of precision which are now in the of the rays is not interfered with.
hands of X -ray workers, Dr. Sequeira said that he Dr. Delpratt Harris thought that in long-continued
preferred that the current of the interrupter should be cases, where the good effects at first produced by irradia
entirely independent of the current in the coil. On his tion were not maintained , it might be wise to vary the
switchboard there are two adjustable resistances-one times of exposure and the intervals between the
for the motor of the interrupter and another for the exposures .
coil. With large coils having a spark of 16 inches, he Dr. Shenton reported one or two cases of scirrhus of
preferred an interruption of about 800 per minute. the breast in which the application of large doses
With regard to the most important problem, that of following a course of treatment by small and regular
dosage, Dr. Sequeira said that in his clinique he doses had resulted fatally. He considered that in
worked on the following lines : The area to be irradiated malignant disease the incidence of a large dose of the
is marked with a blue skin-pencil. The dose to be given rays might possibly make the degenerative process more
is prescribed in terms of the Sabouraud pastille, and the active instead of less active.
patient is irradiated until the requisite change in tint is Dr. Tomkinson pointed out that epithelioma develop
produced. He did not think there was any great advantage ing in tuberculous scar tissue was not necessarily of
in giving the dose in a very short time, although he had X-ray origin. Lupous scar tissue had a natural tendency
obtained the B tint under certain conditions of the tube towards epitheliomatous degeneration quite apart from
in as little as five minutes . In the treatment of rodent any action of X rays. With respect to the bactericidal
ulcer he gives an exposure equivalent to the B dose, and action of X rays, he maintained a neutral attitude. He
makes no further application of the rays until the period said that the experiments which had been conducted
of reaction is passed. This period may extend to three in vitro were interesting but misleading. It was to be
weeks, and is never less than a fortnight. In certain remembered that in radiotherapy we were dealing with
cases of rodent ulcer where there is much infiltration he a bacillus located in the living organism .
has used double the pastille dose. In treating the In his reply Dr. Sequeira was rather sceptical about
ulcerated forms of lupus vulgaris, he finds it wiser to the value of methods of filtration, although he admitted
begin with a small dose, not exceeding the B tint of that in certain cases of carcinoma, epithelioma, and
Sabouraud's pastille. In the treatment of malignant sarcoma, he had been able with the aid of a liquid filter
tumours of the skin and in sarcoma he gives massive to give large doses of X rays without producing der
doses at long intervals. matitis. It was in skin diseases that the filter seemed
In conclusion, Dr. Sequeira said that it had been most likely to nullify the action of the rays, since in
suggested that the administration of small doses of such diseases the most useful rays were those soft rays
X rays over long periods might give rise to a condition which were absorbed by the epidermis and its append
of X-ray dermatitis passing on to epithelioma. He had ages. In the gamut of X rays given off by a focus-tube
seen no such cases of malignant growth which could there were some which would affect the surface tissues
reasonably be attributed to prolonged X-ray treatment, and others which would go deeper, and the filter would
but he thought the possibility should be borne in mind. weed out the former, leaving only the more penetrating
In the subsequent discussion Dr. Ironside Bruce gave radiations, which would have little or no effect on the
the result of his observations on the prevention of superficial tissues. With regard to the alleged more
dermatitis during X-ray treatment. In the treatment rapid dissemination of carcinoma consequent upon larger
of leukæmia he had had no ulceration or any ill effect doses of X rays, Dr. Sequeira had not seen any cases in
whatever following upon X-ray dosage extending over a which this had occurred. He did not, however, advise
period of two years. He attributes his success to the the administration day after day of heavy doses, nor did
use of a filter such as is largely employed in America. It he aim at breaking down the tissues.
consists of four layers of felt, the ordinary material used
under carpets, the whole being about 2 inches in thick
ness . This screen is placed between the focus-tube and
 ARCHIVES OF THE ROENTGEN RAY. 95

A New Meter for Estimating the Dose of The Einthoven Galvanometer .

X Rays . Perhaps the most interesting paper at the meeting
Dr. H. Pirie read a paper on the estimation of the was the demonstration of the use of Einthoven's galvano
dose of X rays by means of a specially designed volta- meter by Professor Salomonson. As this will be printed
meter. In explaining the construction of his meter, in extenso in the October number of this journal, it is
Dr. Pirie said : only necessary briefly to allude to it here. Professor
“ I took a 1 c.c. pipette, about 1 foot long, divided Salomonson has introduced various modifications of
into 100 divisions. I melted one end in a Bunsen Einthoven's model. The latter uses a single electro
burner, and blew a bulb on it about the size of a pigeon's magnet with perforated pole- pieces. Professor Salomon
egg. Through the glass of the tube I sealed two platinum son, on the other hand, uses two electro -magnets in the
wires, so that their free ends projected inside the bulb, form of a nearly closed ring. He dealt with the use of
but did not meet. I then filled the bulb with water, this instrument in the study of the current curves of the
and left a small drop of water in the lumen of the primary of an induction coil. He also exhibited a number
capillary tube opposite the markings of the pipette. The of normal and pathological electro -cardiograms. Every
currer flows through the water from one terminal to muscular contraction causes a so-called action current,
the other, and liberates oxygen and hydrogen. These and thus the heart itself gives an action current with
gases collect and cause the indicator- drop to rise. The every beat. To detect these currents both hands, or one
quantity of gas which collects is thus measured by hand and one foot, are connected to the terminals of the
the divisions through which the indicator-drop rises. galvanometer by means of unpolarizable electrodes of
By a simple arrangement, when the indicator-drop special construction. Generally a small current of rest
reaches the top of the meter, it automatically returns has to be compensated, in order to bring the enlarged
to the zero position, and is ready for the next reading. image of the quartz fibre into the middle of the field of
The quantity of gas liberated is a measure of the current vision. Oscillations of a spot of light synchronous with
passing through the X -ray tube.” the heart-beat are thus obtained.
The ordinary milliamperemeter is under the disadvan
tage that its reading constantly varies with the resist Oscillograph Tracings of Medical Coil Currents.
ance of the X - ray tube and that of the interrupter, and Dr. Lewis H. Jones made a contribution on a some
the resistance of an X-ray tube is constantly changing what similar subject. He showed tracings, taken by
The voltameter is an integrating instrument recording means of Duddell's oscillograph, of the discharges of the
not the quantity of electricity flowing at any particular ordinary medical coil. He finds that the presence of
moment, but the total quantity that has flowed during iron in the core, or of long windings in the primary
the observed time. This, in Dr. Pirie's opinion , is under and secondary coils, increases the duration of the
certain conditions a fairly accurate measure of the out- current waves. This in itself would not be important
put of X rays. He pointed out certain precautions to be were it not for the fact that the longer waves are also
taken in the use of the meter, such as the suppression of the more painful to the patient. Dr. Lewis Jones's slides
the reverse current. He allowed , however, that different showed in a striking manner that the current waves of
X-ray tubes give out different quantities of X rays for the secondary winding of a medical coil vary enor
the same amount of electricity passing through them . mously — from 0·01 to 0.0005 of a second. He also finds
Moreover, alterations in temperature have an effect upon that the presence of a condenser in the primary circuit
the volume of gas collected in the meter ; but for prac- causes the secondary current to be the seat of an oscil
latory discharge. There is, however, no particular
tical purposes this last may be neglected. Dr. Pirie has
worked out experimentally the dose required for epila-advantage for muscle -testing purposes in the use of a
condenser for small coils. He suggested that an im
tion with this meter, without using Sabouraud's pastilles.
By gradually increasing the dose he found that a dose provement in the character of the discharge might be
correspondin g to 10 divisions of his instrument will obtained by using a secondary coil capable of giving a
cause epilation when the focus-tube is at a distance of minute spark in air, and by interposing a gap in the
14 centimetres, whereas at a distance of 7 centimetres circuit. He thought that this form of current might yet
from 3 to 3.5 divisions will cause epilation . prove to be the most advantageous of all from the point
14
 96 ARCHIVES OF THE ROENTGEN RAY .

of view of electro-diagnosis, as the discharge under such reasonably expect that patients undergoing high -frequency
conditions caused little effect upon sensory nerves , whilst treatment would show signs of improved health and
retaining its effect upon striped muscle. vitality

High -Frequency Treatment for Disease of the The Therapeutic Use of Alternative Currents of
Kidneys. Low Frequency.
After instancing the experiments of Bouchard and Dr. E. R. Morton, of the Electrical Department of the
Charrin , Apostoli , Berlioz, and others, on the influence London Hospital, read a paper on the therapeutic value
of these currents in the treatment of various diseases, of alternating currents of low frequency. Dr. Morton
Dr. Somerville passed on to a detailed observation as to said that a current slowly undulating and periodically
the effect of high frequency in facilitating the elimination reversing its direction of flow had always appeared to
of urinary toxins. In most cases under high-frequency him as a therapeutic agent possessing great possibilities.
treatment the amount of urine excreted daily becomes So long, however, as the recent high -frequency wave was
more abundant, but when there is polyuria there is a sweeping over the electro-medical world, there seemed
notable diminution in the excretion. In the case of little use in trying to get a hearing for any other form of
a patient suffering from psoriasis, the amount of urine electrical application. In the early part of the present
excreted during twenty -four hours fell from 150 ounces year Dr. Morton made his first communication on the
to 50 ounces whilst under treatment ; and in a case subject of low-frequency alternating currents ,* and he
of exophthalmic goitre there was a similar diminution. has since continued to make use of them in both hospital
Dr. Somerville furnished some dozen analyses to prove and private practice. He finds them of special use in
that high -frequency currents have undoubtedly a very the electrical treatment of conditions due to atony or
marked influence in improving the metabolism in the degeneration of muscular tissue . In the electrical
body, and in bringing about a better ratio between uric reactions of muscle so affected it is usual to find a
acid and urea . A typical analysis may be given. In prolonged latent period , a prolonged period of contrac
this case before treatment there was deficient excretion tion, and possibly also a prolonged period of relaxation,
both of urea and uric acid-viz. , 301 grains and 7.28 grains which may not be completed until the current is cut off.
respectively in twenty-four hours. The excretion of uric The sum of these several periods might be called the
acid, however, was proportionately lower than that of the " periodic time of the muscle." He insisted that the
urea, giving rise to a disturbed ratio-viz., 1 : 41. Ten interval between the corresponding points of any two
days after treatment commenced, during which time the successive waves of the therapeutic current should be
patient was confined to bed and properly fed and nursed, not less than this. Within reasonable limits, the longer
there was an increase of 119 grains of urea in twenty-four this interval-or, in other words, the lower the frequency
hours, giving a total of 420 grains of urea and 4 :4 grains of the current— the better .
of uric acid . The ratio between the two constituents Dr. Morton went on to claim that with the use of the
almost reached the normal, and the total quantity of low - frequency sinusoidal current we lost none of the
each was almost normal. The amount of urine , too, was advantages of the ordinary constant current, and all its
increased from 26 ounces to 40 ounces in the twenty-four disadvantages disappeared. The fact that the current
hours . was an alternating one effectually removed any possible
Dr. Somerville said that they were frequently told that source of trouble from electrolytic products. As to the
the supposed benefit of high - frequency currents was production of such a current, the best way is to use an
purely imaginary, but he felt himself in a position to ordinary direct current passed through an instrument
demonstrate, by chemical analysis, that irregular and such as Ewing's rhythmic reverser. In answering the
even abnormal metabolism might in great measure be question as to what particular cases benefited most from
corrected or restricted . With the proper and more this current, Dr. Morton said that it was of the very
proportionate excretion of the constituents in the urine, greatest value in the treatment of the degeneration of
they were compelled to judge that fewer toxins were muscular tissue, particularly in the less chronic cases,
retained within the body, and therefore they might * ARCHIVES OF THE ROENTGEN Ray , March , 1907 .
 ARCHIVES OF THE
such as facial paralysis. Another class of cases in which
it was very useful was in atonic conditions of unstriped
muscle, among which were included the atonic dyspepsia
and constipation due to atony of the colon. The current
was very well borne by children-much better than that
produced by the ordinary form of interrupter. Dr. Morton
confined himself to his own personal experience, which
confirmed that of d'Arsonval and others who have studied
the subject .
System in Radiography.
The value of stereoscopic examination was another region. In the normal hip there is an arch formed by
subject which came in for considerable discussion ; and
although Mr. Mackenzie Davidson was keen in his margin of the femoral neck. This line is a continuous
advocacy of stereoscopy, his views by no means met
with unanimous assent . The discussion arose upon two
papers — one by Mr. Edward W. H. Shenton, on " The
Examination of the Hip- joint,” and the other by Dr.
Ironside Bruce, on ““ AA System
System of Radiography ."
Radiography.”
Mr. Shenton introduced his paper by decrying the
attempt to apply geometrical exactness to the human
frame : " There is no straight line of level surface
anatomically ; and though in the animal kingdom there
is a wonderful similarity in the average relation of parts,
there is yet infinitely trifling variation , which renders
mathematical accuracy impossible. There are those
who will localize a foreign body and give the result in
millimetres ; but consider what becomes of millimetres
when the skin is cut and a wound gapes, or the part
swells, or one of many physiological changes takes
place !"
Mr. Shenton remarked that his strictures on the com-
parative inutility of stereoscopic skiagraphy did not
apply to the eye, for in this region the conditions were
so different that general principles did not often hold
good. He went on to say that the only way to carry
out a radiographic diagnosis worthy of the name was to
shut one's eyes to external appearance and one's ears to
suggestion , and repeat to oneself, “ What is there about
this bone that makes it unlike the mental image I have
formed of the normal one ?” Describing his own methods,
he said that in hip examination a diaphragm was an
absolute necessity. Only one hip at a time should be
examined ; any attempt to get two on a plate would normal, he set about constructing an atlas containing
waste the centre field of illumination , which was, of radiograms of the normal bones and joints of the whole
course , the most valuable. An easy way to make an
X-ray proof box for the focus-tube was to line it with
commercial white-lead putty, which was very opaque to
ROENTGEN RAY. 97
the rays and an excellent dielectric. Pieces of lead
with various apertures laid upon the lid of the focus -tube
box made excellent diaphragms. The diaphragm should
be of such a size as to include the great trochanter and
the symphysis pubis. This should be replaced by a
smaller one whenever a suspicious appearance in the
bony outline was detected. In speaking of the advantage
of storing one's mind with the normal image before
attempting to examine the abnormal, Mr. Shenton
demonstrated a useful line, the broken continuity of
which always indicated some serious lesion in the hip
the outline of the obturator foramen and the inner
one in all positions in which it is possible to examine
the hip-joint, but it is best seen when the heels are
placed together and the legs straight. In the various
examples of hip trouble which Mr. Shenton was able to
show on the screen this line was distorted or discon
tinuous in every instance. He concluded with two
principles always to be observed by radiographers in the
examination of the hip-joint :
1. To form a mental picture of the normal to fit over
the abnormal.
2. To keep an open mind when making a radiographic
diagnosis. It goes without saying that the patient should
be previously examined with the fluorescent screen.
Dr. Ironside Bruce, in the course of his paper, “ A
System of Radiography,” also spoke of the importance
of the normal skiagram of bones and joints. In cases of
injury to the bones or joints there never really ought to
be two opinions, once a good radiogram is produced .
With respect to the value of stereoscopic views of the
bones, he said that, although theoretically their utility
was great, yet their usefulness depended on being able
to view the bones really as they appeared to the naked
eye in the dry state, and this could only be if the stereo
scope were perfect and the observer skjlled. He did not
think the stereoscope as now constructed was a perfect
machine, and even if it were, there was the drawback of
the labour, time, and expense that stereoscopic views
entailed. In describing his own methods, Dr. Bruce
said that, realizing the value of a knowledge of the
body. Such an atlas, however, would be of no use unless
the normal radiograms it contained were produced in
such a way that in investigating a case the views pro
14-2
98 ARCHIVES OF THE ROENTGEN RAY.

duced of the abnormal would be identical with the say the extent to which a bullet had penetrated into the
normal so far as concerned the relation between the tissues.
focus -tube and the particular region of the body. In Dr. Ironside Bruce said that his objection to the
order to make this possible , Dr. Bruce arranged an stereoscope was on the ground of expense , and of expense
X-ray couch with a plumb-bob and measuring arrange- alone. This was, perhaps, not so great in the examina
ment, showing the exact course of the normal ray. The tion of a patient, but would be a serious matter in the
production of exactly similar views of any part of the production of an atlas such as he had described.
body was accomplished by placing the anode of the
focus - tube immediately beneath some easily found The Measurement of the Brim of the Female
anatomical point. A further essential for satisfactory Pelvis by Means of X Rays.
comparison was a series of normal views at different Dr. J. R. Riddell read an interesting paper on this
ages so as to show the epiphyses. He selected the ages subject . The special difficulties of such work lie in the
of five, fifteen , and twenty - five years . fact that the plane of the pelvic brim and the surface
Dr. Bruce made a passing reference to the difficulties of the plate on which the shadow is cast are not parallel,
attending the reproduction of X-ray photographs in but lie at an angle to each other, and that the plate
printed form . The most serious difficulty is the pro- cannot be got close to the brim, nor can it be placed
duction of the process block, which causes a great loss always at the same distance from it. He described the
of detail. In ordinary work this is overcome by liberal method of Contremoulins, which consists in applying
touching up, but it is obvious that to retouch a collection stereo-radiography, and of Dr. Morin of Nantes, in
of normal radiograms is to render them of no value. If, which the patient is radiographed in the dorsal decubitus.
on the other hand, no touching up is permitted, the The former method Dr. Riddell considers fairly accurate,
radiograms of the thicker parts when printed lack much and the latter most inaccurate. His own method is
of the detail present in the original. He exhibited his to make a radiogram of the inlet under certain definite
own atlas of normal radiograms, which was ready for conditions, and eliminate the error by calculation.
publication by Messrs. Lewis, and was on view in the 1. The plate is so placed as to rest on the most
British Medical Association exhibition-room at Exeter. posterior part of the sacrum and on the tuberosities of
In this atlas no touching up was done from start to the ischia.
finish, and the result certainly justified such a pro- 2. The plane of this plate will be at a definite angle
cedure, although, of course, there was some loss of with that of the pelvic inlet, which will be nearly the
detail in the reproduction . same in all cases.
In the discussion Mr. Mackenzie Davidson expressed 3. The distance between the plate and the centre of
regret that these talented workers did not use stereoscopy . the pelvic brim will be about 32 inches, and will never
To anyone who possessed binocular vision, and was exceed 4.1 inches.
familiar with a very moderate amount of mathematics, The patient is placed face downwards on a canvas
stereoscopy made everything plain . Surgeons were often covered couch, with the focus -tube in a movable carrier
not very skilled readers of X-ray photographs, but if a underneath. A small air-bladder is placed between the
stereoscopic picture were put before them it was usually abdomen and the couch. The fluorescent screen is
absolutely convincing. We lived and saw in three placed on the patient's back, so as to show the outline
dimensions; why not work as radiographers also in three of the pelvic brim. The focus-tube is then moved into
dimensions ? Stereoscopy only needed the expenditure such a position that the normal ray falls perpendicularly
of a second plate and a very little more trouble . on the plane of the inlet. The focus -tube is then adjusted
Mr. Shenton objected to stereoscopy principally on to a point 24 inches distant from the screen . The
the ground of expense, which was considerable enough plate is placed on the patient's back, resting on the
to make hospital authorities hesitate before using it. It tuberosities of the ischia and the sacrum, and in this
also entailed a great increase of labour, without, in his position a skiagram is taken . The radiogram thus
opinion, adding to the accuracy of the diagnosis. He produced differs from the actual pelvis in that it is
held that the stereoscopic picture was often of little orenlarged owing to the divergence of the rays. It differs
no assistance in estimating the depth of a foreign body, in other ways, but the distortion is so small that it may
 99
ARCHIVES OF THE ROENTGEN RAY.

be neglected. The error due to enlargement is corrected should be a small brass button or knob of about 5 milli
by multiplying the diameter in inches of the shadow of metres in diameter, well covered with a moist cloth.
the pelvis by 0-84, and adding 0.16 inch. Dr. Riddell The diagnostic value of the symptom consists in the
described the experiments by which he and his fellow- possibility of distinguishing between supranuclear and
workers at the Glasgow Royal Infirmary had arrived at peripheral lesions. Moreover, it enables us to diagnose
this formula. The accuracy of the method has been severe, intermediate, and slight cases. It has also a
demonstrated on the dead body. In one case the prognostic value, in that it shows when regeneration of
measurement of the antero -posterior diameter of the the nerve is beginning, this being always accompanied
brim of the pelvis on the radiogram was 4 inches. This by a rapidly decreasing excitability.
gives 4 x 0.84 +0.16 = 3.42 inches for the true diameter.
The actual measurement, carried out during a post Ureteral Calculi.

mortem examination, was 3.43 inches, so that the error Mr. A. D. Reid read a paper on “ Ureteral Calculi,”
amounted only to 0:01 inch. The distance 0:16 inch and showed his instrument for locating a stone in the
represents the distance between the plane of the pelvic kidney during the course of an operation. It is com
inlet and that of the plate. This distance , of course, paratively easy during an operation to localize by palpa
varies, and cannot be accurately determined ; but after a tion a large calculus in the kidney, but it is often a
number of experiments Dr. Riddell believes that in all matter of great difficulty to feel a small calculus in the
but extreme cases the error will be something less than depths of the calyx or in the substance of the kidney,
0.16 inch . The rule to multiply the measurenient and the organ has often to be mutilated severely before
of the radiogram by 0.84 and add to the result 0.16 it can be found. The remedy, says Mr. Reid, is found
can be depended on to give the actual diameter of the in screening the kidney after it is delivered ; but when
pelvic brim . The objections to this method apply equally this operation has been performed with the aid of the
to other methods , while Dr. Riddell claims that it has fluorescent screen, there has hitherto been a risk of the
the merit of simplicity. introduction of sepsis. It is at this point that the ad
vantage of the cryptoscope comes in. The cryptoscope
consists of an aluminium cup, 3. inches in diameter, at
The Electro - Diagnosis of Oculo-Motor Paralysis. the bottom of which is placed the fluorescent screen,
A paper by Professor Wertheim Salomonson on “ The which is kept in position by a wire spring. The bottom
Electro -Diagnosis of Oculo-Motor Paralysis " was read by of the cup, being of aluminium , is quite transparent to
Mr. Deane Butcher. It is often stated that the human the rays. Over this cup slides & cylinder of aluminium .
eye muscles do not contract when electrically stimulated . This bears at its upper end two tubular eye-pieces, and
In normal persons none of the ocular muscles can be the arrangement of the cup and cylinder is such that
stimulated effectually ; but, according to Professor Salo- the screen can be adjusted at a suitable distance from
monson, in certain pathological conditions, such as para the eye of the operator. The screen is completely em
lytic ptosis, the levator palpebræ superioris may be bedded in celluloid, and the whole apparatus consists of
stimulated so as to react by contractions. A current of three pieces, all of which can be completely sterilized .
1 to 3 milliampères causes a slight lifting of the upper The kidney is exposed in the ordinary way, and brought
eyelid to the extent of a few millimetres at the utmost . out on the loin. The tissues around the kidney are then
In cases of complete oculo -motor paralysis the first con- pressed down from the organ by means of a special
traction may generally be observed about the twelfth retractor, also of aluminium. In the central portion of
to the fourteenth day after the onset of the paralysis. this plate-like retractor a hole is made of sufficient size
From the fourteenth day the necessary current strength to allow the kidney to pass through it. The tube is
to produce the contraction diminishes rapidly until about adjusted so that it can readily be brought opposite the
the twenty -fifth or thirtieth day. At that time it has exposed kidney. When the organ has been delivered,
even been possible to produce a contraction with the retractor is placed in position and the kidney ex
0:03 milliampere, and with an electro -motive force of amined directly by the cryptoscope. It is then possible
only 4 volts. The motor point is situated a few milli- to see the smallest fragment of calculus in the kidney
metres beneath the centre of the eyebrow. The electrode and to localize its position accurately, when it is a matter
100 ARCHIVES OF THE
of comparative simplicity to make a small incision over
each calculus and to remove it . Dr. Reid thought that
inasmuch as by this method the removal of the smaller
fragments of calculus was ensured , the danger of recur-
rence, due to fragments of stone being left in the kidney,
was reduced to a minimum . The smallness of the inci-
sion, due to the greater accuracy of method, was another
point in favour of this method .
doses with lengthy intervals of rest, and so attempting
Treatment of Lupus, Ulcer, and Paget's Disease to prevent the onset of cutaneous X-ray intolerance, that
by X Rays.
Dr. J. Goodwin Tomkinson , of Glasgow , brought
forward a new method of treating lupus vulgaris, and
gave particulars of a number of cases which had proved
amenable to a kind of combined treatment. Dr. Tom
kinson has been using the X rays for some time past in
the treatment of lupus vulgaris, and has kept in view two
objects—the relative shortness of treatment and the
production of satisfactory results from an æsthetic point
of view. His method is as follows :
If any crusts exist they are removed by the application
of a salicylated ointment. A tentative X-ray exposure
of three to five minutes is made upon a small area of the
lesions. In a few days the X rays are employed for
about five minutes daily upon a somewhat wider area of
the lesion, unless contra-indicated , until the whole lesion
has been gone over some three or four times. It is then
plastered with Unna's 50 per cent. salicylic acid and
creosote Pflastermulle, which is renewed daily. If its
application be badly borne, the part is previously
swabbed with 20 per cent. solution of cocaine. In a
variable number of days it is found that much of the
tuberculous tissue has come away. The lesion is then
swabbed with the cocaine solution, dried, and afterwards
painted with the following preparation :
R. Acid. carbolici 50 per cent.
Acid. lactici 15
Acid. salicylici 15
Alcohol absolut. 20
few minutes afterwards the lesion is painted with
the following solution :
R. Acid . carbolici ...
80 per cent.
Alcohol absolut . 20
After cauterization, the part is dressed for a day or
two with sterilized lint and carbolic oil ( 1 in 30), and
thereafter with 20 per cent. aqueous solution of ichthyol
until healing has taken place. The X -ray treatment is
then recommenced, short exposures of three to five
ROENTGEN RAY.
minutes — rarely longer — being made. At the end of
three or four months the treatment is discontinued for a
considerable time, during which the patient occasionally
returns for inspection . At the end of this interval
usually of some months — the patient is submitted to a
second course of treatment, which is repeated after
another interval if necessary.
Dr. Tomkinson believes that it is by giving small
the best therapeutic action of the X rays in lupus vulgaris
will be obtained . The cicatrices resulting from this
method of treatment are smooth and flexible. Lupus
secondary to tuberculous adenitis has responded well to
this treatment.
Dr. Delpratt Harris gave a list of cases at the Royal
Devon and Exeter Hospital and in his private practice
in which rodent ulcer and carcinoma had yielded to
X -ray treatment. Of the nineteen cases which he
brought forward , eight were cured, six were benefited,
in one case there was no effect, and in the four remaining
cases attendance was discontinued .
A Case of Paget's Disease treated by X Rays.
Dr. James Taylor, of Bristol , described a case of
Paget's disease that healed under the influence of the
X rays. When the patient first came to him she had
a large ulcer on the breast, flat, red-looking, and with
copious discharge, but there was no trace of tumour to
be felt in the breast itself. After a few applications of
the rays patches of new skin began to grow in from the
edges, and, finally, after fifteen applications, extending
over a period of two months, the ulcer had completely
cicatrized over. Whilst this healing process was going
on , however, a tumour made its appearance in the
substance of the breast, and enlarged somewhat rapidly,
so that the breast had to be amputated. Microscopic
sections of the tissues shown by Dr. Taylor revealed the
fact that there was a continuous line of epidermis over
the whole area where the ulcer had been, and this had
all the appearance of normal skin. Just beneath the
epidermis one or two small ducts were filled with cancer
cells. It was eyident , he said , that the X rays had a
strong, stimulating effect on epithelial growth, as shown
by the complete healing of the ulcer on the surface. It
was very questionable whether the stimulating action of
the X rays on the growth of the epithelium set up the
malignant action in the deeper parts of the breast. It
 ARCHIVES OF THE ROENTGEN RAY . 101

was certainly disappointing to find that whilst the rays The Use of X Rays from the Point of View of
had such a markedly beneficial effect on the superficial the General Practitioner .
disease, yet the deeper disease went on absolutely A paper on this subject was read by Dr. Ellis Pearson,
unaffected by them , and perhaps was stimulated to one of the hon. secretaries of the section . He gave a
greater activity by their agency. survey of work into which X rays had entered both as a
diagnostic and a therapeutic agent. His object was to
The Rationale of Static Currents .
consider the treatment of disease by electricity from the
A paper on this subject was read by Dr. F. Howard point of view, not of the expert, but of the general
Humphris, of Honolulu . He claimed a great deal for practitioner . He said that no responsible person had ever
static electricity, although he admitted that in disease definitely stated that X rays were a cure for cancer, and
which was dependent upon grave organic and structural he thought that those interested in this method of treat
changes neither static electricity nor any other form of ment were to be congratulated on the very guarded
therapeutics could effect a cure. He dealt in turn with opinion they had always expressed as to its use in this
the four different kinds of effects produced by static disease. But any treatment that exerted even a slight
currents - mechanical, electrical, chemical, and actinic. beneficial influence on cancerous growth was worth their
In their mechanical action these currents cause tissue consideration , and it could not be doubted that cases of
contraction-not only contraction of the skin and cutaneous carcinoma and epithelioma had been cured by
muscle, which could be seen, but also contraction of the X rays .
the protoplasm within. Answering the criticisms as to
static currents being merely “ skin currents,” Dr. Practical Demonstrations .
Humphris said that the best physicists of the day were One of the most interesting demonstrations at the
now agreed that the static currents did traverse the Exeter meeting was the exhibition of the orthodiagraph
body, passing along the path of least resistance. Since by Dr. Hugh Walsham and Dr. Halls Dally. A number
the skin was a worse conductor than the moist tissues of orthodiagraphic tracings of healthy chests were
beneath it, it was impossible to imagine that the current shown. In orthodiagraphic examination the “normal
would merely flow over the skin when it could go incident ray ” is conducted round the entire circum
through the tissues . The therapeutic effect of the ference of the organ under investigation , and the exact
current was constitutional as well as local, this being size of that organ can be mapped out. As regards the
evidenced by the increased elimination of urea and other accuracy of the results , Dr. Walsham claimed that they
extractives , the production of perspiration , the altera- were able to measure motionless objects to within the
tion in arterial tension , the increase of carbon dioxide, fraction of a millimetre .
and the general feeling of bien -être. The electrical In the demonstration before the meeting the subject
effects of the currents , producing in the tissues an active was in the erect posture , resting against the canvas of an
metabolism , were partly due to the polarization of the upright couch . The tracing-paper , ruled in centimetre
cells through which the current passed and partly to squares , was fixed to a drawing - board at the back of the
mechanical action . Polarization of the cell elements instrument, and the stylograph was a hollow reservoir
induced cellular activity . The currents acted chemically filled with aniline dye .
by the evolution of nascent ozone and nitrous acid, One of Dr. Halls Dally's tracings showed a case of
which from their very nature were fatal to such bacteria very early pulmonary tuberculosis affecting the left apex,
as the staphylococcus and streptococcus . They also in which the limitation of diaphragmatic movement on
acted actinically , by the germ- destroying effect of light, the affected side was clearly indicated . The infracostal
by the possible diminution of certain toxins , and by angle on the same side was diminished . This tracing
the increasing of the oxidation processes . Almost all supports the observation that unilateral limitation of
disease , said Dr. Humphris , is due to or is accompanied diaphragmatic movement is often the earliest sign of
during its course by congestion or stasis . He held that pulmonary tuberculosis .
each of the four actions of the current contributed in its At the lantern demonstration which concluded the
own way to the relief of stasis , and with the relief of the proceedings Dr. Lewis Jones showed an interesting
stasis came the relief of the disease . radiograph of the lumbar region in which the shadow of
102 ARCHIVES OF THE ROENTGEN RAY .

a wart-like growth on the skin of the patient's back by the fact that German medical literature records but
simulated the appearance of a renal calculus. It showed, four cases in which the diagnosis was determined with
he said, that a small superficial growth of soft tissue in out post-mortem examination. It is only with the
contact with the plate might give a shadow out of all advent of the Roentgen rays that we have been able to
proportion to its density. This fact should be borne in obtain any information as to this fracture. Between
mind when using the X rays for the diagnosis of renal 1903 and 1906 I have myself shown the presence of this
calculi. isolated fracture in twenty-three separate cases. Of
these twenty- three fractures , three were caused by a fall
The meetings of the section closed with a heartily on the outstretched hand , one by a blow from a swinging
accorded vote of thanks to the President, and much door, and seventeen by falling on the shoulder on level
satisfaction was expressed at the character of the work ground. The large proportion were thus caused by a
done. comparatively small force.
I cannot here enter into a discussion on the mechanism
of the origin of the fracture, which I have already fully
dealt with in a former paper. * In ten instances there
FRACTURES ONLY RECOGNIZABLE BY THE AID were only one or more small splinters detached from the
OF THE ROENTGEN RAYS. * bone. In these cases there was always some slight
By Dr. GRAESSNER, Roentgen Institute, Cologne. displacement, usually in a forward rather than an
upward direction . When the tuberculum is broken
The fractures which I wish to bring before your notice right across, the line of fracture is generally curved. In
have a practical interest for radiologists in that they can those rare cases in which the fracture is attended with
only be recognized with certainty by the aid of the great dislocation, the broken portion being displaced
Roentgen rays. As they are usually caused by some outwards and upwards, the defect is clearly visible as a
comparatively slight accident, they are generally mis semicircular cavity in the humerus.
taken for mere bruises or sprains. Hence they are often In many instances the whole protuberance is shattered,
imperfectly treated, and in many cases result in a and if there is simultaneous dislocation, this is readily
permanent disturbance of function . These accidents recognized on the skiagram. If, however, the shadow of
are particularly frequent amongst labourers , and the
the humerus is superimposed on that of the tuberculum,
resulting lameness often gives rise to exaggerated claims the fracture is more difficult to detect. In all cases
from the insurance companies. The occasional occur where such a fracture is possible , if the first Roentgeno
rence of such fractures as those of the carpal and meta gram is not quite conclusive, a further careful examina
tarsal bones , for example, has long been recognized, but tion should be made in order to detect a possible concave
it is my object to show that they are really of much fracture of the surgical neck, which is often accompanied
more frequent occurrence than is usually supposed. My by splintering of the tuberculum majus and of the head
observations were made on the rich material to be found
of the humerus. This is especially necessary in cases
in the city hospitals of Cologne, and I examined with where there is no dislocation , as the fracture will only
the X rays every injury where there was even the
appear as a fine line of fissure, even in the clearest
slightest suspicion of a possible fracture. Roentgenogram .
Amongst these fractures which are often overlooked
In this respect I would give a word of warning against
we must include the uncomplicated fracture of the placing too much credence in the evidence of a skiagram
greater tuberosity of the humerus. It is well known taken immediately after the accident. It is by no means
that this fracture is of common occurrence in cases of easy to make a really good skiagram of a newly injured
dislocation of the shoulder, especially when the humerus shoulder. To secure good results it is indispensable that
is dislocated forwards , but the fracture of the tuberculum the part should be kept absolutely immobile, particularly
majus, uncomplicated by other injury, has been hitherto avoiding any movement due to respiration . If the
regarded as extremely rare. The difficulty of diagnosing patientcan be induced to breathe superficially only,
such a fracture by purely clinical symptoms is illustrated
Veroffentl. aus dem Gebiet des Militarische Sanitätsanstalt, vol .
* Read before the Berlin Roentgen Congress, 1907 . XXXV. Berlin , 1906.
 Fig . 1. - FRACTURA TUBERCULI MAJORIS HUMERI.

Fig . 2. - FRACTURA TUDERCULI MAJORIS HUMERI.

TO ILLUSTRATE ARTICLE ON " FRACTURES ONLY RECOGNIZABLE BY THE AID OF THE

ROENTGEN RAYS ” ( p. 102 ) .

By DR. GRAESSNER.
PLATE CCLXXIII .
(" Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
103
 Fig . 3. --INFRACTIO ACETABU'LI.

Fig. 4 .-- LUXATIO TIBIO - FIBULARIS INFERIOR . Fig . 5. - LUXATIO TIBIO - FIBULARIS INFERIOR.

TO ILLUSTRATE ARTICLE ON “ FRACTURES ONLY RECOGNIZABLE BY THE AID OF THE

ROENTGEN RAYS ” ( p . 102 ) .
By DR. GRAESSNER.
PLATE CCLXXIV .
(“ Archives of the Roentgen Ray and Allied Phenomena ." — Copyright.)
105
 ARCHIVES OF THE ROENTGEN RAY . 107

immobility can often be obtained by placing him on his incomplete fracture of the acetabulum. I am not here
back with a wedge-shaped pillow under the injured alluding to the central displacement of the head of the
shoulder, and securing it in position with sandbags. I femur into the true pelvis, since this can always be
do not recommend taking the skiagram whilst the diagnosed clinically ; but to a fracture of the socket in
patient is under the influence of chloroform , since the which the floor of the acetabulum is merely pressed
deep breathing during unconsciousness makes it almost inwards, with slight displacement of that portion of the
impossible to keep the shoulder sufficiently still. I have horizontal ramus of the os pubis which helps to form the
myself obtained the best results by the use of the com- socket .
pressor diaphragm . I might mention that in all five Fig. 3, Plate CCLXXIV. , shows the appearance of such
of the cases of fracture without dislocation, the first a fracture . The patient was a workman who fell from
skiagram taken without the compressor failed to show a scaffold. In spite of his injuries the man was able to
any indication of the injury. It was only when a sub- walk to his home. The only treatment adopted was to
sequent skiagram was made with the compressor in use, keep the patient in bed ; the injury, however, soon
that the fracture of the tuberculum was detected resulted in severe swelling of the joint. Both the
(Plate CCLXXIII. , Figs. 1 and 2). medical man who first saw bim and the consultant who
With regard to technique, I follow that of Albers- was called in later declared it to be a case of simple
Schonberg. * The injured arm must be slightly rotated contusion. The latter regarded the complaint of arthritic
outwards during the exposure, but excessive rotation is pains as much exaggerated, whilst a third doctor who
to be avoided, and it is not necessary to abduct the limb. saw the patient put him down as a malingerer. It was
The prognosis of unrecognized isolated fracture of the only after taking a Roentgenogram that the serious nature
tuberculum is very unsatisfactory. Niesrytka, as the of the injury was recognized .
result of the study of seven old cases of fractured tuber- Similar cases have come under our own observation.
culum which had not been recognized at the time, but Although clinical symptoms—such as the sensitiveness of
were detected some time later by means of the X rays, the floor of the acetabulum to pressure on rectal examina
gives the following indications : t " The patients com- tion, or on deep pressure on the upper half of Poupart's
plained of long -standing pain, which was increased by ligament—may indicate the presence of some injury to
movement, so that months, and sometimes years, after the the acetabulum , the diagnosis can only be confirmed by
injury they would only move the injured limb very gently , the X rays.
and the range of motion was very limited. They also In all doubtful cases of injury to the hip a skiagram
complained of ever-increasing weakness of the affected is absolutely necessary, even for the detection of an
arm . A feature common to all the cases was the limita- impacted fracture of the neck of the femur, which is by
tion of the power of raising the arm . The active motility no means so rare, even in youth or middle age. The
of the injured shoulder-joint was equally diminished in diagnosis of “ contusion of the hip " should never be
all cases, but there was considerable difference in the considered satisfactory unless a good skiagram has con
passive mobility in different patients. This was ap- clusively proved that there is no fracture of the neck of
parently due to the varying degree of dislocation, and to the femur, the acetabulum, or any other part of the
the severity of the fracture and subsequent arthritis." pelvis. The failure to recognize these fractures is
I have myself observed precisely the same effects in cases generally due to a greater or lesser degree of arthritis,
of old fractures which have come to us either for an which, however, can usually be avoided by the proper
opinion or for treatment, whereas in cases which had application of an extension apparatus.
been put up with an extension apparatus at once, a cure There is another fracture, much less rare, which,
resulted without any loss of functional power. I although well known, is very often overlooked on
Another type of fracture which can only be diagnosed account of the difficulties of its clinical diagnosis. This
with certainty by the aid of the Roentgen rays is an is the luxation of the inferior tibio - fibular joint, the
diarthrosis between the lower ends of the tibia and
* Alberg- Schonberg, Die Roentgentechnik , 1906. fibula . If the anterior and posterior ligaments which
† Deut. Zeitschrift f. Chirurgie, Band 82.
23

I Bardenheuer - Graessner, - Technik der Extensionsverbunde,"

hold the two bones tightly together should become
Stuttgart, 1907. loosened, the bones will separate. If this condition be
15
 108 ARCHIVES OF THE ROENTGEN RAY .

not speedily recognized and corrected, the arch in which we have found in addition a separation of the entire
the astragalus rests yields, and we get an amphiarthrosis lower epiphysis of the humerus.
of the ankle-joint with all its attendant ills. This dis- Even with the aid of a Roentgenogram , it is very
placement of the tibio - fibular ligament may occur alone , difficult to show such a condition where there is no dis
but is usually associated with splintering of larger or location. In many instances it is only when a radiogram
smaller fragments from the outer side of the tibia, or has been taken some weeks after the accident that the
from the articular surface of the fibula ; or with a fracture position of the ossified periosteum indicates the extent
of the fibula itself. As the injury is usually caused by to which it must have been dragged along the shaft of
forcing the foot outwards in excessive supination , it is the humerus.
usually mistaken for a simple sprain, and treated accord- In these last-mentioned cases the accurate diagnosis
ingly. Since there is nearly always a good deal of of the injury does not, indeed, influence the course of
effusion of blood at the time of the injury , the diagnosis treatment in so great a degree , yet it has its value as an
is very difficult unless a fairly large splinter has been aid to prognosis, since when there is also damage to the
detached , so that it can be detected by crepitation. For bone the recovery will be much less rapid .
this reason the diagnosis should be confirmed by a In conclusion , I may mention a case of separation of
Roentgenogram (Plate CCLXXIV., Figs . 4 and 5). the epiphysis of the trochanter minor femoris, which is
When making the skiagram, it is most important that of interest as being the first case to be recorded. The
the foot should be fixed in a position at right angles to diagnosis was given by the Roentgenogram .
the leg, and that the normal ray should fall directly over A fifteen -year -old errand-boy was running very fast
the middle of the joint. Even a slight turning of the with the upper part of the body bent forwards, when he
foot will give a distorted image. In any doubtful case stumbled . To avoid falling on his face, he jerked his
a skiagram of the other foot should be taken under body sharply backwards and to one side. He felt a
precisely similar conditions for purposes of com- sharp pain in the inner side of the thigh, and found that
parison . he was unable to lift his leg. Clinical examination
I would next draw your attention to one or two other resulted in a diagnosis of rupture of the ilio -psoas muscle.
observations which show the value of Roentgenology for A skiagram , however, showed that there was a separa
diagnostic purposes. In a large majority of cases of tion of the epiphysis of the trochanter minor.
joint injury, we find, in addition to hæmarthrosis, some The foregoing cases seem to show that it is to the
fissure or splintering of the bone. This is especially the advantage of the surgeon no less than to the patient to
case in injuries to the elbow or knee. Information as to employ the X rays in cases of accident much more
the presence of such a fissure not penetrating into the frequently than is done at present. In all doubtful
joint is of special import when occurring at the lower cases, even when the injury is recent , he will find their
end of the femur or tibia. As Wagner has pointed out, aid invaluable. The cost is, moreover, but trifling, if we
if a strain be put on it too soon, such an injury may consider the permanent injury which may result from an
easily give rise to arthritis deformans. undetected fracture in a joint.
In two cases, which had been diagnosed as sprains of
the knee, I was able to point out a rupture of the crucial
ligament. In one case the attachment to the inner side
of the femur was torn, and in the other the attachinent THE DISTRIBUTION OF ROENTGEN RAYS FROM
to the tibia. A FOCUS - TUBE .
I have frequently found small splinters of the bone in
By WALTER A. SCOBLE, A.R.C.Sc. , B.Sc.
many cases of luxation in which the clinical examination
gave no indication of the possibility of a fracture. The following is a brief account of experiments made
Again, it should be noted that in many cases of some time ago— (1 ) to compare the intensities in different
fracture that are at once diagnosed as such, there may directions of the radiations issuing from the anticathode
be also some injury to another bone which will only be of a focus -tube ; ( 2 ) to find if the percentage composition
revealed on radioscopic examination . Thus, in separa- of the rays, as regards penetration , varies with their
tion of the epiphysis of the epicondylis medialis humeri, intensity, the same focus-tube being used, but the current
 ARCHIVES OF THE ROENTGEN RAY . 109

sent through it being altered ; (3) to determine whether, Some of the readings were checked by an ionization
at any given time, the composition of the rays is different method, the coil and focus-tube being in an earthed lead
in different directions . box. The rate of leak across a gap was measured by an
Since there is a liability to confusion in defining the electrometer in the usual way.
direction of rays issuing from a focus-tube, the accom- A series of experiments was made with a Müller water
panying illustration may make the matter clearer.. cooled tube, and a second with a Cox regulating tube.
Position 1 is on the line normal to the plane of the anti- The results obtained are given in the following tables,
cathode, the central point of the fluorescent hemisphere. the intensity normal to the anticathode being taken as
unity :
MÜLLER WATER-COOLED TUBE.

Position

ion
tion

Position
Position
36

Posit
Posi
1
35

.
.

.
.
Intensity. Intensity. Intensity. Intensity. Intensity .
1
T
23 3
0 A
-
6 16 A. B. A. B. A. B. A. B. A. B.
33 1.78
22 : 8 2:18 2.16
an

5 7 2.18 2.16 36 14
32 6 16 1.83 23 1.8 30 1.8 35 1.4
1.88 1.94
5 1.73 1.8 15 1.7 22 1.6 29 1:52 34 1.4
14
4 1:48 167 14 1:52 21 1.56 28 1.63 33 1.4
X

3 1.361.43 13 1.37 20 14 27 154 32 1.36

2 1.131.17 11 1.16 19 1.38 26 1.45 31 1.38
26 1 10 1.0 10 1.06 101 18 1.25 i 1.26 25 1.57 | 1:51 17 1.25
19

A = Intensity as measured by photographic method.

8

B = Intensity as measured by ionization method .

?Q

+ 20 Cox RECORD REGULATING TUBE.

ANTICATHODE Inten Inten Inten . Inten
Position . Position . Position . Position .
sity. sity. sity. sity.
CATHODE 9 10
8 1.31
7 1.28 24 1.2
6 1 23 16 1:04 23 1:16 30 1.08
5 1.03 ? 15 1 :1 22 1.08 29 1.06
1.23 14 1.19 21 1.14 1.04
3 1.34 13 1.47 20 1.76 1.02
2 1.2 11 1:36 19 1:43 26 1.19
Positions 1 to 9 are in the median plane through the 1 1.0 10 1.03 18 1.27 25 1.41

cathode and anticathode. In the diagram the positions

are indicated by numbers, the arc between any two The figures given are open to small errors, but the
consecutive numbers being 10 degrees in one direction general character of the results is accurately represented.
and 20 degrees in the other.. It will be seen that the intensity varies very curiously
The tube was supported in an arrangement somewhat with the position, but that the amount and direction of
resembling gimbals, so that it could be turned in any ' the variation depends enormously on the particular
direction as required without altering the position of the focus-tube employed. It might be advisable to expose
centre of the anticathode. The tube could be moved strips of photographic paper over the hemisphere of a
when running, so that sets of readings could be taken new focus- tube in order to obtain a general idea of the
distribution of the rays.
during the same run, eliminating errors which are sure
to occur if the tube is stopped and restarted . In an article in the ARCHIVES OF THE ROENTGEN RAY,
1. To obtain the intensities in various directions a February, 1907, Professor Bordier assumed that the
dome-shaped stand was made to carry photographic optimum direction of irradiation is in the median plane,
plates at 12 inches from the centre of the focus-tube. and found that it made an angle of 75 degrees to
All the exposures for one series of experiments were 80 degrees with the normal to the plane of the anti
made at the same time, and all the plates were developed cathode. For both the Müller and the Cox tubes there
together by a standard method. The densities of the were maxima at about 75 degrees, but in the Cox tube the
developed plates were measured in a photometer, and true optimum direction was not near the median plane.
the corresponding intensities of the rays obtained by 2. For the experiments on penetration the intensity
referring to standard curves , was measured with an instrument somewhat similar to
15—2
 110 ARCHIVES OF THE
Milton Franklin's electroscope, but with a smaller 3. Three positions were taken as being probably
aperture. The rotating shutter over the aperture was typical of differences in the composition of the rays.
replaced by a slide which carried a leaden plate or the
aluminium plates used for the analysis of the rays.
Experiments were then made in order to determine
whether the composition of the rays varied with the
current through the tube. A series of tests were made
during a long run, a water-cooled tube being employed
and the vacuum remaining unchanged. There was an
indication that the rays became harder as the tube was
run more heavily, but the difference was not great. The
fraction of the rays which penetrated 4 millimetres of
aluminium was increased by about 5 per cent. when the
intensity of the rays from the tube was doubled . With
the electroscope used the rays had to penetrate the
ebonite window, so that they were never quite un
filtered .
The next series of experiments was made to determine
whether the percentage composition of the rays was the
same in all parts of the field .
ftotes and Abstracts.
ELECTRO-THERAPY.
Value of the High -frequency Spark as a Local Applica
tion.—Dr. Reginald Morton ( Lancet, June 1 , 1907 ) under this
heading describes cases of alopecia areata, acne vulgaris, and
port-wine marks, in all of which excellent results were obtained.
In the case of alopecia areata, a vacuum glass electrode con
nected to the top of the resonator was rubbed over the scalp
until a bright erythema was produced. In this connexion he
states : “ From subsequent experience I have learned that the
success obtained in the case was in all probability due to the
ease with which hyperæmia was produced, and according as
this is easy or difficult one can predict with a fair amount of
certainty how far one is likely to be successful in any given
case.” With regard to acne vulgaris he states : “ The rapidity
with which the unsightly spots disappeared after some half
dozen applications was as surprising as it was satisfactory."
In the case of port-wine marks, a metallic point electrode,
mounted on an insulated handle and connected with the top
of the resonator, was used. The point was held about 1 inch
from the surface, so that a hot white spark jumped across the
intervening space. This was continued for several minutes,
until vesication was produced over the entire surface of the
patch. In about eight days the old epidermis peeled off,
leaving a smooth surface, pink from the remains of inflam
matory reaction , but otherwise quite normal skin . He mentions
another case similarly successful, and adds : " From such
experience as I have had, I have no hesitation in saying that
ROENTGEN RAY .
Measurements were again taken during one long run,
control - tests being made to be certain that both the
intensity of the rays and the vacuum remained constant.
The rays were hardest in Position 1 ; in Position 5 they
were slightly softer, the difference being hardly definite ;
and in Position 25 they were decidedly softer. The
analysis for the three positions is given below :
Position . Thickness of Aluminium . Intensity.
0 10
1 ! 2 0:56
4 0.37
ANO
10
5 0.54
0 : 346
NO
1 :0
25 0.5
0:3
‫ܛܪ‬
port-wine stains or marks, which at times constitute a very
serious disfigurement, can be entirely removed by this method
when they are only of moderate depth and extent, while the
more severe cases can be at least very greatly improved.”
The Electrical Treatment of Pruritus of the Vulva and
Anus (La Clinique, May 17 , 1907).-- Noiré advocates electrical
treatment in these distressing conditions. Most authorities, he
says, recognize the value of static electricity and the application
of high -frequency currents. Without doubting the value of these
measures, Noiré says that the results obtained are often very
unsatisfactory, and are always inferior to those achieved by the
X rays. Feeble doses ought to be employed. It should be
remembered that the ano vulvar region is one of the most
sensitive to the rays, and an erythema may very readily be
induced . After a single application in one case, which had
previously had twelve high-frequency applications, the author
succeeded in causing the pruritus to disappear entirely. The
whole region should be exposed to the rays. The patient lies
on a couch . Ten days' interval should elapse between each
séance. In applying the X rays in male subjects the testicles
ought to be carefully protected by leaden guards. The results
obtained by this method, both in pruritus of the anus and of
the vulva, are uniformly excellent. The technique is similar in
both cases .
Electricity in the Treatment of Rheumatism ( American
Medicine, March, 1907 ).— Rainear says that in all rheumatic
 ARCHIVES OF THE ROENTGEN RAY.
conditions electricity must be applied constitutionally and
locally. High-frequency and static currents with solenoids and
resonators and ozenotherapy are specially applicable to the
general condition . In considering and selecting the proper
form of local electrization , we have five different modifications
or phases of current at our disposal-viz. , direct, indirect, static,
sinusoidal, and, combining the first two, the well -known galvano.
faradic forms of electricity. Both the general and local
applications cause an increased activity to the animal cell,
increasing the functional capacity by storing up nutritive energy
and causing glandular stimulation and elimination. The writer
is convinced that the continuous, static, high - frequency and
induced forms are the most reliable and permanent in their
actions on the rheumatic condition. There is no question as to
the d'Arsonval or high -frequency current producing metabolism
when molecular conditions are enhanced and oxidation more
complete. Constant and persistent articular pains will be
almost instantly relieved by a high -frequency or a continuous
current. The continuous current is a sedative agent, and when
combined with the induced galvano.faradic the fibrous forma-
tions in joints are destroyed, and upon interrupting the current
the congestions are removed as a result of electrical massage.
General or constitutional galvanization acts as a tonic to the
entire system, but decidedly so on the nervous structures. The
direct and static currents are the most active stimulants of
nutrition we have , and as malnutrition and malassimilation are
present in all rheumatic cases , the organs of digestion, absorp
tion, and elimination are forced to the proper performance of
their functions. The local treatment may be continuous or
interrupted, or the combination, galvano - faradic. The slowly
interrupted faradic current, when locally applied to an individual
muscle, causes a contraction , and indirectly such contraction
means more blood to the part and increased nutrition. When
muscular pain is present, a galvano-faradic current would cause
a contraction, and at the same time decrease pain and soreness
of the parts. If pathological fluid is present, absorption can be
effected by the local application of the current to the joint, or
the insertion of needles attached to the cathode may be
resorted to when the deposits are of the nature of a com-
mencing calcareous or sodium urate formation .
Rainear recommends the following general routine of treat-
ment : When there is much muscular involvement, a primary
and secondary current from the faradic coil of about three to
five minutes' duration should be applied directly to the muscles.
At first currents of minimum strength should be employed, and
the current increased to the maximum power of endurance .
This should be followed by weak interrupted primary faradic
currents. If excessive pain is present, it is advisable to use a
continuous current of 15 to 30 milliampères. When the
articulations are affected, galvano-faradic currents applied directly
over the joints should be employed for from ten to fifteen
minutes. Labile currents following stabile applications usually
give high therapeutic results. The continuous current applied
to the spine, the anode over the exit of the nerve from the cord,
and labile applications of the cathode over the joints and
muscles, are recommended. Spinal galvanism with anode over
the cervical vertebræ , and cathode on the upper section of the
sacrum, using 20 to 35 milliampères of stabile variety, is good large hairs in them must be first destroyed by the electric needle
111
treatment. Finally, no form of electrical applications will give
better results in rheumatism than the wave -current and brush
discharge, causing as they do a prompt cessation from pain and
a marked reduction in the swelling around the affected joints.
Induction of Local Anästhesia by Cocaine Cataphoresis .
-Cataphoresis, by the introduction of drugs into the system by
electricity, is still in its infancy. In the Journal of the American
Medical Association of February 23 , Dr. D. T. Quigley has re
ported very satisfactory results from the induction of local
anästhesia by cocaine cataphoresis. He has used the method
for removal of tumours of the breast and epithelioma of the lip,
herniotomy, removal of hæmorrhoids, and destruction of moles.
The technique is as follows': A piece of aseptic gauze is folded
four times and cut to the size of the part to be operated on.
The gauze is saturated with a solution composed of cocaine
hydrochlorate, 1} drachms, solution of adrenalin (1 in 1,000 ),
2 drachms, in sterile water to 2 ounces. The adrenalin con
stricts the vessels and renders the operation almost bloodless,
but secondary hæmorrhage occurs in about one case in four.
The gauze is covered with metal foil and connected with the
positive pole of the battery. The circuit may be completed by
the patient holding in his hand a wet sponge electrode connected
with the negative pole ; or, better, a large pad electrode may be
attached to the skin by a bandage near the seat of operation,
If the operation is on a limb, the negative electrode may be
attached on the opposite side to the positive one, and both may
be held in position with the same bandage. Care must be taken
that the skin between the poles is perfectly dry, otherwise the
current will follow the wet surface and not pass through the
skin . The time required is from fifteen to thirty minutes, and
may be longer if a deep effect is necessary. Dr. Quigley has
never observed any toxic effects from absorption of cocaine. A
battery of 20 or 30 wet or dry cells should be used. The current
should be as strong as the patient can bear without discomfort.
After the current is turned on, the edge of the foil- covered gauze
should be turned every five minutes and fresh solution applied,
as the gauze should be well saturated to get the best effect. In
operating on hæmorrhoids the gauze should be applied to a cone
shaped metal electrode large enough to have a dilating effect on
the sphincter when applied to the anus. This electrode should
have a wooden or hard rubber handle and be pressed firmly into
the anus by an assistant. In from twenty to thirty minutes the
sphincter will be considerably relaxed and the hæmorrhoidal
area anæmic and numbed. If the hæmorrhoids are large and
pendulous, the base may be grasped gently between the blades of
a forceps, each blade being wrapped with gauze saturated with
the solution. The handle of the forceps is then attached to the
positive pole and the circuit is completed. In a few minutes
the tumour can be cut off without pain. In operating on nævi
the area should be anæsthetized as described . Then the nævus
is transfixed just below the surface with straight needles about
one thirty-second of an inch apart. A fine wire is threaded
through the eyes of the needles and attached to the negative
pole. The current is passed until the spaces between the needles
look seared and pale. This destroys the nævus and does not
leave a scar. The same method may be used for moles, but any
112 ARCHIVES OF THE
attached to the negative pole. The anesthesia lasts over an
hour, so that ample time for the operation is afforded . — The light baths contain, the advantages of radiant baths over Turkish
Lancet.
ELECTRIC CURRENT.
Injury from Electric Current of 16,000 Volts ( Tidskr.
for den Norske Lageforening, 1906, p. 101).— Dr. H. Scheel
reports the case of a workman who was repairing the in-
sulating cover of the leads of an electric transformer, and
approached his head too near the cable. The whole head was
surrounded by flame. There was considerable burning of the
scalp , the right ear, and the right side of the neck and throat.
The man was insensible for several hours. The injured portions
sloughed off so that the skull was laid bare for more than a
hand-breadth. A traumatic cataract of the right eye was also
produced The electric current had a voltage of 16,000 volts,
but it is probable that the head did not come into absolute
contact with the cable .
MECHANO-THERAPY.
Respiratory Gymnastics in Pulmonary Tuberculosis
organ . Every year the value of the method has become more
( Journal de Physiothérapie, January 15, 1907 ).— Rosenthal and more obvious. But there is always a certain degree of
states that a certain number of essential principles ought to
govern the practice of the physician who desires to apply to personal error ; it seemed advisable, therefore, to work out a
tuberculous subjects treatment by means of physiological respi
ratory exercises :
1. The gymnastic exercises should always be applied by the
physician himself. It is absolutely essential that the latter
should understand fully the nature of physical therapeutics, and
how to direct the exercises in any given case.
2. The physician must correct errors of physiological respira
tion in the patient, and re-educate him in the art of breathing.
3. The application of this mode of treatment is difficult, and
should always be carried out with very great care.
4. In cases where weight is being rapidly lost this form of
treatment should be entirely suspended.
5. These exercises should not be carried on continuously, but
the patient should rest for a little at times.
6. Sanatorium treatment is an indispensable adjunct to this
method of treatment. The physician at the sanatorium should
be judge as to whether the exercises should be stopped or con
tinued in any given case.
7. Needless to say, respiratory gymnastics do not take the
place of the other recognized methods of treatment. It is only
as an auxiliary means that it can be said to be useful .
Rosenthal concludes by stating that in early cases great
prudence must be observed, the exercises should be carried out
very gently, and the dorsal decubitus should be maintained
during the process. As a prophylactic measure against pul-
monary tuberculosis he praises the employment of respiratory
gymnastics, and urges this treatment as a valuable adjunct to
sanatorium régime.
PHOTOTHERAPY.
The Advantages of Radiant Baths ( Journal of Advanced
Therapeutics, March , 1907 ).- Finkelpearl, in a valuable article
on the advantages of electric light in the treatment of various
ROENTGEN RAY.
diseases, says that, aside from the chemical rays which electric
or Russian are numerous. He mentions especially the following
in this connection :
1. Radiant heat is more penetrating, and consequently drains
the deeper tissues much better than any other form of heat.
2. Patients who cannot stand a high temperature will perspire
at a much lower temperature when electric light is the source
of heat .
3. Patients will tolerate a higher degree and a longer exposure
to radiant heat than to any other form .
4. It may be given with impunity to people with a weak
heart if the patient is watched.
5. As the head does not have to be included, various substances
may be vaporized within the cabinet, and caused to be absorbed
by the open pores, thus avoiding the liability of irritating the
respiratory organs.
Orthodiascopy of the Human Heart ( Professor H. Rieder,
of Munich ).- F . Moritz was the first to introduce a method of
obtaining a drawing of the heart giving the true size of the
method of obtaining the orthodiagraphic picture of the heart
upon a photographic plate.
Since the “ normal ray ” alone must be used, it is clear that
the outline of the heart must be taken in small sections following
one another in regular order around the margin of the organ.
The method is as follows : The horizontal orthodiagraphic couch
of Moritz is employed. An iris diaphragm enables the pencil
of X rays to be cut down to the required size. The normal ray
is now determined by a plumb-line or a cross-thread arrange
ment. The room being darkened, an orthodiagram is drawn
upon tracing-paper placed in the usual way under the fluor
escent screen. The patient is directed to stop breathing while
the outline of the diaphragm is being drawn.
The iris diaphragm is now cut down to 6 or 7 millimetres (a
still sinaller aperture is not expedient ) ; the dots which have
been drawn upon the tracing paper are joined by a continuous
line, the fluorescent screen is removed, and a sensitive film
(Lumière, marked " sigma," or a film of the Berlin Aniline Co.)
between two intensifying screens is inserted carefully under the
tracing-paper bearing the orthodiagram . During these prepara
tions the patient must lie perfectly still.'
The orthodiagraphic photograph of the heart and diaphragm
is now taken . The current is switched on , and the pencil is
made to pass slowly around the outline of the heart ; the X-ray
tube moves with the pencil, and thus every part of the circum
ference of the heart is exposed in turn.
With an average-sized man the time required to complete the
circuit of the heart and diaphragm is about thirty seconds with
a focal distance of 60 centimetres , and about twenty seconds
with a focal distance of 40 centimetres. The patient is only
required to hold his breath during the few seconds required to
follow the border of the diaphragm . If the sensitive film
between intensifying screens be exchanged for a sensitive plate,
the time required is longer - one or two minutes. In this case
 ARCHIVES OF THE ROENTGEN RAY . 113

the margins of the heart may be followed round either once months. The rash was distributed over the front of the body ;
slowly or several times rapidly. on the back its distribution and extent was similar - it involved
To mark the middle line of the body, a chain or a perforated the neck . The face, hands , and feet were free . Upon the trunk
band of lead may be used attached to the middle line by the lesions ran in oblique lines in its girdle axis. The individual
strapping lesions were macules, and although a number could be felt with
The author's observations with this method extend over the eyes shut, I believe that this was due to temporary tur
eighteen months or more. A number of orthodiagrams, “ ortho gescence. In colour they were a deepish brown, with a tint of
roentgenograms,” and “ Roentgenograms " are given in illustra yellow ; in shape oval. Turgescence of the old lesions on irrita
tion of the method, which is both rapid, safe, and exact, and is tion and factitious urticaria were very marked. Itching was
easily learned (Archiv für Physicalische Medizin und Medi slight. The child was in all other respects healthy, and gave a
zinische Technik, October, 1906 ). normal blood-count.
For treatment the child had three exposures to the X rays at
The Value of Roentgen -Ray Examination in the Diag intervals of a week, the total dose being insufficient to produce
nosis of Early Pulmonary Tuberculosis. - S . Moritz (Medical any visible reaction. For six months from this date both facti.
Chronicle, May 1907) states that a valuable help to the diagnosis tious urticaria and turgescence of the old lesions on irritation
of pulmonary tuberculosis may be obtained by an examination ceased , and no new lesions appeared. At the end of this period
with the Roentgen rays. He refers to the five characteristic the old symptoms returned , but were again removed by three
signs as given by Walsham and Orton - viz .: (1 ) The move doses of X rays, and remained absent after three months. The
ment of the shadow of the diaphragm on the affected side is mother holds that the old macules are lighter in colour, but I am
restricted ; (2) one or both apices fail to light up on deep not convinced of this . —British Medical Journal.
inspiration ; ( 3) the diseased portion of the lung casts a dark
shadow ; (4) the heart in a large majority of the cases is Coincidence of Measles with the Defluvium of the Hair
smaller, and is placed more vertically in the chest ; ( 5 ) any in the X -Ray Treatment of Ringworm of the Scalp (by
alteration in the shape of the chest and in the position of the ribs J. M. H. Macleod, M.D. ).—The X-ray treatment of ringworm of
can be better determined . the scalp has now passed through the experimental stage and
Arnsperger, Schellenberg, and Scherer found only in 6 per become recognized as the most rapidly effective mode of treating
cent. of their cases the first sign-the diminished excursion of the disease, and, if properly done by recent methods, it has been
the diaphragm-which was first described by Francis Williams. shown to be comparatively free from risks. The so-called single
Arnsperger ascribed it to pleuritic adhesions, which in early exposure method, thanks to the work of Sabouraud and others,
cases are frequently absent. He further draws attention to the has replaced the more uncertain method of repeated exposures
fact that the shadows seen at the diseased apex during deep and fractional dosage. So certain and well- regulated has the
inspiration frequently become darker instead of lighting up. dosage become, that the operator now expects the defluvium of
Pförringer and Bung also dispute the value of Williams' sign . the hair from the exposed area to take place on about the
The second, third, and fifth signs are undoubtedly of great sixteenth day, without any marked inflammatory disturbance,
diagnostic value. only occasionally a transient hyperæmia for a few days before
Laennec had drawn attention to the smaller size of the heart the hairs fall out. Consequently, when any marked hyperæmia
in consumptives, while later observers more or less contradicted occurs, it is naturally a source of great anxiety, suggesting the
his statement-thus Reuter, who, in 179 cases of phthisis, found possibility of an overdosage of the rays, or the previous employ
72 with cardiac hypertrophy ; and Hirsch, who found 44 per ment of some irritant to the scalp, such as tincture of iodine.
cent. with an enlarged heart. Bouchard and Balthazard , how Recently I had the alarming experience of an erythema occur
ever, state that in the first and second stages of phthisis the ring on the exposed areas in the scalps of two boys just as the
heart as a rule is smaller than normal, and that this forms one hair was falling out, which was so marked as to cause consider
of the predisposing elements to tuberculosis. In the third stage able anxiety, but which turned out to be due to the singular
the heart becomes larger through the increased resistance in the coincidence of an eruption of measles with the defluvium of
pulmonary circulation . Further improvements in the Roentgen-. the hair. This unusual experience seems to be worthy of
ray apparatus will probably, says the writer, within the next recording.
few years, make this method of examination a still more Towards the end of last October two boys, aged respectively
valuable aid in diagnosing, or at least of confirming our diag nine and four years, suffering from small-spored ringworm of
nosis of, early pulmonary tuberculosis. the scalp, were sent up to me from the country for X-ray treat
ment. In both of them an eruption of measles appeared on the
RADIO - THERAPY . exposed areas of the scalp as the hair was falling out. The
following are brief notes of the cases :
A Case of Urticaria Pigmentosa treated by X Rays (by Case 1.-Aged nine years. Suffering from tinea tonsurans,
J. H. Jacob, M.D .).—- In July, 1906, a male child, aged thirteen due to Microsporon Audouini. The patches of ringworm were
months, was brought to me on account of a rash, which proved confined to the frontal and occipital regions, and could be
to be a very typical exa ple of urticaria pigmentosa. The included in two exposures with a circular localizer of 7 centi.
child had fair hair and blue eyes. The rash first appeared on metres diameter. The exposures were given on October 27 .
the abdomen, eight days after vaccination, at the age of four On November 14 the hair had begun to fall out from the exposed
114 ARCHIVES OF THE
areas, and it was noted that the skin of both areas presented a
vivid erythema. This erythema was not of the mild, diffuse
type usually associated with the falling out of the hair, but was
mottled in character, and consisted of irregularly shaped red
macules or slightly raised lesions, somewhat deeper in tint in the
centre, and varying in size from a pin's head to about } inch in
diameter. The presence of the eruption was not associated with
any itching. At the same time it was noticed that the boy was
out of sorts : he complained of headache and coryza, and had a
temperature of 101 ° F. He was sent to bed, and next morning
a typical measles rash had developed on the forehead, behind
the ears, on the sides of the neck, and was rapidly spreading on
to the chest and back. I saw the case again on November 28 in
consultation with Dr. Owen Lankester , and found that the
measles rash had disappeared and that the hyperæmia had gone
from the exposed areas, which were quite bald , and the ring.
worm cured . An interesting point about the case was that the
measles eruption was first noticed on the exposed areas where
the hair was falling out, and was not present to any extent else-
where on the scalp. The hair had begun to grow by the middle
of January, and he was allowed to return to school.
CASE 2.—Boy, aged four years, younger brother of other case,
suffering from extensive tinea tonsurans due to Microsporon
Audouini. The ringworm was much more widely distributed
than in the former case , and it was necessary to give eight single
exposures of areas 7 centimetres in diameter to include it all.
One small patch of ringworm had to be excluded from the X-ray
exposure, as it had been irritated by previous treatment. The
exposures were given on October 25, 31 , and November 1. On
November 14 the hair had begun to come out of the areas first
exposed, and a mottled erythema, associated with the same
X rays upon this disease. Since the X rays produce a shrinkage
general symptoms as affected the elder brother, had developed, in
but they were more severe in character. Next day the measles vascular thyroids, and were accordingly recommended in the
eruption had become generalized over the skin. On November 28 treatment of thyroid enlargements, generally the method seems
the measles rash had disappeared, and the exposed areas were
bald . The case was not quite so satisfactory as the previous one,
as the unexposed patch had to be needled on several occasions
with croton-oil, and also a few stumps which had been left
between two contiguous exposed areas. The hair had begun to
grow by the middle of January.
These cases were of great interest on account of the measles
eruption appearing on the areas rendered temporarily bald by
the X rays. When the eruption was first seen in this situation ,
in spite of the catarrh and temperature associated with it, the
possibility of its being measles did not occur to me, and some
unusual form of X -ray dermatitis suggested itself. This anxiety
regarding the cases was, however, dispelled next morning, when
the eruption had come out fully . — British Medical Journal.
The Treatment of Prostatic Hypertrophy by Means of
the Roentgen Rays ( Zeitschr. f. Urologie, January, 1907 ) .-
Schlagintweit, who has already described this form of treatment,
says that he has recently treated fifty-three patients ; but in the
paper under consideration he only refers to the results gained in
thirty of these, as in the other twenty-three the treatment was
given up after finding that no result followed three applications
of the rays. The patient is laid in the horizontal position on a
table. The anal orifice is well smeared inside and out with
ROENTGEN RAY.
vaseline, so as to allow of a speculum of 25 millimetres diameter
being introduced without pain. The prostate must be accurately
located by means of the forefinger ; then the speculum, with an
obturator 5 to 10 centimetres in length , is introduced. When
the speculum has been fixed in the desired position, the obturator
is withdrawn. The assistant then pushes through the speculum
a covered tube .
The ages of the patients treated varied from fifty to eighty
four years . In none of the cases was there the slightest evidence
of burning, or even of irritation of the bowel, produced by the
rays. In all of them , with the exception of three in whom there
was a very hard gland, there either resulted an improvement or
the appearance of definite strangury twelve to twenty-four hours
after the operation . There was no change in the character of
the urine, and no alteration in the cystitis. Any improvement
that followed, however, might last for some days or months,
but was never permanent. The gland often appeared for a time
to have altered in form and consistence when examined with
the finger, but these changes were never permanent. The
author therefore concludes that the action of the Roentgen
rays on the prostate is inconstant and uncertain , and has no
permanent effect upon the residual urine, which is such an
important point in the treatment of prostatic disease.
The Roentgen -Ray Treatment of Exophthalmic Goitre.
— R. Freund (Muenchener medizin . Wochenschr., April 23,
1907), in an important communication , refers to the fact that
exophthalmic goitre has within recent years specially engaged
the attention of physicians. Serum -therapy and the surgical
treatment of the disease are specially mentioned . During the
past two years the writer has been trying the effect of the
to be a thoroughly rational one here also. The enlarged, mor
bidly functionating gland will be made to shrink in size, and so
the defective secretion will be destroyed. The only question
remaining is as to what clinical experience teaches on this point.
As clinical records up to the present are very scanty, the author
considers himself entitled to add to the collection of illustrative
cases by recording a few drawn from his own practice.
So far as the cases recorded up to the present are concerned,
those of Beck, which were the first, are not really pure cases of
X-ray treatment, inasmuch as this method was only employed
after operation had yielded an unsatisfactory result. In two of
his cases he performed excision of one half of the gland, and
obtained an improvement, but not an actual cure , of the con
dition. With the knowledge that the X rays have a specific
influence on the bloodvessel walls in tumours, Beck tried the
X rays, and found that they produced after a few séances a
marked improvement in the tachycardia and nervous symptoms.
Then he employed them in a case where he had operated by
removing one half of the thyroid, and after six séances he
obtained a distinct improvement.
Following these experiences of Beck, other observers began to
work, and Wiedermann reported on three cases so treated to the
Society of Medicine in Vienna on December 21 , 1905. He did
not find any diminution of the symptoms in exophthalmic goitre.
 ARCHIVES OF THE
The eye symptoms and pulse -rate remained unchanged. Still, improved, six have no further symptoms of malignancy, and
in two cases the nervous symptoms were beneficially influenced,
while all the cases showed an increase of body weight. Wieder-
mann cautions against great expectations. Favourable results
were later recorded by Gilmer, Schlesinger, Stegmann, Sklodow-
ski , and Schwarz .
The writer then records five cases of this disease treated by
means of the Roentgen rays. He maintains that his case
histories form a very fitting solution to the question as to how
far this treatment has a favourable action . He points out very
particularly that three of his cases are absolutely pure cases of
Roentgen -ray therapy, no other therapeutic measures having
been employed. He found that with a shrinking of the stroma
came a corresponding diminution in the intensity of the nervous
symptoms, and in two cases the cardiac limb became less intense ;
at the same time the body weight showed a distinct increase.
Two of his cases have already been under observation for over
fifteen months, so that in these he is enabled to refer to them as
permanent results. His conclusions are that the Roentgen rays
have a causal indication for their use in exophthalmic goitre,
inasmuch as they bring about a diminution of the pathological
secretion of the glands. They have a very favourable influence
upon the body-weight, and also upon the nervous phenomena ;
and even the other symptoms may become diminished in
severity, especially the cardiac bruits, the enlargement of the
thyroid, and the exophthalmos. The soft, vascular, compressible
thyroids yield the most favourable prognosis , and the evidences
of the disease yield to treatment most rapidly when they are of riginous eczemas of the anal and genital regions, and in eczema
recent date.
LITERATURE
1. “ Ein neues Feld für Röntgentherapie ,” Münch. med . Wochen
schr., 1905 , No. 20. 2. Berliner klin. Wochenschr., 1905, No. 20.
3. Albers-Schönberg, Fortschrittee, Bd. 9, S. 403. 4. Zit. nach
Zeitschr. f. Elektrother ., Bd. 8 , S. 192. 5. Wien. klin. Rundschau,
1906 , S. 321.6. Wiener klin. Wochenschr., 1906 , No. 3. 7. Deutsche
med . Wochenschr., 1906, No. 33. 8. Neurol. Zentralbl., 1906, S. 779 .
9. Möbius, Die Basedowsche Krankheit, 1896. 10. Kongress f. inn.
Med ., 1906 .
The X Ray versus Surgery in Sarcoma . - Aspinwall Judd,
M.D. ( New York Medical Record, December 29, 1906) , con
siders that the results obtained by X-ray treatment in sarcoma
are more favourable than is the case in carcinoma. He states
that nearly all cases of sarcoma treated by the X ray recur - and
in one of his cases this was even true for the third time—but
that, nevertheless, he has found many react to the ray just as
kindly the third time as the first. In speaking of such cases, he
says : “ Whether I shall be obliged to go on treating these
patients for the rest of their natural lives, or whether they will
finally cease to be favourably affected, as some of them already
have, I have no means of knowing ; but, at any rate, if I can
give one or more years of apparent health to even a small
fraction of these patients, I shall feel that in the X ray we have
a remedy which is better than any other so far suggested .”
Reaction , as proved by diminution in the size of the tumour,
is usually slow at first. This depends upon the softness of the
tumour and preponderance of cell elements. The softer the
tumour, the quicker the response. When treatment is complete ,
entire absence of the tumour is not to be looked for, as a fibroma
will remain . Fourteen cases are quoted , of which three are
ROENTGEN RAY . 115
five are dead or unimproved . In nearly all cases, in addition to
the X-ray treatment, thyroid extract was administered in doses
as large as could be tolerated, and resolution of the masses was
found to be more rapid under its use.
The Radio -therapy of Psoriasis and of Eczema (Zeit
schriftf.physik. u. diat. Therapie, June, 1906 ).- H . E. Schmidt
points out that radio -therapy is of great value in the treatment
of psoriasis and of eczema. In using the current we must stop
short of producing erythema, otherwise only harm will result.
Some days after the application desquamation of the patches of
psoriasis ceases, and finally there is a total disappearance of the
infiltrated area .
In the course of ten days the affected parts
are practically healed, and leave no more than a mere pigmenta.
tion, which disappears in from eight to fifteen days' time. The
healthy skin in the neighbourhood shows no appreciable reaction .
The currents employed are so feeble that no fear of injuring the
tissue need be entertained. If after the first sitting no result
is obtained within eight days, then after the lapse of ten or
fifteen days a current of double the strength may be employed.
The cases that are best suited for this treatment are those in
which the patches are localized , inveterate, and which resist all
other modes of treatment. It is also useful in cases of psoriasis
affecting the hands, and where there is diffuse infiltration .
With regard to eczema, radio-therapy should be avoided in all
acute cases. It is, however, of special value in the very pru
of the hands, especially in chronic cases. Eczema affecting the
lower extremities is less amenable to radio-therapy.
On the Treatment of Leukæmia by Means of the Roentgen
Rays ( Blätter f. Klin . Hydrotherapie, January, 1907). -
Golubinin has treated five cases of leukæmia by means of the
Roentgen rays in one of the medical clinics at the Moscow
University. The duration of each séance lasted about half an
hour. In order to obtain the best results, twenty to forty
sittings of from fifteen to thirty minutes' duration were neces
sary. The author's experience goes to prove that the Roentgen
rays present a form of treatment which , in the majority of
cases, displays an undoubted energetic effect upon the numerous
symptoms of leukæmia. In all his cases referred to improve
ment followed the treatment. The composition of the blood
was improved , the glands were reduced a little in size ; but the
strength of the patient, the general symptoms, and the body
weight remained absolutely unaltered .
X -Ray Treatment of Tubercular Adenitis. Barjon ( Lyon
Médicale, No. 41, 1906) reports twelve cases. He found that
the chief effect was on the general infiltration which so often
accompanies this form of adenitis, and unites the glands into a
solid mass . Soon after beginning X -ray treatment the glands
become separated, and later may disappear . If there be any
tendency to softening, he found, as has been stated by many
others , that the rays hasten the softening process , and the
abscess soon requires to be opened . The rays continue to have
a good effect on the suppurating tissues . In none of the cases
were any bad effects produced , or tendency to cause metastasis
noted .
16
 116 ARCHIVES OF THE ROENTGEN RAY .
X Rays and Resorcin in Treatment of Lupus. Reines
( Berliner Klinische Wochenschrift, No. 35, 1906) believes that
better results are obtained in the X-ray treatment of lupus when
the disease has been previously treated with resorcin , the latter
agent preparing the tissue for the action of the rays. A 33 per
cent. resorcin ointment is spread on linen and applied to the
affected area. After twelve hours it is removed, by which time
the superficial layers of the lupus patch have become greyish-
white, and so soft that they can be rubbed off with a piece of
gauze soaked in sublimate solution. The ointment is then re-
applied, and the process repeated for five or six days. The
removal of the tissue should be as great as can be done with-
out pain . When a weeping surface free from epithelium is
exposed, the X-ray treatment is begun, medium hard tubes
being used ; the resorcin treatment is continued at the same
time . He states that there is no risk of poisoning if the
ointment used be no stronger than 33 per cent., and if no
patch larger than the palm of the hand be treated at one
time .
Injury to the Kidneys due to the X Rays. In the
American Journal of the Medical Sciences for May Dr. A. S.
Warthin has published an important paper on the action of the
X rays on the kidneys, a subject on which but little is known.
In 1904 Linser and Baermann found that exposures of one hour
produced transitory albuminuria without apparent changes in
the renal epithelium . Dr. Warthin has found remarkable
changes in the kidneys in two cases of leukæmia treated with
the X rays. In one case of the myeloid type the leucocytes
numbered 800,000 and the spleen was greatly enlarged . Ex-
posure of the splenic region to the rays twice a week for two
months produced great improvement . Daily exposures were
then given for seven months, and the improvement was so great
that hopes of cure were entertained. The patient remained in
a good condition for six months, although the leucocyte count
Reports of Societies .
THE ROENTGEN SOCIETY .
At the last meeting of this Society, Mr. Alan A. Campbell
Swinton read a paper upon Recent Investigations in Connexion
with Crookes's Tubes. “ In course of use the vacuum of X-ray
tubes changes, the tubes become harder, the electric discharge
has increasing difficulty in passing, and the Roentgen rays
produced become more and more penetrative. The original
explanation of this phenomenon was to the effect that the
residual gas was absorbed by the aluminium electrodes. One
American worker actually suggested that the particles of the
residual gas were shot right out through the glass to the
exterior of the tube. Perhaps the investigator was not so far
wrong as many people thought at the time. The first real
solution of the problem was due to Villard, who showed how
minute bubbles could be produced in the glass walls of a
much-used Roentgen -ray tube. Pieces of the glass were taken
was high and there was a large percentage of myelocytes. The
treatment was renewed for seven weeks, but the patient became
worse and died. The necropsy showed changes characteristic
of leukæmia only in the retroperitoneal lymphatic glands. The
viscera showed “ slight parenchymatous degeneration. ” In the
kidneys were remarkable changes. On cutting the kidney,
marked grating and resistance were observed. The cut surface
showed numerous whitish streaks corresponding to the medullary
rays and due to deposits of lime- salts, which filled the tubules
and displaced the renal epithelium. The remaining parts of the
parenchyma were atrophic, and presented cloudy swelling and
fatty degeneration. The intertubular connective tissue was
increased, and there were localized inflammatory changes
throughout the cortex. When the lime-salts were dissolved
out the epithelium of the affected tubes was found to be com
pletely necrosed. In the other case there was small-celled
lymphatic leukæmia, and similar changes were found in the
kidneys. Such changes do not appear ever to have been de
scribed in leukæmia untreated by the rays. In twenty-five
cases of various forms of leukæmia Dr. Warthin examined the
kidneys, and found in all more or less extensive parenchymatous
degeneration, leukæmic metastases, and localized inflammatory
changes ; but in none was there any deposit of lime- salts or
such extensive necrosis as in the cases reported. In another
case recorded by Dr. Grosh and Dr. Stone of Ohio the renal
epithelium showed advanced cloudy swelling, fatty degeneration,
and simple necrosis. Dr. Warthin exposed white ,mice, rats,
guinea -pigs, rabbits, and Belgian hares to the X rays. Small
animals were placed entirely in the field of exposure ; the larger
ones were exposed in the abdominal region (including the spleen
and kidneys). Exposure for from half an hour to an hour pro
duced slight nuclear changes in the renal epithelium , swelling of
the nucleus, vacuolation , and clumping of the chromatin. After
from six to twelve hours there followed a secondary change
characterized by albuminuria and cloudy swelling. - Lancet.
and strongly heated, when the gas that had become occluded in
the glass produced bubbles.
“ I have recently made some further investigations on this
subject. We heated portions of the glass from an old much
used discharge tube with a blow-pipe. Immediately the glass
became clouded. It was translucent, but not transparent.
When examined with the microscope, it was seen to be full of
very small bubbles. The image of the bubbles shows very
clearly on the micro-photograph.
“ The next question was as to the nature of the gas in the
bubbles, which were formed as soon as the glass was heated.
We took a large number of pieces of this glass, put them
between two slightly dished tin plates, soldered very carefully
around the edge, with a metal pipe and a spectrum tube con
nected, and exhausted it until a spark would not pass through the
spectrum tube. Then we hammered the tin plate so as to crush
the glass. This liberated a quantity of gas, which the spectro.
 ARCHIVES OF THE
scope showed to be mainly hydrogen . There were other gases
present ; but there can be little doubt that in all tubes exhausted
in the ordinary way the final residual gas is hydrogen due to
water vapour, the oxygen going to oxidize the aluminium
electrodes.
“ It had been suggested that the hydrogen might have com-
bined with the salts in the glass. Since helium does not com-
bine with anything at ordinary temperatures, we determined to
see what could be done in the way of forcing helium into glass.
We exhausted a Crookes tube as much as possible , and then
admitted helium in small quantities, sparking the tube between
times. We let in altogether 1 c.c. of helium at ordinary atmo-
spheric pressure. The process of sparking and admitting gas
was continued intermittently for twenty days. It took about
eighty hours for the glass to absorb 1 c.c. of helium. The
glass, when heated , gave bubbles, which did not differ very
much from those of hydrogen. On extracting the gas, we got
the helium lines in the spectrum, although there were many
other gases in addition, chiefly hydrogen, of which it seems
impossible to be rid. Helium , however, does not exist in the
ordinary vacuum tube unless it is put there, and in this case
the helium spectrum clearly indicates that helium was obtained
from the glass, into which it had been driven by the action of
the electrical discharge .
“ How far do these gases get into the glass ? One can
estimate the distance of the penetration of the bubbles into the
glass by first measuring the thickness of the glass and then dis-
solving off the surface with hydrofluoric acid, or grinding it off
until the bubbles just disappear, and then remeasuring the
thickness. We found that, on an average, the centres of the
bubbles were about 0.122 millimetre from the inner surface
of the glass. This is a much greater distance than it is possible
to shoot cathode rays through aluminium . Helium and
hydrogen are absorbed by silica or glass by ordinary diffusion
at high temperatures. At the moment of impact of the cathode
rays the temperature for a short space of time may be enormous.
It is therefore suggested that the gas is diffused into the glass
Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
DEAR SIR , I was much interested in the account of “ Base
ball Fingers ” which appeared in the July number of your
journal. It would be very instructive to learn whether any of
your readers have observed a similar deformity in the case of
our own national game of cricket. It would seem probable
that some such thing might exist, since in cricket the ball
is still caught with the naked hand ; and we have not yet
adopted the thick padded catching-gloves now so universal with
baseball players, to the use of which Drs. Hall and Stover
ascribe the fact that they found this peculiarity so much more
ROENTGEN RAY. 117
during these periods, when the inner surface of the glass is at &
high temperature.
“ The bubbles were each about 0.01 millimetre in diameter.
The number of bubbles per square centimetre was 625,000, so
that there was occluded 0 :0001 c.c. per square centimetre of
glass. The total amount of gas occluded in each tube was
thus 0:05 c.c., in addition to the further larger amount which
probably escaped from the surface of the glass on the latter
being heated.
“ In dealing with gases that are not absorbed, for some reason
or other we deposit aluminium over the whole tube.
“ In one instance this faculty of the glass to absorb gas and
heat to develop bubbles has produced a very curious result. We
were trying some experiments with a tube in which we were
bombarding with cathode rays a piece of aluminium mounted
on a piece of glass, and little sparks kept passing from the
aluminium on to the glass. The piece of glass was found to
have some markings on it, which, when examined under a
microscope, had all the characteristics of a positive spark.
“ How did the sparks impress themselves on the glass ? A
higher-power lens showed that the spark had locally heated the
glass, and had caused the occluded gas to form bubbles. Each
spark in that way impressed its own image on the glass.”
Mr. Campbell Swinton then exhibited a vacuum tube con
taining a mica mill driven, not by the cathode rays , but by the
66 1
positive discharge , or Kanal-strahlen ." A mill with light
aluminium vanes behaved in a precisely similar manner. On
the other hand, when the mill is interposed between the anode
and the cathode, the positive bombardment tends to drive it in
one direction , and the cathode stream in the contrary direction.
Under these circumstances, a mill with aluminium vanes will
rotate in a direction corresponding to the positive bombardment,
since the momentum of the canal rays is some fifty times that
of the cathode rays. If the mill, however, has mica vanes, it
will rotate as if driven by the cathode stream, since the cathode
bombardment , acting on a badly conducting medium , sets up a
heat effect which is greater than the effect of momentum .
frequent in men of middle age, who had been players in their
youth , than in the younger generation of players.
Believe me, yours truly,
ATHLETICS .
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR ,-In the July, and also in the April, number of the
ARCHIVES I note tests and description of Dr. Milton Franklin's
electroscope, and the fact is also mentioned that it has been
improved by you, but the nature of the improvement is not
mentioned.
In examining the cuts, one point appears to me to have been
16–2
118 ARCHIVES OF THE ROENTGEN RAY .

overlooked , and that is the impossibility of examining any but
horizontal rays, whereas the instrument might be easily made,
I believe, with the, at present, lower chamber to one side of the,
at present, upper chamber, and the leak gap then placed in a
perpendicular plane instead of a horizontal plane, as at present.
The result of this change would be that one could examine
rays in all directions without changing the position of the
electroscope, as far as its relation to the perpendicular is
concerned.
May I ask you to show this letter to the manufacturers of
the instrument, and ask them to communicate with me on the
matter, as I do not know where to address them ?
Should this letter be of general interest, you are at liberty to
publish it.
Yours very truly,
Fernwell Block, Spokane, U.S.A. HENRY POWER, M.D.
[Note.-The details of the improvements in the electroscope,
and the exact measurements of an instrument to be used as a
standard instrument, are given in the Journal of the Roentgen
Society for April, 1906.-Ed.]

PLATES CCLXXIII. AND CCLXXIV.

To illustrate Dr. Graessner's article on " Fractures only Recognizable by the Aid of the Roentgen Rays."

* The Editor begs to thank those correspondents who have been 80 kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send , with any prints intended for publication, a full account of the
case and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used , or any otherfacts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE EDITOR begs to acknowledge communications from Dr. Herschel Harris (Sydney), Dr. Henry G. Piffard
(New York), the American Roentgen Ray Society (Pittsburgh, Pa. ), Dr. H. P. Wells ( St. Louis, U.S.A.) , Professor
C. Colombo ( Rome), Professor Kienböck ( Vienna),Dr. Groedel (Bad Nauheim ), Dr. H. H.Born (St. Louis, U.S.A.),
Dr. Dawson Williams (London ), Dr. Ulrica de Luca (Rome), Dr. G. P. Girdwood (Montreal), Professor Bashford
Dean (New York ), Dr. Alexander Gregor (Falmouth ), Professor H. Bordier ( Lyon), Dr. J. H. Jacobson ( Toledo ).
The following Journals and Periodicals have been received : “ Advanced Therapeutics,” “ The Electrician,”
“ The Electric Review ,” “ Knowledge," " The British Journal of Dermatology," “ Annals of Physico -therapy,'
“ Medical Times,” “ Medical Electrology and Radiology , ” “ Archives of Physiological Therapy,” “Archives
d'Électricité Médicale ,” “ Le Radium ,” • Annalsd'Electrobiologie et de Radiologie,” “ Fortschritte auf dem Gebiete
der Röntgenstrahlen ," " Münchener Medizinische Wochenschrift," “ Zentralblatt für Physikalische Therapie,"
“ Annali di Elettricità Medica ," “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN RAY, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London, W.C.," or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles and radiographs for publication in our columns are always acceptable, and, in the case of
the former, each contributor will be furnished with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view .
Annual Subscription , payable in advance, Sixteen Shillings net (Four Dollars) , including postage ; single
numbers, One Shilling and Sixpence net (Thirty-six Cents) , twopence extra for postage (Four Cents ). Back
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Communications relating to advertisements should be addressed to the Publishers, REBMAN LTD .,
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 Annual Subscription ,
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L
VO . XII.

No.
6.
451 ARCHIVES
O
RADI
46
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKJAGRAPHY).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE ( New York ); A. BECLERE (Paris); T. P. BEDDOES ( London ); J. BELOT (Paris) ; F. BISSERIE (Paris);
H. BORDIER ( Lyons); J. BURNET ( Edinburgh ); R. HIGHAM COOPER ( London ); W. COTTON ( Bristol); FOVEAU DE
ELE COURMELLES ( Paris ) ; L. DELHERM (Paris); R. W. FELKIN ( London );
CTR L. FREUND (Vierna ); H. E. GAMLEN ( West Hartlepool); G. P. GIRDWOOD
(Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris); R
O E LAPY
OTH
D. GUNZBURG ( Antwerp ) ; J. HALL -EDWARDS ( Birmingham ); G. HARET
( Paris ); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT ( Vienna );
F. H. JACOB (Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );

AMO
ARCH. JUBB (Glasgow ); E. LAQUERRIERE (Paris); 8. LEDUC ( Nantes) ;
E.R. MORTON ( London ); G. HARRISON ORTON ( London ); H. G. PIFFARD (New
07
OC

York ); JNO.C.RANKIN ( Belfast ); WERTHEIM SALOMONSON ( Amsterdam ) ; 9

T.

1 .
W. F. SOMERVILLE (Glasgow ); H. WALSHAM (London ); CHISHOLM
WILLIAMS ( London ); CLARENCE WRIGHT (London ).

CONTENTS
PACE PAGE
EDITORIAL • 119 NOTES AND ABSTRACTS ( continued ) :
THE FAVOURABLE INFLUENCE OF THE ROENTGEN RAYS
SECOND INTERNATIONAL CONGRESS OF PHYSIO. 145
THERAPY AT ROME · 120
IN CHRONIC BRONCHITIS
THE X RAYS IN A CASE OF INVETERATE PSORIASIS OF
ORIGINAL ARTICLES : NINE YEARS' DURATION ·
-

145
THE ROENTGEN -RAY EXAMINATION OF THE DIGESTIVE THE ROENTGEN RAYS IN DERMATOLOGY · 146
Tract. — By DR. FRANZ M. GROEDEL, Bad Nauheim 122
GRANULOMA PUDENDI TROPICUM TREATED BY THE
ROENTGEN RAYS 146
THE PHOTOGRAPH OF A ROENTGEN TUBE IN ACTION . - By
Dr. R. F. S. MEIJERS, Amsterdam 130 EFFECTS OF RADIO -THERAPY ON SPASTIC SPINAL PARALYSIS 146
THE USE AND ABUSE OF SKIAGRAPHY IN FRACTURES AND INFLUENCE OF X RAYS IN THE TREATMENT OF LEUKEMIA
131 AND HODGKIN'S DISEASE .
146
DISLOCATIONS. —By John GOLAND, F.R.C.S.
A CONTRIBUTION TO THE STUDY OF HIGH FREQUENCY X RAY IN SKIN DISEASES · 146
CURRENTS . — By Dr. FOVEAU DE COURMELLES 141 ABORTION CAUSED BY ROENTGEN RAYS 146

NOTES AND ABSTRACTS : REVIEWS :

High -FREQUENCY CURRENTS IN CHRONIC PELVIC CONDI. LES Ions, ET PARTICULIÈREMENT L'Ion IODE 147
TIONS 144 A SYSTEM OF RADIOGRAPHY ; WITH AN ATLAS OF THE
HEALING FISTULOUS TRACTS BY METALLIC CATAPHORESIS 144 NORMAL 147
THE TREATMENT OF RAYNAUD'S DISEASE BY High LIST OF MUSCLES FOR ELECTRICAL TESTING 147
FREQUENCY CURRENTS 144
ELECTRO - THERAPEUTICS OF RHEUMATISM 144 . CORRESPONDENCE - · 148
A NEW FORM OF LIGHT RAYS IN CYSTITIS AND POSTERIOR
URETHRITIS .
145 PLATES :
TREATMENT OF NEURALGIA BY MEANS OF ELECTRICITY PLATE CCLXXV . - TO ILLUSTRATE DR. MEIJERS' ARTICLE
AND RADIO - THERAPY .
145 ON “ THE PHOTOGRAPH OF A ROENTGEN TUBE IN ACTION " 148
PATHOLOGICAL EFFECTS OF ROENTGEN RAYS ON ANIMAL PLATE CCLXXVI. - TO ILLUSTRATE Dr. Bors's LETTER
TISSUES 145 ON “ A CASE OF SUPERNUMERARY Digits ” 148

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To Our Friends :
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VOL. XII.-No. 5. OCTOBER , 1907.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY.
EDITED BY

W. DEANE BUTCHER, M.R.C.S., F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York ) ; T. P. BEDDOES (London ); J. BELOT ( Paris) ; A. BÉCLÈRE ( Paris) ; F. BISSERIE (Paris) ;
H. BORDIER (Lyons) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol ) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris ) ; R. W. FELKIN ( London ) ; L. FREUND ( Vienna) ; H. E. GAMLEN ( West Hartlepool ) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ); H. GUILLEMINOT (Paris) ; D. GUNZBURG ( Antwerp); J. HALL -EDWARDS
( Birmingham ) ; G. HARET ( Paris) ; C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ; F. H. JACOB ( Notlingham ) ;
LEWIS JONES ( London ); A. C. JORDAN (London) ; ARCH. JUBB (Glasgow ) ; E. LAQUERRIERE ( Paris ); S. LEDUC (Nantes) ;
E. R. MORTON ( London ); G. HARRISON ORTON (London) ; H. G. PIFFARD (New York ) ; JNO. C. RANKIN ( Belfast) ; WERTHEIM
SALOMONSON (Amsterdam ) ; W. F. SOMERVILLE (Glasgow) ; H. WALSHAM (London) ; CHISHOLM WILLIAMS ( London );
CLARENCE WRIGHT ( London ).

If the nineteenth century may be regarded as the era
of cellular pathology, the twentieth is without doubt
that of cellular therapy. We no longer watch the con-
test between health and disease vaguely from a telescopic
distance, for the arena of each individual combat now
lies bare before us, illuminated by the search-lights of
the microscope and the spectroscope. The old-time
physician studied and treated as an organic whole an
entity which we now know to be but a commonwealth
of living cells. Modern medicine concerns itself with
the denizens of that commonwealth-the individual cells
themselves. It is occupied not so much with the general
condition and politics of the country as with the hygiene
and general well-being of the inhabitants.
It is well from time to time to take cognizance of this
change of view, and to put fairly and squarely before
our minds the problems which concern the welfare of
the body cells. In his illuminating articles on the blood-
plasma, Dr. Harry Campbell maintains that the chief
- the only possible - business of the practitioner is
the regulation of the plasma in quantity and quality.
This is as much as to say that the only care of the
politician or social reformer should be the quality and
quantity of the people's food .
This view of the subject will hardly commend itself perhaps even mental and psychic stimuli, are necessary
to the student of physical therapeutics . The character,
the inheritance, the fecundity, the resistance, the past
history of the cell-people, is surely of more importance
than its food -supply. It is true that the development
of the cell is in a great degree conditioned by its environ
ment ; but it is no less true that the cell is in some sort
the creator as well as the creature of its environment.
The chemical composition of the blood -plasma is doubt
less one of the chief, but it is not the sole, and perhaps
not the most important, factor in the environment of
that living entity we call a cell . And does not sad
experience teach us every day
“ How small, of all the ills which men endure,
The part which drugs or food can cause or cure " ?
No one will deny that the care of the blood -plasma is
one of the chief duties of the physician ; but we cannot
help thinking that the selection, the making, the culture,
and the training of the cells themselves is of equal, if
not of greater, importance — that the physical environ
ment of the cell is more potent than the plasmic en
tourage. If, as seems probable in the near future, the
physician will be replaced by the director, the trainer,
adviser, or guardian of health, as he may be called, we
may be sure that his duties will not consist merely in
catering for the food of the cell community. Man does
not live by bread alone, nor do his component cells.
Air, light, heat, electrical vibrations, ethereal waves, and
for the due development and healthy growth of a living
cell . Health , then, is not conditioned by healthy plasma
alone. The healthy body is a congeries of healthy cells,
17-2
120 ARCHIVES OF THE ROENTGEN RAY.

and a healthy cell is the descendant of a long line of III.

healthy ancestors, with healthy habits, fed with healthy “ Roll of Physical Agents in the Diagnosis and Treatment of
plasma, in a healthy physical and psychical environment. Workmen's Accidents."
Prof. Thiem , Germany.
All these factors are necessary for the production of the
Dr. Doz . Bum, Austria.
ideal mens sana in corpore sano. Dr. Demunter, Belgium.
According to the new school of humoral-therapeutists Prof. Sigalas, France.
if we may coin a title -- not only disease, but old age, may Dr. Bernacchi and Prof. Luzenberger, Italy.
be held at bay—at least, for a time—by the careful regula IV.
tion of the quality of the blood-plasma. This is not the " Muscular Exercise from the Hygienic and Therapeutic Point
place to inquire how far this view is warranted by facts. of View ."
Certain it is that old age and death are phases of life Dr. Howorka, Austria.
as essential as growih and development. We have it on Dr. Lagrange, France.
Dr. Baumann, Italy.
old Khayyam's authority, V.
“ One thing is certain , and the rest is lies : 97 “ Each Separate Physical Agent may become the Subject of a
The flower what once has bloomed for ever dies."
Special Study in the Laboratories, but their Therapeutic
Moreover, in this respect, the physician who is a reverent Application should be regarded from a General and Syn
9

student of Nature's methods will often hesitate to inter thetic Point of View ."
fere with Nature's kindly intent in the gradual hardening Dr. Van Breemen , Holland.
VI.
of the arteries, whereby she deadens the anticipation of
the coming blow. “ Necessity of Uniform Legislation in all the European States
The questions raised by this most interesting series of on the Subject of Mineral Springs, and Thermal and
Climatic Stations."
articles will not be easily set at rest. The controversy
Dr. Loebel , Germany .
between humoral and cellular therapeutics is a vital one. Prof. Baistrocchi, Italy .
Over the portals of the Temple of Esculapius, says VII .
Dr. Harry Campbell, is to be read the legend : “ Cura
Plasmam ." The votaries of physical therapeutics see " Physical Therapeutics and Hydrology should be Obligatory
Subjects in the Examination for the Doctor's Degree, and
there a nobler and more inspiring inscription : “ Pasce Courses of Instruction should be provided on these
Cellulas." Subjects in Public and Private Institutions.”
Prof. Brieger , Germany.
Dr. Gunzburg, Belgium .
SECOND INTERNATIONAL CONGRESS OF Dr. Kourdumoff, Russia.
PHYSIOTHERAPY AT ROME. Drs. Barduzzi and Ravaglia , Italy.
VIII.
OCTOBER 13 to 16, 1907 .
" The Therapeutic Application of Physical Agents should be
Official Reports and Reporters. reserved for Medical Men. In Hospitals the Gratuito us
GENERAL REPORTS
Treatment by Physical Methods should be reserved for
the Needy Poor only.”
TO BE DISCUSSED AT THE GENERAL MEETING .
Dr. Lossen , Germany .
I. Dr. Gunzburg, Belgium .
“ Physical Agents in Hygiene and as Adjuvants in the Service Dr. Vioglie, Italy.
of Medicine and Surgery.” OFFICIAL SECTIONAL REPORTS .
Prof. Goldscheider, Germany.
SECTION A.
Dr. Van Breemen, Holland.
Dr. A. Corsini , Italy. Medical Electricity.
II . I.
“ The Dietetic Regimen considered as the Foundation of · Electrolysis and Ionization."
Physical Treatment." Dr. Massey, America.
Prof. Excellenz von Leyden , Germany. Dr. Lewis - Jones, England.
Dr. Huchard , France . Drs. Delherm and Laquerrière, France.
Prof. V. Ascoli, Italy. Dr. D'Arman , Italy.
 ARCHIVES OF THE ROENTGEN RAY. 121

II . II .
Present State of Electro-Diagnosis .” “ Mecanotherapy in Orthopedics ."
Mlle. Dr. Joteyko , Belgium . Dr. Schütz , Germany.
Prof. Bergonié, France. Prof. Lemarinel, Belgium .
Prof. Berdez , Switzerland. Drs. Chipault, Gourdon, and Prof. Kirmisson , France.
Prof. Ghilarducci, Italy . Prof. Tilanus, Holland .
Prof. Curcio, Italy.
III.

“ The Hydro -Electric Bath." III.

66

Dr. Dawson Turner, England. • Importance of Kinesotherapy in the Treatment of Maladies

Dr. Albert-Weil, France. of Nutrition and Troubles of the Circulation ."
Dr. Meyers, Holland . Dr. Hasebroek, Germany.
Dr. Luisada, Italy . Dr. Cautru, France.
Dr. Vallebona, Italy.
IV.
High-Frequency Currents ." IV .
Dr. Laqueur, Germany . “ General Physiological and Therapeutic Action of Active and
Dr. Titus, America . Passive Movements .”
Dr. Sloan, England . Dr. Morse, America.
Dr. Bonnefoy, France. Dr. Essers, Holland.
Dr. Vassilidès, Greece. Prof. Wide , Switzerland.
Dr. Lucrezio , Italy. Dr. Angelucci, Italy.
V. V.
“ The Progress of Roentgenology." " Physiological and Therapeutic Action of Massotherapy and
Prof. Lassar, Germany. Vibratory Massage.”
Drs. Johnston and Kassabian, America. Dr. Amson , Germany .
Drs. Béclère and Belot, France. Dr. Brinkman, America.
Dr. V. Maragliano, Italy. Dr, Bum , Austria .
Dr. Martinez, Mexico .
VI .
Dr. Serena, Italy.
“ Present State of our Knowledge of the Action of Radium . " SECTION C.
Dr. Strebel, Germany.
Dr. Morton, America. Hydrology, Balneology, Climatology , Thermotherapy .
Dr. Butcher, England. I.
Dr. Freund, Austria .
Dr. Esdra , Italy. “Our Knowledge of the Genesis and Composition of Mineral
19
Waters."
VII. Prof. Armand Gautier, France.
Prof. Vincent Gauthier, Italy.
" Phototherapy."
Dr. E. Schmidt, Germany. II .
Dr. Cleaves, America .
Drs. Rubow, Hasselbalch and Jacobaeus, Denmark.
“ Molecular and Ionic Condition, and Radio-activity of Mineral
Waters."
Dr. Bollaan , Holland.
Dr. Vermel, Russia. Prof. Strauss, Germany.
Prof. Pellizzari, Italy . Dr. Barduzzi , Italy.
III.
SECTION B.
“ The Absorption of Mineral Waters by the Digestive Tract and
Kinesotherapy and Mechanical Orthopädia. by Intravenous Injection."
I. Prof. Casciani, Italy.
IV.
“ The Re-education of Muscular Movements.”
Dr. Gommaerts, Belgium . “Influence of Balneotherapy on the Circulation."
Drs. Faure , Demeny, and Philippe, France. Drs . Huchard and Piatot , France.
Dr. Frenkel, Switzerland. Prof. Wenckebach, Holland.
Prof. Medea, Italy. Prof. Riva, Italy .
122 ARCHIVES OF THE ROENTGEN RAY .

V. gas, or an increase of density by the introduction of

“ General Physiological and Therapeutic Action of Hydro- metallic salts.
therapy." We are compelled to have recourse to one or other of
Dr. Laqueur, Germany. these methods in our examination of the digestive tract,
Dr. Curran Pope, America.
Drs. Heitz and Froussard , France. since there are no very marked differences of density in
the abdominal contents.
Dr. Wries Reilingh , Holland.
Dr. Baduel, Italy. Methods of examination founded on this principle
VI . were introduced at an early date in the history of
" General Physiological and Therapeutic Action of Applications Roentgenology. The first device was the use of a hollow
of Heat and Cold .” sound , the lumen of which was filled with sulphur,
Dr. Van Oordt , Germany . which rendered it opaque to the Roentgen rays, and
Dr. Hoag, America. enabled it to throw a shadow on the screen . A later
Prof. Battistini and Dr. Zaniboni , Italy.
method was to make the sound opaque by the intro
VII .
duction of metallic powder, shot, or quicksilver. The
Physiological and Therapeutic Factors of Climate - of the Sea examination was thus made easier to the operator, but
--and of High Altitudes.”
at the same time more dangerous to the patient. Boas
Dr. Denison, America.
Dr. Malibran , France. and Levy-Dour made a great step in advance by their
Dr. Vergara Lope, Mexico . introduction of bismuth capsules. These are especially
Dr. Sarafidi, Roumania . adapted for the study of deglutition. A cheaper and
Dr. Jaquerod, Switzerland. more convenient preparation is a wafer or biscuit con
Drs. Francken and Altichieri, Italy. taining bismuth. Cakes may also be prepared containing
VIII .
10 per cent. of bismuth ; these are found especially
Pneumotherapy and Inhalations.” useful for children.
Prof. Lazarus, Germany. Becher was the first to use a suspension of bismuth
in water for the same purpose. This he introduced into
the stomach by means of a tube.
THE ROENTGEN-RAY EXAMINATION OF THE For a preliminary examination I usually make the
DIGESTIVE TRACT. patient swallow 10 grammes of bismuth suspended in
water. I use in addition Schwarz's test of the digestive
By Dr. FRANZ M. GROEDEL, Bad - Nauheim .
function of the stomach - viz ., the introduction of a
The possibility of projecting an image of an organ of the bismuth capsule made of goldbeater's skin.
living body on the fluorescent screen or the photographic At the present day all the above methods are in
plate depends on three conditions. The first of these common use, and are well adapted for the examination
is the sectional area of the organ, and the second is the of the esophagus and stomach when in an empty con
specific weight of the tissue of which it is composed. dition. The examination by means of an opaque sound
The greater the sectional area and the higher the specific has, however, fallen into disuse, and has been replaced
weight, the greater is the absorption of the Roentgen by the much safer and pleasanter bismuth method .
rays, and the greater the density of the resulting The recently introduced method of examination of the
shadow. The third factor to be taken into account is dilated stomach is of far greater importance. Long ago
the density of the surrounding tissues. If the density Rosenthal advocated blowing up the stomach with air.
of neighbouring organs is considerably greater or less than It is not, however, possible in all cases to distinguish the
that of the organ under observation, we have a natural various regions of the organ when dilated merely by the
and easily recognizable difference in density, which insufflation of air. Moreover, the normal form and
renders the Roentgen examination comparatively easy. position of the organ is altered and distorted, as may
Where no such natural difference of density exists, be easily shown by a Roentgenogram taken under these
the Roentgenologist is able in certain cases to produce conditions (Fig. 1).
an artificial difference of density. This may be done by It was only after the introduction of Rieder's bismuth
producing a diminution of density by the insufflation of meal that we were enabled adequately to study the form
 ARCHIVES OF THE ROENTGEN RAY . 123

and position of the stomach in a distended condition.1 gastric ulcer the amount of bismuth subnitrate injected
This method has been universally adopted during the daily was from 10 to 20 grammes, so that in the event of
course of the last three years. The technique is so well constipation the patient on the third day of treatment
established that we are at present able to conduct might have some 60 grammes of bismuth retained in his
digestive tract. Rieder was therefore justified in his
experiments by the experience of hospital treatment of
these cases, which had been continued for years without
any ill effect. In my own practice I have never met
with bad results from the use of bismuth. The vomiting
which occasionally occurs can usually be referred to some
independent accidental cause. The subnitrate of bismuth
remains unaltered by the acid gastric juice or by the
alkaline intestinal secretion. It is passed in the fæces
for the most part unaltered , the crystals being thinly
coated with the black oxide of bismuth. It may be
doubted if bismuth is entirely innocuous to children, to
whom , at all events, it should be given in minimal
doses .
If it be desired to examine the empty stomach, a few
spoonfuls only of the bismuth broth may be given , and
the stomach examined in this condition, after which the
Fig. 1. -ALTERATION OF THE SHAPE OF THE STOMACH DUE TO rest of the broth may be administered.
DISTENSION .
For the examination of the intestine we have two
The continuous line shows the form when filled with food .
The dotted line shows the outline when distended with methods at our disposal.. The first is the administration
gas. of a bismuth suspension , consisting of 100 grammes of
the subnitrate of bismuth in a litre of water. Many
Roentgen examination of the stomach with the greatest patients, however, cannot take so large an amount. In
exactitude. these cases it is better to observe the passage through
The following is a brief description of the method. the bowel of the bismuth introduced by means of the
The Rieder bismuth meal should be of the consistency Rieder meal.
of porridge. It may consist of boiled rice, barley broth , Rieder has shown how readily these observations may
potato purée, spinach, or minced meat, according to the be registered on the photographic plate. For this, how
fancy of the patient. The amount of this broth for an ever, a complete command of Roentgenographic technique
adult is 400 grammes by weight. Forty grammes of is absolutely indispensable — a command which is very
bismuth subnitrate must be well rubbed up into a thin evident in Rieder's work. For purposes of study and of
paste with water or milk, and the broth should be added teaching, the photographic studies of Rieder are of the
little by little to the bismuth suspension. For children , greatest value.
of course, a proportionately smaller quantity is required, For ordinary purposes the fluorescent screen is more
and the taste may be disguised by the addition of the generally useful, and tracings of the shadow may be
juice of raspberries or other fruit. taken on the screen itself. The value of these tracings
And here we may discuss the propriety of introducing is, however, very limited, and great distortion of the
so large a dose of bismuth into the digestive tract. picture is unavoidable. In consequence of the divergence
Holzknecht says that Rieder was the first to have the of the Roentgen rays it is impossible to compare different
courage to give such an enormous quantity of bismuth . tracings, or obtain an accurate measurement of the
This is, however, not quite exact. Long before this organ. We are compelled, therefore, to have recourse
very large doses of bismuth had been used as a remedial to an orthodiagraphic tracing when we desire a record
agent in the treatment of ulceration of the stomach. of the exact size or position of the stomach. It is quite
During the course of Russman's bismuth treatment for possible to obtain such a tracing by means of the
124 ARCHIVES OF THE ROENTGEN RAY,

apparatus hitherto used for the orthodiagraphy of the this means the degree of dilatation may readily be esti
heart. I have, however, described at the Berlin Con- mated, Dilatation of the @sophagus is a frequent com
gress of 1907 an orthodiagraph, which I have designed plication of stenosis of the cardia. If the stenosis is
more particularly for the examination of the stomach.3 due to a neoplasm, the bismuth passes into the stomach
The principal improvement consists in the removal slowly and gradually, the delay being in proportion to
both of the pencil and the drawing-board to the rear of the narrowness of the passage. On the other hand, in
the focus-tube, so that the fluorescent screen may be cases of cardiac spasm , which, in my opinion , are much
brought up close to the surface of the body . By a more common , on relaxation of the spasmodic contraction
further adjustment the small fluorescent screen may bethe shadow of the bismuth disappears from the æsophagus
moved in the direction of the " central ray.” In this quite suddenly.
way it may be made to glide over the surface of the body, In order to follow the course of the food into the
and even be used as a diaphragm for compression, with- stomach itself, we must change the position of the patient,
out disturbing its position with regard to the pencil. so that the illumination may be dorso - ventral, with the
I hope in a future number of the ARCHIVES OF THE focus-tube at the back and the screen on the belly. The
ROENTGEN RAY to give further details as to the technique most noticeable object on the screen is a light, somewhat
of my method. In the present paper I propose merely semicircular spot, the " luftblase,” or “ magenblase ".
to indicate briefly the appearances which may be observed a collection of air at the cephalic pole of the stomach .
by means of this instrument. This lies directly under the diaphragm , and is usually
We will begin with the mouth. The mechanism of bounded below by a straight line. On the screen the
mastication may be satisfactorily demonstrated on the food is seen to be arrested for a short time at the base
screen by lateral illumination of the mouth during the of the " magenblase ,” after which, with the aid of the
mastication of a bismuth biscuit. respiratory movements, it is gradually enveloped by the
With the same lateral illumination we may next watch walls of the stomach .
the process of deglutition, and follow the path of the A narrow canal is formed, through which the bismuth
bismuth bolus through the gullet. The patient in the erect rapidly flows, to accumulate again at the lowest point
posture is next rotated through an angle of 45 degrees. the caudal pole of the stomach. The observation of the
He is now in the so - called “ first oblique position ," with course of this passage, as indicated by the shadow on
the right shoulder towards the screen and the left the screen, is of the greatest importance in the diagnosis
shoulder towards the focus-tube. To the right of the of tumour or stricture of the stomach.
patient we see the spinal column, to the left the heart, The diagnosis of ulcer of the stomach has been greatly
and between the two a clear space containing the trachea facilitated by the Roentgen- bismuth procedure. The
and csophagus. In this clear space we recognize the patient is kept in a suitable position for a considerable
dark outline of the bismuth bolus, or, if the patient is time after the ingestion of the bismuth suspension. Fine
drinking the bismuth suspended in water, we shall see streaks of shadow may be observed at the seat of the
a band of shadow gliding rapidly downwards. If there ulcer, in some cases persisting for twenty -four hours or
is stenosis of the esophagus or a diverticulum , there more after the ingestion of the bismuth.
will be an arrest in the passage of the bolus. The exact The following appearances may be observed after the
site of the abnormality may be ascertained by means of ingestion of bismuth, either in the form of bolus, biscuit,
or suspension. The whole series of observations may
the screen or the photographic plate, or, better still, by
an orthodiagraphic tracing. also be made during the ingestion of the ordinary Rieder
When the food arrives at the cardia the further bismuth meal .
passage is arrested for some seconds. This , at any We first observe the gradual filling of the stomach,
rate, is the case with the more solid portion of the and the alteration of its form and position at different
food . We may observe it rising and falling with the periods of the process. The orthodiagraph is best suited
respiratory movements of the cardia and diaphragm . for this purpose, as it is less subject to errors due to
In cases where dilatation of the cesophagus is suspected, distortion of
distortion of the image.
the image. Fig. 2 shows the ortho
we give the patient first a piece of bread or bismuth diagraphic tracings of the stomach during three suc
biscuit, and afterwards a glass of bismuth water. By cessive stages of the ingestion of the bismuth meal.
 ARCHIVES OF THE ROENTGEN RAY. 125

A much -mooted point is that of the size, form , and Archiv für Klinische Medizin . The following is a short
position of the normal stomach. There is much differ résumé of my results : After the ingestion of a bismuth
meal , the stomach of a healthy man in an erect posture
gives on the screen an appearance very similar to that
described by Rieder. Passing vertically downwards from
the " magenblase,” we see the stomach shadow slightly
contracted and funnel-shaped. This terminates at about
the level of the navel in a sack-like dilatation, and the
shadow then turns upwards with a sharp curve. We
may thus distinguish the “ descending segment,” the
t
h ascending segment, " and the “ stomach - sack . ” The
angle between the ascending and the descending seg
ments may be called the “ stomach angle .” The highest
point of the organ is the "cranial pole " of the stomach ,
and the lowest point is the “ caudal pole .” The ascend
ing segment terminates at the pylorus. A short distance
below the pylorus there is always a deep constriction ,
FIG . 2. - INFLUENCE OF VARIOUS AMOUNTS OF INGESTA ON THE which is due to the action of the sphincter antri.
FORM AND POSITION OF THE STOMACH. Fig. 3 is a diagram of the stomach from an ortho
diagraphic tracing. It gives the nomenclature which I
ence of opinion on this subject. Two principal forms have adopted for different points of the stomach. The
have been described - viz. , Rieder's fish - hook type, older anatomical descriptions of the form of the stomach
and the horn - shaped type described by Holzknecht.2 are no longer applicable. With the body in an erect
With the view of determining this question, I have made posture the stomach is seen to have somewhat the out

Cephalic pole
Magenblase "

Descending seg
Pylorus ment
Antrum
Ascending segment
Sphincter antri
Stomach sack
Caudal pole

1
1

FIG. 3.-ORTHODIAGRAPHIC SKETCH OF THE STOMACH, SHOWING THE AUTHOR'S NOMENCLATURE .

& series of systematic examinations of the stomach of line of a fish -hook , as first described by Rieder . I have
healthy subjects. named this the syphon -form type of stomach, from its
My results are published in extenso in the Deutschen likeness to an ordinary water syphon . The functional
18
126 ARCHIVES OF THE ROENTGEN RAY .

significance of this form appears to consist in its adapta-
tion to serve as a reservoir for the food. In this reservoir
the food is softened, cooled, or warmed. The syphon
ever, be conceded that in certain cases the form of the
normal stomach may vary from this type.
According to my observations the position of the
stomach in the erect posture is as follows : The descend
ing segment lies always to the left, the ascending portion
generally to the right, of the median line of the body.
As regards the stomach - sack, two - thirds lie to the
left and one-third to the right of the middle line. The
pylorus is usually in the middle line, or sometimes
slightly to the right of this.
As regards the size of the normal stomach , we are not

A
Fig. 4. - SYPHON FORM OF THE STOMACH.
(A boy 34 years old .)

finally allows the prepared chyme to pass on into the

intestines, retaining any particles which may not have
in a position to give accurate measurements. I have
measured 100 normal stomachs when the subjects were
in an erect position. Fig. 5 represents the details of the
measurements, which are given in the following table.
The measurements are in centimetres :

Measurement.

KZe
KP
FDM
Average.

20
8.5
9.5
MEN.

Min.

16
6.5
6
Max .

24
11
13.5
Average.

22
8
10.5
WOMEN.

Min .

17
6.5
6
Max .

29
10.5
13.5
been sufficiently softened. I have treated this subject BZe 3.5 1 5 3.5 1.5 5
SK 10 : 5 6 15.5 7.5 3 13.5

FOC KZe is the height of the stomach, the vertical distance between the
levels of the cranial and the caudal poles, measured on the
median line of the body.
FD !I KP is the vertical distance of the pylorus from the caudal pole. This
is the distance through which thestomach has to lift its contents .
7 FDM is the transverse diameter of the stomach -sack.
BZe is the vertical diameter of the " magenblase.".
F01 SK isthe verticaldistance ofthecaudalpolefrom the symphysis pubis,
JPL.FOK . also measured along the median line.
FDM
It will be seen that similar measurements were
NO FOM
obtained from subjects of both sexes. It is noteworthy
that the average height of the stomach is greater in
women than in men. On the other hand, the height of
the ascending segment — the "lift " of the stomach, if we
may use the expression - is less in the female . The
FON
1
stomach-sack is broader, and the distance of the caudal
Fig. 5. — Lines of REFERENCE USED IN MEASURING AN ORTHO- pole from the symphysis pubis is noticeably less in
DIAGRAM OF THE STOMACH . women than in men .
There is, moreover, an essential difference in the form
more fully in & special chapter of the work already of the male and female stomach. The male stomach
alluded to. ( Fig. 6) lies rather more obliquely, and is shorter than
It is evident from its comparative frequency that this the female stomach, which has a more vertical position
syphon form is the normal type of stomach. I found it (Fig. 7) .
in 99 per cent of my cases, in subjects of all ages. The cause of this difference in the form of the male
Fig. 4 is an orthodiagram of this form of stomach in a and female stomach is the difference of size of the
healthy child three and a half years old. It must, how
how abdominal cavity in the two sexes. According to my
 ARCHIVES OF THE ROENTGEN RAY . 127

measurements, the female abdomen is the smaller of the Figs. 9 and 10 show that the only two fixed points of
two, but extends somewhat higher. the stomach are the pylorus and the cardia. The stomach
Fig. 8 shows how greatly any alteration in the size of
the abdominal cavity affects the form and position of
the stomach , and gives orthodiagraphic tracings of the

AN
Fig. 6. —THE MALE STOMACH : MOST FREQUENT FORM. Fig . 8. - FORM OF THE STOMACH DURING DIFFERENT PHASES OF
RESPIRATION .
stomach during the different respiratory phases — i.e., Continuous line, during quiet breathing.
with different positions of the diaphragm . Similar Broken line , during deep inspiration.
Dotted line, during deep expiration.
tracings may be obtained with varying distension of
the intestines with gas or liquid. The stomach rests

Fig. 7. — THE FEMALE STOMACH : MOST FREQUENT FORM .

upon the intestines as on an elastic cushion of varying

size .
It is only by Roentgen examination that we have Fig. 9. – ALTERATIONS OF FORM DUE TO CHANGES OF POSTURE.
learnt how greatly the stomach is altered in form and Continuous line, when standing.
Dotted line, when lying on the back.
position by alterations in the posture of the body. (Normal stomach of a boy 16 years old. )
18–2
128 ARCHIVES OF THE ROENTGEN RAY.

is, as it were, strung up between these two points, and of the cephalic pole, is situated beneath the diaphragm ,
yields in different positions of the body in accordance and in a plane posterior to that of the heart. The
with the law of gravity. In the erect posture it bags caudal pole lies almost in contact with the abdominal
downwards; in the horizontal posture it is displaced wall. Fig. 11 shows & front and also a side view of a

Fig. 10. -ALTERATIONS OF FORM DUE TO CHANGES OF POSTURE .

you
Fig. 12.-FRONT VIEW AND SIDE VIEW OF A PENDULOUS ABDO
MEN, WITH ECTASIS AND Prosis OF THE STOMACH .
( Female patient aged 52. )

normal stomach . Fig. 12 shows similar tracings of the

Continuous line, when standing .
stomach of a woman with a well - marked pendulous
Dotted line, when lying on the left side. belly. In this figure we notice how the caudal pole sinks
(Normal stomach of a labourer 15 years old. ) downwards and forwards, following the contour of the
abdominal wall .
dorsalwards, and when lying on the left side it is
displaced sideways.
The outward form of the body has also a considerable

10།
Fig. 11 .-- FRONT VIEW AND SIDE VIEW OF A NORMAL STOMACH.
(Workman aged 19. )

influence on the configuration of the stomach. In a side

Fig. 13. -INFLUENCE OF TIGHT-LACING ON THE STOMACH.
Continuous line,
Dotted line,
without corset.
with corset.
(Young woman aged 21. )

We find a further example of the correspondence

view of the stomach-i.e. , with dextro -sinistral illumina- between the configuration of the abdomen and that
tion — its position is seen to be an oblique one , the upper of the stomach in the groove which is often seen on the
end being further back and the lower end extending greater curvature, and which is due to tight-lacing
forwards. The “ magenblase," which indicates the position (Fig. 13). This practice of tight-lacing has & most
 ARCHIVES OF THE ROENTGEN RAY. 129

deleterious action on the stomach , as I have shown in dilated stomach follows the outline of the relaxed
my work in the Medizinische Klinik.5 abdominal walls .
To resume, the following are the factors which deter- I have lately endeavoured to define the Roentgen
mine the form and position of the stomach : the posture diagnostic signs of gastric ectasis and ptosis, which are
of the body, the configuration of the abdomen, the size so frequently found in combination. I hope shortly to
of the abdominal cavity, the condition of the abdominal be able to publish my results in detail. I will only
walls, and the position and contents of the intestines . mention here that the ordinary bismuth meal of 400
All these must be taken into consideration when study- grammes is not sufficient to fill the dilated stomach
ing anomalies or pathological alterations in the form completely . Moreover, the walls of the dilated stomach
and position of the stomach . have not the same facility of contracting into a tubular
In my opinion Holznecht's horn -shaped stomach or funnel form. If we refer once more to Fig. 12, we
should be classed among the anomalous varieties. In notice that the lower part of the stomach is not com
100 cases examined by myself, I only found it present in pletely filled, and somewhat resembles an inverted
& single instance (Fig. 14). This was a stout woman in funnel. The “magenblase,” which is normally oval or
hemispherical with a horizontal base, is higher and
narrower than usual, and approximating to the shape of
a long, narrow funnel. If we watch the gradual filling of
such a stomach, we observe that the caudal pole remains
fixed in position . It does not sink with the gradual
XT increase of its load, as does the normal stomach - sack ,
since it has already been stretched to its full extent.
The most important symptom of gastroptosis is the
abnormal movability of the pylorus. The position of
the pylorus is seen to alter considerably with alteration
st
in the position of the patient, whereas in normal cases
the displacement is hardly noticeable.
The diagnosis of tumours of the stomach does not
seem as yet to have been greatly advanced by the
bismuth method . The appearance of the shadow , how
Fig. 14. -HORN -SHAPED STOMACH OF A DEFORMED FEMALE, 52 YEARS ever, enables us to recognize with great accuracy the
OF AGE, WHO HAD BEEN OPERATED ON FOR MYOMA. exact seat of the neoplasm.
The so-called " hour -glass " stomach is a very interest
whom the distance between the xyphoid process and the ing object for the Roentgen bismuth demonstration. It
symphysis pubis was only 13 centimetres, showing that is best to use a bismuth suspension for this purpose .
the abdominal cavity was abnormally small. I have One should be careful, however, not to mistake a chronic,
also met with this form as a consequence of pressure of or perhaps even a temporary , contraction of the stomach
the colon when dilated with gas. walls for an hour-glass contraction. The appearance
It is evident that the form of the stomach may be may also be caused by slight local connective tissue
altered by the presence of abdominal tumours, especially changes in the stomach walls, as the result of continual
hypertrophies of the liver or spleen. I had recently an pressure from tight-lacing or the like.
opportunity of observing such a case both intra vitam We may now consider briefly the functional testing of
and post - mortem . The descending segment of the the stomach by means of the Roentgen rays. For this
stomach was reduced to a narrow tube, and the stomach. purpose we administer a test meal of 400 grammes, to
sack pressed downwards and to the right by a tumour which 10 per cent. of bismuth has been added. Then by
in the liver and spleen : Roentgen examination we observe how long a time is
I have already alluded to the correspondence between required for the complete emptying of the stomach. It
the form of the abdomen and that of the stomach. is important that the meal should be well mixed, should
Fig. 12 shows how in cases of pendulous belly the not be too fluid, and should be swallowed whilst quite
130 ARCHIVES OF THE ROENTGEN RAY.

warm . Naturally the stomach should be completely accumulate. The filling of the entire colon then proceeds
empty at the commencement, and no fluid should be more slowly. It requires an interval of at least twelve
drunk during the observation . If these precautions are to eighteen hours before the whole course of the colon is
observed there will be no deposit of bismuth sediment, rendered visible. In this way we are able to recognize
as has sometimes occurred. In cases with normal the position and extent of each segment of its length.
motility of the stomach , the organ should be found The emptying of the colon varies considerably. It is at
empty after the lapse of four to six hours. least twenty-four to forty-eight hours before all traces of
Schwarz's method of testing the functional activity of bismuth have disappeared from the abdomen. In cer
the stomach is to cause the patient to swallow a small tain cases a few traces may remain for many days.
quantity of bismuth contained in a capsule of goldbeater's This method of diagnosis is very useful in locating the
skin , This appears on the fluorescent screen as a position of intestinal anomalies. It is manifestly of
circular shadow. As soon as the capsule is dissolved by great importance in treatment to know which particular
the gastric juice, the bismuth is set free, and appears as portion or flexure of the intestine is displaced. Of still
a short band of shadow situated at the caudal pole of greater utility is the knowledge afforded us of the exist
the stomach. This method , however, is not completely ence and exact position of a stenosis of the bowel.
reliable. Rieder has recently shown how admirably the bismuth
It is of great importance to watch the movements of method is adapted for this purpose.
the stomach . The mere observation of the peristaltic I have endeavoured to sketch the important contribu
waves affords information on many debated points in the tions which Roentgenography has made to our knowledge
mechanism of the stomach movements . I find that at of the stomach and intestines, and of their pathological
the commencement of digestion the stomach is usually changes. Much has, doubtless, been overlooked, and
in a condition of rest. In neurasthenic patients, on some points of interest have been purposely omitted as
the other hand, an active peristaltic action is visible leading us too far from our subject. I trust, however,
from the very commencement of digestion . The appear- that I have made clear how valuable and far -reaching
ance of anti -peristaltic wave -like contractions is an indi- are the recent developments of Roentgen diagnosis in this
cation of stenosis of the pylorus. direction .
REFERENCES.
The emptying of the stomach is produced by a 1
“ Beiträge zur Topographie des Magendarmkanals,” etc., Fort
mechanism analogous to that of a combined suction and schritte auf dem Gebiet der Röntgenstrahlen Vill. “ Radiologische
forcing-pump. The process may be observed by a suit- Untersuchungen des Magens und Darmes beim lebenden Menschen ,"
Münch . med . Wochenschr ., 1904 , 35. Röntgenuntersuchungen des
able adjustment of the fluorescent screen. The first Magens und Darmes , ” Munch . ined . Wochenschr ., 1906 , 3 .
phenomenon to be observed is the contraction of the Mitteilungen aus dem Laboratorium für radiol. Diaguostik und
Therapie.” Wien . Wiener med . Wochenschr ., 1906, 28-32 ; 1907, 5-8.
-sphincter antri. In this way a small portion of the 3 “ Die Magenorthodiagraphie." III. Röntgenkongress , 1907.
stomach contents is isolated. The pylorus then opens, 4. “ Zur Topographie des normalen Magens , ” Deutsches Archiv für
Klinische Medizin ., Band 90.
and the antrum pylori empties its contents into the 6. " Ueber den schädlichen Einfluss des Schnürens auf den Magen,”
Medizinische Klinik , 1907 , 20.
duodenum . The pylorus then contracts, and the antrum
again expands. In consequence of the negative pressure
thus produced, the antrum is now refilled by a fresh
portion of the stomach contents being forced in. THE PHOTOGRAPH OF A ROENTGEN TUBE IN
The examination of the intestines by the bismuth ACTION .
method is best carried out as a sequel to the examination By Dr. R. F. S. MEIJERS, Amsterdam .
of the stomach, since the bowel itself is not very tolerant
of bismuth enemata. In children or thin adults we It is a well-known fact that the electric discharge in
may observe the bismuth passing rapidly through the high vacua exhibits peculiar luminous phenomena which
upper coils of the small intestine. It then accumulates depend on the degree of vacuum. When the pressure
in the lower portion of the small intestine, where it of the gas is reduced to about 0:03 millimetre of mercury,
may, as a rule, be observed even in stout patients. In the discharge gives rise to the so-called cathode rays.
a comparatively short time fæces impregnated with The presence of these rays is shown by the green
bismuth appear in the cæcum. Here they gradually phosphorescence and by the rise in temperature of that
 ARCHIVES OF THE ROENTGEN RAY . 131

part of the glass which is struck by the rays. If the With regard to the bright spot, the most probable
pressure rises a little above 0.03 millimetre, the cathode explanation is that it is caused by a stream of secondary
rays themselves become visible to the eye as a thin cathode rays set up by the impact of the electrons on
bluish line passing straight outwards from the centre of the surface of the anticathode. These secondary rays
the negative electrode. spread out like a star from their point of origin , and are
Every one who does X -ray work will have observed of sufficient intensity to affect the sensitized plate.
this phenomenon on regenerating a tube too strongly, It is more difficult to give any explanation of the
or when a soft tube has been kept too long in action . second phenomenon. Firstly, it is still questionable
In focus-tubes which are in good condition the cathode whether we get on the plate an image of the cathode
rays are invisible to the eye. We can, however, readily stream itself, or merely the limiting boundary of the
demonstrate their presence by photographic means . In stream of electrons, defined by the glowing particles of
Fig. 1 ( Plate CCLXXV.), which is the photograph of an the surrounding gas.
X-ray tube in action, the cathode rays appear as a thin Setting this question aside, the change of the cathode
white line. If we now photograph a tube in which the stream under the influence of a magnet may, I think,
vacuum is so low that the cathode stream is visible to be explained somewhat as follows. It is well known
the eye, the form of the cathode stream is very different that different kinds of cathode rays exist. Wiedermann
from what its visible appearance would lead us to expect and H. Ebert maintain that under certain circum
(Fig. 2). stances a pencil of cathode rays can be analysed by
Fig. 3 shows a bright spot on the surface of the anti- means of a magnet. This they call the “ dispersion "
cathode, just where the cathode stream strikes it. This of the beam , and they even speak of a “ spectrum " of
spot is larger than the cross-section of the cathode cathode rays. Birkeland, Von Geitler, and Strutt have
stream , and larger even than the section of the beam proved that the cathode rays produced when the current
taken parallel to the surface of the anticathode. It is from an induction coil is used are not homogeneous.
to be noted that no trace of this glowing spot was visible The original negative of Fig. 4, indeed, shows four
to the eye during the time of exposure. The plate was lines, only the two extremes of which were sufficiently
exposed for about ten seconds. intense to be visible in the reproduction . Whether
To prove that the bright line appearing on the plate we have here, then, à veritable magnetic spectrum ,
was really the cathode stream , we next photographed or whether there is some other explanation of the
the tube with a magnet placed at a short distance from phenomenon, is a question on which I will not at
the anticathode. As is shown in Fig. 4, the bright line present venture to give an opinion .
was partially deflected, and the phosphorescent glow However this may be, it seems to me probable that
on the hemisphere opposite the anticathode was dis- the possibility of obtaining a visible reproduction of the
placed, appearing in a position opposite the cathode. cathode stream in a focus-tube may influence the future
The experiment must be made with caution, as the construction of these tubes, especially in regard to the
glass opposite the cathode is speedily heated by the relative position of cathode and anticathode.
impact of the rays, when it may soften sufficiently to
yield to the atmospheric pressure.
This experiment gives us a photograph of the deflected THE USE AND ABUSE OF SKIAGRAPHY IN
cathode beam . There is, however, one other point of FRACTURES AND DISLOCATIONS. *
interest to note. Part only of the beam has been de
BY JOHN GOLAND , F.R.C.S.,
flected, whereas a part of the bright line still remains in Senior Surgeon to the City Orthopaedic Hospital, Senior Surgeon to
its original position, uninfluenced by the magnet. This the Miller Hospital.
splitting up of the line is clearly shown in the photo ONE is often asked whether skiagraphy has afforded us
graph .
generally a clearer knowledge of fractures, a better
These two facts — the bright spot on the surface of diagnosis, and, consequently, better and more efficient
the anticathode and the division of the cathode stream
methods of treatment. To each and all of these questions
by means of a magnet - appear to me to be worthy of
* Lecture delivered at the Medical Graduates' College and Poly
closer attention. clinic, March , 1907.
132 ARCHIVES OF THE ROENTGEN RAY.

I can unhesitatingly answer in the affirmative, provided was especially one for the diagnosis and treatment of
that a proper and scientific observation has been made. fractures and other injuries and urgent cases. I think
I hope to be able in this lecture to point out some of the you will agree with me that these replies hold equally
uses and abuses of this method of diagnosis. good at the present day.
Without the increased experience in technique which In the first place, as to the use of the X rays in
we now possess, and with the many abuses with which clinical diagnosis. Fractures are no longer, or should
the earlier days of the Roentgen process was beset- and no longer be, mistaken for dislocations, sprains, or severe
which, I am sorry to say, too often still exist—the use of contusions, and vice versa , although pain and swelling
skiagraphy must assuredly be more harmful than helpful. exist in all these conditions. Lynn Thomas, however
Any practitioner can set up an X-ray apparatus with a ( British Medical Journal, May 5, 1906), has given us
Crookes tube and fluoroscope, and use it ; but there some startling limitations of the usefulness of the X rays,
will always be a field for an X-ray specialist who is especially with regard to the treatment of fractures. In
always available, and who is competent in the use of the his opinion the rays are of no value in modifying the
X rays, for every other class of case beside fracture — one ordinary methods, and to form a correct diagnosis they
who has a wide knowledge of anatomy, and is skilful inare, in nearly all cases, unnecessary. On reading his
the proper interpretation of skiagrams. Such a person conclusions, one is almost persuaded that it is a great
must necessarily be a qualified medical man. It is misfortune that the rays were ever discovered—at any
monstrous to suppose that all this can be efficiently rate, so far as these injuries are concerned. He admits
performed by an unqualified chemist ; yet we still see that in a few cases they may be of value in clearing up a
advertised in chemists' shops, hydropathic establish- doubtful point, but says " the evidence afforded by X rays
ments, at instrument-makers' , and other places, that an is deceptive, misleading, and should only be submitted
X-ray apparatus is on the premises and available for to and acted upon by those who understand their value .”
their customers. The abuse of powerful apparatus in To the last part of the paragraph all must agree, but
hands such as these will be apparent to all ; yet medical with regard to his other conclusions, I cannot imagine
men are not blameless in this matter : they still send that he has many sympathizers. I am sure that the
their cases to chemists, instrument-makers, etc. Roentgen method has established a clearer and more
I strongly advocated this view of the matter many extended scope in our diagnosis, and, as a consequence,
years ago, soon after the Roentgen method was first our methods of treatment are daily becoming much more
used. At that time I was asked the following questions, definite, less severe, and less complicated, although it
among others, as to the establishment of an X-ray must be admitted that they are rendered wider in range
department in the hospital
ospital of a very large and important and more exacting on the care and attention of the
provincial town : surgeon. Indeed, in many instances our methods of
1. Should not the hospital have the apparatus neces- treatment have already become most exact and perfect,
sary to apply the Roentgen rays to the patients therein, and are carried out with great precision.
many of whom are men who have met with accidents in In detecting the various signs of fracture or dislocation ,
the large works in the district ? mere palpation, however skilful, even when combined
2. Can an ordinary medical man in the borough with large experience, cannot now, and could not in the
properly use it ? past, do what we now perform with the assistance of the
3. What is the cost of a first- rate apparatus ? X rays. Skiagraphy must be employed in the treatment
4. If the medical man cannot use the apparatus, can a of fracture by every conscientious and careful surgeon,
competent photographer use it ? however great may be bis skill in diagnosing these lesions
I replied that a photographer was certainly incom- by the older methods. I cannot do better than repeat
petent, as was also an electrician, unless the latter were what I stated in 1901 : “ The use of the X rays does not
under the supervision of a medical man, and did only supersede the ordinary methods of clinical diagnosis ; it
the manual or operative work ; that there were always supplements them in a most valuable way, especially
excellent medical men in every district who could readily where great swelling of the soft parts exists. It makes
acquire the proper technique ; and that a post for the the presence of a fracture clear where otherwise doubt
medical man should be created at the institution, which might exist. It is now common knowledge that many
 Fig . 1 . Fig . 2 .

FIG . 3 . FIG. 4,

TO ILLUSTRATE DR . R. F. S. MEIJERS' ARTICLE ON THE PHOTOGRAPH OF A ROENTGEN

TUBE IN ACTION ( p. 130).

PLATE CCLXXV.
(" Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
133
 Fig. 1. - Right Hand). Fig. 2.- LEFT HAND.

Fig. 3. - Right Foot, FIG . 4. - LEFT Foot.

TO ILLUSTRATE THE CASE OF SUPERNUMERARY DIGITS DESCRIBED BY DR . H. H. BORN ( p. 148 ).

PLATE CCLXXVI .
(“ Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
135
 ARCHIVES OF THE ROENTGEN RAY. 137

fractures of the carpus, phalanges, metatarsus, and elbow- point about an inch below the external condyle in the
joint were almost entirely unrecognized before Roentgen's line of the forearm. This is for the purpose of opening
discovery." up the joint as much as possible.
5. For the limb, it should be placed as symmetrically
INTERPRETATION OF SKIAGRAPHS. as possible ; and in the case of the neck vertebræ, I have
All of us as surgeons are quite cognizant with the found the best position is with the occiput well over the
normal characteristics of bones and joints as seen by end of the plate and the chin high up, exactly in a
the naked eye , but it is quite another thing to interpret straight line with the sternal notch .
skiagraphs where we have to consider only shadows. I need scarcely repeat the advice that in all cases of
These shadows can be distorted to any extent, and will fracture at least two skiagrams in different positions
vary according to the distance of the sensitized plate should be taken . I have detected an upward displace
from the bones and according to the position of the ment of the astrychis and part of the lower end of the
tube. Take the hip-joint, for instance. If the tube be fibula in a skiagram taken in the antero -posterior
placed below the joint, the shadow of the neck of the position, when a previous lateral exposure had shown
no trace of a fracture .
femur will give the appearance of considerable deformity
whilst the pelvis itself will be considerably distorted. Now, what are the conditions where we find the
The shadow of a bone is an entirely different thing X rays of most importance ? I would enumerate them
from a photograph, or from the naked-eye appearance as follows : ( 1 ) Sprains ; (2) fractures accompanied with
of the same bone. The interpretation of a shadow is great swelling ; (3 ) fractures and dislocations about
unquestionably more difficult than that of a photograph. joints ; (4) fractures with great displacement ; (5) separa
If we could always compare the abnormal shadow of an tions of the epiphyses ; (6) un-united fractures.
injured bone with the shadow of a normal bone in the 1. Take first of all that large class of injuries called
same position , our task would be lighter ; but, unfor- sprains, which were formerly regarded as a laceration of
tunately, no one has yet attempted a complete skia- & ligament of a joint or of other soft tissue. We now
graphic atlas of the whole body. Probably the task is know by the X rays that these usually comprise a de
too immense for any individual worker. To render the tachment of a small fragment of bone. Indeed, a large
interpretation of skiagraphs easy, and to avoid as much number of sprains should be classed under the heading
as possible distortion of the parts, Mr. Chisholm Williams of fractures, and be treated accordingly. I maintain
has suggested the following points : that fracture of a small portion of bone being so often
1. Tbat there should be certain points on the human coexistent with sprain, all cases of sprain should be
subject over which the anode should be placed, and that examined by the X rays. How often in the past has the
on the skiagraph a small mark should denote the position complication of fracture in sprains been undetected on
of the anode. account of the absence of the supposed characteristic
2. That the distance from the tube to the plate or film sign of crepitus ! Very often the complication of fracture
should never be less than 18 inches . is only revealed some time after the receipt of the injury
3. That when radiographing the lower extremities they and its treatment by the doctor, the patient consulting
should be placed at a right angle with a line drawn some non-medical radiographer, to the discomfiture of the
between the two anterior superior spines, and that the surgeon .
spine be absolutely at right angles to this also. In the In sprains of the phalanges of the finger this un
case of one hip-joint being fixed in adduction, the sound detected complication is very frequent. A French
limb should be placed at a right angle with the trunk. surgeon has also lately discovered by means of the
4. In the upper limbs, for the shoulder-joint, the arm X rays that a fracture of one or other of the smaller
should make with the mid-line an angle of 45 degrees, metatarsal bones often occurs in soldiers on the march .
and the hand rest with the palmar surface downwards. The injuries had been previously considered as sprains.
The opposite sound parts should always be shown for 2. In cases where there is immense contusion and
comparison-taken, of course, under exactly the same swelling from rupture of superficial vessels, leading to
conditions. For the elbow-joint, the internal condyle complete obliteration of every bony prominence, the value
being on the plate, the anode should be placed over a of radio -diagnosis is very great, since a complete and
19
138 ARCHIVES OF THE
satisfactory examination by palpation is quite im-
possible. A good instance of this occurred in the early cause of interference with the growth at the epiphyseal
days of the X rays. A young man had fallen off his junction.
horse and injured his elbow. An eminent surgeon who
was called in by the doctor to see the case was quite
unable to make a diagnosis, and rather discountenanced
the use of the rays. The practitioner, on his own re-
sponsibility, took an X-ray picture, which revealed a
complete dislocation backwards of both bones at the
elbow. An anæsthetic was at once given, and the dis-
location reduced, with a most favourable result.
In the case of fracture the very fact of severe con-
tusion and swelling might, as of yore, tempt the surgeon
to make attempts at reduction, and cause displacement
where none existed, were it not for the knowledge
obtained by the X rays. The X rays, being unimpeded
by any amount of swelling, reveal the true condition of
the injury, and instruct us when no manipulations are
necessary and a simple splint or dressing is sufficient.
The study of injuries to the epiphyses in children and
youths entails an accurate knowledge of the normal
ossification of the bones, both as seen by the naked eye
and also as seen by the X rays.
As regards the ossification of the hands, in my
" Skiagraphic Atlas of the Hand and Wrist " I have
endeavoured to give a complete account of this process
fragments. Quite recently, with improved technique,
in the hands . these interposed tissues have in some instances been
In the early days of the Roentgen era the non- detected . If the interposed material be a small portion
recognition of the unossified or partially ossified of bone, it is, of course, readily detected by this method.
epiphyses, which produced no definite shadow, led to
many deplorable mistakes.
I hope not to be thought egotistical when I state that
I was the first to point out the importance of skiagraphy
as an aid to the diagnosis of epiphyseal lesions in
children. I described and figured (British Medical
Journal, March 7 , 1896) the case of a boy, seventeen
years old, where the X-ray photograph confirmed the
diagnosis of a separation of the distal epiphysis of the
metacarpal bone of the index-finger.
There is one very important class of injuries in which
skiagraphy does not help us ; in fact, the negative
findings of this method of examination may lead to
disastrous results. I allude to epiphyseal separations
without displacement.
A common situation for these is the lower end of the
radius and the lower end of the femur. The absence of
diagnosis and consequent neglect of treatment are liable
to be followed by arrest of growth of the bone, since
ROENTGEN RAY .
insufficient care of such an injury is the most frequent
TREATMENT OF FRACTURES .
Accurate apposition of the fragments being the most
serious item in the treatment of fractures, the X-rays
give us the greatest assistance. The bringing of the
fragments of the bones into apposition under the X rays
in recent fractures is an important aid. In this way the
surgeon can see, as well as feel, whether the bones are
in position. It is only, however, in a few situations
that this can be satisfactorily employed, because of the
difficulty in exposing the patient to the X rays with all
the necessary apparatus for fixation of the fragments.
At the shoulder, elbow, and wrist, this method, when
practicable, is particularly useful. The Roentgen process
cannot, however, always determine the cause of the dis
placement or rotation of the fragments of the bone,
although it often gives us valuable points in the display
of comminution of fragments of the broken ends, or of
the rotation of one or other fragment, or of a separated
epiphysis. It cannot show us the hindrance to reduc
tion through muscular spasm , or the interposition of
muscle, periosteum, or other soft structure between the
All fractures should be taken by the X rays after being
" set " ; the stereoscopic method should, if possible, be
always employed. It is easy to watch the position
during the process of consolidation of the fragments,
and, if malplaced, to rectify it as far as possible.
I may here remind you that a little overlapping of
the fragments may look very bad in skiagrams. Such
skiagrams have been produced in the law-courts as
evidence of want of skilful treatment. The overlapping
frequently does not affect the functional result in the
least.
In malposition of the fragments in old fractures the
Roentgen rays enable us to make a complete diagnosis
of the anatomical conditions, and to determine our
operative measures with exactness. This method is
especially useful in depressed oblique fractures of the
femur and at the malleoli of the ankle . In the latter
we are able to resect a wedge from the diaphyseal ends
and correct the deformity.
 ARCHIVES OF THE ROENTGEN RAY . 139

Passing now to a few of the medico- legal aspects of without an examination of the patient at the time the
the Roentgen method : In a fracture in the neighbour picture was taken , and without the guidance of an
hood of the joint the displacement may be slight, and accurate description of the position in which it was
the practitioner may look upon the injury as not par- taken .
ticularly severe. In such cases the X rays would show In concluding these general remarks, I would empha
him that the fracture is really intra-articular or com- size the fact that, especially as regards deformity,
minuted. Contrast this with a case of simple fracture skiagraphs by themselves, without surgical interpreta
with displacement further away from the articulation, tion , and when not taken under proper conditions and
which may be easily reduced and rapidly cured with- considered with the clinical signs , are absolutely of no
out untoward result. The patient would compare the value-indeed, must often be positively misleading.
adverse results in the first case . If the intra -articular I can only briefly allude to the importance of skia
lesion , in the first case, be undetected by the X rays, graphy in various joints and bones as it has presented
the patient is liable to complain of the unfavourable itself to me during the past eleven years :
course of his treatment when compared with the second. Shoulder.-Note the normal acromio -clavicular joint :
So many skiagraphs have lately been produced and this is often mistaken for dislocation on account the

admitted in evidence in courts of law in suits for intervening fibro -cartilage. Fracture of the surgical
damages after accidents and in cases of malpraxis, neck, complicated with dislocation of the head, is not
that I should like to add my protest against the practice uncommon, as revealed by skiagraphy.
as it obtains at present. The Southern v. Lynn Thomas Elbow . - Some of the most difficult points in surgery
and Skyrme case last year was a case in point. The have yet to be solved in connexion with the elbow-joint.
skiagraphs in that case showed that, even under most The Roentgen process has revealed many unheard-of
favourable conditions, some overlapping of the fragments fractures, and complicated injuries too numerous for me
very frequently persists , but that this faulty position, as even to enumerate .
a rule, does not interfere with the ultimate restoration Fissure of the Head of the Radius has only recently
in a strong and functionally useful limb. been clearly ascertained by means of the X rays ; in
Fortunately, in this country we have not had many fact, before this method came into existence its presence
charges of malpraxis or claims for damages in courts was entirely a question of supposition.
of law, which have been so frequent in the United Fracture of the Head of the Radius we now know to
States of America and on the Continent . Yet these be an extremely common injury.
actions at law, based, as I must call it, upon the abuse T. T. Thomas has also drawn attention to the frequency
of the X rays, have become sources of annoyance and of vertical fracture of the head of the radius, in which
financial loss to surgeons . There are some solicitors no other injury to the elbow was discovered by the
only too ready to act in collusion with those X-ray X rays, although more severe injury had been suspected
offices conducted by electricians or mere photographers. in each of the two cases he reports. After a most
The remedy is in the hands of the surgeons, as I have extensive research, he has found no less than fifty -five
hinted at the beginning of my lecture. instances of this fracture among recent skiagraphs taken
The X rays may show a fracture when none exists, or in Philadelphia .
fail to show a fracture which is clearly manifest by Where the fracture and deformity are of long standing ,
clinical signs. This latter is rare , except, as I have the diagnosis, I am sure, would be impossible without
mentioned above, in epiphyseal separations. Again, the the Roentgen method.
deformity from a fracture may easily be exaggerated to In fracture of the Lower End of the Radius skiagraphy
an enormous extent. It is also well to remember that has revealed conditions that were quite unexpected
in recent fractures in which union has taken place, with heretofore. How often do we see a comminution of the
formation of good callus, the condition presented is often lower fragment or an unsuspected fracture into the joint
indistinguishable from that of non-union of a fracture in Collis's fracture .
on account of the non-deposition as yet of the lime The X rays have shown that the anatomical states of
salts. No surgeon should be asked in court (or, indeed, the various forms of fracture and separation of the lower
out of court) to pass an opinion on an X - ray picture end of the radius really differ from one another more
19--2
140 ARCHIVES OF THE ROENTGEN RAY.

than those of any fracture of any other bone. Con- separation , an exact diagnosis is impossible without their
sequently, we now know that the treatment should be employment. I maintain that all cases of even slight
varied accordingly. injury to the hip should be skiagraphed. An injury to
The question of intra- or extra-articular fracture is the epiphyseal line may lead to gradual displacement of
an all-important one ; and in cases of great deformity the head and neck , and, as a result, coxa vara traumatica
osteotomy can now be considered and replacement is developed .
readily effected. For this subject I must refer you to an In congenital dislocation of the hip also the appearance
excellent article by Professor Carl Beck, of New York, of the head of the femur in relation to the acetabulum
on “ The Modern Treatment of Fractures of the Lower after manipulative treatment is most important.
End of the Radius, as indicated by the Roentgen Rays," Knee- Joint. - Injuries to the knee-joint are not difficult
and to his recent excellent work on fractures. of interpretation by the X rays.
Fracture of the Ulnar Styloid in Collis's fracture we Comminuted Impacted Fracture of Head of the Tibia.
now know to be entirely common , occurring in as many Impacted fracture of the head of the tibia was not easy
as 75 per cent . of the cases. of exact diagnosis before the Roentgen era. I had one
Fracture of the Radial Styloid Process alone , extending case under my care many years ago in which this
into the wrist- joint , is not uncommon . It was almost fracture was suspected , there being present some
unknown before the era of the X rays. mobility about the upper end of the bone, but no crepitus
Fracture of the Ulnar Styloid Process alone I have or effusion into the joint. A man in a drunken state
found in one or two instances. had fallen upon his knee. He died in a fortnight's time
Fracture of the Carpal Scaphoid is by no means easy from chest trouble , and the autopsy revealed a com
of detection by the X rays, owing to the peculiar shape minuted fracture of the tibia, the tubercle being driven
of the bone and its oblique position. Its long axis being upwards between the tuberosities, and a fissure extended
placed so obliquely to the bones of the carpus and radius into the knee-joint. The specimen I showed at the time
that its shadow is extremely deceptive, the latter should at the Pathological Society.
always be viewed at a right angle to its long axis. The The X rays in Fractures of the Patella have disclosed
ossified line of the lower epiphysis of the radius and the fact that the displacement of the fragments is always
ulnar might in some instances be mistaken for a much greater than we have anticipated beforehand, due,
fracture . no doubt , to the interposition between the fragments of
Hip - Joint. - In no part of the body are errors so prone some of its periosteum and lacerated extensor tendon .
to occur as in considering skiagraphs of the pelvis and I have not troubled you with the numerous rare forms
hips. In connexion with this subject, I need only refer of fracture, or complicated fracture with dislocation at
to Mr. Muirhead Little's paper in the British Medical the joints, revealed by the X rays which were never
Journal, 1899, where he figures an extremely instructive dreamt of before .
picture of the varying forms of the images that can be In conclusion , I am positive that the ideal method of
produced of the head and neck of the normal femur by diagnosis is that every case should be submitted to the
the various relative positions of the focus-tube, skeleton , X rays, whether uncertainty as to diagnosis exists or
and plate, clearly demonstrating that many deformities not ; and that the Roentgen process should be used as a
can be imitated, the angle of the femoral neck , its thick- scientific adjunct to clinical methods, and in no other
ness, its outlines, and the size and shape of the head, way. Many apparently simple cases display some com
being made to vary considerably. minution, obliquity, or rotation, and vice versa . An
In well- marked instances of coxa vara traumatica a apparently severe fracture, with great swelling and
diagnosis can, from its characteristic signs, be made contusion , will turn out to be a very simple one through
tolerably easily without the assistance of the X rays. this co-operation of Roentgen’s process. But each case
In other cases of coxa vara not due to epiphyseal should be made a complete study in itself.
 ARCHIVES OF THE
A CONTRIBUTION TO THE STUDY OF HIGH-
FREQUENCY CURRENTS. *
By Dr. FOVEAU DE COURMELLES.
The use of high-frequency currents for therapeutic pur-
poses was introduced by d'Arsonval under the name of
autoconduction. He was followed by Apostoli, Oudin,
and myself in 1896. Shortly afterwards Professor
Benedikt, of Vienna, alluded to the treatment as
d'Arsonvalization , a name which has since been generally
adopted.
Of late the lay press has turned its attention to the
treatment as something new, and, as usual, its effects
have been greatly exaggerated . As scientific practi-
tioners we should protest most strongly against such a
course, for exaggeration only injures a cause , however
good . Nevertheless, professional curiosity has been at
last awakened , incredulity has changed to interest, and
there is a disposition in many quarters to render justice
to the claims of the novel treatment.
The apparatus required for high -frequency treatment
is not very complicated. The necessary installation
consists of a source of electricity, a Ruhnkorff coil with
break and condenser, two Leyden jars, a spark - gap, and
a large solenoid . The inner coverings of the Leyden
jar3 are alternately charged and discharged by the
current from the coil. The accumulated charges are
discharged through the spark -gap, and the sudden reper- This regulating action takes place in conditions of
cussion by the oscillating discharge sets up surging hypertension, and also when the hypertension has been
waves of electricity in the solenoid. The frequency of
these alternating waves is some half-million per second .
The patient, comfortably seated in the centre of the
solenoid, has no consciousness of these surging currents
of enormous potentiality passing in closeproximity to him,
since their frequency is vastly in excess of that recog.
nizable by any of his senses. High-frequency currents
do, however, produce a definite physiological effect.
D'Arsonval proved, by experiments on animals and on
himself, that they cause a rise of temperature, an increase
in the respiratory exchanges, an augmentation of organic patient and diminishes his oppression. It avoids and
combustion, and a temporary diminution of weight, with
subsequent increase. Moreover, the pulse is increased
in frequency just as with a static electrical bath . The in so grave a condition our duty is to call in the aid of
most important effect, however, is the profound modifica-
tion exercised on the blood-pressure and the arterial
tension .
* Read before the Congress of the French Association for the
Advancement of Science, held at Rheims, August, 1907.
ROENTGEN RAY . 141
This regulating action of d'Arsonvalization on arterial
hypertension has been made the ground for exaggerated
claims of cure in cases of arterio- sclerosis .
Is this claim warranted ? Will the treatment, as has
been asserted, relieve hypertension promptly and
definitely ? Will it cure the thickening and contraction
definitely
of the vascular walls ? It would, indeed, be a wonder if
this were so -if we could soften the hardened and con
tracted arteries by some half-dozen electrical séances,
and that in a permanent manner.
My experience in this matter dates back for over
twelve years. In 1895 I described the technique in my
book on “ Curative Electricity,” and I defended the
method at the Brussels Congress of Neurology and
Medical Electricity in 1897. As the result of consider
able experience, I believe that the good effect of auto
conduction depends chiefly on its regulating action on
the arterial tension , a regulating action the importance
of which cannot be exaggerated. It has, moreover, a
stimulating action on organic combustions, and produces
a corresponding rise of physiological temperature. In
addition there is an increase of assimilation, and an
increase of the electro -chemical currents of digestion.
I was the first to demonstrate the existence of these
currents. The increase of these due to autoconduction
may easily be demonstrated by means of a condenser
electrometer or a mirror galvanometer.*
followed by a condition of hypotension. The action is
of the greatest utility.
On the one hand, we increase the arterial tension,
giving the arterial blood pressure sufficient force to
reach the capillaries in normal quantity ; on the other
hand, we may diminish the pressure, thus lessening and
softening the circulatory shocks against tissue which
has been rendered fragile and friable by disease. This
is not, indeed, a cure, but it is a very considerable relief
of arterio- sclerosis. It increases the strength of the
retards the fatal termination due to cerebral hæmor
rhage, and may even remedy its effects. It is true that
all other means of treatment, dietetic and medical, as
well as d'Arsonvalization. The latter alone will mani-.
festly be unable to eliminate the alimentary toxins,
which are the cause of arterio-sclerosis, if these are
* Académie de Médecine, July 13, 1893.
142 ARCHIVES OF THE ROENTGEN RAY .

continually renewed in the organism . It does, how have caused it. The idea of producing a cure without
ever, augment the elimination of such toxins, and removing the cause is as seductive as it is false. As
improves the digestive activity, as is proved by the with other therapeutic methods, the results obtained
electroscopic observations on the secretion of gastric differ greatly with different patients. Where observers
juice and saliva carried out by Thiellé and myself. have failed to obtain results , it is in most part due to
In my own practice I have repeatedly observed the faulty technique. In no branch of treatment is tact,
favourable and rapid effects of d'Arsonvalization both in clinical experience, and the knowledge of apparatus so
syphilitic arthritis and in the hemiplegias due to cere- necessary. These, however, are to be acquired with
bral hæmorrhage. The first morbid symptom to dis- care and study, and are not too difficult of attainment
appear was the embarrassment of speech. This was by the earnest student.
followed by improvements in locomotion and in the It may be definitely affirmed, then, that we have in
movements of the hands and arms. Recently I had autoconduct ion &a means of regularizing the arterial
autoconduction
under my care two patients, of the ages of thirty -five and tension. Huchard speaks to the point when he says
thirty- seven respectively, in whom the embarrassment of that it is not too much to call in all the resources of
speech was almost the sole sign of the attack. In both medicine in order to prolong the life and render more
cases the onset was unperceived, the patients waking in tolerable the existence of the sufferers from arterio
the morning with partial loss of speech. Both patients sclerosis .
were completely cured after a course of six séances. Since 1890 I have tended a great number of these
The objection that the good results are due to sug. cases, frequently complicated with diabetes and albu
gestion cannot be entertained in these cases. It is not minuria . The improvement in strength is manifest,
only the patients who believe in the treatment that are even although there is no diminution in the quantity of
benefited thereby. Moreover, there is but little to sugar or albumen. The obesity also disappears. In
impress the imagination where the coil, the spark-gap, certain cases where patients insisted on taking thyroid
and the Leyden jars are banished from the consulting. extract, the drug seemed to be better supported while
room . When this is the case patients who see nothing the patients were under high-frequency treatment.
except the solenoid, and, moreover, feel nothing, are yet Under these conditions a dose of thyroid extract, which
benefited or cured with equal rapidity. had previously caused tachycardia and abundant sweat
I was recently called in to attend a young girl of ing, gave rise to no such disagreeable symptoms. It
seventeen , whose case was somewhat obscure. Sud appears, therefore, that during treatment the action of
denly, without any apparent cause, she was seized with the renal filter is increased, and the drug is more rapidly
attacks, during which she could not stand upright or eliminated. In general, during a course of treatment by
eat , and fainted every five minutes or so. Under treat- autoconduction there is a manifest increase of urea and
ment by d'Arsonvalization the attacks of syncope of the salts in the urine .
gradually became fewer ; she was able to stand up, and In order to determine the arterial tension I had
ultimately to walk a few steps . This result was only hitherto used the ordinary thumb sphygmometer, which ,
obtained after some thirty séances. The cure was com- by means of a column of mercury, measures the pressure
pleted by a course of light baths. After three months' required to obliterate the artery. This method is,
treatment the patient walked as well as ever. I do not however, far from satisfactory, since the observer is
believe this was a case of pure hysteria, nor was the cure liable to error due to auto-suggestion. It is much better
due simply to suggestion. If that were the case the to adjust the pressure necessary to obliterate the pulse
action would have been more rapid. In hysterical cases, without looking at the index, to fix the instrument at
or as the result of suggestion , the morbid process ceases this point, and then to read off the index at leisure.
suddenly, and not, as in this case, by a gradual and At Neckar, M. Huchard showed me a sphygmomano
almost insensible progress. Moreover, the analysis of meter of English make, in which the error due to sugges
the urine showed a continuous though gradual ameliora- tion is reduced to a minimum. For the last two months
tion . I have been using this instrument, which has completely
It is, of course, absurd to promise an amelioration of confirmed my previous observations as to the " regula
arterio -sclerosis if the patient continues the habits which tion " of arterial tension by high - frequency currents
 ARCHIVES OF THE ROENTGEN RAY. 143

viz ., augmentation of tension in cases of hypotension, the treatment of deep-seated tumours in inoperable
diminution of tension in cases of hypertension. cases . I have myself had an opportunity of seeing him
My usual séance is one of fifteen minutes. I use a apply what he calls " electrical sideration " in the clinique
current of 6 ampères at 110 volts in the primary of the of Professor Pozzi at the Broca Hospital. The surgeon
coil, which gives from 350 to 400 milliampères in the makes a preliminary operation and removes as much as
solenoid. The immediate effect on the arterial tension possible of the diseased tissue, after which the high
is of no great importance. I measure the tension before, frequency sparks are applied. The high-frequency sparks
and not after, the séance. The treatment is usually re- of great intensity strike on the tissue and soften it in
peated every other day. In this way I get a definite, if such a way that it can be readily removed subsequently
temporary, result, and I usually get a regular and progres- by means of the curette. Even in cases where there
sive alteration of pressure of some 2 or 3 millimetres of has been considerable hæmorrhage this ceases almost
mercury , either increase or decrease, according to the immediately, and in many cases this fact alone renders
case. These precise measurements are only possible further operation possible. After recovery from the
with the English instrument. anæsthetic the patient appears perfectly free from pain ,
The number of séances varies, but is usually not less even in cases where this has been previously severe. In
than six. We may require ten or twelve to produce a uterine cancer it is occasionally necessary to repeat the
durable result. In very advanced cases the series must operation a week or so after the first electro -curettage, in
be repeated from time to time, the result in these cases order to remove tissue which has become subsequently
being maintained for only a short period. With regard softened. With a current of 250 milliampères in the
to electrical treatment, it is as true as with classical resonator, the installation gives a series of thick sparks.
treatment, " Il y a des malades, non des maladies." It The handle of the applicator is well insulated, and is
is impossible and unscientific to attempt to lay down made hollow, so as to allow a current of air to be blown
rules for all cases. through it by means of a foot-bellows. This serves to
D'Arsonvalization , or autoconduction , is only one cool the instrument and to prevent its being clogged by
branch of high frequency. Oudin introduced the method the burnt tissues. I have seen great relief obtained by
of " effluviation ," which consists of a rain of sparks or means of this procedure. Here again the surgeon finds
of luminous effluves - radiations which have an intense a valuable ally in the ranks of electro -therapy, which he
chemical and photo-therapeutic action. After Oudin , has hitherto looked on with such suspicion.
Boudet of Paris studied this subject, and Morton has In pulmonary tuberculosis good results may be
produced almost similar results with his modification of obtained with the effluve, or , preferably, with a shower
the static spark . of small, fine sparks. With this treatment I have seen
The treatment by effluviation has proved efficacious in a patient put on 2 kilogrammes in weight in the course
cutaneous tubercle, eczema, pruritus, and neuralgia. of a month. This was in a case of phthisis in the third
According to Doumer, fissure of the anus is rapidly stage, as was proved on the patient succumbing to the
cured by this method. I have myself had several disease three months later.
successful cases when using my regulating electrode. At the Milan Congress of 1906 I showed my electrode
Piffard of New York has introduced the treatment with guard. It is designed so that any variety of
by cataphoresis. This is identical with “ l'électrolyse excitators may be adapted to the same handle. By the
médicamenteuse," which I created in 1890, and which addition of glass enveiopes of different colours, a
in these latter days has been renamed " ionization.” photogenic action may be obtained as well.
At the Paris Congress of Electrology in 1900 To sum up, high frequency in its diverse forms enables
J. Rivière drew attention to the efficacy of high-frequency us to cure a number of affections in their early manifes
sparks in the treatment of cancer. Its utility in this tations, and in many incurable and inoperable cases to
disease has been repeatedly verified, and in the Cancer relieve the sufferings of the patient and prolong life.
Number of the ARCHIVES OF THE RONTGEN Ray I have The scientific electro -therapist has no other pretension
shown that high frequency is the ideal treatment of than to aid the medical practitioner where all other
superficial cutaneous cancroids. Since then Dr. de means of treatment fail. In these cases electrical treat
Keating Hart has applied it as an aid to the surgeon in ment is destined to play a real and a most important role.
144 ARCHIVES OF THE ROENTGEN RAY .
Notes and Abstracts .
ELECTRO-THERAPY .
High -Frequency Currents in Chronic Pelvic Conditions
( Journal of Advanced Therapeutics, March, 1907).- Strobell
points out the great value of the vaginal and rectal modalities
in their power to produce a more or less extensive and persistent
pelvic and abdominal hyperæmia. When either of these tubes
is employed for a period of from ten to fifteen minutes, a
decided sensation of warmth is experienced by the patient at
the close of the séance , which is not alone confined to the
pelvis, but affects the abdominal and thoracic viscera in many
instances as well ; the phenomenon usually persisting for from
one to two hours, with entire relief of pain and discomfort. We
thus, he says, have a means of inducing effective pelvic hyper
æmia by an absolutely painless method -a most important and
effective electro-therapeutic contribution to gynæcology. There
is nothing to compare with it in safety, painlessness of
application, and effectiveness in chronic pelvic disease.
Healing Fistulous Tracts by Metallic Cataphoresis.-
F. R. Keck, M.D., states (Pacific Medical Journal) that this
“ treatment is painless, never fails, requires no anæsthetic or
detention from business, and infection is impossible.” The
modus operandi is very simple. A probe-pointed copper wire
almost the size of the fistula is introduced to the bottom of the
fistula, should it be a blind one. If the fistula be complete a
finger must be introduced into the rectum, in order to protect
the opposite rectal wall, and in urethral fistula a rubber or glass
sound is passed, prior to the copper electrode, in order to protect
the opposite urethral wall. The copper electrode is attached to
the positive pole. As a rule six to eight treatments are sufficient
for a complete cure. The amount of current and time of exposure
depend on the size and condition of the fistula . The treatment
may be repeated every four or five days.
The Treatment of Raynaud's Disease by High -Frequency
Currents. - Bonnefoy contributes an important article on this
subject to the July number of the Bulletin Officiel de la Société
Française d'Électrothérapie. He has already recorded two
cases of Raynaud's disease which he has treated in a similar
manner and which have been completely and permanently
cured. In the present article he gives a full account of five cases
so treated with marked success. A curious point in connexion
with his cases is that all of them were females, while only one
was French, the rest being English. The disease is probably due
to vaso-constriction. This is brought about by an overirritability
of the vaso-motor centres in the cord, or it may be due rather
to a peripheral reflex action on the ganglia situated in the
course of the vaso-motor fibres. The author, however, maintains
that, as the neurotrophic disorder present in this disease is so
analogous to that present in the other manifestations of arthri-
tism, the disease is in all probability a syndrome of that
diathesis. The effect of the high-frequency currents in such
cases is to cause a dilatation of the peripheral bloodvessels by
exciting the vaso -dilator nerve fibres, and at the same time
neutralizing the activity of the vaso - constricting fibres. The
author is confident that further experience will prove the value
of this treatment, and that electro-therapy will thus furnish a
new proof of its efficacy in all of those diseases the treatment of
which has up to the present proved an impossibility.
Electro -therapeutics of Rheumatism . - A . Rustling Rainear
( American Medicine, March, 1907 ) says that electricity is most
useful in the treatment of subacute and chronic rheumatism .
It is the best and quickest method of promoting oxidation and
elimination, and at the same time renovating and restoring
function to the part. High-frequency and static currents with
solenoids and resonators and ozeno -therapy are specially
applicable to the general condition. In considering and
selecting the proper form of local electrization, we have at our
disposal five different types of current : direct, induced, static,
sinusoidal, and galvano- faradic. Both the general and local
applications of electricity cause an increased activity in the
animal cell, increasing the functional capacity by storing up
nutritive energy, and causing glandular stimulation and elimina
tion . The author is convinced that the continuous, static,
high -frequency and induced forms are the most reliable and
permanent in their actions on the rheumatic condition. There
is no question as to the high -frequency current producing
metabolism when molecular conditions are enhanced and oxida
tion more complete. Constant and persistent articular pains
will thereby be relieved almost instantly. The continuous
current is noted as a sedative agent, and when combined with
the induced (galvano- faradic ) the fibrous formations in joints
are destroyed, and upon interrupting the current the congestions
are removed as a result of electric massage .
General or constitutional galvanization acts as a tonic ,
especially the nervous structures . The direct and static
currents are the most active stimulants of nutrition we possess.
The general routine of treatment should be as follows : When
there is much muscular involvement, a primary and secondary
current from the faradic coil, of about three to five minutes'
duration, should be applied directly to the muscles. At
first use currents of minimum strength, the electrodes well
moistened with a saline solution, and the current increased to
the maximum power of endurance. This is to be followed by
weak interrupted faradic primary currents. If excessive pain
be present, use the continuous current of 15 to 30 milliampères.
When the articulations are affected, galvano -faradio currents
are applied directly over the joints for from ten to fifteen minutes.
Labile currents following stabile applications are usually of
high therapeutic value. The continuous current may be applied
to the spine, the anode over the exit of the nerve from the cord,
and labile applications of the cathode over the joints and
muscles. Spinal galvanism may be employed with the anode
over the cervical vertebræ , and the cathode on the upper section
of the sacrum , using 20 to 35 milliampères of stabile current,
and this constitutes excellent treatment. In chronic cases from
two to six months' treatment may be necessary.
 ARCHIVES OF THE ROENTGEN RAY.
PHOTO-THERAPY.
A New Form of Light Rays in Cystitis and Posterior
Urethritis. —- After many years of experimenting, Rogers
( American Journal of Dermatology, August, quoted in the
Lancet Clinic) claims to have discovered that, if all the rays of
light from a high candle-power incandescent lamp are converted
into distinct beams of light, they will penetrate any of the tissues
of the human body, including the bones ; that the heat rays
stimulate the penetration , and that the pathogenic germs are
destroyed by the mechanical action of these rapid vibrations.
These new rays, he maintains, relieve pain in some cases even
more promptly than morphine given hypodermically. The rays
are absolutely harmless to healthy tissue. The pain and tenesmus
of acute cystitis are relieved so quickly as to be almost incredible.
The smarting and burning sensation accompanying micturition
in acute gonorrhea is usually overcome by one application of
the rays for two or three minutes over the inflamed urethra.
Stricture so seldom results from gonorrhæa treated by the new
rays that in case it does occur he would question the technique
of the operators or the construction of the lamp. He reports
cases of chronic cystitis and chronic posterior urethritis cured
with only a few (four to ten) applications of the new rays, after
all other known medication, both local and internal, had failed.
The action exerted is relief of pain, destruction of causal germs,
relief of inflammation , oxygenation of the blood, and repair by
tissue. The success of this treatment depends on the technique
of the operator, but more especially on a lamp and reflector
constructed with the correct geometrical proportions necessary
to properly produce the new force.
RADIO - THERAPY.
Treatment of Neuralgia by Means of Electricity and
Radio -therapy (Bulletin Général de Thérapeutique, March 15,
1907 ) .-Foveau states that cases which have resisted all other
modes of treatment may often be relieved by electrical and
allied methods. He cites especially the value of the electric
current in cases of sciatica. He has found that photo -therapy,
radio-therapy, and radium -therapy are all of value in producing More especially do we observeamelioration of the subjective
a powerful sedative effect. The action of light in painful phenomena present, such as the dyspnea and sleeplessness.
affections is well known. Red light is an excitant , blue light a
calmative , agent. It is essential, in making use of such
methods in the treatment of neuralgia , that great care be taken
in their application, otherwise serious injury to the parts may
result. Blue light is a sedative, and ultra-violet still more so .
In using the X rays and radium , Foveau has always been
careful in taking precautions to avoid injuring the patient.
These two modes of treatment generally produce a rapid effect
in cases of neuralgia. The sedative effect, however, is lasting,
and absolutely certain in many cases. In certain very obstinate
cases the writer has found that the use of radium for a few
minutes , following on the application of the X rays to the
painful nerve, has a very beneficial influence.
Sciatic neuralgia yields to these agents. In cases of herpes
zoster the eruption dries up ; the vesicles shrivel and become
pale after three or four séances. The pain is immediately red, slightly infiltrated, and covered with an abundance of
relieved , and disappears entirely after a dozen applications of
the X rays. Their effect upon the patient generally indicates
145
whether the rays are well borne, and whether they may be
safely applied every day. If, however, either radium or the
X rays produce untoward symptoms, they should be employed
at rarer intervals, the duration of the séance shortened, and the
intensity of the application diminished .
Pathological Effects of Roentgen Rays on Animal
Tissues. - Dr. Harvey, in a paper read before the Royal
Academy of Medicine in Ireland (Dublin Journal of Medical
Science, February, 1907) , described his experiments , showing
microscopic and lantern preparations . The animals operated
on were rabbits and guinea - pigs, and the organs chiefly examined
were the spleen, ovaries, testicles, and suprarenals. The experi
ments, which are in a preliminary stage, so far support Heineke's
results in regard to the spleen. The germ-centres of the Mal
pighian corpuscles were observed to be the first to suffer.
Chromolysis and diffuse nuclear staining are present in most of
the sections, and affect chiefly the young and proliferating cells.
Vaso - dilatation and conge ion are also common. The ovarian
and testicular changes were similar to those described by previous
authors. Dr. Harvey found congestion and bæmorrhages in
the suprarenals of all animals subjected to X -ray treatment.
He had read of the X rays being considered as a cause of
abortion , and thinks it is possible they should have such an
effect, as they seemed to show a greater effect on young and
actively developing cells than on adult ones. He considered
that the death of the guinea -pigs in his experiments was due to
the fact that the X rays caused a degeneration of cells, whereby
a toxic product was liberated , which killed the animals. The
toxic effect of the rays had been observed in several cases, and
he was in the habit of seeing that patients undergoing the
treatment for malignant disease should take aperient medicine.
The epithelium of the skin was much less sensitive to the
action of the rays than that of the testicles, ovaries, or spleen .
The Favourable Influence of the Roentgen Rays in
Chronic Bronchitis ( Blätter f. Klin. Hydrotherapie, March,
1907).- Schilling finds that under the influence of Roentgen
rays cases of chronic bronchitis are often greatly improved.
The duration of each séance need not be more than five
minutes, and two to four séances usually suffice to bring about
an improvement in the condition of the patient.
The X Rays in a Case of Inveterate Psoriasis of Nine
Years ' Duration . - In the Lancet Clinic (July 13, 1907)
M. L. Heidingsfeld records the case of a female patient, aged
thirty, who had suffered from inveterate psoriasis for nine years.
The eruption was in the form of large solid plaques, several
inches in diameter, distributed over the extremities, trunk , and
scalp, and followed the removal of a lipoma of the skin. The
patches began in the form of minute lesions, which constantly
grew larger, and showed no tendency to retrogress, in spite of
the most varied treatment as ordinarily employed for the cure
of psoriasis. The patches , however, remained uniformly bright
silvery white scales. The scalp was a mass of bright red scaly
eruption, the latter accumulating to the thickness of the fourth
20
146 ARCHIVES OF THE
of an inch or more, which necessitated the removal of the hair
and the wearing of a wig. Patient was put under treatment
by the X ray. Altogether she received twelve applications with
a soft tube, five minutes' exposure being given to each area .
At the time of writing the author says that all active evidences
of the disease had disappeared . The skin over the affected area
had become perfectly smooth and darkly pigmented, in sharp
contrast to the adjoining areas of normal skin, and showing
well the selective action of the rays in producing this effect
merely upon the pathological areas . Heidingsfeld has personally
found the X rays to be particularly efficacious in all cases of
psoriasis of this character where there is no idiosyncrasy on the
part of the patient against the X rays. This he considers to be
particularly gratifying, because these are the cases of psoriasis
which resist the methods of treatment usually successful in
other cases.
The Roentgen Rays in Dermatology . — R . H. Baggs ( New
York Medical Journal, April 27, 1907) details his experience of
X-ray-therapy in eczema, acne, psoriasis, keloid, cutaneous
tuberculosis, and alopecia areata. In the more chronic and
rebellious cases of eczema, more particularly of the squamous
type, the effects are good. After a few applications the itching
and discharge cease, and desquamation is arrested. The ten-
dency to recurrence is not averted . In acute and subacute
eczema no material benefit accrues from irradiation beyond the
relief of pruritus. In keloid the Roentgen method of treatment
holds the field. It, however, requires considerable time to remove
a keloid and very careful selection of the hardness of the rays
employed.
Granuloma Pudendi Tropicum treated by the Roentgen
Rays ( British Journal of Dermatology, March , 1907) .-J. M. H.
Macleod records the case of a male, aged twenty-two. In
1902 he had syphilis, and in the following year developed a
granuloma in the region of the anus. This gradually increased,
until it extended from the coccyx behind to the scrotum in
front, and for about 2 inches on each side. It was diamond-
shaped, and had begun to ulcerate. The anal orifice was
involved , but the mucous membrane was intact. In the dis-
charge from the ulcerated surface the Spirochæta pallida was
found. The patient was treated with large doses of iodide of
potassium, iodipin, and mercurial injections, but without any
distinct benefit. Local applications of caustics and antiseptics
were likewise unavailing. The patient was then put under
treatment by means of the X rays. He had fifteen exposures
at intervals of a week. The lesion is now ļ inch smaller at the
sides, the ulceration has dried up considerably, and the lesion as
a whole is tending to cicatrize.
Effects of Radio - therapy on Spastic Spinal Paralysis
(Le Progrès Médical, March 16, 1907).–Babinski records the
case of a woman , aged twenty -eight, who developed paraplegia.
There was complete abolition of voluntary movements, marked
contracture of the lower extremities, and spontaneous spasmodic
ROENTGEN RAY.
movements, with exaggerated reflexes. There was diminution
of sensation without any trophic changes. There was no pain
and no bladder difficulty. Mercurial treatment had no effect.
As ordinary treatment failed completely, the Roentgen rays
were applied to the dorsal and lumbar regions of the spinal
column. Three applications were made of five minutes each for
five days consecutively ; four series of such applications were
made altogether- i.e., twelve in all. Rapid improvement
followed . The patient can now get about by the help of a
stick . The gait is improved, and so is sensation . It is possible
that in this case we have an example of compression of the cord
due to sarcoma, which was reduced by the use of the Roentgen
rays .
Influence of X Rays in the Treatment of Leukæmia and
Hodgkin's Disease ( Journal of the American Association,
October 20, 1906 ).- Roth concludes that the beneficial thera.
peutic value of the X-ray treatment in Hodgkin's disease is well
demonstrated. In a case reported, the decrease in the glandular
enlargement was comparatively rapid. In a case of leukæmia,
for a long time X-ray treatment did not inhibit the progress of
the disease, but after one year's systematic treatment the leuco
cyte count finally returned to normal; this was not accompanied
by much decrease in the splenic enlargement. The use of
arsenic as an adjuvant to X-ray treatment seemed of much
benefit.
X Ray in Skin Diseases.- William C. Egelhoff, M.D.,
Chicago ( American Journal of Dermatology, January, 1907),
reports somewhat remarkable cures of epithelioma and car
cinoma, the duration of treatment being two to five months.
He states that the length of treatment and the condition of
vacuum of the tube should vary with the chronicity of the case
and the electric resistance of the patient. In discussing the treat
ment of tubercular glands, he says experience has taught us that
X rays alone will cure this disease in the glands, the only dis.
advantage being that the treatment covers a long period of
time. He states that if the glands have started to break down,
they are liable to continue this process until they, without pain ,
rupture on the surface and heal without leaving an extensive scar,
as would be the case in complete excision. Further X-ray treat
ment will cause the smaller glands to become normal in a short
time, and prevent the possibility of the infection being carried
through the system. Photographs of patients before and after
treatment are shown in support of these statements.
Abortion caused by Roentgen Rays . — Lengfellner (Mün
chener Medicinische Wochenschrift, No. 44, 1906) quotes certain
experiments made on guinea-pigs, which confirm fully the
results previously reported by Gellner, and show that even short
exposure of the abdomen to the action of the rays is able to
destroy the life of the fætus, even shortly before term . The
cause of the death of the fætus could not be determined micro
scopically, but certain changes were found in the ovaries which
suggested sterility.
 ARCHIVES OF THE
Reviews.
Les Ions, et particulièrement l'Ion Iode. By Dr. RAYMOND
BRILLOUËT. Paris : Baillière et Fils.
Anyone desiring to study the new and fascinating subject of
ionic medication cannot do better than take this little brochure
as his guide. Dr. Brillouët is a disciple of Professor Leduc of
Nantes, the great exponent of the modern electrical treatment
by ionization.
The first chapter is devoted to the theory of ionic dissociation
by solution, and the author points out that much of the classic
treatment by internal medication is in fact “ ionic treatment, ”
since a weak solution of a drug, such as iodide of potash, con-
tains free cations of potassium and free anions of iodine.
The second chapter, on the history of electro -therapeutics, is
not of so much practical interest — although it is curious to note
that electrical treatment dates as far back as A.D. 34, when
Scribonius Largus advised patients suffering from rheumatism
and gout to use baths in which were placed electric eels.
The third chapter, on the introduction of electrolytic ions,
is the most important, containing as it does the detailed tech
nique of the method as carried out by the school of Nantes.
Living tissue, impregnated as it is with saline solutions, is
in fact an electrolyte. Any difference of potential produced
at any two points of the body is accompanied by displacement
of ions and consequent electrolysis of the living tissue.
Leduc uses electrodes of tin, to which the conducting wires
are firmly soldered. Between the electrode and the skin he
interposes at least sixteen layers of “ tissu de coton hydrophile .”
This may perhaps best be translated as sixteen layers of
Gamgee tissue. The tin plates should be as large as possible.
If it is desired to limit the area, a layer of oil -silk , with a suitable
aperture, may be interposed between the electrode and the
skin . The Gamgee tissue, or cotton -wool, must be renewed or
carefully washed with distilled water-- not with soap — so as to
get rid of the metallic ions with which it has become impreg
nated. With these precautions currents of considerable intensity
may be borne without distress .
The fifth chapter discusses the relative velocity of the ions
under electric stress, and shows how greatly the resistance of the
skin is reduced by the electrolytic introduction of free ions.
The resistance depends on the nature of the ion introduced , the
ionic saturation of the skin, the voltage, the region of the body
under consideration, and the dimensions of the electrode.
The remaining chapters are occupied with a study of the X -ray
action more particularly of the iodine ion. negatives, but the advance in this direction has made
In the author's hands the introduction of the iodine ion has
given excellent results in the treatment of superficial sclerosis.
The following are his conclusions : The séances should be of
a duration of thirty to sixty minutes. The electrodes should
have a surface of 100 to 300 square centimetres, and the current
should have an intensity of 60 to 80 milliampères.
A very full bibliography completes this little volume of
130 pages, which gives a very complete view of the present state
of ionic medication .
ROENTGEN RAY . 147
A System of Radiography ; with an Atlas of the Normal. By
W. IRONSIDE BRUCE, M.D. Imp. folio, 15s. net. London :
H. K. Lewis .
We heartily welcome the appearance of this most important
work , which we believe is the first atlas of Roentgenography
which has appeared in this country. As the title indicates, it is
an atlas of normal skiagraphy, giving the appearance of the
various regions of the body under normal conditions and at
various ages, and with certain definite positions of the patient
and of the focus- tube. In all, twenty-seven well-defined
positions are given as standards with which to compare the
skiagrams obtained in practice. These twenty - seven positions
are for the most part sufficient for the purpose of the practical
Roentgenologist. It would be of advantage if one or two extra
positions were given, and more especially the oblique position in
examination of the thorax, which is of such vital importance for
the examination of aneurism , or tumours of the mediastinum .
Dr. Ironside Bruce uses a horizontal couch with the focus.
tube below the couch. A plumb-bob above the patient indicates
the direction of the normal ray, and the point of the plumb-bob
coincides with the point of exit of the normal ray from the body
of the patient. By this means a skiagram may be obtained
which is in all respects comparable with the normal view as
depicted in the atlas.
The value of the work is greatly increased by separate
skiagrams of the various bones and articulations at different
ages. This is a most important addition to our knowledge, as a
glance at the figures of the pelvis or the shoulder will show. In
each region a skiagram is given of the joint at the age of five
years, at the age of fifteen years, and again at the age of twenty
five years.
It would be a great advantage to the surgeon if these
standard positions were made use of as a matter of ordinary
routine in the X-ray department of every hospital. To render
the results comparable we require to know the distance of the
anticathode from the point of the plumb -bob, and this distance
should be an invariable one in all cases.
We are indebted to Dr. Ironside Bruce for a real and perma
nent advance in the technique of our art, and the student of
Roentgenography cannot do better than take this atlas as his
guide.
As regards the reproduction of the plates, we all know the
difficulty of obtaining satisfactory blocks for process printing of
such rapid progress that we are rather disappointed with the
results shown in this atlas. The very best that artistic repro
duction can give is not too good for the illustration of a work
such as this,
List of Muscles for Electrical Testing. London : H. K.
Lewis. 1907. Price 2s. 6d. net.
We have received from Messrs. Lewis this booklet of forms,
which will prove very useful in electrical diagnosis, whether for
20-2
 148 ARCHIVES OF THE ROENTGEN RAY.

hospital or private use. The forms are on gummed paper, and one for the lower limb. The nervous supply of the muscle
so as to be easily attached to the patient's board or case-book. is given in each case , which is often of much assistance .
There are four sets of forms in the book—one for the head, We note that the sheets can also be obtained separately
neck, and trunk ; one for the upper arm ; one for the forearm ; in quarto form .

Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN Ray. Should you deem the case of sufficient interest for the
ARCHIVES, I shall be pleased for you to publish the photographs.
DEAR SIR , -- Under separate cover I send you some photo- Thanking you for any consideration you may give them, I
graphs of an interesting case of supernumerary digits. remain ,
The individual is a coloured boy, seventeen years old , and Yours sincerely,
otherwise normal. There is an additional finger on either hand H. H. BORN , M.D.
(Figs. 1 and 2, Plate CCLXXVI.), and an extra toe on the left 3160, PARK AVENUE,
foot (Fig. 4) , whereas the right foot (Fig. 3) is normal . St. Louis, Mo., U.S.A.

PLATE CCLXXV .
To illustrate Dr. Meijers' article on “ The Photograph of a Roentgen Tube in Action."
PLATE CCLXXVI.
To illustrate Dr. Born's letter on " A Case of Supernumerary Digits ."

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send, with any prints intended for publication, a full account of the
case and also an account of the process used in radiography—such as the voltage, ampèrage and spark employed, time of exposure,
nd of sensitive plate or film used, or any other facts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE EDITOR begs to acknowledge communications from Dr. R. D. Carman (St. Louis, U.S.A. ), H. Clyde Snook
(Philadelphia , U.S.A.), Professor Carlo Colombo ( Rome), Dr. Burnet (Edinburgh ), Dr. Harrison Orton (London ).
The following Journals and Periodicals have been received : " Advanced Therapeutics,” “ The Electrician,"
“The Electric Review ,” “ Knowledge,” “ The British Journal of Dermatology, ” “ Annals of Physico-therapy,”
“ Medical Times , ” “Medical Electrology and Radiology, " “ Archives of Physiological Therapy, ” “ Archives
d'Électricité Médicale," " Le Radium ,' Annals d'Electrobiologie et de Radiologie ," “ Fortschritte auf dem Gebiete
der Röntgenstrahlen, ' “ Münchener Medizinische Wochenschrift," “ Zentralblatt für Physikalische Therapie,”
" Annali di Elettricità Medica ,” “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN Ray, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London, W.C.,” or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration, will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view.
Annual Subscription , payable in advance, Sixteen Shillings net (Four Dollars), including postage ; single
numbers, One Shilling and Sixpence net (Thirty-six Cents) , twopence extra for postage ( Four Cents). Back
numbers can be supplied ; prices on application.
RATES FOR ADVERTISEMENTS IN THIS JOURNAL.— Whole page, £5 net ; half page, £2 15s. net ; quarter page,
£1 10s. net ; eighth of a page, 17s. 6d . net. Series discounts, 10 per cent. on 6, 20 per cent. on 12 insertions.
Communications relating to advertisements should be addressed to the Publishers, REBMAN LTD. ,
129 Shaftesbury Avenue, London, W.C. (Publishers of the " Archives of the Roentgen Ray and Allied Pheno
mena , " etc.).- Telegrapbic Address : " Squama, London ” ; Telephone : No. 2026, Gerrard.
Billing and Sons, Ltd. , Printers, Guildford, England.
 Annual Subscription , Price 1/6 net (with postage 1/8).
No. 88 . 36 cents (with postage
16 / - net ($4), in advance. 40 cents ).
L
RA
VO . XII.

No
.
6
THE
HE M
RAANA
IRAH
ARCHIVES B
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S. , F.P.S.
IN COLLABORATION WITH

ROBERT ABBE ( New York ); A. BECLERE ( Paris); T. P. BEDDOES ( London ); J. BELOT (Paris) ; F. BISSERIE ( Paris);
H. BORDIER (Lyons); J. BURNET ( Edinburgh) ; R. HIGHAM COOPER (London ); W. COTTON (Bristol); FOVEAU DE
ELEC COURMELLES ( Paris) ; L. DELHERM (Paris ); R. W. FELKIN ( London );
L. FREUND ( Vienna) ; H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD APY
TRO (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ;
D. GUNZBURG ( Antwerp ) ; J. HALL -EDWARDS ( Birmingham) ; G. HARET
E R
TH April
( Paris); C. THUR AN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ;
F. H. JACOB ( Vottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
ARCH. JUBB (Glasgow ) ; E. LAQUERRIERE ( Paris) ; S. LEDUC ( Nantes) ;
NO

E.R. MORTON ( London ); G. HARRISON ORTON ( London ); H. G. PIFFARD ( New

07
19 .
V.

York ); JNO.C.RANKIN ( Belfast ); WERTHEIM SALOMONSON ( Amsterdam ) ;

W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM
WILLIAMS ( London ) ; CLARENCE WRIGHT ( London ).

CONTENTS
PAGB PAOE

EDITORIAL · 149 NOTES AND ABSTRACTS (continued ) :

PROTECTION OF THE PHYSICIAN AND PATIENT AGAINST
ROYAL SOCIETY OF MEDICINE . - 150
INJURY FROM ROENTGEN AND RADIUM RAYS · 173
ORIGINAL ARTICLES : FAVOURABLE INFLUENCE OF X RAYS IN CHRONIC BRON
ORTHO -ROENTGENOGRAPHY . – By DR . FRANZ M. GROEDEL, CHIAL AFFECTIONS 173

Bad-Nauheim -
150 LEUKÆMIA TREATED BY THE ROENTGEN RAYS - 174

THE EINTHOVEN GALVANOM ETER. --By PROFESSOR J. K. A. ACTION OF THE ROENTGEN RAYS ON PROSTATIC HYPER
157 TROPHY 174
WERTHEIM SALOMONSON, Amsterdam .

CURE OF LUPUS BY THE X RAYS · 174

ON THE TECHNIQUE OF ROENTGEN BURNS AND THE MEANS
THE ESOPHAGOSCOPE · 174
OF DETERMINING THE INTENSITY OF IRRADIATION. -By
DR. R. KIENBOCK, Vienna - 160
REVIEWS :
A CASE OF EPILEPTIFORM NEURALGIA TREATED WITH X
LES IONS ET LES MÉDICATIONS IONIQUES - - 175
Rays. —By ALEXANDER GREGOR, M.D. · · 169
THIRD ANNUAL REPORT OF THE HENRY PHIPPS INSTITUTE
THE ORIGIN OF FROST- BITE, AND ITS TREATMENT BY
ARTIFICIAL HYPEREMJA . Translated and condensed OF PHILADELPHIA FOR THE STUDY, TREATMENT, AND
PREVENTION OF TUBERCULOSIS · 175
from the German of PROFESSOR DR. CARL RITTER by
JAMES BURNET, M.A. , M.D. , M.R.C.P.E. - 170
PLATES :
NOTES AND ABSTRACTS : PLATES CCLXXVII . AND CCLXXVIII. -To ILLUSTRATE
COPPER IONS IN THE TREATMENT OF SUPPURATING PROFESSOR WERTHEIM SALOMONSON'S ARTICLE ON THE
SINUSES AND INFECTED WOUNDS · 173 EINTHOVEN GALVANOMETER . 170

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VOL. XII.-No. 6.. NOVEMBER, 1907.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY , THERMOTHERAPY , ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER, M.R.C.S., F.P.S.

IN COLLABORATION WITH
ROBERT ABBE (New York) ; T. P. BEDDOES ( London ); J. BELOT ( Paris ) ; A. BÉCLÈRE (Paris ) ; F. BISSERIE (Paris) ;
H. BORDIER ( Lyons) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol ) ; FOVEAU DE COURMELLES
( Paris ) ; L. DELHERM ( Paris ) ; R. W. FELKIN ( London ) ; L. FREUND (Vienna ) ; H. E. GAMLEN ( West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ; D. GUNZBURG (Antwerp ) ; J. HALL -EDWARDS
(Birmingham ) ; G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ; F. H. JACOB ( Nottingham ) ;
LEWIS JONES ( London ) ; A. C. JORDAN ( London ) ; ARCH . JUBB (Glasgow ) ; E. LAQUERRIERE ( Paris ) ; S. LEDUC ( Nantes) ;
E. R. MORTON ( London ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD ( New York ) ; JNO. C. RANKIN ( Belfast) ; WERTHEIM
SALOMONSON ( Amsterdam ) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM (London ) ; CHISHOLM WILLIAMS ( London ) ;
CLARENCE WRIGHT ( London ).

One of the subjects about which we need more certain
information is the effect of high-frequency currents on
bloodpressure, and more especially in the treatment of
arterio - sclerosis, D'Arsonvalization , as it has been
called, was received with enthusiasm in the country
of its birth , with active hostility in Germany, and with
more or less suspicion in England . There has been a
disposition of late, both in Germany and England , to
view with greater favour this particular modality of
electric application, and to welcome it as a serious
addition to our means of defence against the evil effects
of high tension in the arterial system.
That a séance of auto - conduction or auto-condensa-
tion will lower the pressure in the bloodvessels is of
comparatively little importance, since a hot bath or
any stimulation of the skin will do the same. There frequency currents so as to correspond with the exact
is, however, a certain amount of evidence to show that
the temporary reduction of blood-pressure is not in all
cases evanescent, but that the effect is a real and per-
manent one . The actual cause of this reduction is still
a matter of debate . One would like to believe that
it is at least in part due to the destruction of the toxins
which are the proximate cause of arterio-sclerosis. Some agreed in regarding high -frequency currents as a power
authorities consider that the good effect of high -fre- ful, though as yet but little understood, method of
quency treatment depends on the more perfect de
mineralization of the blood and lymph in consequence
of a stimulation of the renal excretion ; while others,
again , consider that it is due to a direct nervous influence
on the vaso-dilator centres.
Anyone may easily convince himself that there is
some such influence, by allowing the effluve from the
resonator to play on his own epigastrium. A sensation
of warmth and glow, such as is caused by a dose of
alcohol, is speedily succeeded by a gentle perspiration
and a general feeling of bien -être.
This experiment- viz., that of allowing the effluve
to play on the vicinity of the solar plexus—is, however,
not without danger, if too intense or of too long dura
tion . It cannot be too firmly impressed on those who
administer high - frequency treatment that the effluve
should, as a rule, be used only on the joints or ex
tremities, and that a dangerous fall of blood-pressure
may result if used over the abdomen in patients suffering
from circulatory disturbances.
It may be that we shall be able to tune the high
stimulation frequency of the various nervous centres
one frequency, for instance, stimulating a certain definite
nerve-centre, and that centre only, while a slightly
different note may result in inhibition of the same
centre.
At the present time, authorities in all countries are
influencing lymph circulation and regulating blood
pressure.
There is another aspect of the case which may here
after receive fuller development - i.e ., the local action of
a shower of high-tension sparks or effluves. This is of
undoubted efficacy in chronic effusion into the joints and
21-2
150 ARCHIVES OF THE ROENTGEN RAY .
in the treatment of many skin diseases. The treatment
seems to cause a more or less permanent and localized
hyperæmia of the part, and this, as is proved by the
results of Bier's hyperæmia treatment, is of itself curative
in many morbid conditions.
ROYAL SOCIETY OF MEDICINE .
ELECTRO - THERAPEUTICAL SECTION.
The first meeting of this section was held at 20, Hanover
Square, W. , on Friday, July 12, 1907 , at 8.30 p.m.
Dr. H. Lewis Jones was appointed chairman .
On the motion of the chairman, Drs. Deane Butcher
and A. H. Pirie were appointed scrutineers.
The election of officers then took place, and resulted
in the unanimous election of those suggested by the
Committee of Reference appointed by the late British
Electro-therapeutic Society as follows :
List of Officers.
President : W. Deane Butcher , M.R.C.S. Vice-Presi
dents : Samuel Sloan, M.D. ; Archibald D. Reid ,
M.R.C.S .; H. Lewis Jones, M.D. Council : W. Iron
side Bruce, M.D.; A. Stanley Green, M.B. (Lincoln ) ;
W. S. Haughton , M.D. (Dublin ) ; G. Harrison Orton ,
M.D.; A. Howard Pirie, M.D.; G. Alpress Simmons ,
M.D .; W. F. Somerville, M.D. (Glasgow ); James Taylor ,
M.R.C.S. ( Bristol) ; Dawson Turner, M.D. Representa
tive for the Editorial Committee : H. Lewis Jones, M.D.
Representative for the Library Committee : H. Lewis
Jones, M.D. Honorary Secretary : Reginald Morton , M.D.
Dr. Lewis Jones then vacated the chair in favour of
Mr. W. Deane Butcher, the newly elected President, who
warmly thanked the members present for the honour
done him in electing him as the first President of the
new section ,
It was proposed by Dr. Donald Baynes, seconded by
Mr. A. D. Reid, that the by-laws suggested by the Com
mittee of Reference, copies of which were distributed
among the members present, be adopted. Carried
unanimously .
Dr. Lewis Jones then moved that the secretary be
instructed to call a meeting of the section during October.
This was carried.
The first ordinary meeting of the section was fixed for
Friday, October 25 , at 8.30 p.m.
There being no further business, the meeting then
adjourned.
ORTHO-ROENTGENOGRAPHY.
By Dr. FRANZ M. GROEDEL, Bad -Nauheim .
ONE of the most important and interesting duties of the
Roentgenologist is the ascertaining of the true form , size,
and position of the internal organs during life, and the
control and verification of the classical method of percus
sion, the only one hitherto available for this purpose.
The Roentgen radiations as ordinarily used are not
adapted for this particular purpose . They have the dis
advantage common to all divergent rays, that the shadow
they throw is a magnified one. The degree of magnifica
tion is increased in proportion to the nearness of the
object to the anticathode, and the distance of the plane
of projection from the object. Moreover, the form of the
silhouette will depend on the position of the source of
radiation with regard to the centre of the object. In
Fig. 1 the first diagram illustrates central projection, and
the second parallel projection.
IS
с
AR
A.
S
B.
Fig. 1. - DIAGRAM OF MODES OF PROJECTION.
A, Central projection ; B, parallel projection .
It is true that we may compare the size of objects by
using central projection, provided always the two objects
are compared under exactly similar conditions. In
practice, however, this is hardly ever possible.
From the very early days of Roentgen diagnosis,
various methods were proposed in order to obtain
parallel projection of the internal organs, and thus meet
the requirements of the physician. All these methods
are founded on the principle of projecting the outline of
 ARCHIVES OF THE
the internal organ point by point by means of the
Roentgen rays, and tracing out the contour thus deter-
mined. For this purpose any one pencil of rays would
suffice. In practice that particular pencil of rays is
chosen which is most easily defined — viz., the pencil of
rays which falls vertically on the plane of projection.
We may either lead this normal ray round the circum-
ference of the organ to be projected , or the outline of the
organ itself may be brought into the path of the normal
no
Fic : 2.- VERTICAL ORTHODIAGRAPH .
ray by moving the patient. This latter procedure is,
however, much less convenient.
Rosenfeld was the first to introduce a method of
measurement in which a lead plate was fixed in front of
the Roentgen tube. The edge of the shadow of this
plate was made to coincide with the margin of the organ
to be measured. The patient was then displaced till the
shadow of the organ was just hidden by the lead plate.
The diameter of the organ was then easily estimated by
measuring the displacement of the patient.
ROENTGEN RAY . 151
A similar method was introduced by Payne.?
shadow in this case was that of a stretched wire inter
posed between the patient and the fluorescent screen .
Later on Levy -Dorn had the happy idea of making a
small aperture in the fluorescent screen at the point of
incidence of the normal ray. He passed a pencil through
this hole, and thus traced the outline of the organ on the
skin of the patient .
These and other similar methods did not, however,
meet all the requirements of the case . It is to Moritz
that we are indebted for the orthogonal or parallel
Roentgen projection of the heart, as well as for the
apparatus adapted for that purpose . The orthodiagraph,
as he called the apparatus, consists of a table covered
with sail-cloth, on which the patient lies. Passing freely
over the table is a framework movable only in a longi
tudinal direction. This carries another horizontal frame,
movable on rollers, in a transverse direction. In this
frame is fixed the fluorescent screen . In the centre of
 152 ARCHIVES OF THE
the screen is an aperture through which the pencil is
passed so as to make the necessary outline on the
patient's body. The focus-tube is placed under the table,
and is supported on a rod parallel to the fluorescent
screen .
The whole forms a sort of cage, freely movable
both longitudinally and transversely, which encircles the
table and bears the focus -tube at one end and the
fluorescent screen at the other. Any motion of this
framework thus moves tube and screen equally. The
focus- tube is so adjusted that the pencil of rays which
falls perpendicularly on the fluorescent screen shall pass
through the small aperture in its centre. If now we
6
А.
W
K
61 F
2 Z.H.
al
ம்
Fig . 3. - PLAN OF THE VERTICAL ORTHODIAGRAPH .
move the screen and focus- lube together so that a fixed
mark, the hole in the screen for instance, passes con-
tinuously around the circumference of the heart shadow,
this outline will always be illuminated by rays of equal
penetration, and parallel to one another for every posi-
tion of the screen. We may now trace the track of the
index -mark on the breast of the patient, or on a card
placed upon it, and in this way we shall obtain a parallel
projection of the heart itself. This, then , was the first
procedure employed for obtaining a true orthodiagram of A, which carries the two parallel rods, a and an. One of
the heart.
I will not linger on the description of this method as
designed by Moritz, or dwell upon the imperfections
of his apparatus. I need only note that the absolutely placement of the chariot, W, while at the same time they
ROENTGEN RAY.
horizontal position necessitated by Moritz's apparatus is
very badly borne by patients suffering from heart disease.
It is on all accounts much better to carry out the
Roentgen examination of the heart with the patient in a
standing or a sitting posture.
THE ORTHODIAGRAPH.
The next step was the construction of an apparatus
devised for taking an orthodiagram with the patient in
an erect posture. Among the many types designed, that
of Levy - Dorn was the only one that fulfilled the neces
sary requirements. The followiug description is that of
SF
H
R.
BL
Z.L B.
IL
IZ
z's.
P
this instrument as made by Messrs. Reiniger, Gebbert,
and Schall, of Erlangen , with the modifications designed
by myself. 9
Fig. 2 shows the general appearance of the apparatus ,
and Fig. 3 is a sketch of the instrument as seen from
above.
The instrument rests on a heavy iron foot, F. This
supports the coulisse, K , in which the chariot, W, moves
backwards and forwards. This latter supports the axle,
these rods, a, bears the focus-tube, R, while the other, an,
supports the fluorescent screen, The focus -tube and the
screen are borne equally to the right or left by the dis
 ARCHIVES OF THE ROENTGEN RAY . 153

may both partake of an equal movement in a circular heart during respiration. The principal objection, how
path about the axis, A. The focus -tube and the screen ever, was the impossibility of tracing a true projection
are thus freely movable in all directions, but are com- of the heart on the uneven surface of the chest, distorted
pelled to move in unison . The focus-tube is balanced by as it is by the curvature of the walls and the projection
a movable weight, G, and the screen is balanced by a of the breasts. To obviate this the tracing had to be
similar weight, G. If these are properly adjusted, the copied on a flat plane. The methods introduced for this
whole can be moved with the greatest ease. purpose by Moritz , Albers -Schönberg,11 and others, were
For parallel projection it is necessary , as we have said, not free from disadvantages, and were far from being
to use one, and only one, definite pencil of rays. For convenient.
this purpose we choose the ray which falls perpendicu- The next step was to introduce a tracing - board,
larly on the plane of projection. This so -called " normal transparent to X rays, between the fluorescent screen
ray ” is the one that throws no elongated shadow of a
rod , such as a pencil, held normally to the plane of pro
jection—i.e. , the shadow seen is a mere circular spot.
We adjust the focus-tube, R, so that the distance of its
focus from the axis, A, is equal to the distance of the
centre of the screen, Z, from the same axis. The screen
should be perpendicular to a line joining its centre to the
focus. With these adjustments the focus- tube is said to
be properly “ centred ," and the “ normal ray," ZS, coin
cides with the line joining the focus of the tube to the
index mark, Z.
I have recently devised an adjustable support for the
Roentgen-tube, which greatly facilitates the process of
centring.10
Fig . 4. –TRESTLE FOR ATTACHING THE Focus TUBE TO ORTHO
The focus- tube rests on a little trestle, of such a height DIAGRAPH .

that the centre of the anticathode is in every instance

exactly the same-- viz., 13 centimetres from the base of and the patient, and to trace the outline directly on this.
the trestle (Fig. 4 ) . The base of this trestle, the “ foot ” Although many of the above-mentioned disadvantages
of the focus- tube, as we may call it, slides in a groove in were thus avoided , another difficulty was introduced, viz. ,
the carrier itself. A mark is engraved on this foot, verti- that of seeing and placing on the drawing the necessary
cally under the centre of the anticathode, and thus topographical details. The middle line of the body was in
13 centimetres from it. Another line is engraved on some cases marked by means of a leaden wire, in order
the carrier itself, through a point vertically under the These methods were,
to render it visible on the screen .
centre of the diaphragm , which is also adjusted at however, not very satisfactory. Franke 12 introduced a
134 centimetres from the base. If now the two lines are geometric construction , while Albers- Schönberg 13 con
brought into juxtaposition, the focus- tube is properly trived a very practical device for the purpose . Both of
centred with regard to the diaphragm . The tube is these, however, were too complicated for general use..
shown adjusted in Fig. 4. I have found this method of All these disadvantages are avoided by my improved
support very convenient , both for centring the tube and orthodiagraph . I have transferred the pencil , S, to a
for exchanging one tube for another — a matter which is position in rear of the focus -tube, in a direction coincident
often of great importance in practice . with the prolongation of the " normal ray,” Zs. In this
In the earlier forms the path of the indicator mark, Z, position the pencil follows exactly the displacement of
was traced by means of a pencil inserted through an the indicator, Z. The drawing-board, SF, is behind the
At first the tracing focus-tube, and is always placed parallel to the movable
aperture in the fluorescent screen.
was made on the chest of the patient. This, however, rods, a and az: The path of the indicator, Z, can thus be
introduced many sources of error. For one thing, the traced on the drawing-board by repeated strokes of a
wall of the chest alters its position with regard to the mechanical pen, S, which is driven by air -pressure from
154
ARCHIVES OF THE ROENTGEN RAY.

an indiarubber ball, P. The pen is supplied with ink fixing of the inscribing pencil once for all in the exact line
from a small reservoir. The point can be rapidly changed of the " normal ray,” and in rear of the patient. Moreover,
to draw different kinds of signs, such as points, circles, the placing of the screen behind the focus -tube enables us
to draw the outline of the body and the points of orienta
tion at the same time as the orthodiagram . For this the
fluorescent screen is fastened to the rod ay by means of
a bayonet- joint, B, so that it may be easily removed and
replaced by an arm terminating in a short tube, which
is adjusted so that its axis coincides with the “ normal
ray. ” This tube carries a pointer, which is thus also
held in the direction of the “ normal ray," but which can
be pushed backwards and forwards in the tube (Fig. 5).
The whole system is easily movable by placing the hand
on this pointer, and the normal mark can thus be brought
vertically over any desired point.
FIG . 5. - POINTER . If now this pointer is brought over some point of
orientation, such as the nipple, this may be marked on
broken lines, etc. In tracing an orthodiagram I use a the orthodiagraphic tracing without further trouble, and
small screen with as indicator a dark spot only 2} milli- in this way we may obtain a complete picture of the part
metres in diameter, instead of the comparatively large to be examined, projected on the drawing-board in the
aperture of the earlier instruments. If, on the other same way as the orthodiagram .

Fig. 6. -COMPRESSION-SCREEN ADJUSTABLE IN THE DIRECTION OF THE NORMAL RAY.

hand, I desire to mark the outline directly on the skin, By means of this instrument a true parallel skiagram
I may use a fluorescent screen with an aperture, or I of a tumour may be obtained. In the same way the
may use a second pneumatic pencil, driven by the same percussion figure obtained in the usual manner may be
air-ball, and thus get a simultaneous diagram on the skin transferred to a plane surface.
and on the board. The especial advantage of the above In order to obtain a sharp image, the use of a
disposition is its exactitude, in consequence of the great diaphragm is of great importance. In my apparatus
reduction in the size of the indicator, from some 10 milli- the diaphragm screen is made large enough to protect
metres to 2} millimetres. Another great advantage is the the operator from the impact of the X rays. The
 ARCHIVES OF THE ROENTGEN RAY . 155

aperture of the diaphragm can be altered at will by the patient's body and the fuorescent screen . In this
means of different slides with tubular attachments. new arrangement the supporting rod a, is made with a
When necessary, the area of illumination of the small massive end, with a rectangular hole through it which
fluorescent screen, which is only 10 centimetres in slides along the axis, A. In this way the screen may be
diameter, may be still further diminished. brought close up to the patient's body. In addition to
In order to increase the shadow contrast, on which the this I have made the fluorescent screen itself capable of

06

Fig. 7. - APPARATUS FOR TAKING A VERTICAL ORTHODIAGRAM.

clearness of the orthodiagram so much depends, I have
introduced another adjustment. It is well known that
the Roentgen rays, after issuing from the patient's body,
produce secondary Roentgen rays during their passage
through the air. It is, therefore, advisable to reduce as
much as possible the thickness of the air layer between
adjustment in the direction of the normal ray. Fig. 6
shows this arrangement. The screen is supported by
two short rods which slide easily in tubular sleeves.
By this means the fluorescent screen may be moved for
short distance in the direction of the “ normal ray,” so as
to bring it into contact with the patient's skin, and even
22
156 ARCHIVES OF THE
exercise some pressure in case of necessity. I designed
this “ compression screen " more especially for use in the
orthodiagraphy of the stomach,16 but it is equally con-
venient for making an orthodiagram of the heart.
I have already said that the use of my adjusting tube-
holder dispenses with the necessity of further centring
15
Fig. 8. - ARRANGEMENT FOR TAKING A VERTICAL ORTHODIAGRAM WHEN THE PATIENT IS SITTING .
the focus -tube, since the tube is, as it were, centred auto-
matically. Since, however, the supports are liable to get
slightly bent or strained by use, some method of centring
is required from time to time as a means of control .
The focus -tube, the diaphragm , and the pencil form &
single whole , and their relative positions always remain
ROENTGEN RAY.
unaltered. It may be, however, that the indicating mark,
Z, is not in its true position on the “ normal ray," in
which case it must be adjusted afresh. For this purpose
a diaphragm of very small aperture is used. The index
mark, Z ( Fig. 3), is then brought into the centre of the
illuminated circle by adjusting the height of the screen
by the screw ZH, and its horizontal position by the
screw ZS.
A still better method is to place in position the tube
which supports the tracing pointer. In the place of the
pointer is inserted a tube, closed at one end by a tiny
fluorescent disc , about 1 centimetre in diameter . If the
 ARCHIVES OF THE ROENTGEN RAY . 157

tube is not properly centred — i.e ., not in the direction of the aid of a foot-rest at the bottom of the frame, the
the normal ray—the fluorescent disc will not be uniformly patient may easily be brought into a horizontal
illuminated, but will show a crescent- shaped shadow. position.
BIBLIOGRAPHY.
The position of the screen must then be readjusted until
1 Rosenfeld : “ Die Diagnostik innerer Krankheiten mittels Röntgen
the whole surface of the disc is uniformly illuminated . strahlen ." 1. F. Bergmann, Wiesbaden , 1897.
I will now proceed to describe an apparatus which 2. Payne : ARCHIVES OF THE ROENTGEN Ray, vol. ii. , Nos. 3 and 4.
3
Levy -Dorn : “ Zur Untersuchung des Herzens mit Röntgen
does not properly belong to the orthodiagraph itself, but strahlen .” Kongress firinnere Medizin , Karlsbad , 1899.
4 Moritz : “ Eine Methode um beim Röntgenverfahren aus dem
is nevertheless a very important accessory—that is, the Schattenbild eines Gegenstandes dessen wahre Grösse zu ermitteln
arrangement for the fixation of the patient. (Orthodiagraphie ), und die exacte Bestimmung der Herzgrösse nach
Hitherto there has been great difficulty in fixing the diesem
29 .
Verfahren, ” Münchener medizinische Wochenschrift, 1900, No.

patient in a vertical position while taking an ortho Deutsches5 Moritz : “ Methodisches und Technisches zur Orthodiagraphie,"
Archiv für klinische Medizin , Band 81 .
diagram . The cushions of Albers- Schönberg, the shoulder- 6 Moritz : “ Ueber Veränderungen in der Form, Grösse und Lage des
Herzens beim Uebergang aus horizontaler in vertikale Körperstellung , "
support of Moritz, and the straps of Franke were equally etc., Deutsches Archiv für klinische Medizin , Band 82.
ineffective. I use a couple of large light feather pillows, 7 Levy- Dorn : “ Ein neues orthodiagraphisches Zeichenstativ,"
Fortschritte auf dem Gebiet der Röntgenstrahlen, Band 8 .
some 400 square centimetres in size, which embrace the 8 Groedel Ill.: “ Eine neue Zeichen vorrichtung und einige Ver
chest. These are fastened to a frame which is covered besserungen am Orthodiagraphen .” XXIII. Kongress für innere
Medizin , Munich, 1906.
with sail-cloth. The patient leans against the sail-cloth 9 Groedel III . : “ Zur Ausgestaltung der Orthodiagraphie,” Münch
ener medizinische Wochenschrift, 1906, No. 17.
10 Groedel III . : “ Ein selbstzentrierender Röntgenrohrenhalter,"
Fortschritte auf dem Gebiet der Röntgenstrahlen , XI.
11 Albers-Schönberg : “ Die Röntgentechnik ,” p. 383 . Lucas
Grafe und Sillem , Hamburg, 1906.
12 Franke : “ Die Orthodiagraphie. ” T. F. Lehmann, Munich,
1906.
13 Albers- Schönberg : “ Uebertragung der Körpermittellinie und der
Mammillen auf eine vom Körper unabhangige Zeichenebene,” Fort
schritte auf dem Gebiet der Röntgenstrahlen, 1906 , No. 3.
14 Groedel III. : “ Vorrichtung zur direkten und gemeinsamen
Aufzeichnung der Orientierungspunkte des Körpers auf eine ebene
Fläche.” II. Röntgenkongress, Berlin , 1906.
15 Groedel III. : “ Die Magenorthodiagraphie.” III. Röntgenkon
gress, Berlin , 1907 .
16 Groedel III. : “ Vorrichtung zur Ruhigstellung des Patienten
während der Orthodiagrammaufnahme im Stehen, Sitzen und Liegen ."
XXIII. Kongress für innere Medizin , Munich, 1906.
17 Immelmann : “ Ueber die Orthophotographie des Herzens,”
Berliner klinische Wochenschrift, 1905, No. 19.
Fig. 9. - SAGITTAL ORTHODIAGRAM . 18 Albers-Schönberg: " Eine neue Methode der Orthodiagraphie .”
II. Röntgenkongress, Berlin , 1906 .
V. I. = Fifth intercostal space. 19 Kohler : “ Technik der Herzstellung für orthodiagraphischer
Herzphotogramme, ” Wiener klinische Rundschau, 1905 , No. 16.
the cushions are drawn round the body between the ( To be continued .)
upper arm and the chest, and fastened.16 By this means
the patient has a sensation of restful support, and the
examination is in nowise hindered. For patients who
THE EINTHOVEN GALVANOMETER . *
are very ill the sitting posture is more convenient and
less fatiguing. For these cases the same apparatus is By Professor J. K. A. WERTHEIM SALOMONSON ,
applicable with the addition of a chair-rest. Of late I Amsterdam ,
have taken all my orthodiagrams of the heart with the ( For Illustrations see Plates CCLXXVII. and CCLXXVIII .)
patient in a sitting posture.
In certain cases, and more especially in order to study Some years ago Einthoven of Leyden invented & galvano
alterations in the position of the organ , an orthodiagram meter of marvellous sensitiveness and great simplicity.
has to be taken with the patient in a horizontal posture. A thin wire through which passes a galvanic current is
My orthodiagraph is equally applicable in this position. stretched in a strong magnetic field. As soon as the
The orthodiagraph must be reversed, after loosening the current is switched on, the wire sags in a direction
clamp which keeps it in position, and the fixation -frame perpendicular to the magnetic lines of force. This dis
may be used as a table for supporting the patient. By * Read before the British Medical Association at Exeter, August, 1907.
22—2
158 ARCHIVES OF THE ROENTGEN RAY .

placement may conveniently be observed by means of a plate and the sensitiveness of the galvanometer are so
microscope. By using a very strong magnetic field of adjusted as to give a simple value to the distance of the
some 20,000 Gauss, and by taking an exceedingly thin vertical and the horizontal co-ordinates.
silvered quartz fibre, a sensitiveness of one billionth part The Einthoven galvanometer has proved to be an
of an ampère may be obtained . The sensitiveness may exceedingly useful instrument for the study of the
be varied within very wide limits by altering the tension current curves in the primary of induction coils.
of the stretched wire . Perhaps its most interesting use, however, is in the pro
The instrument possesses some qualities which render duction of the electro-cardiogram .
it exceedingly interesting. One of these peculiarities is I would first draw your attention to a few plates
that it can be arranged to show correctly the instantaneous which show the influence of the condenser on the
value of any current, as little as one hundredth part of a primary current ( Figs. 4 to 9) . The negatives have all
micro-ampère, even if the changes of the current are as been taken with a uniform velocity of 200 millimetres
frequent as 100 times a second. If the sensitivity per second .
be reduced about ten times, current changes lasting Fig. 4 is the oscillograph of the primary current in a
one thousandth part of a second may be observed . The 12-inch coil with mechanical break when no condenser is
movements of the wire can easily be photographed. used . The next three oscillographs show the change of
Einthoven's instrument is somewhat comparable with current due to the introduction of condensers of various
Abraham's, Blondel's, and Duddell's oscillographs , but it capacities. In Fig. 5 the condenser introduced was
is from one thousand to ten thousand times more too small to give the best results, being only some
sensitive. 0 ·005 microfarad . In Fig. 6 the condenser, 2:65 micro
The instrument which I have had constructed for farads, was too large , as is shown by the oscillations at
myself differs somewhat from Einthoven's model. He the point of break . The period of these oscillations is
uses a single electro-magnet with perforated pole-pieces. 596 per second, which agrees perfectly with the actual
I use two electro -magnets in the form of nearly closed primary conductance of the coil, which amounted to
rings. The quartz fibre is placed in the two gaps ; its 0-0275 Henry
tension may be varied by a suitable micrometer mechanism . Fig. 7 shows the form of current obtained when the
The microscope is placed between the two magnets. condenser has been properly adjusted. You will notice
Fig. 1 represents the actual instrument after removal of that the time of break is shorter than in any of the
the case. The two electro-magnets are fixed together by others. In this instance the capacity of the condenser
means of four copper bars, leaving a narrow slit for the was 0.2 microfarad.
fibre. The quartz fibre is supported on the string -bolder The next two illustrations show the influence of the
(Fig. 2), which has micrometer movements for centering it. secondary on the primary current. Fig. 8 shows the
The image of the string, which may be 1 to 3 microns influence of secondary sparking on the primary current.
in diameter, is enlarged about 500 times, and projected The knobs were so arranged that sparks of 5 centimetres
on a screen or on the slit in front of the photographic passed with a maximum current capable of giving
plate. An arc lamp of about 5 ampères is used for 30 centimetre sparks.
illuminating the string. The photographic record is Fig. 9 shows the influence of a secondary capacity
taken by a special apparatus. The photographic plate connected to the secondary terminals. Three Leyden
of 6 by 18 centimetres, enclosed in a double bag, is jars, with a total capacity of 0.00583 microfarad , were
attached to a vertical frame, suspended in a flat vertical used. No sparks occurred. We notice oscillations with
box (Fig. 3). This box has a slit through which the a period of about 185 per second . From this we may
light enters. The plate and its carrier fall by their own calculate the secondary inductance at 126 Henry.
weight. This movement is controlled by a hydraulic If an oscillograph be taken under the same circum
brake, thus producing a perfectly smooth and regular stances, but with sparks across the gap, we find that
descent. The velocity can be altered by a tap to any the influence of the latter is to lessen the induced oscil
required amount, from 1 to 500 millimetres per second. lations, but it cannot stop them .
Horizontal and vertical co - ordinates are inscribed on The next illustrations ( Figs. 10 to 12) show the action
the plate by Garten's method. The movement of the of the Wehnelt break on the primary current. In
 ARCHIVES OF THE ROENTGEN RAY . 159

Fig. 10 we had a large resistance in the primary, and a millivolt . Still larger values are nearly always due to 1

frequency of about thirteen interruptions per second. a pathologically strong contraction, such as may be
In Fig. 11 there was no extra resistance in the observed after a heart-block or after vagus stimulation .
primary, and the frequency was 200 per second, whilst The downward deflections, Q and S, are in most normal
in Fig. 12 there was a small resistance and a frequency cases hardly beneath the zero - line, though sometimes
of about 60 per second. The thin white lines on this potential differences of 0.7 millivolt have been observed ,
figure are due to secondary sparks occurring at the point without anything of a pathological kind to account for
when the current begins to diminish, before it is com- it. They represent a rapidly passing electro-positive
pletely broken . state of the heart-apex—a condition in which this gives
The next two illustrations show condenser discharges. off negative electrons.
The velocity of the plate for these was 500 millimetres Fig. 17 is the cardiogram of a man with a normal
per second . heart, but an habitually slow pulse of only 45 to 60 per
Fig. 13 is a condenser discharge through a large minute. At the moment of taking the electro -cardiogram
resistance. The discharge is a periodic. the frequency amounted to 60 per minute. The Speak
In Fig. 14 the condenser is discharged through induct- is strongly developed. The slowness is due to a lengthen
ance and resistance adjusted so as to obtain a “ critical" ing of the post-diastolic pause .
discharge; this is the quickest discharge that is possible Fig . 19 belongs to a case of chronic endocarditis with
with a given capacity and self-induction . mitral incompetence acquired by a patient of over forty
More interesting is the use of the galvanometer for years of age. When the electro -cardiogram was taken
the recording of electro -cardiograms. In the case of a slight compensating hypertrophy began to show itself.
muscular contraction, each contraction causes a so-called The character of the electro -cardiogram itself is not
action current . The heart also gives an action current notably changed ; only the tops are greatly noticed, and
with every beat. These currents may be detected either more specially the R top. But this occurs also in
a
by means of a capillary electrometer, as Waller has healthy individuals, and may not be regarded as
discovered, or better by an Einthoven galvanometer. pathological sign.
Either both hands or one hand and one foot are con- Fig. 20 shows a slightly irregular pulse in a case of
nected to the terminals of the galvanometer by means an epileptic woman with a complicated valvular disease.
of unpolarizable electrodes of special construction . The mitral valve was incompetent, and the aorta slightly
Generally a small current of rest has to be compensated, dilated. A marked hypertrophy of the left ventricle was
in order to bring the enlarged image of the quartz fibre present. On this curve the extreme height of R is
into the middle of the field of vision . We then obtain noticeable. The P.D. amounts to 2 millivolts .
oscillations of the spot synchronous with the heart- Fig. 21 is a case of Graves' disease, whilst Fig. 22 is
beat. We may now adjust the sensitiveness of the the cardiogram of a patient suffering from compression
galvanometer so as to give a deflection of 10 millimetres of the brain and stimulation of the vagus. There was a
for every millivolt ; we arrange the velocity of the plate slow pulse, showing irregularities.
at 25 millimetres a second, and thus we are able to I hope that these few examples chosen from many
record the electro -cardiogram . interesting types will suffice to show you of what value
The normal cardiogram (Figs. 15 and 16) shows this instrument may prove in the diagnosis and treat
five peaks, named by Einthoven P, Q, R, S, T. The ment of all irregularities in the condition or function of
first one belongs to the auricle contraction , the others the heart.
to the left and right ventricle together. The peak R ,
generally the highest and sharpest, seems to be caused
principally, if not entirely, by the contraction of the left
ventricle, whereas the last summit, T, probably belongs We much regret that by an error the author of the
to the right ventricle. article on “ The Use and Abuse of Skiagraphy in Frac
The absolute value of the maximum excursions of the tures and Dislocations " in our last number was printed
curve differs greatly in different healthy individuals. as John Goland , F.R.C.S. , instead of John Poland ,
R may represent a difference of potential of 0.5 to 1.5 F.R.C.S.
160 ARCHIVES OF THE ROENTGEN RAY.

ON THE TECHNIQUE OF ROENTGEN BURNS AND number of patients for various affections of the face.
THE MEANS OF DETERMINING THE INTEN- At that time I employed the primitive method. In all
SITY OF IRRADIATION . * these cases I used one and the same focus-tube . It was
not regulable, and when first used it fluoresced brilliantly,
By Dr. R. KIENBOCK, Vienna .
gave out a suitable quantity of X rays, and the patients
ACCIDENTAL burning by the Roentgen rays most frequently soon began to show the desired reaction. This , how
occurs after their use for therapeutic purposes. This ever , was not sufficiently intense, and the séances were
was more especially noticeable in the early days of radio- continued for some time . Not only was there no pro
therapy, when there was as yet no method of measuring gress in the reaction , but , to my surprise, the effect
the intensity of the irradiation.The usual method was decreased . By March, 1900, some of the patients had
to follow Schiff and Freund and limit the treatment to had as many as eighty irradiations. The tube had
a series of very feeble irradiations. Hard tubes were meanwhile become gradually harder, until finally,
chosen, and these were driven by a small current, so that instead of fluorescence and X rays , it only gave an
there was very little fluorescence. The distance from electric brush or spark discharge. At this stage the
the anticathode to the skin was comparatively great, tube was cracked by a spark , and I continued the
something like 20 centimetres, and the exposure seldom irradiations with a Müller regulable tube. This tube
exceeded ten minutes. These weak exposures required was driven by a fairly strong current, fluoresced brightly,
to be repeated every day, and in the treatment of and gave intense Roentgen rays of medium softness.
hypertrichosis or any disease of the hair they were After a short use the anticathode would become red
repeated daily until signs of erythema or depilation hot.
appeared. This, the so-called “ primitive method , " was Not quite a fortnight after the change of tube, all the
generally followed by satisfactory results, and is still patients showed signs of inflammation . The irradiations
employed by a large number of radiotherapists. were , of course , discontinued at once ; but it was too
Such a procedure had , however, several disadvantages. late, and the inflammation proceeded to excoriation .
It was a distinctly slipshod method . If all went well, Many other radiotherapists have reported precisely
you gave about twenty séances, but very often these similar cases of overexposure after a change to a new
produced no effect, and you were obliged to continue the focus- tube. It is a typical cause of accidental burns in
treatment much longer. Now and then you might even radiotherapy From various experiments , as well as
give one hundred séances without any result. This was from a close observation of several cases treated in 1900,
usually ascribed to some idiosyncrasy of the patient, but I have convinced myself that it is the X rays themselves
the true reason was that the individual irradiations that are the active therapeutic agents and the cause of
were too feeble to have any effect. dermatitis, and that a strong tube giving medium hard
A still more unpleasant surprise was when, after daily rays is the most active source. The fine brush discharge,
séances for three weeks or even less, instead of the etc. , coming from the surface of the tube or from the
expected slight temporary reaction, you got severe inflam- leads has no action whatever on the skin.
mation. This , again, was ascribed to idiosyncrasy of These facts lead me to adopt a new procedure, which
the patient, whereas, as I hope to show later, the true I advocate in all cases : medium hard tubes with a very
cause was that one or more of the irradiations had been strong current , few séances, and long intervals between
too intense . them . A second series of irradiations should only be
In 1899 much discussion on the subject led to the given after waiting several weeks, or after the complete
dictum on the part of many therapists that the X rays disappearance of all reaction.
were not the true-or at any rate not the only-active Instead of a short series I soon proceeded to give
agent in this treatment. They held that the electric the whole dose in a single sitting—a complete séance
discharge from the active focus-tube was the chief, if not and my endeavour was to adjust this so as to give
the sole, factor of importance. exactly the amount of irradiation required for my
In the autumn of 1899 I commenced to treat a purpose. After numberless experiences it became clear
* Communicated to the Third Congress of the German Roentgen to me that the sensitiveness of the skin to X rays, its
Society . ralio-sensibility, was an approximately constant quantity
 10
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TO ILLUSTRATE ARTICLE ON THE EINTHOVEN GALVANOMETER ( p. 157).

By PROFESSOR J. K. A. WERTHEIM SALOMONSON .
Plate CCLXXVIII .
(“ Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
163
 ARCHIVES OF THE ROENTGEN RAY. 165

and only varied within narrow limits. We could thus of my law of the approximate constancy of the radio
speak of an average normal dose - i.e., the quantity of sensibility of the skin. The doctrine of normal doses
irradiation usually required to cause epilation and was generally received , and the more rapid treatment
erythema, with a latent period of two weeks. This dose by measured massive doses began to replace the primi
is suitable for most purposes, and is used in the treat- tive method .
ment of many skin affections, such as lupus and favus. My average normal dose is the “ maximal dose " of
The dose will have to be somewhat altered to suit the Sabouraud and Noiré, and is equal to 5 H in Holz
particular individual and the purpose for which it is knecht's units or 10 X of the quantimeter.
employed. Thus, we may prescribe half-doses or double It has now been ascertained that erythema, excoria
doses, according to the age and bodily condition of the tion, and ulceration doses are roughly in the ratio of
patient and the part of the body to be treated, since 1 : 2 : 4. With medium sensitiveness — as, for example,
some parts are more sensitive than others. on the skin of the face —the required doses would be
The next difficulty was to ensure giving the prescribed 10 X , 20 X , and 40 X.
normal dose. Attempts were made to measure the dose Experiment with the quantimeter shows how easy it
by placing the patient always at the same distance, and is to err in the estimation of equal doses on consecutive
estimating the intensity of the irradiation by the appear- days, especially when & different tube is used.
ance of the tube. With care and practice, and by using with the greatest care and when a milliampère is
always the same instrument and keeping as many introduced into the secondary circuit, the differences
factors as possible constant, especially the condition of may be as much as 1 : 4-i.e., there may be an error of
the focus-tube, it was often found possible to do this, as 400 per cent., enough to convert an erythema dose into
was proved by the appearance of the erythema at the one causing severe burning. For this reason , when
expected moment. giving a powerful therapeutic irradiation we should in
This estimation would , however, fail now and then, variably use a dosimeter.
and the exposure would either be too feeble or else it The great value of Sabouraud and Noiré's instrument
would be too intense and result in severe dermatitis.is well shown by our experience in the radiological
Even the most experienced radiotherapi sts would now department of the Vienna Allgemeine Polyklinik in 1906.
and then produce blistering and excoriation, and even In that year 1,300 therapeutic irradiations were given,
occasional ulceration . This is less to be wondered at in all of which the radiometer was used . In three
when we remember that the irradiation is totally unfelt quarters of these cases the normal dose (the brown tint
at the time, and that there are neither subjective nor of the scale) was given, the quantimeter readings being
objective symptoms present to indicate when the correct from 6 X to 14 X. In the remaining cases the dose
dose is being exceeded. The estimation of the irradiation given was less than the normal dose. In only 4 out of
is merely approximate ; in the case of a new tube no the 1,300 cases did we get blistering or excoriation lasting
estimation at all is possible. Further, a tube does not several weeks, and all these cases were on areas of the
remain constant, but if not continually regulated it skin which had been irradiated before. In the other
becomes harder or softer during the exposure, giving out cases treated with a full dose, over 1,000 in number, the
varying quantities of energy. reaction never exceeded slight erythema, and as a rule
Holzknecht was the first to recognize this great need , there was no inflammatory reaction, although in all
and to attempt to supply it by the invention of his cases where there was hair on the area treated we got
chromoradiometer in 1902. Some years later Sabouraud complete depilation. This experience not only shows
and Noiré constructed their radiometer, and these two the reliability of the instrument used for measuring the
instruments are now in constant use for measuring the dose, but it also proves conclusively the non-existence
quantity of X rays. The author's quantimeter is for of any idiosyncrasy as to sensitiveness to the rays.
the same purpose, but it has been designed rather as a It would seem advisable here to consider for a
subsidiary permanent record of the dose given than as moment the conception of the superficial activity of the
a substitute for one of these so -called " open " dosi- Roentgen rays , or, as I prefer to call it, the surface
meters . energy E. This quantity is not only of interest from a
The use of a dosimeter soon demonstrated the truth scientific point of view, but is of practical use for deter
23
166 ARCHIVES OF THE ROENTGEN RAY.

mining beforehand the time which will be required to the indications of the milliamperemeter. With a medium
give a definite dose of the rays when the tube is working hard tube, about 5 on Benoist's scale, and with an
steadily. The total energy or total activity of an interruptor dipping about ten times per second, one
irradiation depends jointly on the intensity and on the tenth of a milliampere in the secondary circuit will give
penetrating power of the rays. But as we are generally rays having the unit value for E. Under such conditions,
concerned only with the surface dose -- i.e., the quantity then, the number of deci-milliampères will indicate the
of irradiation absorbed by the skin and superficial tissues, E value of the tube. We must, however, bear in mind
—it is more important for our purpose to know the that this instrument only gives the intensity of the
surface energy. This quantity will be directly propor- current in the secondary curcuit, and not the quantity of
tional to the intensity I, and inversely proportional to rays, and that this current depends on the potential in
the primary, and also on the resistance in the focus-tube.
the penetration P. E or, if A be the absorption of It will thus vary with the hardness of the tube , and
the rays used , E = IA. one-tenth of a milliampère (1 DMA) will therefore in
The surface dose will also depend on the distance of dicate less irradiation with a soft tube than that required
the source of the rays from the surface irradiated-the to give the same reading when the tube is barder. This
focus distance, as it is sometimes called and on T, the use of the milliampere is therefore impracticable unless
time of exposure . R, the intensity at a distance we know the hardness of the tube employed.
E
F from the anticathode, = and therefore the dose If the resistances in the circuit be properly determined,
F2 '
ET the reading of the milliampère will itself give an indica
D tion of the hardness of the tube. Thus, in a certain
F2
If, when exposed for one minute at a distance of installation the passage of 2 DMA indicates that the
5 centimetres, we get an irradiation of 1 X or 0.1 S- N tube is of medium hardness, whilst 1 DMA means &
1 E 5 E 10 E

35
1 X 5 X

20
10 X 1 X 5X 10 X 1X 5X 10 X

10 cm .
20 40 10 cm . 1 4 8 10 cm . 2 4

14 cm . 8 14 cm .
40 80 2 8 16 14 cm . 1 4 8

20 cm . 16 80 160 20 cm. 3+ 16 32 20 cm. 2 8

16
30 cm. 36 180 360 30 cm . 7+ 36 72 30 cm . 3+ 18 36

maximal dose, we say that the rays are of unit
surface energy. Since, for convenience of measuring, we
thus make the unit distance 5 centimetres instead of
1 centimetre, we must, when substituting numerical
values in the above formula, remember always to
measure the length F in 5-centimetre lengths and not corresponding to different values of F and T.
in centimetres. To take a concrete example. Let the
surface energy of the tube be 10 E (i.e. , at 5 centimetres
distance it gives 10 X per minute) , let the focus distance
be 20 centimetres ( = 4x5 centimetres), and the time of
exposure eight minutes. Then the dose will be given by
D=
10 x8
5 X.
4X4
The value of E for any given tube when in use can
only be determined indirectly, by irradiating a dosimeter
for a given time, at a ertain distance from the anti-
cathode. We can also get an idea of its magnitude from
hard tube and 4 DMA a very soft one. Of course, these
values have to be determined for each individual installa
tion , and the method is of no use if there be much
back- current with a soft tube. For most installations,
however, we can construct tables which give the dose
The
above are three such minute tables which give the
time required to obtain the required dose at different
distances with tubes giving rays of intensities 1 E, 5 E,
and 10 E.
We see from the second table that, with a 5 E tube
and a focus distance of 15 centimetres, the times required
to get respectively a mild erythema, excoriation, and
dermatitis - i.e ., 10 X, 20 X , and 40 X - are sixteen,
thirty- two, and sixty-four minutes.
With the knowledge thus obtained I can now get some
idea of what must have been the intensity of the irradia
 ARCHIVES OF THE ROENTGEN RAY . 167

tion used by me in March, 1900, when, as I have fact that the constant dabbling in photographic chemicals
recounted above, all the irradiations given during one probably renders the skin less resistant and more easily
week resulted in excoriation, if not in ulceration. From affected by the action of light.
the record of the current used, and the hardness and
16 Minutes.
condition of the tube—it was before the introduction of
the milliamperemeter -- the rays used must have been
E cm . X
between 3 E and 5 E. In one case inflammation
was set up on either side of the face after thirteen lo 50 0.016
irradiations, each of ten minutes' duration , the distance
10 20 0: 1
from the anticathode to the skin being 15 centimetres.
1 20 1
This gives a total irradiation of 130 minutes on each
cheek, which with a surface energy of 3 E to 5 E is 5 20 5
equivalent to a dose of 43 X to 72 X , a quantity more 5 14 10
than suflicient to produce burning.
10 14 20
The time of exposure required for a given dose, of
course, depends on the intensity and on the distance 10 10 40
from the source of irradiation. Personally I prefer to 10 7 80
work with a focus distance of 16 centimetres, at which
distance my apparatus takes fifty minutes to give a dose
of 10 X. I prefer this to a more rapid treatment at The third source of Roentgen ulcerations is the
closer range, since the slower the increase, the easier it constant exposure to the rays of certain persons who are
is to control the dose. frequently irradiated for demonstration purposes. These
Even at the present day it is still the custom with may be the exhibitors or manufacturers of focus-tubes
many observers to record merely the time of exposure or X - ray installations, who adopt this method of showing
and the distance of the tube from the skin, and perhaps their apparatus ; or they may be patients whose case is of
some rough indication of the kind of rays used , such as interest from the diagnostic point of view, and who are
" medium hard .” They give no indication of the radius of therefore repeatedly examined by the rays for the purpose
the tube, though variations in this may make the differ- of study or of demonstration .
ence between 12 and 16 centimetres in the focus dis- In the early days of radiography we occasionally
lance ; neither do they mention whether the tubes were heard of ulceration caused by too long an exposure when
giving a strong irradiation - say 6 E, or merely some making a skiagram . Such an occurrence is very rare
2 E. With an irradiation of twenty minutes the first now, and can only happen when the operator is very
combination, 12 centimetres and 6 E, would give a dose inexperienced. I will give a short account of two
of 20 X, whilst the second combination would only give typical cases of such overexposure , which may perhaps
4 X. The great variations which can exist in the dose be of interest .
when the instructions are merely an exposure of
CASE 1 : Ulceration due to Radiographic Overexposure of the
sixteen minutes' duration " are clearly shown in the Shoulder.—The patient was a workman, aged thirty -three, who
accompanying table. on May 5 and 6, 1905, was examined at a hospital with a view
Besides the burns accidentally caused during a thera- to detecting a possible luxation of the right shoulder. Five or
peutic irradiation, there are a second group of Roentgen six radiograms were taken, with the plate behind and the focus
tube in front of the shoulder. The focus distance was first 25
ulcerations—those occurring on the hands of physicians and later 15 centimetres, and the exposures varied in length. On
and others working much with the rays. These are due May 11 pigmentation of the skin of the shoulder appeared , and
to the constant exposure of the hands to the rays when there was a good deal of itching. This increased until the
holding the patient or the diaphragm in position, or shoulder was almost black in colour, and a week later an ulcera
whilst manipulating the osmo-regulator or other adjuncts tion appeared, which was about 5 centimetres in diameter. The
pain was severe, especially before the abscess broke. No fever
of a tube used for radiotherapy, and even using the was recorded, but the ulceration persisted until the end of July.
radioscopic image of the hand to ascertain whether the It was treated with lunar caustic and ointments.
tube is of the requisite hardness. To this we may add the On December 4 the patient came under our care at the Poly
23—2
168 ARCHIVES OF THE
clinic for a fresh examination of the shoulder. The skin on the
front of the shoulder was altered in aspect over an almost
circular area some 15 centimetres in diameter, extending from the
clavicula to 3 centimetres below the axillary fold , and reaching
to the nipple line. The boundary was for the most part sharply
marked, but it faded gradually over the deltoid. The skin was
of a deep -brown colour, but there were two distinct lighter-
coloured stripes, which evidently marked where the diaphragm
had been displaced during an irradiation. The skin was very
dry, with formation of scales and a good deal of irritation.
Towards the middle of the patch the skin was irregularly
speckled, consisting of very sinall dark brown spots interspersed
with white ones. Within this was a region of a diffuse pale-red
colour, whilst a portion the size of a bean in the very centre
was of a deep crimson. The pigmented and depigmented
patches also extended into the hyperemic portion. The rest of
the breast was thickly covered with hair, but the whole of the
affected area was quite bare. The right axilla was also strongly
pigmented.
CASE 2 : Ulceration of the Abdomen due to Radiographic
Overexposure. — The subject was & dark - haired mechanic,
twenty -three years old, strong and well-built, who had never had
a serious illness, and who came of healthy parents. In the
summer of 1897 he was in a German factory where, in order to
test a new type of instrument, a series of radiographs of the
lower thoracic spine were taken. Within six days three such
exposures were made, the total time being about seventy -eight
minutes. The anticathode was placed at a distance of about
18 centimetres from the skin of the abdomen , and the tube was
a soft one, giving out copious rays. A motor break was used ;
the coil had a spark of from 25 to 30 centimetres, and the current
of 65 volts was obtained from a dynamo driven by a motor.
Ten days after the first irradiation a violent burning of the
skin of the abdomen appeared. There was a good deal of redness,
as in sunburn or a scald. In spite of applications of aqua plumbi,
the upper cutaneous layer soon rose in a large blister, which
sloughed in the region which had been most strongly irradi-
ated. The inflamed area was some 25 centimetres in diameter,
and in spite of applications of zinc ointment there was much
weeping, followed later by suppuration. The pain was intense,
and the patient was confined to his bed. It was not until six
months later, after repeated treatment with lunar caustic, that
the wound began to heal, the improvement starting at the
periphery, and gradually advancing towards the centre. A year
after the accident the new skin had just covered the whole
surface.
Eight years later the skin is still altered over an area of
14 centimetres by 21 centimetres. The centre is pale pink,
almost white, tender and shining, with here and there larger or
smaller specks of pigmentation and red patches. The outer
margin is finely veined with deep red. The skin is easily broken ;
even the mere rubbing of the clothes causes temporary sores.
Codman examined 167 cases of radiodermatitis, 71 of
which were of the third degree, and came to the con-
clusion that intense inflammation was indeed due to
idiosyncrasy. He, however, holds that there will never
ROENTGEN RAY .
be inflammation if a certain combination of distance and
time of exposure be not exceeded. This “safe exposure "
he gives as eighteen minutes' séance with the tube at a
distance of 6 inches, or seventy-two minutes at 12 inches.
Assuming that the tubes used are as a rule small,
he makes no distinction between the distance of the
anticathode and the distance of the wall of the tube, but
merely states the latter. By thus giving a definite safe
exposure, Codman, although he himself fails to notice
the fact, shows that this so-called idiosyncrasy is strictly
limited. We shall not be surprised that such an ex
posure is always innocuous if we turn once more to our
exposure tables. Fifteen centimetres from the wall of
the tube means at least 20 centimetres from the anti
cathode, so that even if the energy of the tube were
10 E the dose in eighteen minutes would never exceed
11 X, which is at most sufficient to produce some slight
erythema.
Freund states that he has never obtained dermatitis
with his usual dose of fifteen minutes' exposure at
20 centimetres distance . In therapeutic treatment he
advises the commencing with small test irradiations in
order that any idiosyncrasy may show itself in time.
This is an unnecessary precaution, since even his full
dose, fifteen minutes at 20 centimetres, is not sufficient
to produce erythema even with a very powerful tube, as
he himself acknowledges.
Most of the radiographic overexposures were made
whilst irradiating thick portions of the body which are
difficult to show up properly—such as the lower portion
of the trunk for the examination of the hip or the spine.
In many cases the exposure had first been made with
a hard tube, since the soft rays would not penetrate to
the photographic plate at all. The resulting skiagram
would now be poor and lacking in contrast, and the
exposure would therefore be repeated in the hope that
with a stronger current and a longer and closer irradiation
a better picture might be obtained. The result would be
overexposure of the skin, resulting too often in dermatitis.
The practised radiographer, on the other hand, begins
with amedium hard tube, and increases the sharpness of
his skiagram by using & diaphragm , thus avoiding all
danger of overexposure .
This circumstance, that burning usually occurs with
a certain class of irradiations —i.e. , when taking a skia
gram of a thick part of the body - points to the probability
that, at any rate in the majority of cases, overexposure,
and not idiosyncrasy, is the cause of the evil. We
 ARCHIVES OF THE ROENTGEN RAY. 169

have already, in the earlier part of this article , given being in the temporal region . She complained also of
several arguments against the existence of this idio- pain in the left side of the tongue.
syncrasy, and we hope to be able to show that the other On October 18 the first irradiation was given. A hard
cases of dermatitis recorded are due to the same cause. tube was used at a distance of 12 inches from the left
On the trunk we may consider 16 X to be the normal or side of the face, and the whole surface was irradiated . The
erythema dose, and 64 X the dermatitis dose. In the duration of the sittings was five minutes. On November 3,
cases described by Crocker, Deutschlander, Février, and after eight sittings, the patient expressed herself as some
Gross, and also in the second case quoted above, we find what relieved, the interval between the attacks being
that this larger dose was given, if we suppose that the longer and the spasms of shorter duration. She was
strength of the tube was 10 E, a not unusual value for also sleeping better. Four more applications were given,
a powerful installation. In other cases recorded , notably the last one being in the third week of December, after
those of Sorel, Bronson , Destot, Gassman, and Drury, which all treatment was discarded. At this time a
the dermatitis dose would have been exceeded even if further slight improvement was noted , although the
the tube were no more than from 2 E to 4 E , since in patient was by no means free from pain . On March 5
those cases the tube was placed extremely close to she wrote as follows : “ The improvement with me has
the skin, or else the time of exposure was very prolonged. been very gradual, and I am not quite sure of myself
These considerations lead us to the true explanation of yet, as the pain returns now and then pretty sharply.
the phenomenon , and the idiosyncrasy of Codman and I may say that for over a month now I have felt a
others appears to be in reality no more than an incomplete difference."
realization of the extreme variability of the intensity of On July 15 she again wrote : "Since the beginning of
the X rays obtained from different tubes. February there has been a marked improvement, and
now and then a threatening only. The attack has often
left me with a cold, numb feeling in my cheek and jaw,
but without any actual pain ."
A CASE OF EPILEPTIFORM NEURALGIA TREATED I think it may be fairly claimed that the X rays had
WITH X RAYS .
the effect of removing the pain in this case. Prior to
their application the patient had suffered untold agony,
By ALEXANDER GREGOR, M.D. and every remedy had been tried . All drugs had failed ,
as well as spa treatment and galvanism ; in fact, the
The subject of this paper was a lady, aged sixty-two, pain was so persistent that an eminent London physician
who came under my care in October, 1906. She first advised the removal of the Gasserian ganglion.
complained of pain in the left side of the jaw fifteen I do not claim that the X rays have cured the patient
years ago ; the pain was then put down to toothache, of her distressing malady ; the interval of time is too
and a tooth was extracted. The attacks continued at short to speak with such decision ; but to have obtained
intervals for seven years, but they were not very severe. immunity, even for a period of six months, is surely quite
She had her first severe attack in 1899 ; this soon passed sufficient to justify one in applying X rays to all cases of
off; but since 1904 the attacks have lasted longer and epileptiform neuralgia which resist drug treatment. This
have been more severe . In that year she first felt pain simple method of relief, even if only temporary, is much
in the left side of the tongue. She was then under treat- to be preferred to the dangerous operation of removal of
ment for two months, when many drugs were tried with but the Gasserian ganglion , an operation which in its ultimate
little benefit. Matters gradually went from bad to worse results often leaves much to be desired .
until a year before she came under my own observation. The only case I can find recorded of X - ray treatment
During this time the patient suffered agony, the spasms in epileptiform neuralgia is by Béclère and Haret at the
being very frequent—ten to twelve in the twenty-four Société Médicale des Hôpitaux of Paris on May 4 , 1906 .
hours. Each spasm lasted from four to five minutes. Their patient had had the Gasserian and superior cervical
and there was a dull aching in the intervals. The pain ganglia removed, but the pain had returned after a short
originated seemingly in the jaw, and rapidly radiated interval. X-ray treatment gave complete relief for twelve
over the whole side of the face, the maximum of intensity months . The treatment in the case here recorded differs
170 ARCHIVES OF THE ROENTGEN RAY.

from theirs, in the fact that they irradiated the painful tion. Now, hyperæmia plays here a peculiar rôle. It
alveolar region directly through the mouth, whilst in our is, in fact, the first stage of inflammation. This hyper
case the rays passed through the cheek first. æmia, which we thought was directly due to the cold, is
distinctly venous and of a deep blue-red. This venous
hyperæmia , which is certainly not injurious, depended , it
was thought, on congestion.
THE ORIGIN OF FROST - BITE , AND ITS TREATMENT The first occasion of doubt in my mind arose in the
BY ARTIFICIAL HYPERÆMIA .
case of a boy with ulcers due to frost-bite on his fingers.
Translated and Condensed from the German of Professor I was at that time Bier's assistant, and busy with
Dr. CARL RITTER numerous investigations regarding stauung hyperæmia,*
and among other things was trying to treat tuberculosis
By JAMES BURNET, M.A. , M.D., M.R.C.P.E.
by this method. I ligatured the youth's upper arm , and
Many years ago I contributed to the Deutsche Zeitschrift so produced a very intense hyperæmia of the whole limb.
für Chirurgie a short article on a new treatment of frost- The ulcers themselves were covered with antiseptic
bite by artificial hyperæmia. I thought that this con gauze. Within ten to fourteen days the ulcers were
tribution would be sufficient to stimulate others to try it. completely scarred over. Surely this was a reason for
Nevertheless, up to the present it seems to me that the supposing that hyperæmia does not play a harmful rôle
procedure has been but seldom practised. This treat- in cases of frost-bite, as had previously been maintained.
ment is in direct opposition to the formerly supposed I increased the venous hyperæmia in cases of frost - bite
origin and mode of combating frost-bite. Previously the by means of a stauungs -ligature. Instead of producing
number of my successful cases was but small. In my any disadvantageous action , it resulted in a rapid cure of
first article I had only twelve at my disposal. In 1903, the frost-bite. This artificial hyperæmia was always
however, I had completed a record of between fifty and most efficacious. In anamic patients I only obtained a
sixty cases. I think it right, therefore, that I should pale stauung, like that which Bier has named ædema.
once more publish my results, seeing that I am now in It proved quite inefficacious. In such anæmic patients,
a position to turn to account quite a magnificent series however, I have obtained very good results by applying
of cases. Moreover, I think that I can now set aside hot air so as to produce an arterial hyperæmia. In a
and refute the objections and doubts which were once very short time all appearance of disease disappeared.
raised against the treatment. My observations (over 150 in all) have given certain
Remedies against frost-bite are like the sand on the quite definite results. In the first place the symptoms
seashore. Hanusa has collected a great number of them , of frost-bite, as well as the venous hyperæmia present,
and they fill many pages of his work . Still, the enumera
are not harmful, but rather useful. If that be so, how
tion is by no means complete. The great number of ever, then it is also impossible that the hyperäunia is
cures is but a sign that the remedies for the most part go a direct result of cold. I do not, therefore, place it in the
for nothing. In fact, the verdict on the results of the same category as necrosis, which is produced at once by
therapeutics of frost- bite is to-day much as it was when the cold. I have made the assertion that the hyperæmia
Rust wrote in 1834 : “ The immense number of remedies
present in cases of frost-bite, be it arterial or venous,
which are employed against this malady proves that it has the same origin and the same purpose in view. The
defies treatment, and frequently returns every winter in object is to protect the tissues injured by frost with a
defiance of all remedies ;" or, as Lassar asserted in 1902 : greater supply of blood, and to promote regeneration of
“ We have to deplore that experience and science afford the part. Venous hyperæmia is a weak attempt on the
us such very modest help .” It is a difficult matter to part of the body, arterial hyperæmia a stronger-in
bring all these remedies under one point of view, since fact, often too energetic -- and so the difference between
they are evidently for the most part quite empirical. them is only one of degree. Accordingly, it is of service
One can only say that these various remedies all aim to increase this natural means of cure on the part of the
at alleviating the symptoms. Inflammation under all body itself in cases of frost-bite. It seems to me that
circumstances is regarded as injurious, and cure is only Congestion hyperæmia ” fairly well expresses the meaningof this
possible when we can combat the symptoms of inflamma- term.-J. B.
 ARCHIVES OF THE ROENTGEN RAY . 171

credence has not been put in my teaching. In the newer frozen parts are first rendered bright red, then the
text-books, it is true, arterial hyperæmia is finding favour extremities especially become a deep blue -red colour, and
with critics, but stauung, as a remedy in cases of frost- often remain a blackish blue. At first the affected limb
bite, is either plainly declined or else generally not men- itself becomes hot, bright red , and swollen. In my
tioned at all. earlier cases I merely covered the frost -bitten parts with
I must, therefore, go once more deeper into the antiseptic gauze. A moist dressing more powerfully
subject . I said already that earlier writers always assists the action of the hyperæmia. The effect of stau
regarded venous hyperæmia as a congestive phenomenon. ung on the frost-bitten parts is always favourable. I
Such an idea, however, does not appear to me correct, have never seen a bad result .
since in cases of frost-bite and of all chronic inflamma- The existing cicatrices never burst open afresh even if,
tions and swellings the veins in the overlying skin are as so often happens, they are quite full of venous blood.
so slightly filled and distended. In fact, I cannot Moreover, the blebs often show hæmorrhagic contents,
acknowledge that congestion is the origin of the venous but these soon dry up and the crusts become loosened .
hyperæmia present in frost-bite. Experiment proves it The base of the ulcers becomes cleaner and the granula
to have quite a different origin . The action of cold does tion tissue becomes more luxuriant. Soon a line of
not generally produce hyperæmia except in cases of demarcation appears in the gangrenous parts. The
anæmia. I have been able to prove, by means of ulcers, little by little, show well-marked softening and
numerous experiments, that this law holds good for resorption . Very rapidly, and often in a moment, the
every inflammatory hyperæmia. Without a preceding pain disappears. How that comes about I need not
injury to the tissues (that is, necrosis in the widest enter into more fully here. More important, however, is
sense of the term ) there is generally no hyperæmia. I the relief of the itching from which all patients suffer.
cannot go deeper into the question. Those interested To me it appears remarkable how it should disappear so
in the subject should study my work entitled “ The rapidly, and how it should remain away for a long time.
Origin of Inflammatory Hyperæmia." For the sake of comparison we have experimented with
The cases of frost-bite which I have treated by means other remedies. In a case of frost-bite affecting both
of hyperæmia number over 150. Those who made use hands, we have tried stauung on the one side and
of the stauung method formed only the smaller pro- tincture of iodine on the other. The result was much
portion . This was naturally so , because after being in favour of the former. The pain and itching did not
often frost-bitten these patients become so anæmic that disappear when iodine was used, but did so immediately
it is not possible to produce a hyperæmia. In general , with the stauung method. Especially is this method of
I am able to assert that stauung hyperæmia is specially treatment quite a definite remedy against itching. I
suited to acute cases and to the chronic varieties of have tried artificial hyperæmia in skin diseases, and have
frost -bite, except in cases where the patient is too obtained good results. Moreover, the disappearance of
weakly. Regarding the technique, I recommend a itching under stauung hyperæmia is quite patent.
hyperæmia of not too short duration. I advise a dura- Then comes another observation. Frost-bitten people
tion of six to twelve hours per day, and at first at are true barometers . They perceive sudden changes in
night as well, but with an interval of at least two the weather very accurately beforehand, and always
hours . I have already, in my first communication , suffer in consequence. By means of artificial hyperæmia
mentioned a case in which the stauung treatment was this power is taken away, and the pain which was felt is
carried out while the patient was at work. Since then I forgotten. Here, also, artificial hyperæmia displays a
have had additional cases of a similar kind . The advan- beneficial action .
tage is that the patient can carry on with impunity the Although the limb is mostly enlarged by swelling
same work in which he contracted frost-bite, without through the influence of stauung treatment, its mobility
suffering any further trouble ; and therefore the proce- is often actually increased. The stiffness is evidently
dure is the most rapid, in many cases surpassing hot-air due to a kind of muscular rigidity which the cold with
treatment. Best of all, however, is hyperæmia produced its attendant anæmia produces, and which is lost when
by strong heat, by means of which ædema makes its the parts are flushed with blood. Habs has also obtained
appearance: By this form of stauung hyperæmia the quite satisfactory results with stauung therapy. During
172 ARCHIVES OF THE ROENTGEN RAY .

two years he treated thus all cases of acute frost-bite of the hot-air treatment is of no avail is not to be wondered
the first and second degree, and observed within a few One has here to proceed energetically , and I do not
days complete healing and cicatrization . avoid a slight degree of burning. I am careful, however,
With regard to the hot-air treatment of cases, I need at the start, and allow daily only a short séance. As a
not go into the pathological and physiological occur- rule, from a half to one hour is sufficient, and in some
rences , as was necessary in speaking of the stauung cases only ten to fifteen minutes is to be recommended.
therapy, in order to show that the proposed treatment The treatment is continued for from three to fourteen
therewith is not absurd , but quite authentic. Such a days. My longest case lasted five and a half weeks.
discussion is unnecessary, inasmuch as it appears self- While the limbs are treated in a case, I employ, for the
evident that heat is useful as a remedy against cold. frozen ears a tube with a funnel-shaped expansion.
This contention, however, is not altogether right. Hot After the hot -air treatment, I advise, as I have already
air cannot be used with impunity in all cases of frost- done in my first work on the subject, a cold douche or
bite . Hot air is specially suitable for chronic cases. friction with a quite cold , damp towel. By these means
It is, on the contrary, unsuitable for quite acute cases, the ulcers heal rapidly. Deep -seated and indolent ulcers
in which one may even get failures from such treat- show in a very few days granulations on their surface.
ment. The ædematous swelling disappears usually after one or
I must also lay stress on the finding of Statzer, who two days' treatment. While hot air is very often superior
recommends this remedy very highly. His publication to stauung hyperæmia in accelerating absorption, the
is a confirmation of my observations which I very much influence of stauung on the itching, pain, and burning
desired to have. I have experimented many times for sensation is more marked and striking. Still, the disap
the sake of comparison with hot water, massage, tincture pearance of pain and itching is rapid also after the use of
of iodine, and other remedies ; but hot air greatly sur- hot air.
passes all of these. I consider it the best remedy, In particular, we must not forget that hyperæmia can
especially in chronic cases of frost- bite. I cannot agree
be produced in quite a variety of ways. Not every
with Lassar when he speaks of “ our up till now so physician and patient have at their disposal a bot-air
feeble and modest aids to treatment in cases of chronicapparatus ; and one can in many cases employ other
frost-bite ” (“ Therapie d . Gegenwart,” 1902). Lassar remedies, such as massage , friction with snow, and
then goes on to speak of certain movements of the tincture of iodine. The effectiveness of all these remedies,
affected limbs as a remedy. This remedy is certainly however, lies in the hyperæmia produced , not, as one
not altogether ineffectual if the movements are carried formerly thought, in the remedies themselves. It is
out vigorously, as I myself have proved ; but the effect of considerable importance that we have many remedies
soon passes off, and cannot in general be compared with wherewith to produce hyperæmia. In this way we are
the action of hot air. Lassar has evidently not em- able to graduate the treatment ; but the arterial
ployed hot air - at any rate , he does not mention it. hyperæmia produced by hot air acts most powerfully
If hot air is to be effectual its influence must be very and most quickly.
intense. Frost-bitten patients, however, at the be- In conclusion , I must not omit to warn against the
ginning are extraordinarily sensitive to heat. It has application of hyperæmia-producing methods in cases of
frequently happened to me that patients have anxiously universal frost-bite. We have to deal here with con
sought to withdraw their hand from the hot - air ditions which are quite different from those of a local
apparatus, or to break off the séance after only a quarter frost- bite. In such a case life itself is threatened, and the
of an hour's duration. When the hand is taken out of combating of the local condition is a quite secondary
the apparatus it is pale, and not red. That in this way matter.
 ARCHIVES OF THE
Notes and Abstracts.
ELECTRO-THERAPY .
Copper Ions in the Treatment of Suppurating Sinuses
and Infected Wounds. Dr. L. E. Whitney of Carthage, Mo.
( Journal of Advanced Therapeutics, August, 1907 ), relates two
cases as follows :
CASE I.-A middle-aged farmer requested treatment for sup
purating sinus that had remained after an appendisectomy. For
nearly two years, notwithstanding daily irrigations of peroxide,
carbolic, etc., with frequent curetting and packings with
antiseptic gauze, it had persistently refused to heal. An un.
covered copper wire electrode of the calibre of a No. 16 F sound,
insulated for 4 or 5 inches at the base, was introduced to the
bottom of the canal, a distance of 8} inches, and from 25 to
40 milliampères current was given for twenty minutes. This
was followed by a close packing of iodoform gauze, and
repeated every day. From the first treatment there was a
marked change in the character and quantity of pus, and after
the tenth treatment he returned with the dressings perfectly
dry, and showed no response to the peroxide test. After as
many more treatments , given at longer intervals with progres
sively smaller electrodes, the smallest one at hand, about the
size of an ordinary silver probe, failed to find any opening, and
his troubles were at an end .
CASE II.-A young man who had lost the third joint of his
thumb, presumably while being chased by the representatives
of the law, presented himself a week later with the stump in a
gangrenous condition .
After cleansing it, a cup electrode was fashioned of thin sheet
copper to fit over the stump, and for fifteen minutes , while the
patient was dancing a large and assorted variety of jigs, a
current of 15 milliainpères was passed. Upon removal of the
electrode the offending surface was found perfectly odourless,
and as green as a June lawn. A dry antiseptic dressing was
applied, and the patient instructed to return for a second
application in two days. He did not present himself for four
days, but at that time, upon removal of the dressings, the wound
was found in such ideal condition that it was simply redressed, and
without further treatment the healing was rapid and complete .
PROTECTION .
Protection of the Physician and Patient against Injury
from Roentgen and Radium Rays (Münchener Medizinische
Wochenschrift, September 10, 1907).-Dessauer, in this article,
refers to the fact that he has already tried to represent truly
the dangers to doctor and patient of the Roentgen rays, and
how far we ought to speak of these risks. This work was
addressed to educated laymen , and served a double purpose. It
upset the exaggerated notions which are often held regarding
Roentgen -ray diagnosis and treatment, and gave the correct
position which the specially trained physician should take up with
regard to this mode of therapeutics. In the present article,
however, Dessauer takes up another question -- namely, the
means of protecting doctor and patient from risk in actual
practice. By this means he hopes to prove that the science of
the Roentgen rays, when used in a rational manner, is not only
ROENTGEN RAY. 173
å pleasing, but at the same time an absolutely safe, mode of
treatment. The risk is somewhat greater for the patient who
is undergoing treatment. It is necessary to measure exactly
the amount of the rays employed. Bordier's chromoradiometer,
or that of Sabouraud and Noiré, are useful instruments for this
purpose. In order to protect the parts to which the rays are
applied, two methods are at our disposal. We may cover over
the parts with materials which allow the rays to penetrate very
slowly, or we may use a tube which is made of lead-glass or of
metal, and allows only a small number of rays to pass through,
so that the healthy parts are not affected, but only the diseased
portion .
Equally important, however, is the protection of the physician
himself. He is constantly exposed to risks, whereas the patient
only comes under the influence of the rays once or, at most, a
few times. Chronic dermatitis is a risk which has always to be
kept in mind, as it is such a troublesome affection . More
particularly the physician should not expose his own hands or
his body to the influence of the rays when he is demonstrating
his apparatus to friends, or when he is testing the quality of the
rays. When the physician is working with unprotected tubes
we should never forget for a single moment that the whole
field of his investigations has now become an area of dangerous
rays. When the diffusely reflected rays— in other words, the
secondary rays — especially force their way out, everything in
the experimental room, the air, the floor, and the ceiling,
become harmful exits for these dangerous secondary rays.
Against these protection must be obtained . The writer then
goes on to describe the method to be employed in protecting the
physician from the harmful influence of the Roentgen rays.
In examining the thorax and abdomen we must cover up the
parts with large plates which are impenetrable, and leave only
the field of observation free. He warns particularly against the
use of impenetrable gloves. The latter are either heavy or
allow the rays to penetrate. A very useful mode of protection
is afforded by the protecting apron, which is made of a special
elastic material . To protect the eyes lead-glass spectacles
should be worn. It is unadvisable ever to use unprotected tubes
without screens. We can say with precision that the cautious,
practical physician, knowing as he does the risks, is to -day able
to avoid injuring himself by a little foresight on his own part.
The writer expresses the hope that those who have already
received injuries from the use of the Roentgen rays will become
lifelong workers after reading what he has written .
RADIO-THERAPY.
Favourable Influence of the X Rays in Chronic Bronchial
Affections. Schilling (Münchener Medizinische Wochen .
schrift) had occasion to examine a patient with a severe bron
chial asthma, and used the X ray to determine the condition of
the pulmonary organs . The patient found that his asthmatic
condition was very favourably influenced by the X -ray examina
tion. The improvement was so marked as to induce Schilling
to apply the X rays in a systematic manner in a large number
of cases of bronchial asthma and chronic bronchitis. He
24
174 ARCHIVES OF THE ROENTGEN RAY.
tabulates the results as determined by the amount of sputum
raised before and after treatment. In one case this decreased
from 150 c.c. to 80 c.c. in three days after the X - ray exposure .
Another patient had been coughing and expectorating for
months. The day before treatment the sputum amounted to
170 c.c., the day following to 140 c.c.; it had decreased to 40 c.c.
by the sixteenth day, and expectoration had ceased entirely by the
end of the fifth week. In every instance the amount of sputum
dropped nearly one-half after the exposure, and progressively
declined thereafter. Every patient was favourably influenced,
and the improvement or the complete cessation of the expec-
toration and the asthma persisted for months. He suggests as
explanation of the unmistakable and prompt benefit derived
that possibly the proliferating cells of the microscopic glands in
the bronchi react to the rays similarly to the effect observed in
the X-ray treatment of hypertrophied prostate, lymphoma, and
goitre, etc. The extreme permeability of the lungs for the
X rays aid in the process. The patients were seated, and the
exposures were made in two to four different directions, chosen
so as to get to the lungs with the least muscular resistance.
Protection was used for parts not to be treated , and the exposures
lasted from ten to twenty minutes, the distance of tube being
15 centimetres. The total of the exposure was kept below the
maximal dose, and only a single sitting was given. Schilling,
however , in spite of the unmistakable relief from excessive
bronchial secretions and from the tormenting asthma, reserves
his opinion in regard to the therapeutic value of X rays in the
treatment of bronchial affections until he can speak from a
larger experience.
Leukæmia treated by the Roentgen Rays. Pancoast
( Univ. Penn. Bulletin, vol. xix. , No. 11, quoted by Interstate
Med . Jour.) finds records of 63 cases of leukæmia treated by the
X ray. Of these, only 4, or 6:35 per cent. , were still alive three to
six years after the primary symptomatic cure. In 39, or over
70 per cent., of those who died, or who were at that time in a
critical condition, there had been a marked amelioration in the
symptoms, or a symptomatic cure , as a result of the first treat
ment by the X ray. In view of these results the writer considers
that the Roentgen rays could hardly be looked upon as a specific
in this disease. In fact, the results of this treatment are not very
encouraging. Moreover, the danger attending the use of this
form of treatment should be remembered , and the evidence of
toxæmia looked for . Frequent examinations of the urine should
be made to determine the extent and rapidity of tissue destruction
and the state of the kidneys. There is, the writer maintains,
clear evidence that death has been caused or hastened by failure
to observe these points .
Action of the Roentgen Rays on Prostatic Hypertrophy.
-M . A. Guillemonat (Annales d'Électrobiologie et de Radio-
logie, February, 1907) narrates the very interesting case of a
man of sixty -five years whoin he treated for prostatic hyper-
trophy. The patient urinated with great difficulty as often as
twenty - five times a day. The writer first tried the effects of
high -frequency currents. He used the metallic electrode of
Professor Doumer, and made the applications every second day.
The séance lasted ten minutes. After six applications the
patient was not at all improved, and was much discouraged.
In fact, he wished to abandon the treatment altogether. Guille
monat then resolved to try the X rays. After a rest of eight days
he used Belot's localizing instrument, and made applications to
the perineum , at a distance of 2 or 3 centimetres from the
anus . The séances took place every second day, and lasted for
five minutes. After six séances the micturitional frequency
diminished. He had not to get up during the night at all. He
began , however, to complain of testicular pains and also of a
diminution in sexual power. The writer, therefore, made him
rest for six weeks. During this period the number of micturi.
tions varied from ten to fifteen a day ; and on rectal examination
the prostate was found to have diminished considerably in size.
A fresh series of twenty séances reduced the number of mic
turitions to eight or ten . The prostate was but slightly enlarged.
This observation is interesting, for it shows well the profound
action of the X rays in cases of this kind.
Cure of Lupus by the X Rays.-Gavazzeni ( Annales d'Élec
trobiologie et de Radiologie, February, 1907) has arrived at the
following conclusions :
1. The X rays constitute one of the most important therapeutic
agents in the cure of lupus.
2. They are more effective in lupus vulgaris than in lupus
erythematosus.
3. Of the varieties of lupus vulgaris, the form known as
lupus vegetans is the most easily and the most certainly cured
by the X rays.
4. Lupus of the nose is more amenable to this form of treat
ment than lupus of the cheeks.
5. The duration and seriousness of the process are not neces
sarily elements on which to found a grave prognosis.
6. The therapeutic management of lupus by means of the
X rays cannot be determined by any hard -and -fast rules. The
action of the rays varies according to the variety of the lupus
and the individual dealt with . The best guide is individual
experience gained from careful observation.
7. It is useful, especially in cases of deep-seated lupus, to
combine the action of the X rays with caustic applications.
INSTRUMENTATION.
The Esophagoscope ( Dr. Frese, Münchener Medizinische
Wochenschrift).- After a historical survey of the develop
ment of the @sophagoscope, the speaker gave an account
of the present position of the technique of esophagoscopy.
Like most authors, Dr. Frese has quite given up the sitting
position , and now invariably examines his patients lying on
the back, with the head hanging down. There is no doubt
that accurate cocainization of the roof of the pharynx, and of
the orifice of the esophagus, facilitates the introduction of the
tube. The speaker prefers the instrument of Killian, and finds
the nodulated bougies recommended by Starck useful.
Esophagoscopy has considerably increased our knowledge of
the normal and pathological conditions of the esophagus. It is
of great use, therapeutically, especially in the removal of foreign
bodies ,
The instrument was demonstrated on two patients, one a case
of cardio -spasm , the other a case of compression of the eso
phagus from without.
 ARCHIVES OF THE
Reviews
Les Ions et les Médications Ioniques. By Professor
STÉPHANE LEDUC. Paris : Masson et Cie.
This work is one of the series of clinical monographs
on novel subjects of medico-chirurgical interest published affections of the brain and neurasthenia, includes the
under the direction of Dr. Critzman of Paris.
Professor Leduc commences by a chapter on osmotic
pressure. Living beings, he says, are but solutions fully avoiding any asymmetric irritation of the brain.
separated by permeable membranes. Biology, medicine,
the study of life itself, is founded on an accurate know-
ledge of changes of osmotic pressure. Avogadro's law,
that equal volumes of gas at the same pressure contain
equal numbers of molecules, is supplemented by van
t'Hoff's, that equal volumes of solution at the same
osmotic pressure contain equal numbers of molecule of
the solute .
Cryoscopic investigation has shown that the osmotic
pressure of the blood is enormous, more than seven
atmospheres -- a pressure more than sufficient to account
for all the phenomena of cellular interactivity.
Professor Leduc has shown that diffusion under the
influence of osmotic pressure will reproduce the pheno-
menon of cell growth and division. Two centres of
osmotic pressure will comport themselves exactly like
the centrosomes introduced into the ovule by the sperma-
tozoa .
The author points out that all chemical action, and
therefore all toxic, antiseptic, or medicinal action , is
almost entirely an ionic process. The bactericidal and
therapeutic action of salts of mercury, for instance, is
not proportional to the strength of the solution, or even
to its molecular concentration, but depends chiefly on
the degree of ionization of the particular solution
employed.
The whole chapter on the electrolysis of the living
tissue is full of interest. The treatment of sclerosis by
electrolytic medication was introduced by the author into houses which have been contaminated.
tifteen years ago. Complete ankylosis of the articula-
tions are quickly resolved by electrolysis with a liquid
cathode consisting of a solution of chloride of sodium, if we had similar careful observations of healthy subjects
and this without massage or forced movements , and
without pain . The ankylosis disappears day by day and
the articulation recovers its former motility. Professor
Leduc reminds us that the introduction of electrolytic
ROENTGEN RAY. 175
ions into the tissues by means of an electric current
requires as many precautions as surgical asepsis.
The last chapter, on the electrolytic treatment of
author's recent researches on electric sleep. He points
out that all danger of vertigo may be obviated by care
The work has been translated by Dr. MacKenna, and
will appear almost immediately in Messrs. Rebman's list
of new publications.
Third Annual Report of the Henry Phipps Institute of
Philadelphia for the Study, Treatment, and Preven
tion of Tuberculosis.
This is an important volume of 400 pp., containing the
report of the work done at the Institute.
It is interesting to note that only about 59 per cent. of
the patients treated for tuberculosis in the institution are
native -born. The countries which send the heaviest
burden of tuberculosis to America are, in order of
sequence, Russia, Ireland, Germany, England, Austria,
and Scotland . The same order holds good for the
children born of immigrants.
The Celtic race seems to be more susceptible to
tubercle invasion than the Teutonic. Contrary to what
is usually assumed, tuberculosis is very prevalent among
Hebrews, but infrequently takes a fatal form. There
seems to be a racial immunity against the toxin of the
tubercle bacillus, but not against its growth.
The frequency with which the consumptive poor
change their residence is a menace to public health, and
the registration of consumptives is strongly urged . The
object of registration is twofold : first, to educate the
consumptive and his family ; and secondly, to protect
the uninfected from the danger of contagion from moving
The statistics on sleep, dreams, memory, etc. , are of
great interest, but their value would be much enhanced
with which to compare them .
There is a chapter of considerable value on various
micro -organisms other than the tubercle bacillus, asso
ciated with hæmoptysis, the chief of these being the
24-2
176 ARCHIVES OF THE ROENTGEN RAY.

pneumococcus, streptococcus, and a pseudo-diphtheritic
bacillus.
There is a chapter by Dr. Joseph Walsh dealing with
the relation of kidney diseases to phthisis, and the
significance of tubercle bacilli in the urine.
The authors claim that the Institute has had a dis-
tinctly favourable influence on the death -rate from tuber-
culosis of the lungs in Philadelphia. The course of
mortality during the last three years appears to bear
evidence to the truth of this assertion.
An immense amount of work has been expended on
the production of this report. The statistics alone would
be a serious matter to digest . It is a work which the
specialist in tuberculosis can in no wise afford to neglect
The production of the book , in type, printing, and
illustration, leaves nothing to be desired .

PLATES CCLXXVII . AND CCLXXVIII.

To illustrate Professor Wertheim Salomonson's article on “ The Einthoven Galvanometer."

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
TAE ARCHIVES.
He would be very much obliged if contributors would send , with any prints intended for publication, a full account of the
case, and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used , or any otherfacts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE EDITOR begs to acknowledge communications from Dr. Walter C. Oram (Liverpool ), Dr. Lester Leonard
( Philadelphia ), Dr. O. Hensler (Switzerland ), Dr. Morgan (Liverpool), Dr. Groedel (Bad Nauheim), Dr. Béla
Alexander (Hungary ).
The following Journals and Periodicals have been received : “ Advanced Therapeutics,” “ The Electrician ,"
“ The Electric Review ,” “ Knowledge,” “ The British Journal of Dermatology ,” “ Annals of Physico -therapy,"
“ Medical Times , ” “ Medical Electrology and Radiology,” “ Archives of Physiological Therapy,” “ Archives
d'Électricité Médicale,” “ Le Radium ," " Annals d'Electrobiologie et de Radiologie," " Fortschritte auf dem Gebiete
der Röntgenstrahlen,” “ Münchener Medizinische Wochenschrift," “ Zentralblatt für Physikalische Therapie,””
97

“ Annali di Elettricità Medica," “Rivista Internazionale di Terapia Fisica."

THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN Ray, care of
Messrs. Rebman Ltd. , 129 Shaftesbury Avenue, London, W.C.,” or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W.”
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration, will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view .
Annual Subscription , payable in advance, Sixteen Shillings net ( Four Dollars), including postage ; single
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L
VO . XII .
O T H

No.
I

7.
RAD HE
RZANA
ARCHIVES PL
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER , M.R.C.S., F.P.S.
IN COLLABORATION WITH
ROBERT ABBE (New York ); A. BECLERE ( Paris ) ; T. P. BEDDOES ( London ); J. BELOT ( Paris) ; F. BISSERIE ( Paris);
H. BORDIER ( Lyons ); J. BURNET ( Edinburgh ); R. HIGHAM COOPER ( London ); W. COTTON ( Bristol) ; FOVEAU DE
COURMELLES ( Paris ); L. DELHERM (Paris); R. W. FELKIN ( London );

LES PRO
L. FREUND ( Vienna ); H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
R A P Y
THE
(Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT ( Paris ) ;
D. GUNZBURG ( Antwerp ); J. HALL-EDWARDS (Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool); G. HOLZKNECHT ( Vienna ) ;
F. H. JACOB (Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris); S. LEDUC (Nantes) ;
E.R. MORTON ( London ); G. HARRISON ORTON (London ); H. G. PIFFARD ( New 07
DE

l'ork ); JNO.C.RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ); 19 .

C.

W. F. SOMERVILLE (Glasgow ); H. WALSHAM ( London ); CHISHOLM

WILLIAMS ( London ); CLARENCE WRIGHT ( London ).

CONTENTS

PAOE PAGE
ORIGINAL ARTICLES : REPORTS OF SOCIETIES :
THE FUTURE OF ELECTRICITY IN MEDICINE. —By W. ROYAL SOCIETY OF MEDICINE • 203
DEANE BUTCHER, M.R.O.S. , F.P.S. 177
Orthu -ROENTGENOGRAPHY. - By DR . FRANZ M. GROEDEL,
Bad Nauheim .
184 REVIEWS :
PLASTIC ROENTGENOGRAPHY, OR THE REPRODUCING OF LIGHT AND X.RAY TREATMENT OF SKIN DISEASES • 204
X- RAY PICTURES IN RELIEF . - By DAVID MORGAN,
M.B. 195
CORRESPONDENCE . - 205
ON THE USE OF SMALLER DOSES OF X RAYS IN RADIO.
THERAPY. —By PROFESSOR H. RIEDER, Munich 196
NOTE ON High -FREQUENCY CURRENTS IN ENURESIS. - PLATES :
By W. F. SOMERVILLE, M.D. , Glasgow · 199
PLATE CCLXXIX . -NORMAL CHEST OF A YUTH , TO
DETERMINATION OF THE QUANTITY OF X RAYS ABSORBED ROENTGEN
ILLUSTRATE THE ARTICLE ON " PLASTIC
BY THE VARIOUS TISSUES OF THE Body. —By PROFESSOR
H. BORDIER , Lyons · 199 OGRAPHY, " BY DAVID MORGAN, M.B. .
206

PLATE CCLXXX . - FRACTURE OF THE LOWER END OF THE

NOTES AND ABSTRACTS :
FEMUR, TO ILLUSTRATE THE ARTICLE ON · PLASTIC
THE X -RAY TREATMENT OF PROSTATIC ENLARGEMENT - 202
THE IMPORTANCE OF SKILLED RADIOLOGISTS 203 ROENTGENOGRAPHY , " BY DAVID MORGAN , M.B. - 206

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Vol. XII.—No. 7. DECEMBER, 1907.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY , THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER, M.R.C.S., F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York ); T. P. BEDDOES (London) ; J. BELOT (Paris) ; A. BÉCLÈRE ( Paris) ; F. BISSERIE ( Paris) ;
H. BORDIER (Lyons) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris ) ; R. W. FELKIN ( London ) ; L. FREUND (Vienna ) ; H. E. GAMLEN ( West Hartlepool) ; G. P.
GIRDWOOD ( Montreal) ; STANLEY GREEN (Lincoln) ; H. GUILLEMINOT ( Paris) ; D. GUNZBURG (Antwerp ); J. HALL - EDWARDS
( Birmingham ); G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ; F. H. JACOB (Nottingham ) ;
LEWIS JONES ( London ) ; A. C. JORDAN ( London ) ; ARCH . JUBB (Glasgow ) ; E. LAQUERRIÈRE ( Paris) ; S. LEDUC (Nantes);
E. R. MORTON ( London ) ; G. HARRISON ORTON ( London) ; H. G. PIFFARD ( New York ) ; JNO. C. RANKIN ( Belfast ) ; WERTHEIM
SALOMONSON ( Amsterdam ) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM WILLIAMS (London) ;
CLARENCE WRIGHT ( London ).
os

THE FUTURE OF ELECTRICITY IN MEDICINE . accelerated . Seldom in the evolution of a science has
such a rapid advance been made as that of Roentgen
INAUGURAL ADDRESS DELIVERED AT THE ELECTRO diagnosis and electro -therapeutic treatment during the
THERAPEUTIC SECTION OF THE ROYAL SOCIETY OF last decade .
MEDICINE ON OCTOBER 25, 1907. I propose to trace briefly the general trend of this
By W. DEANE BUTCHER , M.R.C.S. , F.P.S.,
advance, and from the direction of progress in the past,
endeavour to predict the course of its future development.
Surgeon in Charge of the Electrical Department, London Skin
Hospital. ROENTGENOGRAPHY . — And first as to Roentgenography,
or skiagraphy — the impression of the shadow of internal
GENTLEMEN,–I congratulate you on your presence here structures on a photographic plate. Marvellous as is
to -night, on what I cannot help thinking is an historic the progress since the appearance of Roentgen's original
event - the first meeting of the Electro-therapeutic pamphlet, “ Über eine neue Art von Strahlen , " we are
Section of the Royal Society of Medicine, the first still far from having attained finality in this direction .
occasion on which electrical science has been represented The Focus- TUBE. — The Roentgen tube itself is but a
in the Witenagemot of medicine. very imperfect instrument, the result more of chance
It would be wearisome to recount the past history of than of design, and far from realizing our ideal of a
electro-therapy, or to dwell on the troubles and indigni. focus- tube - a fixed and unvarying source for the emission
ties of its youth. Suffice it that the Electro-therapeutic of ethereal undulations of definite wave-length and con
Society has taken its place beside its sister societies ; stant intensity.
and it is for us, as servants and votaries of medicine, to Some such tube as this I seem to see foreshadowed ,
prove by zealous service our right to that place. an ethereal musical instrument-able to give out and
The subject of my address is “ The Future of Electricity sustain without alteration of pitch any required note of
in Medicine"—the rôle which electricity is destined to the Roentgen gamut ; able also, at the will of the operator,
play in the future development of the healing art. to run through the whole of that scale with any desired
The first record of electro-therapeutic treatment was rapidity. We require a chord of Roentgen vibrations,
in A.D. 34, when, as Scribonius Largus tells us, patients the component notes of which will in turn bring out on
suffering from rheumatism and gout were placed in a the plate the softer tissues, the muscles, the arteries,
bath containing electric eels. Up to recent times the and the bones. Something of this sort has been already
progress of medical electricity has been but a slow one, accomplished. In the latest development, the plastic
but that progress of late years has been greatly skiagraphy of Dr. Béla Alexander, a soft tube—the bass
25-2
178 ARCHIVES OF THE ROENTGEN RAY.

viol, as it were — is used in conjunction with a hard tube, them completely. So on even the most imperfect
the flute of the Roentgen orchestra. Roentgen negative there is imprinted a vast amount of
A practical advance in this direction would be the detail, which may be brought out by careful manipu
construction of a tube-holder, similar in principle to the lation.
nose-piece of a microscope, which shall hold three or PRINTING . – When the negative is developed we are
more Roentgen bulbs in such a manner that any one of still far from the end of our labours, if we would get the
them can instantly be placed in position over the very best results of which our art is capable. At the
diaphragm . By this means we should be able to switch last Berlin Congress, Dr. Béla Alexander showed how
on radiations of different penetration on the same plate details and differentiation of invisible or barely visible
during a single exposure . shadows may be reinforced by repeated copying and
It is evident that any photograph showing a large recopying of the superimposed negative and diapositive.
amount of detail and differentiation of structure must In this method, the so-called " plastic Roentgenography,”
be the product of a composite irradiation . This I believe the negative is first copied as a diapositive ; the two are
to be the explanation of the supposed superiority of long then superimposed with a very slight displacement, and
exposures in skiagraphy. Radiographers giving a long a plate made from this combination. To obtain a print
exposure are, in fact, using a tube which is gradually of this combined effect it is copied once more, and the
getting harder, and is therefore giving out rays of ever- final print is made from this fourth plate. In some of
increasing penetration . Dr. Alexander's later work every smallest detail of
THE PHOTOGRAPHIC PLATE.-- The photographic plate muscle and tendon, artery and vein , stands out with
is susceptible of as much improvement as the focus-tube. startling clearness .
The compass of the Roentgen scale may be greatly As the length of exposure becomes shorter and shorter,
extended, not only by using a more variable source, but we may expect an extension of the use of reinforcing
also by increasing the sensitiveness of the plate which plates, whereby the exceedingly brief Roentgen illumina
registers the vibrations. So the ripple-marks on the tion is prolonged by phosphorescence. The question of
seashore are dependent not only on the magnitude of screening the plate from the effects of secondary radia
the waves, but on the fineness of the sand which receives tions again is becoming of ever-increasing importance.
their impression. In Roentgenography for the detection of renal calculus
The improvement of the photographic plate offers an and the like, the results may often be improved by
inexhaustible field to the ingenuity of the inventor. The placing a sheet of aluminium or tin immediately over
present tendency seems to be to increase the thickness the photographic plate.
of the film and the density of the silver salts in the TIME OF EXPOSURE . —In the future the time of exposure
emulsion . Some operators even attempt to increase the will certainly be greatly reduced ; the lightning flash of
absorption of the rays by using two plates placed face to X rays will be allowed to act on the plate for only a frac
face. tion of a second. The enormous current necessary for
DEVELOPMENT. — The development of the plate is a this will probably be switched on and off again by a
matter of almost equal importance. It is only an expert single motion of the key, so as to prevent its passage
photographer who can obtain proficiency in the art of for a sufficient length of time to overheat the anticathode
developing the host of superimposed lights and shadows or damage the tube .
which we call a negative. The exposure of the future must be instantaneous, not
Let me explain . If I handle this piece of glass, you only with regard to the respiratory movements, but also
know that the perspiration will leave on it an almost when compared with the heart-beat. This is already
invisible impression of my finger -tips. By appropriate quite within the bounds of possibility. I recently showed
means — the use of osmic acid , photography, and the like- the skiagram of a bullet in the pericardium taken by
we may obtain a permanent record, a detailed plan and Professor Rieder of Munich. The absolutely round con
figuration , of this chance impression . All the lines of tour of the bullet shows that it was practically unmoved
the finished picture were present in the original impres- by the cardiac beat during the time of exposure.
sion , though invisible ; and any want of skill in the Those who have seen the beautiful pictures produced
handling and subsequent treatment would have obliterated by teleroentgenography-skiagraphy at a distance-will
 "-மலைமைய ன்
ARCHIVES OF THE ROENTGEN RAY . 179

காலையும்
மகாவில்
-- --
agree with me that this method has before it a great the patient's body gives the two desiderata - viz ., pressure

-பனாம்
-
future. Dr. Rosenthal of Munich has made some and intimate contact. In examination of the apex of
wonderful skiagrams by this method, which I hope to the lung, however, this is much more difficult of attain .
lay before you at a future meeting. In this procedure ment. In order to compare the opacity of the apices of
the focus-tube is placed at a distance of two or more the two lungs, it might be possible to obtain a closer
metres from the patient. By this means the magnifica- contact by means of an adherent photographic film . In
tion of the shadow is greatly reduced and the distortion the same way the fluorescent screen might perhaps be
avoided. Teleroentgenography will probably be used in made of some flexible material, so as to secure complete
the future to replace the more tedious process of ortho- apposition . Perhaps even it might be possible to paint
diascopy and orthoroentgenography. directly on the skin a collodion film which shall be
At the Surgical Section of this Society Professor sensitive to the photographic or fluorescent action of the
Goldmann showed a somewhat novel procedure for ob- rays..
taining the necessary differentiation of transparency in These, then , are some of the improvements which we
abdominal examinations. The procedure consists in may fairly expect in the production and printing of that
blowing up the colon as far as the cæcum with air, complex impression , a Roentgen photograph . This is
previous to the Roentgen examination. By this method not a simple record, but a most marvellous palimpsest,
he has obtained most interesting skiagrams of calculi where shadow is superimposed on shadow , one record
and concretions in the appendix . This is a similar on another, in seemingly hopeless confusion, but each
method to that which has been used for some time for capable of yielding up its secret to the earnest and patient
the examination of diseased joints, where the necessary student.
transparency of the joint has been obtained by injecting DIAGNOSIS .-In diseases of the chest, diagnosis by
oxygen. The latter procedure is not, however, without means of the Roentgen rays is rapidly developing.
danger, as one or two fatal accidents have been reported Roentgenography is destined to take its place beside, if
by German observers. it does not overshadow , the older classical methods.
COMPRESSION .- On this subject I would draw your The Roentgen diagnosis of infiltration of the apices of
attention to one further point, and that is the raison the lungs is already fairly advanced, and a very satis
d'être of compression . Compression alone does not in- factory instrument has been designed, which enables us
crease penetration. The absorption of the X rays is to compare the opacity of the two apices. What is of
determined by the total amount of tissue traversed, not even greater importance is the possibility of diagnosing
by the closeness of its packing. What compression does infiltrations of the glands of the hilus of the lung- & con
is to abolish air spaces and increase the homogeneity dition which is wholly beyond the ken of the older methods
of the tissue. Those who are familiar with the use of of diagnosis.
the fluorescent screen in the examination of the stomach It needs no prophet, therefore, to foretell that the
will have been struck with the great increase of trans- future hospital or infirmary for diseases of the chest will
parency obtained when the screen is brought into inti- be furnished with an X -ray installation as a matter of
mate contact with the abdominal walls, and a still course.
1
further increase of clearness when pressure is used. The same may be said of orthodiagraphy for diseases
This greater transparency is due to the greater homo- of the heart. In diseases of the stomach also a whole .

geneity of the medium, and to the expulsion of air from new field of research has been opened up by the labours
the region immediately under the screen. A similar of Rieder and Holzknecht- a field which we may rest
phenomenon is well known in optics. The transparency assured will not be left untilled.
of a wetted cloth is due to its increased homogeneity and One of the most vivid impressions of my life was my
to the exclusion of layers of air. In order to obtain the first sight of the beating heart - like some living creature,
best results, the use of a compressor of some sort is tranquilly breathing within its bony cage. Still more
absolutely essential. Some of the best results have been impressive was the sight of the stomach during the
1
obtained by using a pad of loofab under the compressor. digestion of a bismuth breakfast. The course of each
In the search for a renal calculus compression is not so mouthful during mastication and deglutition was visible
important, since the usual position of the plate under on the screen , revealing as it passed the position of the

3
 180 ARCHIVES OF THE ROENTGEN RAY.

oesophagus and the shape and movements of the stomach. therapy may fairly be included within the scope of
The whole process of digestion could be followed, from electrical treatment, if we accept the modern theory
the ingestion of the meal to the final passage of the food that electricity is but the displacement of electrons.
through the pylorus. There is no fundamental difference between the natural
Even the cinematograph has been pressed into the radio-activity of radium and the artificial radio-activity
service of medicine. At the last Berlin Congress the of the anticathode of an X-ray tube.
movements of the diaphragm and viscera during respira- There is no more interesting phenomenon in medicine
tion were clearly reproduced on the lantern screen . If than the withering of a wart, a lupus nodule, a rodent
this is possible only a decade after Roentgen's discovery, ulcer, or a patch of epithelioma under the influence of
what may not our successors hope to witness in the radium irradiation . All embryonic or rapidly growing
future ? neoplasms are apparently destroyed with equal facility,
The differential diagnosis of various forms of arthritis, provided they are sufficiently circumscribed and sur
gout, rheumatism , and rheumatoid arthritis is already rounded with healthy tissue. Could we but discover
well within our reach . Even now in some hospitals a the raison d'être of this action, we should perhaps have
Roentgen examination of the hands is a routine pre- the key to Nature's own method of cure. Do radium
liminary to the diagnosis of chronic disease of the larger and X -ray irradiations act by direct bacterial destruction,
joints. or do they only awaken the resistance of the affected
Before I leave the subject of electricity in diagnosis, tissues ? It would seem that an invaded tissue possesses
there is one of its possible uses which has been hitherto three lines of defence the first hyperæmia, a flushing
overlooked, but which , I think, might be of considerable of the invaded area with lymph ; the second pigmenta
utility. I allude to the employment of electricity during tion , a screening of the organism from malign radiations ;
the preparation and staining of microscopic specimens. the third , an increased production of connective and scar
The demonstration of slight differences of structure, the tissue. All these phenomena may be observed in the
inquiry into the penetration of external remedies, and integument which has been exposed to radium, or to the
the study of ionic cataphoresis, may best be carried out artificial radio-activity of an X-ray tube.
in the field of the microscope. It would be interesting In the early days of radio -therapy, when the rays
to know what is the exact effect of a weak galvanic were used much more than they are now for hyper
current or of the X rays on the staining of a microscopic trichosis, one found again and again that the hair
specimen. In the early days of the Roentgen rays they bulbs were strangled by a reticulated growth of connective
were used commercially in the operation of tanning tissue. After a long series of irradiations the face
leatber. It is quite possible that some interesting facts became smooth , pale, polished, and cold ; and this with
as to skin structure might be obtained by careful out any visible X-ray reaction. The curative action of
experiment on the ionic penetration of the skin under the X rays and radium on cancerous and other neoplasms
the influence of X rays or radium . appears to depend greatly on this stimulating action on
PATHOLOGY.—I have no time to do more than glance the protective growth of scar tissue.
at the use of the X rays in anatomy and pathology. ROENTGENO - THERAPY. - With regard to Roentgeno
In anatomy, the tedious process of dissection to trace therapy, the most important point is the question of
the blood -supply is now replaced by a series of Roentgeno dosage. A recent paper by Rieder of Munich emphasizes
grams of a suitably injected organ. the importance of exceedingly small doses of Roentgen
In pathology also, specimens of the blood -supply of the rays. It is now known that in cases of leukæmia an
neoplasm and its connexion with the glands can best be intense and prolonged irradiation may often have a
examined by injection and subsequent skiagraphy. deleterious effect, even though it results in a cure from
a hæmatological point of view. Formerly it was the
ELECTRO- THERAPY . custom to continue the irradiation until the leukæmia
We must now turn our attention to the more imme- had completely abated. Rieder advises that the treat
diate subject of our lecture-viz. , electro -therapy : the ment should be intermitted as soon as there is a decrease
application of electricity to the treatment of disease. in the number of leucocytes. The first sign of leukopædia
Radium . - And first with regard to radium, for radium- is a contra-indication of further X-ray treatment. He

3
 ARCHIVES OF THE ROENTGEN KAY . 181

obtains the best results from single irradiations of five child. Moreover, the skull of the infant will filter out
minutes' duration at intervals of one or even several some of the softer and more deleterious rays. But even
weeks. so the observation is not a pleasant one, and should give
The same observation applies to the treatment of us pause. The ill-effects, if any, caused by irradiation
struma, Basedow's disease, and the various skin diseases. of the child's nerve centres would be recognizable,
I myself have insisted again and again on the efficacy of perhaps, only after the lapse of years.
small doses, and shown that there is hardly any of these On the other hand, I believe that small doses of
affections, be it chronic eczema or acne, psoriasis or Roentgen rays are of considerable utility in the treat
sycosis, which is not benefited by small doses of the ment of ringworm . The method of introducing the
Roentgen rays. copper ion by electrolysis also bids fair to be of great
As to the bactericidal action of the rays, no one who utility. The chief disadvantage is on the score of pain
has watched the cleansing of a foul varicose ulcer by to the little patients, but this may be obviated in great
the X rays can doubt that they are bactericidal in vivo, measure by the simultaneous introduction of the cocaine
whatever they may be in vitro or on a culture plate. It ion. This question of the penetration of the copper or
may be that the effect is not directly bactericidal, but mercury ion under the influence of the X rays, high
consequent on local hyperæmia . The efficacy of Bier's frequency , and the galvanic current, might easily be set
“ Stauung " treatment seems to indicate that an abundant at rest by suitable experiment. A couple of small
supply of lymph is the chief factor in Nature's mechanism pedunculated fibromata on the same patient might be
of healing. If this be so, I know of no means of pro- treated with ointment or lotion containing a copper or
ducing this limited and localized hyperæmia more certain mercury salt. One of them should then be irradiated or
than radium or X-ray irradiation . otherwise treated electrically. Both should then be
Whatever may be the rationale of the Roentgen cure , examined under the microscope with suitable reagents
to determine the depth to which the metal ion had
there is certainly an increasing tendency to give smaller
and less frequent doses than in the early days of radio-penetrated. Better still, a limb that has been condemned
therapy. Most observers are now agreed that any visible for amputation might be made the subject of experiment.
and intense reaction should be avoided . We have other Each finger or toe should be massaged with an ointment
more efficient and less dangerous means of producing of oleate of copper. One finger might then be exposed
destruction of tissue or cauterization . It is seldom to Roentgen irradiation, another to high -frequency effluve,
necessary to proceed even to epilation. another to the galvanic current, and so on.
RINGWORM . - It may, indeed, be doubted if Sabouraud's High FREQUENCY. - We have but little time to linger
epilation method is the last word to be said in the on the other modalities of electric treatment. High
treatment of ringworm . Parents and practitioners alike frequency treatment has of late been receiving more
are somewhat chary of subjecting very young infants to attention in England. There seems to be no doubt that
so potent and powerful an agent, whose action is so autoconduction and autocondensation are valuable
obscure, and whose ill- effects are so occult and so long means of reducing high arterial tension. The rapidly
delayed. In the future I believe that epilation will be changing magnetic field appears to set up a sympathetic
reserved for older children or for inveterate cases only. vibration of the electrons. According to the rapidity
It is , moreover, somewhat unscientific to root up the and wave-length of this vibration, it may cause either
wheat in order to destroy the tares, when we have such a stimulation or inbibition of the nerve centres. It is
discriminating agent as the X rays at our command. possible that the same frequency of vibration may
At the Berlin Congress, Forstling of Hanover read a cause inhibition of one nerve centre and stimulation of
paper on the ill-effects of X -ray irradiation on develop- another. In this way we might obtain simultaneous
ment, and showed a puppy, one of whose legs had been stimulation of the vasodilator and inhibition of the vaso
exposed to ten minutes' Roentgen irradiation when it constrictor centres. The very marked action of high
was eight days old. The limb was permanently dwarfed frequency currents on the kidneys and on the urinary
and withered. It is true that, as Holzknecht has pointed secretion is probably also due to the direct stimulation 1
out, the development of a young animal is much more of the vasodilator centres.
rapid, and therefore more easily inhibited , than that of a It is surely unscientific to attempt to taboo high

$
182 ARCHIVES OF THE ROENTGEN RAY.

frequency treatment because it has claimed too much , electrodes was in reality ionic cataphoresis. The pure
and been used perhaps for unworthy purposes. The effect of a galvanic current is almost unknown, since
same may be said of any method of treatment, and , even with carbon electrodes and a thick pad of absorbent
indeed, of all human activities. wool, moistened with distilled water, we cannot get rid
The opposition in England and Germany to d'Arsonval- of the action and caustic properties of the hydrogen ion.
ization, as it is called, has aroused the ire of a French The successful treatment by ionic cataphoresis re
writer, who speaks of it in words which are applicable quires the most careful technique, perfect cleanliness,
not alone in France. “ I speak,” he says, “ to the body and as many precautions as does surgical asepsis.
of medical men who work, who desire to know, and The chief obstacle to further progress in this direction
whose brain is not curdled by dull routine. Le reste ne is the difficulty of producing sufficient ionic penetration
compte pas." without excessive pain or injury to the skin . There are
As students of electro -therapeutics we cannot afford two precautions which are of the highest importance in
to neglect any of the modes of motion of the electrons- ionic treatment : one is the absolute steadiness of the
the gentle flow in the galvanic current, the sudden rise current, and the second is the very gradual rise and fall
and fall of velocity in the faradic current, or the lightning of potential when switching the current on and off. The
rapidity of high -frequency vibrations. first of these, the avoidance of accidental fluctuations in
A high-frequency apparatus is, however, a dangerous the current intensity, is absolutely impossible when
weapon in ignorant hands. It is not a plaything to be using the public electric mains. A much better method
entrusted to an inexperienced operator, be he qualified is to use a battery of storage cells for all galvanic and
or unqualified in a legal sense . Only recently I had an ionic treatment. In repeating the experiments on electric
opportunity of seeing the dangerous results of a high- sleep, Dr. Louise Robinovitch found that the sleep was
frequency application in an unsuitable manner. The much more tranquil and profound at Nantes than at
case, one of cardiac debility, was treated by stimulation Rome - 50 much so that she imagined the difference
with a glass exciter over the solar plexus. As might must be due to variations in the physiological suscepti
have been expected, it resulted in a considerable fall of bility of different breeds of rabbits. Subsequently she
blood -pressure, accompanied by weak pulse and great found that in the former town the current was obtained
exhaustion . from storage cells, whereas in the latter the laboratory
It has always been a matter of amazement to me how was supplied direct from the public mains.
practitioners undertake the management of these power- Of equal importance is the gradual and imperceptible
ful instruments with the gay insouciance of ignorance. rise and fall of the current intensity. In ionization or
The most important advance in electro -therapeutics will electric stimulation the pain is not caused by the
be the adequate instruction of the practitioner in the use intensity of the current, but by the variations of
of such lethal weapons as a high-frequency or X-ray intensity. One of the instruments that we most need is
apparatus. It is difficult to believe that the practitioner an automatic contrivance for gradually turning on the
of the future will undertake so grave a responsibility as current , increasing it very slowly, and turning it off
the application of X rays and high frequency with so again with equal precautions. Such & contrivance
little preparation and so small a stock of physical know- should not be difficult to design, and I commend it to
ledge. the notice of the mechanical members of this section,
Ions.One of the most interesting developments of In ionic cataphoresis also the question of dose is of the
electric treatment is that of ionic medication, or ionic utmost importance. Take, for example, the zinc ion .
cataphoresis, as I should prefer to call it. It may be With the introduction of small ionic doses of zinc there
noted in passing that the time-honoured treatment by is an increase of the vitality of the skin , as evidenced by
internal medication - i.e ., the introduction of drugs per the accelerated growth of hair. With large doses, on the
vias naturales — is in reality ionic medication, since, as other hand, we get paralysis of the function of the skin
Van 't Hoff and others have shown, a weak solution of and mortification of the tissue.
an electrolyte is in fact a solution of already dissociated It is curious to note that the lesions due to the intro
ions. Internal medication is, therefore, ionic medica- duction of metallic ions greatly resemble those produced
tion. Again, the old-fashioned galvanism with copper by the X rays, and exhibit a similar phenomenon of
 ARCHIVES OF THE ROENTGEN RAY . 183

latency. This observation, which is due to Leduc, may “ The necessity of finding some safe and simple means
perhaps throw some light on the cause of X -ray burns. of inducing nerve sleep is becoming ever more important
ELECTRIC SLEEP.-Professor Leduc's recent work on as the stress of civilization increases, and the prevailing
electric sleep has opened up a magnificent and far- disease of the present day- a too widely extended and
reaching vista. It has given us the means of producing developed consciousness of our environment–becomes
sensory and cerebral inhibition . In the future an inter- ever more acute. We may live to hear ' two hours inbibi
mittent current of proper frequency may be at our dis- tion ' prescribed before an operation, or a week's electric
posal, by means of which we can at will switch off any or sleep ' before an examination . The possibility of thus
all the nerve centres one by one. suspending growth and tissue changes is brought forcibly
Perhaps the section will permit me to quote from an to our notice by the modern methods of forcing vegetables
editorial which I wrote for the ARCHIVES OF THE ROENTGEN and flowers for the market .
Ray , and which has created a certain amount of interest “ In the vegetable as well as in the animal world the
in the German press : axiom holds good that a period of quiescence or inhibi
" In the armamentum of medicine there is a goodly tion must precede a period of stimulated growth. The
array of weapons for stimulation, but comparatively few winter sleep of plants may be induced at any season of
instruments for inhibition. Professor Leduc has given the year by placing them in cold storage, and plants
us a sleep - compeller, acting, not by poisoning or counter- whose growth has thus been retarded will develop much
irritation or exhaustion , but by the direct and immediate more rapidly on being re-awakened by warmth. More
inhibition of the brain cells themselves. recently the ether narcosis of plants has come into use.
“ The inhibition is produced by an electrical stimulation By this method a brief nap . of some couple of hours
of the nerve cells, with a rhythm which is incompatible seems to fulfil all the purposes of a long winter sleep,
with their physiological activity. To produce the in- and the plant can be forced at once into a new season of
hibitory effect the current oscillations must be in tune growth and activity.
with the physiological note. The frequency for the brain “ It would be a marvellous addition to the forces at our
of the rabbit is 100 per second, and the current duration disposal if we had some similar means for regulating the
one-thousandth of a second . Quietly, without a cry or development and activity of the animal organism . Per
movement, without the least sign of pain or discomfort, chance the electric sleep may enable us to procure the
the animal sinks into a condition of deep narcosis, inhibitory rest required as a prelude to stimulated
similar to that produced by chloroform . On the cessa- growth .” 3)

tion of the current the animal awakens instantly, with- At all events, we may expect great developments in
out any signs of pain , of fear, or of fatigue. the electrical treatment of neurasthenia and brain
" Professor Leduc has subjected himself to the treat- affections, since Leduc has shown, not only that the
ment with no ill-effects, although in his case the experi- brain itself is within the domain of electrical treat
ment was not carried far enough to produce complete ment, but that total inhibition of the cerebral function
narcosis. may be produced by the mere pressure of an electric
“ Not only can general anesthesia be produced by this switch .
method, but by appropriate modifications of the process THEORY. —We may look forward to great progress in
a limited local anesthesia is also obtainable. electrical theory, and a clarification of our ideas as to
“ We are thus furnished with a most potent instrument the rationale of electricity, as the result of the epoch
for producing nervous inhibition, and we may hope ere long making discoveries of the last few years. The electron
to see the electric sleep in use as a practical remedial theory is so beautiful and so simple that we can only
agent, replacing or reinforcing the natural rest. More hope that the physicist will leave it alone as it now
than this, we have some reason for supposing that each stands. For us who endeavour to visualize the passage
muscle and nerve is attuned to its own special period of of electricity through the human body, it is no small
electric stimulation, and therefore of electric inhibition, matter to have replaced the vague conception of an
so that in the near future we may be able to put to sleep electric current by the mental picture of a double train
a tired member or an injured organ, without obliterating of moving electrons.
the general consciousness. It is a most fascinating theme this—the future of
26
184 ARCHIVES OF THE ROENTGEN RAY .

electricity in medicine. But my time and your patience I have tried , I prefer for my purpose either the Gundlach
are both exhausted . In concluding, let me congratulate tube or Bauer's air-cooled tube.
the members of the section on having chosen this, the For the practice of orthodiagraphy it is of the utmost
most interesting and stimulating of all branches of importance to have a well-ventilated and properly
medicine. We stand on the utmost verge and boundary darkened room . The least ray of light interferes with
of things, where the coast -line which separates the the observations. For this reason I even cover up my
known and the unknown is shifting most rapidly. For focus- tube in a piece of thin black linen , to shut out the
us is the supreme satisfaction of watching, and in some light from the fluorescence of the glass. In order to
measure assisting in this transformation ; for us the sensitize the retina, it is necessary to remain for some
whole past of medicine is full of inspiration ; for us the time in the darkened room before commencing the
future of physical and electrical science teems with examination. The walls and floor of my examination
the very embodiments of our most sanguine dreams. room are of a dull reddish-brown , and I find this a most
suitable colour.
Finally, it should not be forgotten that it is essential
ORTHO-ROENTGENOGRAPHY.
to see that the othodiagraph and the supporting frame
are efficiently earthed .
By Dr. FRANZ M. GROEDEL. Before every examination it is as well to ascertain that
the whole system is still correctly centred . I have already
( Continued from p. 157. )
described (p. 156) how the pencil, the middle of the tube
BEFORE discussing the other modes of ortho-roentgeno holder, and the middle of the fluorescent screen are placed
graphy, I will describe somewhat more in detail the whole in one straight line, which is the axis of the beam of light
procedure of preparing an orthodiagram . passing through the centre of the diaphragm . If, now, a
focus-tube which has been properly adjusted on its trestle,
THE MAKING OF AN ORTHODIAGRAM.
as described on p. 153, is placed in the holder so that
For an orthodiagram , as for every other Roentgen the mark on the base of the trestle coincides with that
examination , the chief factor for success is a good coil on the holder, the normal ray will coincide with the axis
and a focus-tube which can be maintained at a constant of the system. If all is correct, when we introduce a
vacuum . I invariably use medium -hard tubes for the diaphragm with a very small opening, the indicator spot
examination of the thorax, and hard tubes for the on the centre of the screen should appear as a dark spot
abdomen . By cutting down the field of vision by exactly in the centre of the circle of light. Slight bending
a tubular diaphragm , and by properly adjusting the of the supporting -rods will unavoidably occur occasion
primary current, I can get great sharpness of outline ally. The apparatus can then be again brought into
combined with a sufficient illumination of the field of adjustment by the screws ZH and ZL (Fig. 3).
view for my purpose. The intensity of the secondary The proper adjustment of the focus- tube on its trestle
current I vary by changing from a Wehnelt to a mer- is best done by the manufacturer. It can , however,
cury break, and by using Walter's device to alter the be done oneself, if necessary, by the following method :
self-induction of the coil. With my 20-inch coil, by A suitable tube, with a fluorescent screen at one end, is
Messrs. Reiniger, Gebbert and Schall, all these altera introduced into the diaphragm. Within this tube are
tions are made by means of various switches on the two small diaphragms of lead . The focus -tube is then
wall-plate. The fine adjustment of the current and moved about on the trestle , and the latter in the holder,
voltage, on the other hand , I arrange on a movable table, until the shadows of the two lead rings completely
so as to be always under the hand of the operator. The coincide. A mark is then made on the trestle opposite
possibility of increasing and decreasing the primary the mark on the holder.
current at will during an examination is, in my opinion, For the orthodiagraphy of the heart it is well always
an essential requisite for successful work . By this we to make the examination with the patient in the
can keep the tube constant and adjust the intensity of vertical position. It is therefore of great importance
that the arrangements for securing the immobility of the
the rays to suit the density of the particular region under
examination. Of the various makes of focus-tube wbich patient should be adequate . The patient must stand
 ARCHIVES OF THE ROENTGEN RAY. 185

very erect in front of the apparatus, with his back to the
sailcloth (see Fig. 7, p. 155). The two supports are then
brought forwards under the arms and fixed in position .
This, however, does not prevent any movement of the
lower extremities, and I therefore generally prefer to
adopt the sitting posture (Fig. 8, p . 156). For this a
small bench is placed in front of the screen, on which
the patient is seated. A strip of sailcloth is then passed
over the upper portion of the thigh and fastened under
the bench. The shoulders are fixed by adjusting the
rests under the arms as before.
When all preliminaries have been attended to , the
operator seats himself on a revolving stool in front of
the apparatus. The light, which should have been
turned as low as possible during the preliminary arrange
the right side of the diaphragm and the outer margin
of the right lung. The normal ray has thus been made
to traverse over the whole of the contents of the
thorax, and their position has been marked on the board .
The resulting drawing is thus a shadow picture of the
lungs and heart taken with parallel projection - i.e ., an
orthodiagram of the lungs and heart .
I have already alluded , in the first portion of this paper,
to the fact that for the completion of the orthodiagram
we require to add certain topographical points of refer
ence. I therefore warn the patient that he must remain
still , as the examination is not yet over, before turning
4

ments, is now turned out completely. It is urgently

recommended that some minutes should now be allowed
to elapse before beginning the examination. The time
may be employed to advantage in an attempt to reassure
the patient. I always lay emphasis on the fact that the !

instrument will make a good deal of noise when turned

on, but that the patient will feel nothing whatever ; and 1
.

I once more warn him of the necessity of keeping abso

lutely still. It is best to give no advice as to the method
of breathing, as the patient is more likely to breathe FIG. 9. - ORTHODIAGRAM WITH SAGITTAL ILLUMINATION.
quietly and naturally if he is not thinking about it. V. I. = Fifth intercostal space .
1

The current is then turned on, and the pneumatic ball

for working the pencil is taken in the right hand. The off the current . The light is then turned up, and the
forefinger should be placed through the ring under the fluorescent screen removed and replaced by the pointer
fluorescent screen, whilst the left hand grasps the rod a (Fig. 5). As we have already explained (p. 154 ) , this
(Fig. 3) close to the screen. In this manner the screen pointer is adjusted in the direction of the normal ray, so
is easily directed , and a short practice will give the knack that it always indicates the spot where that ray would
of moving it in the correct circular motion . The next fall were the focus -tube in action . If, now, we direct this
step is to take a general view of the whole thorax by pointer on various points on the body, and mark each
passing the fluorescent screen over its surface. Then point with the pneumatic pencil, we shall have on the
the index mark, the black spot on the screen, is made to board a parallel projection of these points, just as we
had of the orthodiagram . The points which I usually
cover various points on the outline of the heart, and each
point is marked on the drawing -paper by pressing the mark by this means are the middle of the incisura
pneumatic ball attached to the pencil. It will be found jugularis and of the xiphoid process , and the nipples.
best always to mark the spots in the same order. I usually I also mark the outline of the shoulder and the sides of
begin with the arch of the aorta , which I follow as far as the body by drawing the pointer out as far as possible
possible into the shadow of the heart itself. Next I trace and passing it around the outline. The intercostal spaces
the curve of the lung, and then that of the left ventricle . may also be marked in the same way.
I next trace the left side of the diaphragm , and then The diagram is now completed , and the whole process
the outer margin of the left lung. This latter is indicated has only lasted for some three or four minutes . The
with a few dots only. After this I outline the right paper is now removed from the board , and the dotted
auricle , commencing at its lower extremity and following marks joined by a continuous line. Fig. 9 gives such
the course of the superior vena cava. Finally, I mark an orthodiagram, with all the necessary topographical 2

26-2 1
186 ARCHIVES OF THE ROENTGEN RAY.

points and lines. It is a parallel projection skiagram of
the whole of the thorax, which is composed of the super-
imposed outlines of the frontal view of the various larger
organs. Since for this view the Roentgen rays fall on
the body in a direction parallel to the sagittal suture, we
call it an orthodiagram with sagittal illumination , or,
more shortly, a sagittal orthodiagram .
only a few words of description. The apparatus is turned
round at right angles to its former position by loosening
the fixing screw , as already described. The support now
forms a table, on which the patient lies. There is no
need of special apparatus to secure his immobility, but
care must be taken that he is really lying quite flat, with
both shoulders on the sailcloth . A small cushion may

Fig . 10.-HORIZONTAL ORTHODIAGRAM .

It is scarcely necessary to point out that such an
orthodiagram of the heart, taken with the patient in
a vertical posture, entails but little fatigue. It is much
less exhausting than the horizontal orthodiagram , where
the patient has to lie absolutely flat (Fig. 10). Such
a position is always disagreeable to the patient, and for
those suffering from heart disease it is often impossible.
Nevertheless, in many cases, and especially for experi: stand, as shown in Fig. 11 ; or we may have another
mental purposes, it is necessary to prepare horizontal
orthodiagrams. The technique of this procedure needs
be placed under the head . The examination is proceeded
with in exactly the same manner as before, the operator
standing on the left side of the table.
For observing the movability of the heart especially,
it is necessary also to obtain a view with the patient
lying on his side. For this the vertical orthodiagraph is
employed. For support, we use a board attached to the
frame covered with sailcloth made specially for this
purpose .
 ARCHIVES OF THE ROENTGEN RAY. 187

Of still greater importance, although at present not
always practicable, is the production of a frontal ortho-
diagram — i.e., an orthodiagram taken with the X rays
parallel to the frontal suture . This is taken with the
rays falling on one side, and therefore gives a sagittal
section of the body . It is chiefly useful for enabling
us to measure the thickness of the heart . For this
examination the patient stands with his right side
greater than its thickness, this examination is not always
successful. The tube used should be a very hard one .
Fig. 13 will give an idea of the great aid which a
successful frontal orthodiagram affords in the estimation
of the volume of the heart .
I have no space to enter more fully into the value of
orthodiagraphy of the heart , or to describe the indica
tions for its employment. I hope to return to this

FIG. 11. - ORTHODIAGRAM OF A PATIENT LYING ON THE LEFT SIDE.

against the sailcloth of the frame. The back rests subject of the Roentgen examination of the heart in a
against one of the cushioned supports, whilst the future paper.
other is turned obliquely to serve as a support for the I will now turn to the orthodiagraphy of the stomach .
arms (Fig. 12) . There are no particular points to be As I have already described in a recent article , the ortho
noticed as to the special technique for frontal ortho- diagraphy of the stomach is undertaken after the in
diagrams. They can, of course, be taken with the patient gestion by the patient of Rieder's bismuth meal. This
in either the vertical, horizontal, or sitting posture. Since meal must be always prepared in the same manner. It
the contrasts in density are not very great, and the width is, however, immaterial whether the basis of the meal is
of the thorax from side to side is generally considerably rice, flour, barley, or potato purée, or even spinach or
188 ARCHIVES OF THE
minced meat. The simplest to prepare of uniform
strength , and therefore the best for use in examinations
for purposes of comparison , is a thin porridge of ordinary
flour. For patients over fifteen years of age, 40 to 50
grammes of bismuth are given, and in well-developed
Fig. 12. - ARRANGEMENT FOR TAKING AN ORTHODIAGRAM wiru FRONTAL ILLUMINATION.
subjects even more than this may be used without ill .
effects. The bismuth is well stirred up with lukewarm
water or milk , and then the porridge added to make it
up to 400 grammes. It is of the utmost importance that
the quantity should be weighed correctly, and not guessed.
The porridge may be seasoned to taste with sugar or a
ROENTGEN RAY.
little spice. I have often found it an improvement to use
raspberry juice for mixing with the bismuth ; ladies
especially will take the mixture much more readily when
so flavoured. The patient should never be allowed to
watch the preparation of the meal. Nothing must be
drunk with the meal, nor must any liquid be taken for at
least two hours before it.
As in the examination of the heart, so here, the view
can be taken in any direction , and either frontal or
sagittal , and with the patient either standing, sitting, or
lying.

ARCHIVES OF THE ROENTGEN RAY.
I will first treat briefly the case of the vertical sagittal
orthodiagram . Directly the Rieder meal has been taken,
the patient is undressed and placed against the sailcloth
stand with the rests passing under each arm and fastened
across the chest. As in the examination of the heart , it
is better to give no directions as to breathing. A definite
sequence should again be followed in the examination .
I usually commence with the left side of the diaphragm ,
which I follow across from left to right. I then pass
back along the lower margin of the stomach sack. Next
I mark the greater curvature, the pylorus, and the
portion of the lesser curvature which belongs to the
antrum . Meanwhile the light massage due to the
friction of the small screen has generally caused the
Aorta
Retrosternal space
Nipple
Pulmonary artery
EX
Left ventricle
Fig. 13. - ORTHODIAGRAM WITH FRONTAL ILLUMINATION OF AN EMPHYSEMATOUS SUBJECT.
antrum to relax. I can, therefore, at once mark its out-
line against the body of the stomach. If necessary, I
make more certain of its exact position by a stronger
massage with the screen, passing it repeatedly backwards
and forwards over that region. I lay great emphasis on
the necessity of accurately marking the position of the
antrum pylori , since only thus can we ensure having
correctly estimated the pylorus. After this, I follow the
lesser curvature upwards until it reaches the diaphragm .
In a first attempt, the tracing of this line will often
present the greatest difficulty, since it is sometimes
hidden by the shadow of the vertebræ. In such a case
we follow it at either end for as far as possible into the
shadow , and the subsequent interpolation of the missing
portion will then present no great difficulty. The next
step is to indicate with a few dots the left border of the
heart and a short portion of the edge of the left lung.
189
Finally, we trace the arch of the right side of the
diaphragm , marking the point where it intersects the
right edge of the heart , and then outline the side of the
right lung. This completes the orthodiagram of the
stomach, and it only remains to mark the outline of the
body and to put in the necessary points of reference in
precisely the same manner as already described for an
orthodiagram of the heart.
The pointer is first directed to the apex of the xiphoid
process, then on the navel, and finally on the upper end
of the symphysis. Each of these points is marked on
the board by the pneumatic pencil. If desired , the arch
of the ribs and the inguinal furrow can also be marked.
Finally, I draw the outline of the body, following it
retrocardial space
left auricle
Inferior vena cava
round with the pointer drawn out to its fullest extent.
The middle line is marked afterwards by joining the
two dots which mark the xiphoid process and the
symphysis.
In most cases it is also possible to trace the lower
edge of the spleen. The outline of the liver can also
generally be traced for a considerable distance, on
account of the large amount of air present in the right
flexor of the colon ; but it is seldom visible in its entire
extent. The introduction of these two lines is of great
assistance in showing the topography of an ortho
diagram .
We can then proceed at once to the frontal ortho
diagram . For this I always choose the position with
the rays traversing the body from right to left. The
patient is placed with the right side resting against the
sailcloth of the frame. One of the side supports is
 190 ARCHIVES OF THE ROENTGEN RAY .

placed behind the back, whilst the arms, which are held ORTHOPHOTOGRAPHY,
out horizontally, rest on the other.
In this position one cannot always see the entire To eliminate this personal error, Immelmann "? has
extent of the stomach . It is sometimes impossible to endeavoured to substitute a photographic plate for the
trace the upper portion, or any part of the fundus except eye of the operator. His method of orthophotography
the “ magenblase " —the cushion of air always present at is designed to photograph the outline of the heart by
the cephalic pole of the stomach. But it is just the parallel Roentgen rays. For this purpose he uses any
condition of the “ magenblase ," and the lower portion of make of orthodiagraph. The patient is placed in position
the stomach, which here appears as loose sack lying very as if for an ordinary orthodiagram . In front of the
close to the wall of the abdomen , which is of most thorax he arranges a photographic plate or film , or, better
interest to us. Occasionally the pylorus is also visible still, a film which has been fixed between two intensifying
from this aspect, when it may, of course, be marked on screens . The index mark on the small fluorescent screen
the chart. Here again the diaphragm and part of the is then passed slowly round the outline, which can be
outline of the heart and lungs should be marked. The seen on the screen in spite of the intervening plate. Even
value of a frontal orthodiagram depends greatly on the with a very sensitive film and intensifying screens, the
correct marking of the position of the outline of the body: exposure required will be some thirty seconds. It is,
For this, the back and abdomen are traced round with therefore, best first to draw the right outline and then
the pointer, as in the preceding cases. the left, the patient meanwhile holding his breath. As
For orthodiagraphy of the stomach in other positions will easily be seen, the procedure is both intricate and
I need add no further instructions to those already given difficult, and even so the results are not completely objec
for the examination of the heart. The results of such tive , since the operator has to direct the instrument. It
examination have already been discussed in my treatise is, therefore, not to be wondered at that the method has
on the examination of the digestive tract.* found but little favour.
In the examination of the lungs, the orthodiascope is Albers - Schönberg's orthophotography with a slit
also of use. I have already described how to trace the diaphragm 18 has not been much more favourably
outline of the lungs when dealing with the examination received. He fastens the photographic film in front of
of the heart. Where any pathological change is observed the patient, who sits on a movable chair. The chair
on the screen , the extent of the diseased tissue can, of is then slowly passed in front of the slit in a leaden
course, be indicated on the orthodiagram in the usual box which serves as a diaphragm . The pictures thus
manner. The procedure is not, however, very well obtained are correct in their horizontal proportions, but
adapted to this purpose, since the foci of disease are the vertical measurements of course show the same
often disseminated over the entire area of the lung. On distortion as an ordinary X-ray photograph .
the other hand, in the early stages, when the observation Numberless other attempts have been made to attain
is of most interest, the presence of the processes can a similar result, but they are all alike impracticable for
only be detected with certainty on a photograph. The ordinary use.
chief use of orthodiagraphy of the lungs is, therefore , for In conclusion, I would like to indicate a method which,
physiological experiment. although it cannot as yet be generally adopted, will
I have now given a somewhat comprehensive account doubtless gain ground as the capacity of our instruments
of the chief uses of orthodiagraphy. It would take too is increased. This is the method of teleroentgenography
long to go fully into all possible sources of error. It is which was recommended by Kohler 19 some years
generally conceded that this is the only method at ago, and has now been taken up in several quarters.
present available which is based on exact physical In this method advantage is taken of the fact that when
measurements . It is, nevertheless , not yet quite objec- the source of light is at some distance —2 metres or
tive, since the necessity for the observer to draw what he so -- from the object, the rays are approximately parallel,
sees introduces the personal error. and the silhouette which they throw will therefore be
* ARCHIVES OF THE ROENTGEN Ray, October, 1907.
but slightly distorted. The intensity of the irradiations
obtained from the average focus-tube is at present too
feeble to allow of this method coming into practical use,
 Y95
A
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ROENTGENOGRAPHY
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191
FRACTURE OF THE LOWER END OF THE FEMUR, TO ILLUSTRATE THE ARTICLE ON PLASTIC
ROENTGENOGRAPHY ( p. 195) .

By DAVID MORGAN, M.B.

PLATE CCLXXX .
(“ Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)
193
 ARCHIVES OF THE ROENTGEN RAY. 195

but I feel convinced that sooner or later teleroentgeno- this your print. So that before getting your print four
graphy will prove a formidable rival to orthodiagraphy. plates are required .
To describe the process more in detail :
17. Immelmann : " Ueber die Orthophotographie des Herzens,” Against the film side of the original negative an
Berliner klinische Wochenschrift, 1905 , No. 19.
13 Albers-Schönberg : Eine neueMethode der Orthodiagraphie.” ordinary slow plate is placed , the edges of both being
II. Röntgenkongress, Berlin , 1906 .
19 Kohler : " Technik der Herzstellung fir orthodiagraphischer correctly fitted and bound together with binding strips'
Herzphotogramme,” Wiener klinische Rundschau, 1905, No. 16.
so that no light passes between them. These are exposed
in the usual way either to gas or electric light. The
second plate is then detached and developed in the usual
way, washed , and quickly dried by immersion in spirit.
PLASTIC ROENTGENOGRAPHY, OR THE When dry, place the two glass surfaces of the plates
REPRODUCING OF X -RAY PICTURES IN RELIEF . together, taking care that the two images are quite super
imposed, and bind together along the edges with binding
By DAVID MORGAN, M.B., strips. If these two superimposed plates are now held
Honorary Medical Officer in Charge of X -Ray Department, so that the light passes through them obliquely, the
Royal Southern Hospital, Liverpool. plastic effect is well seen, varying in degree with the
angle at which they are held to the source of light. So
The great drawback in reproducing X -ray pictures direct that it is necessary, before proceeding to the next stage,
from an ordinary negative is the impossibility of showing to determine exactly the amount of tilting necessary to
the relative distances of the parts from one another, or, produce the effect wanted, and this is the most difficult
in other words, the want of perspective. This is due to part of the process. It may be necessary to expose
the absence of the necessary light and shadow required several plates before obtaining the desired result. Having
to produce this effect. “ Plastic roentgenography," decided upon the manner and degree of tilting, a third
which was introduced by Dr.Béla Alexander of Késmárk plate is placed against the film side of the second plate ;
to the X -Ray Congress held at Berlin in 1906 , removes the three are firmly bound together along the edges and
to a great extent this defect. By means of a different exposed to the source of light, at the angle beforehand
illumination of the parts and a combination of plates, determined upon. The third plate is then detached,
which I shall describe later, he is able to throw a shadow developed, washed, and dried. On examination it will
to one side of the object and light up the other, with show all parts standing out in relief. But it is a positive,
the result that the picture is removed from the character and in order to obtain prints it will be necessary to make
of a silhouette, or shadow -picture, to that resembling a & negative from it in the usual way.
sculptured bas-relief. In the case of a limb, not only do To again repeat the order in which the plates are
the outlines of the bones stand out, but also the structural exposed :
detail and the soft parts are shown in relief. Another From Plate I. you get Plate II.
advantage of this method is that radiographs can be From Plates I. and II. you get Plate III.
reproduced for purposes of illustration on ordinary paper, From Plate III. you get Plate IV:
without any very great loss of effect. We are familiar From Plate IV. you get the paper print.
with the dire results which follow an attempt to repro- Dr. Alexander, in his article published in the Fort
duce ordinary roentgenographs on other than plate paper. Schritte auf dem Gebiete der Roentgenstrahlen, July, 1906,
A print which at first looks quite presentable, when again directs that in taking your negative you should first
reproduced is hardly to be recognized, owing to the loss expose with a soft tube, then change this and expose
of detail. with a hard tube. I have found some difficulty in
This process may be applied to pictures taken of any getting the images from the two tubes always exactly
part of the body. superimposed. But when I have been able to do so , it
What you require is a good sharp, clear negative, with has greatly enhanced the final plastic effect. The chief
plenty of detail and not too dense. From this a positive drawback to this method is the great expense incurred
is made ; these two being superimposed, a second positive and the labour entailed before obtaining the final result.
is obtained ; from this, again, a final negative, and from But the expense may be minimized when dealing with
27
196 ARCHIVES OF THE ROENTGEN RAY .

large plates, by reducing the size of the original negative doses that they have very little, if any, reaction on the
in a reducing camera, and proceeding in the same way skin .
with the reduced negative. In my opinion , then , it is the minimum and not the
Some results obtained by this method are shown in maximum dose which is now of the most importance in
Plates CCLXXIX. and CCLXXX. radio-therapy. The fact that the dose chosen was much
Plate CCLXXIX. : Normal chest of a youth. too large for the purpose has been one of the chief causes
Plate CCLXXX. : Fracture of the lower end of the of the untoward results which have now and then
femur. occurred.
The adoption of the largest possible dose compatible
with the preservation of the skin is only to be recom
mended when attacking malignant neoplasms. On the
ON THE USE OF SMALLER DOSES OF X RAYS
other hand, in certain types of disease, especially affec
IN RADIO - THERAPY . *
tions of the skin and of the blood, these large doses are
By Professor H. RIEDER, Munich . not only unnecessary , but in many cases absolutely
harmful.
In spite of much opposition, the development of radio Since electro-therapy is still in its infancy, it is to the
therapy during the last few years has made great interest of future patients that we should take every
progress. Indeed, in many fields it competes with, and opportunity of publishing the results of this treatment in
in some instances has even superseded, the kindred various cases. I will, therefore, make no apology for
method of photo-therapy. This is especially so in the describing somewhat in detail several cases which have
treatment of rodent ulcer, lupus, and other diseases of been much benefited by this treatment. These cases
the skin . have, as a rule, been treated by doses very much
Like all other remedial agents, this, the youngest smaller than those generally prescribed for the purpose.
branch of therapeutics, has a long period of development My experience in this direction has now extended for
to pass through ; and even now, after almost ten years of many years, since I originally started experimental radio
labour, we are often unable to decide whether any par- therapeutic treatment in conjunction with von Ziemssen,
ticular disease should , or should not, be subjected to and have been actively engaged on the subject ever since.
Roentgen radiations. This ignorance, however, does not, In diseases of the blood and lymph we obtain the
and should not, withhold us from making full use of this greatest benefit from Roentgen irradiations. But here
most important remedial agent in all suitable cases. we must discriminate very carefully, especially in the
The experience of the last few years has not only treatment of leukæmia and pseudo - leukæmia. It is
taught us which types of disease are suitable for now known that in the case of leukæmia an intense and
Roentgen treatment, it has also shown the necessity long -continued irradiation often has a deleterious action,
of carefully measuring and determining the quantity even though it may result in a cure from the hæmato
of the dose of rays which is to be given. In all quarters logical point of view . Formerly, when our chief aim was
we see that the necessity of avoiding harmful action to arrest the leukæmia completely, and to cause the
from the rays has led to a reduction of the original rapid reconstruction of the blood - forming organ, the
estimate of the required dose. Practically every radi- correct dose was not unfrequently much exceeded.
ologist has found himself obliged to make concessions in The irradiations should cease as soon as the number
this respect . of leukocytes begins to decrease. Any sign of leukopenia
The method much advocated some time ago for such is a contra-indication for all further applications of the
diseases as lupus, psoriasis, etc., was to give the maximal rays.
dose which could be borne without injury to the normal The best procedure is to use a medium hard tube, and
tissues. This method is now gradually being abandoned, give single short irradiations with one or more weeks'
and rightly so, since we find that the Roentgen rays interval between them . The treatment should be con
often exert a beneficent action when used in such small trolled by frequent examinations of the blood, especial
* Translated and condensed from the Muenchener Medizinische
attention being given to the number of leukocytes
Wochenschrift. present .
 ARCHIVES OF THE ROENTGEN RAY. 197

In one case of chronic leukæmia, the patient, an old effect the drying up of the pustules and removal of the
lady of over eighty, received twenty-seven irradiations in scabs .
the course of one and a half years. During this time With the exception of favus and other diseases which
the number of leukocytes fell from 199,000 to some attack the hair papillæ, diseases of the scalp are, as a
15,000, and the general health was greatly benefited. rule, better treated by light rays than by Roentgen rays,
Similar results have been obtained in cases of pseudo- since the former do not have such an intense action on
leukemia, although in this disease the irradiation does the papillæ .
not seem to have the same effect in reducing the size of Although not suitable for acute eczema, Roentgen
tumours in the spleen as it exercises in cases of leu- treatment is excellent for all cases of chronic eczema ,
kæmia . Even in cases where the rays have no effect on however resistant to other treatment ; except, perhaps ,
the number of leukocytes , they appear to exert a favour- for eczema of the shin , which is generally due to varicose
able influence on the general health of the patient , and to veins .
prolong his life. Circumscribed patches are, of course, better adapted
In all such therapeutic applications of the X rays for this treatment than general eczema. One to three
there are, besides the cellular effects, other secondary exposures of five minutes' duration, at intervals of a
actions on the chemical interchanges and other pro- week, are often sufficient to allay it completely. The
cesses of the organism which are difficult to define. surface becomes flat, hyperkeratosis disappears, and dis
I hope to be able to discuss these more fully at some charging sores become covered with new skin . All dis
future time. The action of the rays on diseases of the charge ceases, as a rule, after the first irradiation, and
blood appears to be exerted, not only on the blood- the itching abates. Further weekly irradiations result
producing organs, but throughout the whole of the in a cessation of vesiculation , a healing of the rhagades,
circulatory system . and a gradual but steady retrogression of the disease.
In the treatment of struma and Basedow's disease, also, Even in inveterate eczema this treatment is generally
one or two irradiations of five minutes each seem to be successful, and in the very persistent eczema caused by
sufficient to produce therapeutic results. The same certain occupations, Roentgen irradiations are often the
treatment has proved successful in persistent neuralgia only treatment to have any beneficial influence.
of the trigeminal and sciatic nerves. The improvement Even the tedious form of eczema intertrigo is usually
in such cases is often of astounding rapidity. influenced favourably by a course of this treatment .
In diseases of the prostate an endorectal direct irra- Roentgen treatment for eczema is not only more con
diation of the seat of the disease can be continued for venient and more cleanly than the application of oint
some time without any fear of dermatitis, since the ments, but its action is, as a rule, more rapid and certain .
mucous membrane is much more resistant to the In psoriasis, again, the results of weekly small doses
Roentgen rays than the skin. of X rays on circumscribed patches is truly surprising.
Another group of diseases in which small doses and Desquamation gradually ceases, the infiltrations become
avoidance of all intense reaction has proved most flatter and decrease in size, and the pigmentation slowly
successful is in diseases of the skin. disappears. It is remarkable that an old patch of
For hypertrichosis the dose should be only just strong psoriasis is more readily cured than a fresh one, although
enough to cause epilation, with as little reaction as even in the former we cannot ensure against recurrence .
possible. The procedure must, of course, be repeated The Roentgen treatment should certainly be employed
as soon as the hair grows again . Even although it for all cases of psoriasis not adapted to treatment with
must be repeated for eighteen months before the epila- chrysarobin .
tion becomes permanent, this method is much preferable In lichen ruber, so much feared on account of its
to the rapid treatment with intense irradiations, which, resistance to all treatment, a weekly irradiation of some
while causing permanent epilation, may also result in five minutes' duration will result in a disappearance of
atrophy of the skin, and in many cases also in telangiec- the severe itching and a decrease in the feeling of tension,
tases, etc. showing that the cornification is retrogressing. In this
In herpes tonsurans, favus, sycosis simplex, and sycosis disease the earlier method of irradiation only resulted in
parasitaria also, this temporary epilation is sufficient to a temporary cessation of itching, and the intense skin
27-2
198 ARCHIVES OF THE ROENTGEN RAY.

reaction resulting from the large doses of rays given had the normal tissues, and only destroying the invading
an unfavourable influence on the local condition. pathological cells, whilst it is also painless, and can be
In ulcerated and warty forms of lupus vulgaris , and employed even in the case of old people. The treatment
lupus erythematosis also, repeated short ( three to five produces a steady disappearance of the infiltration, a
minutes) irradiations with a medium hard tube have decrease of the secretions, a cessation of all bleeding,
proved more successful than intense irradiations with and a gradual formation of healthy scar tissue over the
a soft tube. In lupus vulgaris the combined treatment wound. Roentgen irradiation in such cases is almost
by radio -therapy and photo-therapy seems to have the invariably followed by good results, whether the treat
best results. For this, the individual patches of the ment be by small doses at long intervals, or whether the
disease are irradiated daily with concentrated light from more energetic method of frequent intense irradiations
the electric arc, whilst the whole area affected is sub- be employed. Recurrence is not more frequent than
jected to the X rays for some five minutes once a fortnight. after surgical intervention , and can generally be guarded
We must admit, however, that for lupus there are often against by an occasional preventive irradiation.
other modes of treatment which may in many cases be In deep-seated malignant neoplasms the use of hard
preferable to irradiation : tubes is indicated in order to procure the penetration
In the treatment of persistent acne and keloid in scars, to the seat of the disease of as large a proportion as
and also in chronic furunculosis, the best results are possible of the rays . Whenever practicable the diseased
attained by a very weak irradiation, for a few minutes spot should be irradiated from several different directions,
only, once a week. Since this treatment causes only to avoid too large a dose of rays on one portion of the
very slight reaction it can be continued indefinitely, until skin. The rays are of particular efficacy in the case
the cure is complete. With keloid especially, Roentgen of young, rapidly proliferating cells. The X rays can
treatment is far preferable to any other therapeutic often afford invaluable aid in inoperable cases, especially
method . in sarcoma of the skin, mycosis fungoides, lymphosarcoma,
In cases of pruritus gynæcologists have now for some and in destructive ulcerating carcinoma, such as carci
years been in the habit of prescribing periodical short noma of the lips, or recurrent mammary carcinoma.
irradiations. There is, on the other hand , & great We also get excellent results in the case of mediastinal
divergence of opinion as to the advisability of irradiating tumours, but the results of the Roentgen irradiations of
the ovaries. malignant lymphoma have so far been very disappointing.
In ophthalmic treatment very encouraging results have Besides these local affections, there are the large
been obtained by the irradiation of trachoma. class of diseases which depend on general cell con
In scrofuloderma and tubercular disease of the glands, traction or cell degeneration. In many of these cases
especially where there are sinuses and ulceration , Roent-
the X-ray irradiation of the neoplasm will alleviate pain,
gen irradiations will probably in future be much more and thus have a beneficial result on the patient's sleep
frequently employed than at present, since they are of and general health. Although, as a rule, irradiation has
great assistance in promoting the healing of ulcers and no permanent curative action on these deep - seated
the atrophy of glandular tissue. When the disease neoplasms, yet it will cause a cicatrization of the ulcera
affects the neck and face this treatment is particularly tions, and in many cases also promote a diminution of
indicated , since the cosmetic appearance of the smooth the tumour. This partial improvement is by no means
scars left is much in advance of that attainable by any to be despised, since with the usual medical treatment
other method . even so much as this is but rarely attained. Such im .
Juvenilė warts and multiplepapillomatous proliferations provement is, however, only to be expected in isolated
speedily wither up and disappear under the influence of patches of sarcoma ; and even then we must remember
the X rays, but hard, long-existing warts often require a that a neoplasm will often be extending inwards, even
prolonged treatment before they subside. whilst its external appearance is steadily improving
In cancer of the skin or cancroid the X rays are par- under the action of the rays . We may hope to get more
ticularly valuable, since the cosmetic results are ex- favourable results in this disease when once the instru
cellent, far superior to anything obtainable by surgery. ment - makers have solved the problem of producing &
This mode of treatment has the advantage of conserving focus-tube which, whilst giving abundant hard rays,
 ARCHIVES OF THE ROENTGEN RAY . 199

shall have very few of the soft, easily absorbed rays formed. I can speak from experience of the benefits in
which do so much damage to the skin. With such a the case of both sexes, even to the age of puberty.
tube, the greatest difficulty in the successful treatment The method I employ is to treat the patient with the
of deep -seated neoplasms of the internal organs would " condenser couch " for five to seven minutes. I then
disappear. place a metal disc electrode, 4 inches in diameter, inch
With regard to post-operative treatment in cases of thick, and weighing 31 pounds, directly on to the hypo
malignant neoplasms, Roentgen - therapy is, in my gastrium , connecting it with one terminal of the bigh
opinion , of the greatest value. We seem to be able frequency apparatus, wbile the other terminal is connected
to avoid all recurrence by several irradiations with a with the metal plates behind and underneath the couch .
hard tube and as large a dose as possible, given as soon While using the condenser couch, 150 to 400 milli.
as possible after the operation, and followed by four or ampères may be employed, but when the metal electrode
five subsequent irradiations, at intervals of several weeks. lies on the hypogastrium , 400 to 700 milliampères,
Of pre-operation irradiations, which are advised in several according to age, may be safely given to young people.
quarters, I have had no personal experience. The treatment by this latter method should last for three
In the hands of a skilful and painstaking physician to five minutes, and it should be administered daily.
Roentgen rays are, then, undoubtedly one of the most
useful therapeutic agents, chiefly on account oftheir direct
action on the cell protoplasm . It is, however, of the
utmost importance that all X -ray irradiations, whether DETERMINATION OF THE QUANTITY OF X RAYS
diagnostic or therapeutic, should be carried out under ABSORBED BY THE VARIOUS TISSUES OF THE
BODY.
the direct supervision of the physician in charge of the
case . If the above procedure be adopted, and the By Professor H , BORDIER, Lyons.
irradiation given be the smallest which will secure the
desired result, there is no fear of injury to the patient One of the most important problems in radiotherapy
through accidental dermatitis. This is of the more is the determination of the quantity of X rays which is
importance that we have not yet devised any exact absorbed by the living cells situated at some distance
method of measuring the quantity of rays. It is only under the integument. Hitherto the solution of this
when we leave a large margin of safety that we can problem has been very uncertain. We may assume that
afford to trust to the rough means of estimating the in order to obtain the destruction of the cells of a given
dose by parallel spark, focus distance, time, etc. , and pathological tissue, we must cause it to absorb a certain
avoid the tedious, complicated, and by no means de definite quantity of the radiant energy furnished by the
pendable apparatus devised for measuring the quantity of focus-tube. It is, however, manifest that the destructive
rays absorbed. action will be complete only if this minimal dose of
X rays is transmitted to the cell in question, without
being absorbed by the superimposed tissues. As the
NOTE ON HIGH-FREQUENCY CURRENTS IN result of a large number of observations, we have come
ENURESIS . to the conclusion that at least 8 units must be
absorbed by a neoplastic growth, in order to cause its
By W. F. SOMERVILLE , M.D., Glasgow .
dispersion. In no case can we rely on its destruction
With boys suffering from daily or nightly incontinence unless we can ensure the transmission of such a minimal
of urine, if the exhibition of belladonna and the bromides, dose to the neoplastic cells themselves. For this reason
the passage of a bougie, injections of nitrate of silver, it is, in our opinion, illusory to attempt the treatment of
and circumcision, have failed, high -frequency currents deep cancers of the uterus or the stomach by means of
may effect a cure. The trouble is usually a neurosis, the X rays, with the exception, perhaps, of early cancer
and there is no better nerve tonic for the condition than of the anterior surface of the stomach. When, however,
currents of high frequency. Indeed, unless circumcision the neoplastic cells are situated at such a distance from
be called for on account of a long or adherent foreskin, the surface that the minimal dose can reach them, radio
electricity should be tried before an operation is per- therapeutic treatment has a fair chance of success.
200 ARCHIVES OF THE ROENTGEN RAY.

Thus, in early cases of carcinoma of the heart success tions were made by means of Gaiffe's turbine break.
is frequently obtained. This we have ourselves often The great intensity of current through the focus -tube
verified, both in our private practice and in consultation. was obtained by introducing a resistance consisting of a
In order to estimate the quantity of X rays transmitted rod of carbon 4 millimetres in diameter. In this way
to cells situated in a plane at a given depth, it is neces- the number of interruptions was diminished and the
sary to know, firstly, the quantity of rays received by the intensity of the current increased. *
skin ; and , secondly, the absorptive power of the tissues The details of the experiment were as follows : Three
interposed between the integument and the cells in ques- blocks of tissue were prepared, with a thickness of 1, 2,
tion. If we study the absorption of X rays by various and 3 centimetres respectively. Under each block was
thicknesses of tissue, we find that the quantity of radiant placed a platino -cyanide pastille, and two more pastilles
energy traversing successive layers of tissue does not were placed at the same level, one on each side of the
decrease regularly with the depth. Thus, the first centi- block . These pastilles were prepared according to my
metre of tissue absorbs more than the second, the second method, as used in my chromo-radiometer. I found
more than the third, and so on. that when the platino-cyanide of barium is enclosed in
Kienbock* has published a table in which he gives the collodion, and covered with collodion, it is not acted on
quantities of the X rays traversing given thicknesses by the atmosphere. When enclosed in this waterproof
of muscular tissue for rays of different degrees of covering, the moisture can no longer penetrate to the
penetration. If we take rays of No. 6 on Benoist's microscopic crystals. This is not so when the platino
scale, we find the percentage of the rays traversing 1 , cyanide of barium is unprotected, as, for example, in a
2, and 5 centimetres of muscle respectively is represented test-tube. In conjunction with Galimard, we have shown
by the numbers 60, 50, and 40—that is to say, when that the humidity of the atmosphere has a considerable
the skin is irradiated with a quantity of X rays corre- effect on the coloration , and even more so on the de
sponding to 100 units, the cells at a depth of 1 centi- coloration of the salt.
metre receive 60 units, those at 2 centimetres receive When the pastilles were covered with collodion we
50 units, while those at 3 centimetres receive as much as found that, although in contact with moist tissue, the
40 units. In this case we need not take into considera- salt was perfectly protected from the action of the
tion rays softer than No. 6, since we are dealing only moisture, so that the change in colour took place exactly
with the radiotherapeutic treatment of deep -seated as if it were placed under perfectly dry tissue. This we
neoplasms. verified by repeated observations.
Our own observations do not entirely agree with the The several blocks of tissue to be examined were
numbers given by Kienbock ; but we have found that placed in a box covered by a sheet of black paper, the
the amount of radiation penetrating to the depth of pastilles being placed under the blocks on the bottom of
1 , 2, and 3 centimetres is very considerable, having the box. In this way the pastilles were in complete
regard to the nature of the absorbent tissue. darkness, and were all in the same plane, so that the
In our researches we have used our own chromo-radio- darkening of the pastilles would be proportional to the
meter, which has a standard scale of five tints. This penetrability of the tissues to the X rays. The two
enables us to appreciate doses from 1 up to 15 of uncovered pastilles would, of course, be darkest of all.
the Bordier units, which we designate by the letter I. The focus-tube was adjusted in such a position that
Our experiments were made on three tissues --muscle, the direction of the maximum Roentgen irradiation, as
mammary gland, and adipose tissue. The X rays were defined by me at the Lyons Congress of the Association
obtained from a hard tube, maintained at the same Française in 1906, coincided with the centre of the
degree of vacuum, as should always be done when surface supporting the pastilles. The distance of the
treating deeply - seated tissues. anticathode was 15 centimetres. A Müller focus-tube
The degree of penetration corresponded to 9 or 10 on 20 centimetres in diameter, with water-cooled anti
Benoist's scale. The current through the tube was cathode, was used.
•5 milliampère. The coil gave a 14-inch spark. The An irradiation of about thirty minutes' duration was
primary current was 7 to 8 ampères, and the interrup- given, until an uncovered control pastille had assumed
* Fortschritte auf dem Geb. der Roent. Strahl., February , 1906 * Archives d'Elect. Médicale, July 20, 1907 .
 ARCHIVES OF THE ROENTGEN RAY . 201

Tint No. IV on the chromo-radiometer, which cor- were of greater penetration than those used in his
responds to 15 I.* The blocks of tissue were then experiments.
removed, and the three pastilles at the bottom of the 2. Mammary Gland.-- For this experiment blocks of a
box were compared with the colorimetric scale. thickness of 1, 2, and 3 centimetres were carefully cut
It may be as well here to remind the reader of the out of the mammary gland of a cow.
exact equivalents in Bordier units of the chromo- After an irradiation of thirty -one minutes, the uncovered
radiometer tints : pastille showed the Tint IV, corresponding to 15 I.
The amounts received by the pastilles covered by
Tint O corresponds to 1.8 I. various thicknesses of glandular tissue were as follows:
Tint I 3.4 I.
Tint II 1 ) 5.6 I. Control pastille.
Tint III Tint IV 15 I.
10 I.
Pastille under 1 cm. of tissue . Tint II + 7 1.
Tint IV 1) 15 I. 2 cm . Between I and II
3 4 1.
91 3 cm . Tint O + 2 I.
We can, therefore, express in Bordier units, I, the
quantity of X rays transmitted through each of the The following table gives the percentage results :
blocks of tissue in question, and hence estimate the
quantity absorbed by a given thickness of each of Thickness. Percentage of X Rays Percentage of X Rays
the varieties of tissues. transmitted. absorbed .

The following are the results obtained :

1. Muscular Tissue. The control pastille had acquired 1 cm . 46 : 7 53 :3
Tint IV after an irradiation of thirty -two minutes. On 2 cm . 26.7 73:3
3 cm . 13.4 86.6
removing the three blocks of beef muscle and examin
ing the covered pastilles , the following values were
obtained : Glandular tissue has thus a much less absorbing power
Control pastille 15 I. than muscular tissue, the percentages being 53 and 56
Pastille under 1 cm . of muscle ... 5.6 I.
respectively, when thicknesses of 1 centimetre are com
2 cm . ... 3.4 I.
3 cm . 1.8 I. pared.
3. Adipose Tissue. - This tissue is much more easy to
If we call 100 the amount received by the uncovered obtain in blocks of the required thickness. The same
control pastille, the amounts received under 1 , 2, and dispositions were made as in the previous experiments,
3 centimetres of muscle respectively will be 37, 23, and a focus-tube of the same degree of hardness was
and 12. The difference has been arrested and absorbed
employed
by the tissue. Muscular tissue, therefore, absorbs the In this case the uncovered pastille showed the Tint IV
X rays in the following proportions : after an irradiation of thirty -two minutes. The following
1 cm . 63 per cent. are the doses absorbed by the pastilles covered with
2 77
: : :

different thicknesses of adipose tissue :

3 88
Control pastille Tint IV 15 I.
The following table gives the relative quantities of Pastille under 1 cm, of tissue Tint III
8.5 I.
X rays transmitted and absorbed : 2 cm . Tint II feeble 5 I.
3 cm . Tint I feeble 3 I.
Thickness of Percentage of X Rays Percentage of X Rays The proportion of the rays absorbed to those trans
Tissue. transmitted. absorbed.
mitted by adipose tissue are therefore the following :
1 cm . 37 63
2 cm . 23 77 Thickness. Percentage of X Rays Percentage of X Rays
transmitted . absorbed .
3 cm . 12 88

It will be noticed that these figures do not agree with 1 cm . 56.6 43.4
2 cm . 33 :3 66.6
those of Kienbock, although the rays employed by us 3 cm . 20 80
* Bordier's unit I is equal to about two Holzknecht units. - ED.
202 ARCHIVES OF THE ROENTGEN RAY.

It is evident that adipose tissue absorbs the X rays should be applied in two or three positions, so that only
to a far less degree than either glandular or muscular a portion of the whole dose, not exceeding 5 I, may
tissue. traverse any one area of the skin . From 3 I to 5 I may
Conclusions. - The three tissues we have examined are be safely given, since such a dose will produce at the
those which are most important for Roentgenologists. most but a slight erythema, with no risk of subsequent
They are penetrated very unequally by the X rays. If dermatitis ,
we compare in each case the amount absorbed by a thick- The above tables enable us to prescribe the true dose
ness of 1 centimetre, we get : required for diseased tissues at any depth, taking into con
sideration the decrease of the Roentgen energy , due to the
Muscular tissue 63 per cent .
Glandular tissue 53 superposition of various thicknesses of absorbent tissue.
Adipose tissue 43.4 This law of the decrease of Roentgen energy with the
depth is a most important one in radiotherapy. For
These numbers show that adipose tissue absorbs less instance, in order to give a certain dose to cells lying at
than half of the X rays which fall upon it, and transmits a depth of 3 centimetres under a covering of adipose
rather more than it absorbs. One centimetre of mammary tissue, we need a surface irradiation of four times the
gland absorbs rather more than half, and transmits dose, since of 100 units passing through the skin, 80
rather less than half, of the rays with which it is will be absorbed, and only 20 will reach the diseased
irradiated, whilst 1 centimetre of muscular tissue trans- cells.
mits far less than it absorbs. These results refer only We would attach great importance on the necessity of
to rays of considerable penetration - the only ones which introducing the X rays through various areas of the integu
we need consider in the radiotherapeutic treatment of ment, and making them converge on the diseased focus
the deeper tissues. at exactly the depth where the cells which we desire to
In the treatment of tumour of the breast we may destroy are situated. We would also point out the diffi
assume that the cells of the neoplasm are covered with culty of destroying deep -seated neoplastic cells— & diffi
tissue consisting essentially of fat and glandular tissue. culty which appears almost insurmountable when we
We may therefore estimate the absorptive power as some- consider that the minimal dose to ensure such destruction
where between 43 and 53 per cent.-say 50 per cent. is at least 8 I.
If, therefore, the cells to be destroyed are situated 1 centi
metre under the integument, about one -half of the THE ANNUAL EXHIBITION of new apparatus, etc. , used
rays will be absorbed before reaching them. Since, in connexion with electro-medical work will be held by
then, we suppose that the diseased cells require for their
the Electro -therapeutic Section of the Royal Society of
destruction a dose of 8 I, we must give a dose of double Medicine on Friday, December 13, 1907, at the Small
this amount - i.e., 16 I - at the surface . This large dose Queen's Hall, Langham Place, W.

Notes and Abstracts.

RADIOTHERAPY.
The X -Ray Treatment of Prostatic Enlargement.
Haemisch (Münch . Medizin . Wochenschr ., No. 14) has observed
similar results follow the X-ray treatment of prostatic enlarge
ment to those described by other authors. After treatment the
gland becomes softer and smaller even in the first and second
weeks. There is also complete or partial disappearance of the
suppression of urine. It is most important that suitable cases
should be selected for treatment. The thick, soft, and glandular
varieties which exhibit & pure adenomatous structure are
amenable to X-ray treatment. The fibrous forms, in which
connective tissue and muscle predominate, are refractory. The
treatment must also be abstained from when the suppression of
urine depends on cicatricial changes in the prostatic portion of
the urethra. Treatment of the bladder must necessarily be
carried out at the same time . In connexion with the treat
ment of prostatic hypertrophy, the author remarks that for the
most part we have to do with old and infirm people, who are
unable to undergo much exertion, and so our first care must be
to see that this form of treatment is suitable for such cases.
The body of the patient must be carefully protected from the
X rays. The tubes must be so arranged that in case of a chance
movement on the part of the patient no injury is done to him .
self nor any damage to the tubes.
 ARCHIVES OF THE ROENTGEN RAY.
RADIOLOGY.
The Importance of Skilled Radiologists.-Laquerrière and
Belot (Ann . di Elett. Med. e Terap. Fisica, July, 1907) insist
on the fact that only skilled medical men can fitly satisfy all
the requirements of scientific radiology. A radiographic in-
vestigation of any case should never be undertaken without
Reports of Societies.
ROYAL SOCIETY OF MEDICINE .
X Rays in the Diagnosis of Obscure Abdominal Diseases.
BY PROFESSOR GOLDMANN of Freiburg.
A UNITED meeting of several of the sections of the Royal Society
of Medicine was held on October 23 hear a paper read by
Professor Goldmann. The sections represented were the
surgical, the clinical, the laryngological, the medical, and the
obstetrical, and a number of X-ray workers were also present.
Professor Goldmann read two papers, the first of which dealt
with his researches into the relations of cancer in man and
animals to the vascular system, with especial reference to the
spread of the disease in the bloodvessels, the circulation in
malignant growths, and the defensive power of the bloodvessels
against cancerous invasion. He opposed the prevalent idea that
the surgeon's knife is the only means of combating all cases of
cancer . He thought that sufficient attention was not given to
the defensive processes of the organism , and to the fact that the
healthy tissues outside the cancerous focus are themselves waging
a battle against the cancer cells. He deprecated operations for
the removal, not only of the cancer focus, but of all the parts
that were involved, and of all the affected glands.
In his second paper Professor Goldmann dealt with a subject
of more direct interest to radioscopists, illustrating his remarks
with skiagrams of cases of obscure abdominal disease, such as
intestinal cancer, subphrenic abscess, and appendicitis. He had
found the X rays of the greatest service in discovering suppura-
tion in the abdominal cavity, and he thought it a remarkable
thing that in all the literature that existed on the subject of
abdominal diseases there should be so little reference to the
value of X-ray diagnosis. In many of his cases the ordinary
methods of examination had failed to prove conclusively whether
or not a complication was due to subphrenic abscess. Among distinguished. A number of fine dark lines showed the secondary
them were cases in which, as the X rays subsequently showed,
the subphrenic abscess had been sufficient to cause displacement
of the diaphragin. The X-ray diagnosis was corroborated after-
wards by the operation . He showed on the screen a case of
Albers-Schönberg, in which the subphrenic abscess was clearly
seen to have perforated the diaphragm and entered the pleural
cavity. When subphrenic abscess led to secondary empyema,
both conditions were clearly discernible on the photographic
plate. In order to obviate mistakes, he took more than one
photograph at different times before operating .
Radioscopy was of great diagnostic value in cases of appendi-
citis. In doubtful cases, the presence of a calculus or concretion
in the appendix was of much assistance in diagnosis. In many
203
having first made a radioscopic examination. Every radio
graph should be accompanied by an explanatory note in which
the radiologist should indicate the proper interpretation.
Necessity demands that in future a photograph shall bear out
or supplement in an incontrovertible manner the radiologist's
findings in any given case.
cases the X rays demonstrated the presence of a dark -brown
shadow in the iliac region, due to a calculus in the appendix.
Calculus was particularly distinct and easy to trace in an X - ray
photograph, but before diagnosis he excluded as far as possible
everything that could give rise to the pelvic “ blotch .” It was
also necessary to differentiate between calculus of the appendix
and that of the ureter.
It was generally supposed that there was no great scope for
the X rays in abdominal diagnosis, owing to the absence of
contrast in the shadows of the abdominal organs. Such had
not been his experience. Usually some artificial means were
necessary in order to accentuate this contrast, either by the
ingestion of bismuth or the like, or, better still, by the insuffla
tion of air into the bowel. His method was to give the patient
an a perient, and then to inflate the rectum and colon with air .
The air penetrates rapidly along the gut as far as the ileum,
making the intestinal cavity more transparent, and thus showing
up the dark shadow of any neoplastic growth more clearly.
When the rectum is inflated with air, it becomes so translucent
that the whole bend of the sacrum can be clearly seen. This he
preferred to the older method of injecting a fluid with some
substance in suspension which is opaque to the X rays.
Professor Goldmann showed a number of beautiful lantern
slides, which included one of cancer of the gall-bladder, a case of
cholelithiasis, and various intestinal strictures. In every instance
the size and position of the shadow corresponded with that of the
growth as determined by subsequent operation. It was easy to
diagnose cancerous growth of the mammary gland. The growth
absorbed the X rays much more powerfully than the surrounding
tissues, so that all the ramifications of the growth were clearly
visible. He showed an X-ray photograph of a cancer of the
mamma from the living subject, in which the growth was easily
deposits proceeding from the cancerous nodule and reaching
almost to the axilla. Careful histological examination of these
cases was made , in addition to the X-ray examination, and they
all proved to be true cancer . Another beautiful lantern - slide of
cancer of the stomach was shown, in which the neoplasm had
invaded the wall of the organ .
The lecturer concluded by saying that his work at its present
stage was fragmentary and imperfect, but with improved
technique, more particularly with greater sensitiveness of plates,
he hoped to be able to examine the abdominal regions still more
thoroughly. He emphasized the fact that, “ when we expose a
photographic plate to light, its sensitiveness does not increase
proportionately with the intensity of the reducing ray. Thus,
28
204 ARCHIVES OF THE ROENTGEN RAY.

the effect produced upon the plate by a slight increase in the his fellow-surgeons to consider the possibilities of early diagnosis
brightness of the ray is much stronger than that proportional to in the direction he had indicated, and to join him in endeavour
the increased illumination, to a certain optimum, which, being ing to improve a method that offered so hopeful a prospect for
different in every plate, should be determined.” He appealed to the future.

Reviews.

Light and X -Ray Treatment of Skin Diseases. By England the place occupied in France by Belot's “ Radio
MALCOLM MORRIS, F.R.C.P. , and S. E. DORE , M.D. therapy in Skin Disease." It is one of the series of
London : Cassell and Co. “ Modern Methods of Treatment," published by Messrs.
The publication of this work on the physical treatment Cassell and Co. , and is illustrated by twelve plates, most
of skin diseases by the dermatologists of St. Mary's and of them showing the results of Finsen and X-ray
the Middlesex Hospitals is a matter of great interest at treatment.
the present moment. PERISCOPE .
With regard to lupus, the authors recommend the “ Hot Air in Treatment of Chilblains " (Heisse Luft als
mixed treatment by Finsen light and the X rays, this Behandlungsmittel der Frostbeulen in der Volksmedizin).
Dr. HORNUNG. Münch. Med. Woch. , July 30, 1907.
being supplemented by the use of caustics in refractory “ Local Infection treated by Bier's Method.” PAYNE. Denver
cases. The results were on the whole very satisfactory. Medical Times, June.
“ Bier's Treatment in Gynecology " (Die Behandlungsweise
Of twenty -six cases of small extent all were temporarily nach Bier in der Gynaecologie ). Dr. Nenadovics. Gynaeko
cured , in most of them with short relapses. Of thirty- logische Rundschau , Heft 9, 1967.
“ Electrical Treatment of Atonic Gastric Distension ” (Elek
eight cases of moderate extent all improved under treat trische Behandlung der atonischen Magenerweiterung). Dr.
ment ; in nearly all slight relapses occurred, necessitating MANGELSDORF. Therapeutische Monatshefte, July.
“ The Really Useful in Electro
- Therapeutics." LEWIS JONES.
short courses of treatment. In twenty cases of large Glasgow Medical Journal, August.
extent, nine were partially and symptomatically cured . “ Electro-Therapeutics as used by the Practical Physician "
(Die Elektrotherapie des prakt. Arztes). SANITÄTSRAT PelizaEUS.
In one case an epithelioma developed on a lupus patch. Deutsche Med . Zeitung, June 6.
In lupus erythematosus the authors do not report very Physiological Effects of High - Frequency Currents in
Diseases." SAMUEL SLOAN. Lancet, June 8.
satisfactory results. “ Congestive Hyperemia of Bier in the Treatment of Skin
In rodent ulcer, when the lesion was smaller than and Sexual Diseases " ( Zur Behandlung der Haut und Gesch .
lechtskrankheiten mit Bier'scher Stauung). Priv. Doz. Dr.
a shilling, the treatment was uniformly successful . OPPENHEIMER . Wein . Med. Presse, No, 19.
This consisted in the preliminary application of Finsen “ Iontophoresis ” (Ueber Iontophorese ). Dr. Neumann and
Dr. VOLK Wein. Med . Woch . , July 13 and 20. Price 1s. 6d.
light to soften the edge of the lesion , followed by X-ray " Iontophoresis " (Leber Iontophorese ). Dr. FRANKENHÄUSER.
irradiation . In deep ulcerative cases, with invasion of Zeitschr. f. Physikal. und Diätet. Therap. , Bd . xi . , No. 1 .
“ Light in the Treatment of Dermatological Cases ” (Die
the bone, radium was used with good results on account Anwendung des Lichtes in der Dermatologie ). KROMAYER .
of its deeper penetrating effect. Berliner Klin . Woch ., No. 5, 1907.
The authors do not give any of their personal * Local Action of Light and Bier's Congestive Treatment"
(Oertliche Lichtbehandlung und Bier'sche Stauung). BREIGER.
experience in the treatment of hypertrichosis. Zeitschr. f. Physikal. und Diätet. Therapie, No. 12 , 1907 .
“ Massage and Movement in Treatment of Fractures."
In the treatment of ringworm by Sabouraud's epilation C. W. CATHCART. Scottish Medical and Surgical Journal,
method, the results in seventy cases were satisfactory. July:
Phototherapy in Nervous Disease.” ROCKWELL, A.D. New
In all the recent cases the dose was estimated by means York Medical Record , March.
of Sabouraud's and Noiré's pastilles. Physical Therapy : its Physiological Basis ( Ueber die
physiolog. Grundlagen der physikal
. Therapie) . GOLDSCHEIDER.
The authors consider that sycosis, either of hypo- Zeit. f. Physikal.und Diätet. Therap ., No. 11,1907.
mycelic or of coccogenic origin , is amenable to X-ray “ Radio -active Materials, with Special Reference to Thera
treatment . peutics ” (Radioaktive Stoffe, mit besonderer Berücksichtigung
ihrer Bedeutung für die Heilkunde . Professor Dr. MARCKWALD.
The work is completed by a very extensive biblio- Zeit. für Arztl. Fortbildung, May 1.
graphy and a copious index. It is a work which should der“ Syringomyelie).
Radio-therapeutics in Syringo-myelia ” (Die Radio -therapie
BEAUJARD and LEHRMITTE. La Semaine
be in the hands of every dermatologist, taking in Méd ., No. 17, 1907.
 ARCHIVES OF THE
“ Radio -therapeutics in Diseases of the Hair " (Ueber Radio-
therapie der Haarerkrankungen ). KIENBÖCK. Arch. f. Der-
matol. und Syphilis., Bd. lxxxii., p. 77.
" Radium : Recent Investigations on its Action in Man and
Animals.” L. HUSSAKOFF. Medical Record, July 20 .
“Uviol Lamp in the Treatment of Lupus ( Lupusbehandlung
mittels der Uviol Lampe). AXMANN . Deut. Med . Woch., July 25.
" A New Method of using X Rays.” HOWARD PIRIE.
Lancet, July 13.
“ Experimental and Practical Application of X Rays in
Diseases of the Blood and Blood -forming Organs.” Pancoast .
Univ . of Penn . Med . Bull. , No. 11 , 1907.
Correspondence.
To the Editor of the ARCHIVES OF THE Roentgen Ray.
DEAR SIR,--I have just received the November number of the
ARCHIVES. I want to thank you for the perfect illustrations
you have allowed to my paper. I think the reproductions are
excellent.
In the paper itself I noticed a few errors ; would it be possible
to call attention to them in the next number ?
The frequency of the oscillatory condenser discharge of
Fig. 14 is about 330 per second.
The cardiogram of a man with normal heart, but an habitually
slow pulse, etc. , is Fig. 18, not Fig. 17, as marked in the text.
The description of Fig. 17 has been omitted altogether—it is
the electrocardiogram of a healthy man, aged forty years, show
ing an irregular pulse. It is to be noted that in this, the duration
of the individual pulse-beat is only changed by an alteration in
the duration of the pauses between the heart-beats.
Thanking you in anticipation ,
Believe me,
Yours very sincerely ,
J. WERTHEIM SALOMONSON .
Vondelstraat 43 ,
Amsterdam .
To the Editor of the ArchIVES OF THE ROEntgen RaY.
DEAR SIR,-I have often wished, during the two or three
years I have been one of your subscribers, that you would
publish some of the opinions of X-ray workers on the changes in
the shadow of dead bone as compared with that of living bone.
I refer now to dead bone which has not been removed from the
body, but has lost its vitality as a result of loss of blood-supply
or of infection , and I am satisfied that this is an important
point which has been overlooked .
My attention was first called to this matter by an unpleasant
experience in an attempt to locate a bullet or fragments of
a bullet in the face. Four radiographs were made from side to
side , and markers were placed upon the skin upon both sides.
After many hours had been spent in geometrical calculations, I
was satisfied that there were no less than eleven bits of lead in
the face cavities, mostly in the vicinity of the right antrum , the
bullet having entered near the left zygomatic process, and
broken into the hard palate before coming to rest. Among
these eleven, two or three only were of large size, and at the
subsequent operation an attempt was made to remove them .
ROENTGEN RAY. 205
" X Rays in the Treatment of Bronchitis and Bronchial
Asthma " (Die Behandlung der chron. Bronchitis u . d. Bronchial
asthmamittels Röntgenstrahlen ). IMMELMANN. Berliner Klin.
Woch. , No. 15, 1907.
“ X Rays, the Roentgen Ray, Ultra -violet Ray, and High
Frequency Currents in Diagnosis and Therapy.” S. THOMAS.
New York Medical Journal, June 15.
“ Use ofX Rays in Small Doses in Therapeutics” (Ueber die
Verwendung kleinerer Dosen von Röntgenstrahlen in der
Therapie) . Professor RIEDER. Münch. Med . Woch ., Septem
ber 3, 1907.
I was much surprised, and not a little mortified , to see a thin
sheet of bone removed by the operator which was quite un .
attached, and was almost the exact size and shape of the radio
graphic shadow, which I had believed to represent the largest
part of the bullet .
The operation was terminated without finding any lead, and
only a few smaller bits of bone were removed, which might or
might not have been the origin of some of the other shadows in
my plates. The bullet had probably made its escape by way of
the opening in the hard palate.
The next time I had occasion to think of the matter was
recently, when I was able to make a diagnosis of fracture of the
carpal scaphoid bone, and noted that the shadow of the proximal
fragment was more marked than that of the other part, or of any
of the surrounding bones. This appearance was present in
three plates taken at different angles, and was not present in a
plate taken of the sound hand. Now, I have no proof to offer
that this upper fragment was dead , except the statement that
this part frequently dies as a result of being cut off from its
blood-supply ; and yet the frequent history of slow recovery in
these cases and in this case is without doubt very suggestive of
this condition ,
My object, then, in sending you this letter is twofold : First ,
to ask of the physiologists what, if any, change occurs in these
fragments as a result of which the atomic weight or specific
gravity is increased ; secondly, to ask radiographers if they can
duplicate my observations as to the facts noted.
This is a question of more than academic interest, as it has a
high value in forming a prognosis in many such cases, and may
come to be regarded as an indication for the surgical removal of
bone fragments after various forms of fracture more or less
comminuted. It may even have value in fracture of the neck of
the femur for the same reason.
I will mail to you a copy of the fracture of scaphoid shortly.
Yours ,
HENRY POWER.
208, Hyde Block , Spokane ,
Washington , U.S.A. ,
October 17, 1907 .
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
SIR , -Atthis hospital we see several cases of abscess of the
liver each year. During the past three years much help in
diagnosis has been found in the use of the fluorescent screen .
28-2
 206 ARCHIVES OF THE ROENTGEN RAY .

By this means upward enlargement of the liver, with a high
level of the diaphragm on the right side, can often be readily
made out ; frequently, also, diminished mobility of that side of the
diaphragm, and a more horizontal position of the ribs and wider
interspaces, are to be observed. I have seen scanty references to
these points in the literature.
During the past six months I have three times observed a
distinct and definite shadow - corresponding to the site of the
abscess — darker and more opaque than the rest of the liver
shadow . All three cases were submitted to operation, and the
presence of an abscess thereby confirmed ; and in all three cases
the abscess was found to be where the screen examination
showed this darker shadow, once in the left lobe, and twice
more or less in the centre of the right lobe. In all cases a tube
of great penetrative power was necessary, and the screen was
in front of the abdomen .
I should be glad if you could inform me if this possibility of
seeing the shadow of the actual abscess has been previously
reported. As an amateur in X-ray work, I feel some diffidence
in reporting what appears to be something new. Yet, on the
other hand, both myself and my colleagues are convinced that
in some cases (not in all) this shadow can be seen , and a definite
diagnosis established both as to the existence of an abscess and
its actual site. If this be correct, there is no doubt but that in
the use of this additional method of diagnosis much help is to be
gained in some cases.
The diagnosis of liver abscess, though often fairly easy to
those who have seen several, is occasionally very difficult. I
have seen several cases with absolutely no constitutional dis
turbance and scarcely any definite local physical signs. In
such cases I have found X rays to be of the utmost value.
I have the honour to be, sir,
Your obedient servant,
G. THORNTON, M.D. ,
Medical Superintendent .
Pretoria Hospital,
South Africa ,
October 7 , 1907.

PLATE CCLXXIX .
Normal chest of a youth, to illustrate the article on “ Plastic Roentgenography, ” by David Morgan, M.B.
PLATE CCLXXX .
Fracture of the lower end of the femur, to illustrate the article on “ Plastic Roentgenography,” by David Morgan, M.B.
*** The Editor begs to thank those correspondents who have been so kind as to senul articles and prints of radiographs for
THE ARCHIVES .
He would be very much obliged if contributors would send, with any prints intended for publication, a full account of the
case, and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used, or any other facts of interest.
EDITOR'S AND PUBLISHERS' NOTICES.
THE EDITOR begs to acknowledge communications from Dr. Born ( St. Louis, U.S.A.) , Dr. Harrison Orton (London),
Dr. Burnet ( Edinburgh ), Vernon J. Willey (Ann. Arbor, U.S.A.), Dr. Mangelsdorf (Bad Kissingen), Dr. Wertheim
Salomonson ( Amsterdam ).
The following Journals and Periodicals have been received : “ Advanced Therapeutics ,” “ The Electrician,"
“ The Electric Review ,” “ Knowledge,” “ The British Journal of Dermatology,” “ Annals of Physico-therapy,"
“ Medical Times," “ Medical Electrology and Radiology,” “ Archives of Physiological Therapy,” “ Archives
d'Électricité Médicale , " “ Le Radium ,” “ Annals d'Electrobiologie et de Radiologie ,” “ Fortschritte auf dem Gebiete
der Röntgenstrahlen , “ Münchener Medizinische Wochenschrift," " Zentralblatt für Physikalische Therapie,”
“ Annali di Elettricità Medica ," “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN Ray, care of
Messrs. Rebman Ltd. , 129 Shaftesbury Avenue, London, W.C.,” or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration, will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
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RA
L
T
YO . XII.H

PINo.
DI O

VIV

8E.
RA

NI
ARCHIVES
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY ).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER , M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE ( New York ); A. BECLERE (Paris) ; T. P. BEDDOES ( London ); J. BELOT ( Paris ); F. BISSERIE ( Paris);
H. BORDIER (Lyons); J. BURNET ( Edinburgh ); R. HIGHAM COOPER (London ); W. COTTON ( Bristol); FOVEAU DE
ELE COURMELLES ( Paris); L. DELHERM (Paris ); R. W. FELKIN ( London );
A
CTR L. FREUND (Vierina ); H. E. GAMLEN ( West Hartlepool); G. P. GIRDWOOD
R A P
O (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ;
D. GUNZBURG ( Antwerp) ; J. HALL-EDWARDS ( Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT ( Vienna ) ;
F. H. JACOB (Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
THE
ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris); $. LEDUC (Nantes) ;
E.R. MORTON ( London ); G.HARRISON ORTON (London ); H. G. PIFFARD (New 08
JA

York ); JNO.C.RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ) ; 9

1 .
N.

W. F. SOMERVILLE (Glasgow ); H. WALSHAM ( London ) ; CHISHOLM

WILLIAMS ( London ) ; CLARENCE WRIGHT ( London ).

CONTENTS

PAGE PAGE

EDITORIAL · 207 NOTES AND ABSTRACTS (continued ):

GLOVE FOR ELECTRO -MASSAGE 230
THE ELECTRO-THERAPEUTICAL EXHIBITION • 208
A NEW STOMACH SOUND FOR X-RAY USE . 230
THE INTERNATIONAL CONGRESS OF PHYSIO PROTECTIVE GLOVES • 230
THERAPY AT ROME. ( ABSTRACT FROM ' ARCHIVES THE ACTION OF RADIUM ON PLANTS AND ANIMALS . 230
D'ÉLECTRICITÉ MÉDICALE .” ) By W. F. SomERVILLE, M.D. 209 SYNTHESIS OF PRECIOUS STONES - 231
LOCALIZATION OF FOREIGN BODIES - - 231
NINTH CONGRESS OF MEDICINE AT PARIS, 1907.
(TRANSLATED AND CONDENSED FROM ARCHIVES D'ÉLEC A NEW MEDICAL QUARTZ LAMP FOR LIGHT TREATMENT 231
TRICITÉ MÉDICALE ,” Novi ER, 1907. ) . 212 REPORTS OF SOCIETIES :
ORIGINAL ARTICLES . SOCIETY OF ARTS - 232
The ROENTGEN SOCIETY • 232
Plastic ROENTGENOGRAPHY . By Dr. BÉLA ALEXANDER ,
Késmark, Hungary 216 REVIEWS :
AN ELECTROSTATIC VOLTMETER AS A CONTINUOUS A TEXT- BOOK OF ELECTROCHEMISTRY 233
INDICATOR OF THE PENETRATION OF A FOCUS - TUBE . ROENTGEN RAYS AND ELECTRO-THERAPEUTICS . 234
By PROFESSOR J. BERGONIÉ , of Bordeaux - 225
CORRESPONDENCE . - 235
THE LOCALIZATION OF FOREIGN BODIES IN THE EYEBALL. PLATES :
By H. H. BORN , M.D. , St. Louis, U.S.A. 228
PLATE CCLXXXI . -TO ILLUSTRATE DR. BÉLA ALEX
NOTES AND ABSTRACTS : ANDER'S ARTICLE ON “ PLASTIC ROENTGENOGRAPHY ” - 236
GROWTH OF FOG IN UNSATURATED AIR · 230 PLATE CCLXXXII . - PLASTIC ROENTGENOGRAM OF A
A NEW APPARATUS FOR ROENTGEN - RAY EXAMINATIONS HAND, TO ILLUSTRATE DR. BÉLA ALEXANDER'S ARTICLE
(TROCHOSCOPE) 230 ON “ PLASTIC ROENTGENOGRAPHY - 236

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VOL. XII.-No. 8. JANUARY , 1908.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER , M.R.C.S., F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York) ; T. P. BEDDOES (London ) ; J. BELOT ( Paris) ; A. BÉCLÈRE (Paris) ; F. BISSERIE (Paris) ;
H. BORDIER ( Lyons) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris) ; R. W. FELKIN ( London ) ; L. FREUND (Vienna) ; H. E. GAMLEN ( West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln) ; H , GUILLEMINOT ( Paris) ; D. GUNZBURG ( Antwerp ) ; J. HALL - EDWARDS
(Birmingham ) ; G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool); G. HOLZKNECHT ( Vienna ) ; F. H. JACOB (Nottingham ) ;
LEWIS JONES ( London ) ; A. C. JORDAN ( London ) ; ARCH . JUBB (Glasgow ) ; E. LAQUERRIERE ( Paris ) ; S. LEDUC (Nantes) ;
E. R. MORTON ( London ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD ork) ; JNO. C. RANKIN ( Belfast ) ; WERTHEIM
SALOMONSON ( Amsterdam ); W. F. SOMERVILLE (Glasgow) ; H. WALSHAM (London ) ; CHISHOLM WILLIAMS ( London );
CLARENCE WRIGHT ( London ).

PLASTIC Roentgenography, of which some beautiful some enterprising photographer who would devote him
examples appear in the present issue, bids fair to fur- self to this branch of the art, and show what might
nish us with still another important means of diagnosis. really be obtained, even from a very imperfect negative,
The work accomplished by the various exponents of by the processes of plastic Roentgenography. It is but
relief photography demonstrates the fact which has seldom that the radiologist himself has the necessary
been already suspected—viz., that a Roentgen negative skill and leisure to devote to technical photography or to
contains far more detail than meets the eye. The make the most of the four plates and the host of minor
shadows of different organs of slightly varying density details which are required by this method. It may be
melt imperceptibly one into the other, and it was a true said that the procedure is too complicated and costly for
stroke of genius that created the thin white line which general use ; but since kidneys are more valuable than
in a plastic Roentgenogram separates the darkness photographic plates, the surgeon will probably insist on
from the gloom . For the development of this idea we having the very best information obtainable, cost what
are indebted to Dr. Béla Alexander, who has kindly it will. In diseases of the brain especially the method
written a special paper on the subject for the Archives. should prove of utility. Who would have believed that
His patience and ingenuity have shown us that there is in the formless blotch which represents the brain of the
apparently no limit to the detail that can be obtained fætus represented in Fig. 1 of this issue lay hid the
from a Roentgen negative . The procedure was at first detail revealed in Fig. 2 by the reinforcement of the
regarded as a pretty toy, of no real utility. This view shadows and contrasts according to the new method ?
of the subject has, however, given place to a more just In his paper Dr. Alexander tells us how the inception
appreciation. The method of plastic Roentgenography of the new idea arose in consequence of the accidental
will doubtless receive a large amount of attention in the examination of a compound plate.
future . The procedure, however, is very similar to that which
At the last Berlin Congress, Holzknecht alluded to the has been used for some time in ordinary photography in
marvellous results obtained by Dr. Béla Alexander, and the production of what is known as cameo relief, a
gave his opinion that the procedure was a real advance process which had its origin, we believe, in England. In
in Roentgenography. the Amateur Photographer for 1905 there was an article
That English Roentgenologists are not far behindhand is describing the metbods used by Mr. Vivien Yeo and Mr.
proved by the beautiful specimens, made by this process J. V. Gordon, who appear simultaneously to have made
by Dr. David Morgan , which appear in the December the same discovery. Mr. Gordon's method is thus
number of this journal. There is surely scope here for described : “ The idea consists in superimposing a positive
29-2
208 ARCHIVES OF THE ROENTGEN RAY.

transparency upon the negative from which it was printed, X-ray work has already a history and a past of its own .
and then printing through the two of them simultaneously. This included many early examples designed by Professor
To produce the cameo - like effect, the two plates are placed Jackson and Mr. Glew. They also showed their heavy
slightly out of register. Mr. Gordon places film to film , discharge induction coils, the outcome of experiments
and prints through them on to bromide paper by the aid which were undertaken with the object of discovering a
of an enlarging lantern. Mr. Yeo advocates a mode of series of windings which would give the heaviest dis
working with them glass to glass , which is doubtless charge possible for any given supply. They also showed
convenient for contact printing when both components a complete “ change over " switchboard for working the
are on glass .” coil with both mercury and electrolytic breaks.
In the American Annual of Photography for 1906 is an Messrs. W. Watson and Sons made a special feature
article by Dr. F. Detlefsen on Cameo Relief Printing, of their intensified induction coil with moto -magnetic
illustrated by some interesting cameo prints. The interrupter. They also exhibited the radiographic couch,
author first makes a positive on platinotype paper. This made after Dr. Ironside Bruce's pattern. This couch ,
is placed, slightly out of register, behind the original which was shown at the Exeter meeting of the British
negative, and held in place by a clean sheet of glass. Medical Association, has been designed for the purpose
From this combination the cameo print is made on of securing a definite relation between the focus -tube
platinotype paper in direct sunlight. As the light has and the part under examination. The couch is furnished
to pass through the paper of the original positive, it with a movable upright and plumb-bob, which show the
position of
exact position
takes at least two days to produce one print. A developer exact focus-tube. By placing the focus
the focus-tube.
of the
containing acetate of potash is used, thus producing tube always in the same definite relation to some
great contrast, with bright high lights and dark shadows. anatomical point, the same view of each part can be
It is possible that this method might also be of use in ensured in every case.
plastic Roentgen-photography. Mr. K. Schall exhibited the newest modification of
Dr. Groedel's orthodiagraph. There was also a very
convenient table, with a motor transformer for cautery,
light, galvanization, and faradization . A new feature
THE ELECTRO - THERAPEUTICAL EXHIBITION. was a switchboard well protected with glass. Some of
the recently designed heavy discharge coils were capable
A WET evening greatly interfered with the attendance at of sending currents of from 15 to 20 milliampères through
the Annual Electro - Therapeutical Exhibition at the the focus -tube. He also showed a device for moving
Queen's (Small ) Hall on December 13 ; but there was screen , diaphragm , and tube simultaneously, so that
a good attendance at the conversazione, and many new perfect consonance was assured, and any part of a
objects of interest were exhibited. patient from knee to shoulder could be examined with
A focus-tube with tantalum anticathode was shown the tube, screen , and diaphragm in the same relative
by Messrs. Siemens Bros. The makers claim that position.
the use of this metal obviates one of the disadvantages The Sanitas Electrical Company exhibited a new
of the platinum anticathode, in that there is little or no mercury break which possesses several points of novelty.
disintegration of the tantalum , even when the anti- It is a centrifugal mercury break, but is said to give
cathode becomes incandescent. Other exhibits by this interruptions as rapid as a Webnelt break — some 8,000 a
firm included an improved protecting tube -stand, a minute. It also has the advantage of being able to run
switch-board for working a mercury and an electrolytic for a long period without any deterioration of the
interrupter, with a switch for varying the electrodes of mercury .
the Wehnelt interrupter and the self-induction of the Mr. H. Helm exhibited an assortment of X-ray tubes,
primary . They also showed the Albers-Schönberg com- some of which were stated to be able to stand 4 milli
pressor examining table, with a device for taking stereo- ampères for ten minutes. A novelty was a focus -tube
scopic radiographs. furnished with a nickel mantel to screen the anticathode .
Messrs. Newton and Co. exhibited a most interesting Messrs. H. W. Cox's stall contained some of their
collection of early focus-tubes, which reminded one that heavy discharge portable coils, as well as dark-slides,
 ARCHIVES OF THE ROENTGEN RAY . 209

intensifying screens, and other minor radiographic THE INTERNATIONAL CONGRESS OF

accessories. PHYSIO - THERAPY AT ROME .
Mr. A. E. Dean showed the London Hospital shield,
in front of which was attached a filter to absorb the soft
(Abstract from “ Archives d'Électricité Médicale" ).
rays. The filter consists of a cell made of celluloid, in By W. F. SOMERVILLE, M.D.
which is a saturated saline solution . Another interesting
exhibit was a lamp for producing the infra -red rays of The International Congress of Physio-therapy at Rome
the spectrum , which are said to be very efficacious in the during October of last year proved an unqualified success.
This result was brought about, not only by the number
removal of swelling and inflammatory congestions.
The Medical Supply Association were exhibiting and high position of the scientists from all parts of
their Gaiffe intensive interrupter, which is capable of Europe and from America who attended, but also by the
being adjusted either for radiotherapy or for rapid excellence of the many papers that were read. Physio
radiography. The Gaiffe static installation was also therapy had a triumph peculiar to itself, and testimony
shown. was offered on all sides of its great value in the treatment
A. Favre and Co. showed a bicathodal focus-tube for of disease .

locating foreign bodies. The two cathodes were some But, further, we must acknowledge that the success
inches apart, and each projected a shadow of the foreign was in great measure due to the valuable service rendered
body. The displacement was measured by a pair of by the President, Professor Guido Baccelli, of the Uni
calipers, which were graduated to read off the depth of versity of Rome. No one more suitable for the place of
the body from the surface. This firm also exhibited the honour could have been found in Italy. He was ably
well-known Bauer tube. supported by the Vice -Presidents, Professors Tamburini
The Marconi Wireless Telegraph Company showed and Casciani , his colleagues in the University, while
an interesting assortment of induction coils and mercury special reference must be made to Professor C. Colombo,
and electrolytic interrupters, also a high - frequency of Rome, who as Secretary proved himself to be the
apparatus, in which the frequency can be varied within leading spirit of the Congress. On his shoulders chiefly
wide limits by the simple movement of a small crank lay the burden of the multitudinous arrangements which
handle , the frequency being at the same time indicated were carried out with such gratifying results. The
cordial thanks of all the members were offered to him
on a scale .
A very ingenious instrument was that of Mr. Leslie for his wise and excellent management and for his genial
Miller - a rectifier for use with the rotating mercury courtesy throughout. Valuable assistance was rendered
break. This consists of a rotating mica disc, which by the committee of influential men, among whom we
is perforated in such a manner as to allow the current may mention the names of Professors Capriati , Ghilar
to pass only at the moment of “ break,” thus cutting off ducci , Luzemberger, Bisinino , and others. The com
the reverse current entirely. This rectifier is used with mittee further embraced a host of other illustrious men, 2

a rotating magnetic interrupter. well known in the various departments of surgery,

The exhibition was a great success, and showed
decided advance in electro-therapeutic technique during
the past year. The most noticeable feature was the
increase in power of the coils which were shown , most
of them being of the so -called intension type, capable of
driving heavy currents through the focus-tube.
We greatly regret to hear of the death of Dr. G. W.
Graham , who was formerly treasurer to the British
Electro -therapeutic Society, and also a contributor to
this journal .
medicine, nervous diseases, hygiene, etc.
On the evening previous to the opening of the Con
gress , the committee met to discuss the place of meeting
for the next Congress. In response to cordial invitations
from the French Government and the city of Paris,
presented respectively by Professor Bouchard and Pro
fessor Landonzy, it was unanimously agreed to hold the
third Congress of Physio-therapy in Paris in 1910.
The discussions on special subjects were subdivided
into three sections : (1 ) Medical Electricity, (2) Kinesi
therapy and Orthopedic Surgery, (3) Hydropathy and
Climatology. Only a brief reference can be made here
to a few of the papers read at the Congress.

4
210 ARCHIVES OF THE ROENTGEN RAY.

Professor DOMENICO D'ARMAN (Venice), “ On the the region treated and to the nature of the electrolyte
Introduction into the Living Organism of Various itself. A general account was given of the action of
Drugs by Means of Electricity.” The following were electrolysis in gynecology and in urethral stricture.
his conclusions : While they maintained that the ions did not penetrate
1. Physiology and clinical experience have now beyond a certain limited depth, they acknowledged the
clearly shown that various drugs may be introduced benefit that could be derived by the introduction of
into the organism by means of electricity. lithium in rheumatic arthritis, of chloride of sodium in
2. Physiology has further demonstrated that in certain ankylosis, and of the salicylic and quinine ions in the
circumstances these drugs can be introduced in sufficient various neuralgias and in " tic- douloureux.”
quantity to produce toxic and even fatal results. In addition, they alluded to the action of the zinc ion
3. There is a diversity of opinion among clinical in ulcerations and in small cancroids, of the manganese
observers regarding the advantages of ionization ; and, ion in warts, and of other ions in pleuro-proumonia and
further, it occasionally happens that the same observer in diseases of the throat and nose.
has obtained different therapeutic results, though the The action of the current itself , and not so much the
cases treated were apparently similar in character, the drug employed, is of the greater importance.
technique used remaining the same in each experiment. Dr. BETTON MASSEY ( Philadelphia), “ On the Cata
4. The best results of treatment by ionization have phoric Sterilization of Cancer.” Since 1893 the author
been obtained in cases of arthritis and chronic neuralgia. has been in the habit of employing zinc and mercury
5. Before employing ionization, it may be well to con- electrically introduced for the destruction of cancerous
sider whether it will not be simpler, more economical, tumours, and up to 1905 he has treated seventy-nine
and equally effective to introduce the same drugs by cases by this method. Of these seventy -nine cases only
mouth or rectum , or subcutaneously. eighteen were completely cured, no subsequent trace of
6. When the ordinary methods of treatment have malignant disease being detected. In the other sixty-one
failed, and galvanism alone does not produce satisfactory cases there was, as a rule, considerable improvement,
results, then ionization may be tried. Where failure occurred, this was due chiefly to metas
7. It is of importance to make several clinical experi- tasis having taken place into internal organs previous to
ments in order to dissociate as far as possible the action the time of operation.
of ionization from that of the galvanic current alone. In a second series of sixty-one cases since 1905 no
8. It frequently happens that a current of 25 milli- fatality occurred after operation . Previous to operation
ampères, or even less, cannot be borne by the patient the diagnosis , except in one or two cases, was confirmed
even when the skin is normal. It is therefore of im- by means of the microscope.
portance to examine the portion of the integument to Professor BERGONIÉ (Bordeaux), “ The Importance and
which the active electrode is applied. the Desiderata of Electro-diagnosis."
9. In the present state of our knowledge it is well to 1. In the term “ electro-diagnosis " he includes all the
realize that the introduction of drugs by ionization is objective symptoms produced by a simple electrical
still a matter for further research, although Professor application , and not a combination of muscular reactions ;
S. Leduc, of Nantes, and others have obtained thera- also the variations of electrical resistance, voltaic
peutic results which may be described as amazing. vertigo (Babinski's sign) in the examination of the ear,
DELHERM and LAQUERRIÈRE, of Paris, “ On the and the influence of suggestion .
Electrolytic Introduction of Medicinal Ions." The 2. An International Commission should be formed to
authors alluded to the points on which confusion occa- publish a list of objective symptoms produced by electrical
sionally arises in connexion with cataphoresis and applications , both in the case of healthy persons and
electrolysis. Their opinion agreed with others that those suffering from various diseases, with a note of the
substances can undoubtedly be made to enter the suitable method of application in each case. This would
organism by means of electrolysis. The composition be of value in legal cases and in the diagnosis of
of the ions, their speed of movement, and the amount malingerers.
that can be conveyed into the tissues were also discussed. 3. He maintained that the absence of faradic contrac
Reference was made to the phenomena that occur in tion, and its return after voluntary contraction (reaction
 ARCHIVES OF THE ROENTGEN RAY . 211

of Duchenne), and the slowness of the response to gastro -enteritis. In most of these he used autocon
electrical stimulation (reaction of Remak ), occur quite densation . In gastro -enteritis he employed the bipolar
independently of the patient's will. method .
Dr.LAQUEUR (Berlin ), “ On High-Frequency Currents . " He advocated the use of the current from the top of
1. Local applications were of great benefit in pruri. the resonator. The condenser was of great service in
ginous affections of the skin. In pruritus and eczema chronic sciatica and the vacuum electrode in certain
the cause of the itching was removed. In severe eczema, skin affections.
however, but little benefit was obtained , and frequently Dr. BONNEFOY (Cannes), " On High - Frequency
the itching recurred . The treatment often failed in Currents." Lowering of arterial tension in cases where
pruritus senilis. blood pressure is high is produced by high -frequency
2. General application of high-frequency currents. currents, though time is required to produce this result.
(a) In advanced arterial sclerosis there was no The sphygmomanometer, while of great service in deter
improvement. The blood - pressure was not lowered ; mining the lowering of blood-pressure, does not give
indeed, there was often noticed after treatment a rise of results that are mathematically exact, but only shows
bloodpressure. relative alterations. The influence of high -frequency
(6 ) In high blood pressure in young people, or in currents on the peripheral circulation and the accom.
patients with signs of commencing sclerosis, there was panying subjective phenomena also indicate a fall of
a lowering of the blood -pressure, with corresponding arterial tension.
improvement in the general condition of the individual. The sensations of a patient suffering from high arterial
The benefit was gradual, but, as a rule, permanent. The tension under treatment by these currents are those of
pulse was not altered in character or speed. warmth, first in the hands and forearms, and then in the
(c) Where there is cardiac disease without arterial arms, trunk , and lower extremities. This sensation of
sclerosis, good results were obtained by the local applica- warmth is not felt equally by all patients. Some
tion of a condenser electrode over the precordial region . appreciate the heat from the very first, others only
Not only was the improvement felt by the patient, but when they have been treated on several occasions. But
the cardiac dilatation was less marked . in all cases there is a lowering of arterial tension and an
Dr. Sloan, of Glasgow , “ On High-Frequency Cur- increase in the amplitude in the capillary pulse ( Delherm
rents .” Io Great Britain medical men viewed with some and Laquerrière). Dr. Somerville has demonstrated by
degree of suspicion every method of treating diseases by means of surface thermometers that there is a rise of
means of electricity. Especially is this so in the case of temperature on the surface of the body.
high-frequency currents. Unfortunately in many cases These same currents, which lower arterial tension in
this form of applying electricity had fallen into the hands persons suffering from increased blood-pressure, raise the
of unqualified individuals incompetent to gauge its effi- pressure where the tension is subnormal. This is due to
cacy. It is only of late that scientific observations, based the heart having less resistance to overcome through 1

on physiological effects, have been published.
The influence of high frequency on the pulse-rate and
on blood-pressure varied according to the condition and
the surroundings of the patient, and also according to
the nature of the disease .
The author discussed the question of the different
effects produced on the patient, the dosage and voltage,
and the frequency of application of these oscillating
currents, and suggested that experiments should be made
to determine the exact conditions producing depression
or stimulation .
The author also gave his own experiences in the treat-
ment of cases suffering from perverted cell metabolism,
weurasthepia, diabetes, rheumatism , insompia, and
capillary dilatation , and so recovering its contractile
power ( Bonnefoy). Or it may be caused by the currents
acting directly on the central circulation and on the
heart itself (Sloan) . High- frequency currents may thus
be considered as regulators of the circulatory system .
Those diseases described by Professor Bouchard as
“ Maladies par ralentissement de la nutrition ” —e.g.,
rheumatism and gout, biliary and urinary lithiases,
certain forms of asthma and pulmonary emphysema,
diabetes, eczema, psoriasis, etc. — are all amenable to the
good influence of high -frequency currents.
Dr. DEANE BUTCHER ( London ), “ On the Therapeutic
Action of Radium . ” Like all other new methods for the
treatment of disease, radium -therapy has passed through
212 ARCHIVES OF THE
three stages - first, where promise is given of a cure for
every ill that flesh is heir to ; second, where the pendu-
lum swings in the opposite direction , and the remedy is
declared to be useless as a curative agency ; and, third,
where it is found to be of service in a well-defined group
of pathological conditions.
Nothing is more certain than the fact that a small
superficial neoplasm—e.g., a lupus, a rodent ulcer, or an
epithelioma — will disappear after exposure to the radia-
tions of radium .
Among skin affections, warts, malignant ulcers, lupus
nodules, and syphilitic thickenings also disappear under
the influence of the Becquerel rays.
In the case of cancer, it was only in the early stages
that radium proved of service. It appeared that the
ethereal undulations produced by the a and y rays of
radium were incompatible with the due development of
embryonic or rapidly growing cells.
The question of dosage was all-important . Radium
irradiation has a stimulating effect when employed in
small doses, but a destructive one in large doses.
The most powerful specimen used by the author would
produce blistering of the skin in ten minutes. His
method was to give an exposure lasting from five to ten
minutes once a week. By following this course he was
able to regulate the dose in proportion to the reaction ralgias following zona.
produced, and avoid danger of the production of telangi-
ectases . pruritus, and is infinitely superior to all other means of
The material of the cover of the radium capsule, and combating this " neurosis of the skin . " All cases of cir.
perhaps of the backing, had some effect on the efficacy cumscribed pruritus with lichenification of the skin are
of the irradiation,
The proceedings of the Congress opened on Saturday
evening, October 12, with a general reception given to
the members by the committee of management. On
Sunday forenoon a large official meeting was held in the
Salle des Horaces et des Curiaces at the Capitol, in the
presence of the Minister of Public Instruction . The
morning of Monday was spent in a reception of the
official delegates from the various foreign Governments
by the Ministers of Foreign Affairs and of Public Instruc-
tion at the Consular Palace. On Tuesday evening the
members were welcomed by the city authorities in the
gorgeous Museum of the Capitol. An illumination of
the Coliseum and Roman Forum was given on the
Wednesday, and on Thursday there was an excursion to
Tivoli .
At the termination of the Congress an instructive
ROENTGEN RAY.
excursion was made to the chief thermal springs and the
health resorts in the islands and in Central Italy, with
Professor Casciani as escort and guide.
It is to be hoped that the Congress in Paris in 1910,
under the presidency of Professor Landouzy, will be as
great a success .
NINTH CONGRESS OF MEDICINE AT PARIS, 1907.
( Translated and condensed from “ Archives d'Électricité
Médicale, " November, 1907. )
The Therapeutic Action of Radium .
The Ninth Congress of Medicine, which was held at
Paris from October 14 to 17 , devoted considerable atten
tion to the therapeutic action of radium .
A report was communicated by Drs. De Beurmann,
Wickham , and Degrais on the “Use of Radium in
Pruritus and other Chronic Dermatoses." The reporters
came to the following conclusions :
1. Radium irradiation is a cure for cutaneous epithe
liomata .
2. Pain and itching disappear during the treatment of
epithelioma by radium irradiation. The analgesic action
of radium is also very marked in the treatment of neu
3. Radium is specially useful in the treatment of
at once ameliorated.
4. Radium irradiation may be usefully employed in all
circumscribed dermatoses accompanied by lichenification,
such as chronic eczematous patches. In the treatment
of orbicular eczema of the lips and chronic eczematous
parakeratosis excellent results are obtained. Radium
irradiation produces an immediate cessation of the
itching, and a return of the thickened and infiltrated
tissue to its normal appearance. This improvement is
partly due to the cessation of scratching, but the irradi
ation also appears to exercise a modifying action on the
congestion and infiltration of the dermis, as well as on
the hyperkeratosis and parakeratosis of the epidermis.
5. The resolvent effect of radium irradiation is clearly
shown by its action on psoriasis, psoriasiform parakera
tosis, and parapsoriasis.
6. At the St. Louis Hospital and at the Biological
Radium Laboratory a disc is used, 6 inches in diameter,
 ARCHIVES OF THE ROENTGEN RAY . 213

impregnated with 20 centigrammes of sulphate of radium. encouraging results were obtained in the treatment of
The initial activity of the salt was 500,000. A portion deep - seated visceral pain due to tuberculous cystitis
only of this penetrated the varnish, so that the exterior and cancer. Energetic radium irradiation, on the other
radiation was 300,000. Of this exterior radiation 10 per hand, has been found useful in inflammatory and neo
cent. consists of a rays, 75 to 80 per cent. of B rays, and plastic processes, such as lepra, certain forms of glan
from 10 to 15 per cent. of y rays. The application was dular tuberculosis, and in scirrhus of the breast. Later
made by placing the disc directly in contact with the on these experimental researches will be published,
integument for periods varying from a few minutes to an together with those resulting from the introduction of
hour, according to circumstances. the radium emanation and solutions of bromide of
7. Radium is capable of rapidly modifying chronic radium into the organism .
pruriginous dermatoses which have resisted all other
means of treatment. It speedily cures itching and pain, Mycosis Fungoides treated by Radium (by Drs.
BEURMANN, DOMINICI, and RUBENS DUVUL).
and causes the disappearance of parakeratosis and
lichenification .The treatment is rapid and painless , The authors report a case of mycosis fungoides
and there is no danger of accidental complications, since (lympho-sarcomatous type) treated with radium . The
the dose can be regulated with exactitude. One point of patient, aged sixty - two, was treated at the Hôpital
interest with regard to recurrence is the fact that when Saint- Louis for a mycotic tumour of the lateral region
recurrence does occur it is usually outside the area which of the thorax. The centre of this tumour presented a
has been treated by irradiation. rounded ulceration 3 centimetres in diameter. There
was also a large indurated patch on the left buttock,
The Application of Radium to Internal 18 by 25 centimetres. This was thickly set with hard
Therapeutics (by Dr. DOMINICI). nodules sunk into its substance, with ulcerating and
gangrenous superficial ulcers, the whole giving forth an
The application of radium in internal medicine is of
two kinds-one the action of radium irradiation, the insupportable odour. The patient complained of severe
other the action of the radium emanation. pruritus, accompanied by lancinating pains.
In the application of radium irradiation to the treat- The radium treatment was commenced on August 4,
ment of internal organs it is necessary to suppress the and was continued till September 6. The applicator
action of the softer and less penetrating rays, which are was a disc on which was thinly spread a salt of radium ,
specially noxious to the integument and superficial covered by a thin layer of varnish. At first each application
tissues. The radiations of radium are , in the order of was of two hours' duration , while later on this was
penetration : extended to three hours. Two or three applications were
1. The a rays .
made over different regions every second day.
2. Soft B rays .
The lesion of the thorax received three applications of
3. Intermediate 3 rays. two hours each . The buttock was irradiated so that
4. Hard ß rays . each separate area was submitted to the action of radium
5. The y rays . for twelve hours, divided into six séances. The entire
In a first series of experiments the author utilized the buttock received fifty exposures of two to three hours
action of the intermediate ß rays, the hard ß rays, and each.
the y rays . These observations were carried on in The radium irradiation caused an immediate cessation
collaboration with Dr. Gy at the Beaujon Hospital. of pain and pruritus. The ulcerations cleared up and
Good results were obtained in a number of cases of cicatrization ensued. This was almost complete ten
blennorrhagic arthritis, neuritis, and chronic rheu- days after the conclusion of the treatment. At the
matism . present moment all the ulcers are completely healed
In a second series of experiments observations were and are level with the skin ; the infiltration of the
made on the action of the hard ß and y rays exclusively. integument itself has entirely disappeared, and the skin
This procedure has the advantage of permitting ex- has regained its normal flexibility.
ceedingly powerful radium irradiation of the deeper On microscopical examination the growth was found to
zone without danger to the superjacent tissues. Very be a lymphadeno-sarcoma, consisting of islets of pure
30
214 ARCHIVES OF THE ROENTGEN RAY.

sarcoma, others of pure lymphadenoma, and still others form cells . This angiomyxoma is further transformed
of mixed lymphadeno-sarcoma. into fibromatous tissue.
Under the influence of the radium irradiation the cells It appears from these observations that the healing of
regressed to the embryonic type, and the sarcoma was inflammatory conditions and of certain tumours does not
transformed into embryonic mucous connective tissue. result, as is sometimes supposed, from the destruction
This in turn was transformed into the adult fibromatous of the morbid tissue by the Becquerel rays , and the
type. The embryonic lymphatic cells were in like manner subsequent phagocytosis of these tissues by the macro
transformed into fibromatous tissue . phages. The result of radium treatment depends rather
on a definite modification of cellular evolution , which is
The Histological Modifications determined by determined by the physical effects of the irradiation.
Radium Irradiation (by Drs. DOMINICI and BARCAT).
The authors found the following results to follow The Use of Radium in Dermatology ; Dosage ;
radium irradiation of the normal skin, or of the integu Restitution Tissue (by Drs. WICKHAM and DEGRAIS).
ment which had been more or less modified patho- The following are the authors' conclusions :
logically : 1. The dosage of radium irradiation has enabled them
Normal Skin.—The papillary layer, the dermis, and a to give some 3,000 applications without a single case of
part of the hypodermis are replaced by embryonic con- accidental dermatitis .
nective tissue, formed by long fusiform cells anastomosing 2. As the process is quite painless the application is
so as to form a vast network. This is traversed by extremely easy, the patients being able to hold the
enormous embryonic capillaries, choked with red globules applicator themselves.
and polynuclear cells. 3. Even after a sharp radium reaction the lesion is
There are no inflammatory phenomena, no phago replaced by a tissue so soft and flexible, and so ad
cytosis, and no diapedesis of the polynuclear cells. The mirable from an æsthetic point of view , that it can
subepithelial portion of the integument acquires the hardly be called a cicatrix, but rather a tissue of
structure of an embryonic angiomyxoma . In the second restitution .
stage of transformation some of the capillaries of the Radium -therapy must be regarded as having entered
new formation regress, while the connective tissue is definitely into the domain of practical dermatology. The
transformed into cicatricial tissue of the fibromatous authors draw attention to the following treatises on the
type. same subjects , which they have published at various
Experimental Cutaneous Tuberculosis. The inflam- times :
matory conjunctive vascular tissue around the tubercles (a) “ The Radium Treatment of Cutaneous Epithe
is transformed into an angiomyxomatous tissue. There lioma,” Congress at Rheims, 1907 , and Congress of
is arrest of diapedesis, disappearance of the polynuclear Dermatology, New York, 1907.
cells, arrest of phagocytosis, disappearance of the (6) “ Treatment of Vascular Nævi by Radium ,"
macrophages, elimination of plasma cells, metamor- Académie de Médecine , October, 1907.
phosis of the fixed cells, which have become hyper (c) “ Treatment of Pruritus and Certain Obstinate
trophied by the inflammatory process into embryonic Dermatoses, Neuro-dermatitis, Eczema, Psoriasis, ” etc.,
fusiform cells. There is, moreover, neoformation of Congress of Medicine, October 17, 1907 .
blood capillaries. This transformation includes the
tubercles themselves ; their epithelioid cells are changed The Hæmostatic Action of Radium (by Dr. OUDIN).
into embryonic, fusiform , connective-tissue cells. I have already read , in collaboration with my friend
In the second place, the angiomyxomatous tissue Dr. Verchere, a paper at the Academy of Sciences and
which replaces the inflammatory tubercular tissue is at the Lyons Congress on the “ Use of Radio-active Salts
further transformed into fibromatous tissue. in Gynæcology.” We were induced to study the question
Cutaneous Tumours .-Certain tumours of the skin , by various observations which have been published on
such as sarcoma with atypical cells, are transformed into the diminution in the size of fibromata subjected to the
a tissue resembling angiomatous myxoma by mutation of action of the X rays. We had ourselves verified this
the atypical sarcomatous cells into fixed embryonic fusi- diminution in one case, and we considered it would be
 ARCHIVES OF THE ROENTGEN RAY. 215

much more logical to introduce the source of the X rays X rays. The endothelium of the capillaries is detached
under the form of a radio-active salt into the uterine and the cells become granular. It is probable that a
cavity itself, instead of endeavouring to irradiate the powerful specimen of radium, such as I employ, consti
tumour through the abdominal walls. tuting, as it does, an active source of X rays almost in
Without entering into the details of the modifications contact with the vessels of the mucous membrane,
in the tumours thus treated, we may say that the fact provokes a similar obliterating action in the capillaries
most vividly forced on our notice was the arrest of of the uterine mucous membrane.
metrorrhagia in all cases where this symptom was present. The treatment by radium is absolutely innocuous. I
As there was at the same time a very sensible retrac have repeated it frequently without the smallest un
tion of the tumours and a diminution of the peri-uterine favourable symptoms. A radio-active source emitting
infiltration, we were uncertain if the hæmostasis was from 900 to 1,000 units of radio-activity may remain
due to local congestion , or to a reduction of the calibre with impunity in contact with a mucous membrane for
of the vessels due to the retraction of the fibroma, or, twenty minutes or more. I have tried this experiment
finally, whether it was not caused by some special on the mucous membrane of my own lips, and have in
action on the vessels of the mucous membrane. this way produced slight ulceration , which took a week
In the following cases no fibromatous tumour was to heal , and in consequence of its position was somewhat
present , and, nevertheless , the results were equally painful. The effect is much more superficial than an
favourable . The radio-active substance was the same electrolytic application of 20 or 30 milliampères, and it
I had previously used-i.e., 25 milligrammes of bromide is to be remembered that the mucous membrane of the
of radium , containing 75 per cent. of the pure salt, with uterus is absolutely insensitive.
a radio -activity of 1,800,000. It may be objected that there is danger of causing
The radium was sealed up in a little glass tube sterilization in thus introducing a source of X rays into
25 millimetres in length and 2 millimetres in diameter. the neighbourhood of the ovaries. To this I may answer
The glass tube is contained in the end of a hollow tube that in most of my cases ovulation continued after the
of aluminium , having the form and dimensions of an radium treatment. It would appear from the obser
ordinary uterine sound 34 millimetres in diameter. The vations of M. Pinard that under these circumstances
glass and aluminium together allows the passage of there is no sterilization . At all events, the sterilization
only ooo of the total irradiation - i.e. , 920 units of is not permanent. In any case, one would not hesitate
radio-activity for each 1,800,000. This consists princi- on that account to treat an obstinate metrorrhagia, which
pally of y rays, with a few very penetrating B rays. The does not usually make its appearance till towards the
a rays and the less penetrating ß rays are entirely close of the woman's sexual life.
screened off by the glass and aluminium. The sound
was introduced into the uterine cavity with all antiseptic
precautions, and was left there for a period of ten to A striking instance of the use of Roentgen diagnosis
twenty minutes. is afforded by a case of pneumothorax at Guy's Hospital ,
I will mention four cases of metrorrhagia cured by reported by Dr. J. Fawcett. The patient was a man ,
the introduction of the radium sound. aged twenty-two, admitted with pneumothorax of the
CASE 1. - Three applications of ten minutes each . right side and much dyspnea. As the condition re
CASE 2.—One application of twenty minutes. mained unchanged after nineteen days, the patient was
CASE 3.-Two applications of fifteen and twenty placed on the couch and examined under the X rays.
minutes . The lung was seen to be compressed towards the spine .
CASE 4. - Three applications of fifteen and twenty A trocar and cannula were inserted into the pleural sac
minutes . in the sixth -interspace and connected with a partially
These observations appear to show that the hæmostatic exhausted bottle . The lung was seen then to expand,
action of radium in gynecology is chiefly exercised on and when fully expanded the cannula was withdrawn
the capillaries of the mucous membrane. Histological and the puncture sealed. The lung at once acted
examination has demonstrated that endarteritis obliterans perfectly to the respiratory movements, and the man
is one of the more prominent lesions produced by the was discharged well twelve days later.
30-2
216 ARCHIVES OF THE ROENTGEN RAY.

PLASTIC ROENTGENOGRAPHY. menters modified these defects and made many valuable
By Dr. BÉLA ALEXANDER, Késmark, Hungary. suggestions. None of the results, however, gave the
same accuracy and detail as those produced by th
In March, 1906, I exhibited to a meeting of the Royal method which I exhibited at the Third Berlin Roentgen
Medical Society of Budapest ? a series of photographs Congress. Perhaps I may be allowed to quote the
giving a plastic reproduction of various bones-i.e. , words of the President of the Congress, Dr. Albers
pictures in which the bones stood out in strong relief Schönberg : “ Shortly after last year's Congress I com
instead of the flat silhouettes of the ordinary Roentgeno- menced experimenting with a view to reproducing Dr.
gram. The pictures were from subjects of various ages, Béla Alexander's technique. I had previously come to
and showed different portions of the body, such as the the conclusion from my own experiments, and from the
hand, elbow, shoulder, foot, ankle and knee, the base of observations of others interested in the subject, that the
the skull, and the thorax of a child. In these pictures so-called plastic Roentgenography was a very interesting
there appeared, in addition to the silhouette of the bones, photographic plaything, but of no practical scientific
shadows which represented very distinctly the structure A few days ago, however, Dr. Alexander
interest .
of many of the softer parts. showed me his results, and I had a better opportunity
Shortly afterwards I showed the pictures at the of thoroughly studying and testing them than is possible
Second Congress of the German Roentgen Society, and at a public exhibition. In consequence I have been
explained the process of their production , although at compelled to alter my opinion completely. Dr. Alex .
that time the method had not been finally evolved and ander's pictures have nothing in common with what we
completed. I published my results in the Fortschritte auf have hitherto known as plastic Roentgenograms. The
dem Gebiet der Roentgenstrahlen. Subsequently several technical completeness of Dr. Alexander's results is
radiologists attempted to follow the method outlined in perfect. The finest details of structure are clearly
my first description. I endeavoured to point out wherein shown , and , what is still more marvellous, the veins and
their procedure failed, entailing in some cases the
arteries are visibly depicted in a manner which to the
destruction of the original negative, and in all cases expert is absolutely astounding. We welcome Dr. Alex
causing distortion of the shadows. In the case of the ander's plastic Roentgenography as a real advance in
bones this often went so far as to double their real Roentgenological technique. It brings out details which
breadth. In my own method the original negative is in were indeed present in the original negative, but by
no way injured. The true proportions are neither dis reason of their lack of contrast were hardly appreciable
torted nor contracted . On the contrary, the details to the eye. I cannot doubt that this method has an
stand out more clearly , appearing in their true propor- assured future. Consider what immense importance it
tions and relative positions. may have in the diagnosis of disease of the lungs, in the
An article on the capabilities of plastic Roentgen- recognition of renal calculus, and perhaps even of gall
ography, with a still more detailed account of the stones. The shadows of the abdominal organs, of the
process, has since been published in the Hungarian kidneys , and those of the stones themselves , can by this
paper, the Gyogyászat. Since then I have exhibited and method be emphasized and rendered much more easy of
described a complete series of pictures before the Royal recognition."" 8
Society of Medicine of Budapest . This series illustrates In a good skiagram of any portion of the body, the
each step in the preparation of the plastic Roentgeno- very richness of detail necessitates that some portion of
gram , from the first negative on glass to the final print the complicated structure must hide other portions. Let
on paper. us consider, for example, a skiagram of the hand, taken
These publications were made between my first under the most favourable conditions, with every advan
demonstration of plastic Roentgenography at the Second tage devised by the ingenuity of the skilled radiographer,
Berlin Congress and the meeting of the Third Roentgen and taken with an exposure sufficiently long to bring out
Congress. As already mentioned, my first method had all possible details. In such a skiagram we may discern
to be abandoned, since the results were inaccurate in -if, indeed, we have eyes to see, and knowledge to
their proportions, and, moreover, the method entailed interpret what we see— a host of details that are quite
the destruction of the original negative. Later experi- invisible in the ordinary Roentgenogram , a mere sil
 ARCHIVES OF THE ROENTGEN RAY. 217

houette of the bones with a more or less incomplete in Fig. 2 the tympanic rings on either side show up
reproduction of their structure. clearly with sharp outlines. Each centre of ossification,
As an example of the advantages of plastic Roentgen- both in the base of the skull and in the face, can be
ography, let us compare a plastic Roentgenogram with identified. In Fig. 1, on the other hand , such identifica
an ordinary skiagram of an embryo, showing the ossifi- tion is often impossible. Even after the most careful
cation of the bones . Plate CCLXXXI. , Fig. 1 , shows the examination we can only make tentative guesses at the
skiagram of an embryo 19 centimetres in length. This meaning of any one particular shadow. In Fig. 1 the
picture was the best of a series of experimental plates with smaller ossifications of the base of the occiput are only
varying exposure. I took a number of skiagrams under partially visible. The ossification centres of the parietal
similar conditions and in exactly the same position. and frontal bones are quite distinct in Fig. 2, whereas
These were all developed and compared, and the illustra- even the orbital ossification is ill-defined in Fig. 1. In
tion is a reproduction of the best of the series, so that other regions the difference is as well marked as in the
it may be regarded as the very best simple skiagram bones of the skull. The ossification of the bones is so
which it is possible to obtain of this particular view of clearly shown in the plastic Roentgenogram that we can
the object . trace the various stages of ossification in the bodies of
There is a fact which must have been observed by all the vertebræ from the first appearance of the primary
those who have taken up the Roentgenological study of outer centre in the fifth sacral vertebra to that of the
the embryo-viz . , the great difference in the penetra- inner centre of ossification in the first and second
bility of different embryos by the X rays. Even when lumbar vertebræ.6
every precaution has been taken, radiographs of embryos In the extremities, again , we get a clear and sharp
of precisely similar size may on one occasion result in outline of the structure in Fig. 2, even where the small
an almost perfect reproduction, whereas at another time spots of darker shadow are almost indistinguishable in
the results are much less satisfactory. It may happen the ordinary skiagram.
that a larger embryo will thus give a better picture than In spite of the vast differences in detail , Fig. 2 has
a smaller one, wbich would a priori be likely to give a been obtained from the same negative as Fig. 1.
much sharper and more instructive picture. The method is a simple one , and consists merely in
The embryo's tissues also behave diversely in regard taking a diapositive from the original negative, placing
to the penetrability of the X rays. The skiagram negative and diapositive together with the films outwards,
(Fig. 1 ) is, as we have said, the very best obtainable and then printing another diapositive from the combina
from the given specimen ; yet it does not give all that tion . Fig. 2 is a reproduction of this compound plate.
we could wish as regards sharpness of outline. We A plastic picture may also be obtained by printing on
have, moreover, to look very carefully before we can paper from the compound plate, but the sensitiveness of
distinguish some of the finer details, and in the case of the film on a photographic plate is greater than that of
the smaller ossifications the required information is not the photographic paper, and a reproduction on glass will
forthcoming therefore be much clearer and more exact. I therefore
The difference between this picture and the plastic usually prepare a third plate, a print on glass from the
Roentgenogram in Fig. 2 is so striking that even the compound plate, and this for several reasons. Firstly, a
most cursory glance shows the immense superiority of paper print from Plate III. will be much sharper than
the latter, and yet both of these pictures are made from one made from the combination of Plates I. and II.
the same negative. Secondly, in Plate III. we have a single plate from
On comparing Figs. 1 and 2, whether we study the which additional prints can be made at any future time.
trunk, the skull, or the extremities, we find that the Thirdly, when we desire to compare the three plates, it
second picture is the stronger and shows more detail. is necessary to separate Plates I. and II. , which in that
This increase in clearness is equally evident in the bones case cannot be kept permanently superimposed one on
and other structural details. the other.
On comparing the skull in the two pictures, we see Figs. 1 and 2 show that the action of the diapositive
that in Fig. 1 the centres of ossification of the base of on the negative is to intensify the contrasted shadows,
the skull are blurred and run into one another, whereas and thus make the details sharper and clearer, without
 218 ARCHIVES OF THE
in any way altering or distorting the proportions of the
original skiagram .
My first attempt in this direction was to try the effect picture, which should, of course, depict the details of the
of a combination of two focus -tubes for the production softer tissues as well as the more striking images of the
of a Roentgenogram. I found that this method gave me
excellent results with perfectly clear outlines. I next
proceeded to try a combination of two plates.? My
original method was briefly as follows : From the most
perfect negative obtainable I made a diapositive, and
placed the two back to back -i.e., with the sensitive side
of the glass outwards, adjusting them carefully so that
the two images were accurately superimposed. On
holding these somewhat obliquely to the light, I obtained
such an excellent picture in relief that I carefully fastened
the two plates together and endeavoured to obtain a
reproduction on paper. The resulting print, though a
good picture, was unsatisfactory, because I was unable
to compare it with the original negative , and I at once
saw what an advantage it would be to make a diapositive
of the combination. My expectations were verified ;
the diapositive showed much more detail than the print,
details hitherto quite invisible showing up distinctly.
Further, on comparing the plates I had the satisfaction
of finding by direct measurement that the proportions of
the original negative had not been distorted by the
manipulation of the plates. The sharpness of outline
of the contrasting shadows showed up much detail
which was quite invisible on the original negative, since
the gradual shading off of one shadow into another
renders small differences of density very difficult to
detect. The third plate thus acts as an interpreter,
emphasizing the meaning of the original negative.
In order to reproduce this third plate on paper we
require a fourth plate, a negative from which copies phalanx of the thumb.
may be printed in the usual manner. This Plate IV.
will, of course , be the reverse of Plate III. , bearing to it
the same relation as an ordinary negative to a positive.
Prints from Plate IV. will therefore be reproductions on
paper of Plate III. These are found to be much clearer
and more detailed than those made directly from the
combination of Plates I. and II. There is, of course, no
limit to the number of copies that can be made from
Plate IV.
The original superimposed negative and diapositive much can be accomplished in the differentiation of the
may be best examined on a black background. The
soft parts should be of a bluish, almost blue, tint, with
the bones copper -coloured and with a metallic sheen .
Such a picture, whilst retaining the features of the
ROENTGEN RAY .
original negative, is much more instructive and illumin
ating, and approaches more closely to the ideal Roentgen
bones.
In Plate CCLXXXII ., Fig. 3, we have a skiagram of
the hand of a man, thirty-five years of age, made in this
fashion . It is a print from the fourth plate, and we can
read from it much additional information which was
present, but concealed, in the original negative.
The delicacy and strength of the shadow is very
noticeable, the depth of the shadow varying with the
thickness of the flesh covering the bones. Every smallest
detail is reproduced. There is no distortion of the bone
shadows and no indefiniteness of outline. Nevertheless,
this picture is totally unlike any ordinary print, or even
a diapositive . The modelling of the bones makes them
stand out from the picture in their true relative positions.
In Fig. 3, not only do the bones stand out, but the
palmar surface of the hand itself is depicted. Every
separate fold is reproduced, so that it appears as if it
was a picture of the surface partially obliterated by the
thicker shadows of the bones.
In some cases the shadows of the cutaneous lines are
not intercepted by the denser shadows of bones. Under
these circumstances the striæ will appear as dark lines
crossing the skiagram of the skeleton at various angles.
In such a picture we may even distinguish the striæ on
the dorsum from those on the palmar surface, since the
more sharply defined lines are those of the surface next
the photographic plate, while those on the distal side
are more diffused. In Fig. 3 we see the contour of the
edge of the dorsal epidermis projected through the
Again, in the thumb-nail we
can easily distinguish by the difference in sharpness of
outline which side of the thumb was towards the plate,
and which side of the pail was illuminated through the
substance of the thumb itself.
Similar details can be made out in the carpus and in
the softer parts of the metacarpus . It must be remem
bered that in these pictures nothing whatever has been
added or altered in the original negative. It is by the
intensification and contrast of the shadows alone that so
superimposed outlines.
Not only do we obtain a clear skiagram of the thumb
nail, but the outline of the phalanx underneath is to be
made out through that of the nail, with every detail of
 ARCHIVES OF THE
the furrows in the bed of the nail and the edge of
the skin . We also discern the extent of the softer
matrix of the nail, which is not dense enough to obscure
or darken the bone shadow. The normal striations of
the nail itself can sometimes be seen . We get , in fact,
& picture of the nail, complete to the smallest detail ,
showing the relative penetrability of every tissue to the
X rays .
In like manner we may obtain pictures which show
the digital artery with its branches running along the
sides of the fingers, and even its finer branchings at the
various phalanges.
The tendons are clearly shown in their muscular in the living hand, and note how they are partly inter
attachments, and are also visible through the soft tissues
covering bones, so that we may trace their entire course
from the muscle to their insertion in the bone. At the
last Berlin Roentgen Congress I showed the skiagram of
a hand, in which the whole of the muscular structure
appeared built up by the various bundles of muscles.
In this picture the long snake- like artery following the
course of the bone, and even the individual veins, stood
out clearly. Moreover, where two bloodvessels crossed it
was even possible to determine which of them was
nearer to the plate. Such an “ anatomical Rontgeno
gram " -if we may coin the expression -- will enable us
to determine many details of structure which we have
not hitherto suspected. If we examine Fig. 3 more
closely, we shall see the projection of the radial artery difference exists even when one surface is illuminated by
showing through the proximal portion of the first rays which have already traversed the bone.
phalanx This is visible as a faint , but still clearly
defined, shadow cutting across the proximal part of the
shadow of the thumb.
Just as careful examination shows more and more
detail in the fleshy portions, so the shadows of the bones is true that these relations are only properly appreciated
themselves are no longer mere silhouettes. The most
complicated relations of the different bones can now be
clearly and certainly read off from the plastic Roent-
genogram .
As an example we may take the complicated arrange-
ment of the carpal bones, and more especially the group
comprising the os magnum , scaphoid, and semilunar
bones. How various are the forms of the bones and the
articular surfaces, how complicated the various positions
of single bones, and even of different portions of the
same bone, and yet the X rays are able to show all the
structure and arrangement clear and distinct down to
the smallest detail. Not only do we get a picture of the
scaphoid as a whole, but we also obtain a view of the
ROENTGEN RAY . 219
true relations between the various parts, and the position
of the articular surfaces in which the os magnum rests.
In a good plastic radiogram we can even distinguish
between the palmar and the dorsal surfaces, and the
tissues intermediate between the two . This can be
more easily made out if the photograph is examined
with a magnifying-glass. In like manner we are able to
reconstruct the semilunar bone. We are able to dis
tinguish between the palmar and the dorsal shadow,
and thus are able to determine the relative positions
of the two horns of this bone. We can trace the
articular surfaces of the os magnum and the unciform
twined and partly superimposed, and we can follow out
the relations of the other bones to each other and to the
metacarpals. The result of our radiogram is thus no
mere silhouette , for the bones stand out as solid bodies.
This is specially noticeable if, as has been suggested, we
make use of a magnifying-lens. It is quite unnecessary
to go to the trouble and expense of preparing stereo
scopic views in order to get a relief effect. All the
details are present in the original negative. In even the
most imperfect negative the Roentgen rays reproduce in
detail every variation of position and density of the
various tissues which they traverse. In every case they
must of necessity also differentiate between the proximal
and the distal surface of the irradiated body. This
It is, indeed, this real perspective of the various parts,
and the consequent variations in the depth of tone, that
permits plastic reproduction of the bones. All the
details are already present in the original negative. It
after they have been intensified and emphasized by the
new process, but the only basis of all plastic Roentgen
ography is a good comprehensive negative. It would
take too long to enumerate all the factors which con
dition the production of such a negative, but the chief
point is that the X rays must be allowed ample time to
exercise to the full their powers of differentiation and
reproduction. In judging of the results it must be borne
in mind that even the best print will not show so much
detail as a photograph on glass, and that the repro
duction of the print, however good , will show even less.
In the earlier attempts at relief Roentgenography the
shadows of the bones were too often distorted, and the
proportions and extent of their image differed greatly
220 ARCHIVES OF THE ROENTGEN RAY .

from that of the original radiogram . The results of my fuller account will find it in a paper on the subject
more recent method are free from this distortion. This published by me some two years ago.9 10
was proved by a careful comparison with the original The orientation of the Roentgenogram can be deter
negative. mined by observing the relative position of the different
The absence of all distortion may be further shown bones, and, still better, from the appearance of the
by an examination of Fig. 4. This is the skeleton of a lacunæ between the bone shadows. The latter will
living hand, photographed from a person twenty-four alter in shape and position , disappearing and reappear
years old. The relief Roentgenogram was prepared in ing as the hand is turned round. It must not be for
precisely the same way as before. When the fourth gotten that the ossification of the bones must be taken
plate had been finished and dried, the film was carefully into account, since all the small lacunæ which are seen
cut away, leaving only the image of the bones. This was between the bone shadows do not correspond to in .
then superimposed on the original negative for compari- terstices between the bones. As the hand is moved
son. In this way it was clear that there had been no altera- backwards and forwards these may be occupied either
tion of the relative size and position of the bone shadows. by synovia or by folds of the capsule itself.
It is true that the second sesamoid bone lying over the Some of the smaller interstices which appear on an
distal epiphysis of the base of the thumb, which extends X-ray photograph are merely due to the fact that the thin
into the image of the phalanx, shows a disconcerting layer of cartilage covering the surface of the articulation
alteration in its extent. This is, however, due to an is in many cases not dense enough to show on the
accident. After cutting away the rest of the film a plate. We must therefore differentiate between the true
small fragment became detached. This makes the interstices, which are filled with synovia or folds of
sesamoid bone appear too narrow and project too much synovial membrane, and those simulated lacunæ which
from the bone. The image of the sesamoid bone between are in reality but the lighter shadows of thin layers of
the end phalanx and the middle phalanx appears, how- cartilage.
ever, in its proper proportions. Fig. 4 cannot be considered as a complete picture;
Fig. 4 is a reproduction of a print made from this but still , with all its failings, it yet gives a good view of
plate, and although it does not show the full beauty and the condition of the skeleton in the living hand, and, as
detail of the original, yet it is very instructive, and such, serves to correct much that is not sufficiently ex
shows much well worthy of examination. plained in the ordinary text-books on anatomy, and
The accurate representation of the joint and the rela which cannot be properly learned from diagrams, or
tion of the radius to the carpus is very striking. Although even from the study of anatomical preparations.
the position of the hand is not quite medial-i.e. , the Although even the best reproduction cannot be ex
middle finger and its metacarpal are not exactly in the pected to show as much detail as the original plate,
axis of the hand—we yet see clearly that the fulcrum of still, a comparison of Figs. 3 and 4, both photographed
the whole hand is the surface of the radius in contact during life, will prove of the greatest interest. The
with the semilunar bone. The relation of this latter to slight difference of position in the two hands, and the
the supporting scaphoid and os magnum are clearly fact that the stage of development is somewhat different
shown by the outline of the horns of the semilunar in the two cases, only serves to render the comparison
bone. more interesting and instructive .
We see clearly the palmar horn of the semilunar bone
resting on the scaphoid and reaching to the articular BIBLIOGRAPHY.
surface, while the shadow of the dorsal horn in contact Budapesti Riv. Orvosegyesület, “ Reliefszerii ès Plastikus X -sugaras
with the unciform bone projects far over the image of the képek.”, OrvosiHetilap,
Verhandlungen 1906,II. Röntgengesellschaft, Band 2, "
der Deutschen Ver.
os magnum, which is seen lying between the two horns. besserte Plastische Röntgenbilder.”
We can determine in like manner the relations between 3 Fortschritte auf dem Gebiet der Röntgenstrahlen, Band 10, Heft 19,
1906 , “ Erzeugung Plastischer Röntgenbilder."
the os magnum, the scaphoid , and the other bones of the * Gyogyászat, 1906, Nos. 25-28, “ Plastikus X sugaras képek .”
carpus. To enumerate all the anatomical points which 5 Budapestikir Orvosegyesület, “ Plastikus X -sugaras képekröl .”.
6 Archiv und Atlas der Normalen und Pathologischen Anatomie in
can be made out on such a Roentgenogram would lead Typischen Röntgenbildern, Band 13. Hamburg, 1906.
7 Fortschritte auf dem Gebiet der Röntgenstrahlen, Band 10, Heft 1,
us too far from our subject. Those who wish for a · Erzeugung Plastischer Röntgenbilder.
 .1FIG .2
FIG

B. ELA
DR
BY
ROENTGENOGRAPHY
PLASTIC
ON
ARTICLE
THE
ILLUSTRATE
(PTO
).ALEXANDER
216
CCLXXXI
.PLATE
”—C(“Aopyright
Phenomena
Allied
and
Ray
Rocntgen
therchives
).of 221
 .3
FIG FIG
.4

.BÉLA
DR
BY
ON
TO
ARTICLE
THE
ILLUSTRATE ALEX
ROENTGENOGRAPHY
PLASTIC 2.)(p 16 ANDER
VVTT
nIT

of
Cand
Row rchives
Prontoon
the
Allied omiriaht
A..)"-Phonomena 228
 ARCHIVES OF THE ROENTGEN RAY . 225

& Verhandlungen der Deutschen Röntgengesellschaft, Band 3, 1907, far from precise. It is to be hoped that no one at the
“ Ueber Röntgenogramme,” discussion.
3 " Von den Bewegungen derCarpalknochen bei den Handbewe- present day would be so foolish as to employ the old
gungen ,” Magyar Orvosi Archivum , Budapest, 1904. method of estimating the penetration of the rays by
10° “ Ueber die Knochenbewegungen im Carpus bei Abduction und
Adduction des Daumens,” Fortschritte auf dem GebietderRöntgen- . observing the shadow of his own hand on the screen.
strahlen , 1905.
I had for some time made use of a thermic voltmeter
in the primary circuit. The scale of this instrument
has an aperture with a red glass, and when the index of
AN ELECTROSTATIC VOLTMETER
the voltmeter showed itself in this aperture, I knew from
AS A CONTINUOUS INDICATOR OF THE previous experiment that my focus-tube was giving off
PENETRATION OF A FOCUS - TUBE . rays of penetration No. 6. If it began to move towards
By Professor J. BERGONIÉ, of Bordeaux . the right , I knew that it was giving off No. 7 rays ; and,
on the other hand, if it went towards the left, the radia
One of the most important factors in the dosage of tions were No. 5. I found that in practice this was
X rays for medical purposes is the degree of penetration sufficient for my purpose, and I abandoned the use of
of the rays, as indicated by Benoist's radiochromometer. the radiochromometer, except as a means of standardizing
The use of this instrument, however, is far from satis- my apparatus. This was a matter of no little advantage

th
.)

1
1
1 C.
1
th

FIG. 1 .

factory. It is only at intervals that the telescope of the
instrument can be directed towards the focus-tube, and
then the illuminated sectors must be carefully compared
with the central disc . The measurement is intermittent,
and is impossible when the focus-tube is properly pro-
tected by a suitable cuirass. The only other means of
estimating the penetration is by measuring the equivalent
spark --- & procedure which is also intermittent, and is
to my hands, since the use of the radiochromometer is
not without danger in this respect. There was, indeed,
one serious disadvantage - viz ., that the voltage of the
source could not be changed without upsetting my read
ings—and it was impossible to make use of a rheostat
in the primary circuit. With this proviso, the correspond
ence between the voltage in the primary circuit and the
hardness of the tube was perfect and permanent.
31
226 ARCHIVES OF THE ROENTGEN RAY .

It was, however, at best but a temporary and imper- degrees on Benoist's scale. In my experiments I em
fect expedient. What was required was a voltmeter in ployed a D'Arsonval-Gaiffe transformer, driven by an
the secondary circuit, in parallel with the focus -tube, alternating current of 110 to 115 volts, with 50 periods
which would enable us to measure directly the difference per second. The current was measured by a sensitive
of potential between the anode and the cathode of the milliamperemeter.
tube. The focus-tubes employed were chiefly the Chabaud
After many attempts, I have at last, with the assistance Villard tubes, with osmo-regulator. Both the small and
of MM. Hartmann and Braun, been able to construct the large model, and also the model with water-cooled
à voltmeter for this purpose which is completely satis- anticathode, were employed. Experiments were also
factory. made with two regulating Müller tubes.
The electrostatic voltmeter consists of two fixed The observations were carried out in the following
plates, a and c (Fig. 1), which are charged respectively manner : Benoist's radiochromometer was used. Six
by the anode and cathode of the focus-tube. Interposed exposures were made under exactly similar conditions,
between a and c is a third plate, hung on a hinge, h, but with varying and increasing milliamperage in the
which is in metallic contact with the plate a, and there- focus - tube. The illuminated sectors of the Benoist
fore always at the same potential. When the plates are radiochromometer were photographed and the photo
charged, there ensues an electrical repulsion between graphs compared . It was found that when the voltage
the plate a and the movable plate, and an attraction was kept constant, the degree of penetration of the rays
between the latter and c. The movement of the plate was entirely independent of the milliampérage of the
is transmitted by means of an arm, g, to the index. A current passing through the focus-tube .
very ingenious arrangement is used for magnifying the The law may be expressed thus :
movement of the plate, which is thus transmitted to the 1. In a focus- tube, whatever the intensity of the
index of the voltmeter. current passing through it, if the voltage as measured
With an alternative current this voltmeter may be by the voltmeter is kept constant, the rays emitted are
used to measure voltages up to 40,000 volts. It is fur- always of the same degree of penetration as measured by
nished with two condensers, C1, C2, which protect it against the radiochromometer.
the electrical discharges, so that at its maximum devia- The following may be taken as a sample of our
tion not more than 5,800 volts can pass through the observations :
instrument itself.
EXPERIMENT V. - SMALL CHABAUD-VILLARD TUBE
The instrument is graduated for a frequency of 50
(No. 3,549).
intermissions per second. It may, however, be used for
Number of Milli- Voltage in Degrees on Benoist
a frequency slightly above or below this, if we remember Experiment. ampèrage. Kilovolts. Chromoradiometer,
that the instrument reads too high for slower vibrations I. 0:15 18 2:5
II . 0.36 18 2.5
and too low for more frequent intermissions. III. 0.55 18 2.5
These measurements are independent of temperature. IV . 0.70 18 2.5
The needle is controlled by means of a magnetic break, V. 0.82 18 2.5
VI . 0.28 18 2-5
a matter of importance in the measurements of high
voltages . By adjusting the rheostat in the primary circuit one
One would suppose that such a voltmeter would give could alter the current in the secondary from 0.1 to 9
no indication when used with a static inachine, since the milliampères without any alteration of the voltage in
condensers arrest the passage of any continuous current. the tube , the needle of the voltmeter indicating 18,000
This, however, proves not to be the case, the instrument volts during the whole time. It is very unusual that
giving perfectly reliable measurements when the focus- such a range of milliampérage with constant voltage can
tube is driven by a static machine. Hence we may con- be obtained without altering the vacuum of the focus
sider that the flux of high tension from a static machine tube. As a rule, the osmo-regulator must be warmed in
is a non - continuous current, undulatory in character, if order to keep the voltage constant in spite of the increase
not oscillatory, with change of direction . of current. At all events, it is clear that there is no
We have now to consider the graduation of volts into definite relation between the current and the voltage in
 ARCHIVES OF THE ROENTGEN RAY. 227

a focus -tube. On the contrary, the voltage falls and the chromometer. The following are the results of a series
current rises when the tube is softened by overdriving. of experiments carried out for this purpose :
In driving a tube the voltmeter is a much safer index than Degrees of Voltage in
Penetration. Kilovolts .
the milliamperemeter. The current should be diminished 2 12 ; 16 ; 18 ; 15
or arrested directly the voltmeter shows signs of falling 3 20 ; 21 ; 21 ; 19 ; 22

:: ::
voltage in the tube. 4 25 ; 26 ; 26 ; 25 ; 26 ; 25 ; 25 ; 24 ; 23
As the tube hardens during its ordinary use with a 5 30 ; 30 ; 29 ; 29 ; 29 ; 30 ; 28 ; 28 ;
27 ; 27 ; 25 ; 28 ; 27
small current the voltmeter is seen to rise very gradually. 6 31 ; 32 ; 32 ; 31 ; 32 ; 32 ; 30 ; 33 ;
The following is another experiment illustrating the 33 ; 32 ; 32 ; 32 ; 35 ; 35 ; 34 ; 32 ;
constancy of penetration in spite of variation of current : 33
7 ...
35 ; 36 ; 35 ; 35 ; 38 ; 37 ; 36 ; 36 ; 37
8 39 ; 40 ; 41 ; 40
EXPERIMENT VII.-LARGE CHABAUD-VILLARD TUBE
-NEARLY NEW. It is evident that there are certain discrepancies in
these figures, arising from the difficulty of determining
Ex Milli- Voltage in Pene
posure. ampèrage. Kilovolts. tration .
the exact degree on the chromoradiometer by the usual
I. 0.15 30 5.5 method of reading it. I was, however, anxious to use
II. 0.28 31 5.5
III.
only the simplest clinical methods, without having
0:40 30 5.5
IV. 0.70 29 5.5 recourse to more complicated instruments, such, for
V. 0.95 28 5.5 instance,
rmay s the comparative opacimeter. The above
iqueasbe
VI . 1.10 Tube broke down . m o m é
table t simplified thus :
s radi ochro
D e g r é
5
3
8
q

10
00
0 7
10 00
00
Volts 00

Fig. 2.

As a result of our experiments we may formulate the Degrees of Voltage in

Penetration . Kilovolts.
second law thus :
...

2 12 to 18
2. For higher and higher voltages the radiations 3 19 22
4 23 26
emitted by the focus - tube become more and more 5 27 30
penetrating. This is shown by the following series of 30 34
observations : 7 34 38
8 38 41
EXPERIMENT XXII .
Ex Milli. Voltage in Radiochromo. From this a semicircular scale may be constructed for
posure. ampèrage. Kilovolts . metric Degree. the voltmeter, reading volts on one side and Benoist's
I. 4 16 2+
II. 6 22 3.5 degrees of penetration on the other (Fig. 2).
III . 4 26 4+ The third conclusion derived from this series of
IV. 5 28 5 experiments is this :
V. 5 31 6
VI. 6 7
3. With equal voltages the penetration was equal
36
even with focus-tubes of different models, with different
The next step was to establish the connexion between output and different current intensities.
the indications of the voltmeter and those of the radio This is at least true for all the tubes which I have
31—2
 228 ARCHIVES OF THE ROENTGEN RAY.

examined , to the number of eight, all by well-known of different degrees of penetration in the same tube, heat
manufacturers. All of these had a platinum focus-plate, is produced in far greater quantity with the softer than
but varied in volume and size. Some were ordinary with the harder rays.
regulating tubes , others had osmo-regulators, and two As regards radio -therapy, this means of registering the
were water-cooled. Some, moreover, were nearly new , penetration of the rays adds great precision to the
while others were discoloured by hard usage . question of dosage. In the near future we shall hope to
The following experiment will show this, the numbers be able to prescribe radiations of the exact degree of
being fairly in accordance with previous tables : penetration required for such and such a lesion , taking
into account its nature, its depth and its volume.
EXPERIMENT XVII .-MÜLLER TUBE-OLD AND VERY
A series of researches carried on in collaboration with
STABLE (No. 49,946). M. Triboudeau has demonstrated that certain cells are
Ex Milliam Voltage in Pene
posure. pèrage. Kilovolts. tration . almost insensible to X rays of a certain degree of
I. 5.0 34 6-7
II . 9.5 32 6
penetration, their sensibility being at a maximum for
III . 8.0 29 5+ rays of another degree of hardness.
IV . 4.5 26 5- As regards dosage in therapeutic work, it would seem
V. 5.0 27 5 that exact measurements of voltage, of milliampérage,
VI. 11.0 32 6
and of time are all that are required to enable us to
At the present time in my own laboratory neither I measure the quantity of X-ray irradiation.
nor my assistants could do without the electrostatic
voltmeter. All our exposures, whether radiographic or
therapeutic, are made with the eye of the operator on
THE LOCALIZATION OF FOREIGN BODIES IN THE
the voltmeter and the Bunsen burner in the hand, so as
EYEBALL .
to keep the resistance of the focus - tube absolutely
constant. By H. H. BORN , M.D., St. Louis, U.S.A.
In radiography, if the voltage increases the picture
will lack contrast, and we heat the osmo -regulator The following is a description of an apparatus which I
gradually till the needle of the voltmeter comes back to have devised for locating foreign metallic bodies in the
its original position. The time of exposure, on the other eyeball. It consists of a vulcanite shell in which four
hand, depends principally on the milliamperage. silver wires are embedded. This fits over the anterior
The use of the voltmeter in no way diminishes the
importance of the milliamperemeter. On the contrary,
it increases its importance, and we need a more sensitive
instrument, graduated in tenths of a milliampere, from 6
0 to 10 milliampères.
By the use of these two instruments, the electrostatic
voltmeter and the milliamperemeter, we have a simple
and practical means of determining the amount of
energy expended at each instant in the tube. This will
give us in all probability the best measurement of the
quantity of X rays. I know that the so-called facteur
de puissance has to be taken into account - i.e., the FIG . 1 .
degradation of electric force and intensity into heat.
Practically, however, it may be supposed that there are surface of the eyeball, lying in the conjunctival sac like
no great variations in this factor in a series of instru- an artificial eye. The wires are practically in contact
ments manufactured in the same manner, as, for example, with the conjunctiva. The pupil is located through the
the transformers D'Arsonval -Gaiffe. As the result of my perforation in the shell. The eyeball can move in any
own observations I have found this curious fact : When, direction to a considerable degree without altering the
with the same expenditure of energy, one produces rays position of the wires in relation to the pupil, or to the axes
 ARCHIVES OF THE
of the eyeball. The purpose of the shell is to fix the
wires more accurately and definitely in relation to the
pupil, cornea , and axes of the eyeball than can be done
by merely using crossed wires, as has been previously
the custom .
Fig. 1 is a photograph of the shell . This is 1 inch
long, inch wide, and 3 inch thick, with a perforation
in the centre, } inch in diameter, marking the site of the
a .
FIG . 2.
pupil. At a and b on the outer surface of the shell are
two flanges extending from the perforation to the rim .
When the shell is in place these occupy a position between
the conjunctival sac, the shell is placed in position in
the eyelids, and thus prevent the rotation of the shell the same manner as an artificial eye. The lids are held
together by a perforated strip of adhesive plaster. The
Fig. 3.
by the movements of the eyeball. The shell consists of
vulcanized black rubber, as used for making artificial
dentures.
Fig. 2 is a skiagram showing the four silver wires
embedded in the vulcanite shell, and the perforation in
the centre. It also shows the comparative density of
the vulcanite to the X rays. During the process of
vulcanization the inner wire has moved a short distance
ROENTGEN RAY . 229
away from under the inner flange at a, where it properly
should be. An elliptical wire frame may be added to the
cross -wires if it is thought desirable.
Fig. 3 is a photograph showing the shell in position,
with a perforated strip of adhesive plaster holding the
two eyelids together.
Fig. 4 is a bi-temporal skiagraph showing the wires in
FIG. 4 .
place, and a small piece of metal in the antero inferior
part of the eyeball , just beyond the point of the arrow .
After instilling a 3 per cent. solution of cocaine into
photographic plate can be supported at the side or front of
the head as may be required. I employ a chair designed
especially for this purpose .
NEW RADIO -ACTIVE ELEMENT.
The American Journal of Science gives details of the
discovery by Professor B. B. Boltwood, of Yale University,
of a new source of radium . Evidence has been obtained
of the existence in the uranium metals of a new radio
active element which emits both alpha and beta irradia
tions, which produces no emanation , and which resembles
thorium in its chemical properties. It is, without doubt,
a disintegration product of uranium , and is in all proba
bility the immediate parent of radium. The name
“ ionium , ” derived from “ ion ,” is proposed for this new
substance, which would seem to be appropriate because
of the ionizing action, which it possesses in common
with the other elements which emit alpha rays.
230 ARCHIVES OF THE ROENTGEN
Notes and Abstracts .
CLIMATOLOGY.
Growth of Fog in Unsaturated Air.-F. W. Proctor, in the
Monthly Weather Review for October, 1903, concludes that
saturation of atmospheric water -vapour is a relative condition ,
condensation beginning upon certain nuclei as soon as there is
any vapour at all in the air, and progressing gradually either
with growing vapour pressure or with other favouring con
ditions, such as concentration of dissolved matter in the nuclei,
electric charge thereon, or change of shape of the condensing
surface, in addition to the suitable conditions of temperature
that alone are commonly considered to be the controlling factor
for any given vapour pressure. Thus water -vapour is always
saturated for certain nuclei that are usually found in the
atmosphere. Fog is normally present in the lower atmosphere,
at least near the sea ; often invisible, the visibility depending
upon the size of the droplets (nuclei) and their number per unit
volume. It usually has the aspect of a thin, smoky haze.
Saturation is rarely indicated by observing instruments, the
vapour not being saturated with respect to the covering of the
wet bulb, although supersaturated with respect to the nuclei or
smaller drops of the preceding stages of fog growth. There
seems to be no reason to discriminate between fog and higher
clouds in respect to the general aspects of condensation ,
evaporation, and stable existence in unsaturated air, though the
distribution of various kinds of nuclei probably varies with
height. There would appear to be a regular gradation in the
size of water particles from the smallest invisible condensation
nuclei up to the largest raindrop.- Science Abstracts, August,
1907 .
INSTRUMENTATION .
A New Apparatus for Roentgen -Ray Examinations
( Trochoscope).— Dessauer describes a table for the examination
of patients by means of the Roentgen rays which allows of the
patient being X-rayed in the recumbent position. The tube,
which is placed underneath the table, is easily moved at will, so
that every part of the body can be X-rayed without altering the
position of the patient. As the tube is completely enveloped
and the rays can be weakened as desired, the resulting
differentiation on the screen is a remarkably clear one. The
apparatus can also be used for photographic purposes.
Glove for Electro -Massage. — Dr. Georg Arndt (Muenchener
Medizinische Wochenschrift) has devised a new glove for
electro - massage . It is provided with a special metallic con
nexion, occupying the entire palm of the hand. It has been
found useful in the after-treatment of fractures and of diseases
of joints. Galvanic or faradic current may be used. The well
known roller electrode was introduced to enable some of the
effects of massage to be added to those of the electric current ;
but by the use of this glove all forms of massage may be applied
-stroking, kneading, tapping, etc. After the glove has been
wetted, it retains its moisture for hours, remains soft and
pliable, and allows of the performance of every form of massage
without unpleasant friction . The masseur's hand is not sub
RAY.
jected to any strong current. Far stronger currents may be
applied by means of this glove without distressing the patient
than by means of the ordinary electrodes, and this is, perhaps,
its greatest advantage. As long as the hand is kept moving, no
pain is felt. The glove may also be used, with weaker currents,
as a stationary electrode, its area being readily varied from that
of the entire palm of the hand to that of the point of the thumb
or of the tips of the fingers.
The glove is made of buck-skin. A layer of metallic tissue
occupies the entire palm of the hand and fingers, behind the
skin , and this is backed by a layer of non -conducting material,
consisting of silk, impregnated with rubber. At the wrist is a
band , to which is attached a terminal. For the other electrode
it is best to use a pad electrode or a wet cloth. The material is
astonishingly soft and pliant, and the glove may be disinfected
by boiling or by laying it in lysol. The results were very good.
The glove is manufactured by Messrs. Reiniger, Gebbert, and
Schall, Erlangen.
A New Stomach Sound for X - Ray Use.—Gross (Münchener
Med. Wochenschr. , No. 25) describes an impenetrable india
rubber tube which is pervious to fluids and gases, and can be
used equally well for drawing off the stomach contents and for
the reception of the X rays.
Protective Gloves (by Dr. Howard Pirie) .—Get a pair of
cotton gloves. Put one glove on the hand, and paint it over on
the back only with the following : Solution of rubber as used for
vulcanizing (to be got at a motor-car depot) , one part by volume ;
red oxide of lead, one part by volume. Paint this on thickly
with several (about six) coats till a thickness of i' inch is
attained. Do the same with the other glove . It is only neces
sary to do the backs of the gloves. Send the gloves to a motor
car depot to be vulcanized .
RADIUM .
The Action of Radium on Plants and Animals . - Louis
Hussakof (Med. Record , July 20 , 1907) sums up the recent
investigations as to the effects of radium on plants and animals.
Earlier investigations showed that radium produced reddening
of the skin , inflammation confined to the exposed spot, and a
gradual falling off of the skin, depending on the intensity of the
rays and the length of the exposure. It arrests culture growth
and destroys most germs if long exposed with a sufficient intensity
of the rays. After several days the bacteria become radio -active
themselves. Protozoa are at first stimulated, and later die.
The shelled organisms are more resistant than those containing
chlorophyll. On animals the effects are mainly on the skin, the
connective and muscular tissues being little affected. The
central nervous system is peculiarly sensitive to the action of
radium , and young animals are more susceptible than older
ones. As to the pathological significance, it is certain that
radium rays exert a baleful effect on animal tissues. The
emanations as well as the rays have these effects. There is little
effect on metabolism. Development and regeneration in animals
are retarded as well as plant growth and development. Radium
 ARCHIVES OF THE
has also an effect on biochemical substances, ferments losing
their powers. Red corpuscles lose their hæmoglobin and salts
into the containing solution. Radium emits three kinds of rays,
the alpha having least penetrating power, while the beta and
gamma rays are both physiologically active. When all three
kinds are used the effect is greater. Oxygen seems to play an
important rôle in the effects . — British Medical Journal.
Synthesis of Precious Stones (by F. Bordas).—We know
that corundums are present in nature in the shape of stones of
diverse colours, from the colourless and limpid sapphire to the
brown and opaque corundum .
Between these two extremes there is quite a series of
sapphires tinted yellow, green , blue, or red, with a number of
intermediate shades. It is thought that these sapphires owe
their colouring to the presence of salts of iron , manganese,
chromium , titanium , etc.
The experiments which I have carried on for some time allow
me to believe that the special colouring of these precious stones
is not due to a particular metallic oxide.
It is possible, in fact, to vary the colour of these stones, to
make it pass from the initial red to the violet, then to blue and
green , and finally from green to yellow.
The experiment consists, for instance, in submitting a bluish
sapphire to the action of radium bromide of activity 1,800,000.
It is then found that the colour of the stone is modified, passing
into green , then bright yellow , and then dark yellow . If a red
sapphire is subjected to the same treatment, it passes in succes
sion through violet, blue, green, and yellow.
On graduating the activity of the bromide, or the distance
between the stone and the radio-active preparation, the intensity
of the reaction is increased or diminished . Stones thus treated
are not radio-active. They do not shine in the dark when
exposed to pure radium bromide. Finally, they do not lose
their colour by heating.
Considering the succession of colours from red to yellow as
indicated, it appears that the topaz tint is the last term of this
transformation .
Must we, therefore, admit that these precious stones are found
in regions where the surrounding soil possesses a certain radio
activity ? The hypothesis seems reasonable, considering that
yellow sapphires are the commonest, and that we often find
sapphires coloured at the same time blue and yellow, which
would indicate a very slow modification analogous to that
described. This action of radium bromide of great activity
upon metallic oxides is interesting on account of the possibility
of thus discovering infinitesimal traces of this body.-- Comptes
Rendus, October 28, 1907.
ROENTGEN - THERAPY .
Localization of Foreign Bodies (C. F. Bailey, M.D., British
Medical Journal, November 2, 1907) .—The author describes a
simple method of localizing a foreign body from a simple
examination with the fluorescent screen. Take the common
case of a needle in the hand. Let the hand lie on the couch
palm upwards, and with the screen search for the needle ;
manipulate the hand into such a position that the shadow of
the needle finally lies transversely to the couch and in the
ROENTGEN RAY . 231
centre of the smallest aperture of the diaphragm , the hand still
lying flat on the couch. Now with a damped aniline pencil
mark the shadow line on the palm . Cut a lead stylet, made of
lead-foil twisted into a thin wire, so that one limb corresponds
to the line, the other limb being short and at right angles.
This piece at right angles is merely to make the palmar stylet
distinctive. Fasten the appropriate limb to the marked line
with stamp paper. Re-examine, when dry, with the screen,
when the shadow of needle and stylet limb should register.
Now place the hand palm downwards and again examine ;
make the lines register, and mark on the dorsum of the hand
with the pencil. Again attach as before a straight lead stylet,
and now, on examining the hand palm upwards, the three
shadows should register and appear as one shadow with a short
limb at right angles. We now have fixed the vertical plane in
which the needle lies.
To discover the depth and direction of the needle in this
vertical plane, the tube is moved about 6 inches to one side, say
the left, the diaphragm being much enlarged or removed. The
original single shadow at once resolves into three, thus :
The left shadow is the palmar stylet, the right
the dorsal, and in a variable position between
is the shadow of the needle.
7 The distance
between the lead shadows corresponds to the
thickness of the hand, and for all practical
purposes the proportion of the distance which the needle
shadow (or any part of its shadow) takes up represents its depth
(or the part's depth) in the hand. In the above case the needle
lies parallel with the palmar surface and about half-way between
palm and dorsum , its exact depth being, therefore, one- half the
thickness of the particular hand.
Suppose the three shadows are thus :
Here the needle is in a slanting direction , its
head about one-third of the hand-thickness
from the palm , its point about two- fifths of
‫עך‬ the hand -thickness from the dorsum . We know
the plane it occupies ; its true length may be
estimated by constructing a four -sided figure, whose sides are
the lengths of the stylets and the thickness of the hand, mark
ing off one-third of the upper line and three -fifths of the lower,
and measuring the distance between these points.
Modifications are easily suggested for a needle vertical to the
palm -- a shot, an irregular piece of glass, or a fragment of
metal. It is quite easy to find the relation of the foreign body
to a bone, for instance, by noting the relative displacement of
the foreign body shadow as compared with the displacement of
the spot (either on the bone or between contiguous bones) over
which it was lying when the shadows were in register.
PHOTO - THERAPY.
A New Medical Quartz Lamp for Light Treatment
(Nederl. Tijdschr. voor Geneeskunde, No. 25 ; quoted in the
München . Med. Wochenschr ., October 8, 1907 ).—T . F. Mass
has made experiments with a new form of quartz lamp, from
which he concludes that its penetrating effect is much more
powerful than that of the Finsen lamp. It also seems to affect
the skin surface more markedly , thus shortening the duration of
treatment.
 232 ARCHIVES OF THE ROENTGEN RAY .
Reports of Societies.
SOCIETY OF ARTS.
SIR W. RAMSAY gave the Aldred Lecture on radio-active
phenomena. The subject was more especially the radio
active emanation given off by radium.
The lecture was illustrated by the aid of a relatively
large quantity of radium placed in his hands by the
Vienna Academy. Sir William Ramsay showed that a
spectrum tube containing the radium emanation, on being
kept for a time, gave the spectrum of helium. Both the
emanation and helium passed for elements. There were
degrees in the elementary scale, just as there were
degrees in the stability of compounds. What we called
elements were probably only enormously stable com
pounds. Apparently, not all elements were stable. The
emanation, whether a compound or not, was certainly belonged to the same chemical group.
endothermic . It changed and presumably decomposed
with an almost incredible evolution of heat. A ton of it
would boil away 200 pounds of water in an hour, and
would serve as efficient fuel to warm a house, do all the
cooking, and provide hot baths for a large family, not
only during their own lives, but for about twenty genera-
tions. If the emanation were dissolved in water, it
decomposed the water into oxygen and hydrogen. But
in this way there was always produced a small excess of
hydrogen over that required to combine with the oxygen.
One hypothesis to account for this excess was that
hydrogen, too, was one of the products of the decay of
the emanation, though on the whole that was unlikely.
At the same time there was formed a trace of dioxide of
hydrogen, though not enough to account for the excess
entirely. On removing the oxygen and hydrogen, there
was left neon , With the hope of accounting for the
excess of hydrogen, he exposed a solution of sulphate of
copper to the action of the emanation ; the gases evolved
contained argon , but no recognizable helium or neon.
Some of the copper, too, appeared to have changed, for
the residue of the liquid , after removing all copper from
it, contained a small trace of the element lithium. It
was probable, though not yet proved, that the element
sodium was also a transmutation product of copper,
because the residue, obtained by evaporating the copper
solution , which had been treated with emanation, when
deprived of copper, was more than twice as heavy as that
obtained from untreated copper sulphate. Experiments
were now in progress in which glass was excluded , the
bulb used being constructed of silica free from sodium.
These results admitted of a provisional theory. The
emanation was a very inactive gas of the argon group
helium , neon, argon , krypton, and xenon. There was a
similar series , the first member of which was lithium
and the second sodium, to which copper, silver, and gold
also belonged. It appeared possible that the emanation
degraded, split, was transformed, or transmuted itself
into helium, neon , or argon , according to circumstances ;
and that, similarly, copper might turn , under the
enormous influx of energy brought to bear on its atoms,
into lithium, sodium, and potassium , all of which had
smaller atomic weights than copper, and all of which
THE ROENTGEN SOCIETY .
The first lecture of the session, on High -Frequency Oscilla
tions , was read on November 7 by the President, Mr. Duddell,
F.R.S. The lecturer explained the various methods of obtaining
high-frequency oscillations. An alternating machine cannot be
constructed to give these rapid changes, since even if the discs on
the plate were only lo inch apart, to obtain a frequency of 106
-a very moderate rapidity for medical purposes - would entail
the edge of the plate travelling at a rate of 2,000 miles an hour.
The usual method has been the spark - gap method, in which a
Leyden jar is alternately charged and then discharged across a
spark-gap. In the ordinary Tesla apparatus the spark - gap is
connected with a coil, which by ordinary resonance effects may
be made to prolong the duration of the vibrations during
sparking
In the arc methods the oscillations are produced by an ordinary
arc lightburning between carbon poles. The condensers between
the terminals alternately become over- and under -charged , and
thus give rise to an oscillation .
Under ordinary conditions the frequency attained does not
exceed 30,000 , but if the arc is put in hydrogen or coal gas, the
vibrations are much more frequent.
The frequency may be still more increased if an electro
magnet be placed across the gap to “ blow out ” the arc. By
this means as much as a million oscillations per second can be
obtained even when a large current is used.
Although at present not capable of giving such a wide range
of frequencies as the spark- gap method, the arc method of
generating high -frequency vibrations has several advantages.
Chief of these is the fact that the time during which the spark
is actually passing, and therefore the oscillations started , is but
a small fraction of the time taken to recharge the condensers,
whereas with the arc the oscillations do not die away, but con
tinue constant . This difference was well illustrated by an
 ARCHIVES OF THE
ingenious model in which a steady electric light represented the
arc, whilst a light which flashed out for a second once in ten
minutes only represented the spark.
The lecturer then mentioned several other sources of high-
frequency vibrations, such as the rotating aluminium disc,
which, when rubbed , gives alternations, owing to the film of
oxide which is always present on its surface. He also mentioned
that some Continental workers claim to have succeeded in obtain-
ing these vibrations from a Nernst filament, but he himself had
so far been unsuccessful in all attempts to do so.
The lecture concluded with an appeal to the medical men to
say what voltages and frequencies they really required , as the
physicists hitherto were working in the dark in this respect.
Professor SilvanUS THOMPSON, in proposing a vote of thanks,
endorsed the appeal to the medical fraternity.
Dr. DEANE BUTCHER seconded the vote of thanks , and said
that the better plan would be for the physicists to endeavour to
produce as many varieties of electrical frequency as possible,
and then the medical nen themselves would choose out those
which should prove most suitable for their special purposes.
A MEETING of the Roentgen Society was held on December 5,
Mr. W. Duddell, F.R.S. , presiding.
Mr. J. H. GARDINER read some notes on Mr. C. E. S. Phillips's
conducting glass, with particular regard to its transparency to
X rays and ultra -violet radiations.
Mr. A. A. CAMPBELL Swinton drew attention to the phe-
nomenon , long ago noted by Crookes, that the inside of a
tube was coated with a metal so as to render it conducting, it
had the same effect as raising the vacuum , and suggested that
possibly Roentgen -ray tubes might be made of conducting
glass.
Mr. DUDDELL said that the glass was sufficiently conducting
to screen completely any electrostatic apparatus. He believed
also that , although somewhat soft, it could be blown into bulbs ;
but he thought that any attempt to make X-ray tubes with it
would be rather too daring a leap to take .
Reviews.
A Text- Book of Electrochemistry. By Max LE BLANC .
Translated from the fourth enlarged German edition
by WILLIS R. WHITNEY, Ph.D., and John W.
Brown, Ph.D. New York : The Macmillan Company.
10s. 6d . net.
This is a book well worthy of study by the medical
electrician ; indeed , electrochemistry is at the basis of
all modalities of electric treatment. For the following
notice of the book we are in part indebted to a review of
the work which appeared in the Electrician :
The first German edition of Professor Le Blanc's
work appeared in 1895. Since then two English, an
Italian , and a French version have appeared Professor
ROENTGEN RAY . 233
Mr. LESLIE MILLER showed a 'mica -disc valve, or cut-out, for
X-ray tubes. The valve consisted of a mica disc 1 millimetre
thick, with two apertures. The disc rotates between two con
tacts, permitting the break current to pass, but not the current
at make. By this means a good deal of the reverse current is
cut out.
Mr. CAMPBELL SWINTON called attention to an interesting
form of static machine of very old date, which might, he
thought, be used for X -ray purposes. It consisted of a very large
number of microcondensers of small capacity, and a commutator
by which they could be joined up alternately in parallel and in
series. A machine of this kind, he said, was not at all difficult
to build, using sheets of mica and tinfoil alternately, and he
thought that in this way a series of static discharges might be
obtained for X- ray purposes.
Mr. DUDDELL said that he saw one of these instruments at
work at the St. Louis Exhibition, charging the condensers in
parallel to 10,000 volts, and discharging in series . This
apparatus produced a spark 5 feet in length. Unfortunately,
Lord Armstrong's hydro- electric machine, which gave a con
siderable output, could only be used in the open air on account
of the steam .
The Rev. P. MULHOLLAND showed Professor Mayer's experi
nients with floating magnets as illustrating the electron theory.
The floating magnets experiment was designed to illustrate the
recurrence of the same characteristics in atoms which had some
correspondence between the numbers of their respective
electrons. The experiment ted of a number of magnetic
needles floating in water. They were so arranged as to mutually
repel each other, while a central electro -magnet attracted them
to a common centre. As the number of floating magnets was
increased, different configurations were obtained. Three formed
an equi-lateral triangle, four a square, five & pentagon, six a
hexagon, etc. The triangle, the square, and the pentagon re
appeared as the number of needles increased, thus illustrating
the periodic law .
Le Blanc's treatise is a purely theoretical one. The
book is divided into nine chapters, of which the first two
are introductory. Then follows a short sketch of the
Dissociation Theory, from which standpoint, it is need
less to say, the author treats his subject. Osmotic
pressure , which is now generally understood to be a
suction or a diminution of pressure, is here spoken of as if
it were an actual pressure exerted by the molecules of
the solute. The author certainly does not look upon the
ionic theory in the light of a fetish, but expressly states
that it is a theory, to be tested by facts, and not a dogma.
He might, however, have given more prominence to the
conception of hydrated instead of free ions, which many
32
234 ARCHIVES OF
people now accept as offering a reasonable compromise
between the dissociation and association theories of
solution. The fourth chapter is on Migrations, and is preparation of this work, which we think will become the
admirably lucid and convincing ; and then follows a very classical text-book of Roentgenography in America.
important and, as far as is possible in a text-book , com-
plete chapter on Conductance of Electrolytes, dealing reminded that England was the birthplace of Gilbert's
particularly well with the application of the law of mass
action to such solutions. The chapter ends with an in-
teresting (mostly novel) section on the conductance of
non - aqueous solutions, in which the recent generaliza-
tions of Walden and others are clearly explained .
Chapter VI. is quite short, and touches on electrical
endosmose and migration of colloids, etc., a somewhat
obscure matter now receiving practical attention in
Germany and America. Chapter VII. , on Electromotive peutics.
Force, is a long and important one ; the treatment
generally is that usually given to the subject in the
current text-books brought well up to date , and is based
on thermodynamic principles and the conception of
electrolytic solution pressure. The theories of concen-
tration cells, liquid cells, and single P.D.'s are treated
with particular care and clearness, and the like remark
applies to the section on the almost fundamental subject
of oxidation and reduction cells, in which the recent
experimental work of Abegg, Luther, and others is duly
referred to. The subject of Polarization is one that
belongs peculiarly to Professor Le Blanc, and the chapter
dealing with it is accordingly of great interest, particu-
larly in the applications of the theory to electrolytic
separations.
The account given in this chapter of Alternate - current
Electrolysis is very brief, and the supplementary chapter
on Accumulators is by no means commensurate with the
great importance of the subject. In an appendix on
Notation, the difficult task of reducing the system to
consistency has been attempted, and the system arrived
at has been used throughout the volume.
Roentgen Rays and Electro- Therapeutics, with Chapters
on Radium and Photo - Therapy. By M. K. KASSA-
BIAN, M.D., Director of the Roentgen Ray Labora-
tory of Philadelphia Hospital. Published by J. B.
Lippincott, Philadelphia. Price 15s . net.
Seldom is a quotation so appropriate as that from
“ Hamlet ” on the title-page of Dr. Kassabian's new
work on Roentgenography :
“ You go not till I set you up a glass,
Where you may see the inmost parts of you."
THE ROENTGEN RAY .
The author speaks from an experience of 8,000 cases,
and has had the assistance of many colleagues in the
In the historical sketch of electrical science we are
work “ De Magnete," with its keynote " Magnus magnes
ipse est globus terrestris, " while it was in Philadelphia
itself that Franklin loosened to the breeze the hietoric
kite with its silken cord. According to our author, a
static machine was installed in the Middlesex Hospital
as early as 1767, and in 1777 another was placed in
St. Bartholomew's Hospital.
The first part of the work is devoted to electro -thera
The chapter on static or frictional electricity
is very full, and is illustrated by some good photographs
showing the methods of treatment. The author divides
the varieties of static electricity into conductive, dis
ruptive, disrupto-convective, and convective modalities.
Static electricity holds a much more important position
in America than it does in England. This is largely due
to the drier climate, which greatly contributes to the
facility of using static machines..
Part II . is devoted to the X rays in diagnosis, and is
illustrated by beautifully coloured pictures of focus-tubes
in action .
The photographic technique of developing, fixing,
improving, printing, toning, mounting, etc., is given in
detail, and the description of American methods will
afford useful hints to the workers on this side of the
water.
The subject of the interpretation of the Roentgen
ogram is also discussed in detail, and this chapter will
well repay perusal.
The author is a great advocate of stereo-skiagraphy,
a procedure which has been used with success at the
Philadelphia Hospital in the location of tumours of the
brain .
For anatomical preparations Dr. Kassabian uses the
injection of bismuth , litharge, or mercury. The re
spiratory tract from the larynx to the smaller bronchi
may be skiagraphed after introducing small shot into the
respiratory tube.
In the skiagrams of fractures and dislocations the
various anatomical points are copiously lettered and
named. This may be of advantage to the student,
although it detracts somewhat from the clearness and
beauty of the Roentgenogram .
 ARCHIVES OF THE
There is a very full description of the application of
the X rays for diagnosis of diseases of the thoracic and
abdominal organs. The author seems quite conversant
with the various methods in use in this country and
on the Continent. Dr. Reid's arrangement for renal much of interest, especially the fact that some of the
skiagraphy is described, as is also the later develop-
ments of the orthodiagraph.
In this connexion we are gratified to find the frequency
with which the author refers to reports of cases and
other information derived from the ARCHIVES OF THE
ROENTGEN RAY .
Dr. Kassabian has apparently paid great attention to
the technique of dental skiagraphy. The chapter on
this subject is well illustrated, and is one of the best in
the book . The plate illustrating the extra-oral method branch of electrical work. We may congratulate them
of dental skiagraphy is also of interest, as showing the on having so able an exponent in Dr. Kassabian.
Correspondencc.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR,–Hoping that some of your readers may be
willing and able to help me in the case, I present the following
data for their perusal :
Mr. C an electrical engineer, had lived for some ten
years in South Africa . He never suffered from an actual “ sun
stroke,” and he was in the habit of going about without any
hat on his head . He then had an attack of fever, and after this
went up to Equatorial Africa, and from that time till now
three years—has always " felt ” the sun . I use the word “ felt,"
as it seems best to describe the sensation , for pain is not a
prominent feature, except after the cumulative effect of several
days' exposure ; but rather a consciousness that the sun is
beating down on his head, and it is felt on the prominence of
both parietal bones and at sunset on the occipital region.
He has studied his own case carefully, and has tried different
climates - Switzerland, India, England , and now Western
Canada . In every case he has had the same trouble when the
sun shines through a clear atmosphere, whether in winter or
summer . The effect seems to be heightened when the sun
breaks through the clouds intermittently, and the same effect
is noticed when passing through forest, as if there were some
“ interference ” effect on the rays themselves. At the same
time, a high wind blowing will give relief.
Now as to the means he has adopted to try and get relief.
He has noticed that it makes no difference whether the day be
hot or cold : so long as the atmosphere is clear and free of
cloud, the effect is bad. Moisture in the air is such a protection
to him that he can sometimes on a clear day foretell rain a day
or two off because of the relief. He has shielded his head with
an Indian pith helmet with red lining and green rim ; he has
ROENTGEN RAY . 235
author's very simple method of protecting the operator
by the interposition of a lead plate.
We can only allude to the long chapter on the
Roentgen rays in forensic medicine, which contains
American courts only receive the evidence of a skiagram
when taken and interpreted by a properly qualified
expert.
The chapter on Roentgen -therapy calls for little notice,
although it contains a good résumé of the cases treated
by this method in the United States. The work is com
pleted by two chapters on radium and on photo-therapy.
The work demonstrates that our American brethren
are in no way behind England and the Continent in any
tried aluminium also, without effect. As it seems to be the
ultra-red rays that cause the trouble, I have recommended him
to try a blue lining to his hat, or, as Freund tells us that alum
is a good absorbent of ultra-red , he will try that. The heat of
a fire and the X rays have no irritative effect. Possibly a
rubber -bag lining to the hat , containing water, may be of
service. These he intends to try ; but in the meantime I would
be very grateful for any help your readers may be able to render
me in suggestions for absorbing these ultra- red rays.
Thanking you for any help you may be able to afford me,
I remain ,
Yours sincerely ,
H. RUNDLE NELSON, M.D.
907 , Blanchard Street,
Victoria , B.C.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR, --I am much interested in following the subject of
measurement of the X ray as it is discussed in your publication ,
and would suggest that information of the following character
would be of great value to the average worker, and probably
would be easy to furnish :
Mention is often made of the equivalent spark-gap of a tube ,
and the character of the terminals is a matter that has been
standardized to some extent at least. The character of the
spark, however, is never mentioned, and I find that the distance
that the thick ribbon-like type will occur differs from the dis
tance overcome by the separate blue-coloured sparks.
Again, mention is made of the agreement between the read
ings of the Benoist penetrometer and the equivalent spark - gap ;
but I have never seen any attempt to place these two methods
32-2
236 ARCHIVES OF THE ROENTGEN RAY .

side by side for comparison and mutual verification . A table of does not seem likely to be correct, yet I have no means of
the corresponding values of the two tests would be of great value knowing
to the average worker. Yours very truly,
For example, I find one of my tubes gives a parallel spark - gap Spokane, Washington , HENRY POWER, M.D.
of 10 inches and a Benoist reading of between 2 and 3. This November 20, 1907.

Description of Plates.
PLATE CCLXXXI.
TO ILLUSTRATE DR. BÉLA ALEXANDER'S ARTICLE ON PLASTIC ROENTGENOGRAPHY (P. 216).
Fig . 1 .--Six months embryo, 19 centimetres long. Reproduction of ordinary print. Ossification of the bodies of
the vertebræ from the second cervical to the fifth sacral vertebra. Ossification of the arches of the vertebræ
down to the third sacral vertebra.
Fig. 2. - The same embryo. Reproduction of print from a plastic Roentgenogram , showing increased details of the
ossification of the vertebræ and of the base of the skull, and showing thestructure of the flat bones of the skull.
PLATE CCLXXXII .
TO ILLUSTRATE DR. BÉLA ALEXANDER'S ARTICLE ON PLASTIC ROENTGENOGRAPHY (V. 216).
Fig . 3.–Plastic roentgenogram of a hand.
Fig . 4. -Skeleton of a band photographed from the living subject .
** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send , with any prints intended for publication, a full account of the
cuse, and also an account of the process used in radiography—such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used , or any otherfacts of interest.
EDITOR'S AND PUBLISHERS' NOTICES.
The Editor begs to acknowledge communications from Dr. Schürmayer ( Berlin ), Professor Goldmann ( Freiburg),
Dr. Worrall (London ), Professor Kienbock ( Vienna ), Dr. Guilleminot (Paris), Dr. Kassabian (Philadelphia ),
Dr. Morton (New York), Dr. Granger (New Orleans) , Dr. Willey (Ann . Arbor, U.S.A.).
The following Journals and Periodicals have been received : “ Advanced Therapeutics," " The Electrician ,"
“ The Electric Review ,” “ Knowledge," " The British Journal of Dermatology,” “ Annals of Physico-therapy,”
“ Medical Times,” “ Medical Electrology and Radiology,” “ Archives of Physiological Therapy,” “ Archives
d'Électricité Médicale," " Le Radium ," " Annals d'Electrobiologie et de Radiologie ," “ Fortschritte auf dem Gebiete
der Röntgenstrahlen, ” “ Münchener Medizinische Wochenschrift,” “Zentralblatt für Physikalische Therapie,"
" Annali di Elettricità Medica," “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN RAY, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London , W.C.," or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing , W.”
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration , will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available .
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view.
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L
VO . XII .

THE
ALA

No.
HE LAMA

9.
RA N
ARCHIVES
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY ).

AN INTERNATIONAL MONTHLY REVIEW

OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ELE ROBERT ABBE ( New York ); A. BECLERE ( Paris); T. P. BEDDOES (London ); J. BELOT ( Paris) ; F. BISSERIE ( Paris );
H. BORDIER ( Lyons); J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ); W. COTTON ( Bristol) ; FOVEAU DE
CTR COURMELLES ( Paris); L. DELHERM ( Paris); R. W. FELKIN ( London );
A
OTT L. FREUND ( Vienna ) ; H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
R A P
E the THE
(Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT ( Paris ) ;
D. GUNZBURG ( Antwerp) ; J. HALL - EDWARDS ( Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ;
F. H. JACOB ( Nottingham) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris) ; S. LEDUC ( Nantes) ;
08
FE

E.R. MORTON ( London ); G.HARRISON ORTON ( London ); H. G. PIFFARD ( New

19 .
B.

York ); JNO.C.RANKIN ( Belfast ); WERTHEIM SALOMONSON ( Amsterdam );

W. F. SOMERVILLE (Glasgow ); H. WALSHAM (London ) ; CHISHOLM
WILLIAMS ( London ) ; CLARENCE WRIGHT ( London ).

CONTENTS

PAGE PAGE
EDITORIAL • 237 NOTES AND ABSTRACTS (continued ) :
ORIGINAL ARTICLES : THE KROMEYER QUARTZ VACUUM MERCURY LAMP 263

THE X- RAY DIAGNOSIS OF RENAL AND URETERAL CALCULI .

REPORTS OF SOCIETIES :
By G. HARRISON ORTON , M.A. , M.D. 238
ROYAL SOCIETY OF MEDICINE-ELECTRO-THERAPEUTICAL
SOME EXPERIMENTS WITH ROENTGEN TUBES WITH RESPECT
SECTION - 263
TO THE USE OF TUBES FOR DIAGNOSTIC WORK. By
THE ROENTGEN SOCIETY . 266
VERNOX J. WILLEY, A.M. 248
ROUTINE EXAMINATION OF THE CHEST. By GEORGE A. REVIEWS :
PIRIE, M.D. - 260 KASSABIAN'S MEDICAL ELECTRICITY - 267
NOTES AND ABSTRACTS : MITTHEILUNGEN AUS DER WIENER HEILSTÄTTE FÜR
MEASUREMENT - 261 LUPUSKRANKE · 267
THE ELECTRO-DENSIMETER · 262 WELLCOME'S PHOTOGRAPHIC EXPOSURE RECORD AND

RADIUM EMANATION - 262 DIARY FOR 1908 - 268

SCATTERING OF THE a RAYS · 262
EXOPHTHALMIC GOITRE TREATED BY RADIUM - 262 PLATES :
LUPUS OF THE FACE AND Photo -THERAPY · 262 PLATES CCLXXXIII. AND CCLXXXIV.-TO ILLUSTRATE
THE ULTRA - VIOLET RAY AND HIGH - FREQUENCY CURRENTS THE ARTICLE Ox “ THE X-RAY DIAGNOSIS OF RENAL
IN PHLEBITIS .
263 AND URETERAL CALCULI, " BY G. HARRISON Orton, M.D. 268

LONDON
REBMAN LTD ., 129 SHAFTESBURY AVENUE , W.C.
 NEW HIGH FREQUENCY APPARATUS.
THISpieceof apparatushas been designed withtheobject of over
coming the objection raised to all forms previously placed on the
market, viz.: that the practitioner has been without data as to the
frequency of the current he is applying to his patients, and that no
provision has been made to enable him to regulate the strength of the
current in such a manner that a systematic course of treatment can be
applied.
The machine illustrated is so arranged that the frequency of the
current can be varied within wide limits by a simple movement of a
small crank handle, the frequency being at the same time accurately
indicated on a finely divided scale.
The current applied to the patient is an induced one, and can be
regulated from zero to a maximum by a slight movement of the secondary
coils, which are nicely balanced between centres, the relative strength of
the current at any position being shown on a suitable scale.
Ref. No. 213 .
PRICE 218 : 18 : 0.

Catalogue of other Electro -Medical Apparatus on application to

MARCONIS WIRELESS TELEGRAPH CO., LTD .,

Telegrams : “ ETHERISING , LONDON .”
Telephones : 8388 Central (2 lines) . TYSSEN STREET, DALSTON , N.E.
FIVE

JOINTLESS SECTION
INDUCTION COILS
HARRY W. COX & CO .,
LIMITED,
( Heavy Discharge Type ) Beg to announce that they have obtained
have been chosen for the newly built Out-patient Depart
ment of St. Bartholomew's Hospital, E.C. MORE SUITABLE PREMISES
WHY ? AT
Because they are wound by a patented winding machine in
exact accordance with the theoretically best method, and
there can be no other way equal to it.

L. MILLER, 93, HATTON GARDEN, E.C. 47 , Gray's Inn Road,

E

E
TO TUB
TOUB
T

LONDON, W.C.
TRUE EQUIVALENT MICA DISC
( Near HOLBORN TOWN HALL),
SPARK .
VALVE
where they are continuing as

Actual Makers
JOINTLESS SECTION
PATENT COIL
of all kinds of
X -Ray and Electro
Medical Apparatus
K
EA
BR Y
UR

under the personal supervision of Mr. H. W. COX.

N.B. -A Doctor's Model Consulting Room , with all

the latest appliances, will be shown at the new
premises.
VOL. XII.-No. 9. FEBRUARY , 1908.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER, M.R.C.S., F.P.S.

IN COLLABORATION WITH

ROBERT ABBE ( New York ) ; T. P. BEDDOES ( London ) ; J. BELOT ( Paris ) ; A. BÉCLÈRE (Paris) ; F. BISSERIE (Paris) ;
H. BORDIER (Lyons); J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER (London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris) ; R. W. FELKIN ( London ) ; L. FREUND ( Vienna) ; H. E. GAMLEN (West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ; D. GUNZBURG (Antwerp) ; J. HALL- EDWARDS
( Birmingham ) ; G. HARET ( Paris ) ; C. THURSTAN HOLLAND (Liverpool); G. HOLZKNECHT ( Vienna ); F. H. JACOB ( Notlingham ) ;
LEWIS JONES ( London ); A. C. JORDAN ( London ) ; ARCH. JUBB (Glasgow ) ; E. LAQUERRIERE ( Paris ) ; S. LEDUC (Nantes) ;
E. R. MORTON ( L lon ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD (New York ) ; JNO. C. RANKIN fast ) ; WERTHEIM
SALOMONSON (Amsterdam) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM WILLIAMS ( London ) ;
CLARENCE WRIGHT ( London ).

ELECTRO-THERAPY is only some fifty years old, and may on the quantity of the electric current, that of nerves on
be said to have been born and nurtured in France. The its tension . This led him to design the ordinary medical
French Electro-therapeutic Society has recently been coil with movable helix, which is but little altered at
celebrating a jubilee, the fiftieth year of the scientific the present day.
work of Dr. A. Tripier, the father of the French school His earlier researches led Tripier more especially to
of electro -therapy. Professors Bouchard, d'Arsonval and the practice of gynæcology. He applied electricity to
Oudin united with a host of others - doctors, patients, the treatment of fibroma, of inoperable ovarian cysts,
and friends—to do honour to the veteran, to whom and of uterine varix. Oudin, from whose oration much of
Bouchard applied the happiest of compliments—“ Mes the present description is taken, asserts thatTripier's work
maîtres sont vos élèves." on the diseases of women , published twenty-four years
It was in 1854 that Dr. Tripier began his apprentice- ago, may be read with profit at the present day, when
ship to science in the laboratory of Claude Bernard. the faradic and galvanic currents are once more replacing
In 1859 he published his first memoir on the treatment the curette in the treatment of chronic uterine affections.
of uterine deviations by faradization. At this time Tripier's monograph on hysteria is a classic work,
little had appeared in medical electricity with the treating more especially of the electro-diagnosis and the
exception of the early memoirs of Duchenne of Bologne. electric treatment of the disease .
In the course of faradization of a cyst of the spermatic He gives full justice to our countryman Marshall Hall,
who demonstrated the automatism of the centres of the
cord, Tripier observed that the spermatic artery beats
more rapidly during the passage of the current. This spinal cord and their independence of the brain centres.
observation led him to formulate his theory of vascular The name of Marshall Hall seems again and again like
drainage by means of faradization in chronic congestions. a refrain in Tripier's earlier works on neurology.
In the application of the galvano -cautery, Ciniselli
In 1864 Tripier came to the conclusion that it was the
nervous system that was most powerfully affected by had already differentiated the positive acid slough from
faradization, thus confirming Duchenne's assertion that the negative alkaline one, but he still preferred to use
exercise alone would not account for the good effects of the positive pole as the active anode. Tripier showed
faradization of atrophied muscles, and that if trophic that the important point was not the slough , but the
nerves did not exist, it would be necessary to invent cicatrix, and that the acid cicatrix at the negative pole
them ." was hard , elastic, and contractile, and should therefore
Tripier taught that the excitation of muscles depends be preferred in all possible cases .
33-2
238 ARCHIVES OF THE
In Professor Doumer's Annales d'Electro-biology for
June, 1907, is a detailed account of Dr. A. Tripier's
works, which will well repay perusal.
The portrait which illustrates the number bears
witness to the truth of Professor d'Arsonval's toast :
“ Mon cher Tripier, vous n'êtes pas seulement un grand
médecin ; vous êtes aussi un sympathique."
THE X-RAY DIAGNOSIS OF RENAL AND
URETERAL CALCULI.
READ BEFORE THE ELECTROTHERAPEUTIC SECTION OF
THE ROYAL SOCIETY OF MEDICINE.
By G. HARRISON ORTON , M.A., M.D.,
Chief Assistant in the Electrical Department of St. Bartholomew's
Hospital ; Medical Officer to the X - Ray and Electrical Depart
ments of the Royal Free Hospital.
( For illustrations, see Plates CCLXXXIII. and CCLXXXIV .)
GENTLEMEN,So much has now been written on the sub-
ject of the X - Ray Diagnosis of Renal and Ureteral Calculi,
that I owe, perhaps, some apology for introducing the of soft parts we can obtain , provided always we can
subject before this section of the Royal Society of interpret their shadows, the more data we have to go
Medicine . I cannot hope to introduce much, if any- on , when trying to decide the position of any given
thing, that will be new to the bulk of those present.
Nevertheless, we still have much to learn before this
method of examination becomes perfect, and I trust that
the few remarks I have to make this evening will lead
to an interesting discussion, which may help us towards
the solution of some of the many difficulties we have to
encounter. I shall confine my remarks, therefore, chiefly downwards on a canvas-topped couch.
to my own experiences, and leave it to others to give theirs.
For convenience , I will adhere as closely as possible to
the order in which the various points are printed on the
agenda.
First, then, under the heading of Technique, a few
words as to the preparation of the patient. I do not
think sufficient attention is, as a rule, paid to this point.
I prefer all patients to be prepared much in the same way
as for an anæsthetic , so that the intestines are as empty
as possible at the time of the examination. There are
two chief reasons for this. In the first place, when a
soft tube is used, fæcal masses certainly cast definite
shadows. In the great majority of cases these shadows
do not present any difficulty in the way of diagnosis , but
I have seen at least two cases lately in which there were
shadows quite definite enough for some forms of calculus ,
ROENTGEN RAY.
in patients not properly prepared. These have entirely
disappeared after an aperient and enema. Further, should
the patient be taking certain drugs, such as bismuth, very
dense shadows may be cast ( Fig. 1). These, although , per
haps, not in themselves likely to be mistaken for calculus,
may form a shadow sufficiently dense to mask one. An
interesting case of this sort, with a reproduction of the
skiagram , was published recently by Mr. Thurstan
Holland in the ARCHIVES OF THE ROENTGEN Ray.
Certain compressed drugs also, such as some forms of
Blaud's pills, which have been found hard enough to be
hammered into a deal board after having passed through
the entire intestinal tract, might give shadows difficult to
explain.
Again, after evacuation of the intestines, the colon,
as a rule, is found to be filled with gas. This acts much
in the same way, though to a less extent, as the artificial
introduction of air, whereby a clearer differentiation of
the abdominal contents is obtained. Under such condi
tions it is often possible to obtain an outline of the normal
kidney, such as could hardly be expected were the stomach
and intestines loaded. Naturally, the more differentiation
shadow.
Position of Patient. - I prefer, when possible, to work
from below, and the following is the method I usually
employ. The patient, having been suitably prepared and
clothed (I need hardly mention the importance of the
absence of buttons, etc. , in the clothing), is placed face
Immediately
below the ribs and under the abdomen is placed a
sausage - shaped air - pillow, especially made for this
purpose, and I believe first introduced by Mr. Reid .
The chief advantages of this pillow are as follows :
First, it acts as an efficient compressor, whereby the
movements of the diaphragm are much restricted, so
much so that a calculus remains practically stationary
during ordinary
during respiration . This can easily be verified
ordinary respiration.
by anyone watching the shadow of a renal calculus on
the screen . When the pillow is not in position, this can
be seen moving up and down, with a range in some cases
of quite 1 } inches on deep respiration, whereas with the
pillow properly adjusted the movements can hardly be
detected. The negatives obtained in this manner also
demonstrate this point. If we consider the distance of
the calculus from the plate, which in itself is the cause
 ARCHIVES OF THE ROENTGEN RAY.
of some indistinctness of the shadow, it is evident from
the slight amount of blurring, even after a longish expo
sure, that the kidney may be considered practically
stationary .
Another important point, to my mind, is that the arch
of the spine is obliterated by this method to a much
greater extent than in any other method I know of, and
consequently the plate can be approximated much closer
to the region under examination .
Lastly, the presence of the bag does not in any way
interfere with the passage of the rays. In fact, I have
often noticed that more detail can be made out on the
screen when the bag is in situ than when it is not
employed.
In addition to the compression obtained by the weight
of the patient, I myself always supplement this, when it
can be borne, in the following manner. I have had made
a wooden frame, over which parchment is stretched,
of such a size as to just take a 12 x 10 plate. This is
attached to a frame which slides in grooves on each side
of the couch. The frame is lowered on to the back of
the patient, and when as much pressure as can be borne
is obtained, it is clamped in position by a turn of two provided with a diaphragm to cut off secondary rays.
thumb-screws. It is a recognized fact that the X rays,
after passing through the body, produce secondary rays
in the air. These tend to produce a fogging effect on
the plate, and I am convinced that it is an important
point to have the plate pressed as close to the body as
possible. Of course this pressure can be obtained in
other ways, as by placing sand -bags or other weights on
the top of the plates ; but the method I have described
is, I think, more certain and convenient. Moreover, in
stereoscopic work the plates are quickly and easily
changed, without any disturbance of the patient.
By adopting this method, I find that the movements
due to respiration are in the majority of cases so slight
that it is not necessary to give multiple exposures while
the breath is held at the same phase of respiration
There are, however , some cases when it is still an
advantage to do this. There are many pros and cons
with regard to this question , which I hardly have time
to go into at present .
The focus- tube should be enclosed in an opaque box
which can be moved freely in any direction under the
couch. The opening in the top of the box through which
the rays emerge should be provided with a diaphragm
the aperture of which can be easily altered . There
should also be a means of centring the tube , so that the
239
normal ray may pass through the centre of the opening
in the diaphragm .
Not the least advantage in working from below is the
fact that one is enabled to obtain a view of the region to
be examined on the screen before placing the plate in
position. I attach a good deal of importance to this,
for after considerable practice one is enabled to judge to
a great extent, from the appearance seen on the screen ,
whether or not the tube is working to the best advantage
for each individual case ; and, moreover, valuable in
formation as to the probable time of exposure required
may also be obtained by this means.
Working from Above.-- I have tried many forms of com
pressor for working with the tube above the patient.
Most of these are clumsy and difficult to manage, and I
now have discarded them for the method just described,
which offers certain advantages not obtainable when
working from above. In my hands, at all events, the
method from below has given better results. In cases,
however, where the patient cannot be examined from
below, some form of compressor must be used. In
this case it is essential that the apparatus be rigid, and
The method of taking a large number of small plates, as
adopted by Mr. Thurstan Holland , is hardly practicable
in a large and busy hospital department, and I question
whether any great advantage is obtained.
The X -Ray Tube. —To obtain negatives of the required
quality, as soft a tube as possible should be used, for it
is only a tube with low vacuum that will give a good
differentiation of the soft parts. A hard tube does not
have the same effect on a photographic plate as a soft
one , and a good black and white negative cannot be
obtained, the result, even after prolonged exposure and
careful development , being a dirty grey. I may here,
perhaps, quote from a paper I read at the Exeter
meeting, and give the opinions of others who joined
in the discussion at that time. At the Roentgen
Society a short time ago the question was raised as
to whether a plate could be over -exposed when acted
upon by the Roentgen rays . No definite conclusion was
arrived at. I think I am right in saying that with a low
tube and heavy current over- exposure is certainly possible.
In the course of the discussion Dr. Howlett said : “ I have
come to the conclusion that it is not possible. The expo
sure can be prolonged indefinitely, and development will
still give a good result. My opinion is that exposure can
not be too prolonged under ordinary conditions." No other
240 ARCHIVES OF THE ROENTGEN RAY.

speaker gave a further opinion on the point. I, however, their results ; but I venture to think that there are
am convinced that over -exposure is possible. The negative many, including myself, who are not so satisfied , and
which I now show you is one of the renal region of a stout will work away until still better results can be
patient who was sent to me a short time back. The obtained . Judging from the vast improvements in
spark -gap of the tube was about 3 inches, or slightly under, the results of the last few years, I am inclined to
the current 41 to 5 milliampères through a Bauer air- think that the day when perfection will be the rule
cooled tube. The exposure was two minutes. The next rather than the exception is not so far off. I believe,
negative is from the same case, with the same tube and personally, that it is to improvements in the X-ray
an exposure of fifty seconds. The development of the tube that we now have to look before we can hope
first negative was four minutes, and of the second ten for much better results ; and the improvement will be
minutes, with the same strength of solution. If this in the direction of a better control over the vacuum ,
negative is not over-exposed, what has happened to it ? and the possibility of keeping the required vacuum con
Negative 3 is a specimen of an intermediate stage, but stant during the exposure necessary to obtain the best
in a different subject. I do not believe that a negative results. I know of no tube at present with a spark -gap,
of such a character could be obtained with a high tube. say, of 24 inches, that will stand even a current of
My contention that low tubes gave results superior to 4 milliampères for a minute or two without getting too
those obtained by high ones was supported by Dr. Morton, low to be of value. There are coils to be had giving an
Mr. Lyster, and Dr. Arthur. output capable of smashing any tube on the market.
Mr. Shenton did not agree , and said : What we want now is a tube that will stand this
1. “ I question whether great density is really wanted increased output.
in negatives, from the surgeon's point of view ." With I have no doubt that during a single exposure the
this I agree, but it is not necessary to obtain great quality of rays emitted by any given tube varies, and
density with a low tube. I maintain that you can get the tendency of a tube, if it does not get too hot, is to
more density with a correspondingly greater differentia- rise—that is, give off more penetrative rays. I believe,
tion of soft parts than is possible with a high tube. too, that a low tube becomes higher when extra current
Moreover, with a high tube it is quite possible that a is forced through it. Now , although a negative giving
small calculus of low atomic weight, such as pure uric marked differentiation of soft parts is probably the result
acid , would be entirely overlooked, owing to the greater of a composite irradiation, I do not think it need neces
penetrative power of such a tube. sarily be so, and I do not think that this is necessarily
2. “ I have some radiographs taken with high tubes, the reason why a somewhat prolonged exposure gives
and the negatives are of the washy character familiar to better results than very short ones . The results obtained
all X-ray workers ; yet I find it possible to correct them in the thicker parts of the body by giving a second or
in the printing process ." I fear that negatives obtained two's exposure with a very heavy current-at least, such
with low tubes, too, are often thin and washy , especially as I have seen-are certainly not superior, and I do not
in stout subjects ; but even when thin they show ,I think, think equal to those obtained by moderate currents and
more differentiation of soft parts. This skiagram is very about fifty to sixty seconds' exposure. Nevertheless, I
thin. The subject was a man 14 stone 3 pounds in weight , believe that, if we could get tubes with a spark -gap, say
but, as you see, it shows a marked differentiation of soft of 2 to 22 inches , that would stand these heavy currents
parts ; the edge of the psoas, outlines of the colon , and for a sufficient length of time, we should be on the road
other shadows of soft parts not easy to interpret, are dis- to being able to get certain results, even in the heaviest
tinctly visible, and there is not that uniform grey appear- individuals . I have obtained results good enough to
ance seen in a negative obtained with a high tube. give a negative diagnosis in persons up to and somewhat
3. “ In my opinion low tubes, in order to give these over 14 stone in weight ; but in a friend of mine who
high densities, are not needed ; we can do quite well with weighs over 19 stone, and who was kind enough to lend
the tubes we have got.” Now, to my mind, the X-ray me his abdomen to experiment with, although I was able
tube is at present the most imperfect piece of apparatus, to get a faint image of the spine, I quite failed to get any
and I would rather say, considering the tubes we have attempt at differentiation of the soft parts. No tube I
got, we do not do so badly. Some may be satisfied with possessed would stand sufficient current for a sufficient
 ARCHIVES OF THE ROENTGEN RAY . 241

length of time. At present, then , I believe that for this time before the screen examination is made, and is a
class of work there is no advantage in having very heavy point to which insufficient attention is paid by many
currents for the reasons stated. I was talking the other who wholly condemn such an examination, which un
day to a doctor from America, who had been using cur- doubtedly has a sphere of usefulness. It must not be
rents of 60 to 70 ampères in the primary of a coil which forgotten, too, that the eyes of different individuals vary
gave an enormous output (not measured , however), and he in their ability to appreciate the fluorescence of the
told me that, except for getting a flash exposure of the screen , and there are some who never can, even after a
chest, he had given up using such heavy currents, as the long time in complete darkness , observe details which
results in the thicker parts of the body were inferior to are very evident to others. Constant practice also
those obtained by moderate exposure and current. I enables the eye to see more than that of those who do
understand that the same conclusions have been arrived not so practise .
at by German workers . For giving a negative diagnosis, however, I consider
The excellent results obtained by Dr. Charles Lester the screen examination absolutely valueless ; for there
Leonard, of Philadelphia, in the X -ray diagnosis of renal are some shadows which appear quite distinctly on the
and ureteral calculi, are well known to most of you ; negative which cannot be seen on the screen, even when
and, as a further support of my contention that low tubes their exact position is known. I have tested this in all
are necessary, I may quote from a paper published by cases I have examined in the last six or seven months,
him in the Lancet (June 17, 1905), in which he says : and have found two in which distinct shadows of small
“ I insist upon the following features of my technique calculi were found on the plate (since confirmed by
as producing accuracy, and I believe that a disregard of operation), which by no stretch of the imagination could
them by other operators accounts in a measure for their I see on the screen, even with a small diaphragm con
lower percentage of calculi found in the total of cases tracted round the area where the shadow was known
examined. : .. The first essential of technique is the to exist.
employment of a constant quality of Roentgen ray, the Under this heading I may mention a further use to
penetrating power of which is so low that it will not which the screen has now been put. I refer to the
penetrate the least dense calculi. The negative diagnosis examination of the kidney at the time of the operation,
was established upon the axiom that where shadows of This has now been rendered quite practicable with the
tissues less dense than the least dense calculus are shown aid of the sterilizable cryptoscope designed by Mr.
no calculus should escape detection. The recognition of Reid, which it will be unnecessary to describe in detail,
a negative as possessing these qualities and its proper Suffice it to say that the whole apparatus can be com
translation are essentials of technique. The quality of pletely sterilized . The chief difficulties I have found in
X ray employed has been given off by a tube the relative using it at present are the following :
resistance of which , as measured by a parallel spark in 1. When working in a light theatre, it takes some
air, was from 11 to 2 inches. The tube must be capable time before the eyes can accommodate themselves to
of maintaining itself during the entire exposure at the seeing objects on the screen, and surgeons as a rule
same Vaccuum . Many tubes, and tubes of higher are not patient enough to keep their eyes glued to the
vaccuum , often vary in penetrating power, so that the machine for a sufficient length of time. Further, the
light at one time during the exposure penetrates the eyes of the majority are not trained to screen-work, and
smaller calculi." consequently they take more time, even under favour
The Screen Examination . The screen examination is able conditions , to see what is at once apparent to an
useful, as I have already stated, for gauging whether or expert. This difficulty might be got over in the follow
not the tube is working to the best advantage in each ing ways : (1) If the radiographer present were to wear
individual case. It may be useful in confirming shadows smoked glasses, and were allowed to examine the kidney
seen on the photographic plate in some cases, since a after delivery from the wound , his eyes would be in
very large number of calculi can be made out on screen better condition to seeing the fluorescence of the screen ,
examination , provided the luminous sensibility of the and his experience would enable him to decide quicker.
observer is at its maximum . This can only be obtained (2) Or the theatre might be provided with dark blinds,
by remaining in darkness , or semi-darkness, for some which could be drawn at the proper time. (3) Or the
242 ARCHIVES OF THE ROENTGEN RAY .

operation might be performed in the evening, when one's as well as thickness, as some individuals appear much
luminous sensibility is always at its best. more opaque to the rays than others of a similar weight
2. The eye-pieces of the present instrument do not and size . Here, again , it is only the expert who is able
entirely cut off the light, and the ease with which an to judge the required character of negative ; but it should
eye-bath fits the eye has suggested to me that if the show a marked differentiation of soft parts. The edge of
eye-pieces were made in this shape they would cut off the psoas, and transverse processes of the vertebræ,
the light more efficiently. should certainly be visible, and if the outline of the
Lastly, there is a difficulty in some cases of getting kidney, divisions of colon, etc., can be made out, so much
the kidney sufficiently far out of the wound ; but I have the better ; but I certainly would never give a negative
no doubt this is much facilitated by the weapon which diagnosis on a plate which did not show some differen
Mr. Reid has now designed to help the procedure, and tiation of soft parts. There are some who maintain
which I at present have no experience of. that it is not necessary for the transverse processes of
There can be little doubt that , when this instrument the vertebræ to be seen ; but I am sure this is quite
is more generally known, it will be much used , and wrong, for how can we expect to find a small uric acid
gradually improvements will suggest themselves ; for it calculus which is less dense than bone , if bony points
cannot be denied that it is a great advance over the themselves cannot be distinguished ?
cutting and needling all over of the kidney, with a great I now show you several negatives which I consider
possibility, even after this has been carefully done by a are of such a quality that a negative diagnosis with
skilled surgeon , of a small calculus being overlooked. regard to the regions they represent can be given with
some degree of certainty. And this one shows con
And now as to the value of the X-ray diagnosis of clusively the possibility of showing the outline of the
calculi . It is my belief that every renal calculus-at normal kidney .
any rate, of sufficient size to warrant surgical interference, In the two cases published by Mr. Clement Lucas
no matter what its composition-is capable of being ( British Medical Journal, October, 1904), under the
demonstrated by the Roentgen rays, provided the correct heading “ Two Cases of Renal Calculus in which the
quality of negative can be obtained . The same holds X Rays failed to indicate the Presence of a Stone,” I
good with regard to ureteric stones, with, perhaps, the one feel sure that, either through faulty technique or density
rare exception of small uric acid calculi being in such a of the individual , satisfactory negatives could not have
position in the pelvis that their shadow is obscured by been obtained ; in which case this ought to have been
that of the bones. I mean in such a position- between explained, and no opinion given. One of the cases, how
the bracket in this negative, wbich is one of a normal ever, gives a point for discussion. The patient was a
pelvis. thin man ; the stone was a large branching phosphatic
We now come to a very important point - namely, stone immersed in pus, and it is suggested that the pus
the interpretation of the various shadows seen on the masked the shadow of the stone. This is contrary to
negative. First of all I want to show you a slide of one my experience, and I should much like to hear the
case which is typical of many similar I have seen. The opinion of others.
shadows are apparently normal , but are ever so much The negative I now show you is from a case which was
more prominent in some cases than others. I will operated upon only this afternoon (Fig. 2). The calculus
simply show it, and ask those present to give their which I have here, as you see, corresponds exactly in
opinion , in the discussion to follow, as to what they are size to the shadow. It is composed of phosphates and
due. Are they the shadows of the normal kidney ? carbonates, and was in the pelvis of a kidney which
Now, the number of cases in which a negative of the contained 3 or 4 ounces of very thick pus . You see also
required character cannot be obtained is , I am glad to a minute shadow to the outer side of the larger one.
say, in the hands of skilled operators, becoming gradually This proved to be a minute calculus, no larger than a
less ; but there still are some few cases which, owing to millet-seed, which shows quite clearly in spite of the
the thickness and density of the individual, render the presence of the pus.
production of such & negative impossible. In such cases I may here again quote from Dr. Leonard's paper :
a negative diagnosis cannot be given. I mention density “ The accuracy which has been demonstrated for the
 ARCHIVES OF THE ROENTGEN RAY. 243

method by clinical experience has led me to hold that the A caseous kidney may cast a shadow quite as dense as
negative diagnosis, when proper technique and skill have that of a calculus. In the negative I now show you (Fig. 7)
been employed and a satisfactory plate has been obtained the shadow which you see is due to caseous material
is of such accuracy that surgical interference with the containing lime salts, and I certainly thought this was
purpose of detecting calculi is unnecessary and not due to calculus until the operation proved me to be
justified.” In his series of 330 cases, the total amount wrong. The negative also, again , shows the value of a
of error in both the positive and negative diagnosis was low tube, for although the patient came to me bearing
less than 3 per cent. This is a percentage of error that a note to the effect that it was feared she was too stout
compares very favourably with any other method, or for an X - ray examination to be of value, you will see
all other methods, of diagnosis, including exploratory that what proved to be a cyst at the lower end of the
nephrotomy I am spending a little time over the kidney casts a distinct shadow, and also that not only
subject of the negative diagnosis, because I am con- the psoas but distinct fasciculi in this muscle are easily
vinced that too much importance cannot be attached made out.
to it. And it is important from the physician's as well 2. From the shape of the shadow , however, some help
as from the surgeon's point of view. may be obtained . Small calculi in the kidney are often
There are a great number of cases of oxaluria and phos- irregular in shape, and present no distinctive features,
phaturia which present symptoms so strongly resembling though they tend to assume gradually the special forms
calculous conditions that medical treatment would be obtaining among the larger varieties. Thus, a large
scarcely justified unless a decided negative diagnosis stone in the pelvis of the kidney often possesses irregular
could be given . To be able to give such a diagnosis projections corresponding to the openings of the calices.
may not only save the patient from an unnecessary Such forms often give distinctive shadows, which are
exploratory operation, but justifies the continuance of quite diagnostic. Small stones in the ureter have, as a
treatment by medical measures. The fact, too, that rule, sharp borders, and a more or less oval shape. A
renal calculi may produce albuminuria without other large and irregular shadow in the true pelvis, even
symptoms, and that such cases have been mistaken for though it lies apparently in the track of the ureter, is
chronic interstitial nephritis or other forms of kidney probably due to other causes than ureteral calculus.
disease, must not be lost sight of. So much, then , for the Stones in the bladder are generally round or oval .
negative diagnosis. We will now go on to consider the There are exceptions to all these rules, however, so that
positive diagnosis, or the interpretation of negatives we cannot place too much reliance on the shape of the
which show definite shadows . shadow .
I have mentioned that all calculi met with in the Next as to the position of the shadows. Shadows of renal
urinary tract throw shadows when exposed to the calculi may be found as high up as, and be overlapped
Roentgen rays. The intensity of the shadow, as you by, the last rib, as in the case I now show you. On the
know , varies with the size and composition of the stone, other hand, they may be as low as is shown by the next
uric acid being the least opaque, but containing quite a slide— that is, below the iliac crest. Both these cases
pronounced shadow if a low tube be employed . The three have been confirmed by operation. It was thought that
most important groups of substances found in calculi are the shadow in this last case, although rather far out,
uric acid and its salts, calcium oxalate, calcic and might possibly be due to stone in the ureter, and the
ammonio -magnesic phosphates, while other substances, sterilizable cryptoscope was in readiness at the time of
such as calcium carbonate and cystin ,* which latter casts the operation. On exposing the kidney, however, which
a shadow much denser than uric acid, are occasionally was in a somewhat lower position than normal, the
met with ; and , of course, each stone may be a combina- stone could be distinctly felt in the lower part, and was
tion of two or more of these substances. I do not think, easily removed. It was of a flat, circular shape, as shown
therefore, with the exception , perhaps, that a very by the shadow. Shadows may appear in any position
faint shadow is suggestive of uric acid, that any opinion between these two extremes, as in the next three slides
as to the composition of a calculus can be gleaned from (Figs. 3, 4, and 5). Now, although shadows of calculi in
the density of the shadow. the ureter may be in any part of the ureter, it is a matter
* Henry Morris, Lancet July 21 , 1906 . of experience that they are generally found low down in
34

1
244 ARCHIVES OF THE ROENTGEN RAY.

the pelvis. Should they be higher up—and Mr. Hurry absolutely necessary that the whole urinary tract on
Fenwick has published a case in which a small oxalate both sides should be examined in every case before a
stone was found 3 inches below the right kidney-the patient can be pronounced to be free from stone.
shadow is always closer to the spine than that of a renal 3. All the facts of the case should be taken into con
calculi. The three great features of ureteric stone are, sideration. This method cannot be expected to produce
according to Mr. Hurry Fenwick, “ that they are in the best results when used alone, but, used in conjunction
the line of the ureter, their outlines are sharp, and their with other recognized methods of diagnosis, it adds an
shapes are more or less oval.” Now, the line of the ureter accuracy and precision obtained by no other means.
is quite close to the spine. It crosses the transverse pro- We will now take one by one and discuss briefly
cesses of the lumbar vertebræ, to enter the pelvis, as a rule, various conditions which may lead to error.
rather to the inner side of the sacro - iliac synchondrosis. The most confusing, perhaps, are the shadows cast
You will see that the shadow in the skiagram I have by calcified mesenteric glands . These may appear
just shown of a calculus below the level of the iliac in any part of the urinary tract, and may take various
crest is well to the outer side of the synchondrosis, and forms and shapes. Some of them , from their distribution
therefore the probability would be that, unless the and irregular shape, make us at once suspicious of their
ureter was in an abnormal position, such a shadow character. There are others, however, which it may be
must be outside the ureter. This, as I have already said , almost impossible to distinguish from stones in the lower
was proved by operation to be the case . ureter. In such cases the passage of a shadowgraph
Let us now consider the fallacies due to other con- ureteric bougie, as suggested by Mr. Fenwick , is, I think ,
ditions which produce shadows simulating those of undoubtedly the best procedure. The bougie is passed
calculi, and how they may as far as possible be avoided. into the ureter, and a skiagram is then taken. The
And, first, a few general points which apply to all cases. bougie casts a dense shadow, and the relation of the
1. The shadow or shadows should be present on at shadows to the bougie can thus be determined. I have
least two plates, obtained from two separate exposures. here some illustrations, published by Mr. Fenwick in the
Never give an opinion on a shadow which appears on British Medical Journal, which show the value of this
one plate only. Defects in the plate or errors in de- method. It is not always infallible, however. I know
velopment often produce appearances which are very of one case in which a calcareous gland surrounded and
deceptive. This was very forcibly brought home to me by pressure completely blocked the ureter. The bougie
a short time ago. A plate was shown to me with some would have passed up to this , and, of course, it would
glee by a friend who was somewhat sceptical as to the have been in the line of the ureter. Again , Mr. Thurstan
value of the X-ray diagnosis of calculi. I was told that Holland has lately published a case ( ARCHIVES OF THE
the plate showed a marked shadow of a stone ; that an ROENTGEN Ray, August , 1907) in which a calcareous
operation was performed ; that no stone was found, or gland was found adherent to the ureter, and in the
any other condition which could account for the shadow. ureter at the same spot was found a tiny calculus.
On looking at the plate , it was evident that this was no Nevertheless, there can be little doubt that in certain
stone at all. It was a very thin , poor negative, with cases this procedure may be of great assistance .
no differentiation of soft parts, but the shadow of the Phleboliths , especially in the pelvic veins, are not
supposed stone was most marked, and as dense almost infrequently met with. Two cases were published in
as if a piece of lead had been put on the plate. I should the Lancet (June 15, 1907 ) by Dr. Harris, of Sydney, in
think it was possibly due to a drop of “ hypo .” having one of which an operation for ureteral calculus was per
got on the plate before development. No confirmatory formed . The shadows, however, were found to be due to
plate was taken, and, as I have said, the patient was “ shotty " bodies outside the ureter. The shadowgraph
subjected to operation. It is such defective technique bougie would have probably settled the question in this
and inexperienced interpretation of shadows which tends case. Again , the very small size of the shadows would
to bring the method into disrepute. have warranted a course of expectant treatment, during
2. The impossibility by ordinary clinical methods of which time a careful watch on the signs and symptoms
making a differential diagnosis between stone in the would probably have given valuable information . Before
kidney and stone in the ureter in many cases makes it the introduction of the Roentgen method expectant
 ARCHIVES OF THE ROENTGEN RAY . 245

treatment in many cases was not warranted , owing to tion of the renal region , and the shadows you now see
the impossibility of deciding whether the symptoms were obtained and confirmed. I gave it as my opinion
were due to renal, ureteral, or extra-ureteral conditions. that they were calcareous flakes in a hydro- or pyo
If a careful X -ray examination of such cases be made, nephrotic kidney. An operation was performed and the
however, and negatives of the required character show kidney removed. By the kind permission of Mr. Bury,
only a small shadow, probably due to a small calculus who performed the operation, I now show you the kidney
low down in the ureter, expectant treatment is certainly itself, which has been preserved in formalin. You will see
in many cases warranted , for experience has shown that how very dense it is, and how very thin are the small
in quite a fair percentage of such cases the calculus calcareous flakes.
is eventually passed-twenty-six out of forty in Dr. The slide which I now show you is a somewhat in
Leonard's series . Such treatment must, of course, be teresting and unusual one (Fig. 8) . The patient had
carried out under strict supervision. The negative I several apparently quite definite attacks of appendicitis.
now show you is one in which I believe the shadows The surgeon, before undertaking the operation , wished to
may possibly be due to phleboliths, though, again, they exclude renal and ureteral calculi, for, as you are aware ,
may be due to calcification in a gland. As you will see,, the differential diagnosis between these two conditions is
they lie very near the track of the right ureter. On the often very difficult, and a healthy appendix bas on
other hand, there are two side by side. These do not several occasions been removed when the real cause of
look like stones in the ureter, and there are no symptoms the trouble was ureteral stone. This , then , is what I
pointing to renal or ureteral trouble. This patient is found in the pelvic region of this patient. You will see
perfectly well, with the exception that she has persistent there are three distinct shadows —two on the right
ædema of both feet and legs as high as the knees . She side and one on the left . The two on the right side
was X-rayed with a view to determine whether anything are of such similar density that I believed them to be
could be found which might be exerting pressure on the due to one and the same cause, and I ventured to suggest
common iliac veins, as she was rather too stout for that they were concretions in the appendix. The one
satisfactory examination by other means. These two on the left side is not so dense, and is in a position in
shadows I have confirmed on three different plates ; and which I have seen similar shadows on several occasions,
the position just opposite the intervertebral substance , and several have been published which might almost be
between the fourth and fifth lumbar vertebræ , although duplicates of this, so similar in shape and position are
perbaps rather far out, is suggestive, especially when the shadows. I do not know to what they are due, and
taken in conjunction with the symptoms, of some I know of no published account in which the mystery has
organized thickening obstructing the flow at the junction been solved. This print shows another similar shadow
of the common iliac veins. Possibly they may be due in another part of the pelvis, discovered quite by acci
to calcification of glands exerting pressure on these veins. dent, in a patient examined after a fall from a bicycle.
The shadows can only be obtained by using a very low But to return to the two shadows on the right : the
tube. And it is difficult to maintain such a vacuum with patient was operated upon and the appendix removed .
out its falling too low during the exposure. On a negative It was found to contain nine small shot, about No. 5
obtained with a high tube no trace of these shadows or No. 6, but was otherwise healthy. I have no doubt now
could be seen . that the lower shadow is composed of a group of five or
So great has been the improvement in technique six shot, and the upper shadow of three, or possibly four,
during the last few years that even small calcareous for on close examination certain circular shapes , due to
patches in an atheromatous vessel are now capable of individual shot, can be made out. The position of the
demonstration . These may in some cases cause con- lower shadow is very suggestive of stone in the ureter,
fusion , so that really the chief difficulty now is not in and the two together are interesting as pointing to the
finding a shadow, but in interpreting those we are able regions in which shadows of concretions in the appendix
to obtain. The next case I show you well demonstrates may be expected to be found , and the necessity , therefore,
how plainly these calcareous flakes can be shown even of bearing this possibility in mind when endeavouring to
when embedded in a dense structure. This patient, by interpret shadows in this region.
no means small or thin , was sent for an X -ray examina- Lastly, certain conditions, such as warts on the skin ,
34-2
 246 ARCHIVES OF THE ROENTGEN RAY,

are capable of casting confusing shadows. Dr. Lewis occasionally been able to obtain an outline of the bone
Jones has an interesting negative showing a shadow due in from one to two seconds, but the negatives are inferior
to such a condition . No doubt by the stereoscopic to those obtained by other means. With regard to the
method these might be shown to be outside the body, “ cryptoscope,” I have already shown at one of our
but as a routine I do not think that the stereoscopic meetings the weapon or special retractor that Dr. Orton
method affords much help in the abdominal region . has referred to. It is simply an aluminium plate with
Since, however, it is necessary to take at least two a hole in the centre, and when the kidney is drawn out
negatives, this method might just as well be employed ; from the body it is passed through this hole, and the
it gives some idea as to the depth of the shadows from tissues around the kidney are depressed. By this means
the surface, but gives nothing like as much information it is possible to see the pelvis of the kidney and the
in these cases as in joint conditions , where I have found upper part of the ureter. In each case in which I have
it quite invaluable . It has its sphere of usefulness , used it the stone has been extracted with an incision
however ; and not the least is the fact that two some- not exceeding an inch in length . The shadows at the
what thin negatives, when superimposed by the stereo- lower end of the ureter are a great difficulty. Lately a
scope, reinforce one another, so to speak, and often new shadow appeared which completely baffled us all.
enable one to see more detail than when either is It turned out eventually to be a calcified fibroid depending
viewed separately. from the uterus. The shadow was quite a large one,
I have no time now to more than mention the fact being about the size of the biggest ureteral calculus I
that in localizing small shadows in the pelvis the intro- have seen.
duction of air into the bladder may be at times of great Dr. W. IRONSIDE BRUCE : With a focus-tube the
assistance, and by this means the outline of this organ equivalent spark of which is less than 3 inches, the glass
can be distinctly made out. This slide ( Fig. 6) is of a becomes very hot and the tube is lowered . I believe
large vesical calculus, and you will notice that the out- the lowering of the tube to be largely due to the heating
line of the bladder in this case is distinctly visible of the glass. If it were possible to oil- cool the glass, we
without this procedure, probably due to hypertrophy of might be able to pass a much larger amount of current
its walls. The artificial introduction of air into the for a longer time. With regard to the length of exposure ,
intestines, as advocated by Professor Goldmann before I entirely agree with Dr. Orton that, as a rule, the best
the surgical section of this society a few weeks back, results are gained with the longer exposures. Another
may prove of valuable assistance in some doubtful cases, point insisted on was the necessity for a considerable
especially in thick individuals where the abdomen is distance between the focus-tube and the plate. The
very dense, but at the present I have had no experience tube should be a considerable distance from the plate,
of this method. because it is obvious that the further the tube is away
DISCUSSION . the sharper will be the definition. In my work it is
never less than 22 inches. The advantage in sharpness
Dr. A. D. REID : I quite agree with Dr. Orton with more than compensates for the extra time. I aim at
regard to the greater value of the low tube . There is no producing the outline of the kidney in every case. The
doubt that a high tube is a source of error, particularly information that is obtained from a negative in which
in diagnosing the more transparent calculi. The difficulty the outline of the kidney is visible is very great. It is
is to maintain the tube at its proper vacuum , for it runs then possible to say in what relative position the stone
down so quickly. I have tried in turn the mercurial is to be found, and this is very important from the
and the electrolytic break, and have found with the surgeon's point of view, for it makes it possible to
latter, while the exposures were shorter, the results were remove the stone without splitting the kidney. In a
not so good. I have now gone back to the mercury case in which stone has been found in a kidney, it is
interrupter, and am inclined to come down from the very important also to diagnose the size and condition
quick exposures. I have made experiments with what of the other kidney. With regard to differential
may be called the American methods, but do not obtain diagnosis in suspected tuberculous kidney, it is necessary
such good results as with the mercury break and the to observe the relative size of the kidneys ; and if one of
longer exposure . By the former methods I have them is enlarged, this fact, taken in conjunction with
 ARCHIVES OF THE ROENTGEN RAY . 247

the presence of pus in the urine, may be held to point graphs is much more satisfactory. With the use of the
with certainty to the evidence of tuberculosis. compressor it is perfectly easy to take a stereoscopic
Dr. C. THURSTAN HOLLAND : In my work I use a radiograph. A definite outline of the bladder is thus
220 -volt current, with one of Watson's intensifying coils, obtained, and those little shadows to which Dr. Orton
and the motor-magnetic interrupter. I shall perbaps alluded are seen in their relative positions to the bladder
surprise you when I say that the tube which I have used wall. I took a couple of stereoscopic photographs of a
for the last two and a half years has taken every single case in which there was a chain of five shadows in the
radiograph in my private practice, and has been used lower part of the ureter, in the position instanced by
for every part , including the kidney and bladder, the Dr. Orton. Two of the shadows were on a different plane
shoulder, the hip, and so forth. During the last from the other three. This rendered it improbable that
two and a half years I have examined 300 kidney cases , any of them were ureteral calculi . The whole subject is
a large number of which have been operated upon. In extremely interesting and difficult, and it is only atmeet
every case in which we pledged ourselves that there were ings of this kind that one can hear all the details and
stones, the subsequent operation when it took place arrive at conclusions of any value.
showed stones to be present . In no case of which we Mr. E. W. H. SHENTON : I would deprecate compres
have had knowledge of the outcome has the diagnosis sion, except in rare cases. It is important to allow the
proved inaccurate. One continually gets these trouble- kidney to move freely, and compare the range of move
some shadows in the abdomen, usually from calcareous ment of any suspected calculus with surrounding intes
glands. I once found in the same subject a stone in the tinal matter. The careful observation of these relative
kidney and a calcareous gland. I invariably use an movements will often prevent erroneous conclusions. As
equivalent spark - gap of 3 inches, on a 10-inch coil worked no two workers quite agree as to what is a high and what
from accumulators, and before I commence reduce the is a low tube, I think it unwise to use the terms " high "
vacuum to a spark-gap of under 2 inches. I never give and “ low . ” The tube giving a maximum quantity of
an exposure of more than one minute, and in ordinary rays and a clear image of the renal regions on the screen
subjects exposures often range from thirty to forty - five is the most suitable, and this can only be selected by trial
seconds. Occasionally with an electrolytic break I have and error. Unquestionably, a diaphragm should be used
taken negatives of the kidneys in five seconds. I always in all cases, a larger one being used for preliminary
use the method of placing the patient on his back, examination, and a smaller one for careful search over
raising up the shoulders , getting the arch of the back small areas. I am absolutely convinced that the screen
right on the board , and using firm pressure with a com- examination is all-important. With a suitable tube, it
pression-tube , one side of which is about 5} and the rarely happens that the photographic plate reveals more
other about 4 inches in height. I put the X-ray tube than the screen . On the other hand , there are many
over the compression -tube as nearly as it will go, cen- cases diagnosed upon the screen which the plate fails to
tring it carefully with a plumb-line. The development of confirm . Photographs are merely confirmatory of the
my plate is carried out in the most casual manner. I screen examination . I give a short exposure , not exceed
use pyro-soda developer : 6 grains of pyro to the ounce ing thirty seconds, and from this negative I print on
of pyro solution . I pour it on to the plates, one after No. 2 Glossy Gravura — a paper which was first specially
another , cover them over, and get them well started , made for my work at Guy's Hospital. It is a paper of
leaving an interval of one minute between each. Then extraordinary contrast . I believe the system of short
I get an assistant to rock the plates for fifteen or twenty exposure , thin negative , and vigorous printing contrast is
minutes , after which I take them out one by one and the correct one. The less exposure you give the plate the
put them into a hypo. The results are average good better, as the fogging rays will have less time to act. The
negatives . I do not think screen examination of the image, though faint, will be quite perfect, but it requires
kidney is of much value. The presence of pus makes no a very powerful printing process to extract a good result.
difference whatever to the result. On one or two occa- Much depends upon the operator's skill. It is no more
sions I have had the catheter passed into the ureter, and fair to say that X rays do not show a calculus than that
it has been of assistance. But the method of dilating the ophthalmoscope does not show a certain eye condi
the bladder with air and then taking stereoscopic radio- tion. In both cases the skill of the individual must be
248 ARCHIVES OF THE ROENTGEN RAY.

taken into consideration . There can be no question of SOME EXPERIMENTS WITH ROENTGEN TUBES
the efficiency of positive X-ray diagnoses in urinary WITH RESPECT TO THE USE OF TUBES FOR
calculus disease , and though the negative diagnosis is not DIAGNOSTIC WORK.
infallible, it is incomparably better than any other form
By VERNON J. WILLEY , A.M.,
of negative diagnosis in these conditions. To make a
Instructor in Electro - Therapeutics and Director of the Roentgen
satisfactory diagnosis, the eye of the operator must be in Laboratory, University of Michigan .
a condition to appreciate the screen image — that is to
The Roentgen tube is usually credited with being the
say, he must have been sufficiently long in a darkened
room . Lighting the room with blue light, the comple most important part of the instrumental equipment of
mentary colour to the screen image, has been a great the Roentgen laboratory. No matter how good the coil
help. and interrupter, or other apparatus, unless the tube meet
Mr. C. R. C. LYSTER : I hold the view that a low tube certain requirements, the diagnostic work will not be of
with a lengthy exposure gives infinitely the best results. good quality.
Personally, I am old - fashioned in still retaining the So far as instrumental technique is concerned , in
method of putting the plate at the back , and the tube in order that difficult diagnostic work may be accomplished ,
both the tube and its method of excitation must receive
front. I use a parchment disc with two uprights, and an the careful
air-cushion. One point in favour of this method is, that and intelligent attention of the operator.
The ideal diagnostic Roentgen tube would have, first of
with the patient lying on the back less compression is rays emanating from a point
neceseary. The most important point, however,isthe all, the entire output of
the focal point on the anode.
good focus of the tube, in order that contrast may be
Secondly, all rays of equal wave-length-i.e, the entire
secured . Dr. Orton has hit the right nail on the head wave-front constituted of vibrations of equal period.
when he says that the tube is the weak part in renal
skiagraphy. Thirdly, absolute constancy of penetration , resistance,
Dr. G. ALLPRESS SIMMONS said : Like Dr. Thurstan
and vacuum, when once adjusted to meet the conditions
necessary for the most accurate diagnostic work.
Holland, I have been fortunate in finding a most pheno
Fourthly, perfect efficiency ; all of the energy of the
menal tube. · I have used the same tube in St. Mary's electric current transformed into Roentgen rays — i.e.,
Hospital for a year, and have taken every skiagram
almost 950—by its means. I use accumulators and a no heat-production , with its attendant evils.
Mackenzie-Davidson break. The tube is a Müller tube
Fifthly, symmetrical dielectric resistance, or, better
still , a resistance to the inverse or “ make" E.M.F. of the
with heavy anode, and the ordinary mica apparatus for
lowering the vacuum. It starts by being high, lowers coil greater than the resistance to the “ break ” E.M.F. ,
itself after running one minute, and remains steady. I thus assuring unidirectional excitation .
moment's consideratio
But a n is necessary to reach
have taken a dozen skiagrams in the same afternoon
without any lengthy interval.
the conclusion that not one of these conditions is met in
actual practice with Roentgen tubes in use at the present
time. Some of them may be approximated for a short
time interval ; but the fact that in using a Roentgen
tube we are dealing with a system of variables increases
The International Roentgen Congress at Amsterdam, the technical difficulties of producing uniformly excellent
September 2 to 7, 1908, promises to be a most important diagnostic plates, or of securing uniform contrast and
and interesting event. Besides a contingent from detail on the fluorescent screen.
America and England , we understand that there will be It is not possible at present to secure a focus-tube in
present Oudin , Haret, Guilloz, and Cluzet from France, which the rays emanate from a point, or even from a
Einthoven and Wenchebach from Holland, and Unna circular area, since the projection of a cylinder upon a
and Borullan from Germany. Communications as to surface placed at an angle of 45 degrees from the axis of
papers and reports should be sent to Professor Dr. that cylinder is an ellipse, and not a circle. Therefore,
Wertheim -Salomonson, Vondelstraat 43, Amsterdam . the cathode stream is focussed upon a small elliptical
area of the anode, and all shadows produced by radia
 ARCHIVES OF THE ROENTGEN RAY. 249

tions emanating in straight lines from this area will freed from occluded gases at the time of its exhaustion,
possess a penumbra, and, unless the tube be placed with since in this the anode particularly acts in the same way
its long axis parallel to the plate or screen, an asym- as the shunt regulator, reducing the vacuum by evolution
metrical penumbra. In this position, if the anode is of gases when heated.
45 degrees from the axis of the cathode stream , and It may be demonstrated by experiment that a certain
45 degrees from the perpendicular to the plate, the current may be passed through a given tube, and that
penumbra will be symmetrical, and vary in size directly with this excitation the vacuum will neither rise nor
with the area of origin of rays and the distance of the fall—at least, not for a considerable period of time. If
object from the plate or screen . the current be increased, the penetration and resistance
Secondly, were we fortunate enough to possess tubes will fall, and also the vacuum , due probably to evolution
whose output was homogeneous—analogous to mono- of gaseous particles from the electrodes and walls of the
chromatic light, such light as for the most part passes tube, under the influence of increased heat. If the
the yellow screen in microscopic and ray- filter work- current be increased, the penetration and resistance will
the phenomena of diffraction, if it really exists, would rise, probably because the occlusion of gases exceeds the
be minimized, and there is reason to believe that the evolution from electrodes and glass walls. The current
shadows would be more definite in outline, and that strength which will not change the vacuum through
tissue structures might be more clearly differentiated. heating, may be called the current of equilibrium, or
At present it is not definitely known that Roentgen rays normal current. The seasoned tube, then , is one which
suffer diffraction , but some observed facts may be readily permits a large current of equilibrium , or normal current.
accounted for by such an assumption .? The equilibrium between gaseous evolution and gaseous
It seems quite probable that the train of waves from occlusion is not disturbed in such a tube except by ex
a so -called medium or soft tube is more nearly homo- cessive currents or by a longer period of excitation than
geneous, especially if the tube is well seasoned. In other in the unseasoned tube. Again , a seasoned tube will
words, a Walter 4 tube, or a Walter 5 tube, seems more endure & very large input of current for a short time ;
likely to possess a larger percentage of Walter 4 or it will permit a larger watt-second input or Joule con
Walter 5 rays, than a Walter 6 tube does of Walter 6 stant-i.e. , the continued product of the fall of potential
rays. At present, to say that the penetration of a tube over the tube, the current passing through it, and the
is Walter 5 or Walter 6 does not mean that its entire number of seconds it may be excited-without varying
output consists of Walter 5 or Walter 6 rays. It also in penetration of rays, resistance, and vacuum, than
seems probable that, were this the case, the problem of will a non-seasoned tube. It will permit & large
tissue differentiation would be much simplified . wattage input, and deliver a large radiant output with
The third requirement — that the tube should remain out much variation. A seasoned tube is not necessarily
constant in penetration of rays, vacuum, and resistance, an old tube, though age is of influence, especially with
during the time interval of its longest necessary excita- less perfectly exhausted tubes, where the permanent
tion-may be approximated in certain tubes, and a wide occlusion of a part of the gas is necessary before the
variation from this standard is fatal either to the pro- rate of occlusion of gas equals the rate of evolution for
duction of diagnostic plates of deep structures, or for a large current value, or for a very large Joule equiva
detailed fluoroscopic study of thorax or abdomen . lent .
The constancy of penetration of rays, resistance, and The fourth condition — that of efficiency - I am sure
vacuum depends upon several factors. The size and varies with different tubes ; but there are no tubes in
composition of the electrodes—and, more particularly, which there is no heat-production. The evolution of
the thoroughness with which they are freed from heat is, indeed, an inseparable accompaniment of the
occluded gases before and during the exhaustion of the transformation of electrical energy into Roentgen rays.
tube—the size of the globe, the kind of glass, and the It would also seem that a great deal more of the electri
nature of the residual gas, all have more or less influence cal energyis transformed into heat than into Roentgen
upon the constancy of the tube under excitation. The rays, a conclusion that is borne out by experimental
research .
age of the tube is of some importance, especially in one
not properly exhausted , or whose electrodes were not For the purpose of determining the quantity of heat
250 ARCHIVES OF THE ROENTGEN RAY.

in calories evolved in the excitation of a Roentgen tube,
the rise in temperature of a given quantity of water in
the anode-cooling vessel of a water-cooled anode tube was
determined, first for different degrees of hardness of the
tube under the same current excitation and for the same
Fig . 1. - APPARATUS TO DETERMINE THE QUANTITY OF HEAT
EVOLVED AT THE ANODE.
the well-known law of the heating effect of a current,
first experimentally determined by Joule and Lenz, that
the heating effect is directly proportional to the con
tinued product of the square of the current in ampères,
the resistance in ohms, and the time in seconds. Or,
expressed in symbols :
(H. I²Rt.) (H is proportional to I²Rt. ) Or, H = AI²Rt.
Where A is some constant-viz. , 0.24 for a conductor in
which all the electrical energy is transformed into heat.
The next series of experiments was conducted by im
mersing tubes in a glass calorimeter containing pure
distilled water, both heavy anode tubes and water -cooled
anode tubes being used for the demonstration , to deter
mine the total heat evolved. An open-top bell -jar wa
used (see Fig. 2) for a calorimeter, whose water equiva
lent was determined. The anode end of the tube was
placed downward in this inverted bell - jar, a conductor
passed through , and the opening made watertight by
a rubber stopper. A known quantity of water, just suffi
cient to cover the tube well up to the cathode neck, was
placed in the calorimeter. Over this was poured a layer of
heavy paraffin oil, about 1 to 1 centimetres thick, to pre

tirne interval, and then for different current strengths,

as measured by the milliamperemeter, other factors
being kept constant (see Fig. 1 ). Three Müller, one
Gundlach, and one Machlett water-cooled anode tubes
were used, the first four with 150 c.c. distilled water in
the anode-cooling vessel, the last with 75 C.C. In these
experiments the current was kept constant for a definite
period of time, the applied E.M.F. (in centimetres spark
gap), and the rise in temperature were noted , and the
product of the rise in temperature and the weight of the
water was noted-i.e. , the calories of heat produced.
From a series of experiments performed in this manner,
it was definitely proved that the heat evolved varied
directly as the resistance of the tube, being highest in
tubes of high penetration, resistance, and presumably
high vacuum. It is, of course, very simple to determine
Fig . 2. - APPARATUS TO DETERMINE THE TOTAL QUANTITY OF HEAT
that the heat evolved varies directly as the time. EVOLVED BY A Focus - TUBE IN ACTION.
The second series of experiments was conducted in the
same manner, except that all factors but current strength vent leakage currents. The results obtained simply demon
were kept approximately constant, so that the variation strated the same law, and, in addition, by comparing the
of heat evolved might be determined for variations in results obtained with those from heat evolved at the
current strength. As might be expected, it was easy to anode only , it was determined that approximately 80 per
demonstrate that the heat evolved varied directly as the cent. of the heat is evolved at the anode- i.e. , from 75 per
square of the current strength - i.e., doubling the current cent. to 85 per cent. Some of the actual results obtained
quadruples the heat. Combining these variables, we have are presented in the following tables :
 Fig . 1 . Fig . 2 . FIG. 3.

Fig . 4 Fig. 5 . FIG . 6.

TO ILLUSTRATE THE ARTICLE ON " THE X - RAY DIAGNOSIS OF RENAL AND URETERAL CALCULI ” ( p. 238 ) .

By G. HARRISON ORTON, M.D.

PLATE CCLXXXIII .
( “ Archives of the Roentgen Ray and Allied Phenomena." - Copyright.)
251
 Fig . 7 .

Fig . 8 .

TO ILLUSTRATE THE ARTICLE ON " THE X- RAY DIAGNOSIS OF RENAL AND URETERAL
CALCULI ” ( p. 238 ) .
By G. HARRISON ORTON, M.D.
PLATE CCLXXXIV.
( " Archives of the Roentgen Ray and Allied Phenomena ." — Copyright.
253
11

!
1
 ARCHIVES OF THE ROENTGEN RAY. 255

TABLE I. A series of experiments were also carried on in which

HEAT VARIATION WITH RESISTANCE (HARDNESS ). the immersed tube was excited inversely, and here the
Walter Time of Parallel Rise in Tempera total heat effect followed the same law ; but since the
Current. ture of 150 c.c. resistance of a tube in the inverse direction is usually
Scale. Excitation . Spark -Gap. Water .
considerably less than the resistance in the normal direc
2 20 secs . 3 cm , 6 ma . 2° tion, the heat evolved was correspondingly less for the
3 20 4.5 6 3° same current strength and time.
4 20 6 6 >> 4° Were it possible to determine accurately the value of
5 20 7 6 5.5 °
6 20 8.5 6 6°
the constant A, we could at once determine the efficiency
2 30 3 6 30 of a tube, from the ratio of-
3 30 4.5 6 5° Output (0.24 - A)I2Rt
4 30 6 6 6° = efficiency 0.24 I ? Rt
5
Input
30 7 6 7.5°
8.5
0-24 - A
6 30 6 9° or efficiency =
0.24
As one can only approximate A within certain limits
TABLE II.
-e.g. , by measuring E for the tube with an electrostatic
HEAT VARIATION WITH CURRENT STRENGTH.
voltmeter, and substituting E for IR in the formula, it
Time of Current Increase in is only possible to approximate the efficiency. However,
Walter Scale . Temperature of
Excitation . Strength. 150 c.c. Water. I am certain that the efficiency of a tube is considerably
less than 2 per cent .
CTHA
HAC
OTA

20 seconds 2 ma . 0.5 °
OT
co
CT
O.
os
H

20 > 4 2.0 °
20 6 4 :0°
20 8 7.5 °
20 10 11.0 °
20 12 15.0 °
20
WALTER

15 20.0 °
SCALE

30 2 > 0.70
30 4 3 :0°
30 6 6:5°
30 8 11.0°
30 10 16.5°
6 30 12 22.0 °
6 30 15 3 29.0°

TABLE III .
HEAT VARIATION WITH TIME OF EXCITATION .
12 3 5 6 7 8 9 10 11 12 13 14 15
Increase in Tem .
Time of Current MILLIAMPERES
Walter Scale. perature of
Excitation . Strength . 150 c.c. Water. Fig. 3.

4 20 seconds 12 ma . 8° The relationship between penetration of rays observed

4 40 12 16 °
22°
by using the Walter penetrometer and the current passing
4 55 > 12
4 70 12 28° through the tube, measured by a Weston milliampère
5 15 9 gº meter, was determined for a number of tubes, and the
5 30 9 18 ° results plotted in the form of a curve, in which the milli
.

5 45 9 27 °
60 9 36 ° ampères of excitation are plotted as abscissæ , and the
ososgor

5 75 9 43 ° hardness or penetration as ordinates. It will be noted

6 20 8 > 10° that the penetration increases in direct proportion to the
40 8 20°
55 8 27 ° strength of current through the tube. The penetration
will remain constant for a constant current strength, if
35—2
256 ARCHIVES OF THE ROENTGEN RAY.

the vacuum does not change during the time interval of
excitation (see curve , Fig. 3) .
The relationship between the fall of potential over
the tube and the milliampères passed through it was deter
the minimum current, or its “ ionization potential,” is
also directly proportional to the resistance of the tube,
its vacuum and penetration of rays. The results ob
tained from a Gundelach type G tube are represented
graphically by a curve, in which the milliampères excita
tion are plotted as abscissæ, and the fall of potential
in centimetres of the parallel spark -gap as ordinates (see
curve, Fig. 5) .
The relation between wattage excitation and penetra
tion of rays may be plotted in the same way by using as
abscissæ the products of the fall of potential in centi
metre air-gap and the milliampères excitation, these
products being proportional to the wattage excitation,
and as ordinates the reading of the Walter or the Benoist
penetrometers. The curve so plotted shows that the
penetration of the rays is proportional to the wattage (see
curve, Fig. 6 ).

FIG. 4. - ARRANGEMENT FOR DETERMINING POTENTIAL OF THE

SURFACE OF THE TUBE .
WALTER

mined by placing an adjustable spark-gap directly over

SCALE

the tube, as shown in Fig. 4, and measuring the air- gap

just sufficient to prevent the current from " sparking
over " under the given excitation. The results are
17
16
2
ល

12计

12
. PARK

5 10 15 20 25 30 35 40 45 50 55 60 65
GAP

WATTAGE RATIOS
CM

10
S

FIG . 6.

In order to use a given tube for a heavy current and

for rays of Walter 6 penetration, it is essential that
the tube possess the lowest vacuum , or the highest
current conductivity consistent with the production of
2

Walter 6 rays. The vacuum necessary , then, depends

1 2 3 4 6 7 8 10
9 11 12 13 14 15 upon the current strength , since, as shown by the curve ,
MILLIAMPERES
for 15 milliampères excitation the vacuum should support
Fig . 5. a 17 centimetres spark -gap to produce Walter 6 rays.
uniform in that they show that in all tubes the current Of course the adjustment of vacuum for maximum con
strength is strictly proportional to the fall of potential ductivity on the part of the tube, and the production of
beyond the potential difference required to render the Walter 6 rays, will depend upon the apparatus one is
tube a conductor, or to force the minimum current using, but it may be easily determined by experiment
through the tube. The fall of potential over a tube, for (see curves, Figs. 5 and 6).
 ARCHIVES OF THE ROENTGEN RAY. 257

In the heating experiments it was noted that an that about 80 per cent. of the total heat is developed at
immersed tube remains constant in penetration of rays, the anode, about 10 per cent. at the cathode, and the
resistance and vacuum , for a large current strength, remainder in the glass walls of the active or fluorescing
presumably because the heat is conducted from the hemisphere. The heating of the glass and its fluores
electrodes and glass walls to the water. It is therefore cence seems to be caused by the impingement or bom
probable that the heat equivalent of the current is bardment of its inner wall with gaseous particles -
responsible for the increased conductivity and decreased deflected or secondary cathode rays. Recently this
penetration of the tube. Since the heat increases with seems to have been pretty conclusively shown by Walter.3
the square of the current strength, a tube which per- Walter also points out that the indirect or glass wall
mits a heavy current, and at the same time a large rays, as well as the heating of the walls and their
inverse current - the total current reaching as high a value fluorescence, are caused by one and the same thing
as 50 or 60 milliampères when a yellow -flame arc passes secondary or deflected cathode rays. It may be further
the series spark-gaps—such a tube is subjected to a very demonstrated that the " glass wall rays" are higher in
rapid heating and consequent fall in vacuum. Again, penetration, and hence more in evidence in the so-called
tubes whose anodes tend to burn when transferred from hard tube than in the so-called soft tube. In other
a standard coil with mechanical interrupter
o
o to a special words, the volume and penetration of “glass wall rays "
c
o
o
n
are directly proportional to the heat produced in the
glass wall of the active hemisphere.
Constancy of vacuum , penetration , and resistance,
depend also to some extent upon the ability of both the
anode and the glass walls to dispose of the heat gene
rated . Since the thermal capacity of 150 c.c. water
in the anticathode cooling-vessel is greater than the
thermal capacity of the heaviest metallic anodes, water
cooled tubes have an advantage in this respect.
Furthermore, the ability of the glass walls to dissi
Fig . 7 . pate heat depends upon the surface exposed ; hence
6 , 7, and 8 inch tubes dispose of heat in the ratio of
coil with electrolytic interrupter, designed for heavy 36 : 49 : 64, the squares of their diameters. Of course
output, may permit a current of 25 milliampères for a the rate of air conduction depends upon the difference
short time without burning the anode, with exactly the in temperature between the air of the room and the tube
same degree of penetration as shown when excited by wall. Shields and diaphragms decrease somewhat the
the standard coil, simply by lowering the vacuum slightly rate of conduction of heat, except that the rate of
and lessening the heating effect due to the high resistance. dissipation of heat from the glass sleeve surrounding the
In order to determine the heat distribution in the extension of the heavy anode is not usually interfered
glass walls of the tube, the tube was placed in a shield, with by shield or diaphragm .
the space between the shield wall and the glass wall The fifth consideration—that the tube should have
was filled in by fine dry sawdust, to prevent radiation, equal dielectric resistance or ionization potential in both
and thermometers were placed in different positions directions, or that its resistance to inverse voltage
around the active hemisphere with the mercury bulbs in should be as great, or greater, than its resistance to
contact with the glass wall. The tube was then excited, direct excitation, is an ideal condition not realized in
and the resulting temperatures, plotted in ratios perpen- any of the tubes with which I have experimented .
dicular to a diagrammatic representation of the outline of Under constant conditions , save for reversing the tube,
the tube, give us a graphic representation of the distri- one finds that tubes have a greater conductivity and a
bution of the heat in the walls of the tube after its less ionization potential inversely than directly in the
excitation (see Fig. 7) . Moreover, by measuring the ratio of 1.2 to 3.8 for inverse as against unity for the
amount of heat developed in the anode, and the total direct excitation .
heat in calories, under constant conditions, one finds To prevent the inverse, then, it is necessary to control
258 ARCHIVES OF THE ROENTGEN RAY .

the excitation ; the E.M.F. in the inverse direction must may be passed through the primary by this pressure, but,
be kept below the inverse dielectric resistance or ioniza- unless the interrupter be an especially good one and
tion potential of the tube. Generally speaking, it is the accurately adjusted , it is difficult to break this high
induced E.M.F. at the “ make ” —produced by the grow- voltage cleanly and abruptly, and therefore the secondary
ing magnetic field in the primary or magnetization direct voltage may be actually less than with 110 volts
current - which forces inverse through the tube. applied to the primary.
Since the induced E.M.F. is proportional to the time- When one wishes to make use of low vacuum or soft
rate of change in the magnetic field , and to the ratio of tubes for certain kinds of work, it is highly desirable
the number of turns in the secondary with respect to to be able to excite the coil by a lower voltage than
the primary, the longer spark -length the coil is designed 220 ; indeed , a voltage below 110 is oftentimes of
to deliver, and the higher the voltage of the primary advantage in reducing the inverse E.M.F. of the
current, the higher will be the E.M.F. of the inverse. secondary. In fact, a variable voltage excitation has
A coil that will not deliver an inverse E.M.F. is one in many advantages.
which there is no make, no magnetization of the core, This was accomplished at the University Hospital
and no voltage used in this imaginary excitation—in fact, Roentgen Laboratory by designing and constructing an
a physical impossibility. There are in present use three autotransformer for the three -wire 220-volt 60 -cycle
ways of preventing the inverse E.M.F. from forcing alternating current obtained from the City lighting
inverse current through a tube : First , by interposing a mains.
dielectric resistance in the tube circuit of such value The three-wire 110 to 220 volt alternating current
that the inverse ionization potential of the tube plus the mains permitted us to use an autotransformer built for
ionization potential of the interposed dielectric resistance 110 volts, this being connected across one side of the
are together greater than the maximum inverse E.M.F. line. Then, by using the neutral and the transformer
of the coil—a result that is accomplished by either valve- taps, we can get from zero to 110 volts, and by throwing
tubes or series spark-gaps, or both . A low-vacuum, heavy a double-throw, single-pole switch and connecting in the
anode tube, in the reverse direction to that of normal other side of the line , and again using the transformer
excitation , accomplishes this purpose admirably. taps, we can get from 110 to 220 volts.
The second method—that of employing a coil of lesser For building this transformer we obtained an old shell
ratio in number of turns, and if possible excited by a type, dry, 1,100 to 110 transformer, and took out the
voltage of 110 or less, which generates so low a counter core . This was laminated, and the section of the main
E.M.F. at the make that its maximum is not sufficient path was 84 inches by 2 inches, or 17 square inches.
to break down the inverse dielectric resistance of the tube, Allowing 10 per cent. for lamination , we had 0:9 by
and whose maximum voltage at the break is just sufficient 17 = 15 :3 square inches of iron. Assuming the flux
to render the tube a conductor of a heavy current in the density B as 35,000 lines per square inch, ¢, the total
direction of normal excitation- such a method of excita- Aux, = 15.3 by 35,000 = 535,500 lines. Now, E equals
tion has much to commend it. A properly constructed 4:44 ΝφT where
N equals frequency = 60,
coil of 25 centimetres spark-gap will ordinarily pass 108
ф total flux,
current through a tube capable of T number of turns .
25 milliamp
delivering ères of6 rays,
Walter providing its excitation be of From which

such a nature as not to require some of its spark -length
to be used up in forcing current through a valve-tube or
series spark -gaps. Longer spark- coils generate a higher
voltage, both direct and inverse, and less current per double cotton-covered magnet wire was decided upon .
ampère input-a fact which may be demonstrated both
mathematically and experimentally.
The use of 220 volts rather than 110 for primary
excitation doubles the time rate of magnetization of the
core, and hence doubles the inverse E.M.F. if the in
ductance be kept constant . It is true that more current
108 E 110 x 108
T= 77 turns.
4:44 N 4:44 x 60 x 535,500
Since our maximum load was assumed to be 30 ampères,
The winding space-13 by 13 - permitted more than
77 turns. Since, by increasing the turns, B, and hence
core losses, would be reduced, we decided to wind
on as many turns as possible. A form was made, and
the coil wound on this. Each layer was shellacked and
covered with one layer of friction tape. Taps were
 ARCHIVES OF THE
looped out at the end of each layer. Nine layers, con-
taining alternately 11 and 12 turns, were wound on , conditions, or, in other words, to “ balance ” the
making a total of 108 turns. The coil was then wrapped
with friction tape and the core assembled around it. A
heavy wood box was built to hold the transformer. Ten
binding-posts were placed at the top for the terminals.
The box was finally filled with hot vaseline to perfect
the insulation .
The advantage of the variable voltage excitation of
the primary is that, not only may the inverse E.M.F. be
made so small as not to force current inversely through
low-vacuum tubes, but the current in the primary and
the secondary output may be controlled over a much
greater range than by a rheostat alone.
We were also able to demonstrate that experimentally
the inverse E.M.F. was proportional to the E.M.F.
applied to the primary, other factors being kept constant.
An electro -motive force much below 80 volts is not
practical, however, with an electrolytic interrupter and
a coil designed for a heavy output of current.
Since the dielectric resistance of the valve , or ventral
tube, is asymmetrical, or its ionization potential is not
the same in both directions through the tube, being
greatest when acting in opposition to the inverse E.M.F.
of the coil , it opposes a greater resistance to the passage
of the inverse than to the passage of the current which
excites the tube in its normal direction. Hence, if we
make use of an adjustable spark -gap parallel to and
connected to the terminals of the valve-tube, since the
fall of potential over the valve is greatest when the
inverse E.M.F. is a maximum , if we gradually approach
the points of our adjustable spark-gap, the maximum
sparking distance of the inverse will break down the
resistance of the air between the terminals, and allow
the inverse current to pass. This distance, plus the ampères will pass through a tube so adjusted in vacuum
ionization potential of the tube in an inverse direction
(previously determined ), is the total sparking distance
of the inverse E.M.F. for that excitation of the coil . It
is, therefore, possible to measure the sparking distance
of the inverse E.M.F. of any coil by knowing the
maximum distance a parallel spark-gap may be separated ,
to just allow the inverse E.M.F. to break down the air pressed, Walter 6 rays to be generated, the tube equal to
resistance. This method was made use of in the deter-
minations shown in the curve (see Fig. 8).
If one knows the relationship between the equivalent
sparking distance of a tube and current strength
passing through it, on the one hand , and penetration of
rays on the other, it is quite possible to reproduce these
ROENTGEN RAY . 259
conditions at will , and thus to work under constant
apparatus. One may by the methods given also deter
mine the condition of minimum resistance , and hence
maximum conductivity of the tube circuit, and at the
same time suppress the inverse current.
Thus , for Walter 6 rays, a tube on a given coil takes
about 17 centimetres air-gap if excited by 15 milli
ampères. The vacuum of the valve should be so adjusted
as to be just high enough in resistance to suppress the
inverse . This resistance to inverse voltage in the valve
SPARKING
DISTANCE
INVERSE
OF
80 100 120 140 160 180 200
VOLTAGE OF PRIMARY
Fig. 8 .
equals 9 centimetres air-gap under the conditions for
15 milliampères through the tube , 17 centimetres parallel
tube spark -gap, Walter 6 rays, 220 volts primary excita
tion . Hence the parallel spark-gaps of the valve are set
at 9 centimetres, and its vacuum lowered until 15 milli
that it will not quite equal a 18 centimetres spark -gap.
The primary current and adjustment of interrupter must
be known beforehand , but this is comparatively easy of
accomplishment after this is once done, and it needs no
change except for a different “ balancing." Fifteen
milliampères current, 9 centimetres inverse to be sup
17 centimetres air-gap, are the conditions for " balancing "
the apparatus with which this experimental work was
done, so that the circuit is of minimum resistance to
the passage of a unidirectional current through the tube,
and just sufficient resistance to suppress the inverse.
The determination of the sparking distance of the
260 ARCHIVES OF THE ROENTGEN RAY.

inverse, for any voltage of excitation and for any coil , during which the make or inverse wave is ordinarily
may be obtained by placing in parallel with a suitable suppressed, this interval may be turned to account in
valve tube an adjustable spark -gap. A fairly low exciting the tube, both waves in this case being uni.
Roentgen tube should also be placed in the circuit first, directional. If perfect rectification or an absolutely
so that the current will pass through inversely- i.e . , the unidirectional current is produced , no inverse excitation
Roentgen tube is simply run backward. If the inverse is possible ; and if the period of suppression of the
be completely suppressed by the valve, the ionization inverse is not needed for the tube to dissipate the heat
potential of the Roentgen tube in the inverse direction generated— in other words, if tubes may be shown to be
is determined by approaching the parallel spark-gaps able to support the excessive heating without serious
over the tube, as in Fig. 1 , until the first spark passes ; variations in penetration of rays or of lessening the life
this distance is carefully measured, and the distance of the tube—then we may hope to see from this apparatus,
recorded for further use. The Roentgen tube is then with its large current output, tubes so excited that
so placed as to be excited in the proper direction only, instantaneous radiography will be realized to a degree
and the parallel spark-gaps above the valve are gradually that at the present time is rarely accomplished by the
approximated until a spark passes. This is the sparking open magnetic circuit induction -coil apparatus.
distance of the inverse, if we add to it the number
REFERENCES .
previously obtained. 1
Spark -distance values so obtained, and their relation- Haga and Wind, Wied. Ann ., LXVIII ., 1899, pp. 884 . 2 Preston's
" Theory of Light,” chap. ix . 3 Walter, “ Über die Vorgänge in der
ship to the primary voltage for constant inductance, Röntgenröhre";
Band 11 , Heft 3 . Fortschritte auf dem Gebiete der Roentgenstrahlen,
may be plotted as a curve, in which the primary voltage
is plotted as abscisse and the sparking distance of the
inverse as ordinates. The curve given (see Fig. 8)
shows that the inverse sparking distance increases with
the primary voltage excitation for constant inductance ROUTINE EXAMINATION OF THE CHEST.
and current excitation .
By GEORGE A. PIRIE , M.D.,
Practically , in order to secure uniform results, the Medical Electrician to the Royal Victoria Hospital, Dundee.
most rapid exposures, and to have the conductivity of the
secondary circuit a maximum , it is important that the During the past three years it has been my custom to
valve tube should be so adjusted in vacuum that the fall examine by the X rays every case of chest trouble which
of potential over it, plus the inverse fall of potential of presented any point of difficulty in diagnosis. Of course,
the Roentgen tube, shall just exceed the sparking in the majority of cases nothing abnormal was found ;
distance of the inverse. Hence the higher in vacuum but in some the results were most interesting, and at
and harder the Roentgen tube , the lower is the vacuum times quite unexpected.
required in the valve, and conversely. One may also Let me first describe the apparatus and the method of
determine the sparking distance of the inverse for examination . The town's current of 200 volts is passed
different steps of variable inductance, keeping other through a Watson's interrupter to a 10-inch spark coil,
factors constant , and plot the curve in the same way. whence the secondary current is led to a Müller's self
At any rate, in a tube circuit, consisting of a Roentgen regulating tube held in a firm stand. About 4 ampères
tube and a valve, it is of advantage to have adjustable of primary current are used, giving about 1 milliampère
spark-gaps in parallel with both these tubes, and to so of secondary current. The tube is of medium hardness,
adjust the one with reference to the other that the about 6 degrees on Benoist's scale.
conditions may be constant for the same kind of diag. At first the patient stands with his back to the tube
nostic work. Moreover, the danger of puncture to these and about a foot off, the screen being placed on his
tubes is in this way very much lessened. breast . The room being darkened and the current
The third method, that of rectifying the inverse, and switched on, a rapid survey is made of the chest. With
throwing it directly through the tube, using a closed no shield on the tube there is no possibility of seeing
magnetic circuit high-tension transformer, is certainly any fine detail on the screen , but the main facts may be
promising, since, instead of a relatively long-time interval, observed in a few seconds, thus : Heart, normal in size
 ARCHIVES OF THE ROENTGEN RAY. 261

and position ; lungs, fairly clear all over ; diaphragm , apices of early phthisis, with the deeper shadows at the
about the proper level on both sides ; no unusual roots of the lungs ; the mottled appearance of subacuto
shadows . phthisis ; the lighter central spots and darker bands of
Then I place over the tube a cap devised for the cavity formation ; the varying shadows of effusion ; and
purpose . It is made of rubber and red-lead , has a the black shadow of empyema and chronic phthisis. All
central aperture 2 inches in diameter, and can be slipped these appearances are well known to the trained observer.
on and fixed by elastic bands in a second or two. Now Let me describe three cases of unusual interest :
the patient may be set nearer the tube — say 6 inches off CASE I.-J. E. , aged fifty, tall, thin , haggard , com
--and the screen will show an illuminated space about plained of persistent pain down the right arm, un
6 to 8 inches across. There is less light, but more detail relieved by any previous treatment . The screen ex
is visible. The outline of the heart can easily be noted , amination revealed a large rounded shadow above the
and, if desired, a tracing may be made on the patient's heart, extending to the left side. There was no pulsation .
skin by a dermatographic pencil. My plan is to use a The diagnosis was a mediastinal tumour, with extension
small screen 4 inches square, unmounted. The focus- pressing on the spinal nerve roots. Treatment by rest
tube is kept fixed , but the patient is moved slightly, so and iodide of potash gave speedy relief of pain. The
that the part examined is always near the centre of the patient is now back at work.
bright circle. I then pass the small screen over the CASE II.-W. D. , aged forty, short, fairly stout,
skin , with the pencil at its edge following the contour. complained of pain in the right side, with cough, and
In this way an orthodiagraphic tracing is easily obtained . fever of a week's duration . Clinical examination showed
When examining the lungs, I ask the patient to breathe signs of consolidation of the middle lobe of the right
deeply: If any abnormal shadows are present, they can lung. The X-ray examination fully confirmed this ; a
be detected more easily when moving. Sometimes the photographic print showed a wedge-shaped shadow in
appearance is like a fine net interspersed with knots the middle of the lung. The patient was sent home to
moving up and down, the knots being the shadows of bed, and soon recovered . Ten days later another Roent
miliary tubercles. At other times a specially dark spot genogram was taken. The shadow of the affected lobe
may be seen making an excursion of a couple of inches was still visible, but very faint. A fortnight later it was
up and down during forced respiration. gone. The screen examination showed that both lungs
The position of the diaphragm can also be easily seen , were normal .
and marked on the skin by the method above described . CASE III.-Mrs. B., aged forty - five, complained of
I need only mention the other appearances commonly shortness of breath , with oppression in the chest. She
met with in chest troubles : The larger and darker had a “ brassy " cough. The symptoms led to a sus
shadow of the hypertrophied heart ; the displaced heart, picion of aneurism . The screen examination showed
either drawn toward the dense shadow of contracting that the aortic arch was greatly enlarged and pulsating
lung tissue, or pushed away from that of fluid accu- with each beat of the heart. Rest and iodide of potash
mulating in the pleural cavity ; the slightly dimmed gave great relief .

Notes and Abstracts .

MEASUREMENT.
Guilleminot ( Comptes Rendus de l'Académie des Sciences,
November 11 , 1907) has added another unit to the number of
units already in existence for estimating the quantity of the
X rays. This unit, M, is the luminous effect on a fluorescent
screen of a given standard specimen of radium at a given
distance. The output of the focus-tube is measured by com
paring the luminosity of the screen when illuminated by the
X rays and by the standard radium . The number of units M in a
given dose is determined by the time of application and the
distance (taking into account the law of the inverse square of
the distance). This may be done more conveniently by an
automatic integrator invented by the author .
Dr. Guilleminot is carrying on a series of experiments to
determine the physiological and physio -chemical action of one
unit M , both with radium and with X rays of different degrees
of penetration.
36
262 ARCHIVES OF THE
The Electro -densimeter . - L . Benoist ( Journ . de Physique,
vol . vi. , pp. 604-615 , August, 1907) has devised a measuring
instrument in which the deflection of the leaf is almost propor .
tional to the potential. The single leaf electroscope is chosen as
giving a maximum of sensibility, simplicity, and facility of
reading. The leaf is made so that it can be removed and again
replaced in exactly the same position, and by using leaves of
different size, weight, or material the sensibility may be altered
at will. The leaf is fixed by a steel spring to an insulated
metallic disc 7 centimetres in diameter, which prevents lateral
deviation. The cage is metallic, and, by means of an adjustable
disc connected to it and parallel to the insulated disc, the capacity
of the apparatus may be given some definite value e.g. ,
10 farads . A circular scale is used with an alignment by
which it can be read to { division . The formula 1 (ca - C.)V- =
pl sinº (a/2), (where ca = capacity of system for angle of deflec
tion a , Co = capacity for a = 0, V = p.d. between the insulated
system and the cage , p = weight of leaf, 1 = length of leaf, giving
the relation between V and a), is experimentally verified with
regard to influence of weight, breadth, and length of leaf, and
curves are drawn showing the variation of V with a for three
different leaves. All three curves show that the sensibility
decreases for deflections greater than 60°, the curves up to this
point being almost rectilinear. The sensibility is, however,
made very nearly constant over the whole range by altering the
form of the cage to that of half a circular cylinder of which the
axis coincides with that of the rotation of the leaf. This reduces
to a minimum the change of capacity caused by deflection of the
leaf, and the resulting curve, almost rectilinear throughout, varies
but little from V = K sin (a/2), where K is a constant. An in
strument has been constructed embodying these improvements,
which reads from () to 6,000 volts, and it can also be used in the
measurement of quantities and capacities.
RADIUM .
Radium Emanation . — Sir W. Ramsay has shown that whilst
the spontaneous change of the emanation from radium results
in the formation of helium, when the emanation is in con
tact with and dissolved in water the inert gas produced
by its change consists mainly of neon , only a trace of helium
being detectable . When the emanation is left in contact with
copper sulphate or nitrate solution, the main product of the
change is argon, perhaps a trace of neon being also formed, but
no helium . Spectroscopic examination of the residue, after
removal of the copper from the solution, renders evident sodium
and calcium spectra, and, very faintly, the red lithium line.
Control solutions of copper nitrate, not exposed to the emana
tion, show no trace of lithium . Thus the gases formed by the
degradation of radium emanation belong to the same group of
elements as the emanation itself, and it appears as if copper also
undergoes degradation, yielding one or more of the lower metals
of the copper group.-- Science Abstracts.
Scattering of the a Rays (L. Meitner, Phys. Zeitschr .,
August 1 , 1907.) — When a metal sheet is placed in the path of
a beam of a rays, the decrease in the ionization which is
produced in the gas behind the sheet is attributed by different
authors to one of two causes : either a change in the range of
the a particles or a scattering of the rays. The present paper
ROENTGEN RAY.
attempts to decide which is the true explanation. Two thick
metal sheets have each a hole bored in them, and are then
placed a short distance apart, so that the centres of the circular
apertures are on the same straight line. The ionization , Ju , is
measured behind the first sheet, and also J,, the ionization
behind both, when a source of a rays is placed in front of the
apertures. For a constant distance apart of the sheets J,/J,
must be constant if no scattering is present. The aperture
through which the rays first pass is now covered with a thin
metal sheet. J, and J, are now reduced, but their ratio is
unaltered if no scattering is present, but if scattering occurs
J1/J, is different when the thin metal sheet is present. From
his experiments the author concludes that this scattering does
take place, and depends on the atomic weight of the metal.
Science Abstracts.
RADIUM - THERAPY.
Exophthalmic Goitre treated by Radium . — Abbe has
reported two cases successfully treated by radium . Dominici
reports the case of a patient with marked signs of goitre, with
protrusion of the eyeballs. The thyroid body increased to
35 centimetres ; pulse 108 ; trembling, insomnia, dyspepsia.
A cloth impregnated with radium of activity 500 was placed
around the neck . This was separated from the neck by a layer
of paper and caoutchouc. In this ways the a and B rays were
arrested, the y rays alone penetrating the tissue.
The cloth was worn as a cravat round the anterior three
fourths of the neck, extending from the base of the neck to
above the hyoid bone. The cravat was worn for six hours at &
time, and the application was repeated almost every day for six
days.
The exophthalmia was diminished, the goitre was diminished
to 32 centimetres, the pulse fell to 88, the insomnia disappeared,
and the trembling abated.
In this case radium appears to act like the X rays by causing
a disintegration of the cells of the thyroid body.-Drs. GILBERT
BALLET and DELHERM, Ninth Congress of Medicine, Paris, 1907.
PHOTO - THERAPY .
Lupus of the Face and Photo- therapy . - Mally (Revue de
Chirurgie, August 10), in discussing the effect of light, or what
he aptly terms “ Finsen-therapy," in lupus of the face, declares
that its favourable influence must be due to other causes than
to its distinctive effect upon bacteria, for the following reasons :
(1 ) It has not been demonstrated that the bactericidal effect of
the light can be utilized beneath the surface of the skin . (2) A
certain number of methods, which are not at all bactericidal
(scarification, cauterization , electrolysis, etc.), have also given
curative results in lupus. (3) Certain agents employed to in
crease the bactericidal effects of light upon the lesions have not
been at all successful. (4) The Roentgen rays have been shown
to be effective against lupus, but no one has ventured to suggest
that their merit was to be attributed to their bactericidal action .
(5) If the therapeutical action of light was especially bacteri
cidal, this would not explain why certain forms of lupus are
more or less susceptible to the curative action of the light. But
the results of experience of Finsen showed that the most
virulent - such as the ulcerating tuberculous lupus, or vege
tating lupus - really was cured the more easily, and the more
 ARCHIVES OF THE ROENTGEN RAY. 263

torpid forms, which contain very few bacilli, required a pro- surface of the glass which are near to, but not actually in con
longed treatment, almost discouraging by the slowness of
improvement. (6 ) After an ordinary application of the light,
the skin is not more aseptic than before, and tubercle bacilli,
if placed upon the surface of the skin, and afterwards sown in
cultures, regained their ordinary virulence and vitality. Ac-
cording to Mally, the action of the light is explained by a
common irritation of the skin, analogous to a chemical irrita-
tion , or that of a hot iron , or from scarifications, and of almost
the same intensity, and this irritation causes sclerosis.- New
York Medical Journal.
The Ultra -violet Ray and High - Frequency Currents in
Phlebitis.-- Sinclair Tousey (New York Medical Journal,
November 30, 1907) describes two cases of phlebitis of the leg
successfully treated by the ultra-violet ray and high-frequency
currents . The apparatus employed is an Oudin resonator,
actuated by a 12-inch induction coil, with a mechanical inter
rupter or an electrolytic arc . The induction coil is provided
with two Leyden jars and an adjustable spark-gap. The latter
forms one of the chief means of regulating the character and
strength of the application. The principal other adjustment is
by means of a rheostat which controls the strength of the
primary current. A heavily insulated wire passes from the
Oudin resonator to the special handle devised by The
the author,
to which a glass vacuum electrode is screwed. cord is
the same as is used in automobiles for conducting the high- the skin. Alopecia areata has also responded to the use of this
tension secondary current from the spark-coil to the cylinders. lamp. In cases of lupus vulgaris its therapeutic powers com
The handle is made of hard rubber, completely concealing a metal
socket into which the terminal of the insulating conducting cord
fits, and another into which the glass vacuum electrode screws .
The latter is made of very thin glass, and terminates in a
flattened dome-shaped bulb. The flat surface of the bulb is
rubbed over the affected surface . When the current is turned
on , the vacuum electrode becomes filled with a brilliant violet-
coloured light as soon as it is held in contact with the skin.
The extremely high tension of the current is what carries th
electric power through the glass into the patient's body. A
shower of fine sparks may be seen passing from all parts of the
tact with, the skin . Slight circulatory stimulation is produced,
which may or may not cause slight temporary reddening of the
skin, according to the activity of the effect desired. The ultra
violet rayhas a stimulating effect upon the processes of meta
bolism in the tissues. It is also a powerful agent in the production
of ozone, which is actually absorbed by the tissues under the
influence of the current. This very active form of oxygen acts
as a powerful vitalizer of the tissue cells. The electric current
itself stimulates the circulation , and favours the elimination of
chronic exudates and indurations. It is also a stimulant to the
vitality of the tissue cells.
The Kromeyer Quartz Vacuum Mercury Lamp. — Heidings
feld ( The Lancet Clinic, October 26, 1907) mentions the fact
that the container, being made of glass, allows a very large
and rich quantity of ultra - violet rays to be emitted. The
instrument emits such an intense light that the eyes must be
shielded in using it. On a skin surface it will produce a marked
erythema in ten seconds, and bullæ in twenty to thirty seconds.
He has found this lamp most valuable in lupus erythematosus,
especially in cases which have baffled all other forms of medica
tion. It is also of great use in acne, especially the indurated
forms, as well as in furunculosis and all forms of chronic
inflammation of the skin, such as chronic eczemas, which are
accompanied by infiltration, induration, and lichenifaction of
pare more than favourably with the best results obtained from
the most powerful Finsen instruments. It may also be used
for indoor photography. The writer has been able to photo
graph in one-tenth of a second dermatological eruptions which
ordinarily require from ten to fifteen seconds of exposure with
the brightest daylight. Another great value which this instrument
possesses is for diagnostic purposes. An eruption of roseola in
syphilis can be readily seen twenty -four to forty-eight hours
before it can be easily detected by the eye. The same is true of
the other forms of exanthemata, particularly those which accom
pany the infectious diseases.

Reports of Societies.

ROYAL SOCIETY OF MEDICINE - ELECTRO is believing,” and they place more faith on what the physician
tells them he has seen than upon what he has heard . The
THERAPEUTICAL SECTION .
diagnosis of phthisis in its earliest stage is a matter of vital im
December 20, 1907 . portance, not only to the individual, but also to the State. To
Mr. W. DEANE BUTCHER, President of the Section , in the Chair. ascertain the views held upon this subject, I sent out papers to
fifty consulting physicians in Great Britain , and I had replies
Dr. A. STANLEY GREEN opened a discussion on The Diag from thirty- three. Of these , nineteen informed me that they
nostic Value of the Roentgen Rays in Diseases of the Chest." had no experience on the subject worth mentioning ; and of the
Dr. STANLEY GREEN said that patients are always willing to remainder, five answered all three questions with an emphatic
undergo an X -ray examination because they hold that “ seeing negative.
36-2
264 ARCHIVES OF THE ROENTGEN RAY .
Physicians have not, up to the present, made as much use of
the rays as might have been expected, because they feel that they
are capable of making a correct and accurate diagnosis without
any extraneous help. I use a Gaiffe -d'Arsonval installation ,
and find that it does all that I require. Thirty seconds is
usually an ample exposure except in a very burly chest. Until
about two years ago I was in the habit of using Müller tubes,
and found them very reliable-in fact, I had one in use for ten
months— but now I find the Chabaud -Villard the most reliable ,
although they will not carry more than 1 milliampère for more
than a few minutes without getting either very soft or extremely
hard.
I always screen and photograph patients in the erect posi
tion, because I have found that the diaphragm moves more freely
when they are standing up than in any other position, and they
are photographed sitting as erect as possible because they are less
likely to cough. To ensure perfect darkness I had a corner of
my electrical room built off with black wood in which a large
aperture was cut and then covered with a black curtain ; the
screen, covered with a piece of ground glass (for the purpose of
making tracings) , can be moved up and down in slots, being held
in position by two springs ; this device leaves both hands free.
The patient leans with his back against the screen, and the move-
ments of the diaphragm are noted and exact tracings made.
The patient then turns round and leans with the chest against
the screen , and the movements are again traced on the glass.
The tube is now raised to the level of the third intercostal space ,
and with the back to the screen, the apical regions are carefully
examined for any shadows. If there is any doubt of the presence
or extent of these shadows , a diaphragm is fitted on the tube-
holder and small areas illuminated, and the effect of inspiration
on these shadows carefully observed ; if due to recent disease ,
they light up, the fluorescence being gradually diminished until
the observer is satisfied ; the patient is again turned round, and ,
with the chest to the screen, a further examination is made, and
the cardiac area marked out. This concludes the screen examina-
tion, and the photograph is taken, the plate-to-back method being
always used, the advantage being that it is more comfortable for
the patient, the ribs do not obscure the shadows so much as they
do in the plate-to- chest position , and in a majority of cases the
areas of infiltration and consolidation are nearer to the back than
to the front, and for this reason a sharper outline is obtained .
The development of the plate must be done by the radiographer
himself, especially in the very early cases, because in some of
these the shadows can only be detected by careful watching as
they come up in the plate , obscuring for a time the outline of the
ribs. When one apex only is affected, the difference in the corre-
sponding areas is very marked during the first three minutes ;
development is carried on for about fifteen to twenty minutes
after the image has appeared. I always use Lumière plates
because they will stand a lot of developing without showing
any fog.
The level of the diaphragm is usually higher on the right than
the left. The excursion which it makes when a deep inspiration
is followed by a full expiration averages 27 inches on the right,
and 28 inches on the left. During quiet respiration the dia-
phragm moves about } inch on each side.
There is no difficulty in estimating the limitation of movement
of the two sides, and also the difference between the anterior and
posterior views. Attention was first drawn to this latter point
by Dr. David Lawson, under the term “ associated movements
of the diaphragm ," and he proved that where consolidation is
apparently more marked towards the posterior aspect of the
lung, the amplitude of the range of movement of the diaphragm ,
as seen from the back, was considerably less than the amplitude
at the front, and vice versa. Furthermore, the relative level of
the diaphragm on the affected side, as seen from the back, was
higher than that observed at the front. I am often able, from
my screen examination , to make up my mind about the situa
tion of the diseased area . I am more than ever convinced that
“ unilateral imitation of movement of the diaphragm " is the
earliest known sign of pulmonary tuberculosis. In addition
to the limitation of range of movement, there is also limitation
in the freedom of movement ; and though in some cases the
diaphragm may make an excursion of 1 } inches, yet this is done
in a jerky or stammering manner, and the diaphragm only
reaches its lowest level by a series of jerks. Once seen, this is
very striking, and I consider it of almost as much importance as
the limitation of movement mentioned above .
The progress of the disease can also be watched with the rays.
Patches of light and shadow became brighter when the lungs
were filled by a deep inspiration, and this was evidence that they
were not of long standing. A very definite change had taken
place after a six months' residence at a sanatorium .
In many cases where the physical signs have demonstrated
the presence of the disease in one lung only, the Roentgen
examination has proved that there was some mischief in the
other lung also .
In Calmette's tuberculin, the bacteriological examination of
the sputum, and the Roentgen rays we have three valuable aids
to the diagnosis of pulmonary tuberculosis. I have never found
the rays fail to locate early pulmonary tuberculosis when it has
been proved to exist by other methods of examination .
The question of prognosis in pulmonary tuberculosis is one of
great importance and full of difficulties. If the limitation of the
movement of the diaphragm is not very marked , or is only
marked in one view ; if it improves considerably with treatment ;
if the shadows are thin and not very extensive ; if the cardiac
area is found to be not less than is usually seen in a normal
patient of corresponding size and weight, then the patient has
several points in his favour.
The diagnosis of fluid in the pleural cavities presents no
difficulty to the radiographer, and can be made from the screen
examination alone. The shadow cast on the screen by an
effusion of moderate dimensions is homogeneous in character,
diminishing in intensity from below upwards, and does not show
the mottling which is so characteristic of most intrapulmonary
shadows, whilst differing in outline from the consolidation of basal
pneumonia. When viewed in the erect position, the upper limit
of the fluid is usually concave, and the outer extremity is, as a
rule, at a higher level than the inner, but the contour of the
opacity changes with every alteration of the patient's body.
This is not the case when air as well as fluid is present, as
shall see later. The heart shadow is pushed well over to the
opposite side, and the appearance of the lung above the level of
the fluid varies. In some cases it is translucent, in others it
 .
ARCHIVES OF THE
may be almost as dark as the fluid itself, and when this is the
case pulmonary tuberculosis must be suspected and the patient
carefully watched, and a second Roentgen examination made
when the fluid has disappeared.
The PRESIDENT (Mr. W. Deane Butcher) was pleased to see
the examples of relief skiagrams, which he believed were the
first shown in this country, at all events of the lung. He
thought that plastic Roentgenography was destined to play an
important role in the future of Roentgen diagnosis. The print.
ing need not necessarily be done by the medical man himself. downwards and having the arms hanging over the head of the
He hoped that in the near future the technical process would be
carried out by an expert or in a public laboratory. The amount
of detail shown by plastic Roentgenography, not only in the lung
itself, but in the hilus, was marvellous. He had seen examples
showing very early stages of enlargement of glands in the root
of the lung. The shortening of the exposure within the limits of
respiration , or even of the heart-heat, was also most desirable in
chest examination. He alluded to the importance of the results
of a Roentgen examination as an object-lesson and a warning
Nature's danger-signal was usually hæmorrhage, but, short of
that, he knew nothing better than a skiagram as calculated to
impress on a young patient and his friends the importance of
early treatment.
Dr. DAVID ARTHUR considered an equivalent spark -gap of
4 } inches too high. Recently he had employed a tube a little
softer than that which gave the maximum screen contrast, and
found that 2 to 24 inches brought out detail which a harder tube
failed to show . He believed Dr. Green's measurements of the
diaphragm were of no practical value, though he agreed that
the immobility of the diaphragm was the first sign of pulmonary
tuberculosis. Any measurement to be of use should be done by
orthodiagraphy. In his experience, mediastinal tumours were
very difficult to diagnose from lung disease, and the only means
of settling the matter was by the stereoscope.
Dr. Halls DALLY held that unilateral limitation of the
diaphragm was the earliest known sign of pulmonary tuberculosis.
He did not consider that Calmette's ophthalmic reaction was
yet established. The same was true of tuberculin injections.
The limitation of the diaphragm, taken with other signs, was a
very strong suggestion of the existence of pulmonary tubercu-
losis, quite sufficient to justify sending the patient to a sana-
torium . To wait until there were tubercle bacilli in the sputum
was to allow very valuable time to go by. He regarded the
movement of the diaphragm as one of the important agents in
the expansion of the apex of the lung. The pericardium , the
great vessels, and the root of the lung were all pulled down by
the diaphragm , and therefore influenced the expansion of the
apex far more than the upward and forward movement of the
first rib did. During the past year Dr. Walsham and he had
been working with Groedel's orthodiagraph. The absolute
range of movement between deep inspiration and expiration in
an adult male was 34 millimetres on the right side and 32 milli-
metres on the left ; in adult females 27 millimetres right and
25 millimetres left ; making a total average of 30 millimetres on
the right side and 28 millimetres on the left.
Dr. HARRISON Orton used a focus-tube with a spark of about
2 } inches and a heavier current. He agreed that with the tubes
used by Dr. Green it was impossible to use more than 1 milli-
ROENTGEN RAY . 265
ampère of current. There should be some means of regulating
the tube. If the light were very intense, it was almost impossible
to estimate the difference of density between two apices. He
regarded the erect posture for the patient as the best. By
examining small areas of the chest at a time one got better ideas
of the shadows than by examining the whole of it at once. The
best position for the plate was on the back, for then the lattice
work effect formed by the crossing of the ribs was largely missed.
By working with the focus-tube below, placing the patient face
couch, the scapulæ could be moved out of the way. He em
ployed a rather concentrated developer, and used it quickly,
never taking more than ten minutes. He did not now think the
limitation of movement of the diaphragm was so constant as he
at one time believed. He had seen several early cases in which
there was no such limitation, only the jerky movement which
Dr. Green had mentioned. In more advanced cases the dia
phragmatic movement might not only be equal to normal, but
might surpass it. He had seen advanced cases in which one
apex was very deep in shadow, and where the movement of the
diaphragm on the affected side exceeded that on the sound side.
He agreed that in many cases where only one side was con
sidered to be diseased X rays showed both to be involved. He
asked how much shadow could be obtained in a normal chest .
He had two skiagrams of anæmic girls, with no signs of phthisis
two years ago, and still with no signs of it , but with distinct
shadows on each side of the mediastinum , extending much
farther out than the usual mediastinal cardiac lines. In one of
them the shadows seemed to follow the distribution of the
vessels, and it had been suggested they might be due to tubercle
commencing round the lymphatics. In case of lymphadenoma
the patient died of pneumonia ten days after examination with
the X rays. There were very similar shadows, and post-mortem
nothing was found in the lungs except pneumonia, which was
just commencing at the time of the examination. He believed
that when using a very low tube, such as one of 2-inch spark
gap, the normal chest might throw shadows which were likely to
be confusing. There was much to be learnt before a correct
interpretation of normal shadows could be arrived at.
Dr. SQUIRE was more accustomed to rely upon examination
by the stethoscope and other physical methods than by the
skiagram. The opener was somewhat dogmatic about the
diagnostic powers of the rays. He (Dr. Squire) particularly
wished to ask whether there was anything about the shadows
revealed by the X rays as representing consolidation or tuber
cular lung disease to show whether the lesion was quiescent, or,
on the other hand, a focus which required active treatment.
That point alone would show that unsupported X-ray examina
tion must not be relied on any more than any other means. He
asked, also, whether the pictures shown were supposed to repre
sent early cases of disease which would yield no evidence to the
skilled physician by the ordinary examination . The amount of
shadow in the majority of those cases seemed so great that they
would have caused no difficulty to anyone at all accustomed to
examine lungs. He had not heard anything to convince him
that skilled physical examination by the older methods would
not detect mischief in the lungs as early as could be found by
X-ray examination, although he agreed that the patient would
 266 ARCHIVES OF THE
be more impressed by seeing than by being told what somebody
else could hear.
Dr. Lees was much interested in the question of the exact de.
termination of the earliest indications of pulmonary tuberculosis.
Most of the skiagrams thrown on the screen seemed to be from
cases so advanced that there would not have been the slightest
difficulty in proving, by careful percussion, the presence of areas
of dullness. With the help of Dr. Simmons, he had made some
observations at St. Mary's Hospital to ascertain whether the
X rays were able to reveal the presence of tuberculosis of the
lungs when it was impossible to do so by physical examination :
That, he considered, was the crux of the whole question. The
observations he had made convinced him that the X rays failed
to show any distinct shadow in cases where the loss of resonance
was quite definite on careful examination. If that turned out to
be true generally, however valuable the X rays might be, they
could not demonstrate the existence of tuberculosis in the lung
at as early a stage as was already possible by methods of physical
examination . The earliest indications of pulmonary tuberculosis
were exactly the same as those of pneumonia. The signs to be
. looked for were not auscultatory , but indications given by careful
percussion . The percussion which must be employed was
finger -percussion alone. It must also be a very light percussion .
The percussed phalanx of the percussion -finger must be firmly
pressed on the point to be percussed , the rest of that finger and
the rest of that hand being kept entirely away from the chest-
wall. Such percussion was capable of detecting stages of pul-
monary tuberculosis which were quite early, and which he
believed to be undiscernible by the X rays. He challenged
discussion on the point as to whether careful physical ex-
amination , especially by percussion , did not reveal pulmonary
tuberculosis at a very early stage - earlier, he believed , than could
be revealed by X rays.
Dr. LYSTER thought radiographers could be of great service to
physicians by keeping charts indicating the progress of tuber-
cular disease. He had now pictures of several cases extending
back three years, which had been radiographed every three or
four months, and in which the change in the diseased areas was
very instructive.
Dr. Samuel West thought that it must be admitted that there
were cases of lung disease , deep - seated, and manifest from the
clinical symptoms afterwards, or by post -mortem examination ,
which could not be practically detected during life. There were
cases of fatal hæmoptysis in patients who had been most care-
fully examined, and in whom the hæmoptysis had come as a
complete surprise. There was a group of cases absolutely un
diagnosable from physical signs, and in those X rays might give
very great help .
Dr. ALLPRESS Simmons thought chests should be examined
by the rays more frequently than was at present done. He
agreed with Dr. Lees that the highest percussive skill would
reveal tubercular disease before X rays would ; but all medical
men did not possess that highest percussive skill, and he was
sure many cases of early phthisis were missed in the rush of
general practice. X rays came in conveniently between the
highest percussive skill and the ordinary routine physical
examination .
Dr. GREEN, in reply, said his object had been to raise a
ROENTGEN RAY .
discussion, and in that he had succeeded . He believed it was
the first discussion on the subject which had taken place for
many years. It was of the utmost importance that the patient's
disease should be diagnosed at the earliest possible moment. As
he had laid down ever since he spoke on the subject five years
ago, X rays were to be used as an aid, and only as an aid , not
with the idea of usurping the physician's place.
THE ROENTGEN SOCIETY.
Report of the Standards Committee.
Mr. W. DUDDELL, F.R.S., President, in the Chair.
DR. DEANE BUTCHER read the interim report of the Standards
Committee. The committee recommended that 1 milligram
of pure radium bromide should be taken as a standard, and that
the ionization produced by the Gamma rays from that quantity,
after passing through 1 centimetre of lead, should be taken as
the unit of radio -activity.
Letters were read from Sir W. Ramsay, Professor Rutherford ,
Mr. Soddy, Professor Sylvanus Thompson, and others who were
unable to be present .
Professor Sylvanus Thompson wrote asking whether the radia
tion of a given mass of radium bromide was independent of its
form ? If a given mass were compressed into a sphere, would it
give off the same quantity of y rays as if spread out in a thin
layer ? In other words, was radium bromide perfectly transparent
to its own radiations ? Was there not possibly some organic
reaction which could be made use of as an approximate test of
therapeutic effect ?
Sir William Ramsay wrote that he was carrying on experi
ments in conjunction with Professor Moore of Illinois Univer.
sity and Dr. Brill of Vienna, with a view to determining the
atomic weight of radium by fractionation, and there appeared to
be great probability that it exceeded 240.
Professor E. Rutherford wrote that a lead screen of the
thickness of 5 millimetres would be better than one of 1 centi
metre, because, while it would absorb the inconstant rays equally
well, it would extend the lower limit of comparison. He
doubted if radium could be prepared as yet with a purity of
99.5 per cent. He begged the committee not to accept any par
ticular preparation as pure until there was a general consensus
of opinion on the point. The Society would be doing a good
work in fixing a temporary radio-active standard for radium .
The number of people who had paid for pure radium and had
been given nearly pure barium was legion .
Mr. F. Soddy thought that the chief source of uncertainty
was the exact chemical composition of the radium bromide. The
uncertainties were, first, the amount of water of crystalliza
tion, and, second, the possible escape of emanation from the
hydrated salt, thereby reducing the y - ray activity. The latter
source of error might be prevented by sealing the salt in a little
glass tube, provided with a platinum wire sealed right through
the glass to relieve electrostatic strain . The uncertainty attach
ing to the amount of water of crystallization in the salt might
be obviated by using the fused anhydrous salt, kept for at least
a month after fusing in a sealed tube.
Mr. C. E. S. PHILLIPS pointed out that a specimen of radium
bromide was absolutely opaque to its Alpha, and exceedingly
 ARCHIVES OF THE
opaque to its Beta radiations. It was not absolutely transparent
to the Gamma rays, but the penetrating power of the Gamma
rays was so great that the question of absorption need not enter
into the matter to any considerable extent. He alluded to
a
means of measuring radio-activity by the discoloration
of a solution of iodoform in chloroform. The effect of the
Gamma rays on such a solution was not very strong, but still it
could be used. With regard to the atomic weight of radium ,
Madame Curie had lately confirmed her previous estimation of
225, and the figure of 240 suggested by Professor Ramsay was not
authoritative or final. He was told that radium bromide could
be obtained of 99.5 per cent. purity, but he thought it possible
that that statement in the report would have to be modified .
Dr. DEANE BUTCHER called the attention of the Society to the
fact that these investigations were only the first step towards the
measurement of the artificial radio -activity of a Roentgen tube,
and therefore he hoped the standard adopted would be of con-
siderable strength, with a screen as thin as possible. He sug-
gested 1 millimetre of lead, or of some other metal. As regards
the physiological question, there was a considerable difference
between the radiations of radium and those of an X-ray tube, in
that the former were much more complicated. The Society
should bear in mind, that as a Roentgen Society they were
specially interested in the production of a practical standard for
therapeutic and radiographic purposes .
Mr. C. W. RAFFETTY suggested the difference between the
physiological effects of X rays and radium might be explained by Laboratory.
Reviews .
Medical Electricity. By H. LEWIS JONES, M.A. , M.D.
Fifth edition. With plates and illustrations. Demy
8vo. Price 12s. 6d. net: London : Messrs. H. K.
Lewis .
The fifth edition of this well-known work has just
appeared. Each new edition is brought up to date and
appears to be partly rewritten ; indeed, the alterations
between successive editions of Dr. Lewis Jones's work
are a fair exposition of the progress of medical electricity
during the interval.
This edition has a chapter on the electric oscillations of
the ordinary medical faradic coils. It also contains the
description of rotary interrupters giving intermittent
currents of low tension ,
Great prominence is given to the question of ionic
cataphoresis, and there is a good exposition of the treat-
ment of epithelioma by the introduction of the zinc ion,
a procedure which was introduced into England by Dr.
Lewis Jones himself.
One great advantage that this treatise has over the
ROENTGEN RAY. 267
the fact that the Gamma radiation from radium was due to the
positive acceleration of the electrons, whereas the X rays were
produced by negative acceleration, the former representing the
starting and the latter the stopping of electrons.
Mr. F. H. Glew questioned whether the committee had done
wisely in selecting radium as the standard of radio -activity.
What advantage did radium possess over uranium ? Uranium
gave Gamma rays , and could be obtained in comparatively large
quantities in a pure form . He had made some experiments with
a very large tube of uranium glass, which was probably fused
some forty years ago. At the time the glass was fused all
emanation would probably be expelled, and the chemical condi
tion would be fairly pure. An uranium tube forty years old
should contain radium and perhaps also helium.
The PRESIDENT (Mr. Duddell), in summing up the discussion ,
laid down the two essentials of any such standard as being con
stancy and capability of reproduction. These two considerations
compelled them to take some pure substance in order to get
definite composition . He did not regard the magnitude of such
a standard as being of very great importance ; it was only neces
sary that the magnitude should be a convenient one. Having &
standard of radiation , constant and capable of being reproduced,
a sub -standard could be made. In this sub-standard, used for
practical purposes, permanency would not be so essential, pro.
vided it were checked from time to time with the fundamental
standard, which might be placed in the National Physical
numerous works appearing in France and elsewhere
is the clear and practical instruction for therapeutic
work, and the fact that not all methods of electrical
treatment, but only the best, are described. The book
need not fear comparison with many more ambitious
works published in America and on the Continent.
In his recent review Professor Leduc says truly :
" The work of Dr. Lewis Jones has contributed not a
little to raise in all English -speaking countries an in
creased interest in medical electricity .”
Mittheilungen aus der Wiener Heilstätte für Lupuskranke:
Published by Professor Dr. EDUARD LANG. With
38 illustrations. Vienna : Kommissionsverlag von
Josef Safar. 1907 .
This pamphlet contains Dr. Jungmann's report on the
working of the Vienna Institute for the treatment of
patients affected with lupus during the year 1905. It
also contains a series of experiments made on animals to
show the effect of the X rays on the ovaries during
pregnancy .
268 ARCHIVES OF THE ROENTGEN RAY .

Wellcome's Photographic Exposure Record and Diary for
1908. Burroughs Wellcome and Co.
Nowadays, when every physician, and especially
every Roentgenographer, is something of a photographer,
such an index and diary as the above should be welcome
in fact as well as name .
We need only say that in general get-up, portability,
and contents it seems to be well up to the level of its
predecessors. The record of negative exposures should
be of use in the Roentgen laboratory. We are not aware
if tabloid developers have been used in skiagraphy, but
anything which will minimize the labour of photography
in medical diagnosis will be heartily welcomed by the
overtrained and overworked practitioner.

Description of Plates.
PLATES CCLXXXIII. AND CCLXXXIV.

TO ILLUSTRATE THE ARTICLE ON THE X - RAY DIAGNOSIS OF RENAL AND URETERAL CALCULI,
BY G. HARRISON ORTON, M.D. (P. 238).

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send, with any prints intended for publication , a full account of the
case, and also an account of the process used in radiography - such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used, or any otherfacts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE Editor begs to acknowledge communications from Dr. Kienböck (Vienna ), Dr. Groedel ( Bad Kissingen ),
Mrs. Clark, M.D. (Sydney), Dr. Guilleminot (Paris), Dr. A. J. Anderson (Newport, U.S.A.), Dr. Wertheim
Salomonson (Amsterdam ), Dr. H. Bordier (Lyons) .
The following Journals and Periodicals have been received : “ Advanced Therapeutics,” “ The Electrician , "
“ The Electric Review ," " Knowledge,” “ The British Journal of Dermatology,” “ Annals of Physico -therapy,"
“ Medical Times," “ Medical Electrology and Radiology," “ Archives of Physiological Therapy," “ Archives
d'Électricité Médicale," " Le Radium ,” “ Annals d'Électrobiologie et de Radiologie,” “ Fortschritte auf dem Gebiete
der Röntgenstrahlen, " " Münchener Medizinische Wochenschrift," “ Zentralblatt für Physikalische Therapie,”
“ Annali di Elettricità Medica, “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “The Editor of the ARCHIVES OF THE ROENTGEN Ray, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London, W.C.," or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration, will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published .
The plates are guaranteedtobe faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view.
Annual Subscription , payable in advance, Sixteen Shillings net (Four Dollars ), including postage ; single
numbers, One Shilling and Sixpence net ( Thirty-six Cents), twopence extra for postage (Four Cents). Back
numbers can be supplied ; prices on application.
RATES FOR ADVERTISEMENTS IN THIS JOURNAL.-Rates for ordinary and special positions , and series discounts
upon application.
Communications relating to advertisements should be addressed to the Publishers, REBMAN LTD
129 Shaftesbury Avenue, London, W.C. (Publishers of the “ Archives of the Roentgen Ray and Allied Pheno
mena," etc.).- Telegrapbic Address : “ Squama, London " ; Telephone : No. 2026, Gerrard.
Billing and Sons, Ltd., Printers, Guildford , England.
 Annual Subscription , Price 1/6 net (with postage 1/8).
16/- net ($4) , in advance. No. 92 . 36 cents ( with postage
40 cents ) .

HOT
L
VO . XII .
i t

No.
n

1.0
OT
a p io
P ARCHIVES
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
(Formerly ARCHIVES OF SKIAGRAPHY ).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE (New York ); A. BECLERE (Paris) ; T. P. BEDDOES (London ); J. BELOT ( Paris ); F. BISSERIE ( Paris);
H. BORDIER ( Lyons); J. BURNET ( Edinburgh ); R. HIGHAM COOPER ( London ); W. COTTON ( Bristol); FOVEAU DE
COURMELLES ( Paris); L. DELHERM (Paris); R. W. FELKIN ( London );
LEC
TRO
L. FREUND ( Vienna) ; H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
(Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT ( Paris) ;
R A P I
D. GUNZBURG (Antwerp) ; J. HALL-EDWARDS (Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ;
E TE
TH
F. H. JACOB ( Nottingham) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris ) ; 8. LEDUC (Nantes) ;
08
MA

E.R. MORTON ( London ); G. HARRISON ORTON ( London ); H. G. PIFFARD (New

York ); JNO.C. RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ) ; 19 .
R

W. F. SOMERVILLE (Glasgow ); H. WALSHAM ( London ) ; CHISHOLM

WILLIAMS (London ); CLARENCE WRIGHT (London ).

CONTENTS
PAGE PAGE

EDITORIAL • 269 NOTES AND ABSTRACTS (continued ) :

THE FOURTH INTERNATIONAL TREATMENT OF BRONCHIAL ASTHMA BY MEANS OF THE
CONGRESS ON ROENTGEN RAY 292
ELECTROLOGY AND RADIOLOGY , AMSTERDAM , ON THE INFLUENCE OF CHOLIN AND OF X RAYS ON THE
SEPTEMBER , 1908 - 270 COURSE OF PREGNANCY 293
TREATMENT OF RODENT ULCER BY X RAYS · 293
ORIGINAL ARTICLES :
THE VALUE OF THE X RAYS IN CASES OF SARCOMA 293
EXAMINATION OF THE URINARY BLADDER BY X Rays THE ELECTRICAL CHARGE OF TOXIN AND ANTITOXIN • 294
AFTER INSUFFLATION WITH OXYGEN . By DAVID THEORY OF METALLIC CONDUCTIVITY 291
MORGAN , M.B. 271 .

THE ACTION OF DIFFERENT CURRENTS UPON THE BLOOD

THE TREATMENT OF SCIATICA BY HIGH FREQUENCY VESSELS · 295
CURRENTS. By E. S. WORRALL, M.R.C.S., L.R.C.P. • 272
THE RATIONALE OF STATIC CURRENTS. By F. HOWARD REPORTS OF SOCIETIES :
HUMPHRIS, M.D. ( Brux. ) , F.R.C.P. ( Edin .) · 274 ROYAL SOCIETY OF MEDICINE - ELECTRO - THERAPEUTICAL
TREATMENT OF EPITHELIOMA WITH ROESTGEN RAYS. SECTION - · 295
By DR. EDUARD SCHIFF • 276 • 296
ROYAL INSTITUTION
RADIUM FOR THE TREATMENT OF CANCER AND LUPUS . NEW YORK ACADEMY OF MEDICINE • 297
By WILLIAM J. MORTON, M.D. , New York · -

278
ON THE PRESENT POSITION OF ROENTGEN DIAGNOSIS IN REVIEWS :
DISEASES OF THE STOMACH AND INTESTINES. By DR. RÖNTGEN KALENDER • 298
JOLLASSE, St. George's Hospital, Hamburg 281 L'ANNÉE ÉLECTRIQUE : - 298
A VERTICAL ORTHODIAGRAPH . - By PROFESSOR DR. R. - 299
KIENBOCK , Vienna 288 CORRESPONDENCE -
A NEW INSTRUMENT FOR HIGH FREQUENCY · 291 PLATES :
PLATES CCLXXXV. AND CCLXXXVI. — TO ILLUSTRATE
NOTES AND ABSTRACTS : THE ARTICLE ON “ EXAMINATION OF THE URINARY
: 291 BLADDER BY X RAYS AFTER INSUFFLATION WITH
A CASE OF LYMPHADENOMA TREATED BY X RAYS - 300
RADIO-THERAPY IN SYRINGOMYELIA • 292 OXYGEN, ” by David MORGAN, M.B.

LONDON
REBMAN LTD ., 129 SHAFTESBURY AVENUE, W.C.
NEW HIGH FREQUENCY APPARATUS .
pieceof
THIScoming apparatushasbeendesigned withtheobjectofover
the objection raised to all forms previously placed on the
market, viz.: that the practitioner has been without data as to the
frequency of the current he is applying to his patients, and that no
provision has been made to enable him to regulate the strength of the
current in such a manner that a systematic course of treatment can be
applied .
The machine illustrated is so arranged that the frequency of the
current can be varied within wide limits by a simple movement of a
small crank handle, the frequency being at the same time accurately
indicated on a finely divided scale.
The current applied to the patient is an induced one, and can be
regulated from zero to a maximum by a slight movement of the secondary
coils, which are nicely balanced between centres, the relative strength of
the current at any position being shown on a suitable scale.
Ref. No. 213.
PRICE 218 : 18 : 0.

Catalogue of other Electro -Medical Apparatus on application to

MARCONIS WIRELESS TELEGRAPH CO., LTD .,

Telegrams: " ETHERISING , LONDON .”
Telephones : 8388 Central (2 lines). TYSSEN STREET, DALSTON , N.E.
FIVE
JOINTLESS SECTION | HARRY W.COX & Co. ,
INDUCTION COILS
(Heavy Discharge Type )
LIMITED ,
have been chosen for the newly built Out-patient Depart Beg to announce that they have obtained
ment of St. Bartholomew's Hospital, E.C.
WHY ? MORE SUITABLE PREMISES
Because they are wound by a patented winding machine in AT
exact accordance with the theoretically best method, and
there can be no other way equal to it.

L. MILLER, 93, HATTON GARDEN, E.C.

E 47, Gray's Inn Road,
E

TO TUB
TOUB
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LONDON, W.C.
TRUE EQUIVALENT MICA DISC ( Near HOLBORN TOWN HALL),
SPARK .
VALVE

where they are continuing as

Actual Makers
JOINTLESS SECTION
PATENT COIL of all kinds of
X -Ray and Electro
RY
K

Medical Apparatus
CU
EA
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under the personal supervision of Mr. H. W. COX.

N.B.-A Doctor's Model Consulting Room , with all
the latest appliances, will be shown at the new
premises.
VOL. XII.-No. 10. MARCH , 1908 .

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA ::
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY.
EDITED BY

W. DEANE BUTCHER, M.R.C.S., F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York ); T. P. BEDDOES (London ) ; J. BELOT (Paris) ; A. BÉCLÈRE (Paris) ; F. BISSERIE (Paris) ;
H. BORDIER ( Lyons) ; J. BURNET (Edinburgh) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris) ; R. W. FELKIN ( London ) ; L. FREUND (Vienna) ; H. E. GAMLEN ( West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ; D. GUNZBURG (Antwerp) ; J. HALL- EDWARDS
( Birmingham ); G. HARET ( Paris) ; C. THURSTAN HOLLAND ( Liverpool); G. HOLZKNECHT ( Vienna ) ; F. H. JACOB (Nottingham ) ;
LEWIS JONES (London ); A. C. JORDAN (London) ; ARCH . JUBB (Glasgow ) ; E. LAQUERRIERE ( Paris) ; S. LEDUC (Nantes) ;
E. R. MORTON ( London ) ; G. HARRISON ORTON ( London ) ; H. G. PIFFARD (New York ) ; JNO. C. RANKIN ( Belfast) ; WERTHEIM
SALOMONSON ( Amsterdam ) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM WILLIAMS ( London ) ;
CLARENCE WRIGHT ( London ).

TAE debate at the Royal Society of Medicine on " The to acquire the tactus eruditus and the requisite delicacy
Diagnostic Value of the Roentgen Rays in Diseases of of hand and ear.
the Chest ” sums up very fairly the comparative merits From the point of view of the patient and the patient's
of the new and the older classical methods. friends, the case for X rays is still stronger. “ Seeing is
The Roentgenologist claims that he is able to detect believing, " and' no story of impaired resonance or altered
and to demonstrate the presence of incipient pulmonary respiration is half so convincing as the damning evidence
tubercle at a very early stage — at a stage when it is of the lung shadow itself on the photographic plate.
otherwise recognizable only by the trained and specialized Many questions of great interest have been raised as
diagnostician. The exponent of the classical methods, the result of the discussion . It is doubtful, as Dr. Pirie
on the other hand, claims that he is able to distinguish points out, if negative evidence as to the presence of
impaired elasticity of lung tissue at a stage as early or pulmonary tubercle is of any value, unless the details of
earlier than that recognizable by the X rays. the structure of the hilus of the lung are visible on the
There is no object in a comparison of the two methods, plate-just as negative evidence as to the existence of
since each method is the necessary supplement of the renal calculi is open to suspicion unless corroborated by
other . Such a comparison , moreover, would only be the details of structure of the vertebræ and psoas.
possible when the two exponents were of equal dexterity For purposes of comparison , it is highly desirable that
and of equal training. The X -ray specialist would be we should have a series of pictures of healthy lungs, of
subject to numberless errors, were he to disregard the lungs in which tubercle is latent, of progressing and of
classical signs of disease, and the up-to-date physician regressing disease, and more especially of the lungs
can no longer afford to disregard the evidence of his of patients who have suffered from active disease and
eyes, any more than that of his ears or touch . have been cured. Just as a dermatologist can say in
For the general practitioner, however, it is of the certain cases that a skin disease is progressing or regress
greatest importance that he should be able to diagnose ing by observing the contour -- whether continuous and
with certainty the invasion of tubercle at an early stage, uniform or indented and broken -- 80 may the shadow
and this may be done, we believe, with greater certainty of a pulmonary lesion reveal something of its age and
and with less likelihood of error by means of the X rays. stage of evolution.
The requisite dexterity may be acquired by a few months' It is to the habitual use of Roentgen diagnosis in the
training, while an equal number of years may be needed sanatorium that we must look for the solution of many of
37—2
270 ARCHIVES OF THE ROENTGEN RAY.

the problems of X - ray diagnosis in disease of the lungs. THE FOURTH INTERNATIONAL CONGRESS ON
The limitation of diaphragmatic movement, the lighting ELECTROLOGY AND RADIOLOGY, AMSTERDAM ,
up of circumscribed areas of lung tissue during inspira- SEPTEMBER , 1908 .
tion, the evidence of glandular enlargement in the hilus
We have the honour to inform you that the Fourth
of the lung, are all matters which would well repay pro International Congress on Electrology and Radiology
longed and careful study. will be held at Amsterdam from September 1 to 5, 1908.
It is curious to note that many of the specialists who The results of the three former Congresses - at Paris
were consulted about the matter replied that they had in 1900 , at Berlin in 1903 , and at Milan in 1905 - have
no experience of X-ray diagnosis. The number of pro- proved their utility and importance. The Fourth Con
fessional Gallios who care for none of these things is,gress will be organized on the same lines. We hope
however, slowly but steadily diminishing. “ If I could
that you will give us your valuable co-operation and
not tell temperature," said a distinguished surgeon of
take an active part in our work .
the Abernethian school— " If I could not tell the tem
The programme will comprise questions on Electro
perature better than that glass thing, I would give up my physiology and Electro - pathology, Electro-diagnostics
profession to -morrow !" Yet have his words done the
and Electro-therapeutics, Diagnostics and Therapeutics
thermometer no harm. “ If I could not diagnose incipient of the Roentgen Rays, the Study of Diverse Radiations,
tubercle better than that glass thing, " says the modern Medical Electro -technics.
physician , " of what good is my life -long training of ear In conjunction with the Congress, an Exhibition will
and touch !” Yet does the focus-tube shine on as brightly
be arranged of new or modified apparatus used in
and unabashed .
clinical and laboratorial work, and also a collection of
important radiographs. The Congress and the Exhibi
tion will be held in the University.
In the French Senate a credit of 25,000 francs was
voted for the purchase of radium for the various hospitals. THE EXECUTIVE COMMITTEE.
It was remarked by one of the Senators that this credit Prof. Dr. J. K. A. WERTHEIM SALOMONSON, President.
was inadequate for the purpose of buying a sufficient Dr. J. G. GOAL | General Secretaries and
supply of a substance costing 40,000 francs per gramme. Dr. F. S. MEIJERS Treasurers.
Vondelstraat 53, Amsterdam .
The fourth Congress of the German Roentgen Society
Congress
willbeheld at Berlin at the Langenbruk -Haus on April 26, interest in themembership
developmenttoofbetheopen to -all
electro takingand
biological an
1908, commencing at 9 a.m.
The subject of discussion is “The Value of Roentgen radiological sciences. Members'subscription, £1 10s.
Persons desiring to take part in the Congress are
Examinatio
The n inwill
discussion the be
Early Diagnosis
opened of Lung
by Rieder Tubercle."
of Munich and requested to send in their admission ticket and sub
scription fee.
Krause of Jena.
The official languages to be English, French, and
The secretary is Dr. Immelman, Lützowstrasse 72, German .
Berlin , W. 35.
The reading of reports not to exceed thirty minutes.
There will be an Electrical Section at the Annual Speakers on free subjects to be allowed fifteen minutes,
five minutes to each member taking part in the
Meeting of the British Medical Association at Sheffield, and
discussion. Members taking part in the discussion
1908. The names of the officers of the section are as
follows: President: Edward Reginald Morton, M.D. , Lon must hand in an extract to the Secretary at the close of
don. Vice-Presidents : William Longbottom, M.R.C.S., each meeting.
Sheffield ; Dawson Fyers Duckworth Turner, M.D. , Edin INTERNATIONAL COMMISSION .
burgh ; William Harwood Nutt, M.D., Sheffield. Hon . President : A. Tripier, Paris.
Secretaries : William Jones Greer, F.R.C.S.I., 19, Gold Vice-Presidents : P. Oudin, Paris ; E. Schiff, Vienna ;
Tops, Newport, Mon.; Arthur Rupert Hallam , M.D. , G. Weiss, Paris ; J. K. A. Wertheim Salomonson ,
325, Fulwood Road, Sheffield . Amsterdam,
 ARCHIVES OF THE ROENTGEN RAY . 271

General Secretary : E. Doumer, Lille. left upon a plate by even a good - sized vesical calculus.
Assistant Secretary : A. Moutier, Paris. This is due (when the patient is lying upon his back
Treasurer : Boisseau du Rocher, Paris . with the plate beneath him) to the distance of the organ
Members : Carl Beck, New York ; Benedict, Vienna ; from the plate and the dense structures which intervene.
Bozzolo, Turin ; Deane Butcher, London ; Cirera Salse, Another condition which tends to obscure the shadow is
Barcelona ; Cluzet, Toulouse ; Guilloz, Nancy ; G. the presence of urine in the bladder and of fæces in the
Herschell, London ; Lewis Jones, London ; Libotte, rectum. Urine itself is fairly opaque to the rays, as
Brussels ; Luraschi , Milan ; De Luzenberger, Rome ; will be seen by referring to Fig. 1. Here the entire
L. Mann, Breslau ; Schatzky, Moscow ; Schnyder, Bern ; outline of the bladder is mapped out by the urine. In
Albers Schönberg, Hamburg ; S. Leduc, Nantes. Fig. 3, in like manner, we see the outline of the rectum ,
which is full of fæces. It is, therefore, important before
proceeding to radiograph the pelvis to see that both
rectum and bladder are emptied.
EXAMINATION OF THE URINARY BLADDER BY I was greatly interested in a plate shown me by
X RAYS AFTER INSUFFLATION WITH OXYGEN ." Professor Albers Schönberg, in which he had filled the
By DAVID MORGAN, M.B., bladder with oxygen before taking the radiograph. The
Honorary Medical Officer in charge of the X - Ray Department, Royal bladder in this case was beautifully mapped out, and not
Southern Hospital, Liverpool. only could the stones be well seen, but their structure
( For illustrations see Plates CCLXXXV. and CCLXXXVI.) could be made out. This method of filling the bladder
with air is not altogether new, since it has been described
When examining the pelvis for the presence of calculi in by Wittek in 1904.
the urinary organs, it is often difficult to decide if the The technique of the method is the following : An
shadow seen represents a calculus in the bladder itself aperient is given to the patient the day before, and an
or in the ureter just at its entrance into the bladder, or enema administered the same morning, so as to ensure
whether the shadow is due to a calcareous gland , or the rectum being empty. The radiograph is taken in
merely to pelvic spots so often seen in a radiograph the usual way, with the patient lying either upon his
of the pelvis. These spots may be distinguished from a back or his face, the plate in each case being beneath
stone - firstly, by their position, which is usuallybilateral; him and the focus- tube above. A diaphragm may be
secondly, by their size and form , being small and round, used or not, as preferred. After the patient is laid upon
whereas a stone is oval or angular. But, of course, the table, a soft catheter is passed and the urine drawn
calculi may be of any size or shape. off. Without withdrawing it, the catheter is then con
Many devices have been tried to determine whether a nected up with an oxygen generating apparatus, the tap
shadow represents a concretion within or without the of which is cautiously turned on, so that the oxygen
urinary tract. enters the bladder at not too great a pressure. The
One device is to give the patient fairly large doses of apparatus I employ is that of Dr. Wollenburg, of Berlin,
collargol, as described by Völker Lichtenberg, so that which is most convenient for the purpose, as it serves
the urinary tract may be mapped out by the deeper both for generating and injecting the oxygen at any
shadow due to the presence of silver. pressure that may be desired. The apparatus consists
Another is to pass into the ureter a catheter which is of two chambers—an upper and a lower-connected
made of some material opaque to the rays, and note together with a tube. The lower chamber is filled with
the relation of the shadow to that of the catheter. 3 per cent. solution of peroxide of hydrogen, into which
But to my mind the simplest way is to take the radio- a pellet of permanganate of potash is dropped when it is
graph stereoscopically, and examine the plates in a desired to set free the oxygen. As the gas is generated
stereoscope. If taken correctly, with good plates, we it forces the liquid into the upper chamber. The pressure
are able to determine the relative position of all the of the gas in the upper cylinder is indicated by a pressure
parts of the pelvis. gauge. A scale connected with the lower chamber indi.
I have often been disappointed with the faint shadow cates the pressure at which it is injected, and a tap
* Read at the Liverpool Medical Institution, November 14, 1907. enables one to regulate this pressure.
272 ARCHIVES OF THE ROENTGEN RAY .

Precautions to be taken : shows as a dark shadow corresponding to the outline of

1. That the catheter is aseptically clean.
2. That the oxygen does not enter the bladder at too
great a pressure so as to overdistend or even rupture it,
as it fills up in a very short time with even a moderate
pressure.
3. That the tube used be as soft as possible.
After the radiograph has been taken I reintroduce the
catheter and draw off some of the oxygen. What is left
the patient passes with his urine. The only discomfort
he complains of is that of a distended bladder.
The advantages of the method are that you obtain a
clear picture of the outline of the bladder and its con-
tents, and are able to state definitely as to whether
a shadow represents anything inside or outside the
bladder wall. Also it shows any irregularity of the
surface, such as might be caused by chronic cystitis,
tubercular deposits, villous growths, or tumours.
It might further be possible, previous to the injection
of the oxygen , to coat the surface of the bladder with
some material which is opaque to the rays. In this way
one might be able to demonstrate more distinctly these
irregularities of the surface.
the bladder. These are both from the same photograph,
but Fig. 2 is a plastic Roentgenogram , whereas Fig. 1 is
an ordinary skiagram .
Fig. 3 shows calculus in the bladder. The urine has
been drawn off and the bladder distended with oxygen
The rectum has not been emptied of its contents, so that
its entire outline is shown.
Fig. 4 is the same view as Fig. 3, and has also
been insufflated with oxygen, but the rectum has been
emptied of its contents. The entire outline of the
bladder is well shown , as also is that of the calculus, as
well as the structure of the latter, which consists of an
oxalate centre, with phosphatic deposits around.
THE TREATMENT OF SCIATICA BY HIGH
FREQUENCY CURRENTS.
By E. S. WORRALL, M.R.C.S., L.R.C.P.,
Medical Officer in Charge, Electrotherapeutic Department, University
College Hospital ; Lecturer in Electrotherapeutics.

In a case of villous growths in the bladder which had That a large number of these very troublesome cases
been operated upon I attempted to fill the bladder with may with advantage be treated by high - frequency
oxygen , having previously injected a suspension of bis- currents has been demonstrated again and again in
muth. Unfortunately , however, the patient, owing to practice.
the adhesions which had been formed both outside and Of course, the causes of sciatic pain are varied and
within the bladder, was not able to bear the distension numerous. Some cases, such as those due to involvement
with oxygen . Nevertheless, although the experiment of the nerve in now growth — e.g., cancer-or to pressure
was practically a failure, I was able with the help of the of a tumour or hernia, or those cases due to Pott's
stereoscope to see the growths standing out about the disease or certain diseases of the spinal cord, are not
neck of the bladder. suitable for such treatment . When sciatica is due to
When the bladder is distended with oxygen you get a some diathetic origin, when it accompanies gout, rheu
very clear view of the outline of the rectum, especially if matism , or diabetes, high -frequency currents may have a
it contains anything, such as bismuth, which is opaque most salutary effect, as has been shown in a series of
to the rays. This is shown very well in Fig. 3, where eight cases treated by Dr. E. Bonnefoy, of Cannes, and
the rectum is full of fæces . published by him this year in his book “ L'arthritisme et
The value of this method is greatly enhanced when son traitement par les courants de haute fréquence et de
the plates are taken stereoscopically ; you are then better haute tension ." These cases were all treated by high
able to differentiate the superimposed shadows. frequency condensation treatment only.
In using the fluorescent screen for examination of the The cases reported below show that another modality
bladder, the distension by means of oxygen enables one —viz. , high -frequency effluve - is equally efficacious, and,
to see the details much more distinctly. In one case of being consecutive cases treated by me at University
a stone in the bladder, the stone could be seen rolling College Hospital, they show how common are the cases
about as the patient was moved. which may be relieved by this treatment. Cases which
As illustrating some of the points in the abovemethod- commonly occur nowadays as sequelæ of influenza seem
Figs. 1 and 2 represent the bladder full of urine, which to yield without exception.
 ARCHIVES OF THE ROENTGEN RAY .
I have notes of many more such cases which I have
treated with similar result, but will here confine myself
to the six cases which are consecutive and successful .
I.—E. B. , WARD 6, BED 19.
February.- Patient has had pain along the left sciatic January the pain got much worse and he had to give up
nerve for five months . He has been unable to sit down
to meals during the last month. He has been in bed in
the hospital for a fortnight ; the rest has improved his
condition somewhat, but the pain is still severe and
continuous.
February 20— TREATMENT. — High - frequency effluve
along left sciatic nerve, ten minutes.
February 24. - Repeat.
February 28. - Repeat. Patient slept for seven hours
continuously for the first time for some weeks.
March 3 .-- Repeat. Pain nearly gone. Patient slept
well, and was up yesterday for three and a half hours.
Can sit and walk with ease .
March 6. -No further treatment. Patient discharged
cured.
II.-- H . A. , WARD 6, BED 19.
April 1 .---Patient is a man aged forty years . He lies
in bed with his left leg drawn up. He cannot lie very
comfortably. There is great tenderness down the back
of the left lower limb along the whole course of the
sciatic nerve. The gluteal muscles of left side are flabby,
and there is tenderness here and over posterior part of
iliac crest. When pressure is made over the gluteal
regions there is much contraction. Leg cannot be moved
without causing pain. Patient complains of shooting
pains from hip to heel. The trouble started as an
aching pain across the back, passing down the limb, last
December.
Patient went to work in the beginning of January, but
had to give it up, as the pain got worse . He then took
to bed for six weeks, and the pain got somewhat better,
but came on worse again as soon as he got about.
Patient says bis leg feels dead when he tries to move it.
TREATMENT. - High -frequency effluve along course of
sciatic nerve, eight minutes.
April 4 , 11 , 14. —Repeat. Patient has now only
occasional pain .
April 17 , 19, 21. - Repeat. Time of treatment in-
creased to ten minutes.
April 25 , 26, 28 ; May 2, 3. - Patient much improved, sciatic nerve, eight minutes.
and is now walking about. He was discharged quite
well on May 8 without further treatment.
273
III.-F. K., AGED FORTY-TWO.
April 19. -Patient first had the pain in June of last
year, when he came up to see Dr. Poynton. The pain
was not very severe and he could do his work. Last
his work .
TREATMENT.-High-frequency effluve along the course
of sciatic nerve, ten minutes.
April 27. - Repeat.
April 28.—Repeat.
May 2. - Repeat.
May 5. - Repeat. Much improved, pain less. Able to
walk one and a half miles .
May 16. - Repeat. Patient has commenced work ;
pain very slight. Can sit comfortably. Sleeps well.
May 23. — Repeat. Still more improved.
June 6. — Repeat. Still more improved.
June 13. - Treatment ceases. Patient discharged cured.
IV.-J. A.
Patient has suffered from sciatica continuously for
some months .
June 2 – TREATMENT. — High -frequency effluve along
sciatic nerve , ten minutes.
June 3, 6, 9, 13, 20.—Patient says he is now much
better, pain practically gone , and he is able to return to
work .
V.-H. C. , AGED FORTY-FOUR, O.P. 23 ( MR. POLLARD ).
January 12. - Patient complains of pain on right side
from hip to ankle. It has been much worse during last
week .
TREATMENT. - High - frequency effluve along sciatic
nerve , ten minutes .
January 19.- Repeat.
January 23.-Repeat. Patient says he is much better
and able to cease treatment and commence work.
VI.-EMILY H. , AGED THIRTY-SEVEN, O.P. 144
(MR. RAYMOND JOHNSON ).
June. - Patient has had sciatica on the left side for five
months. She has been under treatment with medicine,
liniments, and rest. No previous attack .
June 27 – TREATMENT . - High -frequency effluve along
June 29.- Repeat.
July 4.-Repeat. She has now very little pain, can
 274 ARCHIVES OF THE ROENTGEN RAY.

sleep well, and can flex limb fully. She can also sit on surface , because that surface is a good conductor, it is
hard seat with comfort . not true as to the human body. Even as it is necessary
July 6.—Repeat. Leg not quite so well. for all electrical currents to have a conductor, so they
July 11.-Repeat. Better. will always choose the best conductor—that is, they will
July 20.-Repeat. Some remainder of pain. flow along the line of least resistance. The skin is a
July 25. - Repeat. Much better since last treatment. hundred times worse a conductor than the tissues beneath
July 27.-- Repeat. Still more improvement. Treat- it. So, when the static current reaches the skin, it is
ment ceases .
impossible to imagine that it would flow over the skin
that is, be conducted by it—when it has the moist tissues
beneath it through which to flow . These tissues are
THE RATIONALE OF STATIC CURRENTS. practically a homogeneous normal salt solution - one
READ BEFORE THE THERAPEUTIC SECTION OF THE BRITISH
of the best possible conductors. The experiment of
D'Arsonval with the cylinder filled with salt solution,
MEDICAL ASSOCIATION AT EXETER , August , 1907 .
and of Maragliano with the incandescent lamp in the
By F. HOWARD HUMPHRIS, M.D. (Bru..), thoracic cavity of a dog, apart from theoretical con
F.R.C.P. (Edin . ), siderations, have proved the fallacy of the “ skin cur
Hon. Physician, Queen's Hospital , Honolulu. rent " theory. The static current, on reaching the body,
rushes through the skin, travelling along the line of least
Too little attention is given by the profession at large to resistance by the shortest possible route to the surface.
the rationale of static currents. The majority knows It either leaves the body there, as in the disruptive dis
nothing about the subject, and speaks only to condemn. charge, or surges back through the tissues, as in the wave
A few will perhaps admit that patients have been relieved current. In auto- condensation it is found that the wrist
and cured by the medium of static electricity, and attribute becomes hot . This is due to the greater resistance of
this fortunate result to " psychic ” agency. But it requires the internal structures of the joint. The skin resistance
something more than psychic influence to markedly reduce
being the same whether the skin be over a joint or over
the swelling of a recently sprained ankle in a few minutes,
soft tissues, the increased heat must be due to the current
to cause acne to disappear from the face, or to cure passing through the resistant joint structure. The best
symptomatically chronic synovitis. It is admitted that physicists of the day are now agreed that these currents
in disease which is dependent upon grave organic and do traverse the body in straight lines along the path of
structural change neither static electricity nor any other least resistance. It would, in fact, be impossible to
form of therapeutics can effect a cure. There are, how- account for the nutritional changes which take place in
ever, few diseases which are not caused by or closely the body during the administration of these currents,
associated with inflammatory processes, and it is to these unless they do actually pass through that body. And,
causes or concomitants of disease that static electricity
is directed .
as Dr. Somerville says, “ there is no doubt that by this
method the body is fully charged throughout. "
Static currents induce physical activity. A departure To return to the mechanical action of these currents.
from physiological health means some lessening, either Certain contractions can be produced by the constant,
local or general, of physical activity whereby metabolism the induced , and the sinusoidal currents ; but they are
is impaired. not so capable of diffusion , nor are the contractions pro
Perhaps the most important attribute of static currents duced as painless as those from the static machine. .
is their mechanical action. They cause tissue contrac-
The enormously high potential of this last form of elec
tion—not only the contraction of the skin and muscle tricity accounts for this superiority.
which can be seen , but also contraction of the protoplasm Allowing, then, that these currents will produce con
within . ... It has been asserted that these currents tractions, varying from the coarser muscle contractions
do not go through the body at all, but merely travel over to the finest cellular and protoplasmic contractions, it is
the surface, and they have therefore been termed " skin not difficult to understand why they should improve
currents." While it is true that with metallic conductors conditions of faulty metabolism , and lessen or remove
the current bas a tendency to become localized near the the stasis upon which all non-infective conditions depend,
 ARCHIVES OF THE ROENTGEN RAY . 275

and which also is the usual concomitant of infective Remembering Thomson's resolution of the hydrogen
inflammations. The removal of stasis has always been atom into some 800 negative electrons, and Lodge's
emphasized by Snow as the chief fundamental principle remark that these electrons seem to be “ the substance
of the manner in which static currents accomplish their of which matter is made,” it is quite possible that these
work . Take, for example, the static spark , the oldest static currents are actually matter in a finely divided
of static modalities. The body being charged from the state surging through the tissues. This would produce
static machine, the whole of this charge is suddenly mechanical effects of a powerful nature, which , when
focussed at one point and there discharged. There is properly controlled, might have valuable therapeutic
enormous activity along the path by which the current effect .
travelled, increasing up to that point at which it is dis- Polarization of the cell elements will also induce
charged from the body, where the energetic contraction cellular activity, or cell gymnastics, according to some
produced by the current is at its maximum . With such writers. D'Arsonval has observed a change of cell shape
contraction stasis cannot long exist, and the fluids from when traversed by the current. In fact, it would be
infiltrated areas must be forcibly expelled. With the difficult to imagine a current traversing the tissues
expulsion of the infiltrating fluids and the removal of the without cellular polarization.
stasis a healthy cell activity is induced, and a physio- There is undoubtedly also some chemical action in the
logical condition replaces the pathological torpor. disruptive and convecto - disruptive currents. Ozone
The local effects of these currents can be seen where and nitrous acid are liberated , which may be of value in
the case of superficial infected areas, though they do not
the stasis is visible , and the effects of the removal of the
stasis can be noted even where the stasis is in a deeper appear to be much used for this purpose.
part of the body. The actinic effects of high-potential currents, when
That the effects of the current are constitutional as administered by means of glass vacuum electrodes, con
well as local is evidenced by the increased elimination tribute in no small manner to the utility of static
of urea and other extractives, the production of per- currents. .. Like other forms of light, the discharges
spiration, the alteration in arterial tension, the increase from glass vacuum tubes have the power of destroying
of carbon dioxide, and the general feeling of bien -être, bacteria. The light acts as a stimulus to the animal
which easily passes on into fatigue and lassitude when functions ; it also stimulates the action of unstriped
an overdose has been administered. muscular fibre.
Its mechanical action alone would render the static Freund says : “ Hæmoglobin gives off its oxygen more
current too valuable a method of treatment to be quickly in the light than in the dark ; hence light
neglected, and is a satisfactory refutation of the objection increases the oxidizing power of the blood, and the
of those who hold that this valuable method of treatment process of oxidation in the human body.” This may
only acts by suggestion . Safe, sure , and satisfactory in account for the fact that certain toxins decrease in
almost all non -infective inflammations, static currents virulence after exposure to high -frequency currents
will be a revelation to those who have not yet used (diphtheria, streptococci, and cobra-venom, according to
them . Guilleminot). It would certainly account (together with
Besides their mechanical action , static currents have the action on unstriped muscular fibre, already noted)
also an electrical effect, wbich produces an active meta- for the fact that a vacuum tube, properly excited,
bolism in the tissues. Electrolysis, such as we know it relieves the trouble caused by sub-involuted uterus and
in the constant currents, is here so small as to be a other pelvic troubles. When applied to the skin, the
negligible quantity, the amperage being too low and the first effect noticed, at the place where the vacuum tube
diffusion too great. is in contact, is the production of hyperæmia, the blood
The electrical effects are partly due to the polarization thus drawn to the surface being immediately brought
of the cells through which the current passes, and partly under the actinic influence of the current.
to mechanical action . The current may be compared to Thus, under the head of actipic effects we have not
a breeze blowing through a field of corn , producing in only the germicidal properties of these currents, but also
its passage cell activity, upon which active metabolism their power to aid faulty metabolism by increasing the
depends. oxidation power of the tissues,
38
276 ARCHIVES OF THE ROENTGEN RAY.

To briefly recapitulate the way in which static currents TREATMENT OF EPITHELIOMA WITH ROENTGEN
act : RAYS. *
Mechanically, by causing contractions, not only of the By Dr. EDUARD SCHIFF,
skin and muscles beneath, but also of the very cells Professor of Radiology at the University of Vienna.
themselves, thus relieving stasis.
Electrically, by polarization, and by the surging At the Third InternationalCongress for Electro-biology
through the tissues of the current, producing that cell and Medical Radiology, held at Milan, September 5 to 9,
activity upon which tissue health is based . 1907, Dr. Eduard Schiff read a report on the treatment
Chemically, by the evolution of nascent ozone and of cutaneous cancer with Roentgen rays.
nitrous acid, which are fatal to bacteria such as staphy- As the subject is of great importance from the patho
lococcus and streptococcus. logical, the anatomical, and the therapeutic point of
Actinically, by the germ-destroying effect of light, by view, Dr. Schiff reviewed the literature of the subject
the possible diminution of certain toxins, and by in- in chronological order..
creasing the oxidation processes. At the outset he alluded to the non -operative treatment
Comparing these effects of static currents with the of epithelioma in general, and to the classification of the
pathology of the majority of diseases, it is easy to see several forms of tumour. One group of epithelial tumours
the reason why the current should benefit the disease. is distinguished by its tendency to invade the surround
Just as almost all pain is due to pressure, so almost all ing tissues, the growth spreading by means of the blood
disease is due to, or is accompanied during its course by, and lymph channels. These are the real carcinomata ;
congestion or stasis. If this be granted, then the case they grow rapidly, and their malignant character is
for the use of these currents needs no further argument. particularly evident. The skin epitheliomata, on the
We have on the one hand a stasis, and on the other a other hand, may remain localized for many years, slowly
current which, by its mechanical action, contracts the extending by invading the surrounding tissues. There
tissues around and the cell elements. Moreover, by its are certain neoplasms which may be said to be always
electrical action it produces that cell activity which is in- malignant-viz. , epitheliomata accompanied by glandular
compatible with the existence of stasis. Its chemical enlargement or other metastasis ; epitheliomata which
and actinic effects destroy any germ process which may are themselves metastatic deposits, the primary growth
situated in some other part of the body ; primary
complicate the stasis, and also further stimulate the beingepitheliomata
tissue activity. With the relief of the stasis comes the skin which have assumed the characters
relief from the disease, of which the stasis was either of alveolar carcinoma. Certain epitheliomata are es
the cause or the complicating concomitant. pecially apt to assume a malignant character; these
include Paget's disease, xerodermia pigmentosum , and
some
cases of lupus and of pigmented nævi . Also
tumours of special etiology, such as sweep's cancer,
the cancer of petroleum refiners, etc.
The cinematograph was pressed once more into the The methods of treatment are as numerous as the
service of medicine by Dr. H. Campbell Thomson at varieties of epithelioma. The cases in which total
the opening meeting of the Middlesex Hospital Medical extirpation is contra- indicated are those in which, from
Society, to demonstrate different points in the diagnosis the situation of the growth, especially if on the face,
and examination of patients in nervous diseases. The the disfigurement produced by the scar would be of
cinematograph may also be used to show the movements importance.
of micro -organisms and their behaviour in various cir- Caustics , such as arsenic acid, are suitable for the
cumstances, such as the clumping of typhoid bacilli in epitheliomata met with in dermatological practice.
the Widal reaction .Dr. H. Campbell Thomson illus- The results are quite as safe as those obtained by
trated the typical diagnostic symptoms of nervous excision , and there is no disfigurement, the scars left
diseases, such as disseminated sclerosis, paralysis agitans, being almost invisible.
Friedreich's disease, and pseudo -hypertrophic paralysis, No one now doubts the good effects of X rays on
by representing the movements of patients on the screen. Report translated and condensed by A. C. Jordan, M.D ,
 ARCHIVES OF THE ROENTGEN RAY. 277

lupus vulgaris, but their curative effect upon epithelio- ever, to offer no definite opinion on the value of the
mata is not yet universally acknowledged. The author method. Fittig published 37 cases of carcinoma treated
is fully convinced of the good effects of X-ray treatment with X rays, 18 of them skin carcinomata. He observed
in both conditions, and many of his most eminent that the small-celled growths resembling rodent ulcer
colleagues are of the same opinion. reacted far more favourably than the more deeply ex
In the literature of the subject the term “ epithelioma " tending large-celled horny growths. He considers X-ray
is frequently used in a vague way ; histological details treatment to be of equal value to operative treatment.
are often wanting, and the details of treatment are not Scholtz of Königsberg comes to the following conclu
always accurately given. Although the statistics obtain- sion : " X -ray treatment has always to be considered in
able are not as complete and conclusive as could have cases of cancroid of the skin when operation is in
been desired , still, the fact that eminent authors in many admissible. Further, the results are so good that in
countries have reported favourably on the Roentgen certain cases the alternative of treating the growth by
treatment of epithelioma is a sufficient guarantee of the operation or by irradiation has to be considered , especially
genuineness of the method . in those cases where operation is difficult, or its cosmetic
The author thereupon proceeds to quote , in chrono- results are bad, as on the face.
logical order, a large number of cases from the literature Schild concludes that X-ray treatment produces ex.
of all countries. Among them are the following : Sjögren cellent results in skin cancroids even when surgical
and Sederholm report on five cases of epithelioma, and interference does not stop the process. Very slight
conclude that Roentgen rays have a decidedly favourable cicatrization occurs. Kienböck says that flat superficial
influence on certain forms of cutaneous cancer, especially epithelioma, such as occurs at the edge of the lips or
rodent ulcer. When the treatment causes a reaction , ale nasi, is sometimes cured by one full exposure (5 H), or
with subsequent necrosis and exfoliation of the growth , by several exposures at intervals of a fortnight. Ulcers
& cure is produced. It is more difficult to understand, heal after a few weeks. Lassar considers X-ray treat
however, how the X rays can exercise this healing ment to be far inferior to surgical treatment, and merely
influence in cases in which no reaction occurs . As to to be used to supplement surgical treatment. At the
the final result of this method of treatment, no definite Berlin Medical Society, May 4, Von Bergmann again
conclusion is to be drawn from these cases. If it can expressed himself as very sceptical of the value of X-ray
be proved that the result is permanent, then it may be treatment ; he regards it merely as a kind of caustic.
used with advantage in cases where the growth is ex Holzknecht regards Roentgen treatment as always in .
tensive, or where the patient would rather undergo a dicated in cases of superficial and papillary cancer of
prolonged course of treatment than an operation. the skin . He summarizes the matter thus : (1) Careful
Freund, at a meeting of naturalists at Carlsbad in application on definite lines is important. (2) Protection
1902, showed his apparatus for applying X rays to the of the healthy parts is necessary ; only 1 centimetre of
interior of the mouth. Pusey met with very good results healthy tissue should be exposed. (3) As to the method
in epithelioma. The advantages of the process are : of application, a full dose of X rays should be given
(1) painlessness ; (2) the affected tissue only is attacked ; from the first, and the applications repeated at intervals
(3) the scar is very fine ; (4 ) in incurable cases the of a month. (4 ) The dose should be 4 H to 5 H. (5) The
further progress is arrested ; and (5) the pain is eased. aim is to produce a reaction of the second degree in the
In the case of carcinoma of the skin it is a question second week, and the maximum reaction in the third
whether radio-therapeutics should not be commenced week. (6) The effect to be produced is shedding of skin
from the first. In cases suitable for operation the result in cases of papilloma, absorption in cases of infiltrating
is said to be improved by the application of X rays or ulcerating growths, followed by the formation of
before and after the operation . Pain is mitigated to epithelium. Deep portions of the growth are liable to
an extraordinary degree. Bashford's publication is par- be left behind. (7) If portions of growth have been
ticularly important. His list includes 400 cases of left behind, they will not be long in making their
carcinoma. Epithelioma relapsed in from 20 to 40 per appearance ; hence recurrence will not appear unless it
ent. of the cases, and complete cure took place in 141 occurs early (8) Each sitting should last from five to
out of 216 cases — i.e., in 65 per cent . He prefers, how- twenty minutes. (9) The duration of treatment is from
38-2
278 ARCHIVES OF THE ROENTGEN RAY,

one to several months. (10) The quickly growing and be too long ; medium tubes should be used, and the
deeply extending skin carcinomata are much less favour- healthy parts carefully protected.
able for treatment. 7. After surgical operation, X-ray treatment may be
Dr. Schiff agrees with these directions as a whole , desirable.
but points out that individuals react differently to 8. It is very important to note that Roentgen -ray treat
Roentgen rays, so that one cannot lay down hard -and- ment may save the patient from an operation , and that,
fast rules as to dosage. in suitable cases, not only is the cure equally good, but
Lehmann points out the objections to operations about the subsequent cosmetic appearance is much better.
the nose and eye. He considers that relapses are rather
less liable to occur after X-ray treatment than after
operation. The cosmetic result is certainly better than
after any other method ; the application is absolutely RADIUM FOR THE TREATMENT OF CANCER AND
painless, and nowadays is free from risk. In superficial LUPUS. *
epithelioma of the face he considers X-ray treatment
the method of choice . (Abstract of Paper read at the Congress of Physio -therapy at
Rome.)
Martial came to the conclusion that X-ray treatment
should be used when the patient refuses operation, or when By WILLIAM J. MORTON, M.D. , New York,
the cosmetic result is of importance, but in these cases Professor of Electro-therapeutics , New York Post-Graduate Medical
School.
only when one is sure that the growth does not penetrate .

deeply. All skin epitheliomata are suitable, even those This paper is a contribution to radium -therapy, fortified
that contain spindle cells. Tumours of very extensive by citation of a few selected cases.
and rapid growth are unsuitable. Whether melanotic It is now beyond question that the Roentgen ray cures
growths are amenable has not yet been decided. X -ray many cases of superficial cancer. But in actual practice it
treatment is contra-indicated in cases of cancer of the has seemed to me that radium is superior to it in many
lip and tongue. cases, granting that we employ the pure radium salt. In
Hahn concludes that the results of the treatment of the actual attack upon a cancerous tumour the Roentgen
rodent ulcer are very satisfactory, 95 per cent. of the ray can never be as successfully applied as can radium
cases being permanently cured . The scar is excellent in by the art of embedding it in a suitable receptacle within
most cases. Success is attained even in cases which are the cancerous mass .
beyond operation. In the other carcinomata the results As regards dosage, one may use a standardized pure
are less favourable. Though pain is usually eased, it is radium bromide of a carefully measured radio -activity.
rare to meet with success ; the method cannot replace This radio-activity is invariable, and the dose may there
surgical treatment. fore be couched in terms of time units. The penetrating
Dr. Schiff himself has formed the following opinions : powers of the gamma rays of radium , by reason of their
1. The favourable effect of X rays on epithelioma is greater velocity, have been shown to be much greater
indisputable. than that of the Roentgen ray. We may therefore
2. The treatment with X rays must not, however, be expect, and do actually obtain, a deeper and wider action .
considered in a category by itself; it must be looked In the use of radium , if we enclose it in aluminium or
upon as an alternative or an addition to other methods . mica receptacles, we utilize the beta, or cathode, ray. This
3. The success of treatment depends on certain bio- we cannot do in Roentgenization except as secondary
logical differences in the various forms of epithelioma : radiations due to the impact of the X rays. This fact
these differences are as yet insufficiently understood. gives the practitioner, for the first time in medicine, the
4. Small operations or cautery may be required to opportunity of directly using the cathode ray - viz., the
aid the effect of the X - ray treatment. negative particle ; and this differentiates radiation by
5. If no improvement is produced after four or five radium very strongly from radiation by the Roentgen
sittings, the treatment should be discontinued, as little ray. This fact alone would lead us a priori to expect
more is to be expected from it. * This paper appears in extenso in the Medical Record, November 9,
6. The intervals between successive sittings should not 1907 .
 ARCHIVES OF THE ROENTGEN RAY. 279

different, if not also greater, therapeutic effects, due to left there a certain number of minutes, determined by
the well-known powerful ionizing, chemical, and photo prior clinical experience.
graphic effects of these beta rays. I have long advocated and practised in selected cases
The best evidence of the therapeutic value of radium the method of embedding radium tubes within the
is obtainable from clinical experience. Radium con- cancer, and have embedded radium contained both in
stitutes probably the best modern treatment for lupus glass tubes and in aluminium tubes secondarily enclosed
vulgaris. It is the writer's belief that the rapid, aggres- in celluloid tubes. I puncture the tumour with a knife
sive , fulminating action of pure radium bromide applied or with a Keyes' cutaneous punch. This instrument
to the treatment of superficial cancer (or by embedding removes a core, as for microscopic examination. Into
in other selected cases) and to the treatment of lupus the tubular cavity I insert the tube. Owing to the
vulgaris constitutes a distinct advance in the treatment extreme hardness of certain carcinomatous masses this
of these diseases. procedure is superior to simple incision, since the tube
My equipment consists of Lieber's aluminium tubes, occupies a pocket without possible pressure and conse
each containing 10 milligrammes of pure radium quent irritation. Often the aluminium or glass tube is
bromide, as obtained from Dr. Schamer of Germany, provided with a silver shield covering one side of it, thus
of an estimated radio -activity of 1,800,000. These tubes protecting the overlying skin and parts not diseased .
may be used singly or may be combined to produce a In this manner very severe radiation treatment may be
total effect. The penetrating power of the gamma rays administered to large tumour masses, or even to enlarged
from this equipment is remarkable. One of these tubes lymph glands and recurrent nodules, without fear of skin
placed upon the skin during twenty minutes produces a dermatitis. Since the epidermis and derma absorb
radium burn, appearing within from four to fourteen perhaps one-half of the radiant energy of the radium,
days, and usually proceeding to the secondary stage of many tumours beneath the skin escape its full influence
serous exudation . when employed from the outside, but by means of this
In addition to the above, I use tubes of lower radio- method of embedding the radium tube the entire energy
activity, and also celluloid rods and discs, made after the of the radium is available. The beneficent influence of
method of Hugo Lieber, of New York, from which are the method is illustrated by Case 1 , in which a large
certainly obtained the beta rays and probably also the spindle -celled sarcoma of the upper arm appears to-day
alpha, since the radium is spread as a thin film upon the to be cured as a result of two months of internal radio
surface of the rod, and covered with the thinnest layer therapy initiated more than two years ago.
of specially prepared collodion. Furthermore, and incidentally, I use radio -active water,
Treatment is carried out , firstly, by the gradual method which is made by a process I have described in the
of frequent consecutive sittings of short duration, extend- Journal of Advanced Therapeutics, October, 1905. The
ing over several weeks or months of time ; or, secondly, emanation dissolved in the water travels in the blood
by an aggressive and rapid attack in from one to four stream, and diffuses the transformation products of
or six sittings, of from twenty minutes up to one hour or radigm .
more each, according to clinical experience. In the latter I should add, also , that I invariably administer to my
case the operator expects to produce a severe radium patients an aqueous solution of fluorescin, or of esculin ,
burn , but the sound tissue heals with excellent cosmetic or of quinine, in order to excite these fluids to fluoresce
results, while the cancerous tissue (rodent ulcer type within the cancerous tissue during the radium treatment.
and superficial face cancer) disappears. Sound or healthy Experiment admits of no doubt that these fluids do
tissue is certainly far less affected by radium than is fluoresce in tissue in dilutions possible to obtain most
cancerous tissue . safely by oral administrations .
My ordinary method of application is to introduce the By the use of the aforementioned gelatin and celluloid
aluminium tube within a very thin gelatin tube, such as tubes, and of shields 4 inch in diameter and from 6 to 10
is used to shield thermometers. Thus, every single inches long, the cavities of the mouth, throat, vagina,
application has its individual uninfected shield , which uterus, rectum , and the interior of ulcers and sinuses,
is then thrown away. The tube thus arranged is laid may be treated in a manner impossible by the use of the
directly upon the spot which it is desired to treat, and X ray.
280 ARCHIVES OF THE ROENTGEN RAY.

CASE 1. Large Sarcoma of the Upper Arm treated by to indicate that the site of the sarcomatous tumour is
an Embedded Radium Tube and Fluorescence.- Remains now composed wholly of osseous reparative material.
apparently cured now , at the end of two years. The CASE 2. Carcinomatous Tumour at Knee.-Dr. Kemble
tumour was fusiform and occupied the upper third of removed as much as possible of the growth, which was
the humerus. It was 4 inches in length and 21 in about the size of a hen's egg . Microscopical examina
width at its greatest diameter. No hope whatever was tion revealed the “ structure of endothelioma," etc.
entertained of saving the patient's life, but as affording Dr. Kemble’s idea in referring the case was to cure, if
her at least a chance, it was proposed to amputate the possible, those portions of the disease which he had
arm at the shoulder. This she refused. The case been unable to remove by the knife. As a result of the
certainly seemed hopeless ; but I decided to insert a operation three weeks prior, there existed upon the knee
glass radium tube into the central portion of the disease. a cicatrix about 6 inches long from the lower border of
This was comparatively easy, owing to the fact that a the kneecap upward, and beneath this an opening.
large opening existed into its centre. I inserted the tube , Into the opening I inserted a glass tube containing
allowing it to remain there continuously for ten weeks. 100 milligrammes of Curie radium, 10,000 radio-activity,
The radium employed was 100 milligrammes of the French and administered at the same time fluorescin, aqueous
chloride of 20,000 radio -activity. At the same time, by solution 1 part to 30, 6 drops three times daily. The
the way of fluorescent treatment, the patient was given patient made continuous and rapid improvement. He
6 drops three times daily of a 1 in 30 aqueous solution gained 11 pounds in weight, his knee was relieved
of fluorescin, and 4 grains of bisulphate of quinine daily. from pain, and gradually grew more flexible.
Also she took radio-active water prepared by a process Six weeks later, since the entire wound had healed
I have already fully described. Beyond this she received and all signs of inflammation and disease had subsided,
no medication whatever nor any other treatment. I removed the radium tube embedded within the flesh
After insertion of the tube, a skiagram was taken above the knee by a fresh incision, and placed high
which indicated beautifully the head of the humerus and power radium, 1,800,000 radio-activity, within the wound
the extent of the sarcomatous tumour, the fracture of for fifteen minutes to prevent soiling of the tissue by
the humerus in the centre of the tumour, the glass tube any possible disease which might remain. Patient
containing the radium , and even the radium as it discharged apparently well.
appeared in the tube. Within ten days after the inser- CASE 3. Lupus Vulgaris. - P. N. G., age fifty - six.
tion of the radium there was great diminution in the The patient, a prominent physician , came under my care
discharge, and at the same time the pain, which had May 25, 1907. He had suffered from lupus for twenty
been somewhat severe, had entirely ceased. Within four one years. The entire left side of the nose up to the
weeks the patient was enabled to dispense with the bone of the bridge of the nose had been destroyed,
splint, which she had worn continuously, and was able leaving an unsightly cavity, to conceal which he wore a
to move the arm somewhat freely, and , moreover, had false nose . The edges of the gaping wound were actively
regained sufficient strength to walk about a little. diseased, ulcerated , and discharging. The upper lip on
Within a period of two weeks she had gained 7 pounds the left side was tumefied and diseased . Isolated
in weight, and her cachectic appearance subsided. The tubercles of lupus existed on the cheek and near the
radium tube was removed and the patient allowed to inner canthus of the eye. The treatment consisted of
return home . During the treatment there was evidence the application, on May 25, of 10 milligrammes of pure
of a radium dermatitis upon the external skin , due to radium bromide enclosed in an aluminium tube for one
radiation outward of the radium . hour on the tip of the nose ; on May 27, of 20 milli
At the end of three months the patient returned for grammes, two tubes on the tip and on the ala nasi for
examination. The wound was nearly healed, and the four hours ; on the 28th, of 20 milligrammes on the
arm looked so well that the patient was sent back home septum, a part of the upper lip, and where the ala nasi
again without further treatment. The opening closed in joins the cheek, for four hours. The entire open area
March, 1906. The arm has never given her any trouble treated was irregular in shape, and would aggregate
since that time . She uses it as freely as ever for all about 1 square inch. During the first week there was
purposes of life . A final skiagraph was taken, and seems not much change noticeable except that the open areas
 ARCHIVES OF THE ROENTGEN RAY. 281

were a little more active than usual . There was no follows : Complete and characteristic parchment-like
pain or discomfort whatever. During the second week cicatrization of all the parts previously involved by the
there was a more decided increase in the symptoms. disease. Where formerly the tissue from the inner
The sloughing became more active in the diseased areas, canthus of the left eye to the opening of the nose was
and there was a large amount of watery exudation, which occupied by tuberculous lupus, there is now a clean ,
soon dried and formed heavy crusts over the entire area white cicatricial patch. This is equally true of the parts
where the skin had sloughed. These crusts had to be of the upper lip involved, also of the rim of the excava
removed several times daily. The open sores or sloughs tion at the side of the nose. As a matter of fact , the
increased somewhat in size , but all were very shallow . disease appears at present completely cured.
During this week very little discomfort was experienced.
Early in the third week the symptoms increased in
severity, the upper lip was swollen to almost twice its ON THE PRESENT POSITION OF ROENTGEN DIAG
natural size, but there was little or no swelling elsewhere. NOSIS IN DISEASES OF THE STOMACH AND
The entire diseased area where the radium was applied INTESTINES. *
became quite sore and painful. This was especially
By Dr. JOLLASSE, St. George's Hospital, Hamburg.
marked on the tip of the nose and where the septum
joins the lip. The physical and nervous exhaustion was Only three years have passed since Rieder opened the
intense, with marked mental depression . The sloughing way to the use of the Roentgen rays for the examination
and watery exudation began to diminish in certain places. of the stomach by the use of bismuth meals.
During the fourth week the swelling of the upper lip began Before Rieder a number of others had endeavoured to
to subside, but the area around and beneath the eye and make use of bismuth for the purpose of demonstrating
the upper part of the nose, which had not been treated the stomach and intestines , but practical results were
by the radium , began to swell, and became quite sore. not obtained .
For a few days the eyelids were swollen until they were In studying the abnormal conditions of the digestive
almost closed. The discomfort here was equal to that tract we find that the changes in the æsophagus can be
previously experienced in the area upon which the radium easily rendered visible by bismuth. Stenosis is the chief
tubes directly rested . There were a number of small condition concerned , and it is immaterial whether the
lumps or elevations in this area, some as large as a stenosis be due to new growth, to scarring, or to com
pinhead and some larger. These became inflamed, and pression from without. In these cases the best plan is
very soon the slough below extended upward to the to use a paste consisting of 1 ounce of bismuth and
inner canthus of the eye, and cleaned out all the lumps ounce of milk-sugar, with a little water. Diverticula ,
or swellings just mentioned. During the latter part of ectasis, etc., may be demonstrated by the same means.
this week the swelling and all other symptoms began to Even foreign bodies, of a kind which throw no shadow ,
subside very rapidly, and healing began in all parts and may be demonstrated by swallowing bismuth emulsion
made rapid progress. The physical and nervous depres- or paste. Thus, Holzknecht showed a date -stone in the
sion rapidly gave way to conditions just the opposite, esophagus of a child ; not only its situation, but even
and instead of the despondency were buoyancy and a its exact position could be clearly made out.
sense of extreme happiness. At the latter part of the In almost every case the patients were examined in
fifth week all parts were healing rapidly, and cicatriza- the vertical position , facing the observer. In demon
tion was nearly complete. The swelling in all parts had strating the cases we are about to describe, we made
entirely subsided, and no discomfort whatever was use, not of photographs, but of tracings from the screen.
experienced. At no time did inflammation extend to These screen-tracings have their advantages and their
tissues which had never been invaded . This would disadvantages. Photographs give better pictures artis
indicate that radium has a selective action on the tissues. tically, and enable details to be reproduced and studied
The cosmetic effect in this case has been remarkably objectively ; the tracings, on the other hand , are cheaper,
good. At no time was the suffering sufficient to prevent and are far easier to produce. This is an important
the patient attending to his professional duties. * From a paper read to the Medical Society of Hamburg. Abstracted
At the end of the seventh week the condition was as and condensed by A. C. Jordan, M.D.
282 ARCHIVES OF THE ROENTGEN RAY.

point if the X-ray method is to find extensive employ- stomach lies to the left of the middle line, and only when
the stomach is full does the pylorus cross over to the
ment in the practical diagnosis of gastric and intestinal
diseases. The tracings give all that is of importance right of the middle line. The pylorus lies normally in
with sufficient clearness. Further, it is advisable to relation with the first or second lumbar vertebra , and
examine every patient with the screen, for there are the cardiac end of the stomach at the level of the tenth
many facts and phenomena of the greatest value for or eleventh thoracic vertebra. In all cases when the
diagnostic purposes which cannot be caught on a photo- stomach is full we may observe the collection of gas at
graphic plate. its highest point. This is the so -called " Magenblase,"
The following are the facts which have been determined a large bubble of gas which, in an upright posture,
by the examination of the living subject : In the first collects under the diaphragm . This bubble consists of
place we learn as an indisputable fact that the stomach , air which has been swallowed. If it should be absent,
normally, is placed vertically ; we find, further, that the it may usually be made to appear on the screen by
size and shape of the stomach is subject to great varia. causing the patient to drink. This gastric bubble is very
tion ; we hardly ever find two stomachs of precisely the variable in size. It is large in pyloric stenosis, and in
same shape. As Holzknecht pointed out, there is only neurasthenia. In hysterical air-swallowers it may
one shape which continually recurs. Holzknecht desig. become of very considerable dimensions.
nated this the “ COw -horn " stomach. The characteristic In every stomach examination we should examine
feature of this stomach is that the pylorus occupies the carefully the peristalsis of the stomach. If it does not
lowest point of the organ. This is, however, not usually occur it may usually be called forth by gentle massage.
the case ; the caudal part usually sinks lower than the In pyloric stenosis peristalsis is often very active, and
pylorus, and then rises again , to form the so-called the occurrence of antiperistalsis is of great importance.
“ lift ” ( Hubhöhe) from the caudal part to the pylorus. As this is seldom well marked, practice and careful
Holzknecht considers the cow -horn variety to be the observation are necessary to recognize it. When it is
truly normal form of the stomach, because of the absence present it is a valuable symptom of pyloric stenosis.
of this “ lift," and maintains that it is the only constant This is an instance of an important sign which can only
form and the most rational form physiologically. All be demonstrated by direct screen observation . We are
other forms are considered by him to be the result of also able to obtain information as to the position of the
commencing ptosis. This view has given rise to lively stomach in various degrees of fullness, and in different
controversy. Firstly, it is illogical to define as the positions of the body, and in pathological conditions.
normal form of stomach one which is not universal in In these cases it has been shown that the results
healthy persons. Less than 20 per cent. of adults have obtained by percussion are often quite unreliable.
this form of stomach , although it is more frequent The differential diagnosis between gastroptosis and
among children . Secondly, the author has shown by dilatation of the stomach is capable of great accuracy by
numerous experiments that the cow-born stomach does this method.
not, as a matter of fact, empty itself of its contents any We are also able to study the motor activity of the
more quickly than does a stomach with a considerable stomach by the bismuth method. After a meal consist
1)
- lift ." ing of 1 ounce of bismuth in 7 ounces of gruel, the
Simmonds has pointed out that by inflating the trans- normal stomach empties itself in a period of three hours.
verse colon , the great curvature of the stomach is pushed If, after three hours, there remains a distinct shadow in
forwards, and the stomach is so altered in shape that the stomach, we are justified in describing the case as
any rise which may be originally present disappears. one of insufficiency of the first degree. Individual
Under these conditions skiagrams may be obtained with- variations lie between two and three hours. If the
out any “ lift.” These, however, differ from the cow- bismuth meal be given in the evening, and it is still
horn stomach , which is a shape sui generis. demonstrable in the stomach on the following morning,
Even in recent text -books we usually find it said that we are justified in concluding that there is absolute
two-thirds of the stomach lies to the left of the middle insufficiency of the motor function of the stomach. In
line, and one-third to the right . As a result of Roentgen severe motor disturbances the shadow in the stomach
examination we find that practically the whole of the may persist for days.
 1
.Fig FIG
.2

AFTER
E
ON
ARTICLE
ILLUSTRATE
TO
R
X
BY
BLADDER
URINARY
THE
"OF
OXYGEN
WITH
INSUFFLATION
AYS
XAMINATION
).( 271
P

.B.
MMORGAN
DAVID
,By
.
CCLXXXV
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Phenomena
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the
of
rchives
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283
 Fig . 3 .

Fig . 4 .

TO ILLUSTRATE THE ARTICLE ON " EXAMINATION OF THE URINARY BLADDER BY X RAYS

AFTER INSUFFLATION WITH OXYGEN ” ( p. 271 ) .
By DAVID MORGAN, M.B.
PLATE CCLXXXVI.
(" Archives of the Roentgen Ray and Allied Phenomena . ” —Copyright.)
285
 ARCHIVES OF THE ROENTGEN RAY. 287

The secretory activity of the stomach may also be free HCl. A screen examination revealed a shadow
demonstrated by the X-ray method — at any rate, as far which indicated stenosis of the pars pylorica. No
as the free hydrochloric acid is concerned. Dr. Schwartz tumour could be felt . Later, these facts were confirmed
of Vienna, a pupil of Holzknecht, showed, by experi- clinically, and the pyloric tumour became palpable.
ments in vitro, that gold-beater's skin is soluble in HCI, On the day of the proposed operation the patient con
the time taken for solution depending on its state of tracted erysipelas and died. The post-mortem exami
concentration. He therefore uses small bags of gold- nation showed that there was a flat carcinoma, not
beater's skin filled with bismuth. These are clearly ulcerated , involving the muscular coats, and leading to
visible as circular shadows in the skiagram . After their extreme stenosis of the entire pars pylorica.
solution they form an irregularly diffused mass in the Unfortunately, we are not yet in a position to diagnose
stomach. The method is very simple. The patient is a carcinoma early enough , although we can often diag.
given a test breakfast, and fifteen minutes later one of nose it before it can be felt. The growth must be of
these fibro - derm capsules, followed by a piece of dry some size before we can detect it by an X-ray examina
bread, to prevent the capsule from remaining in the tion. Neither can we decide whether a given tumour is
@sophagus. A screen examination is made at regular capable of complete removal, for we have no means of
intervals, and it is found that the clinical results agree ascertaining the degree of invasion or the presence of
exactly with the test -tube experiments. metastatic growths.
The following is the rate of solution : Attempts have been made to render a gastric ulcer
In hyperacidity, one and a half hours. visible on the supposition that bismuth adheres to its
With normal HCI, two and a half hours. surface, and forms a protective covering for the ulcer.
In anacidity, five hours or longer. Kraft suggested this at the first Roentgen Congress, and
During the course of the trial the patient should lie the author succeeded in realizing , in a very striking
on the left side. Numerous control experiments have manner, the possibility of this procedure at his first
proved the reliability of this method . In cases where attempt. A female patient, who was known to have a
it is undesirable to use a stomach tube, this method is gastric ulcer, was given a teaspoonful of bismuth in
very useful in enabling us to determine the power of suspension on an empty stomach. She was examined
secretion of the stomach . with the screen after six hours. A distinct shadow was
It may be asked how far the X -ray examination is of seen in the stomach, which remained visible for more
assistance in the diagnosis of carcinoma. We have than twenty -four hours. The same shadow reappeared
already shown that we are able to obtain reliable in the same position on subsequent trials.
evidence on two points : the motor function and the Unfortunately, this is the only case in which the
presence or absence of hydrochloric acid. With regard author was able to show a positive result, and this is not
to the demonstration of impalpable tumours , we can to be wondered at when we consider how slight a deposit
naturally only show those which are of sufficient extent would be formed upon the surface of an ulcer. More
to cause a definite change of shape. We are able to recently Hemmeter has described three cases in which
distinguish three types : those of the great curvature, he succeeded in showing a gastric ulcer by this method .
those of the small curvature, and those of the antrum A carcinomatous ulcer would present exactly the same
pylori. If the pylorus itself is the seat of the tumour, appearance, so that the method is not adapted for
even if extreme stenosis be present, there may be differential diagnosis.
absolutely no change in the outline of the stomach , The stomach may be distorted by causes other than
although there may be ectasis and increased peris- carcinoma, such as adhesions, or by the scars of healed
talsis. gastric ulcers, giving rise to the so-called hour-glass
In one case of cancer of the stomach , the patient, a stomach . These are very well shown by the Roentgen
man of thirty-three, complained of stomach troubles of a method .
kind that might equally well have been due to nervous The intestines may also be examined by the bismuth
or to organic changes. By the X-ray examination one method. The bowels may be made visible either by
was able to determine that there was definite motor injections per anum or by bismuth meals. Food passes
disturbance, and that there was an entire absence of through the small intestines very rapidly in liquid form ,
39—2
288 ARCHIVES OF THE ROENTGEN RAY .

and casts a very indistinct shadow . The large intestine, says, the X-ray examination should be spoken of, not
however, is readily seen in its entire length.
Normally, the ingesta should have passed through the
small intestines within six hours, and through the large
intestines in twenty-four hours. Four hours after a full
meal there is still bismuth in the stomach , and small
quantities remain there a good deal longer.
The abnormal conditions of the bowel which we are
able to show include changes of position, stenosis, and
tumours.
It has been asserted that the Roentgen method is
in opposition to the clinical examination , but as a part
of it.
A VERTICAL ORTHODIAGRAPH .*
By Professor Dr. R. KIENBOCK , Vienna.
ORTHODIAGRAPHIC examination , as introduced by Moritz,
is coming more and more into use, both in medical
practice and in original research ; and it would be still

Fig. 1. -COIL ON WALL -BRACKET.

too complicated for general use in practice. It is not more widely employed if the necessary apparatus were
proposed, however, that the method should displace not so complicated and expensive. This disadvantage
other clinical methods. Its proper rôle is to supple * Translated and condensed from the Fortschritte auf dem Gebiet der
ment these , and to give additional evidence. As Rieder Röntgenstrahlen , October 23, 1907.
 ARCHIVES OF THE ROENTGEN RAY. 289

applies equally to the orthodiagraph of Moritz and to support is similar to that employed by Holzknecht in
that of Levy-Dorn. Besides these, we have the well- his examination of the stomach , but the board is quite
known models of Hirschmann and Dessauer, of Albers- flat and smooth on the far side, so that the hanging
Schönberg and Von Shein , of Béclère and Von Deslot. diaphragm and focus-tube may run smoothly over its

Fig. 2. -APPARATUS IN USE. FIG. 3. - APPARATUS SUSPENDED FROM THE CEILING WHEN NOT
IN USE.

The trochoscope of Holzknecht and Robinson may also surface on a number of little ball castors. Fig. 2 shows
be used for obtaining an orthodiagraphic tracing. Some the arrangement of the apparatus in the Roentgen room
of these models are adapted for examination of the when in use for an orthoscopic examination. From right
patient in a horizontal position, some for a vertical to left we see the coil mounted on brackets attached to

Fig . 4. -HANGING DIAPHRAGM.

position, while others permit of the patient being placed
in any position .
My vertical orthodiagraph consists simply of a hanging
screen and tube support, together with a wooden frame
and board against which the patient leans. This wooden
the wall well overhead, so as to be out of the way. The
leads are supported from the ceiling by pulleys and a
counterpoise. Next comes the focus-tube, clamped behind
the hanging diaphragm , which is also suspended by
pulleys. To the left of this is the wooden support
290 ARCHIVES OF THE ROENTGEN RAY .

against which the patient leans ; and, lastly, we have have the drawing before our eyes during the whole opera
the fluorescent screen, also hanging from the ceiling. tion. In most forms of the orthodiagraph this is not the
In Fig. 3 we see the arrangement of the room when the case, the drawing -board being behind the screen. The
orthodiagraph is not in use. The focus-tube, diaphragm, examination may be completed in less than a minute,
and screen are drawn up to the ceiling, and the sup- and one or more copies of the orthodiagram may then be
porting framework is placed out of the way against the taken off on tracing-paper.
wall.
The hanging diaphragm consists of two zinc plates,
50 centimetres square, placed 21 centimetres apart. In
the centre of each plate is an aperture 20 centimetres
square. Between the plates is one of Albers- Schönberg's
shutter-diaphragms. The shutters can be so adjusted as
to form a vertical or horizontal slit, or a rectangular
aperture of any size. This, in my opinion , is better than
an iris diaphragm . The focus -tube is supported behind
the diaphragm by an adjustable wooden clamp, which
enables us to centre it accurately. Attached to the
front of the hanging diaphragm are six little ball castors
to facilitate the movements of the focus-tube in the plane
of the wooden back-board. A detachable wire cross is
used for centring the focus-tube and for defining the
position of the normal ray. The orthodiagraph, focus
tube, screen, and all is drawn up to the ceiling out of the
way when the examination is completed, and the support
may be removed and stood against the wall , as shown in
Fig. 3. This back-board for steadying the patient is fixed
to a wooden frame furnished with a foot-board, on which
the patient stands. The board itself is 44 inches high ,
24 inches broad, and inch thick. It should be made
of poplar-wood, free froin knots, so as to be transparent
to the X rays. A support for the fluorescent screen is
attached to one of the uprights. The screen may be Fig . 5. – BACK - BOARD AND SUPPORT.
displaced in any direction in a plane parallel to the
back -board , or it can be removed altogether. The It is of great advantage in a small installation that
weight of the patient standing on the foot -board keeps the diaphragm, screen, and focus-tube can also be used
the frame steady. Children may be raised to a con- for ordinary Roentgen examination. In this case we
venient height by means of a stool . Fig. 5 shows this need only remove the metal cross from the diaphragm
apparatus. The whole arrangement is very simple, and and detach the screen support. The wooden frame is
can be constructed by any village carpenter. still of use to steady the patient in the examination of
In making an orthodiagraphic tracing the focus -tube the abdomen with compression or the like, and is also of
with its diaphragm travels on castors over the surface of service in marking the position of the focus -tube.
the back -board , following exactly the outline of the organ The screen and the diaphragm are both supported in
under examination. The observer follows the shadow any position by means of counterpoise, and at the end of
of the metal cross with his pencil, marking the important the examination are drawn up out of the way. The
points on the lead-glass plate which covers the fluorescent frame may then be placed against the wall and the room
screen . This is done with the ordinary grease pencil used for other purposes, which is a matter of no little
used for drawing on glass. The tracing should be made moment where the available space is but small .
only during expiration and at the moment of diastole. NOTE.— The illustrations are kindly lent by Messrs. Reiniger,
One of the great advantages of this method is that we Gebbert and Schall, of Vienna, the makers of the apparatus.
 ARCHIVES OF THE ROENTGEN. RAY. 291

A NEW INSTRUMENT FOR HIGH FREQUENCY.
A HIGH -FREQUENCY apparatus which has some interesting
points of novelty has been lately designed by Marconi's
MTITITUUTTD
An index attached to the inner cylinder of the con
denser slides over a scale of frequencies which is
calibrated by the aid of Dr. Fleming's cymameter. The
quantity of the effluve is regulated by altering the posi
tion in the magnetic field of two subsidiary spirals .
The instrument has, therefore, two new adjustments
one for frequency, by altering the capacity, and one for

quantity, by placing the spiral in different parts of the

-Seele of Intensity magnetic field .
One of the minor points is that the spark-gap is
furnished with easily detachable balls, so that , when
worn, they may readily be replaced by spare ones. The
instrument is well designed and compact , and the adjust
fregues

ments are easily get-at-able.

Scale

In the administration of the effluve to a nervous

of

patient, it is of considerable importance to be able to

apply the excitator to the skin without any sparking or
effluve, and then gradually turn on the current. With
this instrument the effluve can be varied from 0 to a
maximum simply by rotating the spiral, all the other
adjustments of primary current, spark-gap, etc., being
left unaltered .

Notes and Abstracts .

Odjustable Condenes
RADIO - THERAPY.
Tinfoil -Tirfoil -Tinfeil A Case of Lymphadenoma treated by X Rays (J. Mitchell
Clarke, M.A. , M.D. Cantab. , F.R.C.P .).— The case is reported
as showing the beneficial effect of X rays. The patient was
ten years old when he came under observation with well
Spark Gap
marked lymphadenoma. He was treated on three occasions
with X rays, and each time the glands diminished rapidly in
size, until they were reduced to small, hard kernels. At the age
of twelve, when he appeared to be convalescent, he died of
pneumonia.
At the post-mortem examination the tracheal and bronchial
To Loduction Coil glands were found enlarged, varying in size from a pea to a
walnut. They were discrete and firm. The liver contained
numerous lymphadenomatous nodules. The spleen contained
similar nodules, and had a waxy appearance.
The point of interest to note is the rapid effect of the X rays
on the glandular enlargement ; the glands ceased to be visible,
though they were still palpable. The essential change of
High-FREQUENCY APPARATUS (MARCONI COMPANY ). lymphadenoma, the presence of endothelial and giant cells, did
not, however, disappear, so that the disease might recur
Wireless Telegraph Company. The novelty consists in Further, the spread to internal organs continued in spite of the
the introduction of a variable condenser into the primary treatment, although the liver and spleen did not become as
large as is usual.
circuit, by means of which the frequency of the oscilla In leukæmia the X rays produce a great destruction of
tion may be varied through a range of from one and a leucocytes, but the myelocytes appear never to entirely disappear
half millions to two millions per second . from the blood , so that it is not yet certain whether the X rays
292 ARCHIVES OF THE ROENTGEN RAY .
actually cure leukæmia. Linser and Helber believe that there is
a primary destruction of leucocytes in the circulating blood ;
they conclude_( 1) that the white cells are affected in a selective
way by the X rays , the lymphocytes being most susceptible ;
(2) the rays produce in the circulating blood, and also in the
blood outside the body, a leucotoxin , which, when injected into
animals, produces a destruction of leucocytes ; (3) this leucotoxin
produces an immunity against itself, and (4) produces nephritis
by its elimination by the kidneys ; (5) X rays have little or no
effect on red cells, blood -platelets, and hemoglobin .
Radio -therapy in Syringomyelia .-- Beaujard and Lehrmitte
(Semaine Médicale, April 24 , 1907) have treated three patients
suffering from syringomyelia with X rays, and in all there has
been a diminution of motor, sensory, and trophic disturbances.
One of these cases the authors treated systematically for a year.
The patient was a man , twenty-three years of age, in whom , four
years previously, there began motor troubles of the left arm , followed
by atrophy of the hypothenar muscles of the left hand. Three
years ago there appeared a painless whitlow on the right index
finger, which ended by destroying the terminal phalanx. When
first seen by the authors, the left upper limb was considerably
wasted , especially about the hand ; the thenar and hypothenar
eminences of the left hand were flattened, the interosseous spaces
depressed, and the hand “ clawed.” Flexion of hand was feebly
carried out, and extension was impossible, as was also apposition
of the thumb and little finger. Muscular power was well main
tained in the forearm , but the power of extending forearm on
upper arm was markedly diminished. The muscles of the rest
of the body were in a normal condition. Partial reaction of
degeneration was present in the muscles of the left thenar
eminence, and the complete reaction of degeneration in the
hypothenar muscles and the external interossei. There was
lowering of sensation, together with complete analgesia and
thermanæsthesia of the upper part of the body. Vasomotor
and trophic changes were well marked. The skin of the right
palm was horny, and covered with ulcerated fissures. The
tendinous reflexes in the upper limbs were normal, but in the
legs were exaggerated ; there was no foot clonus, the cutaneous
reflexes were present, and the plantar reflex of the normal
flexor type. The sphincters acted normally ; there was scoliosis,
with the convexity of the curve to the left. The other organs of
the body were healthy. X -ray treatment was begun in May, 1906,
the cervico -dorsal region of the spine being exposed to the rays,
the distance of the anti-cathode from the skin being 15 centimetres,
and the radio - chronometer of Benoist registering 7 to 9 centi.
metres. These applications were made once a week. After the third
application the sensory troubles began to retrocede, the mental
state of the patient improved, as did also his general muscular
weakness. After the seventh application a careful re-examina-
tion of the patient was carried out, and it was then found that
the area of skin involved in anæsthesia had markedly diminished,
the tactile sense had completely returned on the left side of the
body, the analgesic and thermanæsthesic areas were not much
altered in extent. Motor power in the left arm had considerably
improved. After the twenty -fifth application it was found that
the analgesia had disappeared on the left side , and had also
diminished in extent on the right ; the area of thermanästhesia
was equally reduced, the muscles of the left thenar eminence
had recovered their power, and the thumb and little finger could
be moved into apposition. At this time there appeared a lower
ing of sensibility on the right side of the face and of the same
side of the tongue, and the cervical spine and back part of the
head were therefore exposed to the X rays. After four applica.
tions the diminished sensibility of the right half of the face and
of the right side of the tongue had completely disappeared .
The authors conclude that the X rays afford valuable means of
treatment of syringomyelia. Under the influence of the rays
motor troubles especially retrocede, and bad positions of the hands
are corrected. As regards sensory disturbances, tactile anæsthesia
disappears first, then analgesia , and lastly thermanæsthesia .
Trophic lesions of the skin and bones clear up in a surprising
manner . Muscles which show the complete reaction of degener
ation remain unchanged, but those which give only an incom
plete degenerative reaction regain their normal size and strength.
With regard to the mode of action in syringomyelia, the X rays
cause an atrophy of the neuroglial cells ; the rays may also have
some effect in modifying the degeneration in the walls of the
vessels supplying the neuroglial new formation in syringomyelia.
In treating cases of this disease by the X rays, it is necessary
that not only the whole extent of the diseased cord should be
exposed to the influence of the rays, but that the healthy part of
the cord or bulb, somewhat above the upper limit of the diseased
region, should also be irradiated. As long as the sensory dis
turbances continue to retrocede, one ought to continue with the
treatment, but if after three or four séances no improvement
has resulted, it is useless to continue the treatment.
Treatment of Bronchial Asthma by Means of the
Roentgen Ray (Medizinische Wochenschrift, No. 51 , 1907).
Gustav Eckstein reports two cases of bronchial asthma which
were treated by means of the X ray with good results. The
first was that of a woman , aged forty - five years, who had
suffered for twelve years from attacks of asthma which began
after influenza , and which at first were sporadic in character,
but later became more constant. Treatment applied to the nose,
removal of polypi, and other measures , were of no avail. The
attacks persisted for days at a time. The patient became much
reduced. Within a few months she lost 15 kilogrammes, and
had to lie in bed on account of her weakness for nine months.
Microscopically, Curschmann's spirals, Leyden's crystals, and
eosinophile cells were demonstrated in the sputum. On the day
after the application of the X ray the patient was able to sleep.
The thorax was X-rayed in circular fashion for five minutes in
each situation. The first séance lasted sixty minutes. After a
cessation of six weeks an attack of asthma came on, which lasted
for four days. The constant bronchitic condition, which was
present before, now began to improve. She then was given a
second application of the ray. Since then she has only had one
attack, which lasted for a day. The patient feels well and has
gained in weight. The second case was that of a girl of three
and a half years, who had her first attack of asthma on July 15,
1907. The attacks came on with increasing frequency, recurring
often by day as well as by night, from this time onwards.
Examination of the nose, pharynx, and larynx revealed no
pathological condition. The percussion note over the lungs was
tympanitic in front as far as the costal margin and behind to the
eleventh rib . Over the entire chest were bronchitic signs. The
 ARCHIVES OF THE
heart could not be made out by percussion . There was stridor
both on inspiration and on expiration. She was X -rayed on
September 2 for five minutes over the front of the thorax , and
at night she slept for the first time for weeks. The result of
treatment was a welcome diminution in the asthmatic seizures
and a lessening of the adventitious sounds in the chest.
On the Influence of Cholin and of X Rays on the Course
of Pregnancy . - A reply to the article by von Hippel and Pagen.
stecher in No. 10 of the Muenchener Medizinische Wochenschrift,
by Dr. Fried. Neumann and Dr. Otfried 0. Fellner. — Hippel
and Pagenstecher irradiated pregnant rabbits with the object of
producing particular ocular diseases in the fætuses ; they then
made the observation that in some of the animals the pregnancy
came to a standstill. In their provisional publication they
quoted the authors' experiments, which consisted in irradiating
the ovaries with the object of bringing pregnancy to a stop. A
parallel is drawn which makes a reply imperative.
Hippel and Pagenstecher first exposed the abdomen to X rays,
and brought the pregnancy to a standstill in 60 per cent. of the
cases. Unfortunately, they give far too superficial a description
of their methods, especially as regards the application of the
X rays. In their second series of experiments the upper half
of the trunk was exposed, and again in 60 per cent. of the cases
the pregnancy terminated . The experimenters conclude that
this result is due to an indirect action of the rays. Reference is
made to the experiments of Linser and Helber, which showed
66
that the radiation resulted in the formation of a Roentgen-
leuco-toxin, " which was carried to the fætus, and brought about
its destruction . The fact that direct irradiation destroys the
fætus is so evident that it requires no demonstration. The
authors covered over the whole of the rabbits' bodies with the
exception of the ovaries, and they obtained the cessation of the
pregnancy in 100 per cent. of their cases, as against the 60 per
cent. of Hippel and Pagenstecher, so that the result is clearly
due to the direct action on the ovaries.
Next, Hippel and Pagenstecher obtained almost the same
results when they protected the upper part of the body, and it
was easy to conclude from this that the general effect of the
rays was really responsible for the result. There is another
explanation, however, which is far more probable. The great
influence exerted by the thyroid gland upon pregnancy is now
well known. This intense irradiation of the thyroid gland is
certain to produce changes quite as marked as those produced
in the ovaries. At the beginning of pregnancy the thyroid
almost always becomes enlarged . Extirpation of the thyroid is
followed by atrophy of the sexual organs and myxædema. This
atrophy is part of cacexia strumipriva . It is quite likely that
the large doses given by Hippel and Pagenstecher led, not only
to atrophy of the ovaries, but also to atrophy of the uterus.
Bleibtreu has performed some very interesting experiments on
the irradiation of the thyroid glands.
Cholin injections are said to produce the same effects on the
fætus as X-ray exposures, and as cholin is a soluble poison, it
reaches the fætus directly. Any other poison might be expected
to produce the same result.
These experiments, then, do not alter the conclusion the
authors have formed. If the irradiation of the entire body,
ROENTGEN RAY . 293
including the thyroid glands and the ovaries, brings pregnancy
to a standstill in 60 per cent. of the cases, while the irradiation
of the ovaries alone produces the same effect in 100 per cent. ,
it is clear that the effect is due to the direct action of the rays
on the ovaries.
The authors' experiments have shown that degeneration takes
place both in the part of the parenchyma where the ova mature
and also in the secretory part. Hippel and Pagenstecher sug .
gested that the effect of the ovaries upon pregnancy could be
best studied by extirpating the ovaries ; but the authors were
anxious to avoid complicating the conditions of their experi
ments by introducing the disturbing factors of shock, hæmor.
rhage, ligature of vessels, disturbance of the uterus, etc.
Treatment of Rodent Ulcer by X Rays.-D. Friedlander
(California State Journ. of Med ., August, 1907) says that, of all
the diseases treated by the rays, the most brilliant and indis
putable results have been obtained in the treatment of the
rodent ulcer type of epithelioma. The advantages of the rays
over the other methods of treatment are manifold . These are
absence of pain, ease of application , the cosmetic result, and the
ability to treat lesions on the nose or eyelids, ordinarily inacces
sible to surgical methods. Since we know that the rays exercise
a selective action on rapidly proliferating cells, we are able to
destroy the new growth without injuring the embedding healthy
stroma. In cases where the edge of the ulcer is surrounded by
epithelial elevations the ulcer will often heal, while the elevated
border still persists. To obviate this the writer now destroys
the border with electrolysis or the high -frequency spark before
applying the rays, and has obtained in this way uniformly good
results .
The Value of the X Rays in Cases of Sarcoma.—
Walter
Berger (New York Med . Times, October, 1907), in referring
to Judd's works on the subject, points out that this observer
believes that all neoplasms, of whatever kind and wherever
situated, should at once be subjected to operation. There are,
however, many cases in which, owing to the flat refusal of the
patient to submit to operation , to the fact that the tumour is
already found to be inoperable on first examination, and also to
the further fact that in certain tumours the cancer- small in
itself --requires a grave or disfiguring operation for its removal,
the surgeon is compelled to consider the chances of radiology in
effecting a cure . Judd believes that the action of the X rays in
sarcoma is the same as in carcinoma, but, owing to the different
reaction of tissue, the result is very different. The stimulation
in these cases causes the changing over of the embryonic type
of connective tissue into the adult type, a change from pre
ponderant cells to a tumour mostly composed of fibres. The
obliterating endarteritis diminishes the amount of nourishment,
and the final result is a fibroma, with possibly latent sarcoma
cells included in the mass. A focus- tube as rich in X rays and
as poor in cathode rays as possible is used. This means a very
high vacuum and a current of considerable ampèrage. The
distance should be considerable, not nearer than 6 inches, and
usually 9 or 12 inches, in order to prevent the action of the
remaining cathode rays upon the skin. Reaction , as proved by
the diminution in the size of the tumour, is usually slow at first,
40
294 ARCHIVES OF THE
depending, of course, upon the relative softness of the tumour or
preponderance of cell elements .
ELECTROLOGY.
The Electrical Charge of Toxin and Antitoxin . - Dr. H.
Bechhold, member of the Institute for Experimental Therapy
at Frankfort-on -the -Main , writes (Muenchener Medizinische
Wochenschrift, September 24 , 1907) : “ The question of the
mode of combination of toxins and antitoxins is one of funda-
mental interest to the workers on immunity. Although much
new material has been accumulated during the last few years,
it cannot be said that the position has been cleared up to any
appreciable extent.”
About one and a half years ago the author experimented with
his new apparatus, to determine the direction in which diph .
theria toxin and antitoxin travelled under the influence of the
electric current. It was shown that the toxin became somewhat
weaker at the anode , the antitoxin showed no definite direction
of movement, while the mixture of toxin and antitoxin, contain-
ing excess of toxin, showed a slight tendency to travel towards
the cathode.
Recently Field and Teague ( Journal of Experimental Medi-
cine, vol. ix., p. 86) published a work on the electric charge of
toxin and antitoxin , which led Bechhold to make known his
former results.
It is known that suspensions and colloids in an electric field
travel toward the anode in most cases, a few toward the
cathode ; while albumen and gelatine, in the perfectly pure
state, show no tendency to migrate, unless the solution be made
feebly alkaline, when they are driven toward the anode, or
feebly acid, when they find their way to the cathode.
As early as the year 1904 Roemer ( Berliner Klinische
Wochenschrift, 1904, p. 209) made experiments in the migra
tion of tetanus toxin and antitoxin ; but his results were
ambiguous, for it was clear that the fluid he was testing became
altered at the electrodes. In Bechhold's apparatus this could
not occur, since the electrodes are separated from the fluid by
a membrane. A pressure of 108 and of 400 volts was used on
different occasions, and the experiments took four and a half
to six hours. The reaction in the apparatus at the end of the
experiment was practically neutral in every case. The original
solutions were tested in the usual way on guinea -pigs both before
and after the migration.
The results show that diphtheria toxin becomes somewhat
weaker at the anode, while antitoxin, perhaps, has a tendency
to wander towards the cathode. In the mixture of toxin and
antitoxin the excess of toxin wanders to the cathode, especially
if the migration occur immediately after the mixing.
The experiments of Field and Teague were performed with
a rather different apparatus. They obtained far more definite
cathodal migration in general, and of the antitoxin in particular.
Exception cannot be taken to their experiments, though their
conclusions cannot be adopted so easily.
Since toxin and antitoxin, in neutral and in alkaline solution ,
both wander to the cathode, they conclude that the combination
cannot be a true chemical one, or they would wander in opposite
directions. They assume that the combination of toxin and
antitoxin is due to the “ adsorption " of one colloid by another.
ROENTGEN RAY .
Bechhold considers that Field and Teague are mistaken.
Many well-defined chemical combinations are composed of
constituents of similar polarity. Thus phospho -molybdic acid
and phospho-tungstic acid are composed of none but acid
i.e. , electro -negative-- parts ; and other examples could be given.
Ehrlich , in 1897 , determined the curve of saturation of toxin
with antitoxin. Many hypotheses have arisen to explain the
form of this curve. In Bechhold's opinion, no hypothesis is
worth considering that does not recognize the specific character
of the combination of toxin with antitoxin . The mere union of
colloids by adsorption-a purely physical phenomenon-cannot
be regarded as an explanation . Nothing was known of the
mutual adsorption of two colloidal solutions until the author
a few weeks ago published his method of “ ultra-filtration "
(Zeitschrift für Physikalische Chemie, lx., p. 257 ).
Of all the hypotheses to explain the union of toxin with
antitoxin, the author considers certain examples from organic
chemistry to furnish the best analogies. Here we see how the
slightest deviations (as, for instance, in the sugar group and in
the polypeptides, which may be compared to the toxins in their
specific characters) produce deep-seated alterations in the
chemical, physical, and biological behaviour of the resulting
body.
Theory of Metallic Conductivity.- Professor J. J. Thomp
son summarizes the corpuscular or electron theory of metallic
conduction , and indicates a few modifications which have become
necessary in the light of recent observations : “ By the action
of one atom of the metal on another corpuscles are split off
from the atoms, and they remain diffused through the mass of
metal, so that we may picture to ourselves a metal as somewhat
like a porous body, the pores of which are occupied by a sub.
stance with the properties of a perfect gas. In the older theory
it was supposed that these corpuscles remained free for a time
sufficiently long to enable them to get in thermal equilibrium
with the metal itself, so that, like all gases, the average kinetic
energy of the corpuscle was a constant merely depending upon
the temperature.” The modification now required is to suppose
that the electric force, instead of acting on the corpuscles after
they have left their atoms, really acts upon the atoms before
the corpuscles leave them. The atoms probably act on each
other like a system of electric doublets, and the electron flows
from the negative end of one doublet into the positive end of
another. This modification is based upon the experiments of
Rubens and Hagen on the conductivity of metals under very
rapidly alternating electric forces of the order of light waves,
which is practically the same as that for steady currents. To
give this conductivity, the number of corpuscles per c.c. would
have to be 1.8 x 1024 in the case of silver. The author states the
difficulty thus arising as follows : “ We require that number of
corpuscles per c.c. to give, in the time deduced from the experi
ments of Rubens and Hagen , the proper electrical conductivity
of silver. Now, you have that number, each possessing at the
absolute temperature o an amount of kinetic energy al, and
therefore to raise the temperature 1° you would have to give to
each one of these an amount of energy a, or to the whole lot an
amount of energy represented by ax 1.8 x 1024, a being about
1 :5 x 10–16 ; so that this energy is 1 :9 x1.5 x 108 ergs — that
 · ARCHIVES OF THE
is, somewhere about 7 calories is required to raise 1 c.c. of
silver 1° C. if you leave the atoms of silver alone and merely
attend to the corpuscles. The actual amount required to raise
the temperature of the silver is only about 0:6 calorie, so that
there is a serious discrepancy between the results of the theory
in this form and the results of experiments on specific heat."
The difficulty may be got rid of by supposing that the electron,
instead of wandering about, jumps practically straight from one
atom into another. As regards the outstanding difficulty of the
Hall effect, this is dealt with by the author as follows : “ Sup
pose that we have a doublet with negative and positive ends :
then, if it is pulled round by an electric force, the ends start
moving, one in one direction and the other in the opposite ; and
if there is a magnetic force acting upon the thing at right angles
to the plane of motion , then there will be forces acting upon
these two ends. If the ends move with equal and opposite
velocities, the forces on the two ends are equal; but if the
velocities are different, then the forces on the ends are different
and there is a couple produced-in fact, the doublet, when
placed in a magnetic field, behaves exactly like a gyroscope.
Suppose we have a pendulum with a gyroscope bob instead of
the ordinary bob ; suppose it were held away from the vertical,
corresponding to one of our doublets before an electric force
acts ; supposing, now, it is let fall : gravity, instead of pulling
it straight down to the vertical, will make it swing round like
a gyroscopic pendulum one way or the other, according to the
direction of the spin in the top in the bob. So that if this gyro
scopic property were attached to a doublet, then, when there is an
attempt to pull it along the lines of electric force, it will come
out a little at right angles, and there will be a current either
that way or the other way, according to the sign corresponding
Reports of Societies.
ROYAL SOCIETY OF MEDICINE - ELECTRO
THERAPEUTICAL SECTION .
Dr. W. IRONSIDE Bruce showed a number of patients suffering
from leukæmia, exophthalmic goitre, sarcoma, etc. , whose con
ditions had been materially improved by exposure to the
Roentgen rays.
The first case was that of a man suffering from spleno
medullary leukæmia. X-ray exposure was commenced on
October 21, 1907, the spleen only being exposed. No other
form of treatment whatsoever was adopted. The effect of the
exposures on the blood-count was most marked, the number of
leucocytes falling steadily from 555,000 to 45,000 in two months.
The patient gained weight and strength, and has lost the look of
extreme anæmia .
The second case was that of a woman , aged forty -one, who was
suffering from symptoms of extreme anemia. The spleen was
markedly enlarged, extending to the right wall beyond the
umbilicus, and downwards almost into the left groin. The
blood-count on March 7 , 1907, when X- ray treatment was
ROENTGEN RAY. 295
to the spin of the top of the gyroscope. So that, in addition to
the movement along the direction of the line of force, the
doublets would tilt up a little bit at right angles to it. There
would be a polarization in the direction of right angles to it, and
that polarization would produce a current in that direction,
so that unless the negative and positive ends move with equal
and opposite velocities — that is, unless the centre of gravity of
the doublet is exactly midway between the negative and positive
charge — these doublets, when they are placed in a magnetic
field, will be acting like gyroscopes, and if it is attempted to pull
them by a force in one direction, they tend to squirm off in a
direction at right angles to it ; and that, I think, accounts for
the Hall effect in metals."-Science Abstracts.
ELECTRO-THERAPY.
The Action of Different Currents upon the Blood vessels
( Annali di Elettricita Med . e Therapia Fisica, October, 1907) .
-Mario Fontana maintains that ascending continuous currents
cause dilatation of the vessels, while descending currents cause
vaso-constriction. The circulatory modifications will produce a
sedative or stimulating effect, according to the state of the par
ticular organ traversed by the current. His observations of the
effects of the induced current upon bloodvessels are not in accord
with those of other observers, such as Onimus and Legros. The
primary current produces vaso - constriction . The secondary
current, if a fine wire is used and the current rapidly inter
rupted, produces dilatation of the vessels ; but if a thick wire is
used and few interruptions made, then it causes vaso -constric
tion. In every case , however, the action of the induced current
is a brief one.
commenced by exposure of the spleen only, showed the white
cells 360,000 , the character of these cells being largely myelo .
cytes. The blood -count fell rapidly to some 30,000. The most
marked change in this case occurred in the general condition of
the patient. The extreme anæmia disappeared , and she was
able to resume her household work. The spleen has to some
extent diminished in size and bulk , and on palpation it is
extremely hard and well defined in outline, a condition which is
characteristic of this organ during exposure to X rays. It is to
be particularly noted that the skin shows little evidence of con
tinued exposure.
The third case was that of a young girl, aged sixteen, suffering
from exophthalmic goitre. The thyroid gland was enlarged and
pulsating, and the patient suffered from the usual muscular
weakness, shortness of breath , and palpitation . On November 21,
1906, the pulse -rate was 106. X - ray treatment was commenced,
and an exposure on each side of the neck to include the thyroid
gland was made three times a week. The general condition of
the patient was much improved. The muscular weakness and
palpitation had disappeared , and she was able to get about with
40-2
296 ARCHIVES OF THE
out feeling out of breath. The thyroid gland was still promi-
nent, but the pulse -rate when taken last was decreased to 86.
The fourth case was that of a girl, aged nineteen , a well-
advanced case of exophthalmic goitre, with all the usual
symptoms. Her pulse when she began treatment was from
112 to 120. X -ray exposures were carried out three times a
week. The treatment has been followed by the most marked
beneficial effects. The pulse has fallen from 120 to 80, and all
the other symptoms have been markedly relieved. There has
been no great difference in the size of the thyroid gland .
The fifth case was that of a man, aged seventy-two. This
patient had, when first seen, a hard nodular growth with an
ulcerating surface involving the posterior part of the hard palate,
and extending to the soft palatine, one gland about the size of
a small walnut in the submaxillary region, and a small papillo-
matous growth the left side of the tongue, 4 inch from tip. The
case was considered inoperable. X-ray exposure was carried out
through the wide-open mouth, the patient holding forward the
tongue, and the side of the neck on which the infiltrated gland
was to be felt was exposed from the outside. The ulceration of
the soft palate was found not to advance, and, indeed , at times
it almost healed up. The submaxillary gland gradually dis-
appeared.
The sixth case was that of a man , aged forty -seven , who in 1899
had a tumour of the lower jaw, which was excised, and proved
to be an endothelioma. In 1905 some recurrence was discovered
and removed. In August of the same year it was found that
the growth had again recurred, and further operation was not
possible. X -ray exposure has been carried out since then till
the present date. The greater part of the recurrence has dis-
appeared, and at the present time the patient shows little sign of
its presence .
The seventh case was that of a man , aged forty -one, with
recurrent sarcoma of the abdominal wall. A tumour had been
removed from the abdominal wall, which when examined
proved to be sarcoma. Some time after operation the growth
recurred. On May 17, 1907, there was to be felt, extending
for about 2 inches on either side of the scar of the operation, a
hard mass . The scar had broken down and was discharging.
X-ray exposure was carried out three times a week, and the
patient's present condition is satisfactory.
DISCUSSION .
Dr. R. MORTON said that at the London Hospital they used a
single thickness of felt or other material saturated with some
substance having high atomic weight, such as tungstate of soda,
as an X-ray filter. He could not see that the therapeutic effects
as regarded the deeper structures were at all diminished by
using the filter.
Mr. A. EDMUNDS noticed the remarkable diversity of the cases
which were amenable to X -ray treatment, but they fell naturally
into a group. Cases as widely separated as malignant disease
and spleno-medullary leukæmia had one thing in common.
The prominent factor in both diseases was the overgrowth of
some particular cell. There were cells in those diseases which
were in excess of the normal number of cells required.
Dr. H. LEWIS JONES said that the experience of most
observers was that the treatment of exophthalmic goitre by
ROENTGEN RAY.
the X rays was disappointing, although sometimes one might
secure a good result. In one instance he had found benefit
follow from mild X-ray treatment, the pulse-rate coming down
to 82, and staying there for a considerable time after X -ray
treatment had been suspended. He ventured to think that
milder treatment more spaced out would be quite as satisfactory
as Dr. Bruce's method .
Dr. HINDS HOWELL said that Dr. Bruce's third case seemed to
be suffering at present from myxcedema. Her whole appear
ance was very phlegmatic and suggested the disease. She said
her hair was coming out, she never perspired, and she was
getting very stout. Her mental processes were slow. He
thought she would be an interesting case to watch. He did
not know whether myxædema was a condition which might be
produced by the X rays. Possibly the treatment this patient
had received was instrumental in producing her condition.
Dr. A. D. REID showed a patient, a boy , with an enormous
growth of very diffuse gonorrheal warts on the penis. The
case showed great improvement. The boy was treated with
X rays. When he first came under treatment the growth of
warts was so diffuse that the glans could not be seen, and the
treatment by X rays was regarded as a forlorn hope in lieu of
amputation. The case had been examined microscopically, and
gonococci had been found.
The PRESIDENT ( Mr. Deane Butcher ) said that he could bear
testimony to the value of the X rays in the treatment of specific
warts about the anus . These were best treated by X rays, by
high frequency, or by the introduction of magnesium ions.
Dr. G. HARRISON ORTON showed a number of slides of
fractures of the scaphoid bone of the carpus. Of all the bones
of the carpus, the scaphoid appeared most frequently to sustain
fracture, and, as would be seen in the slides, the fracture was
almost always in the same situation. As in a Colles's fracture of
the radius, fracture of the styloid process of the ulna was often
associated with it. The fractures were, as a rule, undiagnosed
except by X rays, and there was a tendency for the fragments to
remain ununited, which seemed to produce loss of power and pain
in the wrist.
The PRESIDENT (Mr. Deane Butcher) showed some lantern
slides illustrating plastic Roentgenography. The originals had
been contributed by Dr. Béla Alexander, of Késmárk, the
originator of the method. He also exhibited two skiagrams of a
fætus, taken from the same negative. A great amount of detail
was brought out by the mere process of printing according to the
plastic method. Another series of plastic skiagrams was ex
hibited, taken by an English worker, Dr. David Morgan, of
Liverpool . An ordinary skiagram of the pelvis, showing the
outline of the bladder filled with urine, was compared with the
plastic Roentgenogram from the same negative.
ROYAL INSTITUTION .
Recent Researches in Radio -Activity.
BY PROFESSOR E. RUTHERFORD.
The disintegration theory supposes that the atoms of radio -active
matter differ from the ordinary chemical atoms in being unstable
systems, and that every second a certain fraction, usually an
infinitesimally small one, of the total amount present leaves the
 ARCHIVES OF THE
mass, and causes an explosion, often of great violence. The new
substance itself is also unstable, and its atoms break up in their
turn. Thus the process, once started, passes in some instances
through a number of very distinct stages. The new matter that
arises in consequence of these disintegrations is so small in
amount that we are unable to detect it by ordinary methods, but
the radiations give us a method of quantitative and qualitative
analysis , and allow us to determine with some amount of cer-
tainty the more important physical and chemical properties of
the substances. The number of atoms in any simple radio -active
substance breaking up per second is always proportional to the
number present ; therefore the amount of radio -active matter
decreases in geometrical progression with the time, and we may
call the rate of the disintegration , in proportion to the mass, the
“ period ” of the substance. This period differs enormously in
various radio -active elements. Uranium , for instance, has a very
long period, and actinium a very short one. The period of the
breaking up of radio -active matter is a constant, apparently un-
altered by any agency at our command. Indeed, so constant is
this period that we may almost take the radium or other emana-
tion as a standard of time quite independent of terrestrial in
fluences. Ultimately we hope to ascertain the period of radium
with an error only of something like one part in a million.
Radium falls to half -value in about two thousand years. At
the latter end of the radium family Professor Rutherford places
what he calls “radium G ," which was the first of the bodies
to be extracted from pitchblende by Madame Curie, and named
by her Polonium . It is the last known transformation body of
radium .
Radio-thorium, the most important of the substances pro
duced from thorium , has a period of a little over two years.
Recently we have been able to obtain another substance, called
Meso -thorium . The interest in the separation of these bodies
from thorium lies in the fact that we may hope by their aid to
obtain a reas
easonably large quantity of radio -active matter at a
reasonable price.
Have radium , thorium , uranium and actinium a genetic
or parental relationship ? What is the parent of radium ? To
those who had faith in the disintegration theory it seemed as
though uranium must be the parent, but it was subsequently
found that there must be an unknown substance between uranium
and radium . The parent of radium must be somewhere in
pitchblende. Boltwood thought that possibly actinium was the
body that came in between radium and uranium , but Rutherford
showed that the body, whatever it was, was still eluding pursuit.
Then Boltwood succeeded in separating a new radio - active
element, which he suggested should be called Ionium, and which
" grows" radium very rapidly when separated from pitchblende.
In order to complete the series, however, it was necessary to
show that uranium grows ioniun . This proof we have now
obtained , and the fact that we are able to show that uranium
ultimately changes to radium has allowed us to link up into one
long chain the uranium family and the radium family. This at
once disposes of the idea that a miner might possibly find
nuggets of radium as he finds nuggets of gold.
With regard to the radiations themselves, we un nd fairly
well the Alpha and Beta types of radiation. With regard to the
Gamma rays, it was believed that they were, like the X rays,
ROENTGEN RAY. 297
pulses in the ether. But recently Bragg has suggested, and it
seems probable, that the Gamma rays are really something un .
charged, projected at very great speed. The Alpha rays are
responsible for practically all the heating effect of radium. They
consist of particles of matter projected at a very rapid speed, and
all of them at the same speed. The most extraordinary thing
about them is the sharpness with which the ionization ceases at
a distance of 3.5 centimetres in air . In measuring the Alpha
rays, the ratio of the charge to the mass is given by the number
5,000, while the ratio for the hydrogen atom is 10,000. From
this it might be thought that the Alpha particle must consist of
twice the hydrogen atom -i.e., the hydrogen molecule. We are
not sure on this point, and I personally have considered for a
long time that the Alpha particle, when it has lost its charge, is
in reality a helium atom . We have, at all events, produced
helium from both radium and actinium , and Alpha particles are
the only type of matter common to the two. We have at last
been successful in making some experiments to detect the effect
of a single Alpha particle, so as to determine whether it is helium
or not. The experiment, while successful in the laboratory, is of
rather too delicate a character to carry out at the lecture-table .
Briefly, it consists in using a metal cylinder with a wire down its
centre. The Alpha particle is fired down the cylinder through a
small opening covered by a thin film of mica, and ionizes the gas
in the cylinder. When a strong electric field is applied, the
negative ions are attracted and collide with the cylinder. When
radium is held near the charged wire, we are able to watch in the
electrometer the effect of a single Alpha particle. Being thus
able to determine the charge of each particle, we are able also to
calculate its mass, and by determining both the charge and the
mass we are able to ascertain whether it is a helium particle or
not. The number of Alpha particles that are fired into the small
opening are found to agree with that which we should expect
from the law of probability.
NEW YORK ACADEMY OF MEDICINE.
Meeting of October 3, 1907.
Skiagraphy in Orthopædic Surgery .
DR. F. H. ALBEE said in this paper that the introduction of the
Roentgen ray as a diagnostic aid in surgery had led to the
establishment of a special branch of study—an art--which
might be termed skiagraphic anatomy and pathology. There
were certain rudimentary conditions which must be complied
with if our interpretations were to be of a sufficiently trust
worthy character.
First, it was very desirable, whenever possible, that the plate
itself should be inspected, rather than a print. Second, care
should be taken that the plate was held at a proper distance from
the light, and that the light was evenly diffused over it. Both
the distance and intensity of light should vary with the depth of
development of the plate.
Tuberculosis was the most common bone disease and the one
with which the orthopædic surgeon was most concerned. It was
thought by many of our best pathologists to be nearly always
primary in the bone. This belief, however, was not, in a large
percentage of cases, confirmed by the skiagraphic findings
298 ARCHIVES OF THE ROENTGEN
Although it was not unusual to find a distinct bone focus, it was
more common to discover first the thickened capsule, with a
blurring of the outlines of the bony elements of the joints ; later
erosion of the articular surfaces, and finally a real destruction of
bone. Another very strong evidence of bone tuberculosis,
which was often earlier than any of the above-mentioned more
striking features, was bone atrophy-not only locally, but in the
neighbouring bones. This change could often be detected in the
X -ray plate, even before atrophy of the soft parts took place.
This bone atrophy presented itself not only as a rarefaction of hereditary forms were divided into the early and the late types ;
the bone by a diminution of its salts, but by a lessening of the
diameter of the shaft. Tuberculosis in bone, as in other tissues,
was healed by changes having their initial greatest activity in gelatinous deposit beneath the periosteum and at the epiphyseal
the periphery of the lesion. Much could be discovered as to the
progress of the disease by a repetition of exposures at intervals.
Some had found these skiagraphic warnings very reliable, and
that they occurred many times before the advent of disquieting
clinical symptoms.
Reviews
Röntgen Kalender. By Professor ERNST SOMMER,
Zürich. Published by Otto Nemnich. Leipzig,
1908 .
This is the first year of a calendar published by Dr.
Sommer, Professor of Physical Medicine at Zürich .
From the title-page looks out the somewhat sad and
sensitive face of Professor W. K. v. Roentgen , the most
renowned and retiring of modern physicists. There are
nine contributors to the work , among whom we notice
the names of Dessauer, Franze, Holzknecht, and
Grashey.
The first article describes the wonderful development
of technique wbich has taken place during the thirteen
years which have elapsed since Roentgen's famous dis
covery of the dark rays from a " Hittorf's ” tube - for thus
does the author designate the vacuum-tube, which in
French and English literature is better known as a
Crookes tube.
The chapters on the focus-tube and the valve-tube are
by Dessauer. We notice a novel form of spark-valve for pithy volume,which we would gladly see translated for
cutting off the inverse current, consisting of a series of
twenty plate and point spark-gaps.
The article on the orthodiagraph is by Dr. Franze, of
Nauheim . Among the novelties is a celluloid drawing-
board, which enables the observer to transfer the
RAY.
A frequent situation for tuberculosis was the phalanges of the
fingers, in the so -called dactylitis. This condition was frequently
confounded with a similar syphilitic affection , and the skiagraph
was of extreme importance in making a diagnosis. In con.
trasting osteomyelitis with tuberculosis, it should be said that,
while the latter commonly affected the epiphyses and articular
surfaces, the former rarely did so.
The bone lesions which occurred as a result of syphilitic infec.
tion were numerous and varied in their manifestations. The
the former occurred in the early months of a child's life, and
resembled rickets clinically. They were characterized by a
line, with the resulting X-ray shadow. Of all bone tumours,
sarcomata were by far the commonest, and the distinguishing
characteristics of many of these types could be discovered by
the X ray. The skiagraph was absolute in the distinction of
coxa vara, hip disease, and congenital dislocation .
important anatomical points, nipples, middle line, etc.,
to the orthodiagraphic tracing. Among the apparatus
for protection is a lead-glass screen, which appears &
useful and necessary addition to the Roentgen laboratory
as a protection from the secondary rays, which, as
the author points out, are diffused over the whole
room.
Dr. Wiesner, of Aschaffenburg, gives some most
excellent diagrammatic sketches of joint skiagrams in
individuals of different ages. For teaching purposes
these outlines are much clearer than photographs,
and enlargements of them should find a place in
every laboratory devoted to the practical teaching of
Roentgenography.
Halmich of Hamburg gives a very good résumé of the
present state of Roentgen-therapy, and the same subject
is treated by Holzknecht of Vienna.
To those who have a sufficient knowledge of German
we cannot do better than recommend this short and
the benefit of English readers.
L'Année Électrique. By Dr. FOVEAU DE COURMELLES.
Published by Ch. Béranger. Paris, 1908.
We welcome the eighth appearance of this invaluable
little book, and can only wonder how Dr. Foveau de
 ARCHIVES OF THE ROENTGEN RAY. 299
.

Courmelles has crowded so much information into its now better known as ionto -therapy, or the electrolytic
350 pages . Anyone desirous of being au fait with the introduction of ions.
progress of electrical treatment cannot do better than
buy and study this work. If we may venture to suggest Messrs. Siemens Brothers have issued an excellent
it, there are one or two improvements which would catalogue of electro-medical apparatus. Among the
greatly add to its value. The pages of a book of reference novelties is a horse-gear dynamo, giving an output of
like this should certainly be cut, and it should have an 10 ampères at 30 volts. This should be of great service
index. Another useful addition would be the detailed to country doctors or small hospitals, as also in India
and the Colonies.
reference to the titles of the papers to which allusion is
made in the text . One more improvement in the manufacture of X-ray
Dr. Foveau de Courmelles' name is a guarantee of tubes has been introduced by Messrs. Siemens, and that
scientific accuracy of the work, which is well up to date , is the use of tantalum for the anticathode. As is well
as is evidenced by the inclusion of Lord Kelvin's name known, tantalum has a melting-point some 600° C. higher
in the obituary . than platinum, and is, therefore, much less likely to be
Articles of special interest to readers of this journal dissipated by heat when the tube is overdriven . There
are those on Electric Sleep and on Electrocution ; on is also another advantage in the hardness of tantalum ,
the Electrocardiogram , traced by means of Einthoven's which exceeds that of platinum . Theoretically, an anti
galvanometer ; and the chapters on Electro-therapy, cathode of the new material should transform a greater
Radiography, and Radio-therapy. proportion of the energy of the cathode rays into
In an interesting lecture on Medicamental Electrolysis, Roentgen oscillations, and these should be more homo
given at the Faculty of Medicine of Paris, the author geneous than those proceeding from a more penetrable
claims to have taught medical electro-chemistry as far target. The catalogue will be sent free upon application
back as the year 1890. Medicamental electrolysis is to Messrs. Siemens.

Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
DEAR SIR,—Mr. Deane Butcher, as President of the Electro-
Therapeutic Section of the Royal Medical Society, discussing
Dr. Stanley Green's paper of December 20, 1907, stated in rela-
tion to the exhibition of relief skiagrams that he believed them
to be the first exhibited in this country.
If you will refer to the ARCHIVES OF THE ROENTGEN Ray for
May, you will find published in that journal a plastic skiagram to
illustrate a paper on “ Benign Cysts of Bone, ” published by
Mr. Robert Jones and myself.
On November 14, 1907 , I gave a demonstration on Plastic
Roentgenography at the Liverpool Medical Institute, and showed
many slides. Some of the radiographs have already appeared in
the December issue.
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
DEAR SIR,—The discussions which have lately taken place on
chest and kidney cases at the Electrical Section of the Royal
Society of Medicine have raised the question of what details
should be shown on a skiagram of a chest before such a skiagram
can be considered of value for the purpose of diagnosis.
When we make a skiagram for renal calculus, we must see on
that skiagram the psoas muscle clearly defined before we pass
such a skiagram as one which is good enough for the diagnosis
of renal calculus. Some may even look for finer distinctions,
but one is usually content if one finds the edge of the psoas
clearly defined . In such a negative the transverse processes of
the vertebræ and the ribs show quite clearly, as a matter of
course .

Yours very truly, For the chest there ought to be a similar guide. For instance,
DAVID MORGAN. a radiogram which only shows the ribs, heart, liver, and great
46 , Nelson STREET, LIVERPOOL, vessels of the heart, and no other details, should be considered
February 4, 1908 . worthless for the diagnosis of early pulmonary tuberculosis.
There ought to be a mass of detail shown at the root of the
[We are glad to note the early publication of examples of lungs. What that mass of detail is has yet to be unravelled,
Plastic Roentgenograms in this country. The allusion in the but certain shadows are easily explained. For instance, the
debate on Dr. Stanley Green's paper applied only to plastic outline of the pericardium can always be made out, and should
Roentgenography of the lung.-Ed.) be taken as a guide to the value of the skiagram ,
300 ARCHIVES OF THE ROENTGEN RAY.

What the outline of the psoas is to renal calculus, so is the To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
outline of the pericardium to early tuberculosis. No diagnosis MY DEAR EDITOR , I noticed in the ARCHIVES for December,
of tuberculosis should be made from a radiogram which is not 1907, page 206, that information is desired in regard to litera
good enough to show the pericardium . ture concerning abscess of the liver. I wish to refer you to my
Yours sincerely, recent work on the “ Roentgen Rays," pp. 277 and 278, where
A. HOWARD PIRIE .
two cases are reported.-Yours truly,
27 , New Cavendish Street, W. , M. K. KASSABIAN .
January 16, 1908 . December 19, 1907.

Description of Plates.

PLATES CCLXXXV. AND CCLXXXVI.

TO ILLUSTRATE THE ARTICLE ON EXAMINATION OF THE URINARY BLADDER BY X RAYS AFTER INSUFFLATION WITH
23
OXYGEN . " BY DAVID MORGAN, M.B. (P. 271).

The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES .
He would be very much obliged if contributors would send , with any prints intended for publication , a full account of the
case, and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used, or any otherfacts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE EDITOR begs to acknowledge communications from Professor Goldmann ( Freiburg ), Dr. Power (Spokane,
U.S.A.), Dr. Belot (Paris ), Dr. Foveau de Courmelles (Paris).
The following Journals and Periodicals have been received : “ Advanced Therapeutics,” “ The Electrician,
“ The Electric Review ," " Knowledge," " The British Journal of Dermatology, " “ Annals of Physico-therapy, "
“ Medical Times, " " Medical Electrology and Radiology," “ Archives of Physiological Therapy," “ Archives
d'Électricité Médicale," "Le Radium," " Annals d'Electrobiologie et de Radiologie," " Fortschritte auf dem Gebiete
der Röntgenstrahlen ," " Münchener Medizinische Wochenschrift," “Zentralblatt für Physikalische Therapie,”
“ Annali di Elettricitá Medica, ” “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN RAY, care of
Messrs. Rebman Ltd. , 129 Shaftesbury Avenue, London, W.C.," or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration , will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteed to be faithful reproductions of the originals, and will always be prepared with the
utmost care and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view .
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L
VO . XII .
DA I

No.
11.
ZI
ARCHIVES N
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY ).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH
ROBERT ABBE (New York ); A. BECLERE ( Paris); T. P. BEDDOES ( London ); J. BELOT ( Paris) ; F. BISSERIE ( Paris);
H. BORDIER (Lyons); J. BURNET ( Edinburgh ); R. HIGHAM COOPER ( London ); W. COTTON ( Bristol); FOVEAU DE
COURMELLES ( Paris); L. DELHERM ' (Paris); R. W. FELKIN ( London );
the L. FREUND (Vienna ); H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
(Montreal) ; STANLEY GREEN ( Lincoln ); H. GUILLEMINOT ( Paris) ;
R A
bas D. GUNZBURG ( Antwerp) ; J. HALL -EDWARDS ( Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT (Vienna ) ; THE
F. H. JACOB ( Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
AP

ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris) ; 8. LEDUC (Nantes) ;

08
RI

E.R. MORTON ( London ); G. HARRISON ORTON ( London ); H. G. PIFFARD ( New

19 .
L.

York ); JNO.C. RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ) ;

W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ); CHISHOLM
WILLIAMS ( London ); CLARENCE WRIGHT ( London ).

CONTENTS
PAOB PAGE

EDITORIAL 301 NOTES AND ABSTRACTS ( continued ) :

CONGRESS OF PHYSIO- THERAPY AT PARIS • 302 RADIOSCOPY AND RADIOGRAPHY EMPLOYED IN THE DETEC
TION OF TUBERCULOUS MEAT - 328
ORIGINAL ARTICLES : THE UVIOL LAMP IN DERMATOLOGY - 328
THE EXAMINATION OF THE HEART BY THE ROENTGEN RAYS . THE APPLICATION OF BLUE ELECTRIC LIGHT IN VARIOUS
By Dr. Franz M. GROEDEL, Bad -Nauheim . 303 9
DISEASES 329
THE THEORY AND TECHNIQUE OF TELEROENTGENOGRAPHY. RED LIGHT AND IODINE PAINT 329
By DR. ALBAN KOEHLER, Wiesbaden 311 THE REMOVAL OF THE DILATED VESSELS CAUSED BY
THE SELECTIVE ABSORPTION OF ROEXTGEN RAys. By RADIUM TREATMENT 329
G W. C. Kaye, B.Sc. , A.R.C.Sc. (Lond .), Trinity College, TREATMENT OF ANGINA PECTORIS BY ARC Light Batas 329
Cambridge - 314 EXPERIENCES WITH THE QUARTZ LAMP 329
DIAGNOSIS OF LUNG TUMOURS BY MEANS OF THE
Zinc IONS AND TISSUE CHEMISTRY. By Dr. Alwin KNAUER , ROENTGEN RAYS · 330
Wiesbaden - 324
THE BISMUTH SKIAGRAM IN GASTRO - INTESTINAL Dis.
REPORTS OF SOCIETIES : ORDERS • 330
ROENTGEN SOCIETY 324 EXAMINATION OF THE MOBILITY OF THE STOMACH AFTER
GASTROENTEROSTOMY · 330
REVIEWS :
ON THE ROENTGEN -RAY EXAMINATION OF FRACTURES · 330
DIE ANWENDUNG DER ELEKTRIZITÄT IN DER DERMA FRACTURE OF ACETABULUM - · 330
TOLOGIE 326 CONSERVATION OF THE HUMAN ARTERIAL PRESSURE
THE EVOLUTION OF MATTER - 326 AFTER APPLICATION OF HIGH -FREQUENCY CURRENTS
NEW INVENTIONS . . 327 BY AUTO - CONDUCTION 331

NOTES AND ABSTRACTS :

GLOVES FOR X - RAY WORKERS . 327
CORRESPONDENCE - - 331
THE PROTECTION OF THE ROENTGENOLOGIST - 327
THE PRESENT STATUS OF THE ROENTGEN RAY . 328 PLATES :
N RAYS • 328 PLATES CCLXXXVII. AND CCLXXXVIII. — TO ILLUSTRATE
THE BEHAVIOUR OF URIC ACID AND PURIN BODIES IN THE ARTICLE ON “ THE THEORY AND TECHNIQUE OF
THE URINE AND BLOOD UNDER THE INFLUENCE OF THE TELEROEXTGENOGRAPHY, " BY DR. ALBAN KOEHLER,
ROENTGEN RAYS 328 WIESBADEN 315 , 317

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VOL. XII.-No. 11. APRIL , 1908.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER, M.R.C.S., F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York ); T. P. BEDDOES ( London ) ; J. BELOT (Paris) ; A. BÉCLÈRE (Paris ) ; F. BISSERIE (Paris) ;
H. BORDIER (Lyons) ; J. BURNET (Edinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris ) ; R. W. FELKIN ( London ); L. FREUND (Vienna) ; H. E. GAMLEN (West Hartlepool); G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris) ; D. GUNZBURG ( Antwerp ); J. HALL-EDWARDS
( Birmingham ); G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool); G. HOLZKNECHT (Vienna) ; F. H. JACOB (Nottingham ) ;
LEWIS JONES ( London ) ; A. C. JORDAN (London ) ; ARCH. JUBB (Glasgow ); E. LAQUERRIÉRE ( Paris) ; S. LEDUC (Nantes) ;
E. R. MORTON (London) ; G. HARRISON ORTON ( London ); H. G. PIFFARD (New York ); JNO. C. RANKIN (Belfast) ; WERTHEIM
SALOMONSON ( Amsterdam ); W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM (London ) ; CHISHOLM WILLIAMS (London );
CLARENCE WRIGHT ( London ).

Among the many services rendered by X rays to of the bismuth meal is but faint, owing to the rapidity
medicine not the least is the visual demonstration of of the passage of the contents and the great dilution of
the movements of various portions of the digestive the bismuth by the large quantity of digestive juices
tract. The method of the bismuth meal has recently present in the gut. There seems, however, to be no
rendered visible to us the movements of the large doubt that the process of “ segmentation " observed by
intestine, and for the first time in the history of Cannon in the small intestine of the cat also occurs in
medicine we are in a position to watch the passage of the human subject.
the contents along the course of the large intestine, When, however, the bismuth begins to accumulate in
and to study with scientific accuracy the cause and the cæcum, its presence is clearly defined. Dr. Hertz
cure of constipation. gives an admirable series of skiagrams showing the
Our knowledge of the movements of the intestines as passage of the bismuth-laden excreta through the
revealed by the X rays was initiated by Cannon in large intestine. The bismuth appears at the cæcum in
1898. In his experiments on cats, described in the four hours after ingestion, at the hepatic flexure in
American Journal of Physics, he made use of bismuth seven hours , at the splenic flexure in twelve hours, and
to render visible the movements of the intestines, a in the rectum in about twenty-four hours.
method which, in the hands of Holzknecht and Rieder, The X rays have given the final quietus to the routine
has given us such splendid results. method of purgation for constipation. They have shown
More recently Dr. A. F. Hertz has carried on a most that, however easy it is to hurry the contents through
interesting series of investigations in the physiological the coils of the small intestine, it is quite another thing
laboratory of Guy's Hospital on the normal human to awake and stimulate to vermicular action the sleepy
subject, and also on the movements of the intestines in coils of the large intestine.
abnormal conditions. The results of these X-ray Here, as elsewhere in nature, we must recognize the
examinations of the intestinal movements in the human periodic alteration of seasons of activity and of repose .
subject have been published in a series of lectures in The periods of rest are of equal importance to the
the Guy's Hospital Report, and in a paper read before periods of motion ; hence they should be religiously
the Royal Society of Medicine in January of this respected.
year. There is no doubt that the more enlightened methods
When passing through the small intestines the shadow of physical therapeutics in the treatment of constipation
41-2
302 ARCHIVES OF THE ROENTGEN RAY.

will gain a great impetus from these researches. The and the meeting of the Société d'Électrothérapie. The
X rays will doubtless enable us to recognize and control times of these meetings will be arranged so as not to
more exactly modern methods of vibration , massage , interfere with each other.
and electrical stimulation . The President of the Congress will be M. Oudin ;
Secretary, M. Laquerrière; and Treasurer, M. Delherm .
The first two sessions will be devoted respectively to
Our readers will join in the universal sympathy ex the treatment of traumatisms of the joints and bones,
pressed for the former editor of this journal, Mr. Hall- and the treatment of neuralgia and neuritis. The third
Edwards, Surgeon - Radiographer to the General Hospital, session will be reserved for communications on various
Birmingham , who has suffered amputation of the left other subjects. Members desirous of contributing papers
hand and forearm in consequence of injury to the hands to this section are requested to bear in mind that, since
from X -ray work. the object of the Congress is the comparison of various
Mr. Hall - Edwards was one of the early pioneers of physical agents, technical details and descriptions of
Roentgenography, when the need for protection to the apparatus only of interest to specialists in their particular
operator was not realized, and it is as the result of branch should as far as possible be omitted.
accidents to these early workers that we can now work The papers already arranged for the first two sessions
are :
with absolute safety to ourselves and our patients .
A meeting was held on March 5 at the Birmingham
University, under the chairmanship of Sir Oliver Lodge, I. Physical Agents in the Diagnosis and Treatment
of Traumatisms of the Joints and Bones.
when a motion was submitted and approved recognizing
the valuable services rendered to the community by Belot Radiography.
Mr. Hall-Edwards in the practice of his profession in Dagron Massage.
connexion with the use of X rays, and expressing great Durey Bier's Stauung Treatment.
sympathy with him in the permanent disablement he Laquerrière Electro -therapy.
had thereby incurred. It was then resolved to raise & De Munter Mecano -therapy.
fund, to be invested or otherwise used for the purpose of Pariset Hydrotherapy and Light
assisting him , the following being constituted a com Baths.
mittee for the purpose : Sir John Holder, Bart.,
Mr. E. P. Beale, Mr. Frank Marsh (honorary treasurer), II . Physical Agents in the Diagnosis and Treatment
and Dr. Simon and Mr. J. C. Vaudry (honorary of Neuralgia and Neuritis .
secretaries ). Albert Weil Photo -therapy.
Dausset Aero -thernio -therapy, Hot-air
Douches.
CONGRESS OF PHYSIO - THERAPY AT PARIS . Faure, Beauhen , and
Barcat Radium -therapy.
THE Société Française d'Électrothérapie et de Radiologie Radio -therapy.
Haret
Médicale and the Société de Kinesithérapie bave organized Kouindji Massage and Re -education.
a joint Congress for the study of all branches of Physio Lagrange Mecano -therapy.
therapy. Libotte Hydro -therapy.
The sessions will take place in the small theatre of the Zimmern and Delherm Electro -therapy.
“ Faculté de Médecine " during Easter week. The date
has been chosen to coincide with the Exhibition of the The subscription is 10 francs. All communications
Société Physique, the annual general meeting of the should be addressed to the Secretary, Dr. Laquerrière,
Syndicate of Medical Electrologists and Radiologists, Rue de Bienfaisance 2, Paris.
 ARCHIVES OF THE ROENTGEN RAY . 303

THE EXAMINATION OF THE HEART BY THE prolonged into the shadow of the pulmonary and aortic
ROENTGEN RAYS . vessels. This is the position in which we look for any
possible dilatation of the pulmonary artery, such as
By Dr. FRANZ M. GROEDEL, Bad -Nauheim .,
occurs from obstruction of the lesser circulation or in
Of all the internal organs, the heart is the most suitable persistence of the foramen ovale. In this position also
for examination by the Roentgen rays, since in con any slight dilatation of the aortic arch may be recognized
sequence of its density it absorbs a great proportion of by a broadening and rounding of the normally sharp
the rays. Moreover, the difference of density between apex of the heart shadow.
it and the surrounding organs enables us to obtain a The thorax may also be examined with the patient
clearly defined picture, even under circumstances which sideways, with transverse illumination. This is best
carried out with the left shoulder towards the screen.
are otherwise unfavourable.
In this position we easily make out the extension of the
I. METHODS OF EXAMINATION. heart in depth. In front of the heart shadow appears a
If we examine the chest of a patient with dorso- clear space-the retrosternal space--while behind the
ventral illumination-i.e. , with the focus-tube behind heart is the posterior mediastinum . The heart's apex is
and the screen in front- -we see the more transparentseen beating against the anterior wall of the chest, and
lungs divided by a dark vertical shadow. This is the below this the “ magenb lase " may be discerned , in
magenblase
80 -called “median shadow ," formed by the vertebral dicating the position of the stomach.
column, the sternum, the heart, and the great vessels. When we desire a permanent record of these appear
The heart shadow may be easily distinguished by its ances, the screen may be replaced by a photographic
form and its pulsation. By using a suitable diaphragm plate. The time of exposure required for a Roentgeno
with a narrow slit-like aperture, we are enabled to gram of the thorax is very variable. With ordinary
observe the regularity and extent of the pulsations. In apparatus an exposure of twenty -five to forty seconds
pathological conditions, moreover, such as tachycardia, is required. Such an exposure gives a very beautiful
we may watch the rapid and incomplete fluttering con- picture, showing clearly the structure of the ribs. The
tractions. In cases of Adam-Stokes disease also, the cardiac shadow, however, is enlarged, owing to the
unequal pulsation of the auricle and ventricle is easily movements of the heart and diaphragm during exposure.
seen on the fluorescent screen . It is, therefore, more satisfactory to give a shorter
Roentgenoscopy also furnishes us with valuable in- exposure, during which the patient can hold his breath .
formation as to any alteration or anomaly in the position This may be done by the use of reinforcing screens and
of the heart. On the other hand, the fluorescent screen a very sensitive film . The screens are made of oxide of
affords but imperfect information as to the size of the tungsten and calcium , a substance which fluoresces
heart and aorta . Such alteration in size can only be under the influence of the Roentgen rays, and by its
recognized with certainty by the method of central pro- fluorescence prolongs the exposure. The photographic
jection. I have already described the details of this film is laid between two such screens. With a Wehnelt
method ip Nos. 88 and 89 of the ARCHIVES. break, a Roentgenogram of the chest may in this way be
Roentgenoscopy of the thorax may also be carried out taken in from five to ten seconds, the patient holding
with oblique illumination, the patient being in the so- his breath in deep inspiration. Under these circum
called “ first oblique position.” In this position the stances the heart shadow is much more exact, since the
patient takes a half-turn to the left , so that the right movement due to pulsation of the heart itself is negligible
shoulder is towards the screen and the left shoulder is in comparison with the displacement due to respiration.
turned somewhat backwards. In this position the three Still better results may be obtained by instantaneous
shadows, which together form the “ median shadow ,” exposures, for which, however, it is necessary to employ
are separated one from another. To the right is the special coils and apparatus. For instantaneous photo
vertebral column , to the left is the sternum, and between graphy, moreover, freshly prepared plates are required,
these is the heart shadow , separated from the vertebræ so that this procedure could be but rarely used, even if
by the posterior mediastinum. In this position the the frequent destruction of the focus-tube did not render
heart shadow appears as a triangle, the apex of which is it impracticable.
304 ARCHIVES OF THE ROENTGEN RAY.

A Roentgenogram of the chest may be taken with the side the lower curve is that of the right auricle, while the
subject in any position , although the erect posture is the upper curve is formed by the vena cava superior or the
most convenient both for the patient and the physician . ascending aorta . We may call these the right auricular
Another advantage is the fact that in an erect posture curve (a) and the curve of the great vessels (b).
the heart appears less covered by the lungs and less On the left side the topmost curve is formed by the
sunken behind the shadow of the diaphragm . aortic arch and the commencement of the descending
As a rule, the value of a photograph of the heart is aorta . The second curve is that of the pulmonary
not commensurate with the cost and difficulty of its artery , and the lowest is formed by the left ventricle.
production . We are, therefore, usually content with a Between the second and the lowest curve a very small
radioscopic examination , unless we desire a permanent arc may be seen, formed by the shadow of the left
record of some interesting case. Even for this purpose auricular appendage, or in pathological cases by a por
we prefer the orthodiagraphic method by central projec- tion of the left auricle itself. These four curves may be
tion. This has many advantages, and I shall therefore called the aortic curve (c), the pulmonary curve (d) , the left
treat of it somewhat fully in the following pages. auricular curve (e), and the left ventricular curve ( ).
With the exception of the right ventricle, each section
II. THE ROENTGEN EXAMINATION OF THE NORMAL of the heart participates in the formation of the shadow
HEART.
outline. As a rule, the right ventricle does not take part
Hitherto our knowledge of the form , position, size, in the formation of the apex. Occasionally, however,
and movements of the heart have been based entirely we may observe the line first described by Moritz, the
on the dissection of the cadaver, or on experiments on so -called " supra-apical transverse shadow ," just above
animals. It is only since the introduction of the the actual apex . This shadow, in my opinion, does not
Roentgen rays that we have been able to study the correspond, as Moritzł supposes, with the septum, but is
heart in the living body. This investigation has shown caused by a difference in shadow intensity, due to the
that our previous ideas were very imperfect, and in superposition of the left over the right ventricle.
some instances faulty. As may be seen in the diagram , it is not possible to
First, let us consider what portions of the heart are follow the outline of the heart in its whole extent. It is
visible in a Roentgenogram of a chest taken with dorso but seldom that one can trace the line of separation
ventral illumination. Figure 1 is such an orthodiagram , between the liver shadow and that portion of the heart
showing the relation of the various portions of the heart which is sunk in the diaphragm . Still more difficult is
to the chest - wall. it to define the line separating the heart shadow from
that of the great vessels. Although it is easy to trace
these two lines approximately, their position is very
uncertain. They do not, as Moritz asserts, furnish us
C
with adequate data for an accurate measurement of the
cardiac silhouette.
C

at
- is best carried out by the method shown in Fig. 2.
Fig . 1. -DIAGRAM SHOWING THE PARTICIPATION OF THE VARIOUS
SEGMENTS IN THE FORMATION OF THE CARDIAC SHADOW .
a, Right auricular curve ; b, curve of the great vessels ; e, aortic curve ;
d, pulmonary curve ; e, left auricular curve ; f, left ventricular
curve .
The outline of the cardiac shadow is formed by a
series of convex arcs or curves. These are six in number,
two on the right and four on the left side. On the right
The Measurement of the Cardiac Orthodiagram . — This
Starting from the median line, we first measure the
horizontal distance mR to the right auricular curve.
We next measure mL, the median distance of the left
ventricular curve . The sum of the right and left median
distances, mR + mL, gives us the transverse diameter of
the heart .
The only other requirement is to measure the long
diameter of the heart as accurately as possible. This
diameter, LD, is measured from the apex of the heart to
the point of intersection of the auricular curve with the
curve of the great vessels. Other measurements have
 ARCHIVES OF THE ROENTGEN RAY. 305

been proposed, such as the breadth of the heart, as Schieffer has made some interesting observations on this
shown on the diagram . These, however, are very point.13 He found from experiments on animals that
uncertain, and cannot be determined with sufficient the heart became smaller with insufficient nourishment,
exactitude. and regained its size when the animal was well fed ,
For the sake of comparison I add the transverse showing that the size of the heart is influenced by the
measurement of the lungs. The breadth of the great state of nutrition of the individual. We must, there
bloodvessels at their origin from the heart is also a fore, take into consideration the age, weight, size, and
measurement which it is possible to determine with nutrition of the subject in forming an estimation of the
more or less accuracy . normal size of the heart.
On examining a large number of cases, we find that Next in importance to its size is the form and position
of the normal heart. This varies so much that it may
be almost said that each individual heart has a form of
its own. The general type, however, is an elliptical,
egg -shaped figure. Three main varieties may be dis
tinguished, according to the position of the organ, and
the angle which its long axis makes with the median
line of the body. We have the upright heart of the
young, the oblique heart of adult life, and the horizontal
heart of old age. Of these, the oblique position is by far
the most common .
The principal factors which determine the position of
Im R. the heart are the position of the diaphragm and the
relation between the height and the breadth of the chest
cavity. We may easily satisfy ourselves by observation
that any alteration in one of these factors determines an
alteration in the position of the heart. By deep respira
tion, for example, we can quite perceptibly alter the
position of the heart. Fig. 3 shows how its position
Fig. 2 .--MEASUREMENT OF THE CARDIAC ORTHODIAGRAM : SAGITTAL becomes more horizontal during deep expiration.
ILLUMINATION . A similar alteration in the position of the heart occurs
mR, Right median distance ; mL , left median distance ; LD , longi
tudinal diameter. with change of posture. The diaphragm , as we know,
rises considerably higher when the subject is lying down
the measurements of the hearts of normal subjects is than when he is standing. On the other hand, in a
fairly constant. Dietlen has made such a series of sitting posture the diaphragm falls somewhat lower.
measurements. The following were his results : Men- Hence, when lying down, the long axis of the heart is
mR = 4:3 centimetres ; mL = 8-9 centimetres ; LD = 14.2 more oblique than when the subject is standing. Con
centimetres. Women-mR = 3.6 centimetres ; mL = 8.5 sequently, the heart appears somewhat smaller in the
centimetres ; LD = 13.2 centimetres. These numbers erect posture and during deep inspiration, while the
apply only to adults between twenty and thirty years of visible area is greater in a horizontal posture and during
age, of medium height and weight. With younger sub- expiration. The change during expiration is probably
jects the numbers are smaller, and with older persons due to a slight backward rotation of the heart about its
almost always somewhat greater. The size of the heart long axis.
bas also a tendency to increase with increase of height One of the most interesting and important problems
and weight. The breadth of the chest has also an for the Roentgenologist is the verification and control
influence on its size . With a broad chest the heart is of the classical method of percussion, by means of the
somewhat larger, and with a narrow chest it is some- X rays. As in all other branches of internal medicine,
what smaller than usual. We also have to take into the Roentgen examination should only be used to con .
account the state of nourishment of the individual. firm or complete the previous clinical examination .
306 ARCHIVES OF THE ROENTGEN RAY.

Many observers have already devoted their attention to respect we need only mention three of the more modern
this question, the verification by the orthodiagraph of methods of percussion --viz ., Ebstein's " tast percussion ,
the various modern methods of percussion . I need only Moritz's “ medium percussion ,” and the “ Schwellenwert
mention the works of De la Camp, Goldscheider, Cursch- percussion " of Ewald and Goldscheider. I have had
mann and Schlager, Moritz, Dietlen, and Treupel.8 frequent opportunity of controlling Professor Groedel's
In comparing the results of percussion and ortho- percussion results, and have found them in most
diagraphy, the observer should first percuss the heart instances correct. As Handwerk points out, very light
by one of the methods in vogue, and draw the outline of percussion should be used for defining the left border of
the percussion diagram on the chest wall. With the the heart, while the right border is more easily defined
patient in the same position, the outline of the heart by percussion of medium force . In my opinion, two
should then be traced orthodiagraphically on the things are of the greatest importance — viz., practice in
the particular method of percussion adopted, and an
intimate knowledge of the orthodiagraphic outline of the
heart. This latter, as we have already shown , differs
greatly from the anatomical appearance as we are
accustomed to see it after death.

III. EXAMINATION OF PATHOLOGICAL CONDITIONS OF

THE HEART .

At the commencement of the Roentgen era the radio

Fig . 3. -INFLUENCE OF RESPIRATION ON THE POSITION OF THE
HEART .
The thick line shows the position in quiet breathing.
The dotted line shows the position in deep inspiration.
The broken line - shows the position in deep expiration .
drawing-board. The percussion figure drawn on the
chest is next transferred to the drawing - board by means
of the pointer and the pneumatic pencil, which I have
already described in No. 88 of this journal. In this way
the orthodiagram and the percussion figure of the heart directly over or on the aorta, so that it participates in
may be compared, and the causes of any deviation in the pulsation of the heart. When this occurs we can
the two outlines may be studied.
This comparison has led to two conclusions : firstly,
that the percussion method lends itself not infrequently
to considerable error even in the hands of experts ; and
secondly, that we possess several methods of percussion ,
which, though based on different principles, yet afford,
on the whole, sufficiently trustworthy results. In this
logical examination was undertaken for the diagnosis of
affections of the aorta rather than those of the heart
itself. It is hardly necessary to dwell on the literature
of the subject, which, apart from certain unusual cases,
is not of much interest. The diagnosis of aortic aneurism
is not of itself a matter of much difficulty. The principal
sign is a dilating pulsation , synchronous with the aortic
As opposed to the cardiac pulsation. This, with a sharply
defined outline continuous with the vessel , is charac
teristic . The Roentgen examination is best carried out
under oblique illumination . It is not quite so easy to
diagnose a diffuse dilatation of the aorta. Here we
derive great assistance from the orthodiagraph and
screen examination with oblique illumination. In this
position the apex of the heart shadow appears somewhat
rounded. The most difficult diagnosis, however, is, in
my opinion, that between aneurism and mediastinal
tumour. The latter is most frequently situated either
only rely on the absence of dilatation, on the want of
definition in the contour, and the general outline of the
tumour.
We may here allude to a condition somewhat outside
the scope of this paper - viz., pericarditis. This con
dition seldom comes under the notice of the radiologist,
since the sufferer is not usually able to bear the fatigue
 ARCHIVES OF THE
of an X-ray, examination. The heart shadow is enor
mously increased in size by the exudation , the shadow
being at the same time more diffuse and less sharply
defined than in enlarge nent of the heart itself. In
many cases, as Lehmann and Schmoll first pointed out,
one can also distinguish the remnants of a pericarditis.10
In such cases one finds bands of adhesion filling the
angle of the diaphragm , distinct serration of the heart
shadow , fluttering pulsation of the heart, and diminished
movement of the diaphragm .
The Roentgen rays are particularly adapted for the
diagnosis of anomalies in the position of the heart .
Among congenital anomalies of the heart, dextrocardia
FIG . 4. - SITUS INVERSI'S.
is very readily demonstrated . In these cases of dis-
placement of the heart to the right, the left cusp of the
diaphragm is usually found to rise abnormally high .
The situs inversus has not, to my knowledge, been
hitherto described. I had recently an opportunity of
examining such a case. Fig. 4 shows this case, in
which the position of the heart appears transposed as in
& mirror. The liver lies to the left, and the stomach,
rendered visible by a bismuth meal, is to the right-hand
side.
Dextrocardia may in some cases be an acquired heart shadow was always upright or oblique, whereas in
anomaly, as a result of chronic lung disease and pleuritic aortic insufficiency the position of the heart was more
effusion . The heart may also be displaced more or less
to the left by similar causes, or, as occurs more frequently,
by tumour of the liver. On the other hand, the heart the aortic valves. We find a considerable increase in
may be driven upwards and to the right by elevation of the transverse diameter of the heart, more especially
ROENTGEN RAY. 307
the left cusp of the diaphragm. I have met with a
number of instances of this “rudimentary eventration ,"
as Hoffman calls it.11 It is, however, often difficult to
differentiate this condition from diaphragmatis hernia.
If now we turn to diseases of the heart itself, there is
but little positive information to be found in the litera
ture of the subject. Apart from the increase in area of
the heart silhouette, a Roentgenogram shows but little
which is characteristic of the various forms of heart
disease . It is true that some authors speak of a
" mitral-heart ” or an “ aorta-heart." In these cases,
however , we obtain merely a corroboration of the older
classical method of percussion . In cases of persistence
Fig. 5. — PERSISTENCE OF THE FORAMEN OVALE,
of the foramen ovale there is, however, a definite appear.
ance, which has been described by several authors — viz .,
a bulging forwards of the pulmonary artery. According
to my observations, however, it is quite possible to
diagnose this condition from the presence of a singing
murmur over the seat of the pulmonary artery, even
when there is no sign of bulging.
In a work undertaken in collaboration with my
brother, Dr. Theo. Groedel, I have discussed the subject
of the heart shadows which characterize the various
We made use of a large amount
valvular affections. 12
of material. Our observations were made in the usual
manner by means of the orthodiagraph. A hard focus
tube was employed, with a diaphragm of very narrow
aperture. We attached great importance to the simul.
taneous observation of the heart -beat and the precise
reproduction of each individual curve of the shadow
outline. We found that in mitral insufficiency the
horizontal.
Fig. 6 shows a case of uncomplicated insufficiency of
42
308 ARCHIVES OF THE
towards the left, while the vertical diameter is unaltered ,
The whole heart lies transversely in the chest. It may
best be described as the “ horizontal, egg-shaped heart,"
Fig. 6.- AORTIC INSUFFICIENCY.
the right auricle forming the larger and the left ventricle
the smaller end of the egg.
In aortic insufficiency, as is well known, the left
ventricle is greatly dilated and hypertrophied. Hence
a considerable increase in the transverse diameter of the
heart towards the left may be ascribed to hypertrophy
of the left ventricle. Moreover, in aortic insufficiency
find, even in children , the right vessel-curve greatly
exaggerated. Of course, this appearance is not in every
case due to aortic dilatation. The bulging is the ex
pression of the stronger pressure in the first part of
latter larger than normal. The type is that of an egg
the aorta. The right auricular curve is slightly more shaped heart in an upright position .
prominent than normal, and the pulmonary curve is
The origin of this form is easily explained. In mitral
bulged forwards more or less strongly. The left auricular
curve is usually invisible .
ha FIG. 7 .-- AORTIC STENOSIS,
We have here alterations similar to those which we
Fig. 7 is a diagram of a case of pure aortic stenosis. vessel's curve is normal, as is also the curve of the aorta .
have already seen in aortic insufficiency, only in a lesser the ventricle is increased in size and bulges outwards,
ROENTGEN RAY.
degree. In this case also the heart is horizontal, but its
egg - shaped contour is more rounded. This is due to its
increased breadth, resulting from primary hypertrophy
of the left ventricle. In cases of dilatation of the left
ventricle due to valvular failure, with imperfect com
pensation , this increase of the transverse diameter of the
heart is very marked.
This form of the heart occurs also in sclerotic stenosis
of the aorta, in sclerosis of the first part of the aorta , in
the heart of old age, and in all cases characterized by
obstruction to the complete emptying of the left ventricle.
Fig. 8 shows the form of the heart shadow in uncom
plicated mitral stenosis. It is that of a relatively small
heart, with no special peculiarity in any of the cardiac
curves, with the exception of those of the left ventricle
and the left auricle, the former being smaller and the
Fig. 8. -MITRAL STENOSIS.
stenosis there is an obstruction to the passage of the
blood from the auricle into the ventricle. The blood
therefore accumulates in the auricle. The latter becomes
dilated and later on hypertrophied, as a result of in
creased action . Hence we get in the Roentgen picture
a powerful hypertrophied left auricle, which projects
beyond the heart shadow. The left ventricle, on the
other hand, gets a diminished supply of blood , so much
so that in the post-mortem room it is usually found more
or less atrophied. This will result in a certain diininution
of the projection of the left ventricular curve.
Mitral insufficiency, on the other hand, gives us an
entirely different outline, as shown in Fig. 9. Here the
evidence of hypertrophy is manifest in various directions.
The right auricular curve is strongly marked . The right
The pulmonary curve is bulged outwards. The curve of
 ARCHIVES OF THE ROENTGEN RAY. 309

more especially upwards towards the left axilla. The
whole heart is of a globular form .
Thus, in mitral insufficiency we get obstructive dilata
tion , but no hypertrophy of the left auricle. The increase
of work falls on the left ventricle, which becomes hyper
of the right ventricle in a case of mitral insufficiency .
The right ventricle may dilate in two directions : it may
increase in breadth, projecting more towards the left, or
it may increase in height. This bulging of the right
ventricle to the left and upwards towards the left axilla
is, in my opinion, characteristic of mitral insufficiency.
The increase in this direction also causes the heart to

Fig . 9. - MITRAL INSUFFICIENCY .

Fig. 11 .--AORTIC INSUFFICIENCY PLUS MITRAL INSUFFICIENCY .
trophied in consequence. This is expressed in the
Roentgenogram by a bulging of the left ventricle to the assume a more globular form . For a similar reason in
left. There is, moreover, a congestion of the pulmonary mitral insufficiency the dilated left auricle is hidden from
circulation, due to obstruction in the left auricle, which view, whereas it is clearly visible in cases of mitral
appears in the Roentgenogram as a bulging of the pul- stenosis .
monary curve. The increased resistance in the pulmonary In mitral insufficiency combined with stenosis, as
circulation increases the work of the right ventricle, shown in Fig. 10, the signs of both abnormalities are
which thus becomes hypertrophied. Where there is inore or less clearly indicated.

Fig. 10. -MITRAL INSUFFICIENCY PLUS MITRAL STENOSIS.

Thu
FIG. 12. -CHRONIC MYOCARDITIS.

When mitral insufficiency is coupled with aortic insuffi.

insufficient compensation, this may be followed by ciency, we have, on the contrary, & Roentgenogram
secondary dilatation of the right ventricle. On the which is altogether sui generis. This is clearly shown
other hand, dilatation of the right ventricle sometimes in Fig. 11. The heart is pear-shaped, markedly oblique
shows itself even before there is any evidence of obstruc- in position, and the left border of the shadow has a
tion in the right auricle. peculiar appearance, somewhat like a flight of steps.
It may be asked how we are to recognize hypertrophy I have no time to follow the question further or to go
42—2
310 ARCHIVES OF THE ROENTGEN RAY.

into the other varieties of valvular disease. I will only strenuous exertion. The influence of bicycling on the
allude to one other form - that of myocarditis. heart is also well known. I need only allude to the
Fig. 12 is the radiogram of a case of myocarditis, works of Mendelsohn,19 Alber,20 Beyer,21 and Schieffer.22
showing an enormous increase in the size of the heart The latter found no dilatation of the heart after a single
shadow. The different curves are barely recognizable, bicycle ride. There was, on the contrary, usually a
the heart having the appearance of a flexible bag. diminution in size, due probably to the falling of the
IV. OBSERVATIONS ON THE ALTERATIONS IN THE diaphragm after exertion. He found that enlargement of
the heart is almost universal in bicyclists, in proportion
VOLUME OF THE HEART.
to the length and severity of their rides. The influence
We now come to a question which has excited a good of other forms of overexertion are also frequently
deal of attention—viz. , the alteration of the size of the recognized by the Roentgenologist , as, for instance,
heart under various conditions. It is of the greatest in athletes, long-distance walkers, football players, and
importance to the physician to be able to estimate skaters. Kienböck23 has recently studied the influence
accurately the diminution of a cardiac enlargement, or of swimming on the heart. He comes to the conclusion
to watch the development of a dilatation in its various that the heart is not enlarged, but rather diminished in
stages . Even before the introduction of accurate volume, as a consequence of a single long-distance swim .
methods of Roentgen measurement Schott and others It is immaterial whether this diminution is real or only
published photographs of the diminution of heart dilata apparent ; for myself, I believe there is only an apparent
tion after a single Nauheim bath or a single gymnastic alteration in volume. On the other hand, Kienböck
treatment. These have, unfortunately, passed into draws attention to the injurious effects on the heart of
English literature, although they have been very un swimming as a sport when continued for months or
favourably criticized both by Professor Groedel and by years. The most recent contribution to the subject is
Metzner. 14 15 that of Bruck,24 who found that the heart was diminished
The results are quite otherwise when we are dealing in size as a result of sudden strong exertion, as in
with a course of baths or a series of gymnastic move Valsalva's experiment.
ments. The influence of such a treatment on the My own observations agree with the above conclusions
enlarged heart is well authenticated, both practically and - viz ., that the size of the heart is not influenced by a
from a scientific standpoint. We have had unusual single effort of exertion or by a single therapeutic or
opportunities for making observations on this subject, gymnastic treatment. After great exertion the heart
and we have come to the following conclusions, which appears to be smaller. This is due to the sinking of the
are equally true with regard both to enlargement and to diaphragm , in consequence of which the heart assumes
dilatation of the heart . a more upright position. It may also be that the heart
Up to the present time there has been no record of the is somewhat diminished by the increased volume of air
occurrence of cardiac dilatation as a consequence of over- in the lungs. The diminished blood -supply to the heart
exertion. We already know , from the results of post- after violent exertion might also have a similar effect.
mortem examination, that repeated injuries of the heart Habitual overexertion , on the other hand, produces &
may produce cardiac dilatation, and that prolonged over general increase in the volume of the heart. It is
exertion causes cardiac hypertrophy. Moreover, in therefore impossible to believe in an immediate and
opposition to Schott and Smith, De la Camp 16 and others sudden diminution in the size of the heart as the result
have shown that single doses of alcohol or nicotine. do of therapeutic treatment. It is, however, no less certain
not increase the volume of the heart. On the other that an equable and gradual diminution of cardiac en
hand, the beer-heart, due to long-continued alcoholism , largement or dilatation may follow a continued course of
and the athletic heart are well known, and are recog. treatment during a protracted “ cure " conducted on
nizable by Roentgenological methods. scientific principles.
In this connexion the observations of Lennhoff, Levy
BIBLIOGRAPHY.
Dorn, and Mendl and Selig, are of interest —viz. , that
in the case of wrestlers and pugilists an acute attack of 1 Moritz: “ Ueber Veränderungen in der Form, Grösse und Lagedes
Herzensbeim Uebergang aus horizontaler invertikale Körperstellung,"
heart dilatation is unknown ,17 18 even after the most Deutsches Archiv für klinische Medizin, 82, 1905.
 ARCHIVES OF THE ROENTGEN RAY . 311

? Dietlen : " Ueber Grösse und Lage des normalen Herzen , ” disadvantages, of this method of examining the heart by
Deutsches Archiv für klinische Medizin , 88, 1906 .
3 De la Camp : “ Zur Methodik ' der Herzgrössenbestimmung ," means of the X rays.
XXIter Kongress für innere Medizin. The assistance which teleroentgenography should
4 Goldscheider : “ Ueber Herzperkussion ,” Deutsche medizinische
Wochenschrift, 1905, Nos. 9 und 10. render in examination of the heart is evident. Every
5 Curschmann und Schlager : “ Ueber Goldscheiders Methode der
Herzperkussion ,” Deutsche medizinische Wochenschrift, 1905, Nos. 50 roentgenologist is but too familiar with the many
und 51 .
6 Moritz : " Einige Bemerkungen zur Frage der perkutorischen
difficulties which beset the attempt to determine the
Darstellung der gesammten Vorderfläche des Herzens,” Deutsches true size of this organ . Roentgen rays diverge from a
wahren
Archiv für klinischeMedizin, 88, 1906 . Herzgrenzen, ” Deutsches single point, and the position of the heart is at some
Dietlen : “ Die Perkussion der wahren Herzgrenzen ,” Deutsches
Archiv für klinische Medizin , 88, 1906. distance from the surface of the chest, and hence from
8 Treupel : " Der gegenwärtige Stand der Lehre von der Perkussion
des Herzens,” Münchener medizinische Wochenschrift, 21 , 1907. the fluorescent screen or photographic plate. From this
9 Handwerk : * Ueber die Bestimmung dez Herzumrisses (nach
Moritz) und deren Bedeutung für den praktischen Arzt, ” Münchener it follows that the projection of the heart will be more
melizinische Wochenschrift, 6, 1902. or less magnified. To correct this error, Professor
10 Lehmann und Schmoll : “ Pericarditis adhaesiva im Roentgeno Moritz invented a form of apparatus which enabled him
gramm ,” Fortschritte auf dem Gebiete der Rocntgenstrahlen , ix. 3.
11 Hoffmann : “ Ueber rudimentare Eventration ," Münchener medi- to draw the outline of the heart by means of a beam of
zinische Wochenschrift,
12 Groedel 3 , 1907
II . und Groedel III. . : “ Die charakteristischen Merkmale X rays which was always normal to the screen , and
der Herzsilhouette bei den verschiedenen Herzaffektionen .” Versamm : thus obtain the outline without magnification. This
lung deutscher Naturforscher und Aerzte, 1907.
13 Schieffer : “ Ueber den Einfluss des Ernährungszustandes auf die apparatus was named by its inventor an orthodiagraph.
Herzgrösse,” Deutsches Archiv für klinishe Medizin, 92, 1907. In accordance with the new nomenclature, it is also
14 Dumstey : “ Ueber Veruenderungen am Herzen durch Bad und
Gymnastik, nachgewiesen durch Roentgenstrahlen ." Deutsche medi- known as the orthoroentgenograph . Its use is well
zinische Wochenschrift, 18, 1897.
15 Dumstey und Metzner: " Die Untersuchung mit Roentgen known to every worker in Roentgen diagnosis, and its
strahlen," Fortschritte auf dem Gebiete der Roentgenstrahlen , Band 1 . great value is undisputed. It has, however, several
16 De la Camp : “ Experimentalle Studien über die akute Herzdila
tation ,” Zeitschrift für klinische Medizin, Band 51 . disadvantages. Its theoretical accuracy is much in
17 Lennhoff und Levy -Dorn : Deutsche medizinische Wochenschrift, validated by the introduction of the personal equation of
31 , 1905 .
18 Mendl und Selig : Medizinische klinik , 6 , 1907 . the observer, in that the outline has to be drawn by
19 Mendelsohn : Der Einfluss des Radfahrens auf den mensch
lichen Organismus.” Berlin, 1896 . hand. We must therefore always allow for some error
20 Alber : Berliner klinische Wochenschrift, 34 , 1897.
21 Beyer : Münchener medizinische Wochenschrift, 1905. in using this instrument, and the results can only be
Schieffer: “ Ueber Herzvergrösserung in folge Radfahrens, " assumed as correct within some 5 millimetres.
Deutsches Archiv für klinische Medizin, 89, 1907 .
23 Kienböck , Selig , Beck : “ Untersuchungen an Schwimmern ,” To return to the question of radial projection from a
Münchener medizinische Wochenschrift, 1907, Nos. 29 und 30. point. It is well known that, when the shadow of a
2+ Bruck : “ Ueber den Blutdruck bei plötzlichen starken Anstren
gungen, " etc., Deutches Archiv für klinische Medizin . 91 , 1907.
25 Groedel : " Zur mechanisch - gymnastischen Behandlung
body is projected on a plane, the size of the shadow will
der
chronischen Kreislaufstörungen ,” Petersburger medizinische Wochen . approximate more nearly to the size of the object as the
schrift, 1897 , No. 13 . distance from the source of light increases. The heart is
situated some few centimetres from the surface of the
chest. In ordinary Roentgen examinations the screen
or plate is placed on the chest some 50 to 70 centimetres
from the anticathode. The magnification caused by
such an arrangement increases the width from the
THE THEORY AND TECHNIQUE OF TELE median line to the left outer margin of the heart by
ROENTGENOGRAPHY. some 10 to 15 millimetres. Since the heart is not

By Dr. ALBAN KOEHLER, Wiesbaden . placed symmetrically, this magnification is accompanied

by a deformation of the shape of the heart shadow. It
It is with much pleasure that I accede to the request of is therefore evident that a Roentgen examination of the
the Editor of the ARCHIVES to give some account of the heart at this distance is of little or no value for clinical
teleroentgenographic examination of the heart. purposes.
It is probably unnecessary to explain at length what Now consider how these errors in size are affected
is meant by teleroentgenography, or radiography at a when the focus-tube is removed to a distance of 1} or
distance . It will be of more value to devote this article 2 metres from the photographic plate. Let us assume
to a discussion of the aims, principle, advantages and that the apex of the heart is 5 centimetres below the
312 ARCHIVES OF THE ROENTGEN RAY.

surface of the chest, and 7 centimetres from the median published in 1905 under the title of “ Ueber die
sagittal plane of the body. If the distance of the anti- Herstellung fast Orthodiagraphischer Herzphotogramme
cathode is 1 •4 metres, then the augmentation of the mittels Roentgeninstrumentarien mit kleiner Elektrizi.
shadow of the heart at the left apex will not exceed tätsquelle.” The method at first found but few sup
2 5 millimetres. It is, of course, assumed that the anti- porters. Very few Roentgenologists adopted the new
cathode is placed vertically over the median line of the method, but those that did so were men of the foremost
body, and that the normal ray is at right angles to the rank, such as Albers -Schoenberg, Cowl, Bade, Freund,
anterior surface of the body and to the photographic Grashey, Guttman, Ossig, and Haenisch. One of these
plate. hit on the happy term of “ Teleroentgenog " to
With a focus distance of 2 metres the error will be designate this particular method of Roentgenography.
reduced to 1.7 millimetres, which does not much exceed There is, of course , no limit to the distance at which a
the width of the mark made by a dermatological pencil focus-tube may be placed, provided that we can obtain
used to delineate the outline of the heart on the skin in an installation of sufficient power to give the necessary
orthodiascopy . intensity of irradiation. It is, however, very doubtful
The left auricle and the arch of the aorta are situated whether we shall derive any real advantage by increasing
much deeper than the apex in the thorax. Their outer this distance beyond 3 metres or so. If it is possible to
edge is, on the other hand, much nearer to the median take the photograph during respiration, a greater distance
line, so that here also the error will not exceed 2 milli- is permissible, since in that case the exposure may be
metres. The displacement of the shadow of the right prolonged for several minutes.
margin of the heart is even less. Mathematical con Focus
siderations therefore prove that in the teleroentgeno.
graphy of the heart the measurements may be taken as
substantially correct , since the error is not greater than
that introduced into orthodiagraphic projection by the
personal equation of the observer.
In the early days of Roentgenography, our apparatus
was not powerful enough to admit of our taking a radio
gram at such a distance from the focus-tube. Even
when the construction of the coil and the interrupter
had improved, it apparently did not occur to anyone to a
experiment as to the greatest distance at which the
heart could be radiographed , since by that time we were
already familiar with the orthodiagraph, which seemed
to satisfy all requirements. The author first attempted
to photograph the heart of a thin slender subject by an
exposure of a few seconds at a distance of 2 metres. m

The experiment was successful, and even exceeded his

expectations. This first skiagram was made without an
intensifying screen , and with an exposure of thirty -five
seconds. The attempt was quite successful , but the
plate had to be intensified with sublimate solution . The
instruments used were a 40 centimetre Ruhmkorff coil
with a sliding contact break , and a current of 24 volts
obtained from accumulators. This was some four or five
years ago, and although at that time not every attempt exceed 1 centimetre .
was successful, yet it was evident that the perfection
of the method of photography at a distance was merely
a matter of time. My first paper on the subject was
Photographic Plate
The distance of the apex of the heart from the surface
can be determined by a screen examination with lateral
illumination . This determination need not be made
with any great accuracy , so long as the error does not
The magnification of the distance to the heart apex
from the median sagittal plane may easily be calculated
for a focus distance of 1.5 and 2 metres.
 ARCHIVES OF THE ROENTGEN RAY. 313

Let a = the distance of the anticathode from the plate ; 2.5 millimetres. With the focus-tube at a distance of
b = the distance of the heart apex from the plate ; 1.5 metres, this average error is 3.5 millimetres. If the
m = the distance of the apex from the median focus-tube has not been accurately placed in the horizontal
sagittal plane of the body ; plane passing through the heart apex, but is somewhat
2 higher, at the level of the sixth or seventh spinal process,
the increase in size caused by the radial pro-
jection. the numbers given in the above table will vary some
Then a : (a - b) = (m + x) : 2. what, but the difference is so slight that it may be safely
The values of x for various distances of the heart apex neglected.
from the photographic plate are given in the accom . These numbers show that teleroentgenography is
panying tables : sufficiently exact to compete with orthodiagraphy.
In his article on orthodiagraphy in the December
Focus DISTANCE 2 METRES. number of this journal, Groedel himself writes : “ I
would like to indicate a method ... which will doubt.
Distance of less gain ground as the capacity of our instruments is
the Heart Distance from the Heart Apex to the
Photographic Plate.
Apex from increased. This is the method of teleroentgenography
the Median
Sagittal
which was recommended by Köhler some years ago, and
4 cm . 5 cm . 6 cm . 7 cm . 8 cm .
Plane. has now been taken up in several quarters. I feel con
7 cm . 1.4 mm. 1.7 mm. 2.1 mm. 2.5 mm. 2.9 mm . vinced that sooner or later teleroentgenography will prove
8 1.6 2 :0 > 2.4 2.9 3 :3 a formidable rival to the orthodiagraph ."
9 1.8 2.3 2.7 3.2 3:7
10 2:5 3.0 3.6 4: 1
To carry out long-distance skiagraphy with success, it
2.0 >

11 2.2 2 :8 3.4 3.9 4.5 is, however, not absolutely essential to use a very powerful
installation . The ordinary apparatus, as now constructed
by the best instrument-makers, is quite sufficient for the
Focus DISTANCE 1.5 METRES . purpose. My first experiments with teleroentgenography
were published in the Wiener Klinische Rundschau of
Distance of Distance from the Heart Apex to the April, 1905. The apparatus with which I then worked
the Heart
Photographic Plate. was driven by accumulators having a potential of only
Apex from
the Median 24 volts. My second paper on the same subject was
Sagittal 5 cm . 6 cm . 7 cm . 8 cm .
Plane. 4 cm . published in the Deutsche Medizinische Wochenschrift,
1908, No. 5. For further details as to the method of
7 cm . 1.9 mm . 2.4 mm . 2.9 mm . 3-4 mm . 3.9 mm .
8 2:1 2:7 3 :3 3.9 4.5 >
procedure I would refer the reader to these two papers.
9 2.4 3: 1 3.7 4 :4 5.0 I have only space here to mention one or two of the
10 2 :7 34 4:1 4.8 5.6 chief points in the latter paper.
11 3.0 3 :7 4.5 5.3 6 :1
One great advantage of teleroentgenography is that we
have a true reproduction of every detail of the contour of
From these tables we see that , with a focus-tube the heart. The human hand, which marks the outline
2 metres from the plate, if the heart apex is at a depth of the orthodiagraphic tracing, is incapable of following
of 4 centimetres, then a median distance of 7 centimetres the curves and angles of the silhouette of the heart and
will be exaggerated by 1 :4 millimetres. On the other large vessels as faithfully as does the photographic plate.
hand, if the apex lies 6 centimetres below the surface For accurate diagnosis, the individual details of the heart
and 9 centimetres from the middle plane, the error of shadow are as important as the determination of its size.
the measurements on the photographic plate will be If, for example, the enlargement of the heart is due to
2.7 millimetres. Only in the case of the apex being valvular failure, the heart will change from its normal
11 centimetres from the middle line and 8 centimetres shape, and the alteration is typical of the disease and of
from the plate does the error in measurement amount the extent of its progress. I am, indeed, of opinion that
to more than 6 millimetres. With the focus-tube at a in course of time we shall come to lay more weight on
distance of 2 metres, the average value of the increase in the shape of the heart than on the absolute measure
breadth of the skiagram of the left side of the heart is ments of its various diameters. The shape of the heart
314 ARCHIVES OF THE ROENTGEN RAY.

must necessarily be better shown by a teleroentgenogram plates to be over -exposed, the developing solution should
than by an orthodiagram . As we have shown, the be fairly concentrated, and the negative may be inten
actual size can be measured with the same degree of sified, if necessary, with perchloride. The duration of
accuracy by either method. the exposure varies from fifteen seconds for slender
I always advocate the taking of a Roentgenogram with patients to thirty seconds for those of a stouter build. If
the patient in an erect posture and during deep inspira- the teleroentgenogram is taken while the patient is
tion. Patients who, from shortness of breath, are unable breathing quietly, it will be unnecessary to use an inten
to hold their breath for ten to fifteen seconds must be sifying screen or intensifying developer, since in this
radiographed during quiet breathing. In these cases we case the exposure may be prolonged, if necessary, for
do not indeed get so sharply defined an outline, but with several minutes.
the tube at such a distance the contour is usually suffi- The accompanying illustrations ( Plates CCLXXXVII.
ciently clear --more so, indeed, than one would expect . and CCLXXXVIII. ) show some examples of the tele
The focus-tube should be placed in the median sagittal roentgenography of the heart.
plane of the body, and at the level of the sixth spinal Fig . 1.-Male, aged twenty -eight years. Height, 168 centimetres.
process. Its position should be adjusted with as much Neurosis of the heart with no clinical symptoms. Front view
with the patient erect. Focus distance, 1.5 metres. Exposure,
accuracy as is devoted to the correct centring of the twenty seconds during inspiration .
Fig. 2. - Male, aged twenty -four years. Height, 170 centimetres.
tube for orthodiagraphy. With thin subjects, tele Acute polyarthritis five years ago. Systolic murmur at the apex ;
roentgenography may also be successfully carried out diastolic murmur at the pulmonary area . Front view with the
with lateral illumination . patient erect. Focus distance, 1.5 metres. Exposure , twenty
seconds during inspiration.
The installation which the author has found sufficient FIG. 3. — Female, aged twenty -eight years. Height , 158 centimetres.
Influenza, with ſever, two years ago. Systolic murmur at the
for all his work is neither very complicated nor very apex. Dyspnea ; only slight diaphragniatic breathing . Front
costly. It consists of a Ruhmkorff coil of 40 centimetres view with the patient erect. Focus distance, 2 metres. Exposure,
two minutes during quiet breathing.
spark -gap, which has already been in use for six years. Fig . 4. - Female, aged twenty -four years. Height, 174 centimetres.
No oppression of the heart. Left lateral view with the patient
To this is attached a condenser, since I work with a horizontal. Focus distance, 1.5 metres. Exposure, twenty -five
mechanical break. For some years I have worked seconds during inspiration.
exclusively with a regulating Monopol focus-tube of the
Hirschmann-Koehler type. I use a rotary break with
rubbing contact (Hirschmann model), which in my THE SELECTIVE ABSORPTION OF ROENTGEN
opinion is still one of the best, if not the best, for the RAYS. *
purpose . This is indeed a mercury break, but the
mercury forms no part of the actual contact, as in most By G. W. C. KAYE , B.Sc. , A.R.C.Sc. ( Lond .), Trinity College,
interrupters; it is used only to lubricate the sliding Cambridge.
copper contacts by forming an amalgam on their surface. MCCLELLAND | has shown that there is a close connexion
The advantage of this is that the mercury does not between the secondary radiation given out by a sub
become emulsified, and the necessity of a weekly cleaning stance exposed to the ß and y rays from radium and the
out of the interrupter is thus avoided. In ordinary use
I find that it will work for three or four months without
atomic weight of the substance. More recently Professor
J. J. Thomson has obtained a similar relation between
requiring
which attention.
I obtain I use a voltage
from accumulators whichofaresome secondary Roentgen
32 volts, secondary
permanently Roentgen radiation
radiation and
and atomic
atomic weight.
weight. With
With
the exception of nickel , an increase in atomic weight
attached to the public electric main, for charging. For was always accompanied by an increase in the amount
teleroentgenographic work the current is from 5 to of secondary ionization.
6 ampères. The focus-tube has a penetration of from
6 to 8 on Benoist's scale .
In view of these interesting results, an attempt was
made to derive a relation between primary Roentgen
Except when the patient is of slender build , I make use radiation and the atomic weight of the substance pro
of an intensifying screen, such as that made by the
* Reprinted by kind permission of the Cambridge Philosophical
Polyphos Company. The grain of these screens is very Society .
much finer than that of the older screens, and is, indeed , † McClelland, Sci. Trans. Roy. Dublin Sac ., 1905 and 1906.
# J. J. Thomson, Proc. Camb. Phil. Soc., xiv. 1 , p. 109 , November ,
hardly noticeable. Since it is quite impossible for the 1906 .
 FIG
.1 FIG
2.

"T11HE
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ARTICLE
THE
ILLUSTRATE
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TELEROENTGENOGRAPHY
OF
TECHNIQUE
AND
).THEORY
KOEHLER
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DR
By LBAN
,Wiesbaden
.
CCLXXXVII
PLATE
Phenomena
Allied
and
Ray
Roentgen
the
of
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opyright
315
3

.3
FIG FIG
4..

THEORY
"T
ON
ARTICLE
THE
ILLUSTRATE
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TELEROENTGENOGRAPHY
OF
TECHNIQUE
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Aiesbaden
DR
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LBAN
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CCLXXXVIII
PLATE
"(“Archives
Phenomena
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and
Ray
Roentgen
the
)—C.of
opyright
317
 ARCHIVES OF THE ROENTGEN RAY. 319

ducing the rays. A special form of Roentgen bulb was which passed through corresponding holes in the body
employed, and the quantity of rays emitted was measured of the car. The latter for convenience of space was
by an ionization method. slung from the axles of the wheels. Underneath each
There were one or two things to be considered. axle was fastened a piece of soft iron, and by means of
Firstly, some of the substances it was proposed to use a small electro -magnet outside it proved very easy to
have comparatively low melting points, and therefore it move the car along the rails and bring any metal desired
was not advisable to focus the cathode rays on the anti- under the beam of cathode rays.
cathode by using a concave cathode. A plane cathode In every case the metal of the anticathode had its
was accordingly employed. Secondly, this being so, surface cleaned and polished. This was usually done
only a central pencil of the cathode rays should be used, first with the finest flour emery, and finally with
so as to restrict them to the anticathode area . jeweller's rouge. The lead plate had its surface renewed
It follows that the quantity of Roentgen rays produced by planing.
would never be very large, and might in unfavourable With the first batch of metals introduced, a small
circumstances be small . So it was advisable
to keep down the capacity of the ionization TO ELECTROSCOPE
TO EARTH
chamber system, and also to allow the
emergent Roentgen rays to pass out of the 1
1
.
bulb through as thin an aluminium window I
I
I
as would withstand the atmospheric pressure I
I
I
I
from without . Such a window would of
course stop all the secondary cathode particles
which are produced along with the Roentgen CATHODE
pulses when the primary cathode particles 2
.
9
1
m .

are arrested by the anticathode .

TO PUMP
AND
ARRANGEMENT OF APPARATUS. CAUCE

The general arrangement is shown in B

Fig . 1 , which is drawn to scale. The dis

charge tube D, containing the cathode and,
ANODE А
in a side-tube , the anode , was constricted ANTICATHODE

over its lower half, where it met the anti FE

cathode tube A. The central beam of cathode
rays met the anticathode at 45 degrees, and
a pencil of the Roentgen rays produced
passed along the tube B, which was mounted at right
angles to the discharge tube. These relative directions
were chosen because they are the usual ones in ordinary
X-ray practice.
Both the electrodes were of aluminium .
The metals used as anticathodes were mounted on a
car, which ran along horizontal rails fastened by sealing-
wax to the bottom of the tube A. For rails one - half of
a piece of aluminium tube split from end to end was
used. The car was also made of aluminium, and was
arranged to carry some eight metal discs in line. These
were of diameter 2-5 centimetres, thickness 2 milli-
metres, and were kept in position by small central pins,
Fig. 1 .
willemite screen took the place of one of the metals.
This was prepared by dusting finely crushed willemite
(natural silicate of zinc) on a small piece of glass plate
previously moistened with a weak solution of water
glass (silicate of soda), and then drying over a small
flame. Such a screen does not impair the vacuum by
giving off gas when a discharge plays on it. The cathode
rays when they struck the screen produced a bright
green elliptical patch of phosphorescence, which served
as a test of whether the rays would be truly directed on
the anticathode metals which were in line with the screen
on the car.
The whole anticathode system was earthed and joined
4342
320 ARCHIVES OF THE ROENTGEN RAY.

outside by a wire to the anode. The discharge was pressure. It was not possible to cement such a sheet
generated by a 6 - inch Apps induction coil. In parallel of metal directly to the thin edge of the glass tube, and
with the tube was an adjustable spark -gap between two be sure of a joint which would stand. To get over this,
brass spheres 2.54 centimetres in diameter. These were a brass tube which would just slip over the glass tube
kept well cleaned and polished, and their distance was provided with a heavy flange. A stout ring was
apart for the first spark gave a rough measure of the screwed down to this by six screws equally spaced. The
mean potential difference between the terminals of the aluminium sheet was gripped between the ring and the
tube. flange, and the joint was completed with sealing -wax,
A Töpler pump was used to produce the vacua, and a the screws being tightened up while the sealing -wax was
McLeod gauge gave a measure of the pressures. With still molten . The brass tube was then sealed to the
such a large mass of metal in the tube it was to be glass tube, and this part of the apparatus gave no further
expected that a considerable quantity of gas would be trouble through leakage.
evolved when the pressure was reduced, and, indeed, these The whole of the discharge tube was surrounded with
expectations were not belied, for it took some weeks of sheet-lead, through a hole in which the Roentgen -ray
pretty steady pumping with the discharge running before tube B penetrated.
any readings could be taken. The ionization chamber consisted of a flat cylinder
At one stage one could
not keep pace with the evolution of gas, and it was of brass about 4 centimetres long and 9 centimetres
difficult with the discharge running to get below a diameter. The faces were covered with aluminium leaf
pressure in the neighbourhood of 30 millimetre. 0:01 millimetre thick . The front face was situated
Such pressures are very favourable to cathodic disin- about 3 centimetres from the aluminium window of
tegration , and aluminium deposits were in this way the tube, and was symmetrically placed with respect
formed on the anticathode. It may be worth noting to it.
that the evolution of gas was hastened by reversing the A ring of aluminium wire of diameter rather less than
discharge, and thus using the anticathode as cathode. hat of the cylinder was mounted with its plane parallel
The plan has, moreover, the advantage of splashing off to and midway between the faces of the cylinder. Over
on to the surrounding glass any cathodic deposit which the ring was fastened aluminium leaf, and the whole
may have been formed on the anticathode. The forma- was supported by a wire passing through and clamped
tion of these disintegration deposits, it was found , was in a tube insulated by a sulphur plug, which was inserted
almost, if not entirely, prevented by earthing the anti- in an earthed guard-tube. The guard-tube was insulated
cathode system and with it the anode: from the chamber by an ebonite stopper let into the side
At this point it is interesting to note the behaviour of of the cylinder.
the lead disc which formed one of the metals of the Aluminium leaf was chosen for the ends of the ioniza
anticathode. Villard * showed that cathode rays reduce tion chamber, partly because it is very transparent to
an oxidized copper plate to metallic copper. In just the Roentgen rays, and partly because it emits, as J. J.
same way it was noticed that the lead disc, which had Thomson, * Townsend, † and Barkla I have shown, but
tarnished a little before the apparatus could be sealed little secondary Roentgen radiation, and that of a kind
and exhausted, gradually developed a bright elliptical closely resembling the primary rays. It was, of course,
patch of clean lead at the place where the pencil of essential to compare incident radiations by their direct
cathode rays impinged. ionizing effect, complicated as little as possible by any
As mentioned above, a portion of the Roentgen rays secondary radiation.
passed along the tube B and out through the aluminium The electrical connexions are shown in Fig . 2.
window Winto the ionization chamber C. If a The outside of the ionization chamber was raised to a
screen S was used to cut down the rays, it was inserted potential (200 volts) sufficient to give the saturation
in front of the ionization chamber. The aluminium current for all the degrees of hardness of the Roentgen
window was 0.067 millimetre thick and 2 centimetres rays measured. The potential was supplied from &
diameter, and perceptibly sagged under the outside * Thomson, Proc. Camb. Phil. Soc., xiv. , p. 109, November, 1906.
+ Townsend, ibid ., X. , 1899 , p. 217.
* Villard , Journal de Physique, 3me Série, viii., p. 140, 1899. # Barkla, Phil. Mag ., [6] 7, p, 543, 1904.
 ARCHIVES OF THE ROENTGEN RAY. 321

battery of small accumulators, with the negative pole

MEASUREMENTS .
earthed .
A Wilson tilted electroscope, E, was used to measure In a comparison of the Roentgen rays from two metals
the leaks, and with its great range of sensitiveness, of the anticathode, electroscope readings were taken
obtainable without the aid of any added capacity, proved alternately a great many times, first using one metal
extremely convenient for the purpose. If the electro- and then the other. It is essential that the incident
scope was adjusted for great sensitiveness , a potential stream of cathode rays should remain steady and
divider, P, giving a control of zy volt, was used as a fine constant for a proper comparison . An induction coil ,
adjustment on the potential of the charged plate, which such as was used, working with a hammer -break inter
ordinarily was raised to something in the neighbourhood rupter, cannot always be relied upon to run perfectly
of 200 volts . steadily and well for any length of time. It needs very
Indeed, this potential divider proved to be a real con- careful adjustment of the current in the primary, of the
venience for all degrees of sensitiveness, and the zero of hammer -break and its tension screw , to get good results
the electroscope, taken when the entire gold -leaf system for the particular pressure inside the tube. The surfaces
was earthed , could be kept perfectly constant. The of contact of the platinum break require attention from

TO EARTH
TO EARTH

B
-ht
TO EARTH

FIG. 2.

movement of the gold -leaf over a definite range was time to time ; they should be kept clean and smooth and
observed through a small telescope having a scale in parallel. The amount of sparking at the hammer- break
the eye- piece. The times were taken with a stop- interrupter must be as small as it is possible to get it.
watch. When & coil is working well it emits a steady purr,
A calcium chloride solution key, K , which was operated unbroken by kicks and bumps at the break.
from a distance, made or broke the earth connexion . For steadiness of running the current in the primary
It is perhaps worth while laying stress on the advantages must be much smaller than that which would make the
that a solution of metallic salt has over mercury for a coil give its longest spark. In other words, the coil must
key. The kick so common with mercury keys on making run on a light load, and it is therefore better to use as
or breaking connexion is quite prevented. The electrifi- big a coil as is convenient.
cation produced by the splashing of solution of salts is In spite of all precautions, only a small fraction of the
very small ; for mercury it is large. readings actually taken were good enough to use. By
The insulation was of sulphur throughout. The comparing different pairs of metals, and thus getting a
electroscope was out of the path of, and well shielded number of cross-checking results, an accuracy of 1 or
by lead from, stray Roentgen radiation. The connexions 2 per cent. could probably be ensured for the final
of the ionization chamber to the electroscope were , as is readings.
usual, well shielded by earthed metal tubes. From time to time the pressure in the tube was read
322 ARCHIVES OF THE ROENTGEN RAY.

by the McLeod gauge, and a reading was taken of the Roentgen rays is taken into account. It will be noticed
length of the alternative spark -gap. By taking a that, with the exception of aluminium , there is not a
number of successive readings with the electroscope for great deal of difference between the amounts of radiation
the same anticathode, one could tell whether the coil from any of the other metals.
were working well or not. Screens of aluminium, 0.25, 0:5, and 1.0 millimetre
The usual length of a reading was from twenty to thick, were then inserted in turn in the path of the
fifty seconds, and the coil was given two minutes' rest Roentgen rays. The first thickness of screen alters the
between successive readings. This, of all the methods relative amounts of radiation considerably, but very
tried, was found to be the most satisfactory for yielding little further change is produced by thicker screens.
results which were concordant. Indeed , the numbers for the 0.5 millimetre and the
1.0 millimetre screens are almost identical .
RESULTS .
In column 4 (under aluminium screen) is given & set
For the results given below a constant pressure of of comparative values for the radiations (still keeping
0 ·005 millimetre of mercury was maintained in the tube, Pt = 100) from which the softest rays have been sifted
out by an aluminium screen 1 millimetre thick. Such
and the length of the alternative spark - gap was 0.8 centi
metre, which is equivalent to a mean potential difference a screen cut down the radiation from platinum about
of about 25,000 volts between the cathode and anode. thirty -five times .
Hence the Roentgen rays worked with were distinctly It is very evident that the radiation from an anti
soft in character, and were largely cut down by quite cathode of low atomic weight - e.g., iron or nickel - is
that are very soft in character.
thin sheets of metal. The aluminium window would let largely made up of rays
through all but the very softest rays. Such metals have their relative radiation values largely
Anticathode

reduced when the screen is used . On the other hand,

Weight
Atomic
Weight
Atomic

Relative Radiation. metals of high atomic weight, such as lead and silver,
.

have radiation values which are increased when we deal

.

Screen
.

only with the harder type of Roentgen rays. These

No

Screen of
(R
.

metals obviously give off a larger proportion of hard

)

Al . Pt . Cu . Ni . Fe. rays than the metals of less atomic weight.

The outcome is that all the relative radiation values
for rays which have passed through an aluminium
( R)
88 24 24 26 screen now follow the order of the atomic weights of
207 :0 Pb 93 109 0:53
195.0 Pt 100 100 100 24 24 25 0:51 the anticathode metals ; indeed , the two exhibit an
108.0
Ag 77 86 66 21 19 22 (0:56 ) approximately linear relationship.
( 154.0)
64.0 Cu 87 35 29 35 35 12 0.55 In the last column of all the ratio of the radiation
58.7 Ni 89 33 24 26 33 11 0:56 value to the atomic weight is given , and, as will be seen ,
56 :0 Fe 83 30 19 6 14 30 0:54
27.0 Al 20 14 9 3 5 50:52 is roughly constant.
The case of silver must be mentioned. It amalgamated
with the mercury vapour from the pump before any
The amounts of Roentgen radiation from the different measurements could be made. It is hoped subsequently
metals were first compared when no additional screen to make an analysis of the surface of the silver ; but it
was used to cut down the rays, so that they had only is very probable that in the presence of a continual
to penetrate the thin aluminium window to reach the supply of mercury vapour the amalgam that silver
ionization chamber. These relative values (calling forms is AgHg. The mean atomic weight of this is
platinum 100) are given in the third column of the 108 + 200
2
= 154 , and dividing this number into the
table of results. No very evident relation is apparent
between these numbers and the atomic weights of the radiation value for the silver, it will be seen that the
anticathode metals-e.g. , lead, silver, and nickel are all quotient comes into agreement with the other values
out of place. Perhaps this result is not altogether tabulated in the last column .
surprising when the heterogeneous character of the In the remaining columns are given the relative
 ARCHIVES OF THE ROENTGEN RAY. 323

radiations which are transmitted through screens of transparent to radiation from copper than to radiation
platinum, copper, nickel, and iron . from iron. A copper screen transmits radiation from
Consider the case of the platinum screen, and compare nickel far better than radiation from iron , while a screen
the values with those obtained in the case of the of iron transmits radiation from copper and from nickel
aluminium screen. It was arranged that the radiation almost equally badly. Barkla,* working with secondary
from the platinum anticathode should be cut down as Roentgen radiation , has noticed a similar resemblance
much with the platinum screen as it was formerly by between copper and nickel, and a corresponding jump
the aluminium screen, so that rays of equal hardness between nickel and iron .
were employed. It will be noticed that, again giving Yet it must be remembered that the atomic weight of
platinum the value 100, the values for all the other nickel (58.7) is nearer the atomic weight of iron (56)
metals are considerably less than they were when the than it is to that of copper (64) . Nickel and iron show
aluminium screen was used. The value for lead is now some chemical resemblances, and are placed in the same
actually less than that for platinum, but, with this group (VIII. ) of the periodic classification, copper being
exception, the order is undisturbed. Evidently a plati- situated in Group I. On the other hand, a point worthy
num screen shows a special transparency to Roentgen of remark is that copper and nickel have densities which
rays from a platinum anticathode. This abnormal differ but little-8.95 and 8.8 respectively - while the
transparency is shared in less degree by rays from other density of iron is distinctly less, 7-8. It would seem,
metals, to an extent depending on the proximity of the therefore, that the density of the absorbing screen rather
atomic weight to that of platinum - e.g ., lead and silver than its atomic weight is the important factor in this
have their former values cut down by about 20 per cent. , screening effect.
while nickel and aluminium are about 35 per cent. less
CONCLUSIONS.
than they were with the aluminium screen.
Now compare the column of values for the copper The results indicate that a metal screen is specially
screen with those for the aluminium screen. For ease
transparent to Roentgen radiation from an anticathode
of comparison copper is given the value 35, the same as of that metal, and that this abnormal transparency is
it had with the aluminium screen. It will be seen at shared in less degree by metals with atomic weights
once that there is evidence of marked selective trans differing little from that of the anticathode.
mission . A copper screen is now easily first in trans
The effect seems to point to the view that the
parency ; the next is nickel, whose value exceeds those of Roentgen rays emerging from the interior of the anti
silver, platinum, and lead, although their atomic weights cathode to the surface undergo selective absorption,
are much higher. leaving the remainder specially penetrating to further
forSimilar results will be observed when the columns
nickel and iron screens are also compared with the layers of the same substance, and to a less extent to
substances of neighbouring atomic weights.
column of values for the aluminium screen. Take the
Using a plate of aluminium as the absorber, the
case of the iron screen and compare it with the alu amount of transmitted radiation was found to be
minium screen. in
same value,30, Then,
eachgiving
case,theit radiation from that
will be seen iron the
the approximately proportional to the atomic weight of the
metal used as anticathode over a wide range of atomic
new values for lead, platinum, and silver are about a
weights.
quarter, and those for copper, nickel, and aluminium It may be that this selective absorption is a maximum
about a third , of their values with an aluminium screen. for one particular degree of hardness of X rays depending
This again indicates that the degree of transparency of on the metal, and that a metal of high atomic weight
a metal to Roentgen rays is a function of the proximity shows selective absorption for a harder type of Roentgen
of the atomic weight of the radiating metal to that of
ray than that which gives the effect for a metal of
the screen .
smaller atomic weight.
It is worth noticing the big jump that occurs in the The experiments are being continued.
character of the radiation in passing from nickel to iron, I should like to thank Professor Thomson for some
and the resemblance between the radiation from nickel
and from copper. For instance, a nickel screen is more * Barkla, Nature, February 14 , 1907.
324 ARCHIVES OF THE ROENTGEN RAY .

helpful suggestions, and for his interest in the investiga- The great chemical resistance of this reaction may be
tion, which was carried out in the Cavendish Laboratory diminished by catalytic action, and especially by the
Note. —The illustrations for this article have been catalytic action of Pb, Hg, or Zn, so that in presence of
kindly lent by the Cambridge University Press. these metals the reaction may take place even when the
hydrogen ions retain a comparatively high electrical
charge. This electrical surcharge of the hydrogen takes
ZINC IONS AND TISSUE CHEMISTRY . place especially in an alkaline medium such as that
of the animal tissue.
By DR. ALWIN KNAUER, Wiesbaden.
Thus the electrolytic introduction of zinc into a tissue
( Translated and condensed from the Zeitschrift für medizinische sets free hydrogen ions. These ions are prevented from
Elektrologie und Röntgenkunde.)
uniting to form bubbles of molecular hydrogen . Hence
WHENCE comes the phenomenal action of the zinc ion they act by reducing the albumin of the surrounding
on the mechanism of tissue change, deleterious in large tissue, splitting it up by hydrolytic action, and thus
doses, and stimulating in smaller doses ? Why among destroying it. In addition, we have a great concentration
all metallic ions does the zinc ion alone possess this of the hydrogen ions, which is increased by their rela
power ? Leduc considered that the peculiar property of tively slow velocity. This, together with the acids
the zinc electrode is due to the absence of hydrogen catalytically produced, causes the destruction of the
bubbles. The contrary, however, is the case ; with no complicated molecular structures of the tissue.
other metal is the secondary hydrogen reaction so strong On the other hand, with smaller doses, instead of a
as in the case of zinc. destructive, we may get a productive influence on cell
Metal ions driven into a living tissue are speedily growth , as observed by Leduc in experiments on guinea
deposited , partly in consequence of diminution of their pigs, when an increase of hair-growth followed the
osmotic pressure, partly from failure of the electromotive cautious introduction of zinc ions.
force. The secondary action of the metallic ions is over- According to Oswald, there is hardly a tissue reaction
shadowed by that of the Na and K ions set free in the which is not facilitated by the action of the hydrogen
tissue. Only in the case of lead and mercury is there an ion . It is quite conceivable that the normal synthetic
exception to this rule, both metals giving evidence of a tissue changes may be thus facilitated by the presence
deeper penetration into the organism . These metals, of the hydrogen ion. There is, of course, an optimum
therefore, show evidence of elective affinity for the ions degree of concentration for the hydrogen ions, or, what
of the tissues. Alone among the metals, mercury, lead, is the same thing, of the zinc ions which set them free.
and zinc have the property of setting up secondary It would not be expected a priori that molecular
reactions when electrolytically introduced. hydrogen should act in the same way as the hydrogen
Among the anions set in motion by the electrolytic ions, even where there is no free charge, as is the case
current, hydrogen ions are found accompanying the with a platinum electrode. It may, however, explain
metallic ions down the electric stream. These hydrogen the exceptional catalytic action of molecular hydrogen ,
ions unite, H + H = H,, and separate as bubbles of gas. which is much less than that of the hydrogen ions.

Reports of Societies .
ROENTGEN SOCIETY.
( Thursday, February 6.)
The Standardization of Roentgen Light.
By W. DEANE BUTCHER.
X RAYS may be regarded as ultra -ultra - violet light. The energy
which radiates from a Crookes tube is Roentgen light. To
measure this Roentgen light, we must fix on some international
unit, and define, if possible, the Roentgen candle. We should
endeavour to correlate the artificial radio-activity of a focus-tube
with the natural radio -activity of radium , and adopt as our
Roentgen candle that standard of radio -activity recommended
by the Standards Committee.
We must first define the colour of the light - the quality, or
hardness, or penetration of the Roentgen rays. Roentgen
colour, like ordinary colour, depends only on the wave -length of
the electro-magnetic pulses set up in the ether ; and the wave

+
 ARCHIVES OF
length of these pulses depends on the velocity with which the
electrons strike the anticathode and on the suddenness of their
stoppage.
If we imagine all electro-magnetic vibrations spread out in
octaves, as on the keyboard of a piano, the bass will be formed
by the Hertzian waves used in wireless telegraphy. The middle
portion is the octave of visible light, above are a few notes of
ultra - violet light, and higher up we get the shrill treble of the
Roentgen ultra -ultra -violet vibrations. It is this piercing treble
that we have to measure, and that not a single clear note, but a
most complicated
If we chord
visualize one of these chords,pulses.
of ethereal produced by the pattering
of projectiles on the target of the focus-tube, we may conceive it
as a beam composed of red , green and blue rays like those of the
visible spectrum ; the red being the soft rays of long wave
length, and the blue the hard rays of shorter wave-length. The
beam of Roentgen rays known as No.5 Benoist may be imagined
as containing a few soft red rays, a large number of medium
green rays, and a few hard blue rays. How are we to define
such a beam, or recognize it when we meet it again ? We
cannot spread it out in a spectrum. We only know that it is
composite by the unequal absorption of its rays as it passes
through a screen of lead. Benoist defines it as the composite
pencil of rays whose intensity is equally reduced by a filter of
0:11 millimetre of silver and by 5 millimetres of aluminium.
A better measurement would be to interpose an aluminium
screen of such a thickness as to cut down the intensity of the
emergent pencil to one half that of the incident pencil. The
penetration of a pencil of X rays might then be defined by the
thickness of the aluminium screen required to reduce it to half
its original value.
The author then described a Half- Value Penetrometer, in
which on one side the X rays are cut down to half-value by the
cogs of the rotating wheel, and on the other by an aluminium
filter of varying thickness .
The practical attainment of any particular X-ray chord is best
carried out by the assistance of Bergonié's static voltmeter, since
the degree of penetration depends only on the difference of
potential between the anode and cathode of the focus-tube.
The author then passed in review the various devices adopted
for measuring the quantity of X rays. The only methods at
present used practically, in England, were Sabouraud and
Noiré's pastilles as an indicator of the maximum dose for
therapeutic use, and Kienböck's photographic method.
The author then proposed a method of measuring the
radiations from a Roentgen tube by direct comparison with
those from the standard specimen of radium. This method
would give us three units of X-ray measurement :
The standard Roentgen candle = one radium candle = 1 milli
gramme of radium .
Unit of irradiation = one radion = the irradiation due to one
Roentgen candle at a distance of 1 centimetre.
Unit quantity of rays = one radion minute = quantity of rays
absorbed in one minnte when the irradiation is one radi
He exhibited an instrument designed by Mr. Bowron for
comparing radium and Roentgen fluorescence, and showed
THE ROENTGEN RAY . 325
illustrations of an apparatus designed by Professor Guilleminot
for the same purpose. In both these instruments the X rays
are compared with an arbitrarily chosen specimen of radium ,
which could, however, be easily standardized by comparison
with the unit when that has been successfully defined by the
Standards Committee.
The discussion was postponed until the next meeting, on
March 5.
• The PRESIDENT (Mr. W. Duddell) opened the discussion,
and, speaking of Dr. Butcher’s suggestions for a unit of Roentgen
illumination, said that he was not very much taken with the
expression “Roentgen candle " as the name for the radiating
standard . He preferred to call the radiating standard a
“ radion ," so that X-ray tubes would then be rated in radions.
He further said that a word was greatly needed to express what
Dr. Butcher called the unit quantity of rays - unit illumination
acting for unit time. If a really good word could be found it
would be of great value, as all ordinary photographic exposures
and the doses given in X -ray therapeutics would be expressed in
terms of this unit.
Mr. C. E. S. PHILLIPS suggested a modification of Professor
Bergonié's electrostatic voltmeter in the shape of a differential
method by which a dial and a pointer could be used to give a
definite reading while the patient was being actually exposed to
the X rays. Any variation in the intensity of the beam during
treatment could then be noted. The phenomenon of ionization
might be used for this purpose . A leak of electricity might be
produced by means of radium or other radio -active body which
would charge up a plate. It might be so arranged that when
the rate of charging up was equal to the rate of discharge the
needle was at zero. Then when any change took place the
needle would be deflected to one side or to the other, and the
operator would have a useful and practical means of keeping
the irradiation constant. Mr. Phillips demurred to the sug
gestion of the term “ standard Roentgen candle as ambiguous.
As regards the selenium cell as a measure of Roentgen irradia
tion, it took a long time after irradiation to regain its normal
condition of sensitivity. It had lately been stated, however, that
the electrical resistance of a selenium cell varied with pressure,
and he thought it was worth trying whether some method of
bringing the selenium cell quickly back to its normal condition
might not be possible.
Mr. J. H. GARDINER asked whether medical men could tell
him by any standard that he could obtain exactly the absorb
ability or penetration or wave-length that was needed in a
case of ringworm . Physicists could furnish medical men with
all kinds of radiations; they required to know what was really
wanted by the medical profession.
In reply, Dr. DEANE BUTCHER said that his paper was merely
an historical one, giving as far as possible the details of the
problem and the manner in which it had been attacked. Silver
was not aradiochroic, but according to Professor Bergonié was
one of the least radiochroic substances. With regard to the
selenium cell method, he believed that it was a fact that the
recovery of the selenium was much quicker after irradiation
with X rays than after exposure to light. The term " Roentgen
44
326 ARCHIVES OF THE ROENTGEN RAY.

candle " was used by him merely as a façon de parler. What safety of their patients. Early X -ray workers wandered blindly
Roentgenologists wanted, and what they would get ultimately, in an unknown country ; at the present day “it was only a
was a definition of the physical remedy which they used. criminal who burned his patient, and only a fool who burned
Already they had means of measurement which ensured the himself."

Reviews.

Die Anwendung der Elektrizität in der Dermatologie. authors quoted, a very fair proportion is English. The
By Professor S. EHRMANN, Vienna. Published by subjects treated are electrolysis, under which term the
Josef Safar, Vienna and Leipzig . writer includes treatment with the ordinary galvanic
This work is the result of a course of practical electric current, Roentgen -therapy, high frequency, static elec
treatment in dermatology, which has for some years tricity, light-therapy, and kataphoresis, or iontophoresis,
been carried out by Professor Safar in Vienna. as the author calls it.
In the chapter on Electrolization the author insists A copious index completes a useful work, which we
on the necessity of asepsis and antisepsis before treat should be glad to see translated into English, as it gives
ment. The instructions for electrolytic radical epilation the German view of the electrical treatment of skin
are very complete. Professor Ehrmann is one of the disease, just as Belot's (London : Rebman Ltd.) well
first authorities on the subject, and the instructions in known work gives a résumé of French work in the same
this volume are the fullest we have met with on the direction,
technique of this slight but delicate operation, which is
so often attempted and so seldom adequately performed . The Evolution of Matter. By GUSTAVE LE Bon. Trans
The author recommends epilation for the treatment of lated by F. Legge. Walter Scott.
sclerotic folliculitis of the neck, which, however, is In this volume the well-known author of the
perhaps better treated by X rays or radium. He speaks “Psychology of Crowds " gives a popular account of
highly of the treatment of alopecia areata by faradiza- his researches in radio-activity from the famous discovery
tion . of “ la lumière noir " to the present time.
In the chapter on d'Arsonvalization, he recommends The experiment and apparatus are clearly described ,
the high -frequency current for the treatment of a and placed in a section by themselves. The condensing
number of diseases, among which are pruritus, herpes differential electroscope, designed to prevent the effluves
zoster, alopecia areata , and lichen . or emanations from travelling round obstacles, may be
The author goes somewhat fully into the details of of interest to those who are beginning to work upon the
photo-therapy, with descriptions of the Finsen light, subject. Le Bon analyzes the various types of radiation,
Kromayer's quartz lamp, and the Uviol lamp. and lays special stress upon the importance of the infra
In the treatment of lupus Professor Ehrmann speaks red, the spectrum of which he tells us in a later French
with approbation of the sensitization of the skin by the work ( " The Evolution of Forces " ) extends beyond the
injection of fluorescing substances, such as eosin and visible spectrum in the proportion of 12 to 1. The
erythrosin, previous to irradiation with X rays or photographs of the artificial equilibria of " dissociated "
Finsen light. He considers that it is sufficient to paint matter are very remarkable, and there is an interesting
the solution over the surface of the skin, and in this way chapter on crystallization, with discussion of Schran's
he has obtained good results in cases of lupus hyper- results. There is instructive parallel between hydro
trophicus and verrucosus . Recently esculin and uranin dynamic and electric formulæ and principles, partly
and dilute solutions of arsenic have been injected previous borrowed from Corner.
to irradiation, with apparently good results. Of Le Bon's theories and speculations we need say
The bibliography is very complete, the list of works little more than that they will probably interest those
cited extending to over twenty pages. Among the whose views do not travel on conservative lines.
 ARCHIVES OF THE ROENTGEN RAY. 327

Probably the most striking conception ( although it has ideas, and it has been brought up to date by the valu
been elaborated before) is the asymptotic curve of the able notes of Mr. Legge. We would draw the reader's
apparent mass of the dissociated corpuscle. We may, especial attention to the suggestive note on p. 194 :
perhaps, regard this as the curve which goes to sleep, “ It is not only physical but historical events and
since Lorentz and others have shown that the path of a social phenomena which can likewise be defined by
corpuscle in a magnetic field is asymptotic to a circle. curves possessing the properties we have just stated,
Rutherford has noted the fact that the great velocity of in which , consequently, very small changes in & cause
the particle cannot be suddenly impressed upon it, and may produce very great effects. This is owing to the
although Le Bon does not consider this, the inference fact that when a cause acts for any length of time in the
as to its probable orbit whilst retained in the atomic same direction, its effects increase in geometrical pro
system is inevitable. gression, whilst the cause varies simply in arithmetical
The work of Le Bon is full of far-reaching and acute progression. Causes are logarithms of effects."

New Enventions.
It gives us no small degree of pleasure to find that we while development and fixing are completed in a very
are no longer dependent on foreign manufacturers for short time .
photographic plates. The new Ilford X -ray plates They are not suited to a standard pyro - soda developer,
appear to satisfy the requirements of the most exacting and the best results are obtained by the developer
radiographer. The following is the report of an X -ray recommended by the makers, which is a more or less
specialist who was asked to give us an opinion of the concentrated solution of metol and hydroquinone.
comparative value of the new plates : Almost identical results are obtained with 1 part of
“ I have tested these plates on every class of subject, rodinal solution in 10 parts of water.
from the simplest to the most difficult, and have not " When either of these solutions is used, the duration
the least hesitation in saying that they are quite the of the X -ray exposures can be reduced by nearly one
best I have used. half, and the general quality of the negatives is above
“They have great rapidity, give exceptional detail, the average.'

Motes and Abstracts..

PROTECTION.
Gloves for X -ray Workers (by Dr. William Mitchell).—
Take a pair of thick leather gloves ( for example, pruning -gloves)
and soak thoroughly in saturated solution of bismuth chloride,
made by dissolving bismuth carbonate in pure HCl. Then
throw the gloves into cold running water for an hour. This
causes an interstitial precipitation of oxychloride of bismuth,
which is highly insoluble. Next thoroughly dry and then
repeat process two or three times. A glove will then be obtained
much more protective than the usual rubber gloves, and not
poulticing the hands as rubber gloves do. Bismuth, having a
higher atomic weight than lead, gives more protection than
gloves with interstitial precipitation of lead salts.
The Protection of the Roentgenologist (New York Med .
Journal, November 16, 1907 ).— Dr. Charles L. Leonard calls
attention to the dangers which the use of the Roentgen ray
entails upon medical men employing it. Rules and limits of
safety, he says, have been determined which render accidents
rare, and the more serious are now only found amongst prac
titioners who are attempting to employ this powerful agent,
whose potency they cannot comprehend, with little theoretical
and no practical knowledge or experience. There is no doubt
that much of the gravity of Roentgen operators’ lesions is due to
meddlesome surgery and medication. This is the result of lack
of appreciation of the true character of these lesions. They are
due to trophic nerve injury, decreased nutrition and blood
supply of the part affected. The best local treatment is to let
the lesions alone and to protect them from further irritation .
After all, however, the best mode of treatment is prophylactic,
and therefore the protection of the operator should be carefully
studied. The best method of protecting both operator and
4442
328 ARCHIVES OF THE
patient is to confine the radiations to the area to be examined
or treated. This can best be accomplished by surrounding the
tube or source of all radiations by sheet lead of sufficient thick-
ness. The entire tube should be enclosed in a box of sheet lead
having diaphragms of varying size, through which alone the
rays are permitted to pass. This material can be employed by
leaving an air insulation of 4 inches on each side of the tube.
RADIOLOGY.
The Present Status of the Roentgen Ray ( New York
State Journ . of Med ., December, 1907).- Dr. Arthur Holding
states that to-day radiography bears all the ear- marks of a
clinical laboratory method - i.e., the required instruments are
costly and delicate ; they require an operator with technique to
get satisfactory results ; X-ray observations are of clinical value
to the general profession ; their therapeutic value is occasional
rather than general, and should not be magnified. The Roentgen
ray is still the X or unknown ray, although the generally providing a cheap and suitable mercurial lamp for the prac
accepted theory is that the wave-lengths of this light are far
shorter and their rate of vibration far more rapid than those of
ordinary light. These short waves of light are destructive to the
human organism , as witnessed by the development of carcino
mata and azoospermia among the X-ray operators. Therefore
to-day the radiographer avoids all exposure to the rays. This
has led to the passing of direct fluoroscopic examination. To-day
it is generally recognized that the X ray causes degeneration of
epithelial tissues , especially those of the skin and its appendages.
It also causes endarteritis, as well as destruction of the lym
phatic tissue. The X ray has proved curative in intractable or lamp was destined to prove of value, especially in scaly skin
inoperable cases of tuberculous adenitis, pruritus, acne, sycosis, affections, in lupus, impetigo, and baldness. He also praised it
lupus vulgaris and erythematosus, spleno -myelogenous leu on account of its bactericidal value. In another article Axmann
kæmia, pseudo-leukæmia, and eczema. It is, moreover, relates his practical experiences with this lamp. He employed it
a
specific cure for epidermoid cancers. It has also a beneficial
effect in cases of cancer and sarcoma to which the ray can be
applied directly.
N Rays . - In the Journal of the Franklyn Institution for
July, August, and September, 1907, will be found a series of
articles on the n rays, n , rays, and physiological rays , by
G. F. Stradling. A brief résumé of the contents of the original
articles is given, and a list of references is given to the articles
dealing with the subject. The list includes 278 articles in
different scientific journals.
The Behaviour of Uric Acid and Purin Bodies in the
Urine and Blood under the Influence of the Roentgen
Rays. — Linser and Sick contribute an interesting paper to the
Deutsches Archiv f. Klin . Med ., which is referred to in the
Münchener Med . Wochenschr. (May 14, 1907) . In healthy blood
we find that the Roentgen rays produce a marked diminution in
the number of the leucocytes ; and in connexion therewith we
find an increase in the total nitrogen elimination, as well as an
increase in the amount of uric acid and urinary salts. The
destructive action of the Roentgen rays affects not only the
leucocytes in the blood, but also the organs themselves. In
consequence of the destruction of the white cells, there is pro-
duced a toxic material which in turn affects the blood and the
constituents of the urine.
ROENTGEN RAY .
RADIOGRAPHY.
Radioscopy and Radiography employed in the Detection
of Tuberculous Meat (H. Martel, Archives d'Él. Médicale,
XV. , p. 557 , July 25, 1907. From the Semaine Méd ., June 19,
1907).-Radioscopy affords a ready means of detecting tubercular
lesions in the bronchial and mesenteric glands and in the lungs,
while radiography is still more exact. A negative result cannot,
however, be always relied upon. The method has many advan
tages over dissection, which takes much longer to perform and
depreciates the value of the carcass.
PHOTO-THERAPY .
The Uviol Lamp in Dermatology ( Therapeutische Rund
schau , No. 6, 1908 ).- Friedrich Kalmus contributes a very
complete account of the references in the literature regarding
this lamp. He says that the Uviol lamp has afforded us
marked improvement in the treatment of skin diseases. It was
invented by Schott in 1905. By its introduction the problem of
titioner has at last been solved. Quite a number of articles
have been written within the past two years on the value of this
lamp, and the last word has certainly not yet been spoken
regarding it. Axmann of Erfurt was one of the first who
devoted himself to the study of the Uviol lamp. He gave his
experiences with this new method of light treatment in various
articles. He praises it very highly, and appears to prefer it to
all other therapeutic light methods. From theoretical con
siderations in connexion with the ordinary course of practice,
this observer so early as July, 1905, considered that the Uviol
in cases of eczema, acne vulgaris, and alopecia, and obtained
excellent results. Cases which had resisted other modes of
treatment for a long time yielded after one or two applications
of the Uviol lamp. A case of complete alopecia was greatly
benefited, so that after the third application downy hairs began
to make their appearance, and after the tenth séance the head
was covered with short but genuine hairs. Axmann claims that
the beneficial properties of this lamp are due to its ozonizing
action. He also records excellent results in cases of psoriasis,
intertrigo, lymphangitis, furunculosis, ringworm , and sycosis.
He also obtained complete cure of a chronic conjunctivitis
which had lasted for a year . Axmann sees in the action of the
Uviol lamp a somewhat analogous effect to that produced by
Bier's stauung hyperæmia.
Another experimenter with the Uviol lamp is Strauss of
Barmen . In August, 1906, he published a paper on the
“ Scientific Basis of Uviol- Therapy.” He praises the lamp
very highly. He has obtained good results from its use in
cases of folliculitis barbæ, acne vulgaris, and acne rosacea , as
well as in subacute and chronic eczema. Its use is contra
indicated, according to Strauss, in acute cases. In psoriasis
good results followed the use of the Uviol lamp, but they were
not lasting. In parasitic skin diseases, such as pityriasis and
gworm , it acted well. In different forms of alopecia Strauss
obtained good results from the use of this lamp. Observations
 ARCHIVES OF THE
by Assfalg of Frankfurt coincide with those of Axmann and
Strauss. He obtained good results in cases of alopecia areata,
acne vulgaris, acne rosacea, eczema, and ulcers of the foot.
The beneficial results obtained in cases of psoriasis proved to be
only temporary. In this experimenter's opinion the Uviol lamp
does not come into consideration in connexion with cases of
lupus, as in such cases the penetrating action of the Finsen
lamp is more beneficial.
Meyer of Kiel gives us a more extended contribution on the
uses of the Uviol lamp in dermatology. Meyer considers that
the great advantage of the lamp over ointments is its simple and
convenient mode of application . Finally we have the observa-
tion of Stern and Hesse of Düsseldorf, in an article entitled
“ On the Action of Uviol Light on the Skin and its Therapeutic
Application to Dermatology.” They made some experiments
with this lamp on the normal skin. The séances lasted for
fifteen minutes. Within three hours there were no apparent
changes ; within twelve hours there was slight ædema of the
cells of the rete ; and after thirty -six hours this ædema had
increased, and in a few places small hollow spaces were observed
on the skin. On the third day after the use of the lamp the
middle layer of epidermis was seen to present numerous small
cavities. Stern maintains that the beneficial effects of the Uviol
light are due to improved nourishment of the skin from long
continued hyperæmia and the throwing off of its upper layers,
while its bactericidal action is only slight and quite superficial.
He finds that the Uviol lamp is by no means a cure-all, and
ought never to be brought forward with exalted claims as to its
merits .
Kalmus concludes this excellent survey with a full bibli-
ography brought completely up to date.
The Application of Blue Electric Light in Various
Diseases ( Allg. Wr. Med . Zeitung, April, 1907 ).- Manujlow
refers to the reports of the collected literature on the effects of
sunlight as resembling in many respects those produced by
electric light, and then goes on to speak of his own personal
observations on the subject. He generally employed blue lamps of
25, 32, and 50 candle-power, and compared with these the effects
of ordinary glass lamps. The duration of the séance depended
on the severity of the case, the nature of the disease , and
results obtained . In skin diseases the author combined the
light treatment with the application of a 5 per cent. eosin or
fuchsin solution. Results were obtained, not only in many
instances of neurasthenic and hysterical affections, but also in
various neuralgic conditions, acute and chronic rheumatism ,
and in the pain associated with gastric cancer. Inflammation
of the liver, malarial spleen, and pleurisy were equally bene
fited as regards alleviation of the pain, while the resolution of
the inflammatory process was hastened . Improvement also
followed in tuberculous disease of the hip-joint. The skin diseases
which the author found to be most improved by the treatment
were lupus, parasitic sycosis, psoriasis, and eczema.
Red Light and Iodine Paint. - J. Dunbar Brunton, M.B.
(Brit. Med . Journ .), points out a fact about the use of iodine
which is not generally known . If iodine is painted on the
human skin in the dark, and only a red light such as is given by
an ordinary photographic lantern is used, there will be quick
ROENTGEN RAY. 329
absorption. The skin will be neither discoloured nor blistered
even under prolonged use . He believes he is the first to discover
this method, and has used it for ten years at least.
The part painted should be immediately covered up, as
exposure to any white light fixes the iodine in the skin .
The Removal of the Dilated Vessels caused by Radium
Treatment (HANS AXMANN, Erfurt). — Every one who has
worked with radium is familiar with the dilated vessels which
are apt to occur in the neighbourhood of the scar, beautifully
white and smooth as is the scar in other respects. These dilated
vessels may not appear until months after the treatment.
For three years the author has been working at the preven
tion of this trouble. Caustics and the like usually make matters
worse. Eventually he lighted upon the idea of using radiations
of a different sort namely, Uviol rays . These ultra- violet rays
of short wave -length are in a certain sense antagonistic to the
corpuscular emanations of radium. This applies to both their
physical and their chemical actions, and it appears to apply also
to their physiological actions.
A few vigorous irradiations with a uviol or a quartz lamp
sufficed to cause the permanent disappearance of these telangi.
ectases . To prove this experimentally, he made use of his
forearm , which was the seat of numerous radium scars , the
results of former experiments with radium . The vessels of the
left arm were treated once or twice with the rays, with the
result that they disappeared , while those of the right arm,
which was not treated , still persist after six months.
The procedure is of theoretical interest also, since ultra -violet
rays are largely used in the treatment of vascular nævi occurring
spontaneously.
Treatment of Angina pectoris by Arc Light Baths.
Hasselbach and Jacobaeus describe the treatment as the
exposure of the entire surface of the patient to as long-continued
and intense action of the electric rays as will produce as severe
a dermatitis as the patient can bear. They report several cases
of angina pectoris in which this form of treatment was attended
with excellent results. The improvement was very noticeable
in one case after the first bath, in another after the second,
while in almost all it was very marked after the third . — New
York Medical Journal.
Experiences with the Quartz Lamp (Deutsche Med .
Wochenschr., No. 42, 1907).- Heymann records improvements,
and even cures, in cases of lupus vulgaris, nævus, psoriasis,
eczema, acne vulgaris, ulcer of the leg, and other conditions,
from the use of Kromayer's quartz lamp, which was employed
partly with and partly without compression . The markedly
powerful surface effect upon necrosis is specially noteworthy,
and is to be observed even in spite of the application of methy
lene blue solution. The use of this solution as a filter for the
other powerfully irritating ultra - violet rays is, he maintains,
unreliable, since it is difficult to gauge the correct degree of
concentration. More reliable as a filter is one of the Quartz
Lamp Company's lately introduced “ultra-violet discs,” which
are made of a special kind of blue glass, and which are now in
every case employed by the writer.
330 ARCHIVES OF THE
RADIO-DIAGNOSIS.
Diagnosis of Lung Tumours by Means of the Roentgen
Rays. —- Karl Parascandolo (Wiener Medizin. Wochenschr.,
No. 38) states that Lohnstein, Leo, and other writers can
demonstrate tumours of the lungs by radiography, inasmuch as
the part occupied by the tumour appears as a shadow. The
normal penetrability of the lung.tissue for the X rays will, we
presume, become altered as occurs in cases of tuberculous con
solidation, ædema, foreign bodies, and fluid in the pleural
cavity or in the pericardium . The distribution and localization
of the increase in the lung density differ in different affections
of the thoracic organs. The diaphragm gives us another
diagnostic aid by the changes which take place in its linear
shadow. Thus a pneumothorax shows quite a characteristic
curve on the affected side. The Roentgen examination in this
way is a valuable addition to our methods of physical diagnosis.
The Bismuth Skiagram in Gastro - Intestinal Disorders.-
The principle upon which the method is based is that of giving
the patient a mixture in which a bismuth salt is suspended in a
mucilage; the bismuth is precipitated within the alimentary
canal, and the organ in which it is so precipitated gives a dark
shadow both on the X -ray screen and in an X-ray photograph .
The best salt to use is the carbonate, from which no ill effects
accrue . The subnitrate is liable to cause formation of nitrites,
with somewhat unpleasant results in a few cases.
It is essential that the stomach or intestines, as the case may
be, should be as free from food or fæces as possible at the time
the X -ray bismuth picture is being taken. Fæces in the large Gastroenterostomy . — Goyanes (El Siglo Medico, August 10,
intestine throw all sorts of shadows, and the picture may be still
more confused if very clear areas due to gas in the bowel alter
nate with darker areas due to fæces . This is well known in
cases where a kidney is being examined for a calculus. If the
bowel has not been emptied before the skiagram is taken, an
opacity in the photograph may suggest a renal calculus, though
it may really be a scybalous mass in front of the kidney in the
ascending or the descending colon. Very soon after the bismuth
mixture has been swallowed the precipitated bismuth forms a
uniform coating to the inside of the stomach , and the X rays
show the exact outline of this organ. After a longer or shorter
interval the bismuth begins to pass through the pylorus into the
duodenum , and a measure of the mobility of the stomach can
thereby be obtained . In cases of pyloric obstruction, the great
delay in the passage of the bismuth onwards is a very valuable
additional means of diagnosis. After a certain number of hours
the bismuth should all be in the colon, and it may here be
investigated with the X rays again, if necessary.
The X -ray examination by means of the bismuth shadow is
applicable to every portion of the alimentary canal below the
pharynx. The stomach and intestines can be studied more
completely and more accurately by this method than has
heretofore been possible. Marked prolapse may be detected
when other physical examinations fail to show it.
The technique varies in the hands of different observers. As
a rule bismuth carbonate is the salt used, suspended in mucilage,
and added to a bowl of bread and milk ; and from 1 to 4 ounces
of this salt are given in from 6 to 30 ounces of total bulk of
bread and milk . The patient finds no difficulty in taking it,
ROENTGEN RAY.
though naturally he would not be asked to do so unless his
illness made it well worth while pursuing this particular method
of investigating it. In some cases the bismuth is given through
a small-bored stomach tube, and then, although ill - effects are
not to be anticipated from the quantity of bismuth used, the salt
can be removed from the stomach by means of the same tube
after the X-ray picture has been obtained. The patient should
hold his breath for eight to fifteen seconds if a photograph is
taken , to minimize any blurring that might arise from move
ments of the diaphragm .
If it is desired to investigate the mobility of the stomach or
the condition of the colon, the bismuth must naturally not be
siphoned off again. It is then usual to take three skiagrams at
intervals. The first is taken within half an hour after the
bismuth is administered ; the second six hours later, no solid
food being allowed in the meantime; the third twelve to four
teen hours after the first, this being the best time for pictures
of the colon. The first skiagram shows the size, shape, and
position of the stomach ; the second affords a measure of the
mobility and emptying power of the stomach ; and the third
shows the position, size, and shape of the colon.
Skiagrams have proved serviceable in the diagnosis of
stricture, dilatation, and sacculation of the æsophagus ; of
dilatation and prolapse of the stomach ; of hour-glass stomach ;
of pyloric obstruction by healed ulcer or by growth ; of stricture,
dilatation, and tumours of the intestine ; of prolapse of the
colon and sigmoid flexure. — The Hospital, November 23, 1907 .
Examination of the Mobility of the Stomach after
1907 ) has been investigating this by means of the X rays. He
states that the new pylorus acts in the same way as the original
one, and notas if it were a simple opening. It offers resistance
to the passage of fluids and gases, and keeps back the stomach
contents for a longer or shorter time. The emptying of the
stomach takes place in about the same time as in the normal
case . Moreover, the necessary motor power is the same as in
the normal stomach . A pre -existing dilatation of the stomach
is scarcely altered by the operation.
On the Roentgen -Ray Examination of Fractures ( Wiener
medizin . Wochenschr., No. 45 ).— Grashey in this valuable con .
tribution records the results of 1,500 cases of fracture examined
by means of the Roentgen ray. When clinically there only exists
a suspicion, it is well to treat such cases as if they were fractures.
If, however, one waits until the shadow due to callus formation
can be obtained , then a certain diagnosis can be made. Many
fractures are only diagnosed by the Roentgen rays when they
deviate from the ordinary type. Illumination is only of service
for localizing the fracture ; for purposes of diagnosis the photo
graphic plate is of greater importance. The Roentgen rays have
widened our knowledge of fractures very considerably, but they
have not rendered superfluous the use of clinical methods of
investigation ; on the contrary, they have rendered the picture
obtained by external examination by the hand more perfect and
more complete.
Fracture of Acetabulum . - Dr. Lewis Jones showed a skia
gram taken by Dr. Graham recently of a peculiar injury in the
hip region, with perforation of the acetabulum by the head of
 ARCHIVES OF THE
the femur. A lady, aged twenty, sustained a severe fall upon
her side, the force of the blow being concentrated upon the great
trochanter. A severe bruise resulted, and the lady was in bed
for three weeks. When ultimately a skiagram was taken it was
found that the head of the femur had been driven right through
the acetabulum , and protruded for some distance into the pelvis.
Around the head of the acetabulum a quantity of callus had
formed , and this was visible in the X-ray photograph .
ELECTRO - THERAPEUTICS.
Conservation of the Human Arterial Pressure after
Application of High -frequency Currents by Auto-conduc-
tion. J. Bergonié, A. Broca, and G. Ferrié (Archives d'Él. previously used. It is not proved that an electric excitation
Médicale, October 10, 1907).— The experiments were made with
& 10-kw. wireless telegraph plant from which effective (r.m.s.)
currents of 15 to 20 ampères at a frequency of 400,000 per
Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
SIR,—At a meeting held at the Birmingham University on
the 7th instant, presided over by Sir Oliver Lodge, a fund was
started to assist Dr. Hall -Edwards, who is well known as a
pioneer in this country in radiographic work.
As a result of his work, cancer of the skin has developed in
both hands. It has been found necessary to amputate one
hand, and it is feared that he will lose the other.
Dr. Hall-Edwards is in consequence deprived of all means of
earning a livelihood , and has to face an uncertain future with
the added distress of financial difficulty.
It is felt that Dr. Hall- Edwards' work , both in connexion
with the use of the X rays and in investigations arising from
the same, will largely do away with the risk and terrible suffer
ings which he, as a pioneer, has had to bear.
Dr. Hall- Edwards joined the Imperial Yeomanry at the time
of the Boer War, and for eighteen months was attached to the
Army Medical Department, where his X-ray apparatus and
work was found of the utmost service.
A subscription of about £ 800 has been raised locally, but it is
felt that further assistance is needed to enable Dr.Hall-Edwards by restoration of the lymphatic glands to their physiological
to live on with anything like comfort.
With these facts we feel that we can appeal to the public for
support with confidence, and would ask that any subscriptions
should be sent to the Hon. Treasurer, Frank MARSH, F.R.C.S.,
93, Newhall Street, Birmingham .
We are yours ,
ROBERT M. Simon , M.D. ,
J. C. VAUDREY, M.Inst.C.E. ,
Hon. Secretaries.
41 , Newhall Street, Birmingham .
March 21 , 1908 .
To the Editor of the ARCHIVES OF THE ROENTGEN Ray.
DEAR SIR ,—Since contributing an article on the induction of diagnostic purposes. By “ pericardium ” we presume he means
auto -vaccination by X -ray irradiation of lymphatic glands
ROENTGEN RAY. 331
second were obtainable, currents nearly ten times greater than
had hitherto been employed for this purpose . Using an output
of 5 kw. and a maximum P.D. at the terminals of the auto -con
duction solenoid of 100,000 volts ( 15 centimetre spark ) and 10
to 15 wave- trains per second, the maximum intensity of each
wave - train being about 500 ampères, it was found that of 39
concordant measures, 3 were indecisive, 4 gave a reduction, 10
an elevation, and 21 no variation of pressure. It is thus con
cluded that no change in pressure is produced.
This note was presented to the Academy of Science (Septem
ber 16, 1907) by D'Arsonval, who remarks that the experiment
was made with currents ten times more intense than those
repeated 50,000 times per second has the same or a greater effect
than one with a frequency of but 5,000. It even seems probable
that the maximum effect is found with this latter frequency.
involved in tuberculosis, which appeared in the ARCHIVES OF
THE ROENTGEN Ray for April, 1907, I have been engaged in
similar observations in regard to the effects of irradiation of the
lymphatic glands involved in early cancer. These observations
were not controlled by estimations of the opsonic index, as was
done in the former condition , the reason being the lack of
sufficient knowledge regarding the specific micro-organism
responsible for the disease, and of its life phases and cultivation
in artificial media.
The clinical changes, objective and subjective, were, however,
easily noted, as they were manifested during the course of
treatment which extended over a few weeks. By the use of
Belot's shield and localizer it was possible to restrict the
molecular action of the X rays to the small surface of skin
corresponding to a single gland, any deeper glands which
chanced to lie in the course of the rays being included in their
influence to a lesser degree. The rest of the body, including the
lesion itself, was effectually protected from the influence of the
rays. In four cases of unquestionable epithelioma, arrest of
growth, retrogression , and disappearance of the lesion , followed
state, have so far resulted. I hope soon to submit full details of
these cases, which seem promising.
Yours faithfully,
H. D. McCULLOCH, M.D.
Bassendean, Bournemouth .
February 27, 1908.
To the Editor of the ARCHIVES OF THE ROENTGEN RAY.
DEAR SIR,—Dr. Howard Pirie in his letter raises a point of
great interest to all engaged in the production of skiagrams of
the chest .
He suggests that the presence of the shadow of the pericardium
may be used as a safe guide as to the value of a skiagram for
the indefinite shadows seen on each side of the heart, always
 332 ARCHIVES OF THE ROENTGEN RAY.

most marked on the right, to which Dr. Halls Dally applied the based. If it does not do so , an expression of opinion as to the
name “ pleuro-pericardial lines," and of the real origin of which presence of early tuberculosis is, we think, not justified.
we are still in doubt. Unfortunately , though never entirely
This test is a simple one, and we have found it reliable.
absent, the density of these lines varies greatly in different Yours faithfully,
individuals, hence their use for the purpose suggested is liable to David Lawson, M.D.
be very misleading . R. H. CROMBIE.
For some time we have considered that a negative which Nordrach - on - Dee,
shows clearly the outline of the first two or three dorsal inter Banchory, N.B.
vertebral discs is one which a satisfactory opinion may be March 14 , 1908.

Description of Plates.

PLATES CCLXXXVII. AND CCLXXXVIII.

TO ILLUSTRATE THE ARTICLE ON “ THE THEORY AND TECHNIQUE OF TELEROENTGENOGRAPHY . "
BY DR. ALBAN KOEHLER, WIESBADEN (P. 311 ).

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send, with any prints intended for publication , a full account of the
case, and also an account of the process used in radiography — such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate orfilm used, or any other facts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE EDITOR begs to acknowledge communications from Dr. Nunn ( London), Dr. Goldmann (Freiburg ), Dr. Béla
Alexander (Hungary ), Mrs. Savill, M.D. (London) , Dr. Hertz ( London ), Dr. Foveau de Courmelles ( Paris).
The following Journals and Periodicals have been received: “ Advanced Therapeutics, ” “ The Electrician,”
“ The Electric Review ,” “ Knowledge," " The British Journal of Dermatology ," “ Annals of Physico -therapy,”
" Medical Times," “ Medical Electrology and Radiology ," “ Archives of Physiological Therapy ,” “ Archives
d'Électricité Médicale," " Le Radium ," " Annals d'Électrobiologie et de Radiologie,” “ Fortschritte auf dem Gebiete
der Röntgenstrahlen," " Münchener Medizinische Wochenschrift," " Zentralblatt für Physikalische Therapie,”
“Annali di Elettricitá Medica," “ Rivista Internazionale di Terapia Fisica."
THE ARCHIVES OF THE ROENTGEN RAY AND ALLIED PHENOMENA is published monthly.
Communications should be addressed to “ The Editor of the ARCHIVES OF THE ROENTGEN Ray, care of
Messrs. Rebman Ltd., 129 Shaftesbury Avenue, London, W.C.," or to “ W. Deane Butcher, M.R.C.S. , Holyrood,
Ealing, W."
All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration, will be acceptable, and each contributor will be furnished
with a limited number of reprints free of cost.
All radiographs and photographs must be originals, and must not have been previously published.
The plates are guaranteedto be faithful reproductions of the originals, and will always be prepared with the
utmostcare and by the best process available.
Readers sending pictures for reproduction are asked to send with them full notes of the cases, so as to make
them interesting from all points of view .
Annual Subscription , payable in advance, Sixteen Shillings net (Four Dollars), including postage; single
numbers, One Shilling and Sixpence net (Thirty-six Cents) , twopence extra for postage (Four Cents). Back
numbers can be supplied ; prices on application.
RATES FOR ADVERTISEMENTS IN THIS JOURNAL.-Rates for ordinary and special positions, and series discounts
upon application .
Communications relating to advertisements should be addressed to the Publishers, REBMAN LTD .,
129 Shaftesbury Avenue, London, W.C. (Publishers of the “ Archives of the Roentgen Ray and Allied Pheno
mena," etc.).- Telegraphic Address: “ Squama, London" ; Telephone : No. 2026, Gerrard.

Billing and Sons, Ltd. , Printers, Guildford, England .

 Annual Subscription , Price 1/6 net (with postage 1/8).
16/- net ($4), in advance .
No. 94 . 36 cents (with postage
40 cents ).
L
VO . XII .

No.
12.
F H
P
RA
IP ARCHIVES
OF

THE ROENTGEN RAY

AND ALLIED PHENOMENA
( Formerly ARCHIVES OF SKIAGRAPHY ).
AN INTERNATIONAL MONTHLY REVIEW
OF

THE PRACTICE OF PHYSICAL THERAPEUTICS.

Edited by W. DEANE BUTCHER, M.R.C.S., F.P.S.
IN COLLABORATION WITH

ROBERT ABBE ( New York ); A. BECLERE ( Paris) ; T. P. BEDDOES (London ); J. BELOT ( Paris) ; F. BISSERIE ( Paris);
H. BORDIER (Lyons); J. BURNET (Edinburgh ); R. HIGHAM COOPER (London ); W. COTTON ( Bristol); FOVEAU DE
ELEC COURMELLES (Paris); L. DELHE & M ( Paris); R. W. FELKIN ( London );
a
TRON L. FREUND (Vienna ); H. E. GAMLEN (West Hartlepool); G. P. GIRDWOOD
(Montreal) ; STANLEY GREEN ( Lincoln ); H. GUILLEMINOT ( Paris ) ; e r
I D. GUNZBURG ( Antwerp) ; J. HALL -EDWARDS ( Birmingham ); G. HARET
( Paris); C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT ( Vienna ) ;
F. H. JACOB (Nottingham ) ; LEWIS JONES ( London ); A. C. JORDAN ( London );
o th
ARCH. JUBB (Glasgow ); E. LAQUERRIERE ( Paris) ; S. LEDUC ( Nantes) ;
E.R. MORTON ( London ); G.HARRISON ORTON ( London ); H. G. PIFFARD (New 08
MA

York ); JNO.C.RANKIN ( Belfast); WERTHEIM SALOMONSON ( Amsterdam ) ; 9

1 .
Y.

W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM ( London ) ; CHISHOLM

WILLIAMS (London ) ; CLARENCE WRIGHT (London ).

CONTENTS
PAOK PAGE
EDITORIAL .
333 NOTES AND ABSTRACTS ( continued ):
PROGRAMME OF THE FOURTH BERLIN CONGRESS EXPERIMENTS ON THE LAW OF THE ACTION OF THE
OF THE GERMAN ROENTGEN SOCIETY 334 ALTERNATING CURRENT ON ORGANIZED STRUCTURES - 360
THE ELECTRICAL SECTION OF THE BRITISH THE EFFECT OF ARTIFICIAL LIGHT ON PLANT LIFE • 361
MEDICAL ASSOCIATION AT SHEFFIELD 335 THE ROENTGEN-THERAPY OF TUBERCULOUS CYSTITIS - 361
TREATMENT OF EPITHELIOMA WITH ROENTGEN RAYS · 361
ORIGINAL ARTICLES : HYPERTROPHY OF THE PROSTATE TREATED BY RADIO
THE VALUE OF THE X RAYS IN THE DIAGNOSIS OF OBSCURE THERAPY • 362
ABDOMINAL DISEASES . — By PROFESSOR Edwin E. GOLD EPITHELIOMATA TREATED BY ROENTGEN RAYS · 362
MANN , Freiburg, Breisgau : -
· 235
REPORT OF 107 CASES OF CANCER TREATED WITH THE
ON THE USE OF THE SABOURAUD PASTILLE FOR THE X RAY 362
MEASUREMENT OF X RAYS. - By AGNES F. SAVILL, THE INFLUENCE OF THE ROENTGEN RAY ON THE DIAGNOSIS
M.A. , M.D. , M.R.C.P. 340 AND TREATMENT OF FRACTURES OF THE ELBOW - JOINT 363
RADIOGRAMS OF Syphilis Of The Long Bones. — By The REMOVAL OF A FOREIGN BODY FROM THE LEFT
MARTIN W. WARE, M.D. 343 BRONCHUS 363
RECENT PROGRESS IN ROENTGENOLOGY AND ROENTGENO . ELECTRICITY AS AN IMMUNIZING AGENT AND DISINFECTANT 363
THERAPY . - By DR. J. BELOT 344
TREATMENT OF Tic · DOULOUREUX BY ELECTROLYTIC
REPORTS OF SOCIETIES : INTRODUCTION OF THE SALICYLIC ION • 363
ROYAL SOCIETY OF MEDICINE-ELECTRO-THERAPEUTICAL THE GALVANOMETER IN THE STUDY OF MENTAL DISEASES 361
SECTION 354 EXPERIENCES IN THE TREATMENT OF ACUTE ARTICULAR
REVIEWS : RHEUMATISM WITH STAUUNG - HYPERÆMIA · 365
.

ATLAS CHIRURGISCH -PATHOLOGISCHER ROENTGENBILDER 358 TREATMENT OF EPITHELIOMA OF THE SKIN BY HIGH
L'IONOTHÉRAPIE ÉLECTRIQUE - 358 FREQUENCY CURRENTS · 365
LEITFADEN DES ROENTGENVERFAHRENS . 359 THE VALUE OF RHYTHMICAL EXERCISES IN THE TREAT
NOTES AND ABSTRACTS : MENT OF SPASMODIC NEUROSES 365
THE SPECIFIC ACTION OF RADIUM IN THERAPEUTICS 359 - 366
THE ACTION OF RADIUM EMANATION • 360 CORRESPONDENCE -
SELECTIVE ABSORPTION OF THE ROENTGEN RAYS - - 360 PLATES :
GAS FROM THE GLASS OF X- RAY TUBES - 360 PLATES CCLXXXIX . AND COXC . - To ILLUSTRATE
ORIGIN OF ROENTGEN RAYS • 360 PROFESSOR GOLDMANN'S ARTICLE ON “ THE VALUE OF
OPHTHALMOLOGICAL EXPERIMENTS MADE WITH THE AID THE X RAYS IN THE DIAGNOSIS OF OBSCURE ABDOMINAL
OF LIGHT OF MERCURY VAPOUR 360 DISEASES ” . 347, 349

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VOL . XII.-No. 12. MAY, 1908.

ARCHIVES OF THE ROENTGEN RAY

AND ALLIED PHENOMENA :
RADIOTHERAPY, PHOTOTHERAPY, THERMOTHERAPY, ELECTROTHERAPY .
EDITED BY

W. DEANE BUTCHER , M.R.C.S. , F.P.S.

IN COLLABORATION WITH

ROBERT ABBE (New York) ; T. P. BEDDOES (London ); J. BELOT ( Paris) ; A. BÉCLÈRE (Paris ) ; F. BISSERIÉ (Paris) ;
H. BORDIER ( Lyons ) ; J. BURNET ( Edinburgh ) ; R. HIGHAM COOPER ( London ) ; W. COTTON ( Bristol) ; FOVEAU DE COURMELLES
( Paris) ; L. DELHERM ( Paris) ; R. W. FELKIN ( London ) ; L. FREUND (Vienna) ; H. E. GAMLEN ( West Hartlepool) ; G. P.
GIRDWOOD (Montreal) ; STANLEY GREEN ( Lincoln ) ; H. GUILLEMINOT (Paris); D. GUNZBURG ( Antwerp ); J. HALL -EDWARDS
( Birmingham ) ; G. HARET (Paris) ; C. THURSTAN HOLLAND ( Liverpool) ; G. HOLZKNECHT ( Vienna ) ; F. H. JACOB ( Nollingham ) ;
LEWIS JONES (London ); A. C. JORDAN (London ) ; ARCH . JUBB (Glasgow ) ; E. LAQUERRIÈRE ( Paris ) ; S. LEDUC (Nantes) ;
E. R. MORTON ( London ); G. HARRISON ORTON ( London ) ; H. G. PIFFARD (New York) ; JNO. C. RANKIN ( Belfast); WERTHEIM
SALOMONSON ( Amsterdam ) ; W. F. SOMERVILLE (Glasgow ) ; H. WALSHAM (London ) ; CHISHOLM WILLIAMS ( London );
CLARENCE WRIGHT ( London ).

RECENT painful events have brought more prominently 1. The focus-tube should always be completely enclosed
before the public and the profession the grave risks in- in an envelope which is opaque, at all events to the
curred by X -ray specialists. It would almost seem as if softer rays.
Roentgenology must be classed among the dangerous 2. The operator should not be allowed to switch on
occupations which require to be regulated by the legisla- the current without first putting on his gloves. For
ture . The list of those who have been injured severely, therapeutic work these need not be of any great thick
or even fatally, is daily growing longer , and is out of all ness ; an ordinary pair of leather gloves with a layer of
proportion to the inevitable risks which are always tinfoil over the back is quite sufficient. If preferred, the
accepted with equanimity by the practitioner who devotes palmar surface of the fingers of the glove may be cut
himself to the service of mankind . The list includes away.
the names not only of medical men, but of scientists, of If, in addition to these simple regulations, we secure
electricians, of laboratory assistants, and of not a few adequate ventilation of the room , and cut down the
manufacturers of X-ray apparatus. Both in England hours of duty to a minimum , we shall hear but little of
and abroad it is rare to see an early X -ray pioneer who X- ray dermatitis, and of those nervous and atrophic
does not exhibit some traces of honourable scars. affections which are the opprobrium of X-ray practice.
There is, however, no necessity at the present day for It should be remembered that both for medical men
the radiologist to expose himself, or his assistants, to any and their assistants X-ray diagnosis and treatment is
exceptional danger. There is no reason why, with due à serious and nerve- exhausting occupation , hence the
precautions, the X-ray room should not be as safe as any hours of duty should be short and the operator ade
other laboratory. quately remunerated. The slightest browning of the
The hospital authorities and those in charge of the skin should be taken as a danger -signal, a warning
electrical department have a serious responsibility, not which should never be neglected. The focus-tube should
so much with regard to the patients, as with regard to be entirely enclosed with the exception of the diaphragm
all members of the staff who frequent the X-ray room . aperture . Only in this way can the operator be pro
It should not be difficult to draw up regulations to be tected from the secondary radiations to which he is
observed by all persons working in the electrical depart- exposed even when not in the direct line of fire.
ment. Of these, the two following are the most im- Medical men are by no means free from the ordinary
portant. recklessness of human nature - a foolhardy disregard of
45—2
334 ARCHIVES OF THE
daily repeated dangers. Who has not seen a student
sitting on the X -ray couch, with the Roentgen light
shining gaily through his pelvis, or a member of the
junior staff warming his shins at the baleful glow of a
focus-tube beneath the table ?
The routine of Roentgen examination , and still more
of radio-therapy, necessitates a drill as strict as that of
asepsis. It is time that those in charge of our electrical
departments should take the matter in hand, and insist
that the student and the nurse should possess the neces
sary training and should take adequate precautions.
One need only allude to the other dangers of X -ray
irradiation — the arrest of development in young tissue,
and the possible injury to the reproductive organs, the
kidneys, and the pancreas—to emphasize the absolute
necessity for precaution and protection. Unless it be Grisson Transformer. "
kept under proper control, there is no more « fearful 22. Koch of Dresden : “ Skiagrams of Great Intensity."
wildfowl” than your focus-tube. 23. Maar of Munich : (a) " A Universal Stand " ; (6) “ Lead
PROGRAMME OF THE FOURTH BERLIN
CONGRESS OF THE GERMAN ROENTGEN
SOCIETY .
Held at Berlin on April 26.
I. TUBERCLE OF THE Lungs.
Papers by RIEDER of Munich and KRAUSE of Jena “ On the
Value of Roentgen Examination for the Early Diagnosis
of Tubercle of the Lungs.” Discussion by Levy-Dorn of
Berlin , Cornet of Reichenhall, and Wolff of Berlin .
1. GROEDEL of Nauheim : “ Skiagrams of the Apices of the
Lungs ."
2. ALBERS - SCHÖNBERG of Hamburg : “ Contribution to the
Roentgen -Diagnosis of Tubercle of the Lung Apices.”
3. STUERTZ of Metz : “ Pneumonic Foci in the Hilus of the
Lung in Tubercular Subjects.”
4. KLIENEBERGER of Königsberg : “ Demonstration of a Skia
gram of a Case of Miliary Tuberculosis."
5. SCHLAYER of Tübingen : " The Limits of Roentgen Exami
nation in the Early Diagnosis of Tubercle of the Lungs."
6. SCHELLENBERG of Beelitz : “ The Value of Roentgen Exami
nation in the Early Diagnosis of Tubercle of the Lung,
especially in Sanatorium Practice.”
7. IMMELMANN of Berlin : “ The Ossification of the Cartilage of
the First Rib ."
II. TECHNICAL PAPERS.
8. HOLZKNECHT of Vienna : “ Homogeneous and Central Irra
diation of the Deeper Tissues."
9. Heinz BAUER of Berlin : " On a New Method of Driving
Roentgen Tubes . ”
10. BÉLA ALEXANDER of Késmárk : “ On Roentgen Pictures.”
ROENTGEN RAY.
11. FÜRSTENAU of Berlin : “ On a New Measure of Penetra
tion. "
12. Harras of Berlin : “ Demonstration of a New Measure of
Penetration."
13. IMMELMANN of Berlin : ( a) “ A New Measure of Penetra
tion " ; (b) “ A New Orthophotograph."
14. HESSMANN of Berlin : " The Dosage of Roentgen Rays in
Practice ."
15. Grisson of Berlin : “ Errors in Methods of Measurement."
16. GRASHEY of Munich : “ Skiagrams -- Instantaneous, and at a
9
Long Distance.”
17. GROEDEL of Nauheim : "•Teleroentgenography and Instan .
taneous Roentgenography."
18. Horn of Munich : " Instantaneous Roentgenography.”
19. LESTER LEONARD of Philadelphia : “ Instantaneous Roent
genography of the Heart."
20. Grisson of Berlin : " On a Method of Taking Roentgeno
grams with Short Exposures."
21. LEVY-DORN and LOOSE of Berlin : Experiments with the
Masks in Therapeutic Irradiation .”
24. Heinz -BAUER of Berlin : “ On Roentgen Tubes."
25. EPPENS of Berlin : " A New Method of Regeneration of the
Roentgen Tube."
26. Ronde of Hamburg : ( a) “ A New Central Tube " ; (b) “ A
New Circulation Tube ” ; (c) “ A New Contrivance for
Regulating the Roentgen Tube."
27. Gocht of Halle : “ Technical Apparatus.”
28. EBERLEIN of Berlin : “ The New Roentgen Laboratory at
the Veterinary School."
29. WOHLAUER of Charlottenburg : “ A New Case for Exhibiting
Roentgen Negatives."
30. SCHNEIDER of Bad Brückenau : “ A New Apparatus for
Irradiation of the Prostate Gland.”
31. HAGGERMÜLLER and WINKLER of Munich : " Hesychos, a
New Break consisting of a Membrane and a Silver Rod . "
32. GRISSON of Berlin : “ Means of Avoiding High-Tension
Leads in the Roentgen Laboratory .”
III . PHYSICAL PAPERS.
33. Walter of Hamburg : “ On the Avoidance of the Polariza
tion of Photographic Plates with regard to Light and the
Roentgen Rays."
34. Cowl of Berlin : “ The Reverse Current and the Electric
Dynamometer ."
IV. DIAGNOSTIC PAPERS.
35. KÖHLER of Wiesbaden : “ On a Hitherto Unknown Disease
of the Bones in Children ."
36. BIESALSKI of Berlin : “ The Movements of the Human
Joints."
37. Kaisin of Florence : “ The Use of Oxygen Gas in the Radio.
graphy of the Joints.”
38. HEINRICHSDORFF of Berlin : “ Affections of the Spine."
39. REYHER of Berlin : “ Alterations of the Bones in Here
ditary Syphilis.”
 ARCHIVES OF THE
40. SCHEIER of Berlin : “ The Roentgen Rays in Rhinology. "
41. PLAGEMANN of Rostock : “Roentgenographic Examination
of the Mastoid Process.”
42. LEVY- DORN of Berlin : 66 Roentgenographic Examination of
Normal Respiration."
43. GRUNMACH of Berlin : “ The Roentgen Examination of
Asthma Gastricum . ”
44. GRUNMACH of Berlin : “ A Rare Affection of the Lungs
recognized by the Roentgen Rays."
45. RODLER of Nürnberg : “ Demonstration of the Skiagrams of
a Rare Disease. "
46. Muskat of Berlin : " The Migration of Foreign Bodies . "
47 SETTEGAST of Berlin : “ Exostosis Bursata . "
48. GRAESSNER of Cologne : “Furstenau's Method of Localiza-
tion of Foreign Bodies."
V. THERAPEUTIC PAPERS .
49. Grunmach of Berlin : “ On the Treatment of Carcinoma of plete they are.
the Stomach with Roentgen Rays.”
50. H. E. SCHMIDT of Berlin : “ The Treatment of Rodent Ulcer
and Carcinoma with Roentgen Rays, with Demonstration
of Patients ."
51. FRIEDRICH of Jena : “ The Biological Action of Roentgen
Rays on Internal Organs.”
52. Evler of Treptow : “ On the Curative Action of the Roent
gen Rays in Circumscribed Abscesses."
VI . LANTERN SLIDES.
53. ALBERS -SCHÖNBERG of Hamburg : “ Diseases of the Skin .”
54. FRAENKEL of Hamburg : “ Tumours ef the Spine."
55. GOTTSCHALK of Stuttgart : “ Plastic Roentgenograms."
56. ROSENTHAL of Munich : “ Demonstration of Skiagrams."
57. Wichmann of Hamburg : “ The Permanent Cure of Lupus
Vulgaris by Roentgen Irradiation ."
58. HAENISCH of Hamburg : Skiagrams of the Kidneys."
THE ELECTRICAL SECTION OF THE BRITISH
MEDICAL ASSOCIATION AT SHEFFIELD.
The annual meeting of the British Medical Association
will be held at Sheffield. The President, Henry Davy, the diaphragm and broken into the pleural cavity, it has
M.D., F.R.C.P. , will deliver the opening address on given rise to a conical elevation at the apex of the
July 28. The various sections will meet on the following diaphragm . It is easy to trace the history of the abscess
three days.
The officers of the Electrical Section are :
President : Edward Reginald Morton , M.D. , 22, Queen
Anne Street, London .
Vice-Presidents : William Longbottom, M.R.C.S., Shef-
field ; Dawson Fyers Duckworth Turner, M.D. , Edin-
burgh ; William Harwood Nutt, M.D., Sheffield .
Honorary Secretaries : William Jones Greer, F.R.C.S.I.,
19, Gold Tops, Newport, Mon.; Arthur Rupert Hallam,
M.D. , 325, Fulwood Road , Sheffield,
ROENTGEN RAY . 335
THE VALUE OF THE X RAYS IN THE DIAGNOSIS
OF OBSCURE ABDOMINAL DISEASES.
By Professor EDWIN E. GOLDMANN, Freiburg, Breisgau.
( For illustrations see Plates CCLXXXIX. and CCXC.)
On several occasions I have drawn attention to the im
portance of X-ray examination in determining obscure
abdominal disease. I have been requested by the editor
of the ARCHIVES to amplify the remarks I made on the
subject at the meeting of the Royal Medical Society on
October 23, 1907. I will therefore endeavour to give a
detailed and illustrated account of the present stage of
my investigations, although knowing full well how incom
At the outset I wish to remark that I
look upon X -ray examination merely as an aid and supple
ment to our older methods of diagnosis.
My attention has been specially given to the various
forms of abdominal suppuration, the diagnosis of calculus
of the appendix, and the various forms of abdominal
cancer .
Amongst the diseases of the first group there is hardly
one of which the diagnosis is fraught with greater diffi
culties than that of subphrenic abscess. In reviewing the
enormous quantity of literature on subphrenic abscess
which has accumulated within the last few years, it
seems remarkable that the X rays have been so rarely
used for its diagnosis. Although Jaworski pointed out
in 1897 how useful the X rays might be in differentiating
pleural and subphrenic effusions, it was not until 1904
that Albers- Schönberg was able to report upon his first
successful case . With his kind permission I reproduce
his plate (Fig. 1 ) illustrating the peculiar change which
the normal appearance of the diaphragm has undergone
in subphrenic abscess. As the abscess has perforated
by the dark shadow of the pus revealed on the plate.
Since we know how frequently subphrenic abscess is
associated with gaseous decomposition of its contents,
we must be prepared to find transparent fields on the
skiagram, and yet guard ourselves against an error, such
as has been recorded by Béclère. He observed a case
in which the right half of the diaphragm was pushed
upwards by a coil of intestine that had found its way
between the liver and the diaphragm. The skiagraphic
appearance had erroneously led him to believe that he
336 ARCHIVES OF THE ROENTGEN RAY ,

was dealing with a case of pyopneumothorax sub- we can easily make out the psoas and iliac muscles and
phrenicus. Under the influence of sleep and as the distinguish the septum which divides them. If pus
result of coughing, the bowel returned to its normal accumulates between the fibres of the psoas muscle, its
position . Hence Béclère's advice to take several skia- shadow becomes more pronounced. The muscle appears
grams at various times in doubtful cases, before making broader as compared with the healthy side, and in
a diagnosis of subphrenic abscess. advanced cases the line of division between the psoas
In two cases of my own , which had resulted from and iliac muscles is obliterated . A broad , irregularly
appendicitis, the X rays showed the right half of the shaped shadow is found in the place of the obscured
diaphragm tilted upwards. All doubts as to the exact muscles.
position of the shadow -casting effusion were removed Similar conditions prevail in cases of pelvic suppura
by the fact that the contours of the diaphragmatic tion . On one occasion, in dealing with pelvic osteo
shadow remained convex. Subsequent operation proved myelitis, the X rays were of great assistance in deter
that our diagnosis of subphrenic abscess was correct. mining the presence of pus on both the outer and inner
It might appear that in a number of cases the X ray surfaces of the diseased iliac bone .
would fail to be of use, as subphrenic suppuration is so The advisability of skiagraphing in doubtful cases of
frequently associated with pleurisy. In my own cases appendicitis was brought home to me by the following
pleurisy was already present at the time when the first experience. An anamic patient, whose general health
skiagram was taken, and yet the distinctness of the plate had greatly suffered , was admitted to my wards with a
had not suffered . This is due to the fact that, especially previous history of acute appendicitis. On examination
in the earlier stages of -subphrenic abscess, the pleural I found a hard swelling in the ileo-cæcal region having
fluid is serous or sero- purulent, whereas the subphrenic all the appearances of a far-advanced malignant growth.
fluid is invariably purulent, so that the contrast between The intestinal symptoms I regarded as secondary,
pleural and subphrenic exudation is well maintained . probably due to secondary invasion of the bowel. In
As regards technique, I strongly advise skiagraphing order to clear up the diagnosis I decided upon a proba
in various positions, and , when the condition of the tory incision . I found the parietal layer of the peri
patient permits, examination in an upright position toneum adherent to the swelling. Repeated endeavours
before the fluorescent screen also, in order to determine to liberate the apparent growth from its adhesions proved
whether the mobility of the diaphragm during respira in vain. I therefore abstained from a radical operation,
tion is normal or impaired. Naturally subphrenic abscess and merely removed a section from the surface of the
gives rise to irregular contractions of the affected half of swelling for microscopical investigation. In doing so I
the diaphragm . hit upon a small cavity filled with pus of fæcal odour,
I may remark in passing that the X rays were of great and containing an oblong calculus about the size of a
help to me in a case in which the puncturing needle had hazel-nut. Prolonged search for the ruptured appendix
given exit to pus under the diaphragm , and in which it led to no result . On re- examining the skiagram I had
was impossible to say whether the pus had escaped from taken of the patient before operation, I discovered a
an abscess of the liver or from a subphrenic effusion. On shadow in the sacro-iliac region corresponding exactly
skiagraphing I found the diaphragm in its normal posi- to the calculus which was removed . This shadow was
tion, and the pleural cavity transparent, from which I no longer to be seen after the operation. All doubts
inferred that it was a case of abscess of the liver. This as to the shadow-casting opacity of the calculus were
was confirmed by the subsequent operation . removed by fixing the calculus to the abdominal wall of
It is a fact only too well known to surgeons, that a healthy individual and X-raying him . The calculus
spinal caries in its early stage may remain unnoticed was plainly visible .
until a prævertebral abscess has formed . As such The chemical analysis of the calculus, kindly executed
abscesses invariably invade the sheath of the psoas by Dr. Knoop at the University laboratory, proved that
muscle, and descend along it into the pelvic cavity, one its chemical constitution was the ordinary one. I may
may diagnose them by means of the X ray before they add that the histological examination of the wall of the
reach the surface. In a skiagram of the lumbar region abscess showed that the disease was actinomycosis.
of a healthy individual, taken after clearing the bowel , Subsequent experience, gained on patients and on
 ARCHIVES OF THE ROENTGEN RAY. 337

museum specimens, has convinced me that calculus of denied its feasibility on the strength of the fact that
the appendix is perfectly demonstrable by means of the the absorbent property of the abdominal organs for
X rays (Fig. 2). X rays varies so slightly as not to afford a sufficient
Weisflog of St. Gallen was the first to communicate contrast. Various means have been adopted in order to
a paper on the X-ray diagnosis of chronic “ appendicitis remedy this want of contrast. As regards the intestinal
calculosa . " Oddly enough, Weisflog's experience was canal, bismuth has been introduced throughout its entire
exactly like my own . It was only subsequent to the length, thus affording skiagrams of great distinctness.
operation that he saw the shadow of the calculus on the I reproduce a plate (Fig. 3) illustrating a method in
photographic plate and understood its origin. use at our hospital for determining pathological con
The statistics of our most experienced surgeons show ditions of the sigmoid flexure and colon. After emptying
that in 50 per cent. of the cases in which an acute the bowel thoroughly, an emulsion of bismuth and linseed
perforation of the appendix occurs, the disease is asso- oil is injected per anum . The fluid passes easily as far
ciated with a calculus. Hence the evidence of its as the ileo- cuecal valve without any great pressure being
presence in doubtful cases given by an X -ray examina- needed . By this means dislocations of the bowel,
needed.
tion must be of great importance in advising as to the strictures, or circumscribed dilatations are readily recog.
removal of the appendix . nizable. The splendid results achieved by Holzknecht
Unfortunately , it is not always easy to differentiate and his pupils with the bismuth method in cases of
calculus of the appendix from concretions in the ureter, gastric cancer are already well known.
or the other various affections which produce the so- My attempts at skiagrapbing abdominal tumours are
called " pelvic blotch ," such as phleboliths in the veins of based upon an entirely different principle. They resulted
the broad ligaments or calcareous deposits on their valves. from the observation that the cancerous growths them
A sound passed along the ureter will sometimes help to selves absorb the X rays. If we skiagraph a cancerous
elucidate the condition . mamma after its excision , we can distinguish, not only
As a result of my own experience and that of Weisflog, the tumour, but its multitudinous ramifications into the
I have no hesitation in maintaining that a calculus of surrounding tissue (Fig. 8). In cases where the gland has
the appendix has shadow -casting properties, and that in a been removed in continuity with the lymphatic glands of
number of cases its existence can be determined by the the armpit, the infected lymphatic vessels as well as the
X rays, especially if we employ the technique which I minute cancer nodules in the glands are plainly visible.
am about to describe in connexion with the X - ray Similar results are obtained on examining cancer of the
diagnosis of abdominal cancer. In this connexion I bowel and stomach , and even of parenchymatous organs
may mention the fact that hardened fæcal matter absorbs such as the liver. This method of examination should
the X rays to such an extent as in many cases to blur prove useful to pathologists for the purpose of denion
the skiagram of the abdominal cavity. Quite recently strating cancer and its spread in various organs. Most
I treated a case of doubtful appendicitis, in which the beautiful plates may be obtained by filling the diseased
symptoms had been induced by chronic constipation bowel with air, or injecting air into the bloodvessels of
associated with stone -like concretions in the colon . parenchymatous organs previous to making the skiagram .
the plate I could trace a whole string of these concre In order to ascertain whether this simple method of
tions in the descending colon and sigmoid flexure. After skiagraphing cancer is applicable for the clinical diagnosis
emptying the bowel the shadows of the coproliths were of cancer, I began by X -raying cancer of the mamma.
no longer visible on the skiagram . Fig. 5 shows how clearly the cancer deposits stand out
In the present age of advanced operative technique against the transparent background of the pleural cavity.
nothing can be more disheartening to the surgeon than I have no experience of my own as to whether skia
the fact that so many cases of malignant growths affect- graphy offers any prospect of diagnosing lung tumours.
ing the abdominal organs defy early diagnosis, and for Recent research has shown how useful it is in detecting
this reason are often not brought to him until already localized pathological conditions in the lung, such as
incurable . abscess, tubercular deposits, gangrene, etc., so that one
It seemed a hopeless task to attempt the skiagraphy can hardly doubt its applicability to the diagnosis of
of the abdominal cavity, after Albers- Schönberg had tumours of the lung. There can be no doubt of the
338 ARCHIVES OF THE
importance of a successful skiagram in localizing the
disease, especially in cases where surgical treatment is
indicated.
I have already mentioned the difficulties which confront
the skiagraphy of the abdominal cavity. The contrast
produced by bismuth is naturally useless in the attempt
to trace abdominal cancer by its capacity of absorbing
the X rays. In such cases contrasts of an inverse order
are wanted, and are achieved by rendering the abdominal
cavity transparent by means of inflation of the bowel.
If the reader will compare Figs. 3 and 4, he will
FIG. 9. -CARCINOMA OF STOMACH .
find that, as far as distinctness is concerned, the " air
method " fully holds its own when compared with that
of the injection of bismuth into the bowel.
My method for skiagrapbing abdominal cancer is as
follows : Before the Roentgen examination the patient
receives an aperient. After this has acted, the intestine
is carefully washed out and cleansed of its fæcal contents,
the irrigating fluid being allowed to escape. The bowel operating I found the gall-bladder transformed into a
is then inflated by means of an ordinary air-bag. The
patient, as a rule, hardly complains of discomfort,
although the whole length of the large intestine is widely
dilated. A similar procedure is followed in cases of
cancer of the stomach. Immediately before the X - ray
examination an effervescent powder is administered , and
ROENTGEN RAY.
the patient is enjoined to retain the gas during the
examination .
The following is a short history of a series of cases in
which I succeeded in diagnosing abdominal cancer by
Roentgen examinations, and in which the diagnosis was
confirmed by the subsequent operation :
The first case was that of a woman, aged sixty-three ,
who was admitted to my wards for biliary calculus. The
gall-bladder projected about 2 inches below the hypo
chondrium , and felt unusually hard on palpation. The
skiagram revealed a dark, pear-shaped shadow corre
sponding to the enlarged gall-bladder (Fig. 7). This
unusual appearance of the gall bladder, so entirely
different from what is generally seen in ordinary cases
of biliary calculus, made me doubt the clinical diagnosis
of the case . Since there was no fever or tenderness of
the projecting organ , suppurative cholecystitis was ex
cluded , and I inclined to the diagnosis of cancer. On
solid cancerous growth. The cavity was narrowed down
to a slit, which contained a tiny calculus. The micro
scopical examination of the excised gall-bladder confirmed
the diagnosis of cancer.
In the second case, that of a woman, aged forty seven,
there was a fair amount of clinical evidence pointing to
 ARCHIVES OF THE
a malignant growth of the stomach. On the other hand,
there was no tumour to be felt in the region of the
stomach, and the chemical analysis of the gastric juice
gave no evidence of its existence. On the skiagram an
irregularly - shaped shadow was seen occupying the
fundus of the stomach, and stretching towards the
cardiac region (Fig. 9). I decided upon an exploratory
incision , and found in the stomach an extensive infil-
trating growth which corresponded exactly to the size
and seat of the shadow shown on the plate.
A third case, a woman, aged fifty-seven , suffered from
symptoms which her medical attendant attributed to
FIG. 10. -CANCER OF THE DUODENUM .
biliary calculus. A hard lump about the size of a
billiard -ball was to be felt in the right epigastrium near
the median line, apparently adherent to the gall-bladder.
In this case also the skiagram of the tumour showed an
irregularly -shaped dark shadow (Fig. 10). On opening
the abdominal cavity I discovered a tumour of the
duodenum which had matted the adjacent coils of
intestine into an entangled mass . A radical operation
was impossible. The patient died some weeks after the
wound had healed. The pathological diagnosis was that
of cancer of the intestines.
The fourth case was that of a patient who had
developed symptoms of stricture of the bowel. A hard
ROENTGEN RAY . 339
mass was felt in the ileo -cæcal region. The skiagram of
this case was a particularly clear one, so that there could
be no doubt as to the nature of the stricture (Fig. 6).
On cutting down on to the tumour I found extensive
cancerous destruction of the ascending colon, so that
I was obliged to limit my operation to entero-anastomosis.
The size and position of the growth corresponded exactly
to that of the shadow on the plate.
Finally I may mention a patient who had been losing
weight for three months previous to his appearance at
the hospital. His symptoms were those of chronic con
stipation. Neither by rectoscopic examination nor by
frequent abdominal palpation could I trace the cause of
the patient's trouble . After the usual preliminaries I
took a skiagram of the descending colon , and found a
shadow occupying its lower third , and narrowing the
gut to about one -third of its normal width. Unfor
tunately, the patient refused an operation , so that I
was not able to corroborate the skiagraphic diagnosis of
cancer .
Whilst pending these notes I have seen another case
of cancer of the stomach, in which the operation proved
that the skiagraphic evidence of existing cancer was
correct.
I am well aware tbat at the present stage my investi
46
340 ARCHIVES OF THE
gations are most incomplete and unsatisfactory. I have
hopes that by improved technique better results may be
19 Albers- Schönberg : Harnleiteruntersuchung
obtained, especially if we can procure photographic plates Fehlerquellenwider
of greater sensitiveness, and if the intensity of the reducing
ray is so proportioned that the best effects are produced
on the sensitized plate. I hope that my attempts at
diagnosing cancer by means of its absorbent qualities for
the X rays may find favour with X-ray specialists who
have better opportunities than I have to improve and
perfect its technique.
DESCRIPTION OF ILLUSTRATIONS .
Fig. 1.-Subphrenic Abscess Perforating the Pleural
Cavity. The right side of the diaphragm is pushed
upwards, giving a convex shadow-contour.
Fig. 2. - Calculus of the Appendix.
Fig . 3. - The Large Intestine, injected per anum with
an Emulsion of Linseed Oil and Bismuth.
Fig . 4. —The I arge Intestine, inflated with Air per
апит :
(a) Haustra.
(6) Nozzle of the injecting syringe.
Fig. 5. - Skiagram of Cancer of the Mamma in the
Living Subject, showing Cancer Nodules. The nipples
are marked by coins.
Fig. 6 .-- Cancer of the Ascending Colon.
Fig. 7. —Cancer of the Gall-bladder,
Fig. 8. - Skiagram of an Excised Cancerous Mamma
and Axillary Lymph Glands containing Cancer Nodules. light, if possible, upon several much -debated points.
Fig. 9. — Cancer of the Cardiac Region of the
Stomach .
Fig. 10.-Cancer of the Duodenum .
BIBLIOGRAPHY .
1 Perutz: “ Der subphren. Abscess,” Centralblatt für die Grenz
gebiete der Medizin und Chirurgie, vol. viii. , 1905 .
2 Beck : “ Subphrenic Abscess,” Med . Record , vol. xlix. , No. 17,
p . 217 .
3 Béclère : “ Abscés sousphrénique révelé par l'Examen radio-
scopique, ” Soc. méd . des Hôpitaux, May, 1899. Subphrenic
4 Barnard : “ An Address on Surgical Aspects of
Abscess ," British Med . Journal, February, 1908.
5 Albers-Schönberg : Der diagnostische Werth der Roentgenunter
suchungen für die innere Medizin ,” Moderne ärztliche Bibliothex,
No. 20.
6 Jaworski : “ Beitrag zur diagnostischen Durchstrahlung der
Respirationsorgane, ” Wiener klin . Wochenschrift, 1897, p. 702.
7 Determann : Beitrag zur Diagnose des subphren. Abscesses,”
Deutsche med . Wochenschrift, 1907, No. 13-18.
8 Schelble (containing notices of my first case of subphrenic abscess) :
Münchener med . Wochenschrift, 1904, No. 10.
9 Goldmann : “ The Value of X Rays in the Diagnosis of Obscure
Abdominal Cases,” Proceedings of the Royal Society of Medicine,
vol. i. , No. 1 , 1907.
10 Weisflog : “ Zur Roentgenographischen Diagnose der Enterolithen
des Processus Vermiformis , ” Fortschritte auf dem Gebiete der Roentgen
strahlen, vol. x. , No. 4 .
ROENTGEN RAY.
11 Fittig : “ Die Bedeutung der Enterolithen des Processus Vermi
formis im Roentgenbilde," Fortschritte auf dem Gebiete der Roentgen .
strahlen, vol . xi., No. 5.
(a ) “ Roentgentechnik." Verhandlungen
,” 1906 des
; ( b) “ Ueber
Berliner Roentgencongresses, 1906 ; (e) “ Zur Differentialdiagnose der
Harnleitersteine und der sogen. Beckenflecken ,” Fortschritte auf dem
Gebiete der Roentgenstrahlen, vol. ix ., p . 255 ; ( d ) “ Aus der
Roentgenologie und Roentgentechnik,” Zeitschrift f. ürztliche Fort
bildung, No. 7 .
13 Reichmann : ** Ueber Schatten im Roentgennegativen , die
Uretersteine vertäuschen können , " Fortschritte auf dem Gebiete der
Roentgenstrahlen , vol. ix., p . 254.
14 Holzknecht : (a) “ Die RoentgenologischeDiagnostik der Erkran
kungen der Brusteingeweide,” 1901; (W) “ Die radiologische Unter
suchung des Magens,” Jena, 1906.
15 Schürmayer : " Zur Roentgenologie des Abdomens und Topo
graphie der Nieren,” Fortschritte auf dem Gebiete der Roentgenstrahlen,
vol. x . , No. 6.
16 Otten : “ Zur Roentgendiagnostik des primären Lungencar
cinoms, " Fortschritte auf dem Gebiete der Roentgenstrahlen , vol. ix. ,
P. 269 .
ON THE USE OF THE SABOURAUD PASTILLE
FOR THE MEASUREMENT OF X RAYS.
By AGNES F. SAVILL, M.A., M.D., M.R.C.P.,
Assistant Physician to St. John's Hospital for Diseases of the Skin .
During the past fourteen months I have kept strict
records of the electrical readings of the apparatus in use
for the treatment of ringworin and other cutaneous
diseases at St. John's Hospital for Diseases of the Skin.
The focus tubes, seven in number, to which the records
refer were employed by no one except myself.
The investigation was commenced in order to throw
1. It is often stated that the Sabouraud pastille is
so much affected by the weather that it is unreliable in
a damp climate . Is this the case ?
2. Does the weather affect the time of exposure ? Is
there any relationship between the dampness or dryness
of the air and the length of the exposure required ?
3. Is there any constant relationship between the time
required for the epilation dose and the penetration of
he rays from a given tube as measured by the Benoist
radiochromometer ?
4. With a given tube, when the voltage and the milli
amperage readings are the same, is the Benoist reading
also always the same ?
5. With a given tube, and the same voltage, ampèrage,
and milliampérage, is the time required to alter the
pastille to tint B always the same in the same apparatus,
so that one can dispense with the use of the pastille
after once determining this time ? Is it true of every
form of installation ?
 ARCHIVES OF THE ROENTGEN RAY . 341

6. Is there any constant relationship between the the pastille. The following table, however, shows that
time of exposure necessary for the epilation dose and this is not invariably the case. A spark-gap rectifier was
the time that elapses between the sitting and the hair. used .
fall ? Or is this “ latent ” period always the same in Am Milli .
Cases . Volts. Spark ! Benoist. Time.
the same individual ? pères. ampères . gap .

The following record relates to a period of fourteen Cm . No. Min .

months, during which, with every exposure, a note was January 27 ... 4 58 0 : 5i 10 5 13-15
58 2 0.8 7-10 7 12
made of the voltage and ampèrage of the primary circuit, February 10
3 ... 5 58 3 0.8 7 6

the length of the spark-gap, the milliampérage, the 24 58 3 0.8 4-8 9 14

Benoist reading, and the time required for the alteration
of the Sabouraud pastille to tint B. When the tube was When the Benoist reading is as low as No. 2 or No. 3,
hard, necessitating much softening during the irradiation, the time required for the epilation dose is very long. If
the spark- gap, milliampérage , and Benoist readings were one attempts to hasten matters by increasing the voltage
noted at the beginning and at the end of the exposure. and ampèrage, the tube becomes still softer, and only a
During the first seven months there was no spark -gap blue reverse current is visible.
rectifier or other means of excluding the reverse current, The following tables show the results obtained with
and it may be objected that this is the explanation of several days' consecutive use of a focus-tube which was
the variation of the readings on different occasions with very soft at the start .
the same tube. During the second seven months, how June 2
ever, a spark-gap rectifier was constantly in use, and Volts. Ampères.
Milli . Spark - gap.
Cm . Benoist.
Time.
Min .
ampères.
the variations in the readings were quite as marked as 1 . 42 11 23 2 No. 3 75
before. 2. 46 2 1 3 No. 3 45

1. During the past year I have found no reason to June 10

Time.
Volts, Ampères.
Milli . Spark -gap. Benoist.
Cm . Min .
alter the opinion I expressed as to the reliability of the 1. 48 2
ampères.
1 No. 3 50
Sabouraud- Noiré pastille in the paper contributed to this 2. 50 2 14 5 No. 2 40
3. 58 2 2 4 No. 2 28
journal.* In that article I showed that, although the 3 5 No. 3 26
4. 58 21
times of irradiation required to produce tint B had
June 17 (the five readings were almost alike) -
varied from ten to ninety minutes, the resulting epila Volts .
Milli. Spark-gap. Benoist. Time.
Ampères . ampères. Cm . Min .
tion in every case followed the same normal course, 60 1-2 0.8-1 4-10 No. 4 26
whether after a long or a short exposure .
June 24–
With regard to the influence of a damp climate, I may Volts .
Milli . Spark -gap Benoist.
Time.
Ampères. ampères. Cm. Min.
mention that the work was carried out in a room heated 1. 46 1 7 No. 5 30
2. 3 12 7 No. 7 20
by hot-water pipes, so that the pastilles were never 3.
70
70 11 7. No. 7 17
exposed to damp. On the other hand , the windows 4. 70 3 14-1 7-11 No. 7 16
8-11 No. 7 15
and door of the room were always wide open during the 5. 70
sittings.
2. I found no relationship between the atmospheric It is usually said that it is best to work with a tube
conditions and the time necessary for obtaining the the Benoist reading of which is No. 6 to No. 8 ; but
tint B, whether the day was dry or wet, foggy or clear, I have observed quite as rapid results with a reading
cold or warm . The readings of the voltage, ampèrage, of only No. 4 or No. 5. The following are the readings
milliampérage, Benoist, spark -gap, and pastille time on different occasions with the same tube :
appeared to be quite independent of the weather.
Am Milli . Spark. Time.
3. With a given tube there was apparently some Cases. Volts .
pères . ampères. gap .
Benoist.

relationship between the Benoist reading and the time

Cm. No. Min .
required for the epilation dose ; but this was by no February 4 5 60 1-2 0.5-0.75 7-10 4-5 17-20
means constant. As a rule, with the same tube, the March 18 5 58 21 0.9 7-8 5 15
April 8 5 68 21 0.5 9 9-10 10-15
higher the Benoist the shorter the time required to alter 22 4 58 3-4 0.75-1.5 8-11 5 12-15
* ARCHIVES OF THE ROENTGEN RAY, May, 1907.
46–2
342 ARCHIVES OF THE ROENTGEN RAY .

Questions 4 and 5 may be answered together. Ques- rule to be followed, at least with my apparatus, is to rely
tion 4 arose from the following statement, quoted from entirely on the pastille , although this may not be true of
M. Brocq in Belot's “ Radiotherapy ” (p. 61 ) : " Sup- every apparatus . It may, however, be admitted that
posing, for instance, we are using a Chabaud focus-tube. when the tube is working smoothly, when it is not either
With a pressure of 45 volts in the primary circuit , and a very hard or very soft, and when the electrical readings
current of 2 milliampères through the tube , we get rays are constant, the pastille dose will take the same time
of a degree of penetration corresponding to No. 6 on within a minute for five or six successive exposures on
the Benoist scale . The tube may be removed and used the same day.
with a different transformer ; its vacuum may be altered, TUBE I.
rendering it harder or softer. On connecting it to the 1. February 25 , 1907.-- Grey, damp, iather cold - fourth day of use.
original transformer, with a pressure of 45 volts , we 2. March 25, 1907. - Mild , dry, and bright - eighth day of use.
need only adjust the vacuum until a current of 2 milli Volte . Am . Milli Benoist. Spark -gap . Pastille
pères. ampères, Time.
ampères passes, and we may be certain that the X rays
emitted are of No. 6 degree of penetration .” Belot adds : No. Cm . Min .
“ For a given tube, a given current and voltage always 1. February 25 58 11 4 17
2. March 25 ... 58 11 5-9 6-10 13
produce the same quality of rays.""
I found that this was not invariably the case. The
statement is sometimes true, but in my experience it TUBE II .
cannot be relied upon when the electrical energy is 1. June 24, 1907.-Cold , grey, windy day - fourth day of use.
obtained from a Ruhmkorff coil . It would be interesting 2. July 1 , 1907 .--Cloudy, damp, windy day-fifth day of use.
3. July 8, 1907. -Cold , cloudy day - sixth day of use.
to discover whether the above statement was found to be
Am Milli . Pastille
Volts . Benoist Spark -gap .
true when the tube was used on different days, after a pères, ampères. Time.

few days' interval, and after the tube had been employed
No. Cm . Min .
for some months and had given about ten or more hours 1. June 24 70 3 11 7 7 20
of work. 2. July 1 70 15 7 13
3. 8 70 4 11 8 9 14

13
99

( 1 ) The following tables show that even when the

voltage and milliampérage are alike, the Benoist readings
TUBE VI.
may differ ; and (2) that when voltage, ampèrage, milli
ampèrage, and Benoist readings all correspond, the time 1. January 6 , 1908. -Moist, muggy day -- fifth day of use .
2. January 12 , 1908. — Cold , foggy - sixth day of use.
required for the pastille to alter may vary - i.e ., the
Am . Milli. Pastille
quantity of X rays emitted may vary even when all the Volts.
pères. ampères.
Benoist. Spark -gap. Time.

electrical constants are the same. Attention is drawn to

No. Cm . Min .
the remarkable figures obtained with Tube VII. 1. January 6 ... 60 2 0.7 6 not noted 23
It would serve no useful purpose to give further 2. 12 ... 60 2 0.7 7 6 13
examples from the lengthy list of tables compiled during
the year. The examples given suffice to disprove the TUBE VII. (a very steady good tube).
unqualified statements so often made by workers with 1. February 3, 1908.- Moist, foggy - second day of usc.
the Roentgen rays. These statements mislead beginners, 2. February 10 , 1908. — Mild , bright — third day of use.
3. February 17 , 1908. — Wet, warm -- fourth day of use.
and therefore inight lead to serious consequences . It is 4. February 24 , 1908. -Cold , wet, windy - fifth day of use .
a matter of regret that I had no means of investigating
Am Milli . Pastille
the measurement of X-ray dosage by counting the Volts. Benoist. Spark -gap. Time.
pères. ampères.
number of interruptions. The tables show that, even No. Cm, Min.
when the voltage, ampèrage, milliampérage , and Benoist 1. February 3 58 2 0.8 7 7
9
12
6
2. 10 58 0.8 7
readings are alike, the pastille alteration time may vary. 3. 17 58 3 0.9 5 14
1
The only possible source of variation lies in the inter 4. 24 58 3 0.9 9-10 8 14

rupter. Some observers claim that by counting the

number of the interruptions they can estimate the correct Question 5 was more difficult to answer than I had
dose as accurately as with the pastille. The only safe anticipated. In hospital practice the average parent
 ARCHIVES OF THE ROENTGEN RAY .
finds it impossible to notice or remember when the hair
first began to loosen, and when it ceased to fall out.
After a careful analysis of the cases, I have come to the
conclusion that there is no causal relationship between
length of exposure and time of hairfall. In certain
found that
made on Idifferent
patients thereevery
days,after remained, aftereven
exposure, those
an almost
complete defluvium , a few scattered long hairs over the
entire area which had been exposed . In two children
there were left at the margins of every exposed area a
number of short " exclamation point " hairs, such as
are found with alopecia areata. In both types of cases
these remaining hairs fall out several weeks later, either
spontaneously or on slight traction .
When the exposure was protracted-three-quarters of
an hour or more-the hairfall rarely began within three
weeks, and was not so complete as usual. This may be
due to the fact that the operator's patience is usually
exhausted, and the exposure is arrested as soon as the
pastille can be said by the impatiently sanguine observer
to be “ turned ,” whereas in shorter exposures the operator
allows the pastille to be very definitely turned before
stopping the dose.
In very extensive areas of irradiation , such as the
entire vertex or side of the head, the hairs which were in
the central portion always fell out more rapidly and com
pletely than those at the margins, owing to the increased
distance of the curve from the anticathode.
Similarly ,
when the distance of irradiation was too great, the epila
tion was not only incomplete , but later in its occurrence .
This was very noticeable in one child who had several
incompleto exposures on different areas. On each of
these areas the hair began to fall three weeks after the
sitting. On two subsequent occasions this child had a
complete irradiation, and in each instance the hair began
to fall on the twelfth day after the sitting.
As regards the latent period I could not ascertain any
definite rule. In some children the hair always falls
completely and rapidly ; in others completely, but
slowly ; in others, again, the hairfall is always in
complete.
The hairfall did not, as I had anticipated, vary
definitely according to the region irradiated . Some
authorities have stated that the occiput and crown are
less sensitive, and therefore the defluvium occurs later
on these parts than on the side of the head. I could not
confirm this statement.
343
RADIOGRAMS OF SYPHILIS OF THE LONG
BONES. *
By MARTIN W. WARE, M.D.
WHEREAS it cannot be claimed that a pathognomonic
picture of syphilitic affections of the bones can be
obtained in every instance, yet these radiograms show
a uniformity in type. Furthermore, a prognosis may be
based on the radiograms and the efficacy of treatment
estimated by the regressive changes visible in successive
radiograms.
A typical sign is the circumferential thickening of the
periosteum. The thickening is not necessarily sym
metrical. It may be localized, and this is apparent to
a large extent in all the radiograms. This predominance
of the thickened periosteum stands out conspicuously
in favour of syphilis of the bones, as distinguished from
the chronic infections of the bone. The interpretation
of this shadow indicates a gummatous deposit. In some
instances this gummatous material encroaches upon the
cortex of the bone. At some levels it becomes fused
with the cortex, materially contributing to the thickening
of the bone ; at other levels it remains quite distinet.
The intensity of the shadow of the periosteum sometimes
points to a deposit of lime salts in the periosteum , whilst
translucent areas in the periphery of the bone speak for
the destruction of the gumma and bone absorption. If
the subperiosteal gummatous deposit be situated in the
interosseous space, its diagnosis would escape detection
were it not for its exposition by a radiogram . Finally ,
the thickened periosteum may be lifted from the bone
beneath .
In the bones there is an increase in diameter, the dis
tinctions in the shadows perceptible in a normal bone
become obliterated , the corticalis appears as a denser
shadow of wider extent and irregular in outline, often
encroaching on the medulla to such an extent as to
obliterate it. This is due to gummatous deposit in
the bone, which may be irregularly deposited , giving
rise to a striated appearance. If, as in periostitis, this
gummatous material breaks down, we have areas of
more or less translucency, surrounded by areas of
greater bone activity ( osteosclerosis ), which appear as
dense shadows. The gummatous deposit of the peri
osteum in the bone is attended at times by a growth in
* Read before the Sixth International Dermatological Congress,
September 13, 1907.
344 ARCHIVES OF THE ROENTGEN RAY.

the length of bones, when a bowing of these bones can pictures, most interesting from a clinical point of view,
be made out ( Fournier). which are of great help in the diagnosis of difficult
Of great service is the use of the X rays in aiding us cases.
to differentiate between a tuberculous and a syphilitic In my opinion, a Roentgenoscopic examination should
dactylitis. always precede the radiographic record. In taking a
photograph of a landscape one begins by arranging the
subject. One looks at the picture on the ground glass,
and alters the point of view so as to obtain a good
RECENT PROGRESS IN ROENTGENOLOGY AND picture. We should do the same in taking an X ray
ROENTGENO - THERAPY. * photograph --with this difference, that the fluorescent
screen replaces the ground glass.
By Dr. J. BELOT,
In examining a patient, whatever his complaint, after
Assistant Radiologist at the St. Antoine Hospital, Paris.
making a clinical examination, I begin the X - ray
In medicine the Roentgen rays are utilized either as diagnosis by using the fluorescent screen. I may
a means for diagnosis or as a therapeutic agent ; the perhaps learn but little from this, but it supplies me
science which studies these different applications is with a general idea of the seat of the disease, and
medical radiology, or, as it is called in Germany, with the best position to give the limb and the focus
Roentgenology tube. Having thus arranged my subject, I replace the
It was my intention to limit the subject of my report screen by a photographic plate, which gives me a per
to Roentgeno -therapy, since the Congress is chiefly manent record of the finer details which were invisible
occupied with therapeutics. Recent violent criticisms on the screen .
on Roentgenoscopy, however, oblige me to say a few For the examination of the bones and the recognition
words on the subject of the examination of the patient of urinary calculus Roentgenography offers greater pre
by means of the fluorescent screen. Our opponents cision. It is otherwise, however, when we examine the
assert that fluoroscopy gives no precise results, that it lungs, the heart, the aorta, the mediastinum , the æso
is a dangerous procedure on account of the burns that phagus, or the stomach . A screen examination of these
it inflicts, and that it must eventually give place to organs is quite sufficient, provided the observer has an
Roentgenography. One of the most recent writers, Dr. exact knowledge of anatomy, physiology, and clinical
Kassabian, of Philadelphia, while recognizing the fact methods. These examinations are made with the
that the procedure furnishes interesting results, does greatest ease . When the patient is able to stand up
not advise it, and emphasizes the risks to which patients right, Béclère's focus-tube stand is the simplest and the
are exposed as a result of the examination with the most practical. For patients who need to be examined
screen , It is impossible to allow such assertions to pass in a horizontal posture, I have constructed a table on
without protest. It would compromise without reason which the patient lies as on a stretcher. In this case
one of the most important branches of the new science. the focus- tube is supported underneath the table, and
In my opinion, Roentgenoscopy and Roengenography the screen is held in the hand above the region to be
should not be separated. Each method has its own studied .
special use, and each completes the other. The radio- As to the danger of this method of investigation , I
graph shows us clear and beautiful details, particularly cannot understand how it has come to be exaggerated to
of the bony structure, while the fluoroscope exhibits the such a degree . I have seen and made thousands of
organs in movement. It is the picture of life itself screen examinations, and I have never seen the slightest
which is revealed on the screen . By changing the accident to a patient. The only precaution is, not to
position of the patient or the tube, the organs appear expose the patient too long to the action of the rays.
under varied aspects, and in a comparatively brief Protective apparatus has been introduced to shield the
period the whole body may be examined , each region operator from the serious effects which were formerly of
in its turn. There passes before us a whole series of frequent occurrence. The chronic dermatitis of the
operator is now rarely seen unless dating from injury
* Official Report of the International Congress of Physio -therapy,
Rome, 1907. Translated by A. Howard Pirie, M.D. received in the early days of Roentgenography, when
 ARCHIVES OF THE ROENTGEN RAY. 345

sufficient protection was not used, and before the temerity type. During recent years it has been much improved .
of ignorance had given place to prudence. I must repeat, The insulation has been made more perfect, the winding
then, once more : Roentgenoscopy should always precede is better, and its power has been considerably increased .
Roentgenography. The two examinations supplement Most of the modern coils have an adjustable primary
one another. circuit. The self-induction may be altered by means of
ROENTGENO -THERAPY.— When one considers the evolu- a plug joining up one or more layers of the primary coil.
tion of Roentgeno-therapy, one cannot but be surprised This method , which is almost indispensable with an
at the extraordinary rapidity with which it has spread, electrolytic break , provides the operator with the means
the widespread application of those somewhat mysterious of varying the electrical constants according to the
radiations which pass through the body, producing in degree of hardness of the focus-tube and the amount
their passage such profound effects on the cellular of current required .
elements exposed to their action. New cases of cure By using an appropriate interrupter a Ruhmkorff coil
surprise us every day. may be driven either by a continuous or by an alternating
Instead of passing in review the different stages of current . For continuous current the interrupters of the
evolution of radio -therapy, its seems more simple to turbine type appear the most regular and the easiest to
describe its present state. I propose to touch upon the keep in order. Recently Gaiffe of Paris has constructed
points which seem to me both new and interesting, and an interrupter, the “ Autonome," with two combinations,
consider successively the apparatus, the technique, and one for instantaneous radiography, which has all the
the clinical methods. advantages of an electrolytic interrupter, and the other
APPARATUS . - In order to produce the X rays, one giving a feebler output for ordinary work .
must have an electrical source and a Crookes tube. Of Formerly when using the alternating current one had
all electric generators, the static machine alone supplies to employ an electrolytic interrupter. We have now,
a current capable of lighting up a focus-tube directly, however, mechanical breaks, which work quite as well as
i.e. , a current of relatively small intensity at a potential with the continous current. The Blondel-Gaiffe “ Auto
of 60,000 to 80,000 volts. I will only allude in passing nome " turbine is certainly the best in France.
to the generators of high -tension continuous corrents A type of transformer which seems destined to attain
which have recently been used in Switzerland (Thury), great success is the transformer with closed magnetic
as these are not of much practical use in Roentgenology. circuit working with an alternating current without an
Whilst much used in America, where it has attained interrupter. It is analogous in principle to the com
great dimensions, the static machine is losing its ad- mercial transformer. It necessitates some means of cutting
herents day by day. In France, in spite of great im- out one phase of the electrical oscillations, the other phase
provements in the mechanical construction and in the being used to drive the Crookes tube. This is usually
method of working, it remains a laboratory instrument. accomplished by means of one or more spark -gaps, or
Its rate of rotation has been accelerated , the number of by the use of Villard valves, as in Gaiffe's apparatus.
its plates has been increased, its parts have been made This type of transformer is excellent. It does not
more accessible, and it has been made less dependent on readily get out of order, since it has no mechanical
atmospheric influences, whilst recently it has been im- break. It is always the same, and works without noise.
mersed in a condensed atmosphere of carbonic acid gas. By inserting a system of condensers of variable capacity
In spite of all this, it remains a very capricious generator, in the secondary circuit, it is possible to vary the current
and very irregular in its output. through the focus-tube without altering the current in
Current transformers are much to be preferred for- the primary
raising the potential. As the name indicates, these do not The primitive Crookes tube was long ago replaced by the
directly produce electrical energy, but transforma focus-tube. Since then another great advance has been
current of low potential (110 to 500 volts) into one of made by the adoption of vacuum regulators. As is well
high potential. The ratio between the energy absorbed known, the Crookes tube changes during its action ; its
and the energy given out constitutes the efficiency of the degree of vacuum gradually increases, until the resist
apparatus. ance to the passage of the current becomes so great that
The Ruhmkorff coil is the oldest and most widely used the tube is of no more use . Under these conditions it is
346 ARCHIVES OF THE ROENTGEN RAY.

impossible to keep the tube constant or to produce rays gives out X rays, it should be possible, if the co -efficient
of a definite quality. In order to obviate this alteration of transformation is known, to measure indirectly the
of the vacuum, it is necessary to adopt some device output of X rays by the constants of the electric current
which will give out gas to the tube when it contains supplied .
too little, and take away gas when there is too much. The quantity of electric current passing through
Of all regulators, the simplest and most perfect is the the focus-tube was first measured by Gaiffe, who made
Osmo -regulator of Villard . By its means the tube can a special milliamperemeter for that purpose. Recently
be hardened or softened , whether in action or out of a static voltmeter has been constructed to measure the
action, by simply warming the platinum tube with a difference of potential between the anode and cathode
Bunsen flame. of the Roentgen tube. These instruments are most
In Germany a glass annexe is blown on to the tube, valuable. They tell us what happens in the focus - tube
containing a porous body, which, under the influence of itself, which is much more important than what happens
heat produced by the electric spark, gives up the gases in the primary circuit. Unfortunately, they only tell
which its contains. The capacity of this gas-holder, us very imperfectly what comes out of the tube - i.e .,
however, is soon reduced, and in a short time its the quality and quantity of the X rays. Focus-tubes
regulating power fails and the tube is of no further use. as transformers of energy cannot as yet be compared
Another disadvantage is the heating of the target or one with another. Moreover, electric measurements
anticathode under the impact of the cathodic particles, have only an absolute value for a given installation.
which strike it and give rise to X rays . As electric Electric measurements of voltage and ampèrage are,
generators grew more powerful this heating of the anti however, of the greatest assistance, since they enable us
cathode became more harmful. Anticathodes of iridium to maintain the tube at a constant vacuum. Experi
and platinum , whose temperature of fusion is very high, ments made by myself and others have shown that the
were made ; then the idea of cooling by means of water same focus-tube with the same vacuum gives out practi
was introduced . In spite of these improvements, tubes cally rays of the same quality and the same quantity
rapidly deteriorate when driven by a strong current of per unit of time. It is to be hoped that in the near
6 or 10 milliampères. The device of reinforcing the future every focus-tube will bear some such mark as the
anticathode by a large block of metal was next intro- following : Voltage, 60,000 ; current, 1 milliampère ;
duced, and by this means the heating effect was reduced. No. 6 rays at a standard distance of 15 centimetres
These tubes soften readily, but as they are only in use = 5 H in ten minutes. Under these conditions the
for a short time, this is not of any great moment. electric measurements multiplied by the co -efficient of
Focus-tubes have been specially designed for radio- the tube will define the penetration and the quantity of
therapy . Some of these are made of glass which is the rays given out by the tube. As yet, however, we
opaque to X rays, leaving only a small transparent have not reached this stage. In every luminous field
window to allow their passage. Other focus-tubes have two factors are to be considered—the quality of the rays
been constructed with the source of the X rays at the length of wave) and the quantity.
end of a small tube, so that the rays can be directed into M. Benoist originated a method of qualitative measure
& cavity, such as the uterus or rectum . These tubes, ment based on the following fact : “ Given two bodies of
however, are fragile and not to be recommended. different atomic weight, and consequently of unequal
Instruments of Measurement. — There is a well-known transparency to the rays, such as silver and aluminium ,
dictum , “ Science is measurement, ” and radio-therapy the relative transparency of these two bodies varies
is no exception to this rule. The early workers who with the quality, or, more exactly, with the power of
wished to define the condition under which their ex- penetration of the rays." This is the principle of the
periments had been carried out noted the constants radio-chromometer. It gives a measurement of the
of the electrical generator. It was soon discovered that power of penetration of the rays under consideration,
these had but little value. The same condition could easily defined , and independent of any theory as to their
not be repeated and could not be defined . constitution.
If it be admitted, however, that the Crookes tube is a I now turn to the direct methods of measurement of
transformer of energy, which absorbs electric energy and the quantity of X rays. Holzknecht, of Vienna, brought
 Fig . 1 . Fig. 2.

6
FIG. 3. FIG . 4.

TO ILLUSTRATE PROFESSOR GOLDMANN'S ARTICLE ON - THE VALUE OF THE X RAYS IN THE DIAGNOSIS
OF OBSCURE ABDOMINAL DISEASES ” ( p. 335 ).

PLATE CCLXXXIX.
(“ Archives of the Roentgen Ray and Allied Phenomene .” —Copyright.)
347
 Fig. 5 . FIG . 6 .

FIG , 7 . Fig . 8 .

TO ILLUSTRATE PROFESSOR GOLDMANN'S ARTICLE ON " THE VALUE OF THE X RAYS IN THE DIAGNOSIS OF
OBSCURE ABDOMINAL DISEASES ” ( p. 335 ).

PLATE CCXC .

( " s Archives of the Roentgen Ray and Allied Phenomena .” — Copyright.)

319
 ARCHIVES OF THE ROENTGEN RAY. 351

forward an apparatus, the chromoradiometer, which These are not usually malignant, but sometimes ulti
measures in units I the quantities of X rays received mately become so . To obviate this various methods of
at a given point. The method is based on the colour protection have been evolved . They are designed, above
assumed by certain salts under the action of the X rays. all, to shield the doctor froin direct irradiation . We are
The reagent is placed on the skin of the patient, and all familiar with the protecting cabinets used in Germany.
from time to time the tint is compared with that of a This method is not much used in France. I prefer to
graduated scale. When its colour is the same as that of use an apparatus to enclose the tube and stop all X rays
the tint corresponding to the dose required, the séance is which are not wanted. Various makers have made
stopped . similar models. X -ray -proof gloves and aprons should
Following Holzknecht, others have introduced similar also be employed.
methods. Among the best I would mention the quantito- TECHNIQUE. Since more accurate apparatus for
meter of Kienbock , who uses a photographic paper sensi- measurement has been designed the technique has
tive to the X rays. The paper is developed under detined been greatly modified. Empiricism , which reigned
conditions. Other methods are the radiometer of Sabour formerly, has now given place to a more rational
aud and Noiré (who use a pastille of platino -cyanide of method . The approximate measurement of dose during
barium ), the radiometer of Freund ( iodoform in chloro- treatment has rendered this evolution possible. The
form ), and the calomel precipitation of Schwartz. primitive method, which gives each day a very short
All of these methods of measurement are more or less sitting until reaction appears, is losing little by little its
useful. They give us the means of defining the technique last supporters, and is now only of historic interest.
used, so that an experiment done in Vienna can be To-day, when we have a lesion to be treated by X rays,
reproduced in Paris. Nevertheless, chromoradiometers we should endeavour to determine at once the quality
are only indicators, and not real methods of measure- of X rays, the approximate quantity which should be
ment . Their variety proves that none of them are given at each séance, and the interval between the
perfect. sittings. It is evident that the quantity and the intervals
Dr. Luraschi , of Milan, has recently brought out a will vary according to the progress of the disease, the
method of measurement based on the alteration of the idiosyncrasy of the patient, and the local reaction .
resistance of a selenium cell irradiated by the X rays . Thus, with a spot of ringworm we know that epilation
This is an interesting apparatus, but it has not yet will result from the absoption by the affected spot of a
reached perfection. It has certain disadvantages due dose of 5 H (the maximum dose, corresponding to tint B
to the alteration of resistance to which selenium is of Sabouraud and Noiré's radiometer) of rays Nos. 5 or 6.
subject, and , above all, to the difference between two With an ulcerating cutaneous epithelioma, I usually
cells under identical conditions. begin with a dose of 7 to 8, and sometimes 9 H, with
A better method is the measurement of the ionization rays of penetration No. 6. A fortnight later—three
produced by the rays. weeks if the reaction is pronounced—I give a second
However imperfect our means of measurement, at the application of 4 to 5 H. With these measurements any
present day no one has a right to practise radio -therapy other operator is able to give the same dose, though
without approximately measuring the quantity of X rays working under different conditions. He could not do
absorbed by one or other of the methods available. this with the information formerly supplied, such as,
Those who persistently reject them are as irrational. “ A sitting of ten minutes, at 15 centimetres, with soft
as the merchant who, wishing to weigh out nails, will rays."
not use a balance because it will not measure milli- Careful measurement alone allows of rational and
grammes. The ideal quantitometer is yet to be invented . scientific treatment, and makes accidents more and
Meanwhile the indicators which we have at present more rare . These are the principles which ought to
should be used , and, if necessary, the comparative use guide one in giving therapeutic treatment.
of one or more methods will avoid any danger to the There are one or two further points of importance to
patient. be considered. During a Roentgen irradiation the
Certain cutaneous lesions used frequently to occur in absorption of the X rays decreases rapidly as we
the hands of operators daily exposed to the X rays. proceed deeper below the surface. The skin absorbs
47
352 ARCHIVES OF THE ROENTGEN RAY .

the greatest quantity of the rays, and the portion the fluorescent substance as a powder, although more
absorbed by the deeper layers diminishes with remark- rational, were no more satisfactory. We know , in fact,,
able rapidity. This physical law explains the small that fluorescent crystals struck by X rays give birth to
action of the rays at a depth. They are unable to ultra - violet radiations .
exhibit any curative action, since the dose absorbed by It is not unreasonable to suppose, with Goldstein and
the diseased elements is quite insignificant. The skin Holzknecht, that Roentgen rays and radium rays have
or mucous membrane forms, therefore, & wall of iron the common property of being ultimately transformed
against which the X rays beat in vain . into ultra-violet light of short wave-length . One can
One is on the horns of a dilemma. We may guard the imagine that each of these different rays is propagated
skin , and thereby give a dose too small to penetrate to in its own way, but at the end of its course it is
any depth. Or we may give a dose large enough to absorbed in the form of ultra-violet light. This final
penetrate to a depth, and so, perhaps, cause a severe absorption depends on the wave- length of the initial
burn . This latter should always be avoided. radiation and the atomic weight of the substances inter
There are various ways of overcoming this difficulty. posed in the course of the rays. In this way it may be
One is, of course, the use of very penetrating rays. supposed that by spreading a substance capable of emit
Another is to put the source of X rays at a considerable ting ultra-violet rays on a diseased spot the action of the
distance . Calculation and experience show that the Roentgen irradiation might be reinforced.
greater the distance separating the source of rays from There is another method of sensitizing that I have
the skin, the less is the difference between the amount already indicated, which, I believe, has failed to give
of the rays stopped by the skin and that reaching the good results only because its application is so difficult.
deeper parts. Unfortunately, the diminution of intensity We know that each molecule struck by a Roentgen ray
with the square of the distance makes it necessary to gives birth in its turn to secondary radiations, and that
employ long sittings when the tube is at some distance. these on striking another body transform themselves
In the case of large tumours, they can be attacked from into tertiary radiations, and so on. This is, in fact, the
different sides. They can be divided into parts, and mechanism by which X rays are absorbed. If before
each part treated separately. In this way the neoplasm irradiation one injects into a tumour a body of higher
receives the X rays from all sides, while each portion of atomic weight - a non -caustic iron salt, for example
the overlying skin receives only one irradiation. I have --the result will be as follows : On encountering the
named this method " multipolar irradiation ." iron molecules a fraction of the X rays will be
When we desire to treat a large and deeply-situated absorbed , and secondary and tertiary rays will be
neoplasm, a leukæmic spleen for instance, we may emitted by the metallic particles struck by the primary
proceed in the following manner : The skin over the rays. These secondary rays are softer than the primary
swelling is divided into a number of small areas 4 to rays, and therefore more easily absorbed by the morbid
5 centimetres square. Each of these areas is irradiated cells. The effect of the primary irradiation might thus
separately, the others being covered with protective be reinforced .
tissue. The rays are directed on the centre of each THERAPEUTICS. — The beginnings of Roentgeno -therapy
area and the focus-tube brought close to the skin. Since were very modest. In the early days, when it was
the beam of rays emitted by the anticathode is cone- looked upon only as a depilatory agent, it would have
shaped, each area of the skin surface will receive but one been difficult to foresee the place it was destined take
irradiation, whereas the deeper parts underneath will but a few years later. At the present day the diseases
receive rays during successive irradiations of contiguous treated, cured , or improved by radio -therapy are too
areas . numerous to mention , and, as the indications for
It has been suggested that we should sensitize the Roentgeno-therapy are now well known, I shall content
tissues by the injection of salts which fluoresce under myself with drawing attention to some of the more
the influence of X rays. For this purpose eosine has important poiuts.
been recommended . This proceeding, however, has no It has been well said by Dr. Brocq that at the present
value, since the secondary rays emitted by these bodies time Roentgeno-therapy dominates the therapeutics of
are not analogous to the primary rays. Attempts to use dermatology. This was its first, and still remains its
 ARCHIVES OF THE ROENTGEN RAY . 353

' most important field of action. It has revolutionized cutaneous neoplasm , and especially in cancer of the
the treatment of tinea tonsurans, furnishing us with a breast, it should be the rule to seek surgical advice, in
certain and rapid cure in a hitherto rebellious affection . order that the patient may not lose the benefit of early
It gives incontestable results in a variety of skin affec- intervention and complete removal of the disease. In
tions, among which I may mention psoriasis , acne, such cases Roentgeno -therapy should only be resorted to
chronic eczema, keloid, pruritus, and lichen. Its action when the surgeon considers that no harm will result
is apparently chiefly local. As a rule, it is advisable to from postponing the operation for from six to eight weeks.
try other remedies first, and to have recourse to radio- X-ray treatment occasionally gives such rapid improve
therapeutic treatment only when other therapeutic ment that the question of operation no longer exists.
means have failed. Under its influence pruritus dis- In inoperable cases, and where the patient refuses
appears and the fungus-like tumours of mycosis melt operation, Roentgeno-therapy offers advantages which
away. As regards the latter disease, I have published a are obtainable by no other method.
case which has remained cured after the lapse of several In cases of cutaneous or subcutaneous recurrences
years, and other observers have confirmed my results. after removal of the breast, careful irradiation is followed
Lepra in the nodular form is favourably influenced. by remarkable amelioration, and cure, at all events of
On the other hand, contrary to the usual belief, X rays the local lesion. On the other hand, the method is
only occasionally cure lupus vulgaris. They are, how- usually powerless against deep-seated cancerous lesions.
ever, of great value in preparing the ground for operation For visceral cancers, stomach , uterus, etc. , X rays
in cases of extensive ulcerated or turgescent lupus. In may be used if removal is impossible. In this case,
lupus of the natural orifices I begin by scarification , however, the treatment can only be considered as
immediately followed by irradiation . By this means I palliative..
have obtained very rapid results. Usually Roentgeno- Neoplasms of vasculo -connective tissue, sarcoma in
therapy leads to & more or less rapid improvement. particular, exhibit a surprising sensibility for the X rays.
Then follows a period in which the lesion appears to Nevertheless, in the case of an operable sarcoma X rays
remain stationary. The nodules which remain are should not be used unless the surgeon believes that a
apparently resistant to the X rays, and one must then delay of some weeks before operation will not diminish
have recourse to other therapeutic means . the chances of recovery. If this be so, we may proceed
The treatment of lupus, perhaps more than that of to experiment whether the tumour is in fact sensible to
any other disease, necessitates a long experience. The the X rays. We have seen enormous sarcomas, deeply
specialist must know how to select the appropriate situated in the mediastinum and quite inoperable, which
therapeutic agent, to replace one method by another, have entirely disappeared with methodical X -ray treat
to combine radio-therapeutic and surgical methods—in ment.
fact, to carry out what may be termed a " mixed treat- It is hoped that all surgical intervention will in future
ment." be followed by careful X -ray treatment. It should be
In the treatment of neoplasms Roentgeno-therapy begun on the bleeding surface before the closure of the
indisputably gives the best success. It is the ideal wound. If this is impossible, radiation should be com
treatment for cutaneous epithelioma ; a cure is the rule, menced some days later through the dressing. This
and a failure the exception , provided that the lesions will destroy any portions of the neoplasm which have
have not penetrated the deeper tissues. Where , how- been left behind , and will thus prevent recurrence.
ever, the neoplasm is undergoing rapid evolution , the This procedure is warranted by our knowledge of the
focus-tube must yield to the knife. The curette, the specific action of X rays on the cellular elements of the
bistoury, and the focus-tube are allies, and the final neoplasm. It is also confirmed by the experiments of
result often depends on the careful carrying out of a Dr. Manoury, of Chartres.
mixed treatment. In conclusion, let me allude to the numerous and
In cancer of a mucous membrane satisfactory results wonderful results obtained in the treatment of leu
are only obtained in very early stages. Surgical inter- kæmia and adenopathies. Under the influence of
vention is usually necessary, but this should be succeeded X rays one sees enormous spleens gradually reduced
by a course of X-ray treatment. In the case of a sub- to their normal size. At the same time the patient's
47—2
354 ARCHIVES OF THE ROENTGEN RAY .
health is greatly improved and the blood -count ap the imagination of the public. Roentgeno-therapy should
proaches to the normal. The results obtained are more
constant , more regular, and more durable in leukæmia
of the myeloid type than in the lymphatic type. The
results are very irregular in non -leukæmic adenopathy.
X-ray treatment when well carried out presents no
danger. If it is often powerless against cancer, it is also
powerless to produce a general metastasis, as has been
asserted by certain authors.
Thanks to the measuring instruments which we now
possess, X-ray treatment has become an exact science.
One need no longer fear the terrible burns which were at
one time far too common, and whose spectre still haunts
Reports of Societies.
ROYAL SOCIETY OF MEDICINE - ELECTRO-
THERAPEUTICAL SECTION .
The Principles of Ionic Medication.
By H. L. JONES , M.D.
Since the publication of my papers on the treatment of rodent
ulcer by zinc ions, in 1905 and 1906 , I have received many
inquiries concerning the principles of ionic medication. Great
interest in the method has been excited among medical practi-
tioners in this country, since the plan of introducing drugs into
the tissues by electrical means appears to afford a new and useful
therapeutic procedure.
The laws governing the behaviour of solutions through which
electrical currents are flowing are well established, and a know-
ledge of these laws is requisite if one is to succeed in the
application of electrolysis to medical work.
[Dr. Lewis Jones showed an experiment to illustrate the
movement or migration of ions. It consisted of a conductor
composed of a number of layers of parchment paper and filter
paper in which conduction and ionic movement took place in
such a way as to allow of a visible recognition of the changes
which occur. )
The electrolytic circuit is composed as follows : Between
the poles of the metallic part of the circuit (composed of two
plates of iron) there are arranged, in a double series, first some
layers of filter paper, next a diaphragm formed of a piece
of gutta -percha tissue, with a central hole of 1 centimetre in
diameter, next some twenty layers of parchment paper, and
then a considerable block of filter papers. This last body of
filter papers is in the centre of the pile, with the other com-
ponents arranged symmetrically on either side of it. The
parchment paper portions are made up of a long strip, folded in
such a way as to form a number of squares which follow each
other in order when the paper is unfolded. This parchment
only be practised by a medical man with the necessary
clinical experience and technical knowledge.
Radio-therapy is advancing with giant strides after an
initial period of difficulty and neglect. The rapidity
with which it has been accepted even by the most con
servative minds is due to the wonderful results which
have been obtained in practice. It has a great future
before it. There is still much to be accomplished, particu
larly with regard to instruments and technique. X -ray
treatment gains new converts every day. Medicine
and surgery contribute equally to its progress, a progress
which will not be easily arrested .
paper has a thickness of } millimetre when moist, so that the
twenty layers have a thickness of 4 millimetres. The object of
the gutta-percha diaphragm is to limit the path of the current,
and therefore the stream of ions, to the central part of the
parchment papers. The iron disc beneath is connected to the
negative pole, and the iron disc above is connected to the
positive pole. All the papers are moistened with a dilute 2 per
cent. solution of a simple neutral salt. Sodium sulphate is
chosen for this experiment, though any soluble salt might be
used provided it were without action upon the ions under
examination . As an indicator the parchment papers contain a
trace of phenol.phthalein, a colourless body which has the pro
perty of turning purple in the presence of hydroxyl ions .
Under the conditions just described the flow of current
through these papers will set up a double movement of ions.
SO, ions will move to the iron positive pole, which will also give
off iron ions, and these will migrate towards the opposite pole,
penetrating the layers of paper as they move. At the iron
negative pole no iron ions will be found , but sodium will begin
to appear from the sodium sulphate of the electrolyte, and
through a secondary reaction with the moisture present will
form hydrogen, which is set free as a gas, and sodium hydrate
(NaOH ). The hydroxyl ions will split off from this compound,
and will move away towards the positive pole, indicating their
progress as they advance through the papers by a change of
colour in the phenol- phthalein. I hope to demonstrate the
presence of iron in the layers of parchment paper on the anode
side, and of hydroxyl on the side of the cathode.
[At the conclusion of the experiment, which occupied fifteen
minutes, the current being 20 milliampères, the layers of parch
ment paper were unfolded, and showed a central red stain
extending through the entire series from the cathode to the
central block of filter papers. On the anode side the parchment
showed no red stain due to the presence of hydroxyl, but was
slightly discoloured from the presence of iron ions. After being
 ARCHIVES OF THE
washed and wiped it was immersed in a solution of ferricyanide
of potassium, which brought out the presence of iron ions, giving
the well-known Prussian blue reaction.]
The amount of any substance thus liberated by the passage
of an electric current is a perfectly definite quantity depending
only on the intensity of the current, the time for which it passes,
and the electro -chemical equivalent of the substance in question.
Tables of electro -chemical equivalents have been calculated
which enable us to determine the quantity of any ion set in
motion. Suppose zinc ions be driven into the skin of a patient
with a current of 10 milliampères for fifteen minutes, the
calculation is as follows :
The amount of zinc set in motion by a current of 1 ampère
running for one second is 0 :00034 of 1 gramme.
0.00034 gramme for 1 ampère per second.
0.00034 gramme for do ampère (10 milliampères) for
100 seconds.
0.00034 gramme x 9 grammes for 900 seconds = 15 minutes.
0 ·00306 gramme = 3 milligrammes.
By weighing the zinc electrode before and after an application,
one might be able to determine that the loss of weight during
the application was of that order of magnitude, and, indeed,
without weighing it is often possible to recognize by the appear-
ance of the surface of the metal that there has been a loss of
some of its substance .
In addition to calculations of the amount of any substance set
in movement, we require, for medical purposes, to know the
depth to which a drug can be made to penetrate in the time of
its application . Sir Oliver Lodge has given the following rates
for certain ions when impelled by an electric pressure of 1 volt
per centimetre : Hydrogen, 10.8 millimetres per hour ; K,
2:05 millimetres per hour ; Na, 1.26 millimetres per hour ; Cl,
2:16 millimetres per hour ; I, 2:16 millimetres per hour. At
higher pressures the rate is increased proportionately. In the
experiments which we have just seen with the parchment paper,
it appears that the ions penetrated about one thickness of
paper 0.2 millimetre per minute, under the conditions of the
experiment.
The rates of migration through simple conductors supply only
rudimentary information as to the behaviour of ions driven into
an electrolyte with such a complex composition as the human
body.
The beginnings of the use of electricity for the purpose of
introducing drugs into the human body date back to 1833, when
Fabre Palaprat claimed to have introduced iodine into the
tissues in this way . In this country Benjamin Ward Richard-
son devoted a good deal of attention to electrolytic medication
about 1859, in the search for a mode of producing local anæs .
thesia by means of solutions of aconite and of other drugs.
Bruns, in 1870, introduced iodine electrically, and afterwards
recovered it from the urine of a patient ; and Munk, in 1873,
succeeded in setting up tetanic convulsions in a rabbit by using
electrodes moistened with solutions of strychnine. Since that
time the subject of cataphoresis, or cataphoric medication , has
been studied by a great number of persons, including Foveau de
Courmelles in France and Morton in New York, but the theory
was imperfectly understood .
ROENTGEN RAY . 355
In 1900 Professor Stéphane Leduc read a paper on the intro
duction of medical substances into the depths of the tissues by
the electric current before the International Congress of Electro
biology in Paris. Some chemical bodies which possess powerful
effects upon protoplasm when in their ordinary elemental con
dition, lose these properties entirely when in the ionic form . For
instance, chlorine in its free state is a strong oxidizing body
and a destructive agent ; but chlorine ions, which are present in
abundance in normal saline solution, have no such properties,
and it would be a futile proceeding to introduce chlorine ions
electrically for the sake of an effect like that of chlorine water
as observable in a test-tube. The same applies to iodine, and,
indeed, to the whole class of strong chemicals whose action
depends upon their degree of concentration. Caustic potash or
nitric or sulphuric acids are all powerful reagents in the chemical
laboratory, but lose their properties when greatly diluted . Those
bodies which are active in the ionic form are independent of
their degree of dilution.
Again , for ionic medication one can only use such substances
as undergo dissociation or ionization when dissolved in a solvent.
This excludes a number of organic medicinal compounds which
are insoluble or are not dissociated when dissolved. Chloral,
chloroform, ether, alcohol, phenol, camphor, etc., are instances
of medicines which are not available for ionization. Still, there
are a very large number of active substances which can be used.
We are not limited to inorganic salts, because among organic
compounds there are many which fulfil the conditions of
solubility and dissociation. The alkaloids, as, for instance,
strychnia, quinine, cocaine, aniline, adrenalin , are available,
and have been found useful for ionic medication . Salicylic
acid, too, and many other of the coal tar compounds, are found
to exist in the ionic form .
The ions of the metals, the alkalies, and the alkaloids are
electro-positive, and are therefore repelled from the anode.
They must therefore be driven into the skin by placing them
at the anode of the circuit. The acids, on the other hand, are
introduced from under the kathode, and the same is the case
with chlorine, bromine, or iodine. An exception must be made
for lead, which under some conditions migrates to the anode as
lead peroxide.
We have to consider the effect of the components of the
juices of the body in combining with ions, and so arresting their
further progress. Some ions, especially those of the heavy
metals, are likely to be precipitated in the form of phosphates
by the albuminous fluids of the body, although the amount of
phosphoric acid in the blood -serum and lymph is very small
(about 0·025 per cent., the sodium chloride being about 0:5 per
cent.) . The other ions may be pictured as gradually losing
their velocity, after they have penetrated a few millimetres,
and subsequently passing into the circulation by diffusion, until
they become eliminated .
The strength of the ionic solution matters little. In a 1 per
cent, solution there are abundant ions present to carry any
reasonable medical current, and if the ion to be introduced is
that of a metal, such as zinc or copper , the supply of ions is
continually being renewed from the electrode, in exact propor
tion to the number of ions moving forward into the body.
When the ion is not so renewed, as, for instance, when a carbon
356 ARCHIVES OF THE ROENTGEN RAY.
electrode is used, it is better to use a stronger (2 per cent. )
solution for moistening the pad, and to employ a great number
of layers of lint in the pad to act both as a reservoir for the
material and as an absorbent for the hydrogen or hydroxyl ions
set free at the positive and negative electrodes respectively.
Both these ions are caustic , and are the cause of the soreness
which is sometimes set up at the points of contact in galvanic
applications. The hydroxyl ion migrates rapidly, and the
hydrogen ion moves more rapidly still,
[In a second experiment iodine ions were caused to penetrate
twenty layers of parchment paper from a kathode, and copper
ions were driven in similarly from a copper anode. The iodine
ions were demonstrated with mercuric chloride, which gave an
orange stain to the paper, and the copper ions with potassium
ferrocyanide.]
In hypodermic medication the injected fluid enters the inter-
stices of the tissues, and is rapidly carried away into the general
circulation, while the ions introduced electrically penetrate into
every conducting element of the tissues—that is to say, into the
actual protoplasm of the cells of the part traversed by the
current. It has been found that cocaine and adrenalin intro-
duced in the ionic form produce a physiological effect which is
more durable than that obtained by the method of injection,
although the quantity of the drug conveyed into the system by
an injection may be by far the greater. The effect produced
upon a rodent ulcer by zinc ions continues for a long time, as
though the zinc were locked up in the part treated. It has also
been observed with lithium , that after its electrical introduction
into the tissues its elimination by the urine is extended over a
longer time than is the case after oral administration.
It is the slowness of the ionic movement, and also the fact
that the procedure of ionic medication is apt to be painful,
which are the stumbling-blocks of the treatment . In future we
shall, I believe, often employ ionic medication under local or
even general anesthesia , with larger currents, and for longer
times of application. The times and magnitudes of current
which I have given hitherto for the treatment of rodent ulcer
by zinc ions, namely, twelve minutes and 3 milliampères per
square centimetre, are an irreducible minimum , and both time
and current strength might be increased with advantage.
The disease for which ionic medication has proved most
successful so far is rodent ulcer treated with zinc ions. This
application of ionic medication was indicated by Leduc in 1903.
Since then I have given a good deal of attention to the treatment
of rodent ulcers in this way, and I consider the method to be
most valuable. The treatment of rodent ulcer by zinc ions is
uniformly successful when applied in the early stages of the
disease, but I have not yet learned how to cope with the exten.
sive and appalling examples of old neglected rodent ulcers which
are seen from time to time.
The procedure for the treatment of small rodent ulcers is
quite simple. The surface is covered by three or four layers of
lint wet with a 2 per cent. solution of sulphate or chloride of
zinc ; a zinc electrode of suitable size is applied and connected
to the positive pole of an ordinary medical continuous current
battery, the circuit is completed through a second indifferent
pad electrode, and the current turned on to 5 milliampères to
10 milliampères, and kept on for fifteen minutes. The magni-
tude of the current must be proportionate to the size of the
area , and Leduc has suggested 3 milliampères for each square
centimetre . On the face this magnitude can usually be tolerated
well, but, if desired, a little cocaine can be introduced first by
proceeding identically as described for zinc, but with the positive
pad moistened with cocaine hydrochlorate.
Zinc ionization may also be used for pustular eczema, for the
sterilization of teeth , for diphtheritic foci, for sinuses, and for
corneal ulceration .
In the treatment of multiple warts of the hands I have found
magnesium ions very effective, so much so that I have several
times seen all the warts disappear from a hand after two appli
cations of magnesium ions. These can easily be applied from a
solution of magnesium sulphate, using a carbon electrode with
a thick pad of lint to hold sufficient solution. A magnesium
metal electrode can also be used. I have not found that all warts
disappear so easily by magnesium treatment, and for hard solitary
warts I prefer to use zinc ions, and to ensure the penetration of
the metal by using a zinc needle to transfix the wart. A current
of 2 milliampères for two minutes will usually suffice in this case.
Lupus is a disease which naturally should be susceptible to
ionic medication. I have had a few minor successes in its
treatment. Aniline and zinc have both seemed valuable.
Aniline has a high chemical combining weight, and therefore
a larger quantity is carried in by a given current than is the
case with zinc and copper . With aniline hydrochlorate a
current of 10 milliampères for ten minutes will introduce
6 milligrammes of aniline ions.
The introduction of cocaine ions will render a small patch of
skin insensitive in about five minutes, and I have frequently
used it as a preliminary to small cosmetic procedures of electro
lysis for the removal of xanthelasma, small moles, etc.,,on the
face. The introduction of cocaine will also relieve the pains of
neuralgia temporarily, and in some instances one or two such
applications may be followed by a complete disappearance of
the neuralgia. Observers on the Continent have reported good
results in trigeminal neuralgia after the introduction of quinine
or salicylic acid. It is quite possible that the drug, when intro
duced over the area of the distribution of the nerve, might be
absorbed by the lymphatics of the nerve trunks, and so con
veyed to the Gasserian ganglion .
Discussion.
Mr. FREDERICK C. Wallis said that the subject was one of
extreme interest to him in connexion with the treatment of
various forms of ulceration at the lower end of the alimentary
tract. For some years he had been looking for an effective
treatment for such forms of ulceration of the large bowel. He
had tried other methods with only limited success , and the
removal of the diseased part was only possible in a small
number of cases ; but in those cases -- they had not a large
number yet—in which ionic medication had been tried, the
success made one quite enthusiastic as to the possibilities of
curing this form of ulceration, which was largely progressive
by submucous filtration . The interesting question was as to
whether it was possible to drive the metals or ions through
sufficient depth of tissue to frustrate the further progress of the
disease in the submucous tissue.
 ARCHIVES OF THE
Dr. E. S. WORRALL had used this treatment with uniform
success in a variety of cases, but in a few cases of ringworm he
had found copper ionization unsuccessful. Some of the patients
would endure the burning sensation caused by this process
The position of the part affected also had
better than others.
some influence. The patients would stand the burning near the
angle of the mouth better than on the tip of the nose . In a case
of rodent ulcer affecting the lower lid , he did not feel justified in
applying the current of 3 milliampères per square centimetre.
He applied a milder current, giving eight applications of ten
minutes each at intervals , and the result at the end of the treat
ment was all that could be wished . Sometimes one could use
the current at the density specified , and the patient would not
complain , but in many other cases the patient would not tolerate
such a current . Recently he treated a case of rodent ulcer by
driving in a 10 per cent. solution of cocaine hydrochlorate in
guaiacol for five minutes, and then proceeded with the zinc
ionization to the full strength of the current , which could be
readily tolerated after driving in the cocaine.
Dr. Donald Baynes said that he was glad to have something
other than X rays brought before the Section. Sometimes at
previous meetings he had thought that the old British Electro
Therapeutic Society had become since the amalgamation part
and parcel of the Roentgen Society. He alluded to the use of a
copper plate connected to a positive pole in cases of threatened
appendicitis ; here there must be fairly deep penetration to
relieve the pain, and the pain is not relieved by the current
without the copper plate. He found that if cocaine were in
jected hypodermically the patients felt less pain than when it
was introduced cataphorically. The effect was not lasting
unless care was taken to cut off the circulation by means of an
Esmarch bandage.
Dr. Bolton (Nottingham) found that in rheumatoid arthritis
salicylate of soda by itself has but little effect, and the same
was true of the high -frequency current. The case would
improve for a fortnight and then come to a standstill. If, how
ever, he gave salicylate of soda by the mouth, and immediately
followed it up with high frequency, the improvement was
manifest. It was possible that by using the electrical treatment
and the salicylate together the salicylate was driven deeper into
those parts of the joints which could not be reached without the
electrical treatment.
Dr. E. G. GRAHAM LITTLE suggested that the treatment might
be tried in histologically superficial diseases of the skin, such as
psoriasis, which was often obstinate. Was there any difference
in using a zinc as against a copper solution in cases of ring
worm ? He had a case of very persistent erythema with local
dilatation of the superficial bloodvessels , which it was extremely
difficult to treat by any method at his disposal. He now
thought of trying suprarenalin ionization .
Dr. A. H. PIRIE had used ionio treatment with copper sulphate
solution for ringworm, and after about three weeks succeeded
in getting a great improvement. The way in which the patches
cleared was remarkable, but on looking carefully he found that
two or three hairs had always escaped the cure, and that
seriously reduced the value of the treatment.
Mr. T. J. P. HARTIGAN said that his experience of rodent
ulcer was confined almost exclusively to the radium treatment,
ROENTGEN RAY. 357
and the results so far, except in extensive cases involving bones ,
left nothing to be desired. He had treated varicose ulcer of the
leg by the ionic method, and obtained very fair results ; the
wounds seemed not only to clean up better, but also to heal
appreciably faster. In minor affections, particularly of the
face, necessitating a trifling operation, the previous introduction
of cocaine by this method was of material assistance. The
greatest successes which seemed to have attended their efforts
had been in the application of this treatment to lupus erythe
matosus, for which purpose he preferred copper rather than zinc
ions.
Dr. G. B. BATTEN said there was a class of cases of ringworm
of the scalp, consisting of small, disseminate patches, which was
tedious to treat by the X rays. It would be useful to know
whether metals or salicylates were the more promising for ring.
worm treatment, also whether boils had been sterilized in this
way. One member had spoken of the effect of high -frequency
currents in driving salicylates into the joints. Dr. Clarence
Wright once read a paper on that subject before the old Society,
and suggested the use of the high-frequency current electro
lytically. The use of high frequency under such conditions
would possibly be a great deal less painful than the constant
current.
Dr. LEWIS Jones, in replying, said it had been observed that
after the administration of magnesium internally warts had
disappeared. This made him think that if magnesium had that
effect when given as a drug, it would be better accomplished by
the regular introduction of magnesium ions into the warts them
selves. In the case of ringworm there were serious difficulties.
Although improvement and new growth of hair could readily be
obtained by the introduction of the ions of zinc or of copper, yet
the actual curing of a case of ringworm was a different matter.
Some infected hair follicles escaped ; and even if it were possible
to sterilize nine-tenths of the affected follicles by zinc or copper,
it was all of no value if the other tenth remained unsterilized .
It was just this difficulty which had been experienced in the
past with other medications for ringworm. As to the most suit
able ion for the purpose, zinc and copper seemed to act well, but
their solutions were astringent fluids, and perhaps salicylic ions
from a solution of salicylate of soda might have a greater
tendency to soften the epidermal tissues and to penetrate better
and more uniformly. Another serious difficulty in the applica
tion of the ionic method to ringworm was the necessity of
treating the whole scalp, and over such a large area a current
of 3 milliampères per square centimetre was a large current for
a child to bear. Sycosis could be successfully treated by an
electrolytic procedure by introducing a fine copper wire, con
nected to the positive pole, into each of the suppurating follicles.
This was rather tedious, but seemed to answer well, especially
if combined with careful cleanliness of the skin, so as to avoid
reinfection . In the case of a woman who had hydrops articuli
of both knees, he had tried the effect of iodine, introduced from
the kathode, and of lithium , simultaneously introduced from the
anode, the electrodes being two pads, applied one on either side
of the joint. The effusion in the joint rapidly disappeared after
a
agle application, and the joint became normal ; and the same
treatment then being applied to the other knee, a similar result
followed in that one also.
358 ARCHIVES OF THE ROENTGEN RAY.

Reviews.

Atlas Chirurgisch - pathologischer Roentgenbilder. By L'Ionothérapie Électrique. By DELHERM and LAQUER

Dr. RUDOLF GRASHEY. Published by J. F. Leh- RIÈRE . Baillière et Fils, Paris, 1908. Price 1 fr.
mann, Munich, 1908. Price 22 marks. 50 c.
This, the sixth volume of Lehmann's well-known This is a little book, but full of meat : its hundred
series of medical atlases , is the work of Dr. Grashey, pages contain the best description extant of the modern
assistant-surgeon to the Royal Hospital at Munich , who
theory of ionic medication .
is already well known in England as the author of the The authors present the case of new method very fairly,
“ Atlas of Normal Roentgenograms,” forming the fifth commencing with a detailed account of its history and
volume of the same series. development. They point out that it is by no means
The first chapter deals with the skiagraphy of foreign certain that the success of modern so - called ionic medica
bodies. Perthe's “ puncture method " and Grünfeld's tion is due entirely to ionic phoresis; it may be in part
" harpooning method" of location are described. Dr. the effect of the direct action of the galvanic current
Grashey has designed an operating -table in which the itself.
focus-tube is above the patient, and the screen image is The histological examination seems to show that in no
reflected by a mirror beneath the table, so that the case do the immigrant ions penetrate the subcutaneous
examination for a foreign body and its extraction may tissue, but that they are deposited in the cutis, whence
be carried on simultaneously . they are absorbed more or less rapidly.
Another ingenious device is a small cryptoscope which The indubitable effects of ionic treatment may not,
may be clipped over one eye during the whole operation, after all, be entirely due to the penetration of ions, but
so as to maintain the sensitiveness of that eye to the to the secondary effects, the hyperæmia and infiltration
fluorescent rays, the other eye being meanwhile used for of leucocytes , and the displacement of the electrons in
arranging the patient and for operating. This device the molecules of the deeper tissues.
might possibly prove useful for keeping the calculus in As the authors insist in their concluding chapter, it
view during its extraction from the kidney. has been amply demonstrated that the constant current
Part II . is an atlas of autotypes of more than 200 itself has a real value, without the addition of medicated
skiagrams, with a short description of each . These ions ; that neuralgia, arthritis, ankylosis, are all amenable
include foreign bodies, concretions, injuries to bones and to treatment by the galvanic current, provided the
joints, deformities, tumours, luxations, fractures, and intensity be sufficiently great and the time sufficiently
what is a special feature in Dr. Grashey's work , some long, and therefore we need to exercise considerable
excellent pictures of diseased conditions of the soft parts. circumspection in estimating the true value of the
Part III. consists of a series of actual photographic modern ionic medication. The authors sum up their
prints on glossy paper. These are very beautiful, and conclusions in these words : " The principal factor is the
reproduce the original negative with greater exactitude continuous current ; the introduction of medicaments is a
than can be attained by process-printing, however good , useful adjunct.”
since the best reproduction must necessarily lose much The chapters on The Theory of Ions and on The
of the finer detail visible on the original plate. Therapeutic Application of Electric Iono-therapy are
We may draw attention especially to Fig. 12 in particularly good . As the authors point out, it is in
Part II., which shows the broken end of a probe in the dermatology that one would expect to get the best
antrum of Highmore. The pictures of gout and rheuma- results from ionic treatment, since the skin and its
toid arthritis are also particularly good, illustrating appendages are well within the reach of electric currents
clearly the differences between these two diseases. of moderate intensity and duration .
The description of the various plates is very well done, The book is one of the series of " Les Actualité
the landmarks being clearly lettered and defined. This Médicale, ” published by Baillière et Fils, and the work
is a work which should be in every Roentgen laboratory, is written with that clarity and distinction which note
and we hope to see it shortly in an English dress. the French school.
 ARCHIVES OF THE
Leitfaden des Roentgenverfahrens. By F. DESSAUER and
B. WIESNER. Published by Otto Nemnich , Leipzig. repetition, if necessary, only after a month's interval.
Price 10 marks.
This is the tbird edition of the well- known handbook
on Rontgen technique by Dessauer of Aschaffenburg.
The present edition is brought out in collaboration with
Dr. Wiesner, and contains articles by Blencke, Hilde
brand, Hoffa , Hoffman, and Kienböck. Tbat a third
edition of this book has been called for within four years
is the best testimony as to its utility, and also to the
amount of attention which has been devoted to the
subject in Germany .
The chapter on technique by Dr. Wiesner describes Phys. Med .,October, 1907.
Radio- Therapeutics : Its Biological Basis, Applications,
a lead -glass screen for the protection of the operator, and
a useful hand -protector which leaves the fingers bare,
and thus facilitates the manipulation of the patient and
the tube .
Professor Hoffman of Düsseldorf is responsible for the
chapter on Orthodiagraphy. The hanging diaphragm
and focus -tube seems to find most favour with Professor
Hoffman, and this is also used by Holzknecht, who
writes the chapter on Diagnosis by Means of the
Fluorescent Screen .
A long chapter follows on Roentgenology in Surgery,
by Professors Hoffa of Berlin and Blencke of Magde-
burg .
The question of Roentgen-therapy is treated by Holz-
knecht, who is an acknowledged master of the subject.
He was, as is well known, the originator of direct
measurement of the X rays. He gives an interesting
table showing the gradual diminution of cases of
accidental Roentgen dermatitis from 9-5 per cent. in 1902
to 0 in 1906. He advocates in most cases—for instance,
Notes and Abstracts.
RADIUM-THERAPY.
The Specific Action of Radium in Therapeutics. ( Jour. photographic plate provides a good test to show the working
'Amer. Med. A880C., October 5, 1907).- At the Dermatological
Congress held in New York in September last, Dr. Robert Abbe
said that radium ranks, not with caustics, cautery, antiseptics,
or medication, but with specifics. This does not mean a specific
for cancer in the popular sense, but for erratic cell-growths con-
stituting some types of tumour tissue in the earlier stage of
invasion or of moderate development. Details of the method
of using it have not yet been fully worked out. The dosage, so to
speak, or time of exposure necessary for curative action , is as
ROENTGEN RAY. 359
in epithelioma of the skin—a single application , and a
The Radiological Diagnosis of Internal Diseases is by
the same author, and contains a description of his
investigations on the stomach and intestines after a
bismuth meal .
The book is a useful and compendious handbook , a
trustworthy guide to the Roentgenologist.
PERISCOPE .
“ Pruritus Cutaneus, The Treatment of, especially of Pruritus
Ani.” KROMAYER. Deutsch. Med . Wochenschr. , January 9 ,
1908 , p. 59 .
“ Psoriasis, The Treatment by X Rays of. ” Max JOSEPH.
Rev. de Méd. Phys. Contemp., October 15, 1907 ; Zeits. f. Neuere
and
Indications. " R. KIENBÖCK.
Ringworm and its Treatment : Technique of Röntgen Treat
ment.” L. H.HARRIS. Austral. Med. Gaz. (Sydney), October,
1907.
“ Sweating Hands, Rontgen Rays in the Treatment of.”
KROMAYER. Berl. Klin . Wochenschr., December 16, 1907 .
“ The Finsen Lamp and the Quartz Lamp. Experiment on
the Action of,” P. MULZER . Archiv f. Derm . u. Syph .,
November, 1907, p. 11.
“ X Rays in Radio - Therapy, On the Use of Small Doses of.”
H. RIEDER. Archives of the Roentgen Ray, No. 89, December,
1907, p. 196.
“ X Rays and High -Frequency Currents, Report of 800 Der.
matological Cases treated with. ” SAMUEL STERN. Journ. of
Cut. Dis. , October, 1907 , p. 459.
“ Electricity and Magnetism of the Human Skin, Further
Researches on the. E. HARNACK. Münch, Med. Wochenschr .,
No. 5 , 1908, p. 224.
"Finsen and Quartz Lamps, Experimental Study of."
P. MULZER. Archiv f. Derm . u. Syph ., December, 1907,
p . 307 .
66
Roentgen Ray Pictures of Position of Diaphragm, with
Suction Mask in Action.” Deutsch . Med . Wochenschr. , No. 37,
1906.
“ The Influence of Electrical Irritation on the Distribution of
the Blood - Stream . " GEISSLER. Münch. Med. Wochenschr.,
No. 2, January 14, 1908.
“ The
Journ Roentgen
. Amer. A880c.,Rays in Oral
February Surgery." G. A. PFAHLER.
8, 1908.
yet empirical. Some apparent cures of small epitheliomata or
sarcomata have endured already more than three years. A
force of an unknown specimen in comparison with one of
standard strength . It is not entirely a mysterious force, but , in
part at least, is an electric discharge, essentially of negative
elements. Hence, so far as it is possible to say, it suggests a
theory of its action, in that it may supply an element of electric ,
force vital to normal and orderly growth, the loss of which may
bave caused a disorderly cell- growth which, in the aggregate,
constitutes tumour masses . It is supplementary to Roentgen
rays, and in some cases it is efficient where they fail. The intense
48
360 ARCHIVES OF THE
action of strong radium is destructive, and vitiates the benefit of
moderate use. The best results have followed one hour's
exhibition of the working unit (i.e., 10 milligrammes Ra Br.) on
small growths, and three to four hours on larger ones, with an
interval of one hour for study of the effect. Ischæmia of the on being powdered . Moreover, the glass of a helium tube gives
parts during treatment generally enhances its action. Pigmented no helium on being powdered, unless it carries a surface film of
moles, melanotic growths, and giant cell sarcomata, like epi- aluminium . — Deutsch. Phys. Gesell., July 30, 1907.
theliomata of the eyelids, face and body, are particularly sus
ceptible to its curative action as a specific agent. Its value in
nævoid and angiomatous tumours is due to its irritant action,
producing endarteritis obliterans and changes of a fibroid nature.
The Action of Radium Emanation (Berliner klin . Wochen-
schrift, No. 35, 1907).— Loewenthal records a case of chronic
articular rheumatism which was treated by radium emanation .
The patient had been previously treated with various remedies
without any result. Then carbonic acid brine-baths were em
ployed , supplemented with 100 cubic centimetres of emanation- centres of emission of the Roentgen rays. When an electron
water . After the first bath a distinct reaction resulted, with
increased painfulness in the affected joints. Then followed an
improvement in the condition, and within a few months from
the cessation of the bath treatment (twenty-one baths in all)
complete cure resulted .
ROENTGENOLOGY.
Selective Absorption of the Roentgen Rays (Cambridge
Phil. Soc. Proceedings, October 15, 1907) .- When any substance
is irradiated by B and y rays of radium or by X rays there is
found to be a marked relation between the quantity of the
secondary rays given out and the atomic weight of the substance.
Kaye has made a series of experiments to determine whether
a similar relation exists between primary X rays and the sub
stance forming the anticathode.
He uses a focus-tube in which anticathodes of various metals
may be brought in front of the cathode by means of an external
magnet. The Roentgen rays issue from the focus-tube through
thin aluminium window and pass into an ionization chamber,
also closed with aluminium . The ionization in this chamber is
proportional to the Roentgen rays produced. Under these con-
ditions there is no apparent relation between the X rays and the
atomic weight of the metal forming the anticathode. When,
however, the Lenard rays issuing from the focus-tube are filtered
out by a sheet of aluminium the relation immediately becomes
apparent, and holds good over a wide range of atomic weights.
When the metallic screen is of the same metal as the anti
cathode a larger proportion of the rays are given off. This
abnormal transparency is shared in a lesser degree by metals with
atomic weight differing but little from that of the anticathode.
Gas from the Glass of X - ray Tubes. - Campbell Swinton
observed bubbles in the glass of old focus-tubes. These he
attributed to particles of residual gas shot out from the anti-
cathode, fusing the glass and becoming embedded in its substance.
These bubbles are liberated by the heat of the blow-pipe flame,
and also by trituration of the glass wall of the tube.
R. Pohl takes exception to this explanation. He attributes
the bubbles to traces of aluminium deposited on the glass. On
the glass being thoroughly cleaned with aqua regia (nitric acid
ROENTGEN RAY .
not being sufficient), no such bubbles are formed on heating the
glass. The phenomenon is well known to glass-blowers who
repair X-ray tubes, and it can be reproduced with an artificial
coating of aluminium . Every variety of glass gives off hydrogen
Origin of Roentgen Rays (by C. H. Wind). - Wien and
Carter have measured the fraction of the energy of the cathode
rays that is transformed into Roentgen rays, and so from
the theory of Abraham have deduced the thickness of the
pulses constituting the latter. These results do not agree well
with those deduced by Haga and Wind from diffraction experi
ments. Various suggestions have been made to account for
this. The view is now advanced that not simply the cathode-ray
electrons, but also the atoms of the anticathode, are the principal
passes through an atom, the electro-magnetic field of the latter
is altered and a pulse sent out. About the character of these
pulses we can say little without making definite assumptions as
to the nature of the atom ; but there is one point in which all
the pulses will be to a certain degree similar - viz ., their dura
tion. The thickness of these pulses will be of the order ca/v,
where c = velocity of light, v = that of the electron, and
a = diameter of the atom . This gives a magnitude slightly
exceeding the pulse thickness obtained from diffraction, and
hence these disturbances might be Roentgen rays. - Science
Abstracts .
PHOTO- DIAGNOSIS .
Ophthalmological Experiments made with the Aid of
Light of Mercury Vapour (P. Fortin, Comptes Rendus, clxv.,
pp. 355-358, July 29, 1907).— The light from three Cooper-Hewitt
tubes is passed through two thicknesses of blue glass, and
received on the field of a large lens mounted in an opaque
frame. The eye of the observer is placed close to the lens, a
small screen with a pinhole aperture intervening. He then
perceives an image of the fine structure of the fovea and the
capillaries of the macular region, which has the appearance of a
delicate histological preparation stained with methylene blue.
The capillary network appears in very dark blue on a light blue
ground, in the centre of which is the fovea, which looks like a
deep blue stain composed of a multitude of small circles, corre
sponding, probably, to the visual cones . The retinal circulation
can be examined in the same way by omitting the screen with
the pinhole aperture, and in the capillaries are seen tiny black
discs, which are the red cells. The phenomena known as
Haidinger's tufts can also be observed by interposing two Nicol
prisms.
· ELECTRO-PHYSIOLOGY.
Experiments on the Law of the Action of the Alternating
Current on Organized Structures ( E. Reiss, Zeitschr. Elek
trochem ., xiii., pp. 474-477, July 26, 1907 .) - In 1899 Nernst put
forward the view that the current strength necessary to produce
a definite physiological effect is proportional to the square root
of the frequency of the applied alternating current-i.e.,
J = C /N , where C = constant. By means of special apparatus
 ARCHIVES OF THE ROENTGEN RAY .
the author has tested the validity of this view on the sensory
nerves human beings. For frequencies of 30 to 3,500 per
second the law is found to hold , but for frequencies lower than
30 the values of C increase as the frequency diminishes. The
results are completely in accordance with the theoretical deduc.
tions of Nernst, and support the idea that in organized structures
the electric current depends on alterations in the ionic concen
trations-i.e. , on osmotic processes.
PHYSIOLOGY.
The Bffect of Artificial Light on Plant Life.— Very in
teresting experiments to test the effect of light on the growth of
certain plants have lately been carried out by the Royal Botanic
Society . As much as twenty -five years ago, Sir William
Siemens showed that electric light could, to some extent, take
the place of sunlight, but it has remained for an English
electrical engineer, Mr. B. H. Thwaite, to elaborate a system by
means of which this idea may be rendered of practical value to
horticulturists.
The Thwaite system of electric culture is briefly as follows :
The source of power is an ordinary gas-engine, supplied from a
gas-generator, the power from the engine being transferred to a
dynamo from which the current to work an arc-lamp is ob.
tained. The heat generated by the working of the gas -engine,
is utilized by surrounding the cylinder with a water-jacket and
taking pipes from this to the interior of the house ; the gases
given off by the engine, being rich in carbonic acid gas, are also
utilized as a plant food.
The arc-lamp is suspended on a trolly which, by means of a
motor, is made to move slowly up and down the length of the
house. This is an important point, for it must be remembered
that the sun's rays are never stationary .
To test the value of this method, a glass house in Regent's
Park was set aside, filled with certain plants, and an apparatus
installed, a number of similar plants being placed in another
house under normal conditions in order to act as controls.
After about forty -eight hours' treatment only, the beneficial
results began to be apparent. Chrysanthemums were most
inarkedly affected, some growing in a given time to twice the
height of similar specimens under normal conditions, others
producing flowers when their fellows elsewhere had still but
small buds. Tomato plants grew so fast that they became
rather drawn in appearance, which seems to show that the
amount of illumination allowed for each plant will be a matter
for nice adjustment in order to obtain the most beneficial results,
The colour of the foliage of all plants treated was of a fine rich
green, with much more tone than those not so treated. This
fact tends to show that the electric rays ensure a very perfect
elaboration of the chlorophyll. It is intended shortly to try the
effect of passing the light through various coloured filters, for
M. Camille Flammarion , some years ago, demonstrated the
retarding effect of blue rays and the stimulating effect of red
rays upon vegetation .
The advantages of being able to retard or accelerate the growth
of various crops, flowers especially, obtain the est market
prices is evident, and the cost of running such an installation is
said to be very small.
361
RADIO - THERAPY .
The Roentgen - Therapy of Tuberculous Cystitis (by John
M. Garrat, M.D., Buffalo, New York) .—Three cases of tuberculous
cystitis are reported in which the progress was unusually
prompt and satisfactory. The results of Roentgen -therapy
depend in a marked degree upon the efficiency of the apparatus.
The best results are obtained with a coil of a high voltage wound
with No. 36 wire.
In the first case reported , a man of thirty-five years
tubercle bacilli were present in the urine. Roentgen treatment
was given for ten minutes every other day, alternately over the
pubes and the perineum . In each region a medium soft and a
hard focus-tube were used alternately.
On the tenth day of treatment all discomfort of the bladder
had disappeared, and micturition was normal. There was no
relapse after an interval of two years.
Case 2 was a man of thirty -three with strangury, and tubercle
bacilli in the urine. The capacity of the bladder was only
three - quarters of an ounce. A bichloride of mercury pack was
applied to the scrotum , and it was rayed every other day.
This case also improved rapidly under treatment. A year after
treatment the symptoms were nil, and there were no bacilli in
the urine. In addition to the Roentgen treatment, the bladder
was irrigated and inflated with pure.oxygen .
Case 3, thirty years of age, was admitted with all the symp
toms of calculus. No stone was discoverable, either by Roent
genograph, or by sounding, but there were tubercle bacilli in
the urine. Benzosal and cod - liver oil were given internally,
and one or two drachms of hydrogen peroxide were added to
each quart of water drunk by the patient. The case was
treated in the usual way, and the bladder was irrigated. The
case did not improve in spite of treatment, but rather grew
worse . On the commencement of Roentgen irradiation the
patient speedily improved, had better sleep, put on weight, and the
micturition decreased in frequency. The tubercle bacilli in the
urine entirely disappeared. — New York Medical Journal,
October 5, 1907.
Treatment of Epithelioma with Roentgen Rays (Lancet,
November 23, 1907 ).- Schiff, in his lecture before the Inter
national Congress for Medical Radiology recently held at Milan,
arrives at the following conclusions :
1. The favourable effect of Roentgen rays on epithelioma is
indisputable.
2. The treatment with Roentgen rays must not, however, be
considered in a category by itself ; it must be rather looked
upon as an alternative or as an addition to treatment by other
methods.
3. There are obviously biological differences in the various
kinds of epithelioma which have so far not been sufficiently
explained pathologically and anatomically, and on which the
success of the Roentgen treatment is dependent.
4. To aid the effect produced by the Roentgen treatment
small operations may be done and the cautery applied , according
to the nature of the case.
5. In those cases in which no favourable influence is produced
by the Roentgen rays, at the latest after the fourth or fifth
4842
362 ARCHIVES OF THE
sitting, this treatment must be discontinued , as little more is to
be expected from it.
6. The intervals between the single sittings must not be too
long. A more active Roentgen light - medium soft tube—with ,
of course, a careful covering of the healthy parts of the skin, is
to be recommended .
7. In the case of surgical operations a subsequent application
of Roentgen rays is eventually desirable.
8. It is of especial importance to lay stress on the fact that
by the application of the rays the patient is saved from an
operation , and the result produced by the Roentgen treatment
is not only equally good as regards the cure, but much better
as regards the subsequent appearance .
Hypertrophy of the Prostate treated by Radio - Therapy
(Bulletin Officiel de la Soc. Française d'Electrothérapie,
January, 1908). — Billinkin has treated two case of prostatic
hypertrophy by means of the Roentgen ray with marked success.
The question of the rectal or the perineal route for the intro-
duction of the rays had to be considered. The rectal method is
not of great value. It is painful, and the results are far from
good. In France, Tansard and Fleig have obtained excellent
results by adopting the perineal route. It appeared to the
writer, however, that the prostate could be influenced in both
ways, by the rectal as well as the perineal method of application
of the rays. In carrying out the intrarectal projection of the rays
he made use of Trélat's speculum under complete local anæs-
thesia of the parts. He passed a current of high frequency with
Doumer's electrode for a period of five minutes. After dilating
the rectum , a sheet of lead can be passed into it so as to cover
the buttocks as well as the sides of the speculum, and the
mucous membrane except the portion covering the antero-
inferior part of the rectum. The position of the patient is not
of very great importance, provided the handles of the speculum
are directed towards the sacrum . The patient may lie either on
back, stomach , or side. In applying the rays to the perineum ,
the patient must lie with his hips elevated or on his side, but
always with the legs markedly flexed on the abdomen. Billin-
kin's patients had a séance every five days. On the first day
the rays were applied by the rectum, on the sixth and eleventh
by the perineum . The ages of his patients were sixty and
sixty two years respectively . They both benefited greatly from
the treatment. The author remarks that it is very probable
that radio -therapy may be of service in many prostatic cases in
which, on account of the patient's age and the condition of the
urine, an open operation is very likely to prove fatal.
Epitheliomata treated by Roentgen Rays.-W. A. Pusey
( Jour. Amer . Med . Assoc., October 5 , 1907) summarizes his
cases as follows : Of the thirty-one cases which are classed as
not entirely successful , twenty-eight were cases which had failed
under other forms of treatment ; only three were primary cases .
These three cases were all in the group of failures, and they were
all cases of inoperable carcinomata involving the orbit, and were
all patients who abandoned treatment before any result might
have been expected. There are in this entire list of twenty -nine
cases not successful, only five cases in which , in his opinion,
there was any hope of cure by other methods of treatment.
ROENTGEN RAY .
These five cases had all been referred by surgeons to the
author, after having undergone surgical treatment. One case in
the practically successful group was that of an epithelioma in
volving the external auditory canal. The other four cases were
among the failures. In three of these the patients would not
take the trouble to complete the treatment. In other words, in
an entire series of 111 cases treated there were only 3 failures
amongst those cases in which there was any reasonable hope of
access . Twenty - eig of the 111 cases were hopel or most
unpromising so far as any other method of treatment was con
cerned . Of the 83 remaining cases, 80 were successful. Counting
these 31 cases as failures, there were 80 successful cases in the
list of 111 consecutive cases of epithelioma treated more than
three years , a showing of 72.5 per cent. of successful results in 111
unselected cases.
Report of 107 Cases of Cancer treated with the X Ray.
(American Roentgen Ray Society, October, 1907) .-E . G.
Williams emphasizes the vast difference between the clinical
nature of different cases of cancer, and states that it is only
possible to approach an estimate of the value of the ray by
studying a large number of cases, divided into classes, which
are more or less similar, and consequently susceptible of com
parison . The first class of cases includes those growths on the
skin having a thick scale covering an ulcerated area of long
standing, with the history of growing more rapidly of late, and
also those growths with elevated margins and ulcerated centres,
growing steadily, having started usually from a mole or
papilloma. Of the fifty-three cases, fifty-two healed. In the
unhealed case the treatment was interrupted by an attack of
pneumonia. The growth was afterwards excised. In four out
of the fifty -two cases there was a recurrence, which healed again
with the X ray. The second class includes those growths which
originally began as those of the first class, but have reached a
more advanced state and invaded the subcutaneous tissues, often
giving rise to a large protuberant mass . Of the seventeen cases,
eleven healed , four were improved, and two remained in statu
quo . The third class includes the extensive recurrent and
metastatic growths in the deep structures. The original growth
may or may not have been on the skin. Of nine cases, two
showed an immediate disappearance of the growth , two were
temporarily improved, while five were unimproved. The
fourth class includes carcinomata on mucous membranes. Of
ten cases, the results were not by any means uniformly success
ful. The fifth class includes primary carcinomata of the breast.
Here the number of cases was small, and the results on the
whole good. The sixth class includes the recurrent carcinomata
of the breast, and many of the cases treated yielded satisfactory
results. The writer remarks that in every case healing seemed
to take place better when the growths were exposed to air and
sunlight, than when covered with dressings and ointments.
The apparatus used was two static machines and three coils,
with mechanical, mercury, and electrolytic interrupters. The
distance of the anticathode from the surface varied from 6 to
10 inches in deep cases. The duration of single exposures
varied from ten to twenty minutes. Practically all cancerous
conditions commencing on the skin can, in their early stages,
be completely and permanently eradicated by means of the
 ARCHIVES OF THE
X ray, in a simple and painless manner, without leaving a scar,
and without any danger to the patient. Much benefit may be
expected even in the advanced stages, by relieving pain , retard-
ing the growth, and prolonging life. ' The X ray, however, is of
doubtful value in the treatment of cancer of the mucous
membranes and primary growths of the mammary gland
RADIO-DIAGNOSIS.
The Influence of the Roentgen Ray on the Diagnosis
and Treatment of Fractures of the Elbow - Joint ( Berliner
Klinische Wochenschr., No. 50, 1907 ).-- Cohen of Berlin states
that with the perfection of X-ray diagnosis sprains and similar
conditions in the region of the elbow -joint have become rarer.
We have now arrived at the conclusion that the number of
injuries to bones in the region of this joint are few in proportion
to the injuries to the surrounding soft parts. We are also by
means of the X ray enabled to differentiate between injuries
actually within the joint and those which occur in its immediate
neighbourhood. The prognosis as to the ultimate issue of the
case so far as function is concerned will also be materially
advanced by this means. In children the diagnosis of the
nature of the injury to the joint is often only possible by means
of the Roentgen ray. So far as actual treatment is concerned,
Roentgen diagnosis plays an important part. The broken ends
of the bones can now be brought into absolute anatomical
continuity with comparative ease . Passive movement of the
joint is now possible at a much earlier period than before,
and the fixation of the joint has lost much of its pristine
value .
The Removal of a Foreign Body from the Left Bronchus.
-Dr. Carlau (Münchener Medizinische Wochenschrift) read
a paper on this subject before the Medical Society of Kiel . The
removal of foreign bodies from the respiratory passages is
always a matter of difficulty, and although Kilian's method of
bronchoscopy has facilitated the matter somewhat, the instru
high tension, is a disinfectant of great value . When used as an
ments are not always available, and the technical knowledge inhalation, it is of service in catarrhal affections, diseasesof the
required for their use is not always at the disposal of the
surgeon who is called upon to deal with this uncommon con
dition. A very simple instrument for the removal of such
foreign bodies is described by Helferich in the Deutsche Zeit.
schrift für Chirurgie (“Festival Souvenir for von Esmarch ,”
1902). It consists of a flexible tube of brass, rounded at one
end to form a kind of button ; a rubber ball is tied over this
end in such a way that the tube projects some distance into the
ball. It was designed for the removal of a pencil-case from the
left bronchus. The elongated rubber ball was introduced so
that its end entered the lumen of the case. It was then inflated ,
when the case became firmly held , while the proximal part of
the ball kept the walls of the bronchus distended .
By the aid of this instrument the pencil- case was at once
withdrawn .
Professor Petersen used this , instrument of Helferich in a
similar case in the Anschar Hospital, Kiel, in 1906. A boy of
eight had swallowed a pencil-case the day before. The skia-
gram showed it to be in the region of the left bronchus. The
boy was well and lively ; the lungs were not affected. On the
fourth day the following condition was found : Over both lobes
ROENTGEN RAY . 363
of the left lung the note was impaired, the breath sounds were
considerably reduced, so as to be hardly audible . The left half
of the chest did not move with respiration ; the intercostal
spaces were considerably narrower on the left side than on
the right.
Professor Petersen performed low tracheotomy, but finding
the isthmus very broad, he extended the incision upward. The
trachea was held open by retractors. The pelvis was then
raised, so that the patient was almost vertical, with the head
down. The tube already described was now introduced , arined
with the finger-stall, and bent so that it would reach the foreign
body whose position was shown by the skiagram. It glided
readily into the left bronchus. The ball was now slowly inflated
by means of a good-sized syringe. But there was no feeling of
resistance, so the bag was deflated again. By gentle pressure it
was now found possible to cause the tube to glide a little further
into the bronchus. The ball was now carefully inflated once
more, and gently withdrawn, while the inflation was continued.
However, the ball appeared in the tracheotomy wound without
any foreign body. At this moment the foreign body was seen
in the wound immediately behind the ball, and was readily
removed with a forceps. No disturbance to respiration was
produced. The boy made a good recovery.
The author believes that compact foreign bodies could be
equally well removed by means of Helferich's method. The
inflated ball widely dilates the bronchus, and, as it is with
drawn, a negative pressure is produced, which will tend to draw
the foreign body down into the wound.
ELECTRO-THERAPY.
Electricity as an Immunizing Agent and Disinfectant
(E. Albert-Weil, Journal de Physiothérapie, September 15, 1907 ).
-Ozone, which is given off by small apparatus specially designed
for the purpose , or by static machines, or, better still, by
apparatus for producing high -frequency currents or currents of
bronchial tubes , and in whooping-cough. When directed upon
suppurative sores, such as varicose ulcers, it produces a true
disinfectant action. The continuous current, on the other
hand, is also an antiseptic agent under certain conditions. It
may be used in this way for the treatment of septic cavities.
The antiseptic effect is heightened if a rod of copper or of zinc
is used. The products of the electrolysis of the tissues attack
the zinc and the copper. Finally, the ultimate effect of the
passage of the current is the introduction of the zinc or of the
copper into the infected mucous membrane itself.
Treatment of Tic- Douloureux by Electrolytic Introduc
tion of the Salicylic Ion.-René Desplats ( Journal des Sciences
médicales de Lille, September 7 , 1907) reports his experience
with the method introduced by Leduc, of treating obstinate
spasmodic neuralgia of the face by the electrolytic introduction of
salicylic and ions. He gives the clinical notes of those cases in
which this method was successful . In all of them other
methods of treatment had been unsuccessful, and in one the
extirpation of the Gasserian ganglion had been under considera
tion . The treatment is easily applied. The negative pole is
364 ARCHIVES OF THE ROENTGEN RAY .
covered with absorbent cotton, and moistened with a solution
of salicylic acid in distilled water. A current of 25 milliampères
is passed for half an hour. This is reduced subsequently to
20 milliampères, and the time lengthened to one hour. The
séances are repeated every three or four days, until all pain and
tenderness have disappeared. In the most obstinate case the
symptoms had not entirely disappeared by the tenth sitting, but
the patient's condition was one of great comfort compared with
his previous state. In most cases the spasm of the muscles and
the severe pain were observed to be greatly relieved by the first
application , and the subsequent improvement was rapid . In
fact, the results were so encouraging that the author states that
in similar cases in the future he would always have recourse to
this method at the beginning of the treatment.
The Galvanometer in the Study of Mental Diseases. A
paper was read by Dr. F. Peterson, of Columbia University,
New York, under the proceedings of the Section of Psychological
Medicine, entitled the “ Galvanometer as a Measurer of the
Emotions. ” It was founded upon the results of certain psycho-
physical investigations with the galvanometer and pneumograph
which had been carried out by Dr. C. G. Jung, of Zürich
University, and Dr. Peterson at the laboratory of the Clinic for
Psychiatry at Zürich last year. A fuller account of their work
was published in Brain, vol. xxx., No. 118, July, 1907 .
It has been proved that every stimulus accompanied by an
emotion causes in normal people a deviation in the galvano.
meter, recorded upon a kymograph as a curve, the amount of
such deviation , or the height of the curve, being in direct
proportion to the liveliness and actuality of the emotion aroused .
The stimuli were of the most varied kind -for example, the
threat of a needle, the sudden fall of a weight with a loud
noise , or the threat of it, arithmetical calculation , sudden call
by name , and so on- and the resulting curves were found in
normal people to vary directly in amplitude according to their
unemotional and phlegmatic or excitable temperament. Certain
features , however , were constant : firstly, successive stimuli
caused a diminishing reaction ; secondly , in all cases a certain
initial latent period was obtained , differing in different people
and at different times , but as a rule lasting between two and
five seconds ; and, thirdly , this latent period increased with
successive stimuli .
Results were obtained in eleven cases of dementia præcox of
different types—three cases of paranoid dementia , two cases of
hebephrenia, and six cases of katatonia. The galvanometer
curves were found in many of these tests to be extraordinary.
In the paranoid and hebephrenic forms the curves showed no
marked departure from the normal, but in the cases of katatonia
the waves were almost always of gradual ascent and of exceed-
ingly small amplitude, while one case showed no reaction
whatever to any kind of stimulus. Further, all of the katatonic
cases in which reaction occurred showed a marked lengthening
of the latent period, amounting in one case to as much as
26.94 seconds.
Perhaps the most interesting part of these investigations is
concerned with the authors' association experiments in combina-
tion with galvanometrical tests. It will be remembered that
since Galton, Wundt, and Kraepelin employed these simple
association tests, which consist in presenting, orally or visually ,
words-a
5 — as a rule substantives— to the test person, who must
respond, as quickly as possible, with the first word which
occurs to him. The employment of the galvanometer in these
association experiments endows them with additional value.
Freud has shown that in hysteria and obsessional states there
are always certain hidden “ thought-complexes " associated with
strong emotional tone which dominate the individual and decide
the symptoms, powerful emotional associations, which had
their origin in real life possibly years before. Boris - Sidis, in
his “ Psycho- Pathological Researches,” has called them " resur
rected moments. " Such underlying ties may be disclosed in
hypnotism , or by association experiments. Jung and Peterson
maintain that in dementia præcox there is a close causal
relationship between the mental disorder and an underlying
complex ; a subconscious complex was discovered in a normal
individual by means of marked fluctuations in the galvanometer
curves at the associations “ sun -burns," " floor-parquet,” “ pay
write ,” and “ warm -stove " ( the case mentioned at the sectional
meetings, in which the subject, an asylum attendant, had had
to pay for damage by a stove burning the floor), by the word .
association and galvanometer method. The authors hoped to
lay bare the underlying thought-complexes in their insane
test-persons by the same method . In the word-association
tests the reaction times were found to vary, the period between
the word and the response being of considerable length in some
cases, In repeated tests, the same words were in some instances
always followed by a comparatively slow response. It was
found that wherever this occurred a hidden complex had been
hit upon -- for example , a patient who a short time before had,
when greatly depressed , determined to drown himself, gave
long reaction times with water , lake, ship, and swim . Further,
in such cases the reproduced response was often a different
word from that first given that is , there was an inhibition
depending upon strong emotional tone . The task of the authors
was, therefore , to discover whether the “ psycho -galvanic "
reflex ran in parallel course with the complex indices just
mentioned . In the normal individuals this was found to be the
case , certaincases showing a correspondence between the
length of reaction time and the height of the galvanometer
curve , and also such associations as were changed in the
repeated tests, showing a notable increase in the galvanometer
curve as compared with that of those reproductions which were
unchanged. Unfortunately, only two cases of dementia præcox
were susceptible of combined galvanometrical and association
tests, and the results obtained from these cases were entirely
inconclusive and even contradictory, the reaction times being in
certain tests extraordinarily long, but with only average galvanic
durations. The authors give their results with great reserve,
regarding them was only preliminary and of questionable value,
but as foreshadowing features of interest for future inquiry and
investigation . " It certainly appears as yet uncertain whether
the galvanometer will give information of the underlying
mechanism of mental disorders, which cannot be more easily
obtained by the ordinary psycho -analytic methods. Nevertheless,
its value as a measurer of emotional reactions seems beyond
doubt, and certainly in the detection of simulated psychoses it
appears likely to be of use .
 ARCHIVES OF THE ROENTGEN RAY . 365

Experiences in the Treatment of Acute Articular Rheu- has been repaired, any effort which the patient may make to
matism with Stauung -hyperæmia ( Berlin. Zeitschr. f. klin. open up the newly restored track may prove ineffective, because
Med ., Wiener med . Wochenschr ., October, 26, 1907) .--Steinitz the nerve impulse simply travels along the well- worn but
says that in most cases of acute articular rheumatism this form ineffective nerve path, and the paralysis in this way may
of treatment may be tried before all others. Patients cannot become permanent so far as the patient's unaided efforts are
endure the application of the Stauung-ligature, and the existing concerned. In such a case of paralysis, therefore, we must
excessive pain would not be readily alleviated by the ligature reckon with this law of habit, and tell the patient not to try and
when either the shoulder or hip joints or the vertebral column use the limb, or, in a case of aphasia, not to speak, till the power
is markedly affected, and so in such cases treatment by salicylates begins to come back.
is ordered. High temperature is no contra -indication to this This law of habit is of still greater importance when we have
mode of treatment. On the contrary , Stauung hyperæmia is to to deal with excess of movement instead of paralysis, and in
be recommended in cases with much fever ; but if within five spasmodic neuroses, such as spasmodic wry- neck, habit must
days the treatment produces no evident reduction of the play an all-important part. Even in such a disease as paralysis
temperature, then recourse must be had to the salicylates. The agitans the movement can be materially lessened and the strength
same holds true when the pain is not at all alleviated after five restored by counteracting the morbid habit of tremor.
days' Stauung-treatment, and also in those cases where the joint In the usual treatment of spasmodic torticollis this is
condition rapidly shifts from one articulation to another. In cases attempted by removing a piece of the nerve supplying the
which do not react to salicylates, the treatment by these should affected muscles, and thus giving them rest for a time. But I
no longer be pushed, but recourse should be had to Stauung, think a more rational way of neutralizing the habit factor in
and if the alleviation of the pain in the least degree is observed these cases is to induce another habit of movement of such a
the treatment ought to be continued.' Urgent cases may be nature as to counteract the morbid one. To attain this end a
treated in this way as well as by physical methods. In cases new habit must be established , not only in the case of the indi
of recent endocarditis salicylate medication may be stopped, vidual muscles directly or indirectly concerned in the spasm by
and treatinent by Stauung-hyperæmia commenced. means of rhythmical exercises very frequently repeated, but also
Treatment of Epithelioma of the Skin by High -Frequency in the case of the groups of muscles which have acquired a
Currents (Bulletin Gén. de Thérapeutique , February 8, 1908). morbid habit of combined movement .
-Leredde says that, so far as the treatment of cutaneous epithe The same rule holds good for such conditions as trade spasm of
liomata by means of high -frequency currents is concerned, we various kinds, and the rhythmical exercise cure will prove of far
lack proofs enabling us to form a correct opinion. Lebon, who more value than the rest cure . In writer's cramp, also , the same
has made use of this mode of treatment, declares it to be an principles must be adopted, and an elastic apparatus should be
excellent one if employed intelligently. The tissues ought to constructed for exercising the fingers, and also for finger exercise
have a whitish appearance at the time when the application is combined with movements of the whole arm , so as to break the
stopped. The method undoubtedly is a very tempting one, habit of combined movement of the finger and arm muscles as in
inasmuch as it affords a rapid means of cure, one séance sufficing writing. As all these inovements must be even and regular
for the destruction and cure of a sinall tumour. The cicatrices ones , it is of importance that the elastic, whatever its strength,
left are excellent . Leredde does not consider that simple nega should be yielding enough for one part of the exercise not to
tive electrolysis , as recommended by Brocq, is of much value. require more force than another, as would be the case if a short,
It has no selective action , and the writer has personally met strong elastic cord were used. Such an elastic cord as that
with two cases in which negative electrolysis was employed in a supplied with the Whiteley exerciser is preferable to a shorter
thorough manner, and yet recurrence took place. He cannot, one with less range of movement. The associated exercises
therefore, recommend Brocq's method. It is, moreover, a painful must be the reverse of the usual movements of writing. Thus a
one, although the pain may be relieved to some extent by large elastic rubber ball must be squeezed by the fingers at the
employing cocaine. same time as the wrist and arm are extended, and for the reverse
MECHANO-THERAPY. exercise an elastic ring made up of many strands of thin elastic
must be opened out by the fingers whilst the wrist and arm are
The Value of Rhythmical Exercises in the Treatment being flexed. This ring can easily be carried in the pocket, and
of Spasmodic Neuroses (T. Stacey Wilson, M.D. , British then during spare minutes by day the fingers can be exercised ;
Medical Journal, July 20, 1907).— The author insists on the and if, instead of a ball, a metal ring fitted with steel springs be
important part played by habit. Habit is based upon the used, this also could be carried about, and the fingers could then
physiological law that the more a nerve path is used the more be exercised quietly in the coat pockets while walking about
easily does it transmit nerve impulses, or the more any par- town or in trams, etc., as well as having the regular exercises
ticular nerve mechanism is used, within the limits of its power before and after business hours.
of nutrition , the more easily does it work in the future . In stammering we must give the patient regular exercises of
Every time a patient tries to use a limb which he cannot use, his speech muscles quietly by himself, as Demosthenes is re
he does something else-probably using muscles adjacent to ported to have done, under surroundings different from those
those paralyzed — and thus establishes a habit of directing his which are apt to indụce the spasm. In other cases, such as
nerve impulses along some other path than the right one. If those of spasms of the laryngeal muscles, where exercises are
there be any hysterical element in the case, this may produce so less available, it may be necessary to resort to hypnotic sug
well-worn a track in a wrong direction that when the damage gestion in order to break the habit.
 366 ARCHIVES OF THE ROENTGEN RAY.

Correspondence.
To the Editor of the ARCHIVES OF THE ROENTGEN Ray. The error escaped my notice when correcting the proofs, owing
DEAR SJR ,—May I draw attention to a misprint in my article to my not having a copy of the diagram before me at the time.
on “ The Theory and Technique of Teleroentgenography ” There are also two small numerical errors on p. 312. Line 3
published in the April number of your journal ? should be 1.5 metres (not 1.4) , and line 5 , 2.4 millimetres
The formula on p. 313 should, of course, be (not 2:5) .
Yours truly ,
a : (a - b) (m + x ) : m, ALBAN KOEHLER.
not (m + x) : 2. Wiesbaden.

Description of Plates.

PLATES CCLXXXIX . AND CCXC.

TO ILLUSTRATE PROFESSOR GOLDMANN'S ARTICLE ON " THE VALUE OF THE X RAYS IN THE DIAGNOSIS OF
OBSCURE ABDOMINAL DISEASES (P. 335) .

*** The Editor begs to thank those correspondents who have been so kind as to send articles and prints of radiographs for
THE ARCHIVES.
He would be very much obliged if contributors would send , with any prints intended for publication, a full account of the
case, and also an account of the process used in radiography—such as the voltage, ampèrage and spark employed, time of exposure,
kind of sensitive plate or film used, or any other facts of interest.

EDITOR'S AND PUBLISHERS' NOTICES.

THE Editor begs to acknowledge communications from Dr. G. A. Pirie ( Dundee), Dr. Emil Beck ( Chicago) ,
Dr. Millican (Chicago ), Dr. Thurstan Holland ( Liverpool), Dr. Green ( Newport, Mon.), Dr. Morton ( New York).
The following Journals and Periodicals have been received : - Advanced Therapeutics,"" The Electrician ,”
“ The Electric Review ,” “Knowledge," " The British Journal of Dermatology,” “ Annals of Physico-therapy,"
“ Medical Times,” “ Archives of Physiological Therapy," “ Archives d'Électricité Médicale," " Le Radium ,"
" Appals d'Électrobiologie et de Radiologie," " Fortschritte auf dem Gebiete der Röntgenstrahlen,” “ Münchener
Medizinische Wochenschrift ," “ Zentralblatt für Physikalische Therapie ,” “ Annali di Elettricità Medica ," “ Rivista
Internazionale di Terapia Fisica ."
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All contributions to the Journal should reach the Editor by the 7th of the month.
Original articles, with radiographs for illustration, will be acceptable, and each contributor will be furnished
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All radiographs and photographs must be originals, and must not have been previously published.
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