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THURSDAY, JULY 24TH.Dr. C. F. BAILEY (Brighton), in a paper on

L’lectrot7cerapeutics in Neuron Lesions,referred to various recent advances in our knowledge of thestructure and functions of the nervous system, and pointedout that our more extended acquaintance with nerve

physiology and histology tended more and more to confirmtheoreticallv the value (which had been proved in practice)of electro-therapy in the treatment of pathological conditionsof the nervous system. He attributed a larger portion thanhad been hitherto insisted on of this value to reflex arc con-duction of the nerve impulses initiated by electric stimuli,and showed how afferent impulses which might be set upwould have an extensive and widespread influence in main-taining the integrity and promoting the repair of the nervoussystem. He considered that by keeping neurons in a stateof activity, albeit an imperfect activity, by electricity, theywould recover more rapidly than if left at rest. He men-tioned a practical point, that the clumsiness which was oftena feature of the hyper-protopathic sensibility, occurring lateafter a successful nerve-suture of a nerve such as the ulnar,was greatly relieved for a time by the interrupted currentgiven by the warm bath method with intermitting periods ofrest.

Dr. H. LEWIS JONES read a paper on

The Use of Condensers in -Electrical Testing.Following up his work on the use of condenser dischargesin diagnosis, he now wished to advocate the use of the samedischarges for treatment. While much had been done to

improve the induction coil of late years the fact remainedthat such currents were disagreeable except when of suchsmall magnitudes as to be of little practical use-especiallyfor the treatment of paralytic conditions and the new treat-ment for obesity, where the demand was for a method ofstimulation that could set up vigorous muscular contractionswith a minimum of sensory effect. Condensers provided ameans of obtaining waves of current which were shorter thanthose of any induction coil, and experience had shown thatcondensers were admirable for producing painless muscularcontractions. He then showed an apparatus for making con-venient use of such currents. It consisted of an electricmotor provided with a condenser commutator and a rhythmicinterrupter. The former was so arranged that it charged theselected condenser from the main and then discharged it

through the patient. The interposition of the rhythmic devicecaused the impulses to rise and fall in magnitude in theway that had been found most suitable when treatingparalysed muscles. As a general rule he found that smallcondensers charged from a high voltage gave better resultsthan large condensers charged from a low potential.

Dr. LEWIS JONES also read a note on

The Treatment of Corns and other Callosities by Ionisation.The method consisted of ionising the growths with zinc. Thelatest views were to the effect that many or most of suchgrowths were of microbic origin and not merely due tofriction. The method had given very excellent results in hishands, and he considered it preferable to any other he hadtried.

Dr. E. P. CUMBERBATCH (London) read a paper onThe Results of Mzcsele Testing by the Condenser Method.

He showed the great superiority of the method over that ofthe coil and constant current formerly employed. Thevarious degrees of degeneration of muscle could be identifiedmore or less readily, and it was now possible to ascertain theprogress of a case with some degree of accuracy. Whilemuch had been learned about the new method, there weresome points that arose from time to time that showed ourknowledge to be incomplete, and further study and inves-tigation were necessary.

Dr. J. D. HARRIS (Exeter) explained a method of employingSecondary X Rays in Connexion with Ionisation.

He drew attention to a case, described at the Birminghammeeting, of epithelioma affecting the lower jaw of a childwhich absorbed under the influence of long sittings of X raysin which secondary X rays emanating from the expandedbone appeared to have an important bearing. Cases wererelated in which the curative effect of the X rays appearedexhausted, after first producing a satisfactory result. The

object of this paper was to show that this exhausted !cuiative action seemed capable of restoration by ionisa-tion. To establish this, cases were related: 1. Ofulceration of the scalp after removal of a papillomasurgically, which at first did well with X rays, buton failing to heal permanently, ions of zinc were

introduced until the thin skin which healed over the ulcerrefused to allow the ions to pass into the granulations.X rays were then resorted to, and when smaller and smallerulcers broke open in the cicatricial tissue zinc ions were-again introduced, followed by X rays, which again producedhealing. 2. Of superficial lupus of the nose, in whichsimilar alternate treatment produced healing. 3. Of scalylupus of the bridge of the nose and an ulcerated papillomaon the upper lip, both existing in one patient. The scalylupus quickly gave way to X rays alone, whilst the ulceratedpapilloma was much benefited by X rays at first, but failed torespond until the ions of zinc were introduced. The alternatetreatment ended in complete healing and disappearance.4. Of a form of superficial ulceration of the left nipple in awoman 70 years of age, in which the alternate treatment.

proved successful in healing after zinc ions alone had failed.5. Of tubercular ulcers of the skin. 6. Of a small pene-trating rodent ulcer of the alse of the nose in a sailor aged80 years. 7. Of a tuberculoma of the skin of the chest.

involving caries of the cartilages of the first and secondribs. 8. A case of actinomycosis of very severe type-was also cited in which a solution of potassium iodidewas repeatedly injected hypodermically as well as taken.

by the mouth, and the seat of the disease subjectedto X rays immediately after injection: in this case

resolution occurred with very little loss of tissue. The-

opinion was ventured that the renewing of the success byX rays, when that was lost, was by secondary X rays.emanating from the ionised solutions, which were not merelyon the tissues but in them. The system pursued was.

essentially two or three sittings with ionisation of ten.minutes’ duration a week apart, followed by two exhibi-tions of X rays one or two weeks apart of a length of time-suitable to the kind of case. Thus superficial tuberculosis-would require five minutes’ exposure once a week, whilst a.rodent ulcer would receive 15 minutes’ once in three weeks.

Dr. F. H. HUMPHRIS (London) read a paper on

Eectricity in the Reduction of High Arterial Tension.He pointed out the importance of recognising a pathologicalblood pressure and the advantages of being able to reduce itby means of electricity; at the same time he deprecatedindiscriminate interference with a condition which might beof actual benefit to the patient. He described a simpleelectrical means of clinically differentiating between thosecases in which attempts should be made to lower the pressureand those which it was better to leave alone. The form of

electricity which Dr. Humphris preferred for reducing bloodpressure was the auto-condensation couch of d’Arsonval, buthe used a multiple spark-gap with nine gaps. With the

apparatus which Dr. Humphris fully described, he was ableto give the patient a current of from 1000 to 1500 ma. in the-patient’s circuit, and the sphygmomanometric reading after-wards would show the pressure to have fallen 10 per cent.Dr. Humphris advanced the view that arterial tension dietnot of necessity increase with advancing years, but althoughthis condition usually obtained, the increased pressure was.due to something erroneous in the patient’s habits or

pathological in his system.Dr. T. LEWIS (London) gave a description of the

Electrocardiograph and its Use in Medicine.He explained the method of taking simultaneous electro-

cardiograms and heart sound records. The method, he said,.was particularly valuable, because it gave a very exact ideaof the time relations of heart sounds. He illustrated themethod by showing lantern slides of normal heart soundsand the common murmurs. The chief topic of the paperwas the character and time relations of the murmurs inmitral stenosis. He said : When the heart’s mechanism is.normal, the murmurs fill diastole (when the heart-rate isfast or the stenosis is severe), or occupy presystole orpresystole and early diastole (when the heart-rate is slowerand the grade of stenosis is less). The presystolic murmuris not usually crescendo ; the crescendo quality is given bythe accentuation of the first sound. When the auricles

fibrillate, the murmurs fill diastole in the short cycles, or in

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,all the cycles, when the heart-rate is fast; they lie in the<early diastole of the long cycles and are confined to early-diastole when the heart-rate is very slow ; under the last-named circumstances the murmur may be separated from the,preceding second sound by a short interval of silence. Anisolated presystolic murmur is not found when the auriclesflbrillate. The relation of the diastolic murmurs of mitralstenosis to the auricular contractions when heart-block is

present shows that these murmurs are largely controlled by-the positions of the auricular contractions. The explanationof all the diastolic murmurs of mitral stenosis is to be foundin a study of the differential pressures between the auricleand ventricle, and therefore in the velocity of flow through- the mitral orifice.

FRIDAY, JULY 25TH.

Dr. AGNES SAVILL (London) gave notes of two cases of-Fibronta

.cured by the X rays (Bordier’s method). She was not

altogether in favour of the technique as advised by Bordier,and considered that there was an element of risk of producingradio-dermatitis that militated against its more general.adoption. Apart from this there were some deferred changes,such as telangiectases and other local trophic troubles. Thelater method of Bordier advocated giving nine exposures onnine successive days just after the menstrual period. Dr.’Savill went on to test the relative efficiency of screens madeof aluminium, felt, lint, and lint that had been treated bysodium tungstate in the manner advocated by Dr. ReginaldMorton. It was found that 12 layers of felt, four layers of’tungstated lint, and 3 mm. of aluminium gave almost the.same filtering value, but she expressed a preference for theyrepared lint.

Sir A. PEARCE GOULD opened a discussion onTlte Use of the Gctmntcc -adiations in Surgery.

In the course of his very interesting address he laid downsome important principles that had been arrived at in the.cancer research laboratories at the Middlesex Hospital. Thefirst was that the emanations of radium check cell growth,.and have a direct action on the nucleus. This checking.action is much greater on malignant cells than normal ones,and is about 20 times greater than on the leucocyte. Further,it has more influence at the moment of division than duringthe resting stage. The second great principle was that theradiations could check the growth of the cancer cell without,destroying the immunity reaction, but that it was possibleto push the dose to the extent of destroying not only thecell but also the immunity reaction. These principles mustalways be borne in mind when using radium, since theyshowed that, while it had an immense power for good,it was capable of doing much harm. With regard tothe treatment of quite superficial malignant ulcers, hedid not think that radium had any advantage over theX rays, but it was more valuable than the latterfor more deeply-seated lesions. For these he consideredit essential that the radium be introduced into the growth-it was not sufficient to place it on the surface-and he citedcases showing the extreme value of this procedure. Finallyhe urged the necessity for caution and reserve in speaking ofthe value of radium, especially in the treatment of malignant:growths.

The discussion was carried on by Dr. ROBERT ABBE (NewYork), who was inclined to take a more optimistic view ofthe value and future prospects of radium He illustrated aseries of results obtained in his experiments with seeds ofvarious plants, and he found that while radium exerted adestructive action under certain conditions it was easy toobtain stimulation and retrograde action by suitable variationsin the method adopted. In his opinion the gamma radia-tions of the X ray tube and those of radium were not thesame. In support of this he showed photographs of a caseof chronic X ray dermatitis that was cured by radium

applications. He also showed photographs of the larynx ofa lady who had lost the use of her voice through the presenceof papillomata on the vocal cords. With the use of radium- complete restoration of the speaking and singing voice hadbeen obtained. He also pointed out that there were dangersattending the use of radium, especially through overdosage,which often caused a great deal of pain that was difficult toalleviate.

Dr. F. HERNAMAN-JOHNSON (Darlington) read a paper onThe htdiecztion for X Ray Radiation Before, -D?tring, and

After Operation for Cancer.He said: The commonly accepted dogma that operationshould always take place immediately on the diagnosis ofcancer ought to be subjected to fresh examination in thelight of present knowledge. Surgical interference alwaysinvolves a risk of disseminating malignant cells. If all thecells of a cancerous growth are in a depressed state at thetime of operation they will have less chance of establishingthemselves at a distance in face of the normal opposition ofinvaded tissues. A very moderate amount of radiation is

capable of producing a temporary depression in cancerouselements ; three weeks’ pre-operation treatment is sufficientfor the purpose. The statement sometimes made to the effectthat normal tissues which have been subjected to X rays donot recover well after surgical trauma is not true unless theradiation has been excessive. On the contrary, healing is pro-moted. When pain and ulceration are present pre-operationraying should be insisted on. The patient can in a

few weeks be placed in a much better state to with-stand operation. For this the opportune moment mustbe seized before the crest of the wave of improve-ment is reached. It must be recognised that the benefitto be derived from X rays is in most cases not permanent,and to delay calling in the surgeon until relapse is in sightis fatal to the patient’s chances. The suggestion made byDr. Morton to the effect that a heavy dose of X rays shouldbe delivered into operation wounds before the flaps are

closed should be carried out wherever possible, and thisshould be done even if it turns out that the tumourcannot be removed. As to post-operative or preventiveraying, this should be commenced as soon as the patienthas recovered from the immediate shock of the opera-tion. This rule applies, however, only to cases whichhave not received preparatory treatment. Here, further

radiotherapeutic measures may safely be delayed for fromthree to four weeks. Delay is otherwise dangerous, becausethe foundations of metastatic mischief are probably oftenlaid during the weeks immediately following operation. Incases in which the surgeon considers the patient’s chancesare fair as a result of operation alone, prophylactic rayingshould rather aim at stimulating the resisting power of thetissues than attempt to attack wandering cancer cells

directly Short courses, separated by intervals of severalweeks, are best for this purpose. When, however, recurrenceis confidently looked for within a few months the radio-

logist must pursue a bolder policy. Treatment shouldinclude not only the original site of the disease, but allthose parts and organs which experience teaches us are

likely to be the seat of metastatic growths. Radiotherapy isnot a substitute for operation, but neither is it a mere

adjunct to surgery. Every case of cancer should be fromthe outset treated jointly by a surgeon and a radiologist ;,but the latter, if he wishes to rank as the equal of hiscolleague, must be a student of disease no less than ofelectrical technique.

Dr. FRANK FOWLER (Bournemouth) dealt withThe Technilne of the X Ray Treatment of Cancer.

The reason of failure in the treatment of deep-seated cancerwas the fact that the dose that reached the part wasinsufficient. This could be increased by (1) increasing theskin-focus distance ; (2) by cross-fire; (3) by filtration ; or(4) by the use of very hard rays. In the past they had beenmisled by physicists who had advised the use of rays as softas possible ; in practice very hard rays were found to havedefinite effects, although almost entirely unabsorbed. Thedose must be measured after filtration, as error and confusionhad arisen from the practice of measuring the dose above thefilter. If treatment was thoroughly carried out ulcerationshould never occur, and mediastinal infection was rare.

Dr. G. B. BATTEN (Dulwich) read a paper onThe X Bay Treatment of Ringworm

After referring to the various modifications of techniquethat had been introduced, he described a method devised byhimself which had the effect of saving a great deal of timeas well as the life of the tubes-an important matter wheremany cases had to be done. He also showed a special formof tube-holder for carrying out the method he advised.