the therapeutics of the x rays

2
1481 corresponding reflective power and self-restraint there the l morbid germ develops until it may even become epidemic over a wide area. We have already noticed some of its manifestations and have referred to the instability of will and the incoordinated action which are its natural consequences. In these circumstances its effective treat- ment is obviously most desirable. Fortunately it is a true functional disorder and there is no reason to regard it as incurable. If only the exciting cause be frankly recognised and grappled with much will have been done towards providing a remedy. In order to arrive at a successful result, however, it is necessary to begin by admitting that scrutiny in technical matters, even by those whom it may concern, may be overdone. It matters little whether it be carried out by a subordinate Government official, by an over-zealous pressman, or by a private individual more eager than judicious ; if superfluous the effect is the same. To let well alone is an axiom synonymous with sound practice. To say that details of matters not belonging to the province of common knowledge should be left in the hands of selected and competent persons is another way of expressing the same truth. The contrary method, that of prying and open-mouthed publicity, is incompatible with successful business, with the public service, and with the very desirable extinction of the alarmist neurosis. NICETIES OF NURSING. THAT a good nurse must have other qualities besides a sufficient knowledge of, and skill in, her profession is as plain to all who have had the misfortune of being" patients " as it is that similar advantages are necessary in a medical man if he is to be, not only a safe, but also a welcome, adviser. For a nurse, indeed, these qualities, which we may take to be tact, sympathy, and the knack of doing the right thing with the least possible unpleasantness, are even more essential than they are in the practitioner’s case, for he sees comparatively little of his patients, while the nurse is to a large extent constantly present. The modern nurse is such a vast improvement profession- ally upon her predecessor and her position in the sick- room and in the hospital is so well established and generally so well filled that she is apt to overlook or to forget the great importance of being pleasant and con- siderate as well as professionally accomplished. The old- fashioned nurse was of very little benefit to her patient in illness and the modern nurse seems sometimes to imagine that it is for her benefit that the patient is ill. She demands sometimes little attentions and consideration which really it is her duty to supply. It is particularly, of course, in private houses that a selfish or a thoughtless nurse can make her presence a necessary evil instead of being a grateful source of ease to her patient. Many of the little extra points by attention to which a nurse can multiply many times the gratitude of those in her charge are given in an address on the " Little Niceties of Private Nursing " by Mrs. Emily F. Stewart Brown, lady president of the Liverpool Hospital for Women. The address contains, moreover, some directions bearing upon small points in a nurse’s actual duties of much importance but often neglected in private nursing where the conveniences of a hospital and the watchful eye of a superior may be alike absent. Mrs. Stewart Brown’s advice is contained in a series of "Don’ts" and is based upon true instances. We pity the patient whose experi- ence of nursing provided Mrs. Stewart Brown with this succinct prohibition, "Don’t cultivate a love for the succulent onion." A wise injunction to nurses engaged in private houses is "Don’t forget that illness upsets the routine of a household, and make things as pleasant as you can ; if you don’t your meals will be anything but elaborate and the attention you will receive very limited." Mrs. Stewart Brown is not in her address concerned with the- other side of the question, or we can well imagine a series of "Don’ts" applicable to people who employ nurses and’ who are sometimes strangely inconsiderate in what they expect at a nurse’s hands. Sometimes there is a tendency to’ overlook the fact that a nurse needs food, sleep, and some- comfort even as ordinary persons do-still more than other folks, perhaps, when engaged upon an arduous case. To- very many nurses, we are glad to know, most of Mrs.. e Stewart Brown’s prohibitions are superfluous ; by none, however, can they be read with anything but pleasure- and by most, we are sure, with very great advantage. SUCCESSFUL TREATMENT OF PARENTAL NEGLECT. REFORMATION rather than punishment has always beera the aim of the National Society for the Prevention of Cruelty- to Children. It affords protection to helpless children but. it does more than this. It endeavours to awaken, if possible, in defaulting parents a desire to do likewise. Two cases- mentioned in a recent issue of the society’s periodical go to prove that its efforts in this direction have not. been altogether unsuccessful. In each instance a drunken.. mother had grossly neglected her duties to her family and had been sentenced to a term of imprison- ment. Both women after their liberation abandoned the drinking habit, became industrious, maintained their’ children in sobriety and comfort, and eventually re-, turned to thank the agents of the society for what it- had done for them. This, we are assured, is the kind of’ work which is being carried on throughout the country. We, believe the statement though we are also alive to the fact- that actual punishment is not lightly resorted to. These: cases are their own commentary. They show that a penalty when judiciously employed may and does act as a stimulus to the parental sense of responsibility. There must be few persons who do not join us in the hope that such work may continue. THE THERAPEUTICS OF THE X RAYS. THE value of the light treatment in lupus and in certain cases of superficial malignant disease, particularly rodent; ulcer, is now established. But the permanency of the "cures" " which have been obtained and the utility of the- treatment in other forms of malignant disease and in other diseases remain to be determined. In the Journal of the- American Medical Association of April 12th Dr. Allen Pusey, professor of dermatology in the University of Illinois, has. published a well-reasoned paper which tends to show that the field of utility of the x rays is greater than that in which they have been employed in this country. H& describes 36 cases of various diseases, principally malignant, and gives 24 excellent illustrations showing the condition before and after treatment. His results therefore cannot, be gainsaid. In lupus they are simply confirmatory : the x rays cause the disease to disappear and yield white, soft, pliable scars which could not be less extensive under- any other method. Even in the case in which the longest interval-18 months-had elapsed since recovery there was no sign of recurrence. Eight consecutive cases of "ep:- thelioma " (most, if not all, of them appear to be cases which- in England would be termed " rodent ulcer ") were treated successfully, the ulcer being replaced by healthy scar. One case "was beyond relief by any other method" and. Dr. Pusey with pardonable pride claims it as "unique." A man, aged 35 years, came under treatment. 11 years before a small nodule appeared on the right cheek below the eye. It gradually enlarged and after

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1481

corresponding reflective power and self-restraint there the lmorbid germ develops until it may even become epidemicover a wide area. We have already noticed some of itsmanifestations and have referred to the instability of

will and the incoordinated action which are its natural

consequences. In these circumstances its effective treat-

ment is obviously most desirable. Fortunately it is a

true functional disorder and there is no reason to

regard it as incurable. If only the exciting cause be

frankly recognised and grappled with much will have

been done towards providing a remedy. In order to arrive

at a successful result, however, it is necessary to beginby admitting that scrutiny in technical matters, even bythose whom it may concern, may be overdone. It matters

little whether it be carried out by a subordinate Governmentofficial, by an over-zealous pressman, or by a privateindividual more eager than judicious ; if superfluous theeffect is the same. To let well alone is an axiom synonymouswith sound practice. To say that details of matters not

belonging to the province of common knowledge should beleft in the hands of selected and competent persons is

another way of expressing the same truth. The contrarymethod, that of prying and open-mouthed publicity, is

incompatible with successful business, with the publicservice, and with the very desirable extinction of thealarmist neurosis.

NICETIES OF NURSING.

THAT a good nurse must have other qualities besides a sufficient knowledge of, and skill in, her profession is as plainto all who have had the misfortune of being" patients " asit is that similar advantages are necessary in a medical manif he is to be, not only a safe, but also a welcome, adviser.For a nurse, indeed, these qualities, which we may taketo be tact, sympathy, and the knack of doing the

right thing with the least possible unpleasantness, are

even more essential than they are in the practitioner’scase, for he sees comparatively little of his patients, whilethe nurse is to a large extent constantly present. The

modern nurse is such a vast improvement profession-ally upon her predecessor and her position in the sick-

room and in the hospital is so well established and

generally so well filled that she is apt to overlook or to

forget the great importance of being pleasant and con-

siderate as well as professionally accomplished. The old-

fashioned nurse was of very little benefit to her patient inillness and the modern nurse seems sometimes to imaginethat it is for her benefit that the patient is ill. She demandssometimes little attentions and consideration which really itis her duty to supply. It is particularly, of course, in privatehouses that a selfish or a thoughtless nurse can make herpresence a necessary evil instead of being a grateful sourceof ease to her patient. Many of the little extra points byattention to which a nurse can multiply many times thegratitude of those in her charge are given in an address onthe " Little Niceties of Private Nursing " by Mrs. Emily F.Stewart Brown, lady president of the Liverpool Hospital forWomen. The address contains, moreover, some directionsbearing upon small points in a nurse’s actual duties of muchimportance but often neglected in private nursing wherethe conveniences of a hospital and the watchful eyeof a superior may be alike absent. Mrs. Stewart Brown’sadvice is contained in a series of "Don’ts" and is based

upon true instances. We pity the patient whose experi-ence of nursing provided Mrs. Stewart Brown with thissuccinct prohibition, "Don’t cultivate a love for the

succulent onion." A wise injunction to nurses engagedin private houses is "Don’t forget that illness upsets theroutine of a household, and make things as pleasant as youcan ; if you don’t your meals will be anything but elaborate

and the attention you will receive very limited." Mrs.Stewart Brown is not in her address concerned with the-other side of the question, or we can well imagine a seriesof "Don’ts" applicable to people who employ nurses and’who are sometimes strangely inconsiderate in what theyexpect at a nurse’s hands. Sometimes there is a tendency to’overlook the fact that a nurse needs food, sleep, and some-comfort even as ordinary persons do-still more than otherfolks, perhaps, when engaged upon an arduous case. To-

very many nurses, we are glad to know, most of Mrs.. e

Stewart Brown’s prohibitions are superfluous ; by none,

however, can they be read with anything but pleasure-and by most, we are sure, with very great advantage.

SUCCESSFUL TREATMENT OF PARENTALNEGLECT.

REFORMATION rather than punishment has always beerathe aim of the National Society for the Prevention of Cruelty-to Children. It affords protection to helpless children but.it does more than this. It endeavours to awaken, if possible,in defaulting parents a desire to do likewise. Two cases-mentioned in a recent issue of the society’s periodicalgo to prove that its efforts in this direction have not.

been altogether unsuccessful. In each instance a drunken..mother had grossly neglected her duties to her familyand had been sentenced to a term of imprison-ment. Both women after their liberation abandonedthe drinking habit, became industrious, maintained their’

children in sobriety and comfort, and eventually re-,turned to thank the agents of the society for what it-

had done for them. This, we are assured, is the kind of’work which is being carried on throughout the country. We,believe the statement though we are also alive to the fact-that actual punishment is not lightly resorted to. These:

cases are their own commentary. They show that a penaltywhen judiciously employed may and does act as a stimulusto the parental sense of responsibility. There must be few

persons who do not join us in the hope that such work maycontinue.

____

THE THERAPEUTICS OF THE X RAYS.

THE value of the light treatment in lupus and in certaincases of superficial malignant disease, particularly rodent;ulcer, is now established. But the permanency of the

"cures" " which have been obtained and the utility of the-treatment in other forms of malignant disease and in otherdiseases remain to be determined. In the Journal of the-American Medical Association of April 12th Dr. Allen Pusey,professor of dermatology in the University of Illinois, has.

published a well-reasoned paper which tends to show thatthe field of utility of the x rays is greater than that in

which they have been employed in this country. H&

describes 36 cases of various diseases, principally malignant,and gives 24 excellent illustrations showing the conditionbefore and after treatment. His results therefore cannot,be gainsaid. In lupus they are simply confirmatory : thex rays cause the disease to disappear and yield white,soft, pliable scars which could not be less extensive under-any other method. Even in the case in which the longestinterval-18 months-had elapsed since recovery there wasno sign of recurrence. Eight consecutive cases of "ep:-thelioma " (most, if not all, of them appear to be cases which-in England would be termed " rodent ulcer ") were treatedsuccessfully, the ulcer being replaced by healthy scar. Onecase "was beyond relief by any other method" and.Dr. Pusey with pardonable pride claims it as "unique."A man, aged 35 years, came under treatment. 11

years before a small nodule appeared on the rightcheek below the eye. It gradually enlarged and after

1482

two years it ulcerated. Five years later a radical opera-tion was performed ; the ulcer and a large amount of thesurrounding tissue were removed. The lower eyelid hadto be restored by an extensive plastic operation. After a

year recurrence took place and the orbit became involved.The disease was so extensive that a surgeon would .not

operate. The entire orbit, both eyelids, the side of the noseand the cheek were involved. The eyeball was shrunkenand retracted in the orbit. Microscopical examinationconfirmed the diagnosis of epithelioma. The eyeballwas removed but this did not relieve the severe pain.Exposures to the x rays were given almost daily until

erythema ancl slight desquamation were produced. Withina, week the pain ceased and the discharge diminished.’The borders and the nodules shrank and the ulcer beganto heal. The surrounding tissue became smooth, soft,moveable, and free from induration. After three months

the’ulcer was almost healed and the patient had regainedhealth. Sections of the border of the ulcer made beforeand after the exposures demonstrated the effect of the

treatment : the abundant downgrowth of epithelium wasreplaced by a degenerated, structureless, wavy substance.A very similar case has recently been recorded by Dr.G. Stopford Taylor. 1 In three cases of recurrent

cancer of the breast remarkable benefit was obtained.Thus in one case the skin and subcutaneous tissue for

an area six inches in diameter round the scar were infil-

trated with cancer and there were ulcerating nodules.

Four months after the treatment was begun all traces of

cancer had disappeared. In three other cases, however, thetreatment failed. In lymphadenoma exposure of enlargedglands to the x rays was followed by almost completesubsidence and improvement in the general condition-forexample, the haemoglobin in the blood increased from 50 percent. of the normal to 80 per cent. Of course, the questionwhether the improvement in all these cases will remain per-manent cannot yet be answered. But even if it does notthe striking benefit obtained in the inoperable cases ofcancer is sufficient to make the light treatment a valuableaddition to therapeutics. Moreover, in case of recur-

rence it may yield in turn to the same treatment. Dr.

Pusey’s paper is all the more valuable because he doesnot attempt to claim too much. He points out that

the advantages of the x-ray treatment are : (1) that it ispainless ; (2) that it destroys diseased tissue but leaves

healthy tissue in its place ; (3) that it leaves small scars ;(4) that it can be used when the surrounding healthy tissuecannot be sacrificed (in operations about the eye and nose) ;(5) that it is applicable in inoperable cases ; and (6) that itoften relieves pain. With commendable caution he does notadvise the use of the x rays for operable malignant growthsexcept for I I cutaneous carcinoma" (rodent ulcer). On the

other hand, he thinks that the x rays should be used as aprophylactic measure in all cases of malignant diseasewhich have been operated upon and should be tried in

all inoperable cases--in which there are a probability ofrelieving pain and a possibility of inhibiting growth.

THE MEDICAL ORGANISATIONS OF FOREIGNARMIES.

WE desire to call attention to a very useful little officialhandbook dealing with the medical organisations of foreignarmies (chiefly for war) which has been compiled byLieutenant-Colonel Frank Howard, Army Medical Staff

(retired pay), and is issued by authority. A brief descrip-tion is given of the army medical organisation of some 20foreign countries. The information, which must have costthe writer much care and labour to get together, strikesus as being clearly and succinctly epitomised, and, setting

1 THE LANCET, May 17th, 1902, p. 1395.

aside any intrinsic interest attaching to the subject, themanual supplies a want on the part of army surgeons whowill be required to show some knowledge of it in their future

examinations for promotion. Readers of the handbook will

naturally turn first of all to the medical organisations of

the armies of Germany, France, America, Russia, Austria-Hungary, and Italy. Speaking generally, there is a greatsimilarity, on the whole, in the army medical organisation,arrangements, and transport of the different military powers;they all recognise very much the same aims and principles.although there are, as might be confidently expected, some

diversities of procedure-of ways and means and details-incarrying them out. The handbook is a little mine of com-

pressed information which does not easily lend itself to

review, but we may say that the sections devoted to France,Germany, America, and Japan seem to be full and precise.We should add that the price of the handbook is ls.

THE LATE MR. BRAXTON HICKS.

WE regret to see the announcement of the death from

pneumonia on Saturday last of Mr. Athelstan Braxton

Hicks, coroner for the South-western District of London andfor the Kingston Division of Surrey. Mr. Hicks, who wasa legal coroner, was a son of the late Dr. Braxton Hicks, thedistinguished obstetrician, and was, we believe, at one timeintended for the medical profession and studied for some

years at Guy’s Hospital. He eventually, however, was calledto the Bar and in 1883 was appointed deputy coroner for Mid-Surrey and subsequently deputy-coroner for the City of

London, the Borough of Southwark, the City of Westmin-ster, and Western Middlesex. In 1885 he became coronerfor Surrey in succession to the late Mr. George Hull. Onthe passing of the Local Government Act and the formationof the administrative county of London his district wasdivided and he became coroner for South-west London andthe Kingston division of Surrey. Mr. Braxton Hicks was

at the time of his death Vice-president of the Coroners’

Society ; he also was, and had been for many years, secre-tary of the society and had a wide knowledge of the lawsappertaining to the duties and position of coroners. Wehave frequently been indebted to him for information of thisnature which was always freely and promptly placed at ourdisposal. As a coroner he performed good public service inmany ways. He was largely responsible for the licensingof small boats and did much to bring about an alteration inthe law with regard to the sale of carbolic acid. He alsomissed no opportunity of exposing the evils of baby-farming,and up to the time of his death was engaged in impressingupon the poorer classes of the public the necessity of theprovision of fire-guards to protect their children fromaccidental burning.

-

A CASE OF ABNORMALLY HIGH BRAIN-WEIGHT.

AN interesting case of abnormally high brain-weight in aman who died at the age of 37 years in an asylum, but who,until the age of about 35 years, had his mental faculties

practically normal, is published in the Journal of MentalScience for April last by Mr. John Sutcliffe and ProfessorSheridan Delepine. The brain belonged to a man who wasby profession an accountant and estate agent, a sober,steady, hard-working man, who had built up a good business.He had married at the age of 21 years and was the father offour children. He had had good health till the age of 22

years, when epileptic fits began to appear, one fit occur-

ring at intervals of two or three weeks. When 25 yearsold he was assaulted and knocked down and remainedunconscious for three days. Since then the fits becamesevere and frequent and he also suffered from headaches.

For some months before admission to the asylum at Cheadle-viz., Feb. 6th, 1900-he had been suffering from delusions of