British Medical Journal, Jime 27th. 18^6 
 
 THE 
 
 THE JOURNAL OF THE BRITISH MEDICAL ASSOCIATION. 
 
 INCLUDING 
 
 AN EPITOME OE CURRENT MEDICAL LITERATURE. 
 
 EDITED EOB THE ASSOCIATION BY 
 
 ERNEST HART, D.C.L. 
 
 0 
 
 ASSISTED BY 
 
 DAWSON WILLIAMS, M.D. 
 
 VOLUME I FOR 1896 
 
 January to June. 
 
 Eontion: 
 
 PRINTED AND PUBLISHED BY THE BRITISH MEDICAL ASSOCIATION AT THEIR OFFICE, 429, STRAND. 
 
 5 
 
 MDCCCXCVI 
 
Digitized by the Internet Archive 
 in 2018 with funding from 
 Getty Research Institute 
 
 https://archive.org/details/reportonapplicatOOrowl 
 
Feb. 8, 1896.J 
 
 CLINICAL APPLICATIONS OF THE NEW PHOTOGRAPHY. 
 
 I" The British 
 L'Teihcal Journal 
 
 361 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 I. 
 
 We have commissioned Mr. Sidney Rowland to investigate 
 the application of Roentgen’s discovery and to study prac¬ 
 tically its applications. He is employed now in doing so, 
 and with some interesting results. Any of our members who 
 may have suitable cases of interest which they desire to have 
 investigated by the new photography are invited to com¬ 
 municate with us. Mr. Rowland writes to us as follows : 
 
 Not much further light has been thrown on the nature of 
 the new radiation since the discovery was announced. The 
 interest in the subject has not diminished, and numerous 
 communications have appeared; yet it is hard to find any 
 matter of importance as to this very difficult problem. In 
 England, Air. Gifford, of Chard, has been working hard, and 
 has produced many curious results, it is true, but none that 
 are in any way explanatory of the new discovery. The chief 
 difficulty in making rapid headway consists in the scarcity 
 of suitable tubes, the whole of the English stock having been 
 bought up almost on the first receipt of the intelligence from 
 Germany, and of these but a small proportion have been 
 found to be of any use. Fresh arrivals are daily coming in, 
 and some are being made in Germany. As many of our 
 readers are probably already trying the new method, a de¬ 
 scription of the actual appliances employed may be of use, 
 together with some hints as to the choice of apparatus and 
 good methods of working. 
 
 The Choice of a Coil and Transformer. 
 
 First, as to the coil. This must be a fairly large one, say 
 7-inch spark. It must be a really good instrument, made by 
 a reliable maker; the cheaper French coils are of no use. It is 
 important to have sufficient battery power, for want of this is 
 the most frequent cause of failure in coil work. Dry cells are 
 of no use at all, and bichromate batteries fall off so rapidly that 
 they are unsuitable for the long exposures sometimes neces¬ 
 sary. The best form of battery is undoubtedly Groves’s or 
 Bunsen’s. A street supply from a company’s mains, if avail¬ 
 able, can be used with the least trouble. In using it, how¬ 
 ever, care must be taken to transform it to a suitable 
 pressure. 
 
 Although results undoubtedly can be obtained by the use 
 of a coil alone, yet the best so far have been obtained by 
 using a small Testa transformer. These transformers can now 
 be obtained from the instrument maker of suitable size for 
 coils from 2-incli spark and upwards. Their effect is to 
 raise the frequency of alternation of the current to 
 an exceedingly high pitch. The choice of the tube is the 
 most important matter. Too much care cannot be devoted to 
 this. The vacuum must be exceedingly high ; nothing else 
 is of the slightest use. Before purchasing one it should be 
 tried by the instrument maker, and the character of the dis¬ 
 charge noticed. If the tube lights up with an apparently 
 uniform whitish green glow, then the tube may be expected 
 to give good results ; if, however, the discharge is continuous 
 from pole to pole the vacuum is a low one, and the tube use¬ 
 less for the purpose in view. The character of the glow as 
 noticed by the eye can be taken as a fairly good criterion as to 
 the possible performance of the tube. The glow should, I find, 
 foe of a whitish purplish colour, quite distinct from the green 
 fluorescence of the glass. Great care must be taken of such a 
 tube, and when in use it must be most carefully insulated, 
 for a frequent cause of destruction of good tubes is the break¬ 
 ing through of the discharge to some neighbouring good con¬ 
 ductor. The tubes must be suspended by silk threads from 
 a glass support, and carefully cleaned on the outside. 
 
 Mr. Gifford’s Results : their Explanation. 
 
 Mr. Gifford’s work has already been alluded to. He has 
 found, among other things, that it is possible to photograph 
 through opaque bodies without a tube at all, using simply the 
 brush discharge from one of the dischargers of a large coil. 
 In this way he lias produced images of coins quite distinctly. 
 
 I have repeated these experiments, using, instead of a coil 
 discharge, that from a Testa transformer, with the result that 
 I have obtained not only the shadow of the coin on the plate, 
 but a perfect picture of the engraving on the coin. Mr. Gifford 
 argues from these experiments that Roentgen x rays are not 
 of the nature of light, but rather of an electrical effect. But 
 this argument fails, I think, in the light of the following ex¬ 
 periment. In this case the penny was placed behind the plate, 
 so as to avoid the possibility of any shadow effect, and with 
 exactly the same result—namely, a faithful image of the im¬ 
 pression of the coin. It is obvious, therefore, that we have 
 here to do with an electrical contact effect, and not with 
 Roentgen rays at all. 
 
 As to the best plates to employ, I have found the best 
 results from isochromatics of high rapidity developed with 
 pyro and soda. There is thus no insuperable difficulty in 
 working the new process ; it only needs care in details and 
 the careful selection of the tube. The latest form is of this 
 shape, one electrode being an aluminium plate and the other 
 a ring. The plate should be the cathode. 
 
 With an apparatus of this description, which is not very 
 bulky, and only requires care in working, it is quite possible 
 for anyone to obtain negatives that will show all that has 
 been shown up to the present. The accompanying hand 
 (p. 363) was taken by me with such an apparatus with an 
 exposure of twenty minutes. 
 
 Professor S. P. Thompson’s conclusions up to the present 
 are : 
 
 1. That success depends more on the degree of exhaustion 
 (of the tube) than anything else. Only the highest exhaustion 
 is of use. 
 
 2. Sharply defined shadows need as a source a small bulb. 
 
 3. The x rays do not emanate exclusively, as has been sup¬ 
 posed, from the phosphorescent patches on the glass. On 
 the contrary, he has cases of double shadows cast by one tube, 
 where the stronger shadow was shown as by rays emanating 
 straight from the cathode, while the weaker one was thrown 
 as by rays emanating at the phosphorescent patch. 
 
 4. Professor Thompson finds diamond to be more opaque 
 than black carbon. 
 
 5. In wood (pine) the dark resinous streaks are more trans¬ 
 parent than the lighter coloured tissue. 
 
 6. A specimen of flies in amber shows no shadow of the 
 flies. 
 
 7. There appears to be no difference in the degree of opacity 
 of magnetised and non-magnetised iron. 
 
 Professor Thompson and Professor Lodge agree in regard¬ 
 ing the rays as rather of the nature of sound waves than of 
 light. But they differ as to the length, the one considering 
 them as excessively short, the other (probably) as longer than 
 the rays of visible light. 
 
 And these embody all that can be definitely stated at 
 present. It is hoped that next week photographs of cases 
 will be ready demonstrating the practical application of the 
 new discovery. 
 
 Someof the earliest endeavours to apply Professor Roentgen’s 
 discovery not only to diagnosis but to treatment are reported 
 from Vienna. Professor Mosetig was the first to utilise the 
 new method. At the Medical Society he reported two cases 
 in which operative procedures were carried out under the guid¬ 
 ance of the exact knowledge of the anatomical conditions ob¬ 
 tained by the new radiation. The accompanying illustrations 
 
62 
 
 The British 1 
 Medical .Tourna' j 
 
 CLINICAL APPLICATIONS OF THE NEW PHOTOGRAPHY. 
 
 [Feb. 8 , i8q6. 
 
 are reproductions of photographs of the cases which were 
 taken by Roentgen’s method in Professor Franz Exner’s Phy¬ 
 sical Institute. The first case is one of deformity of the 
 distal phalanx of the hallux, which appeared to be double. 
 This diagnosis had already been made without the help of 
 the new photography, but there was a difficulty in distin¬ 
 guishing which of the two bones was the normal one and 
 which the supernumerary. As this could not be made out, 
 Professor Mosetig would have had to resort to remove the 
 whole of the double distal phalanx. The Roentgen photo¬ 
 graphy showed, however, that only one of the two bones (the 
 lateral one) articulated with the first phalanx, while the 
 other was merely a supernumerary appendix, articulating 
 with the normal distal phalanx by a sort of facette, dis¬ 
 tinctly to be seen in the photograph. Besides the great 
 comfort it afforded to the patient to see with his own eyes 
 the real condition of his abnormality before having a part of 
 his body removed, the surgeon was enabled to spare the 
 normal phalanx. 
 
 In the other case the situation of a revolver bullet could be 
 exactly made out after every other method had failed. The 
 bullet had imbedded itself into the fourth interosseous space 
 of the right hand, and become tightly fixed to the fifth meta¬ 
 carpal bone. The photograph shows ..clearly the bullet and 
 the slight deformity caused by it in the metacarpal bone. In 
 this case also the surgeon’s hand'was guided by the photo¬ 
 graph, and the bullet was easily removed. These photographs 
 were taken by means of a very larg'e Ruhm-Korff inductor, 
 the exposure being two hours, for which time the patient’s 
 limb had to lie directly (and quietly) on the box with the 
 sensitive plate. This seems a great drawback of the method, 
 but good photographs have since been obtained after a much 
 shorter exposure. 
 
 Professor Neusser was the first to attempt the application 
 of the new discovery to medical diagnosis. He had photo¬ 
 graphs taken, outside the body, of gallstones and of a vesical 
 calculus, the latter consisting of phosphates, which proved 
 quite impenetrable to Roentgen’s rays, while the cholesterine 
 stones were not quite opaque. The photograph of the latter 
 was taken through a layer of calf’s liver 4 centimetres thick. 
 The results were so promising that Professor Neusser intends 
 soon to give the method a trial on the living patient. 
 
 Herr E. Haschell and Dr. 0 . Th. Lindentlml have made 
 experiments in the Physico-Chemical Institute of Professor 
 Franz Exner, of Vienna. 1 In the finger of a colleague, 
 through which a pistol bullet had passed many years before, 
 they were able to shoiv the injured bone in which the loss of 
 osseous.tissue had been made good by callus. They also suc¬ 
 ceeded in photographing the bones of a child’s arm, forearm, 
 and foot, but they failed in their attempts to get pictures 
 of the bones of the skull and trunk. On a dead hand, how¬ 
 ever, after injection, they were able to photograph the blood 
 vessels. This seems to open up a new possible application of 
 the method to the teaching of anatomy. 
 
 Professor Adolph and Dr. Lenz, of Elberfeld, seem to have 
 been successful in a further modification, or rather extension, 
 of the Roentgen photography. They announce that they are 
 able to photograph the bones of thicker parts of the body 
 than the hand—such, for instance, as the arm and wrist; and, 
 further, that their method enables them to photograph not 
 only the bones but the connective tissue. 
 
 In France experiments are being made in the laboratories 
 by Professor Lannelongue and MM. Perrin, Ma scarf, and 
 Oudin. M. Gariel, Professor of Physics in the Paris Medical 
 Faculty, doubts whether the new photography can be so 
 generally applied in medicine and surgery as at first sight it 
 was supposed. He asks how this method can be applied to 
 the greater number of the organs contained in the human 
 body. In the thorax, for instance, the organs placed behind 
 the sternum and those in front of the vertebral column would 
 not by made clear. The same difficulty applies almost 
 equally to photography of the stomach, liver, kidney, and 
 heart. M. Gariel asserts that in order to obtain infor¬ 
 mation by this method of photography the organs under 
 examination must be photographed by diffusion not by 
 transparency. Perhaps this step in advance will be realised, 
 but at present there are no indications which permit the 
 hypothesis; even were it so an “image” mus t be uro- 
 
 1 Wien . klin . Wochenschrifl , January 23rd. 
 
 duced and not a “shadow” on the sensitive plate. There 
 must be discovered reflecting and refractive methods of 
 acting on the rays in the same way as concave mirrors- 
 and lenses act on ordinary light rays. Research has shown 
 that these rays are not submitted to refraction nor to regular- 
 reflection in the conditions under which they have been 
 studied. It would perhaps be rash to say that these effects 
 will never be manifested under other conditions, but Pro¬ 
 fessor Gariel considers it to be barely probable. He acknow¬ 
 ledges the importance of the results of the application of the 
 Roentgen method made by M. Lannelongue, already noticed 
 in the British Medical Journal, but he points out that 
 they in no way invalidate the conclusions summarised above. 
 The cliche examined by the Academicians present when M. 
 Lannelongue made his communication showed that there are 
 white patches in the midst of the shadow thrown by the bone, 
 proving, as M. Lannelongue had previously affirmed, that the 
 destruction of the osseous tissue operates from the centre to 
 the periphery, not from the periphery to the centre. All the 
 three cases photographed were simple. It is precisely in 
 these that the method of photography by the new radiation 
 will be of service. 
 
 From Montpelier comes also testimony to the possi¬ 
 bilities of the new photography. Three lecturers in that 
 medical school have succeeded in photographing a 5-franc 
 piece which was placed inside a purse, and had four folds of 
 leather between it and the apparatus. The form of the money 
 came out distinctly on the photographic plate, as did also the 
 shape and texture of the purse. 
 
 THE NEW KIND OF RADIATION. 
 
 Sir, —It is known that cultures of the bacillus of tubercle 
 are sterilised by direct sunlight. So far as I am aware, no 
 differential experiments have been made to ascertain whether 
 this result is produced by sunlight in its totality, or, if not, 
 by what part of the spectrum. It is certainly possible that 
 the violet or ultra-violet rays may be the active agent. This 
 suggests the desirability of determining by direct experi¬ 
 ment whether the new radiant has or has not a sterilising 
 effect upon tubercle bacillus. 
 
 It is superfluous to point out that should this prove to be 
 the case, it- would place in our hands that which has been for 
 some time our highest aspiration—namely, a means of 
 sterilising the tubercle bacillus in situ within the body. Even 
 the lungs, though partially protected by impermeable ribs, 
 would not be entirely withdrawn from this influence.—I am, 
 etc., 
 
 Birmingham, Jan. 28th. WILLOUGHBY WADE, F.R.O.P. 
 
 *** This letter, received last week, was, in the pressure on 
 our columns, inadvertently omitted from the last number of 
 the Journal. 
 
 A bacteriological department has been established at 
 the Central London Throat, Nose, and Ear Hospital, and 
 Mr. St. George Reid has been appointed to take charge of it 
 for twelve months. 
 
 A meeting of the South-Western Division of the Medico- 
 Psychological Association will be held at Barnwood House, 
 Gloucester, on Tuesday, April 14th. After the election of 
 new members the report of the Committee on Criminal Re¬ 
 sponsibility will be considered, to be followed by a discussion 
 on the Nursing Staff in Asylums. 
 
 Cholera and Typhoid Fever in Indta.— The next annual 1 
 report of the Sanitary Commissioner with the Government 
 of India will, the Pioneer Mail states, contain an interesting 
 summary of all the evidence regarding the comma bacillus 
 and its relation to cholera. The question of epidemic typhoid 
 will also be dealt with in this report, which is to be issued 
 during the current month. 
 
 Royal Maternity Charity.— The annual meeting of the 
 governors of this charity was held on February 4th at the 
 Society’s house, 31, Finsbury Square, under the presidency of 
 Dr. Robert Barnes. The 140th annual report, which was read 
 by Mr. J. W. Long, the secretary, stated that last year the 
 charity nurses ministered to 4,445 poor married women in 
 their hour of trial. That was the-largest number of patients 
 relieved by the institution in any one year since 1825, and it 
 was very satisfactory to state that out of the large number 
 only four women died. 
 
CLINICAL APPLICATIONS OF THE NEW PHOTOGRAPHY 
 
 I" The British 
 | Medical Journal 
 
 363 
 
 Feb. 8 , 1896.] 
 
 Roentgen photography of the normal human hand. 
 
Roentgen photograph o£ hand showing bullet wound. Roentgen photograph of foot showing supernvpnerary phalanx. 
 
 364 
 
 The British "I 
 Medical Journal] 
 
 CLINICAL APPLICATIONS OF TIIE NEW PHOTOGRAPHY 
 
 [Feb. 8, 1896, 
 
Feb. 15, 1856.] 
 
 THE NEW PHOTOGRAPHY. 
 
 L The British 
 Medical Journal 
 
 431 
 
 Inductograms of various coins, showing the possibility of photography without a Crookes’s tube the effect being due to a contact effect. 
 In the second figure the coins were placed behind the plate.—Sydney Rowland (photo.) 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 II. 
 
 Mr. Sydney Rowland, B.A., reports that the past 
 week has not been fruitful of so much advance as 
 could have been wished, and beyond the strength that experi¬ 
 ment and personal experience of the new method has given, 
 the developments have been rather of the nature of defining 
 the difficulties and causes of failure than of removing them. 
 Owing to the loss of the best tube it has not been possible to 
 apply the method clinically, as was hoped last week, except in 
 the case to be alluded to. New tubes are, however, 
 to hand, and progress is again being made. For the 
 benefit of other workers it may be of use to give at length the 
 chief difficulties that I have found, and the best means of 
 surmounting them. 
 
 First and foremost among the causes of failure must be 
 placed the deficiencies in the tube itself. It does not seem 
 possible at present to define with any accuracy what kind of 
 tube is most suitable ; this can only be found by actual ex¬ 
 periment. In the tube itself there are several causes of pos¬ 
 sible defect. 
 
 First as to the degree of the vacuum necessary. Certainly 
 this must be “ high,” but on the other hand not too high. 
 If too “ low,” the discharge simply breaks from pole to pole 
 in a continuous stream ; if too high, on the other hand, it is 
 not possible to excite it without using very powerful cur¬ 
 rents such as are not always available. It seems, therefore, 
 
 to be a question of hitting the balance between the degree 
 of exhaustion, the strength of the current, and the frequency 
 of interruption ; at least this is my experience. The tube 
 with which the hand published last week was taken would 
 certainly not be called a very high vacuum tube, and yet it 
 gave, when the current was adjusted to it, and only then,. 
 very excellent results. The tube figured last week has failed 
 in my hands to give any results at all, and yet I hear that 
 other workers using the same tube have been able to produce- 
 good results, possibly because in their case the current used 
 was just suitable to the degree of exhaustion. 
 
 To sum up, then, with regard to the tube : It is little more 
 than a matter of chance at present whether any given tube 
 will produce results or not; having a tube the current must 
 be adjusted to it, and even then it may not give results. New 
 light on these points is most urgently needed before the new 
 method can become an accepted means of clinical diagnosis,, 
 and can be shed only by accurate and laborious physical' 
 experiments. It is only to be hoped that the many workers- 
 now engaged in investigating Professor Roentgen’s rays will 
 soon tell us something on these points. 
 
 With regard to my statement last week that Mr. Gifford’s 
 results without using a Crookes’s tube were not due to- 
 Roentgen’s rays, the following letter has been received: 
 
 Sir,— In the British Medical Journal of February 8th r 
 li. 361, I note that Mr. Sydney Rowland, in his report on the? 
 “ new photography,” refers to the results I obtained without 
 using a Crookes’s tube. Will you permit me to remove a mis¬ 
 apprehension ? He says lie'has produced “not only,” as I 
 did, “the shadow of the coin on the plate, but a perfect 
 picture of the engraving on the coin.” I have not done this ; 
 the discs I used had numbers stamped on them, but neither 
 
THE NEW PHOTOGRAPHY. 
 
 [Feb. 15, 1896. 
 
 432 
 
 The British "I 
 Medical JournalJ 
 
 Plio':ograpli of a human foot by Mr. Sydney Rowland, showing the deformity of the terminal phalanges owing to the use of tight boots. 
 Owing to the plate being accidentally broken, the metatarsal bones are not visible. 
 
 these nor any other surface markings were reproduced. From 
 what I have referred to, he argues that 1 have represented 
 the x rays as being a direct electrical effect of this kind. 
 That is not so. My ideas, which are quite as indefinite as 
 those of others at the present stage of the inquiry, were and 
 are that these are electrical wave phenomena. My meaning 
 will be clear to those at all versed in the doctrines and 
 teaching of Hertz. 
 
 The effects Mr. Rowland refers to are nothing new. These 
 induction phenomena were present in my experiments both 
 with and without the tube in the form of spark and brush 
 discharge between the discs of a most interesting form, and 
 are a distinctly different class of phenomena from the shadow 
 ■effect. But their appearance in experiments made with a 
 Crookes’s tube, as well as without, seemed to point to a 
 possible identity of the shadow effect with and without.— 
 I am, etc., 
 
 Chard, w.C., Feb. 9th. J. William Gifford. 
 
 I may be perhaps allowed to say that Mr. Gifford does not 
 apparently know what he means, and what he now writes in 
 no way invalidates the comment. My point is tlie fact that 
 in my experiments it was immaterial whether the coin was 
 placed in front of or behind the photographic plate, and that 
 therefore such effects could not be the result of shadows 
 thrown by the coin on the plate. And as this is the essence 
 of the new photography, it was argued that the effect to which 
 he refers was not due to .rrays, but of the nature of a direct 
 electrical effect, the same or similar to the well-known in- 
 duetograms. Figs, a and b show the results I obtained and 
 
 alluded to last week. Fig. a was taken with the coin in front 
 of the plate, and Fig. b with the coin placed behind the plate. 
 
 My photograph of the foot, which is reproduced above, shows 
 very clearly the nature of the bone changes and atrophy pro¬ 
 duced by the wearing of tight boots, and the accompanying 
 history given by the patient may be of use in the explanation 
 and treatment of similar symptoms when again met with. 
 
 The owner of this foot says that when a child she was 
 obliged to wear boots which were made to measure, and were 
 consequently supposed to fit. She remembers well the tor¬ 
 ture consequent on new boots, and the pain particularly pro¬ 
 duced in the little and fourth toes. In fact, later on, when a 
 girl, the constant aching pain in both the fourth toes became 
 so great that boots were discarded for shoes, and walking 
 became a penance. She says she frequently expressed a wish 
 to have the fourth toes amputated. She had no comfort in 
 walking till she wore broad, square-toed French boots, and 
 since then she has not suffered. Therefore the toes are very 
 deficient in prehensile power, and she has frequent falls. 
 
 From Professor Roentgen have been received copies of the 
 photographs taken by him which are now so familiar. They 
 include one of a fracture of the forearm with much displace¬ 
 ment. The lesion shows quite clearly on the photograph, 
 but it has not been possible to reproduce it. Professor 
 Roentgen has also sent a signed photograph of himself, 
 which it is hoped to reproduce shortly. 
 
 Mr. Robert Jones, of Liverpool, and Dr. Dawson Turner are 
 both kind enough to send specimens of their work, which, how¬ 
 ever, as yet shows nothing new ; so already the new method 
 is being taken up by medical men in actual practice. 
 
Feb. 15, 1896.] 
 
 THE EOENTGEN RAYS. 
 
 The British 
 Medical Journal 
 
 Professor Oliver Lodge also sends a negative showing the 
 position of a bullet in a wrist, but too late for publication 
 this week. 
 
 In regard to the newspaper reports describing the alleged 
 production of Roentgen photographs by means of the light 
 emitted from paraffin lamps and bunsen burners it is not 
 possible to speak at present. Such results seem very impro¬ 
 bable, and until more is known about them and actual speci¬ 
 mens of the work done come to hand we must rest content 
 with the reports. 
 
 THE NEW KIND OF RADIATION. 
 
 Sir,— Should it be proved, as Sir Willoughby Wade has 
 suggested, that the bactericidal rays of sunlight are identical 
 with Roentgen’s x rays, or even if they can be proved to be 
 similar in their penetrating power without being actually of 
 the same kind, the fact will open up a wide field in thera¬ 
 peutics. For not only only is the tubercle bacillus destroyed 
 by exposure to sunlight, but a number of other bacilli and 
 pathogenic organisms of various kinds are similarly affected. 
 It is interesting to note that as long ago as 1888 1 Dr. R. L. 
 Bowles recognised the interesting and important fact that in 
 Alpine regions a peculiar photo-cliemical effect was due to 
 certain rays reflected from large areas on masses of snow, and 
 that these rays penetrated to a certain depth below the sur¬ 
 face of the skin, causing in summer severe sunburn, and in 
 winter a characteristic brownish staining. Further, he has 
 demonstrated the fact that these same rays act upon the wood 
 of which the chalets are built, penetrating the wood to a 
 considerable depth, and that these rays acted primarily on 
 the resin of the wood; and it is somewhat remarkable that 
 Professor S. P. Thompson has arrived at a similar conclusion 
 as to the effect of Roentgen’s rays upon resinous wood. I 
 was influenced by the views thus expressed by Dr. Bowles 
 when at the discussion on the Latency of Disease Germs at 
 the Royal Medical and Chirurgical Society on December 10th, 
 1895. I suggested as a possible explanation of the thera¬ 
 peutical influence of sunlight in phthisis that the bactericidal 
 rays had a power of penetrating deeply into the tissues of the 
 body. I made this suggestion before Roentgen’s discoveries 
 and his “ bone-shadow ” pictures had become known to anyone 
 in this country. I think with Sir Willoughby Wade that it is 
 most important to ascertain whether there is any relation, 
 and if any, what kind of relation, between the Roentgen arrays 
 and the bactericidal rays already assumed to be part and 
 parcel of the sun’s light.—I am, etc., 
 
 W. Spencer Watson, M.B., F.R.C.S. 
 
 Henrietta Street, W., Feb. nth. 
 
 Re ROENTGEN RAYS AND TISSUE TRANSPARENCY. 
 Sir,— It may interest you to know that, in conjunction 
 with my colleague, Professor Kuenen, I have been testing the 
 relative transparency to Roentgen rays (generated for a 
 Crookes’s tube) of various tissues from the same animal (cat), 
 placed in slices 3 mm. thick over a photographic plate, 
 separated by light proof black paper and gutta-percha 
 tissue. 
 
 The tissues used were bone, cartilage, fat, liver, muscle, 
 kidney, cerebrum, and cerebellum. Of these, bone was the 
 most, and cartilage the least, opaque. Fat was more trans¬ 
 parent than any of those remaining on the list. In the kidney 
 the cortex was far more transparent than the medulla (the 
 outlines of the bases of the Malpighian pyramids being very 
 distinct in the region of the boundary zone), while in the 
 brain, in both cerebrum and cerebellum, the white matter was 
 more transparent than the grey. 
 
 Transparency, then, is not related to water content of 
 tissue, a fact evident enough from the transparency of the 
 nails in the hand and foot photographs. 
 
 An experiment with a slice of cancerous human liver, 
 kindly supplied by Dr. Stalker, showed no difference in 
 1 transparency of the cancerous and normal parts.—I am, etc., 
 
 E. Waymouth Reid, 
 
 Professor of Physiology in University College, Dundee. 
 
 <3r. H.—Glass is only relatively opaque to the x rays ; for this reason the 
 latest form of tube is made with very thin ends. Some maintain that 
 lie x rays are generated at the glass surface by impact of other rays. 
 
 1 Sunburn <on the Alps, by Dr. R. L. Bowles, 1888. 
 
 THE ROENTGEN RAYS. 
 
 By G. M. KEEVIL, M.R.C.S., L.R.C.P., L.D.S.Eng. 
 
 In the course of some experiments on the Roentgen rays I 
 have hit upon a series of such extraordinary effects that I 
 hasten to place them on record without further loss of time, 
 believing them to be of the utmost importance. The most 
 simple of apparatus was used, consisting only of a 50-candle 
 power incandescent lamp, with the filament broken, the two 
 ends of the broken filament being about half-an-inch from 
 each other. 
 
 This broken lamp was substituted for a perfect one in the 
 fittings of the latter, that is to say, it swung from the ceiling 
 by the usual wire. Under this broken lamp was placed a dark 
 slide containing a Cadett rapid plate, this being at a distance 
 of about 3 inches from the lamp, and the film being directed 
 upwards. 
 
 On this slide were placed two keys and a penny piece. The 
 current was now switched on (I should observe that these 
 experiments were done in a photographic dark room, no 
 other influence could affect the plate, and the broken lamp 
 did not show the slightest signs of any blush or glow what¬ 
 ever)—and as I did not dare to hope for any result from such 
 a faint current and such imperfect apparatus, the arrange¬ 
 ment was left in situ overnight, and when the plate was re¬ 
 moved and developed, it had been subjected to the rays about 
 twelve hours. 
 
 The photograph (No. 1) shows the print obtained from this 
 
 Fig. 1.—Exposure of 12 hours under broken incandescent lamp, distance 
 about 3 inches. 
 
 negative thus produced, and in it I beg to call attention to 
 the remarkable shadow shown on the left hand of the ob¬ 
 jects, the outline of the other side being perfectly sharp. 
 We are completely ignorant as to the cause or meaning of 
 this extraordinary appearance; it is certain that no extra¬ 
 neous light found admittance, and indeed such an effect 
 could not be produced by ordinary light; it is equally certain 
 that movement of the objects on the dark slide or of the lamp 
 (what I will call the illuminating point) did not produce it, 
 and for reasons which I will state when considering the Pho¬ 
 tograph No. 2. 
 
 Another point to which I wish to call attention is the 
 absence of graduation in the shadow. Photograph No. 2 
 is of even a more extraordinary and interesting character 
 than No. 1 ; exactly the same arrangement of apparatus was 
 used, the objects being a half-crown, a shilling, a silver 
 collar stud, a cameleon seal with two links at its upper edge, 
 and a metal button placed face downwards and having a 
 small metal eye on its now upper aspect. The silver collar 
 stud was also standing upright on its large end. 
 
 1 beg here to call particular attention to the position of 
 
THE BATTLE OF THE CLUBS. 
 
 [Feb. 15, 1896. 
 
 434 
 
 The British 1 
 Medical JournalJ 
 
 these articles in view of the astounding nature of the result. 
 The current being now turned on, the slide was subjected 
 to the influence for an hour and ten minutes, Mr. Friese 
 Green, F.K.A.S., Dr. Bull, of Paris, and others being present. 
 At the end of this time the plate was removed and developed, 
 with the lesult that a negative was obtained from which 
 Photograph No. 2 was printed. In this photograph the 
 shadows are again produced, and in the same direction as 
 before : but what is most striking of all is the impression of 
 the collar stud and the metal button, both of which were 
 standing upright on the slide. These articles have been 
 developed on the plate as though the rays had fallen upon 
 them at an angle of about 15 degrees with the horizontal 
 
 Fig. 2.—Exposure of i hour and 10 minutes under broken incandescent 
 lamp distant 3 inches. 
 
 plane, this being the point at which I was obliged to place 
 my eye to view the articles—put in the same positions—in 
 order to obtain the same apparent effect. The photograph 
 also shows a faint shadow to the right of the rounded objects. 
 This effect is apparently due to some of the rays affecting 
 the plate in a vertical direction, whereas the majority of the 
 rays, being very oblique, have passed under the edge of the 
 rounded objects in question. 
 
 Neither 1 nor those with me at the time can venture to ex¬ 
 plain these astonishing results, but we are convinced that 
 there has been no discoverable fallacy in the experiments. 
 
 For various reasons, I suggested that the axes of the 
 shadows and of the magnetic meridian might be coincident, 
 but on consulting the compass needle we thought that the 
 coincidence was not perfect enough to account for the 
 direction. 
 
 Outside the dark room, and at a distance of about six feet 
 from the apparatus, was a photographer’s electric light, con¬ 
 sisting of a series of 50 candle-power lamps, twelve in num¬ 
 ber, but, as the circuit through this was complete, we are 
 not of opinion that this accounts for the phenomenon, but if 
 it is so, it is no less remarkable that this current should be 
 capable of influencing the Roentgen rays than is the fact that 
 these rays themselves are capable of producing the results 
 here shown. 
 
 In conclusion I beg to point out that the broken lamp was 
 
 hanging over the centre of the plate, and yet the rays must 
 have affected the plate at an angle of about 15 degrees with 
 the horizontal. 
 
 [The publication of this paper was unavoidably postponed 
 last week owing to the difficulty of reproducing the photo¬ 
 graphs.] 
 
 THE BATTLE OF THE CLUBS. 
 
 Leicester. 
 
 We are informed that an invitation has been issued to all 
 the medical men resident in Leicester to attend a meeting on 
 February 20th, to consider the relations existing between 
 medical men on the one hand, and dispensaries, medical aid 
 societies, and clubs on the other. 
 
 We are requested to call the attention of any medical man 
 who may have been disposed to answer advertisements from 
 the National Medical Aid Society, or the Liverpool Victoria 
 Legal Society, for a medical officer for Leicester, to the fact 
 that the medical profession there are seeking by united action 
 to prevent the extension of this system of downward competi¬ 
 tion, which threatens to reduce the profession to the 
 level of a trade, with medical officers as the paid servants of 
 limited companies. The method on which some at least of 
 these limited companies conduct their business seems to- 
 many to be little better than a colourable evasion of the 
 Medical Acts, and, however this may be, it may positively be 
 asserted that any man who permits himself to be made the 
 stalking horse of these companies, not only places himself 
 in a position of opposition to the best traditions of the medi¬ 
 cal profession, but sacrifices his own independence for the 
 sake of an appointment of which the tenure is uncertain 
 and the remuneration]inadequate. 
 
 The Oxford Branch. 
 
 The Oxford Branch of the British Medical Association was: 
 amongst the earliest bodies to take action in the matter of the 
 abuse of clubs, and the extension of the operations of the 
 medical aid companies. Two years ago the Branch adopted 
 the following resolution: 
 
 Tliat'Jin the opinion of this meeting medical men ought not to meet in- 
 consultation medical officers of medical aid associations, as defined]by 
 the Committee of the General Medical Council. 
 
 It will be remembered that the committee referred to in this 
 resolution recommended that the General Medical Council 
 should record its opinion that- a medical practitioner acted in 
 a reprehensible manner if he held a medical aid appointment: 
 (1) Where the duties are so onerous that he cannot do justice 
 to the patients under his care. (2) If he consent to give cer¬ 
 tificates, where in his opinion they are not justifiable on 
 medical grounds. (3) If he accept or retain employment by 
 an association in which canvassing is used to attract mem¬ 
 bers. 
 
 At a meeting of the Branch last October it was resolved to 
 send a copy of the resolution of the Branch above quoted to- 
 every member of the Branch, with a request that he would 
 answer “Yes” or “No” to the question whether he was in 
 agreement with the resolution. A subcommittee was ap¬ 
 pointed, consisting of Drs. A. Winkfield, A. H. Boissieiv 
 .T. W. Edwards, S. i. Ilayman, with Dr. W. Collier, of Oxford, 
 as Honorary Secretary. In reply, 70 members expressed their 
 concurrence with the view expressed in the resolution, 5 dis¬ 
 sented, 3 were doubtful, and from 10 members no answer was; 
 received. Further steps, we are informed, will now be taken 
 in the hope of bringing about complete unanimity. 
 
 The British Medical Aid Society. 
 
 A correspondent sends us a circular of the above Society* 
 and a letter received from the agent inviting him to become 
 its medical officer. The letter runs : 
 
 My Dear Sir,—I am organising the British Medical Aid Society in- 
 
 and I should like to give you the first refusal to act as medical officer 
 (most probably the only one). The terms are : 
 
 2S. 6d. per member (annual) 
 
 4s. 6d. per 2 members in family 
 6s. od. per 3 ,, ,, 
 
 7s. 6d. per 4 ,, „ 
 
 9s. od. per 5 ,, ,, 
 
 ios. 6d. per 6 
 
 Please let mo hear from you.—Yours faithfully, etc.,-. 
 
Feb. 22, 1896.] 
 
 491 
 
 THE BATTLE OP THE CLUBS. [h^KSSai 
 
 the medical profession would absolutely decline the club as a 
 whole while willingly accepting single units at a reasonable 
 payment, I cannot doubt that much good would speedily 
 follow. 
 
 The subservience of the surgeon and the tyranny of the 
 Club Committee would equally come to an end ; more than 
 this, it would be easy for the profession to decline attend¬ 
 ance upon well-to-do or unsuitable members, and to insist 
 upon reasonable, if quite moderate, rates of payment. This 
 view I am delighted to see is accepted by one at least of the 
 new friendly societies (vide British Medical Journal, Feb¬ 
 ruary 8th, 1896, p. 367). 
 
 It must always happen that a very large section of the com¬ 
 munity finds itself, in the face of disabling illness, unable to 
 make more than moderate payments for the skilled help 
 urgently needed. Every variety of scale of payment seems 
 to have been tried with more or less success in different 
 localities, yet there may be room at least for a suggestion. 
 
 Some years ago the question was asked from quite a large 
 number of men (having only in common the fact that their 
 weekly earnings did not exceed 25s. per week) what payment 
 they could afford to make to a doctor for his services for 
 ordinary illness during one year ? It is needless to add that 
 their views and their phraseology differed as widely as the 
 colour of their coats ; but when the replies were committed to 
 writing and carefully compared there was a singular una¬ 
 nimity in their conclusions. Briefly put it came to this : 
 that one week’s wages would form a reasonable return, and 
 •one, too, that they would accept without hesitation. It seems 
 not unreasonable to suppose that the profession would do 
 well to accept, with possible elasticity here and there, this 
 as a fair basis for medical remuneration. It would press 
 hardly upon no paying member of any friendly society com¬ 
 pared with his unavoidable expenditure for daily needs ; it 
 would compare very favourably with the miserable pittances 
 which are daily offered on the one side, and I fear I must add 
 ungraciously accepted on the other.—I am, etc., 
 
 Stamford, Feb. nth. W. Newman. 
 
 Overpressure of Medical Officers. 
 
 Sir, —With regard to the account of The Battle of the Clubs 
 in the British Medical Journal of January 25th, I should like 
 to remark that, in my opinion, the resolutions approved of 
 by the Dundee Branch of the British Medical Association, 
 and referred to by you as very moderate, are far too 
 moderate. 
 
 I maintain that 5s. ought to be the minimum fee accepted 
 by any doctor for any adult club member per annum, inclusive 
 of medicine, and that even this fee is, in the vast majority 
 of cases, totally inadequate. If success in the battle of the 
 clubs means 4s. 4d. per annum, inclusive of medicine, for an 
 adult member, I say this contest is not worthy of the name 
 of a battle, and that no Branch of the British Medical 
 Association ought to be congratulated on gaining such a 
 victory. 
 
 The weak point in connection with this so-called battle 
 seems to me to be the want of unanimity amongst the com¬ 
 batants. Every Branch seems to be fighting on its own 
 account, and what one Branch would no doubt regard as a 
 great victory, another would probably think not worth 
 fighting for. If a satisfactory scale of fees were drawn up by 
 an admittedly influential body of medical men appointed, 
 say, by the various Branches of the British Medical Associa¬ 
 tion, then I think we should soon gain a victory which we 
 might be proud of. 
 
 We have only ourselves to blame, I am convinced, for the 
 •disgraceful way in which we club doctors are sweated. I 
 have a large club practice (the minimum adult fee being, I 
 am glad to say, 5s.), but I cannot even make an honest 
 attempt to do my work properly, and my own firm conviction 
 is that very few club doctors do or can look after their 
 patients as they ought to. No doubt they do their best, a 
 large portion of their work being practically gratuitous, but I 
 maintain that club practice, as it is generally seen in England, 
 has a most demoralising effect upon the body and soul of the 
 unfortunate “ club doctor,” who is at the beck and call of 
 everyone who chooses to pay a penny a week for “attend¬ 
 ance and medicine,” and who in doing this has often the 
 audacity to think he is paying the doctor well, and who feels 
 
 quite aggrieved if he cannot have a few bottles of medicine 
 in the year, whether he requires them or not. The result of 
 a large club practice is of necessity carelessness in one’s work. 
 The work has to be done ; it cannot be done properly, so one 
 must do it in the best way possible. A certain number of 
 bottles have to be filled in the morning ; careful dispensing 
 is absolutely impossible ; therefore the bottles must be filled as 
 quickly as possible with stock mixtures. A certain number 
 of patients have to be seen ; to think of studying or investi¬ 
 gating each case is absurd ; time does not admit of it. The 
 visits are hurried over, the daily round being a race against 
 time. 
 
 Such is, I think, a pretty accurate description of a club 
 doctor’s life in the country. Can anyone call this a noble 
 life? Is it a life which any gentleman ought to lead? As 
 house-physician and in my student days I took a great inte¬ 
 rest in studying and carefully watching disease as seen in 
 hospital. I now loathe my professional work, and wish I had 
 never spent so many years in preparing for a profession the 
 rewards of which for many, and apparently only the more 
 fortunate members, are 4s. 4d. a year inclusive of medicine.— 
 I am, etc., 
 
 B.A., M.D., B.Ch., B.A.O., and a Club Doctor. 
 
 January 27th. 
 
 Dundee. 
 
 The recent conference at Dundee is beginning to bear fruit. The Dundee 
 Courier of February 7th reports that two clubs (A.O.F.), “Court Robin” 
 and “ Admiral Duncan,” have come to a decision that members “should 
 adopt the system of calling in their own doctors and establishing a cen¬ 
 tral pharmacy.” _ 
 
 Belgium. 
 
 The practitioners of Liege and Namur have followed the example of 
 those of Brussels and Mons, and have “struck” against the vexatious 
 demands of the clubs. 
 
 Tu Quoque. 
 
 Dr. A. Kenward Matthews (Stoke Newington) writes : At the present 
 time, when we are being called upon to make a stand against medical 
 aid societies, on account of their poor pay, etc., it would not perhaps be 
 out of place to look at the value medical men put upon the work of 
 other medical men. I refer to the payment of qualified assistants. 
 ^120 a year outdoor, or £60 indoor, cannot be said to be a well-paid 
 post: and if one is to be rated at this figure by a medical man, is it to be 
 wondered that those outside the profession should not consider our 
 services of very great value ? It seems to me it is preferable to be the 
 doctor to a large club, with the chance of private practice, than to do 
 somebody’s club and poor for the assistant’s beggarly salary. By all 
 means let us uphold the nobility and dignity of the profession, but 
 should it not be upheld by the old-established and successful practi¬ 
 tioners as well as by those who are beginners ? If assistants were less 
 often “ sweated,” the medical aid societies would not have such an easy 
 task. 
 
 Difficulties of Young Practitioners. 
 
 “Junior,” writing on the present crowded state of the prfoession, re¬ 
 marks that “ in most places four-fifths of the artisan population are 
 attended on the club system, and many of those in a higher position,” and 
 that “ the club appointments are held by his elders, the consequence is 
 that it is almost impossible for him to obtain patients, the alternative 
 before him being either to retire from the field or to accept offers made to 
 him to work at a lower rate than his neighbours.” It must be confessed 
 that there is some truth in this contention, and it ought not to be for¬ 
 gotten that a portion of the responsibility for the unprofessional practice 
 of juniors lies at the door of their senior brethren, who have in certain 
 cases not scrupled to take appointments at very low rates, and have thus 
 injured the prospects of junior practitioners. He further says : “ As long 
 as the present club system continues, which allows patients who can pay 
 fair fees to be attended for a paltry 5s. a year or less ; and as long as one 
 or two men receive inadequate remuneration for work which should yield 
 support for another in addition, so long will younger men be compelled 
 to accept terms which they know to be undignified.” Every stand, there¬ 
 fore, made by the profession against the present low rate of club pay¬ 
 ments tends to remove a very obvious grievance of our younger brethren, 
 and to diminish tiiat lower residuum out of which clubs and medical aid 
 societies obtain their tools to oppose us in enforcing our just claims. 
 
 At the last meeting of the Anatomical Society of Great 
 and Ireland, which was held at St. Mary’s Hospital, com¬ 
 munications were made by Dr. Rolleston, Dr. Wardrop Grif¬ 
 fith, Mr. E. M. Corner, Dr. J. IT. Sequeira, and Dr. Barclay 
 iSmitli. Mr. J. IT. Targett showed specimens of hip bones 
 from cases of congenital dislocation. 
 
 At the dinner to be held in May in aid of the funds of Guy’s 
 Hospital the Duke of Fife, the Earl of Durham, the Earl of 
 Dudley, Lord Tweedmouth, Lord Wandsworth, Lord Hilling¬ 
 don, Lord Aldenham, Hon. W. F. D. Smith, Sir Arthur 
 Arnold, Sir David Baird, and Sir Horace Farquhar have sig¬ 
 nified their willingness to act as stewards in support of the 
 Prince of Wales, 
 
492 THE NEW PHOTOGRAPHY. [Feb. 22, 1896. 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SIDNEY ROWLAND, B.A. 
 
 III. 
 
 The Possibility of Photographing Deep Structures. 
 As many applications have been received for photographing 
 the deep structures of the body for the purpose of locating 
 tumours or foreign bodies, a feiv words may be said on the 
 possibilities which the new process holds out for work of such 
 nature. It must be understood that the permeability of the 
 body tissues to the new rays is entirely a matter of relative 
 and not of absolute transparency or opacity. Thus if the ex¬ 
 posure is sufficiently prolonged it is possible to obtain a 
 photograph which will not show even the bones, they having 
 during the time of the increased exposure allowed sufficient 
 of the x rays to pass through them to affect the plate in the 
 region of their shadow, which thus appears as dark on 
 development as the rest of the plate. That being so, it is 
 theoretically possible to obtain a shadow photograph of any 
 structure that is surrounded by tissues which are either more 
 or less transparent to the x rays than in the structure itself. 
 There is no good reason theoretically, therefore, why such 
 subjects as stone in the bladder could not be photo¬ 
 graphed successfully, but the practical difficulties in the 
 way of accomplishing such things are very great. Take 
 the case, ii for example, of an impacted foreign body in 
 the mediastinum. To attempt its photography the pa¬ 
 tient would have to lie down with the photograph plate 
 tightly fixed to his back. The Crookes’s tube would have 
 to be suspended over the chest. Under these conditions the 
 x rays from the tube would have to traverse the whole of the 
 structures comprised within the thorax, together with the 
 bony investment and skin. Such a procedure would involve 
 a very long exposure, and although not impossible, is for all 
 purposes at present impracticable. I have repeatedly tried 
 to obtain skiagrams of the knee, but never with absolute 
 success, although the results, so far, are encouraging, and I 
 hope soon to be successful. 
 
 The Cryptoscope. 
 
 The reported invention by Professor Salvioni of an instru¬ 
 ment for enabling the eye to see objects which are 
 covered by materials that were heretofore opaque is con¬ 
 firmed if later telegrams are to be believed. The instrument 
 is said to consist of a cylinder of cardboard, the inner surface 
 of which is coated with a substance that becomes fluorescent 
 under the action of Roentgen’s rays. The other end is pro¬ 
 vided with a lens. The object to be examined and the 
 cylinder are placed before the invisible rays developed by a 
 Crookes’s tube, when, by applying the eye to the lens, the ob¬ 
 server sees on the fluorescent substance the shadow of the 
 objects that are impenetrable to the rays. The instrument is 
 called a eryptoscope, and hopes are entertained that it will 
 shortly be perfected. 
 
 It will be remembered that Professor Roentgen, in his first 
 researches, made use of a fluorescent screen for the purpose 
 of testing the transparency of various substances to his x 
 rays. In these first experiments it was not possible to do 
 more than determine the existence of transparency, and that 
 when the professor held his hand in front of the screen it 
 was possible to see the relatively more transparent flesh in 
 contrast to the more opaque bones. It was not possible to 
 make out any details of structure. Professor Salvioni, how¬ 
 ever, has been at work on this application of the discovery, 
 and it is to be hoped that before long we shall have the oppor¬ 
 tunity of testing its practical utility in England. 
 
 I have made some preliminary experiments in the direction 
 laid down by Professor Salvioni, but as yet it is too early to 
 speak definitely on the subject. Next week I hope to have 
 completed a trial of the instrument, and to have the oppor¬ 
 tunity of describing it and speakingwitli more confidence,of its 
 performance. 
 
 An Alleged “ Brain Photograph.” 
 
 As to the newspaper reports of the discovery by Dr. Carleton 
 
 Simm (of New York) of the possibility of photographing the 
 interior of the brain, it is not possible to speak until more 
 details come to hand. The wording of the telegram is quite 
 unintelligible; it runs as follows: “The rays I use in con¬ 
 junction with sound, and they are electric rays so far as the 
 light is concerned. 1 produce the effect by attraction of the 
 light and propulsion through the brain substance. At the 
 time of photographing, the whole internal chamber of the 
 brain is illuminated. My discovery is not consequent on the 
 application of the cathode ray to photography.” A suffi¬ 
 ciently unintelligible communication, which, if not the fault 
 of the reporter, is well calculated to deceive the uninitiated. 
 
 The Infra-Red Rays. 
 
 At a meeting just held of the Society de Medecine et Chir- 
 urgie de Bordeaux, Dr. Armaignac is reported to have shown 
 a very clear photographic proof which he had obtained by 
 simply exposing to the light of a petroleum lamp furnished 
 with a parabolic reflector, a negative in contact with a sensi¬ 
 tised gelatin bromide plate, enclosed in an iron box. After 
 three hours’exposure, the plate was developed in the usual 
 manner, and gave a very distinct positive image of the nega¬ 
 tive. In his experiments with the light of a petroleum lamp. 
 Dr. Armaignac observed that two or three sheets of black 
 paper entirely arrested the photogenic rays, whilst a sheet of 
 iron permitted their easy transmission. Such a result is, of 
 course, at present entirely inexplicable, except on the basis of 
 the work done in this country by Captain Abney, who suc¬ 
 ceeded in obtaining photographic records of radiant heat. It 
 is just possible that in Dr. Armaignac’s case his result was 
 due to this action of the infra-red heat rays. The fact noticed 
 by him that the effect depended upon the presence of the iron, 
 which presumably was heated during the long exposure, 
 seems to support this hypothesis. 
 
 Yon Bergmann’s Estimate of the New Photography. 
 
 Professor von Bergmann has performed his first operation 
 in which the diagnosis had been made with the help of 
 Roentgen’s method. The patient was a young man who, 
 while handling a revolver some time ago, fired twenty small 
 shot into one of his hands. Most of the pellets were removed 
 immediately, and the remainder have now been extracted by 
 Professor Bergmann after their position had been exactly 
 ascertained by means of the new photography. On this 
 occasion the celebrated surgeon made the following remarks : 
 “ There are many arts and sciences to which Roentgen’s dis¬ 
 covery is of incomparably greater value than to surgery, and 
 its application in this art will lead to many abuses. Every¬ 
 body, I suppose, who knows that he has a bullet or some 
 other foreign object in his body expects it to be found by the 
 new method, and wishes to have it removed by an operation. 
 After many years’ practice in peace and in war, I maintain 
 that foreign objects, the presence of which in the body 
 is not the source of any trouble or danger, ought to be 
 left where they are. The consciousness of having some extra 
 lead, for instance, in one’s body, especially when it causes one 
 no inconvenience whatever, does not in the least counter¬ 
 balance the danger of the operation necessary for its removal. 
 This is especially the case in war, when it is often impossible 
 to operate with all the antiseptic precautions. But even in 
 time of peace, when all those precautions can be observed 
 with the utmost care, my advice is not to operate. If special 
 merit was attributed to me in the Russo-Turkish war, in 
 which I was permitted to hold an influential position among 
 the Russian surgeons, I ascribe it partly to the fact that when 
 my colleagues came up with bullet probes of every kind, I 
 dissuaded them from their purpose. Even then I had a tough 
 battle to fight—a battle which is not cpiite ended even yet, 
 and will now, after Roentgen’s discovery, begin afresh. In¬ 
 comparably more important and progressive, as far as surgery 
 is concerned, is Esmarch’s discovery of the means of pro¬ 
 ducing an anionic condition, which enables one to survey the 
 whole field of operation with greater precision, a result which 
 is not likely to be achieved by means of Roentgen’s photo¬ 
 graphs. I will not, however, for a mr merit refuse to recognise 
 the importance of Roentgen’s discovt ry to surgery, as well as 
 to other arts and science. It is a welcome addition to the 
 surgeon’s means of diagnosis, but Esmarch’s bandage and 
 antiseptic are greater achievements ; till. 
 
Feb. 22, 1896.I 
 
 THE NEW PHOTOGRAPHY 
 
 [ 
 
 The British 
 •Medical Oocrnal 
 
 493 
 
Osteo-arthritis of Hand. 
 
 The British I 
 Medical JournaiJ 
 
 THE NEW PHOTOGRAPHY 
 
 [FET!. 22, 1896. 
 
Feb. 22, 1896.] 
 
 THE NEW PHOTOGRAPHY 
 
 The Brit sh 
 Medical Jocrnw 
 
 495 
 
 Fig. 5.— Photograph of Injected Vessels of the Hand. 
 
THE NEW PHOTOGRAPHY. 
 
 490 
 
 The British 1 1 
 Medical JournalJ 
 
 [Feb. 22, 189$. 
 
 Professor Bergmann’s remarks while not in the least detract¬ 
 ing from the value of the new method, cannot but 
 be received in this country with all the respect due to 
 the eminent surgeon who made them, and may serve as a 
 warning to many who, perhaps, having had a foreign body 
 quietly encysted in some part of their system for many years, 
 may now rush to have it removed by the aid of the new 
 discovery. 
 
 Experiments in London. 
 
 The first practical demonstration in London of the value of 
 the new method as an aid to diagnosis has been given in 
 London at St. Thomas’s Hospital. Although the case (frac¬ 
 ture of one of the linger bonds) was a small one, still it 
 exemplified the value of the method, and led to many satis¬ 
 factory expressions of opinion from the members of the pro¬ 
 fession then present. 
 
 Roentgen Photography at the Royal Society. 
 
 A paper by Lord Kelvin on The Generation of Longitudinal 
 Waves in Ether was read at Thursday’s meeting of the Royal 
 Society. He described an arrangement for obtaining pressural 
 disturbance through a considerable space of air, accompanied 
 by a very small proportion of ordinary transverse waves. His 
 apparatus would afford the means of exposing sensitive plates 
 to these longitudinal vibrations, and thus might assist in 
 elucidating the nature of the Roentgen rays. A paper by 
 Professor J. J. Thomson was also read relating to experi¬ 
 ments from which he concludes that all substances when 
 transmitting the Roentgen rays are conductors of electricity. 
 A discussion followed the reading of these papers, in which 
 details were given of many experiments on these x rays. Its 
 general effect was, however, to show that, while many interest¬ 
 ing points have been noted, the obscurity hanging over the 
 subject had not been appreciably lightened. Considerable 
 differences of opinion were manifest even upon the condi¬ 
 tions of the Roentgen experiments. While some advocated 
 the use of very powerful currents, others had been successful 
 with relatively weak ones; and while some were in favour 
 of regarding the phosphorescence of the glass as the efficient 
 source of the rays, others ascribed them to the glow of the 
 electrodes. A new turn was given to the discussion by Cap¬ 
 tain Abney, who ventured, amid some expressions of dissent, 
 to doubt whether the action of the Roentgen rays on a sensi¬ 
 tive plate could properly be described as photographic. He 
 cited several facts which, in his opinion, excluded the theory 
 of direct photographic action in any ordinary sense, and 
 indicated some preference for the view that the Roentgen 
 rays acted by first setting up phosphorescence or action of 
 some unknown kind in the glass at the back of the sensitive 
 film. This view was corroborated by an experiment described 
 by Professor Dewar upon platino-cyanide of ammonium at 
 low temperatures. This salt, ordinarily fluorescent, only 
 became phosphorescent at the temperature of liquid air. On 
 being exposed to Roentgen rays instead of to ordinary light, 
 while immersed in liquid air, it showed ivhen the liquid air 
 was poured off brilliant phosphorescence. This proved that 
 whatever might be the nature of the Roentgen rays, they 
 were convertible into light rays affecting the human eye. A 
 large number of experiments were, also described by Pro¬ 
 fessor Dpwar showing that resistance to the passage of 
 Roentgen rays increased with increase of atomic weight. 
 Organic substances were all relatively transparent, following 
 the carbon, oxygen, hydrogen, and nitrogen of which they 
 are composed. Mere complexity of structure made no differ¬ 
 ence, but substitution products showed increasing opacity in 
 the order of the atomic weights of the combined chlorine, 
 bromine, and iodine. 
 
 Mr. Keevil’s Results. ' 
 
 The results obtained by Mr. Koevil. and published 
 in the British Medical Journal of February 15th, p. 433, 
 are so remarkable and inexplicable that' a few words 
 of reference to them will not be out of place. The first diffi¬ 
 culty consists in understanding how it is that, although the 
 presumed source of the rays (the lamp with the broken fila¬ 
 ment) was placed immediately over the centre of the plate, 
 yet the shadows thrown are such as would result from the 
 source of the rays being very much to the side. Putting 
 aside the improbable hypothesis that the,rays travelled,in a 
 
 circle or other curved figure, it will, I think, be admitted 
 that there must have been some other source than that of the 
 broken filament. Possibly such source may be found in the 
 lamps described as being present in the adjoining room, but 
 until Mr. Keevil will make the crucial test of repeating the 
 experiment with all the conditions present, as in the pub¬ 
 lished result, omitting, however, the lamp with the broken 
 filament, it is not possible to ascribe with absolute certainty 
 the source of the rays which affected the plate to this lamp. 
 
 The New Photography in Sheffield. 
 
 Since February 1st at Firth College Professor Hicks, F.R.S., 
 the Principal, has been experimenting with Roentgen’s rays. 
 The apparatus used consists of an ordinary battery of cells 
 with an induction coil and a, Crookes’s tube. The current has 
 never been used above the strength of one giving a spark of 
 3 inches. In the earlier experiments, the exposure was 
 usually from twenty minutes to half an hour, but during the 
 last week very good shadows of the bones of the fingers have 
 been obtained under an exposure of a minute and a-half. The 
 Crookes’s tube is used with a glass shield, having a window in 
 it of about | inch in diameter. 
 
 The work on the effects of staining the tissues en masse and 
 of the effects of intravascular injections of parts removed 
 from the body or in situ , is being carried on by Dr. Addison, 
 of the medical school. The shadowgraph of the bones and 
 vessels of the hand (Fig. 5) was obtained on February 6th from a 
 specimen injected with the ordinary red lead mass used in dis¬ 
 secting rooms, also the one showing thevessels of the kidney. 
 The hand was nailed on to a half-inch board, and therefore is 
 not quite so clear as the kidney preparation (Fig. 4), which was 
 simply laid on the plate beneath the light, the plate having- 
 been previously' wrapped. 
 
 The illustration (Fig. 2) which we also publish is a case of 
 osteo-arthritis from a patient at the Royal Hospital un¬ 
 der the charge of Dr. Arthur Hall. 
 
 Dr. Hicks has obtained sharper shadows in the shorter ex¬ 
 posure experiments ; in the joints of the fingers the cartilage 
 appears as a semi-transparent covering of the darker bone, 
 and the ligaments are shown at the side of the joint. 
 
 In a case of cellulitis of the finger, with partial destruction 
 of a phalanx, in a child, from the Royal Flospital, the centres 
 of ossification of the bones of the carpus and the epiphyses 
 of the metacarpal bones and the phalanges show very clearly, 
 and would be most instructive for teaching purposes. 
 Another case, that of a boy, supposed to have a piece of a 
 needle in his foot, was examined, and in the prints the 
 needle showed as a dark spot in the less opaque shaft of the 
 fourth metatarsal bone, about an inch from the base. From 
 looking at the negative, where of course it appeared as a 
 bright spot, the house-surgeon, Dr. Stedman, the same even¬ 
 ing cut down upon and removed the needle. 
 
 The shadow of the hand of another patient from the same 
 institution, under the. care of Mr. Pye-Smith, was taken, and 
 a needle found lying deeply in the palm, transversely across 
 the shafts of the three inner metacarpal bones. 
 
 After the meeting of the Medico-Chirurgical Society held on 
 Thursday, February 13th, it was resolved to obtain a second 
 set of apparatus for use at the medical school, and a fund 
 was raised for the purpose. 
 
 Among the cases that I have investigated and photographed 
 this week are the following : 
 
 A CASE OF OSSEOUS ANKYLOSIS SKIOGRAPHICALLY 
 DIAGNOSED AND SUCCESSFULLY TREATED. 
 
 By Bertram L. Abrahams, M.B., B.Sc., M.R.C.P.Lond. 
 
 The following case is one in which, by Professor Roentgen’s 
 method, a diagnosis was made which was otherwise practical ly 
 impossible, with the result that the condition ivas cured with¬ 
 out the necessity for an open operation. 
 
 The patient, V. F., was a youth of 19, who during last 
 summer injured the last phalanx of his right little finger 
 while attempting to catch a cricket ball. When the swelling 
 had subsided he noticed that the last joint of the finger was 
 bent at a slight angle, and-found at the same time that it was 
 fixed in this position without allowing either flexion or exten¬ 
 sion. The condition prevented him from completely closing 
 
Feb. 22, 1896.J 
 
 THE SEW PHOTOGRAPHY. 
 
 r The British AQ'J 
 I 'funiCAi 1 .'TiRNAt,' n-y l 
 
 his fist, and any force transmitted through the bones of the 
 finger caused great pain, which also resulted from pressure 
 on the last interphalangeal joint. As he was by this compelled 
 to give up all gymnastic exercises, and greatly inconvenienced 
 in other ways, he attended as an out-patient at a general hos¬ 
 pital in London. After being treated for some little time, he 
 was told that there had been a fracture of the phalanx extend¬ 
 ing into the joint, which was now firmly ossified, and that 
 nothing short of amputating the phalanx would afford him re¬ 
 lief. Before resorting to this extreme measure, he calledonMr. 
 Sydney Rowland to see if the new method of diagnosis would 
 throw any light on his case. Mr. Rowland took a skiagram 
 which he showed to me. We came to the conclusion that a 
 bridge of bone uniting the two last phalanges had been thrown 
 out as the result of traumatic inflammation of the joint. Next 
 day I saw the patient myself, and found the joint firmly 
 fixed in a condition of partial flexion ; I therefore suggested 
 that I should break down the spur of bone which appeared to 
 me to be the sole cause of the trouble. To this the patient 
 readily consented, and, an anaesthetic having been adminis¬ 
 tered I had very little difficulty in snapping it across. The 
 joint could then be normally flexed, but extension was not 
 quite perfect owing to slight deformity of the terminal 
 phalanx. The patient at once expressed himself as delighted 
 with the result. He was immediately able to use his closed 
 fist without pain, and by the use of passive movements the 
 condition of the finger has now become perfectly normal. 
 The skiogram taken by Mr. Rowland immediately after the 
 little operation shows the separation between the fragments 
 of the bony spur. 
 
 The points of interest in this case are: (1) The patient was 
 saved the loss of a phalanx. (2) The previous diagnosis was 
 disproved and a condition recognised which could otherwise 
 have been detected only by cutting down upon the joint. 
 (3) The line of treatment was indicated by the discovery that 
 the ankylosis was only partial and not total. All this was 
 ascertained by means of Mr. Rowland’s skilful use of the 
 skiographic method, to which the successful issue of the case 
 is mainly due. 
 
 This case is therefore the first in which an actual diagnosis 
 lias been made by means of the new method. No other 
 method (short of an open operation) could have fixed with 
 any certainty the presence of the small bony spur on which 
 the deformity depended. In all other reported cases some 
 idea has been formed-of the presence of such foreign bodies 
 as needles, and the Roentgen method served but to fix its 
 exact position. In this case, however, the complete diagnosis 
 was given, and could have been given by no other method. 
 
 Demonstration at the Medical Society. 
 
 On Monday next, February 24th, before the Medical Society 
 of London, a demonstration will be given by Mr. Sydney Row¬ 
 land, B.A., whose articles on the subject have been appearing 
 recently in these columns of the methods employed in pro¬ 
 ducing the shadow photograph by Roentgen’s ,r rays. Photo¬ 
 graphs will be taken of a simple case to illustrate the method 
 more fully. The demonstration will be given at the close of 
 the discussion on two papers on Renal Pain, to be read by Dr. 
 Ralph and Mr. Hurry Fenwick. 
 
 Other cases of interest are : 
 
 PHOTOGRAPH SHOWING BULLET DEEPLY 
 EMBEDDED IN WRIST. 
 
 By Professor Oliver Lodge, F.R.S., 
 
 University College, Liverpool. 
 
 G. H., aged 12, was brought to my laboratory by Mr. Robert 
 .Tones with a pellet of lead lost in his left hand or forearm. 
 Two preliminary short exposures to Roentgen rays indicated 
 that the metal was not in a fleshy part readily penetrable by 
 those rays, but was probably embedded among the bones of 
 the wrist. The difficulty consisted in the opacity of those 
 bones. 
 
 I therefore took a tube with large electrodes made and ex¬ 
 hausted by my assistant, Mr. E. E. Robinson, containing 
 potash, so that its vacuum could be adjusted to. the best 
 value, and arranged a magnet to concentrate the inside 
 
 cathode rays on a definite part of the glass, which phos¬ 
 phoresces and acts as the source of the rays, the rays spread¬ 
 ing from each point of the glass in all directions. The boy 
 was comfortably seated at a table with his palm down on an 
 aluminium-protected Edwards’s isochromatic half-plate, 9 
 inches vertically below the vacuum tube, and rather more 
 than two hours’ exposure was given. The coil used was an 
 ordinary Rahmkorff, giving about 2-inches spark at most, 
 and it was excited by five storage cells. The vacuum was 
 such that a l-incli spark in air was usually preferred to the 
 tube. The result was to bring out the wrist bones clearly 
 and to show the position of the pellet (Fig. 3). 
 
 Note by Mr. Robert Jones, F.R.C.S.E. (Honorary 
 Surgeon to the Royal Southern Hospital, Liverpool).— 
 G. H. was brought to me by Dr. Simpson, of Waterloo, hav¬ 
 ing shot himself in the left hand just above the deep palmar 
 arch. The wound was enlarged, but the bullet could not be 
 found, and it was thought injudicious to prolong the search 
 in view of the important structures in the vicinity unless 
 one possessed a clue to its position. Professor Lodge kindly 
 consented to take a photograph, and the position of the 
 bullet was very clearly outlined ; it : lies against the base of 
 the third metacarpal bone over its articulation with the os 
 magnum. This is, I think, the first photograph taken of a 
 bullet embedded in a wrist, in this case considerably 
 thickened as the result of inflammation. It will now be 
 quite easy to extract it. The photograph (Fig. 3) was taken 
 in the presence of Dr. Houlgrave, who succeeded Div 
 Simpson in the treatment of the case, 
 
 We shall be glad to hear of further cases of interest for 
 investigation, and in which the new photography has been or 
 can be usefully applied, and we place the services of our 
 Commissioner at the disposal of our members for such a pur¬ 
 pose. The cases at present most suitable are boile affections 
 of the hands and feet. 
 
 I have succeeded in very greatly reducing the exposure 
 necessary to obtain distinct images on the photographic 
 ■plate. I have not yet completed the experiments I am carry¬ 
 ing out in this direction. I have found that certain fluorescent 
 solutions, if applied to the plate and allowed to dry on, very 
 materially hasten the process. In one instance 1 obtained a 
 very good negative of the hand in twenty seconds. Another 
 method which, while not giving such good results, yet is 
 very promising, consists in placing a fluorescent screen 
 immediately in front of the plate. 
 
 THE LIONEL SMITH FUND. 
 
 We are glad to be able to announce that since the last appeal 
 made in the British Medical Journal the following addi¬ 
 tional subscriptions have been received by Dr. de Havilland 
 Llall (47, Wimpole Street, London, W.), who is acting as the 
 Honorary Treasurer of the Fund. The circumstances of 
 peculiar hardship under which Dr. Lionel Smith found him¬ 
 self compelled, after many years of service in another colony, 
 to accept the appointment of District Surgeon at Rorke’s 
 Drift, are already well known to our readers. He has pro¬ 
 ceeded to Zululand, where he will shortly arrive, but it is to 
 be feared, in an almost penniless condition: 
 
 (s. d. £ s. d. 
 
 Dr. Simpson Ladell .o 10 6 Mr. E. W. Emtage . 050 
 
 Di 1 . G. Fielding Blanclford ... 1 1 o Mr. Frank Pearce . 1 1 o 
 
 “ A Tardy Subsbriber ” ... 1 1 o Mr. S. R. Platt, D.L. (per 
 
 Mr. Gilbert Barling . 220 Dr. George Thomson) ... 5 o o 
 
 We have also received the following subscription, which 
 we have forwarded to Dr. de Havilland Hall: 
 
 Mr. P. B. Burroughs . 5s. 
 
 IRISH DISPENSARY ELECTIONS. 
 
 In his address to the Dublin Branch, which we published on 
 February 15th, Mr. Thomson urged the need of competitive 
 examinations for Poor-law medical appointments in Ireland, 
 and he stated that elections are not always conducted with a 
 regard to the candidates’ merits. A very strong proof in 
 
498 
 
 The British 1 
 Medical JournalJ 
 
 ASSOCIATION INTELLIGENCE. 
 
 [Feb. 22, 1896. 
 
 support of liis case was then in existence had he known of it. 
 A correspondent sends a copy of the Dundalk Examiner , in 
 which the following document appears : 
 
 Town Hall, Enniskillen, 
 
 January 21st, i8g6. 
 
 At a meeting of the Nationalist Guardians of tlie Enniskillen Union, 
 held here this day, Mr. J. Jordan, M.P., presiding, and twenty-six mem¬ 
 bers present, it was unanimously resolved: 
 
 “ That inasmuch as we, the Nationalists, could not return our Catholic 
 and Nationalist candidate for the medical officersliip of the Enniskillen 
 Workhouse, we withdrew Hr. Kelly and supported Dr. Wilson, the farmer's 
 candidate, against Dr. Kidd, the candidate of the landlords, gentry, and 
 their agents and hangers-on, on an understanding and an arrangement 
 with Dr. Wilson that he would support and use his influence with the Dis¬ 
 pensary Committee in recommending to them Dr. Kelly, and to have him 
 returned as medical officer for the Barronstown Dispensary district, and 
 we hereby recommend Dr. Kelly to the consideration of al sections of 
 gentlemen on said Dispensary Committee.” 
 
 Signed on behalf of the meeting, 
 
 Jeremiah Jordan, M.P. 
 
 We do not know liow this is looked upon by the gentlemen 
 who are parties to it, but it will strike the ordinary reader as 
 an unjustifiable arrangement all round. If the facts are pro¬ 
 perly represented in the resolution given above, we think the 
 Local Government Board ought to have their attention drawn 
 to them. Elections under such conditions are. simply far¬ 
 cical ; and their legality may ivell be questioned. 
 
 Seven fresh cases of cholera were reported in St. Peters¬ 
 burg from February 1st to February Stli. The medical re¬ 
 ports show no further cases in the province of Kieff. 
 
 The series of the Royal Society Catalogue of Scientific Papers, 
 covering the years 1874-83, has just been completed by the 
 publication of Vol. xi, containing the authors between Pet.— 
 Zyb. 
 
 French Congress of Alienists and Neurologists.— The 
 Seventh French Congress of Alienists and Neurologists will 
 hold its opening meeting at Nancy on August 1st. The ques¬ 
 tions proposed for discussion are: 1. The Pathogeny and 
 Pathological Physiology of Hallucinations of Plearing; 2. 
 Symptomatology of Tremors : 3. The Confinement of Lunatics 
 in Special Institutions ; Treatment and Legislation. 
 
 ^ The St. Petersburg School of Medicine for Women.— 
 The Russian Government has assigned an annual grant, 
 equivalent to about .£10,000, to the Medical School for Women 
 in St. Petersburg. The city undertakes to provide another 
 £2,400, and private munificence has raised an endowment 
 fund of £ 70,000. Preliminary courses are already being given, 
 but another year must elapse before the school can be 
 housed in its own buildings. 
 
 Messrs. Olipliant, Anderson, and Ferrier, St. Mary Street, 
 Edinburgh, announce a series of biographies of “Famous 
 Scots.” We gather from the prospectus that “ uniformity of 
 treatment, distinctly national colouring, and unity of 
 criticism,” are to be the characteristic features of these little 
 books. Among the earlier volumes, besides those devoted to 
 Scott, Carlyle, John Knox, Robert Burns, and other glories 
 of Scotland, we note with pleasure that there is to 
 be one of Sir. James Y. Simpson, by E. Blantyre 
 Simpson. In addition to the biographies of particular men, 
 there will be volumes 011 such subjects as admit of a grouped 
 or conjoint as distinguished from an individual treatment, 
 such as medical, scientific, legal, and artistic notabilities. 
 
 The Annual Report of the Library Committee of the New 
 York Academy of Medicine presented at the meeting on 
 January 2nd, gives the number of medical journals on file as 
 follows: American, 7; English, 80; French, 140; German, 
 167; in other languages, 56: total 653. The number of new 
 books added to the library during the year was 2,039; of 
 duplicate copies of books, 1,006; and of pamphlets, 3167. 
 The total number of volumes in the library is 33,140. There 
 were 6,574 readers during the twelve months,, being 590 more 
 than in the previous year. The funds at the disposal of the 
 Library Committee during the year had been 5,458 dollars 
 (about. £1,080), and there was a deficit of 79 dollars. The 
 Committee asked for 5,000 dollars (£i,ooo) for 1896, which 
 was 500 dollars (£100) more than had been appropriated in 
 1895. 
 
 ASSOCIATION INTELLIGENCE, 
 
 NOTICE OF QUARTERLY MEETINGS FOR 1896. 
 
 ELECTION OF MEMBERS. 
 
 Meetings of the Council will be held on April 15th, July 
 8th, and October 21st, 1896. Candidates for election 
 
 by the Council of the Association must send in their 
 forms of application to the General Secretary not later than 
 twenty-one days before each meeting—namely, March 26th, 
 June 18th, and October 1st, 1896. 
 
 Any qualified medical practitioner, not disqualified by any 
 by-law of the Association, who shall be recommended as 
 eligible by any three members, may be elected a member by 
 the Council or by any recognised Branch Council. 
 
 Candidates seeking election by a Branch Council should 
 apply to the Secretary of the Branch. No members can be 
 elected by a Branch Council unless their names have been 
 inserted in the circular summoning the meeting at which 
 they seek election. 
 
 Francis Fowke, General Secretary. 
 
 LIBRARY OF THE BRITISH MEDICAL 
 ASSOCIATION. 
 
 Members are reminded that the Library and Writing Rooms 
 of the Association are fitted up for the accommodation of the 
 members in commodious apartments, at the offices of the 
 Association, 429, Strand. The rooms are open from ioa.m. to 
 5 p.m., Saturdays, 10 a.m. to 2 p.m. Members can have their 
 letters addressed to them at the Office. 
 
 BRANCH MEETINGS TO BE HELD. 
 
 Metropolitan Counties Branch.— General meeting of the Branch 
 will be held at 20, Hanover Square, W., on Monday, March 2nd, at 8.30 p.m. 
 Business : The Relation of the Association to the Question of Medical 
 Protection and Defence. The Relation of the Profession to Medical Aid 
 Societies.— Andrew Clark and Isambard Owen, Honorary Secretaries. 
 
 Metropolitan Counties Branch : North London District.—A 
 meeting of the District will be held on Thursday, February 27th, at 
 4 P.M., at the Hampstead Infirmary. Dr. Cleveland will preside. Dr. 
 Norman Kerr will read a paper upon Cases of Recovery without Opera¬ 
 tion in Obstruction after Faecal Vomiting. Interesting clinical cases 
 will be shown by Dr. Cook, Medical Superintendent of the Infirmary. 
 The District Committee will meet at 3.50 p.m.—Hugh Woods, M.D., Hono¬ 
 rary Secretary. 
 
 Metropolitan Counties Branch : South London District.— The 
 next meeting will be held in the Court Room of Guy’s Hospital (by kind 
 permission of the Treasurer) on Wednesday, March 4t.l1, at 8.30 p.m., Dr. 
 Hector Mackenzie, Vice-President of the District, in the cliair. A paper 
 will be read by L. A. Dunn, F.R.C.S., on some eases of Intestinal Obstruc¬ 
 tion. Cases of clinical interest, from the wards of tlie hospital will be 
 shown. All practitioners, whether members of the Association or not, 
 will be heartily welcomed.—H. Betham Robinson, Honorary Secretary, 
 1, Upper Wimpole Street, Cavendish Square, W. 
 
 Staffordshire Branch. —The second general meeting of the session 
 will be held at. the North-Western Hotel, Stafford, 011 Thursday, February 
 27th, 1896. The President, Dr. George Reid, will take the chair at 4.30 P.M. 
 Communication from General secretary re Medico-ethical Committees; 
 report of Council on the Abuse of Medical Charities; exhibition of Patho¬ 
 logical Specimens, Living Cases, New Instruments, etc. Mr. J. F. Hall- 
 Edwards (Moseley) has kindly undertaken to demonstrate Roentgen’s 
 Rays as applied to Shadow Photography. Papers: Mr. F. Edge: 
 Vaginal Coeliotomy. Dr. W. G. Lowe: Uncontrollable Vomiting of Preg¬ 
 nancy. Dinner at 7 p.m., 5s., exclusive of wine.—F. Milnes Blumer, 
 Honorary Secretary, Stafford. 
 
 South-Eastern Branch : East Surrey District.— The next meeting 
 of the above District will be held at the Queen’s Hotel, Upper Norwood, 
 on Thursday, March 12th, at4P.M., ,T. H. Galton, M.D., of Upper Norwood, 
 in the chair. Dinner at 6 p.m. ; charge 7s., exclusive of wine. Ail mem¬ 
 bers of the South-Eastern Branch are entitled to attend, and to intro¬ 
 duce professional friends. Nominations for representatives on the Coun¬ 
 cil of the Association will be received. Papers: Dr. Pye-Smith: The 
 Local Distribution of Diseases as an Aid in their Diagnosis. Mr. J. Bland 
 Sutton: On Wandering Spleens. Mr. A. PI. Tubby: Some Paiuful Affec¬ 
 tions of tlie Foot. Members desirous of exhibiting specimens or reading 
 notes of cases are invited to communicate at once with the Honorary 
 Secretary, Henry J. Prangley, Tudor House, Anerley. 
 
 Bath and Bristol Branch.— Thefourth ordinary meeting of the session 
 will be held at the Grand Pump Room Hotel, Bath, on Wednesday even¬ 
 ing, February 26th, at 7.30, Carey Coombs, M.D., President. The fol¬ 
 lowing communications are expected:—Mr.R. J.H. Scott: Harrison'streat- 
 mentof Lupus; three cases will be shown. Mr. W.M. Beaumont: Argyrosis 
 (card case). Mr. S. E. Rigg: A case of Intestinal Obstruction, with specimen. 
 Dr. Arthur S. Wohlmann : The Clinical Significance of the Human 
 
Feb. 29^. i896.]( ! 
 
 THE ASHANTI .EXPEDITION. 
 
 The, ^miSH 
 Mbdical Journal 
 
 555 - 
 
 his wife, and all his children up to the age of 12 years; that many of these 
 members likewise belong to the National Deposit Friendly Society, and 
 when ill require to be attended by him as the dispensary medical officer. 
 Surely this is only natural; if the member can get his medical attend¬ 
 ance for id. a week in this way it is hardly likely lie will be willing to pay 
 the higher rate of the National Deposit Friendly Society. Were our cor¬ 
 respondent not attached to this dispensary he could insist on the scale 
 allowed by the latter, but he can hardly do so if the member can com¬ 
 mand his services on another account. The intention of the National 
 Deposit Friendly Society is that if medical aid is procured through its 
 means the practitioner shall be paid according to its scale of fees, but 
 not to prevent members, if they choose, from getting their medical 
 attendance in another way. 
 
 THE ASHANTI EXPEDITION. 
 
 The Entry into Kumassi. 
 
 Our correspondent with the advance column writes from 
 Kumassi on January 17th: The troops arrived to-day after a 
 tiring march from Leda Sewa. It was only a ten-mile march, 
 but it was one of the most tiring we have had, as we were 
 only able to get forward at a mile an hour, but halted half 
 way and had tea. The previous day the bearer company 
 marched from Edurrku. For the past three days the column 
 has been in fighting formation ; the bearer company was 
 divided, the left half company under Surgeon-Captain 
 O’Callaghan marched in rear of the special service company, 
 next came the 14th West Yorkshire, and the right half 
 company bearer company followed them. The portion of the 
 provisional company Medical Staff Corps told off as a flying 
 field hospital under Surgeon-Major Porter came on in front of 
 the rearguard. There has been no fighting, but the medical 
 staff have had a very busy time of it. Fever has had far 
 more victims than the Ashantis would have had with their 
 flintlock and old rifles. At Suberri the bearers picked up 
 nine of the Special Service Corps who were down with fever, 
 and took them on to Naunku, where a native house was 
 arranged by the Principal Medical Officer as a hospital, the 
 men of the bearer company looking after them. There have 
 been no cases up to date of dysentery; all the cases are from 
 fever, with high temperature ranging from 103° :to 104.5 0 , 
 with severe pains in head and back; very few men fell out 
 to-day. The bearer company had two cases of fever during 
 the last four days ; both have been sent to the field hospital. 
 Surgeon-Major Porter has recovered from his second attack of 
 fever ; he is very hard worked. Surgeon-Lieutenant Spencer 
 has been detailed from the bearer company to help at the 
 field hospital; he left on the 15th. 
 
 The field hospital brought in 37 sick to Kumassi this after¬ 
 noon. They are all comfortably quartered in native houses, 
 chosen by the Principal Medical Officer this morning. The 
 bearer company are quartered close to the field hospital, also 
 in native houses. Kumassi is a very dirty, straggling, native 
 town. The water supply ought to be good, as it springs out 
 of the earth, but it is muddied and dirtied by the natives. 
 When proper arrangements are made by the Royal Engineer 
 Department we expect to have very good drinking water. 
 
 All the troops are quartered in the town. King Prempeli 
 and all his chiefs had a parade before Sir Francis Scott at 5 
 o’clock this afternoon. All the Ashantis seem most friendly; 
 still, we do not quite trust them. The Principal Medical 
 Officer hopes to be able to start a complete hammock train 
 to the coast by the 19th. The transport has failed, or there 
 would have been no difficulty in arranging it at once. The 
 cots and hammocks of the bearer company, now that there is 
 to be no fighting, are to be used for this hammock train. We 
 do not expect to be more than four days here. The Governor 
 arrives to-morrow. Surgeon-Captain O’Callaghan is ; down 
 with a slight attack of fever; Lieutenant Wilson, A.S.C., 
 attached for transport to the bearer company, is ill with fever, 
 Major Wolf Murray is also very ill. 
 
 Arrangements for the Return. 
 
 This is our last evening in Kumassi. We all—that is, 
 white troops—start for the coast to-morrow (January 22nd). 
 The 2nd West York Regiment starts at 6 a.m.; they escort 
 King Prempeh and all the prisoners. Surgeon-Captain 
 Maher still in medical charge, of the headquarters, follows 
 them ; then half of what is left of the bearer company, with 
 hammocks for sick if any fall out; Sergeant-Major Steward is 
 in charge of these men as Surgeon-Captain O’Callaghan is 
 
 $till ill. At Kwisa, which is five marches from this, Surggon--, 
 Captain Wilson will join the bearer company, and go op in, 
 command of this half bearer company if Surgeon-Captain' 
 O’Callaghan is still too ill to resume his duties with the 
 company. At 6.30 the Special Service Corps starts, with the 
 other half and headquarters of the bearer company under 
 Surgeon-Major W. O. Wolseley. The baggage and ammuni¬ 
 tion train follow, and then comes the field hospital. It was 
 found impracticable to arrange a hammock train for the 
 removal of the sick, so all the sick in the field hospital will 
 jae removed with and by the hospital to-morrow ; they have had 
 a very busy and anxious time since the day we arrived; it was 
 no small matter to arrange for the housing of 60 sick in those 
 small dirty houses. It has been very well done, the patients 
 have been comfortably housed and well looked after; the' 
 result is most satisfactory as all the cases are improving. 
 Great credit is due to Surgeon-Major Porter and his Staff- 
 Surgeon Captain Joslin and Surgeon-Lieutenant Spencer. 
 There is an excellent supply of medical comforts in the shape 
 of tinned chicken (whole), champagne, brandy, etc, There' 
 has been an issue of fresh bread for the last two days. There 
 was an issue of fresh beef on Saturday, but it was not a suc¬ 
 cess, it was very poor in quality and tough. 
 
 There are 2 of the Medical Staff Corps in hospital suffering 
 from fever. On Saturday there were 58 in the Field Hospital 
 ^-31 of the West Yorks, 21 Special Service Corps, 3 Medical 
 Staff Corps, 1 Royal Engineers, 1 Royal Artillery, i Ordnance 
 Staff Corps. I do not think that Kumassi is so very un¬ 
 healthy ; it is nearly 400 feet above sea level. Where we are 
 camped is on a height above the palace and principal part of 
 the town. All the weeds and high grass have been cut down 
 and a clear view of the town obtained. After Prempeh was 
 taken prisoner on Monday, the Royal Engineer Department 
 were ordered to pull down a lot of houses; they also blew 
 down with gun cotton most of the fetish trees, some of which 
 were huge specimens. They also went into the sacred grove 
 just outside the palace, where only the kings are allowed to 
 be bulled, and dug up the graves, and pulled down the paling 
 round it. . The palace is the only two-storeyed house in the 
 place. The houses are rather clean inside. All the sleeping 
 places are on a plinth of 2 feet 6 inches, but outside the houses 
 tilth abounds. The valley where all the victims’ bodies are 
 thrown is a most ghastly sight. The portion where the bones 
 lie is only about half an acre in extent, but from the piers of 
 bodies thousands must have been thrown there. There are 
 several fetish trees in the grove which have, been blown down 
 by the Royal Engineers. I went to see the great Fetish House 
 burned down yesterday; it was a grand fire. I think all this 
 ought to put an end for ever in Kumassi to human sacrifices. 
 None of us are sorry to bid adieu to Prempeh’s country. All 
 the hospitals and camps are being evacuated, and the sick 
 from them sent down to the coast. I hear that there have 
 been 140 admissions in the Base Hospital up to the 15th and 
 1 death. We make a day’s halt on the 23rd at the Adra river. 
 The 2nd West Yorks go on a day in advance from there with 
 the prisoners. . , 
 
 Prince Henry of Battenberg. 
 
 Our correspondent at the base (Cajie Coast Castle) gives 
 the following particulars with regard to Prince Henry’s 
 journey to the coast. He left Mansu at 7.30 a.m. on January 
 15th, and arrived at the base hospital on the sain9 day at, 
 10 p.m. On the following day (January i6th).he had high 
 fever, but on January 17th the temperature, was comparatively 
 low, and he was much better. The Prince expressed a dps ire , 
 to leave at once, and was embarked, on H.M.S. Jlloride .that 
 morning. He went on board .in good spirits in medical 
 charge of Surgeon-Captain Hilliard. The Blonde left imme¬ 
 diately. |", 
 
 The Sick at the Base Hospital. 
 
 Our correspondent adds that down to January 22nd, the' 
 date of his letter, some 175 men had passed through the 
 base hospital, chiefly men of the Yorkshire Regiment and 
 the West Indian Regiment. Only 6 men of Ihe, Special 
 Service Corps had been admitted (2 of them. suffering from' 
 scalds). The type of fever has been decidpcjly mjld, no cage 
 of fever having lasted more than eight consecutive days, 
 although many had had relapses. Most of the cases of 
 remittent fever were associated with vomiting of bile, which , 
 seemed to relieve them. We have had two slight showers' 
 
5 56 
 
 The British "| 
 Medical JournalJ 
 
 THE NEW PHOTOGRAPHY. 
 
 [Feb. 29, 1896, 
 
 this week. We hear that there are 3 officers and some 50 men 
 sick at Kumassi who will be sent down country in the next 
 Sew days. Two officers and 7 men left in the mail steamer 
 to-day ; 12 men were to have gone, but there was only accom- 
 anodation for 7. Another case of dysentery arrived yesterday 
 from the front. With the exception of a European sergeant 
 an the West Indian Regiment, who died, all the cases of 
 dysentery have done well under ipecacuanha and opium. 
 
 UNQUALIFIED PRACTICE AND THE LAW. 
 
 THAr the Medical Act requires amending is fairly well known 
 sto most members of the profession, and two prosecutions 
 under Section 40 by the Medical Defence Union lately at 
 Cardiff has brought this fact into greater prominence than 
 ever. In one case a person calling himself “ Dr.” Bridgwater 
 has, according to the evidence given at the police court on 
 February 12th, been practising as a physician, his name not 
 being upon the Register. He was summoned by the Medical 
 Defence Union for “wilfully and falsely using the title of 
 Doctor of Medicine.” The defence raised was that there was 
 no false pretence, inasmuch as he displayed his true qualifi¬ 
 cation, namely, that of a qualified American body, and always 
 appended the letters U.S.A. to the title M.D. whenever he 
 used it in his advertisements. The stipendiary, after hearing 
 certain of the witnesses only, dismissed the summons, but 
 without costs. His remarks, as reported in the South Wales 
 Daily News, are as follows : “It appeared to him that the 
 sole question for determination was whether the defendant 
 used a description implying that he was registered under the 
 Medical Practitioners Act (sic). The description he did use, 
 as it appeared on every handbill and document which had 
 been put in, was ‘Dr. Bridgwater, M.D.U.S.A.’ If he was a 
 medical practitioner of U.S.A. he could not be a medical 
 practitioner under the Medical Practitioners Act. Therefore 
 there could not be a doubt that he did not use a description 
 implying that he was a registered practitioner of the United 
 Kingdom, and the summons must be dismissed.” 
 
 Without wishing to comment upon this judgment, which 
 we learn will be, if possible, appealed against in the High 
 Court by the Medical Defence Union, and will there¬ 
 fore form the subject of inquiry by the judges in the 
 Appellate Court, we would only refer to the case lately 
 reported in the British Medical Journal, that of Fer¬ 
 dinand, who under almost exactly identical conditions 
 was prosecuted and fined the full penalty; he appealed 
 to the Quarter Sessions, and the conviction was confirmed 
 with full costs. No Act of Parliament should be framed so as 
 to admit of such absolutely opposite interpretations in 
 England and in Wales as to the meaning of one of its clauses. 
 On similar line's, the two cases being almost identical, a 
 magistrate in London convicts, inflicting the full penalty, 
 and in Cardiff the stipendiary dismisses the summons. 
 Those who have the drafting of a new Medical Act will do 
 well to bear these two cases in mind. 
 
 The second action to which we referred above was also 
 taken by the Medical Defence Union at the same court, and 
 therefore before the same stipendiary magistrate. The par¬ 
 ticulars are thus reported in the South Wales Daily News: 
 “‘The court then took the summons against Eliza Foster 
 McDonagh Frickart, who was also charged with wilfully and 
 falsely pretending to be a doctor of medicine. Mr. Ward, for 
 the prosecution, said in this case there was a certificate. The 
 defendant was at one time registered, but her name had been 
 •erased from the Register." The defence raised was that Miss 
 Frickhart (who was associated with “Dr.” Bridgwater in his 
 practice) was a licentiate of King’s and Queen’s College, 
 Dublin, and a doctor of medicine of the University of Zurich, 
 and that her name had been erased from the Register, she 
 having changed her address, and not having received any 
 notice that her name had been erased. I11 the report it does not 
 appear that this statement was contradicted ; the erasure was 
 actually under the 29th Section of the Act for infamous 
 conduct in a professional respect, and all the necessary forms 
 had been followed by the General Medical Council before the 
 erasure was effected. 
 
 The magistrate in spite of the prosecution producing evi¬ 
 dence of the erasure, dismissed the summons on the following 
 grounds—namely, that “ once a doctor of medicine always a 
 
 doctor.” He does not think the defendant could be said to 
 have wilfully and falsely pretended to be a doctor of medicine, 
 she being in fact a doctor of medicine. This case, too, will 
 probably be made the subject of appeal, and therefore we 
 cannot comment upon it. 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shuter Scholar of St. Bartholomew’s Hospital. 
 
 IV. 
 
 Intensification. 
 
 Now that the first excitement caused by Professor Roentgen’s 
 remarkable discovery is over, the weekly record of discoveries, 
 although none the less interesting, cannot but have lost much 
 of its attraction to those who care only for the results of its 
 practical application. I have pursued my investigations in 
 sensitising the photographic plates especially for impression 
 by the x rays. I am glad to report I have met with success, 
 although I have not yet reached such a final stage as would 
 warrant a full explanation of my process. 
 
 Fig. 1.—Photograph of the case of Osseous Ankylosis recorded by 
 Dr. B. L. Abrahams in the British Medical Journal, February 
 22nd, page 496. 
 
 Foreign Bodies. 
 
 Reports continue to come in of the successful application 
 of the new method from all parts of the country. Dr. Hall 
 Edwards, of Birmingham, has succeeded in locating a bullet 
 in the hand of a patient, and in another case a needle was 
 easily found. 
 
 Dr. Hazelwood Clayton, of Queen’s Hospital, Birmingham, 
 has sent a description of a successful attempt to locate the 
 position of a needle by the new method, and an account of its 
 extraction. Similar success is recorded by Professor 
 Wertheimer and Mr. Charles A. Morton, and at page 558 a 
 full report is given of a case of needle in the foot operated 
 on by Dr. Mackenzie Davidson, of Aberdeen. In this case a 
 wire was used around the foot externally to serve as a 
 guide to the localisation of the needle. The plan may 
 have a further application in other cases, as the shadow of 
 the wire could be clearly seen in the photograph. 
 
Feb. 29, 1896.J 
 
 THE NEW PHOTOGRAPHY. 
 
 The British 
 Medical Journal 
 
 557 
 
 .Fig. 2.—Photograph of oationt boio" skinerc-Bcd together with the apparatus necessary ; on the left is seen the induction coil and on th right 
 the Leyden jars and Tesla transformer. The operator controls the key and passes the current at intervals of a quarter of a minute, so as to 
 give the tube time to cool and to allow the glass to recover from the intense molecular strain. 
 
 Possible Application to Abdominal Surgery. 
 
 Professor Kinsing, of Hamburg, is reported to have been 
 successful in obtaining a photograph of a foetus inutero. If 
 this report proves to be correct, it opens up a wide field of use¬ 
 ful applications in the domain of abdominal surgery. Here, 
 perhaps, will be some of the greatest uses of the new method. 
 
 Cases. 
 
 Among the cases I have investigated this week are the 
 following. The first case, that of F. B., is as follows. The 
 notes have been kindly forwarded by Mr. Battle : 
 
 F. B., aged 30, was seen by Mr. Battle as an out-patient on 
 February 14th. She was complaining of pain in the region 
 of the metacarpo-phalangeal joint of the right thumb, which 
 she said was due to the presence of part of a needle which 
 she ran into this part of her hand six months ago. An 
 attempt to find the needle three months previously had 
 failed. There was an appearance of slight swelling in the 
 
 neighbourhood of the joint, considerable tenderness, and 
 some feeling of resistance, but the needle could not be got 
 between the fingers nor an end distinctly felt. The patient 
 was advised to have a photograph of the hand taken by the 
 Roentgen rays. This was done by Mr. Rowland, and the needle 
 was seen to be lying across the metacarpo-phalangeal joint. 
 On February 21st, when the patient was anaesthetised, Mr. 
 Battle made an incision half an inch in length on the outer 
 side of the joint, and at once came upon the end of the 
 needle, which, being extracted, was found to be a fragment 
 three-quarters of an inch long. 
 
 In another case of suspected tuberculous disease of the 
 foot I obtained a very good skiogram. As to its interpreta¬ 
 tion, however, I am not quite certain. At the head of the 
 metacarpal bone of the great toe are two whitish patches, 
 the meaning of which is not quite evident. It is possible 
 that they represent tuberculous foci. 
 
558 the NEW PHOTOGRAPHY. [Feb; 297 1896.' 
 
 I have also, in con junction^ with Mr.-Waggett, made two 
 attempts to obtain a negative that would show the position 
 of foreign bodies in the larynx. Neither attempt could be 
 said to be quite successful, although the second gave signs of 
 promise, and I have every hope of succeeding in the end. 
 
 Among the many communications received is one from Mr. 
 John Finley calling attention to some work which was done 
 nearly twenty years ago by Mr. William Brookes. I11 March, 
 1877, Mr. Brookes read a paper before the London Photo¬ 
 graphic Society at the Society of Arts. This paper was pub¬ 
 lished at the time in the British journal of Photography and in 
 the Photographic Lews. Mr. Brookes there calls attention to 
 the action on a photographic plate of certain invisible 
 actinic rays. He used an ordinary horseshoe magnet about 
 8 inches long, poles uppermost, and the sensitive plate was 
 distant about half an inch from the poles. A card with cer¬ 
 tain perforations was placed between the poles and the plate. 
 Images were obtained both of the perforations and of certain 
 letters on the card, which had been obliterated as it was 
 supposed with Indian ink. Whether the rays which pro¬ 
 duced these results were of the same nature as Roentgen’s x 
 rays must remain an open question. 
 
 THE POSITION OF A BROKEN NEEDLE IN THE FOOT 
 
 DETERMINED BY MEANS OF ROENTGEN’S RAYS. 
 
 By James Mackenzie Davidson, C.M., 
 
 Ophthalmic Surgeon, Aberdeen. 
 
 Dr. George Gibb, who sent me the case, has favoured me 
 with the following notes :— 
 
 “ On February 13th, J. P., aged 9 years, was brought to me 
 with the history that half a sewing needle was in her foot. 
 She had 011 the morning of February nth been walking bare¬ 
 foot across a room when a needle sticking in a mat entered 
 her foot and broke in two, one part remaining in the foot the 
 other being found on the floor. She was unable to stand, 
 with severe pain. On examination a small round punctured 
 wound was manifest on the skin of the sole, 3^ inches from 
 the Jieel, exactly in the middle line of the foot. Palpation 
 caused pain but gave no other clue to the presence or direc¬ 
 tion of the needle. I sent her to Dr. Mackenzie Davidson 
 that a shadowgram of the foot might be obtained. This was 
 very successfully accomplished, and showed the needle lying 
 in the longitudinal axes of the foot with its extremity not far 
 from the skin puncture. LTnder chloroform one incision, f of 
 an inch in length, was made transverse to the inferred direc¬ 
 tion of the needle, as revealed by the shadowgram, and about 
 ^ inch behind the point of entrance. The scalpel on pene¬ 
 trating J inch in depth struck steel. A longitudinal incision 
 was then made from the steel to the skin aperture left by the 
 needle. The end of the needle was then seen lying at a depth 
 of J inch from the surface, and was easily removed by for¬ 
 ceps. It proved to be i T V inch in depth. The operation was 
 rendered extremely easy by the accuracy with which the 
 needle had been located.” 
 
 I will now give a short description of the apparatus 
 employed and the method adopted. The current from the 
 main reduced from no volts to about 8 or 10 works a 10-inch 
 spark induction coil made by Apps, London. A Tesla’s appa¬ 
 ratus (supplied by Messrs. Baird and Tatlock, Glasgow) is in¬ 
 terposed, and the Crookes’s tube used is similar to the one of 
 which an illustration appears in the British Medical Journal 
 of February 8th. 
 
 One of the chief difficulties is to get sharp shadows. I find 
 that the whole lower surface of the tube gives origin to the x 
 rays, and evidently not uniformly so, as is shown by the fol¬ 
 lowing experiments : I put nails of varying sizes into a piece 
 of thick cardboard perpendicularly, and across two of them, at 
 different levels, I placed two knitting needles, and laid the 
 whole on a photographic plate, which was wrapped in three 
 folds of black paper. The Crookes’s tubeiwas placed perpen¬ 
 dicularly 2 inches above the head of the middle nail, and the 
 current was turned on for five minutes and the plate 
 developed. The negative showed that the middle nail imme¬ 
 diately beneath the centre of the tube cast a circular shadow, 
 but the ones at the side cast comet-like shadows, and the 
 knitting needle, 1 inch from the plate, gave four shadows. 
 The one half an inch from the plate gave a very blurred 
 shadow. From experiments of this kind I learned how to 
 
 estimate the size and position of objects from the character of 
 their shadows, and had it not been for these preliminary in¬ 
 vestigations I doubt whether I could have correctly inter¬ 
 preted the position of the broken needle from the shadow it 
 east in this case. The method employed was as follows : 
 
 The Crookes’s tube was 6 inches from the photographic 
 late (Cadett lighting), which was wrapped in three folds' of 
 lack paper. I fixed a piece of small copper wire across the 
 sole of the patient’s foot, near the wound. The child then 
 placed her foot flat upon the plate, so that the puncture jon 
 the sole lay perpendicularly beneath the centre of the tube, 
 and forty minutes’ exposure was given. My tube had b^en 
 in use-for some time, and so the bones do not come out wjdl, 
 but the wire is distinctly seen, and in exactly the middle 
 line the cometlike shadow of the broken needle. The wire 
 was T V inch in front of the small puncture in the sole of the 
 foot, and in the negative the lower point of the needle isj T V 
 inch from the shadow of the wire, showing that one end was 
 a little behind the puncture. The sharpness of the shadow 
 indicated that the end near the wound was lowest, and pot 
 far from the skin. The blurred appearance of the other part 
 clearly indicated that it was higher and in the middle line 1 of 
 the foot. I judged it to be about an inch in length. These 
 particulars, given before the operation, proved correct, and I 
 think this case confirms the opinion that for the detection of 
 metal in the body, the Roentgen rays will be of marked ser¬ 
 vice. In cases where the exposure might have to be too pro¬ 
 longed to show the bones clearly, the use of wire or wires as 
 landmarks appears to me to make localisation easier and 
 more precise. What is required is a tube that will give in¬ 
 tense x rays coming from a point. With our present tubes 
 short exposure means proximity to the tube and morei or 
 less blurred shadows, or else at a greater distance sharper 
 shadows, but a prolonged exposure. 
 
 THE USE OF ROENTGEN’S RATS IN THE DIAGNOSIS 
 OF PAINFUL TOE. 
 
 Sir,— In the British Medical Journal of February 15th 
 Mr. Sydney Rowland supplies a photograph of a human foot 
 which shows clearly the lateral displacement of the distal 
 phalanges of the three outer toes, with atrophy of the 
 proximal phalanges produced by the use of tight boots. Lie 
 gives the history of the case, saying that it may be of use in 
 the explanation and treatment of similar symptoms when 
 again met with. 
 
 In the Lancet of March 19th, 1892, p. 628, similar symptoms 
 were described, and similar treatment recommended under 
 the heading “ A Form of Painful Toe.” Two cases of this 
 affection were recorded, in one of which downward displace¬ 
 ment of the second phalanx of the left fourth toe, and in the 
 other lateral inward dislocation of the distal phalanx of the 
 right little toe were respectively held to be the cause of pro¬ 
 longed suffering. It is satisfactory to find that this view as 
 to the pathology of this most common and distressing com¬ 
 plaint has been confirmed by the use of Roentgen’s rays—a 
 method of precision at that time unsuspected. 
 
 My object in writing, however, is to emphasise the fact 
 that neither Roentgen’s rays nor any special knowledge is 
 required for the recognition and cure of this affection, but 
 only the use of common sense by both practitioner and 
 patient. 
 
 Not long ago a stout elderly woman consulted me for pains 
 in both feet. Six or eight months previously, during a tiring 
 walk uphill on a very hot day, she was suddenly seized with 
 acute burning pain in the third and fourth toes of the right 
 foot. The pains were at once relieved by taking off her boot, 
 but from that time whenever she wore it, whether standing, 
 walking, or sitting with the foot hanging down, the pains re¬ 
 curred. They were absent so long as she wore large loose 
 slippers or walked barefoot. In order to relieve the right 
 foot she had taken to resting all her weight which was con¬ 
 siderable—on her left foot, and lately she had had severe 
 pains referred to the dorsum of that also, which was evi¬ 
 dently due to strain of the long extensor tendons and ante¬ 
 rior annular ligament. The right toes were not paining her 
 at the time I examined her, nor could I find actual displace¬ 
 ment of the phalanges then. The terminal phalanges of the 
 toes were, however, unduly mobile, and on squeezing the 
 
Feb. 29, 1896.] 
 
 ASSOCIATION INTELLIGENCE. 
 
 [ The British 
 Medical Journal 
 
 toes together the characteristic boring burning pain 
 was at once reproduced. Her boots were square-toed, 
 the uppers stiff and unyielding; they overhung the 
 soles, which were thin and too narrow. 
 
 On making her stand on tiptoe and placing the boot beside 
 the foot for comparison, it was obvious that there was not 
 room for free lateral expansion of the toes whilst the boot was 
 being worn. Hence, as soon as the foot became congested 
 and slightly swollen whilst the boot was on. the toes were 
 crushed together and the pain occurred. 
 
 I was once asked to see a young lady, who was said by her 
 mother to be suffering from rheumatism of the feet. She had 
 danced steadily through the season, and had wound up by 
 fainting at a ball owing to excruciating pains which had 
 occurred suddenly in both great toes. I found that the 
 metatarso-phalangeal joints were swollen and tender and the 
 great toes themselves pointed strongly inwards. She was in 
 the habit of forcing her naturally small feet into elegant little 
 liigh-heeled pointed shoes, the forepart of which would not 
 admit three of my fingers abreast. 
 
 On my suggestion that her sufferings were caused by 
 wearing these she became extremely indignant, and told me 
 flatly that I was talking nonsense. “ The shoes,” she said, 
 “could not be too tight, because she could kick them off with 
 ease whenever she chose.” Also “ she had worn similar shoes 
 all her life, and had never had such pains before, so it was 
 perfectly absurd to suppose they had anything to do with 
 it.” 
 
 I failed to convince her of the flaw in her reasoning, arid 
 she eventually dismissed me, stating her intention of seeking 
 other advice, which I sincerely hope she got. 
 
 Unfortunately it is a fact that patients of this sort keenly 
 resent a doctor’s use of common sense for the treatment of 
 their ailments, both because they think it implies a want of 
 it in themselves, and also because it appears to minimise the 
 importance of their case. These are the Naamans whom we 
 have to treat. In deference to their susceptibilities it may 
 be advisable to dignify the homely complaint—painful toe — 
 with some such ponderous title as podo-phalangalgia. The 
 Greek is not very bad, and may serve to reconcile them to 
 the simplicity of the treatment, which is - to wear boots in 
 which the toes can be as freely expanded as when standing 
 barefoot or tiptoe. Let the heels below, the soles broad, and 
 the uppers flexible. Elegance in appearance can be ensured 
 without damage by closely fitting and supporting the instep. 
 —I am, etc., 
 
 Upper Berkeley Street, Feb. 17th. Leonard G. Guthrie. 
 
 THERAPEUTIC USE OF ROENTGEN’S RAYS. 
 
 Sir,— In view of the expectations which have found ex¬ 
 pression in the lay press regarding the possible curative 
 action of the Roentgen rays, it may interest your readers to 
 know the results of some preliminary experiments made by 
 Professor Schuster and myself in relation to this during the 
 last two weeks. We had from the first arranged that, as soon 
 as other work would permit, the action of the x rays on 
 bacteria would be tested. On February 17th and on the 
 following days nine tubes containing quite recent cultures of 
 the cholera vibrio, bacillus coli communis, and bacillus of 
 typhoid fever, were exposed to the rays for 15 minutes, 30 
 minutes, and 1 hour. Control tubes were kept under exactly 
 the same conditions (but for the exposure to the rays). From 
 each of these tubes minute quantities of material were taken 
 to inoculate in each case one tube of bouillon and two or 
 three tubes of nutrient gelatine. On watching these tubes 
 for several days afterwards it was found that no difference 
 could be detected between the growths of organisms which 
 had been exposed to the rays and of those which had not been 
 exposed. The growth being absolutely equal and typical in 
 the thirty-nine tubes under observation. 
 
 On Februaiy 19th a new set of tubes was prepared, this 
 time the organisms used being the bacillus anthracis, the 
 bacillus of typhoid fever, and the cholera vibrio. Nutrient 
 gelatine was this time used as the medium on which the bac¬ 
 teria were exposed to the rays. 
 
 A continuous exposure of 1 hour 15 minutes, followed 
 after an interval by an exposure of 45 minutes, had no effect 
 whatever on the growth of the tubes. 
 
 Under these circumstances it is difficult to bejieve that the 
 Roentgen rays possess a very powerful germjicidal action. 
 Yet, it must be remembered, that with more concentrated or 
 reinforced rays, and also with longer exposure, it is possible 
 that we may obtain different results.—I am, etc., 
 
 Sheridan DelGpine. 
 The Bacteriological and Physical Laboratories, 
 
 Owens College, Feb. 25th. 
 
 Cryptoscopy. 
 
 Mr. A. A. Campbell Swinton, electrical engineer (Victoria Street, 
 S.W.) writes: It may interest your readers to hear that, witli the 
 assistance of Mr. J. C. M. Stanton, I have succeeded, by means of the 
 Roentgen rays, in actually seeing the coins inside a leather purse, the 
 metal instruments inside a closed wood and leather case, a coin 
 through a piece of wood half an inch in thickness, and also through 
 a sheet of aluminium. Photography was not employed, but the shadows 
 of the enclosed objects were made directly visible to the eye by means 
 of a fluorescent screen. The precise arrangement was similar to that 
 recently described by Professor Sal vioni, of Perugia, whose results, though 
 in accordance with certain experiments of Professor Roentgen, have, so 
 far, been received in this country with a certain amount of scepticism. 
 The apparatus consisted of a tube of opaque pasteboard with a simple 
 aperture at one end, to which the eye was applied. The other end 
 was provided with an opaque diaphragm of double black paper upon 
 which, on the inner side, was laid a piece of blotting paper impreg¬ 
 nated with platino-cyanidc of barium in a crystalline state. 
 
 The purse or other object was held against the diaphragm with the 
 Crookes’s tube beyond it, so that the rays from the latter cast a shadow 
 of the coins through the leather and black paper upon the inner im¬ 
 pregnated screen. The platino-cyanide fluoresced brightly under the 
 stimulus of the rays on those portions of the blotting paper where no 
 shadow was cast, and consequently the form of the metallic objects 
 w'as made clearly visible. Non-metallic objects were also clearly seen, 
 though more faintly, owing to their greater transparency to the rays. 
 
 Besides being exceedingly interesting in itself, and possibly capable 
 of sufficient improvement to render it of service in medicine aud 
 surgery, the appliance will be very useful for the purpose of ascertain¬ 
 ing without the tedious process of exposing and developing a plate 
 whether any given Crookes’s tube is suitable as regards exhaustion and 
 form for photographic purposes. It can be seen at once whether the 
 tube is working at the best advantage, and is giving clearly defined 
 shadows. 
 
 P.S.—Since writing the above I have been able to see quite distinctly 
 the bones in the thick portion of my own hand. 
 
 ASSOCIATION INTELLIGENCE. 
 
 NOTICE OF QUARTERLY MEETINGS FOR 1896. 
 
 ELECTION OF MEMBERS. 
 
 Meetings of the Council will be held on April 15th, July 
 8th, and October 21st, 1896. Candidates for election 
 
 by the Council of the Association must send in their 
 forms of application to the General Secretary not later than 
 twenty-one days before each meeting—namely, March 26th, 
 June 18th, and October 1st, 1896. 
 
 Any qualified medical practitioner, not disqualified by any 
 by-law of the Association, who shall be recommended as 
 eligible by any three members, may be elected a member by 
 the Council or by any recognised Branch Council. 
 
 Candidates seeking election by a Branch Council should 
 apply to the Secretary of the Branch. No members can be 
 elected by a Branch Council unless their names have been 
 inserted in the circular summoning the meeting at which 
 they seek election. 
 
 Francis Fowke, General Secretary. 
 
 LIBRARY OF THE BRITISH MEDICAL 
 ASSOCIATION. 
 
 Members are reminded that the Library and Writing Rooms 
 of the Association are fitted up for the accommodation of the 
 members in commodious apartments, at the offices of the 
 Association, 429, Strand. The rooms are open from ioa.m. to 
 5 p.m., Saturdays, 10 a.m. to 2 p.m. Members can have their 
 letters addressed to them at the Office. 
 
 BRANCH MEETINGS TO BE HELD. 
 
 Yorkshire Branch.— The next meeting of the Branch will be held at 
 Huddersfield, on Wednesday, March 18th, at 3.45 p.m. Members intending 
 to read papers or to propose members of the Association as members o 
 
560 
 
 The Brittsh | 
 Medical JournalJ 
 
 SPECIAL CORRESPONDENCE. 
 
 [Feb. 29, 1896. 
 
 the Branch, are requested to communicate at once with the Secretary.— 
 Adolph Bhonner, Honorary Secretary { pro . tern.), 35, Manor Row, Brad¬ 
 ford. 
 
 South-Eastern Branch : West Kent District.— A meeting of this 
 District will be held at the Asylum, Banning Heath, Maidstone, on 
 Friday, March 13th, at 4 p.m., Dr. F. Pritchard Davies in the chair. The 
 dinner will take place at the Mitre Hotel, Maidstone, at 6.30 p.m. Charge 
 6s. 6d., exclusive of wine. All members of the South-Eastern Branch are 
 entitled to attend this meeting, and to introduce professional friends. 
 Gentlemen who reside at a distance, and wish to attend the meeting, are 
 requested to communicate with me on or before Wednesday, March nth, 
 in order that arrangements may be made for conveying them to the Asy¬ 
 lum. The Chairman will give an address on Genei'al Paralysis, 
 illustrated by cases in the wards.— Edward Ground, M.D., Honorary 
 Secretary, 1, Ashford Road, Maidstone. 
 
 Metropolitan Counties Branch. —A general meeting of the Branch 
 will be held at 20, Hanover Square, W., on Monday, March 2nd, at 8.30 p.m. 
 Business : The Relation of the Association to the Question of Medical 
 Protection and Defence. The Relation of the Profession to Medical Aid 
 Societies.— Andrew Clark and Isambard Owen, Honorary Secretaries. 
 
 Metropolitan Counties Branch : South London District.— The 
 next meeting will be held in the Court Room of Guy’s Hospital (by kind 
 permission of the Treasurer) on Wednesday, March 4th, at 8.30 p.m., Dr. 
 Hector Mackenzie, Vice-President of the District, in the chair. A paper 
 will be read by L. A. Dunn, F.R.C.S., on some cases of Intestinal Obstruc¬ 
 tion. Cases of clinical interest from the wards of the hospital will be 
 shown. All practitioners, whether members of the Association or not, 
 will be heartily welcomed.— H. IIetham Robinson, Honorary Secretary, 
 1, Upper Wimpole Street, Cavendish Square, W. 
 
 South-Eastern Branch : East Surrey; District.— The next meeting 
 of the above District will be held at the Queen’s Hotel, Upper Norwood, 
 on Thursday, March 12th, at 4 p.m., J. H. Galton, M.D., of Upper Norwood, 
 in the chair. Dinner at 6 p.m. ; charge 7s., exclusive of wine. All mem¬ 
 bers of the South-Eastern Branch are entitled to attend, and to intro¬ 
 duce professional friends. Nominations for representatives on the Coun¬ 
 cil of the Association will be received. Papers : Dr. Pye-Smith: The 
 Local Distribution of Diseases as an Aid in their Diagnosis. Mr. J. Bland 
 Sutton: On Wandering Spleens. Mr. A. 11 . Tubby: Some Painful Affec¬ 
 tions of the Foot. Members desirous of exhibiting specimens or reading 
 notes of cases are invited to communicate at ouce with the Honorary 
 Secretary, Henry J. Prangley, Tudor House, Anerley. 
 
 HONG KONG AND CHINA BRANCH. 
 
 The members of this Branch were entertained at dinner by 
 Dr. Cantlie, the retiring President, in the Mount Austin 
 Hotel, Hong Kong, on the evening of Saturday, December 
 14th, after winch the annual meeting for the election of office¬ 
 bearers for the ensuing year was held. 
 
 Election of Officers. —The following were elected:— President: 
 J. A. Lowson, M.B. Vice-President: S. Westcott, Surgeon- 
 Major A.M.S. Honorary Secretary and Treasurer: J. C. Thom¬ 
 son, M.D. Council: S. Keays, Staff-Surgeon R.N. ; A. E. 
 Hayes, Surgeon-Major A.M.S.; P. H. Johnston, M.D., Sur¬ 
 geon-Major A.M.S ; J. M. Atkinson, M.B. ; J. Cantlie, M.B. ; 
 F. W. Clarke, M.B.; W. Hartigan, M.D. ; G. P. Jordan, M.B.; 
 F. O. Stedman, M.D. 
 
 A meeting of this Branch was held at the Government Civil 
 Hospital, Hong Kong, on January 10th ; Dr. J. A. Lowson, 
 President, in the chair. 
 
 New Members. —Antonio Simplicio Gomes, M.R.C.S., was 
 elected a member of the Association and of tire Branch. The 
 following gentlemen, already members of the Association, 
 were admitted to the Branch : F. W. Clark, M.B.; Fleet- 
 Surgeon C. C. Godding, R.N.; Surgeon-Major A. E. Hayes, 
 A.M.S., D.S.O.; Staff-Surgeon S. Keays, R.N.; Surgeon F. D. 
 Lumley, R.N. ; Surgeon M. L. B. Rodd, R.N.; Surgeon E. A. 
 Shaw, M.B., R.N. 
 
 Communications. —Dr. Lowson showed a case of Arrested 
 Development of the Female Genital Organs.—Dr. Wilm ex¬ 
 hibited a series of Bacteriological Preparations under the 
 microscope.—Dr. Hartigan introduced a discussion of the 
 Recent Fever Epidemic in Hong Kong, and the following 
 gentlemen took part in it: Dr. Atkinson, Dr. Jordan, Dr. 
 Stedman, Fleet-Surgeon Godding, R.N., and Surgeon-Major 
 Hayes, A.M.S., D.S.O. There was considerable diversity of 
 opinion on the subject—relapsing fever, influenza, dengue, 
 malaria, filth fever, and various combinations of these each 
 finding its advocate. 
 
 MONTREAL BRANCH. 
 
 The annual general meeting of this Branch was held on 
 January 18th, Dr. T. G. Roddick, Vice-President, in the 
 chair. Thirty-two members were present. 
 
 Election of Officers. —The election of officers for the present 
 year resulted as follows:— President: Dr. T. G. Roddick. 
 Vice-President: Dr. E. P. Lachapelle. Council: Dr. James 
 Penigo, Sir William Kingston, and Dr. Shepherd. Secretary : 
 Dr. Springle. Treasurer: Dr. J. Alex. Hutchison. Auditors: 
 Dr. Kenneth Cameron and Dr. J. H. B. Allan. 
 
 Annual Reports. —The reports for the past year were very 
 satisfactory, and showed the Branch to be in a good 
 position. 
 
 New Members. —Seven new members were elected. 
 
 Invitation to the Association. —After some discussion, it was 
 moved by Dr. J. Geo. Adami and seconded by Dr. Proud- 
 foot: “That an invitation be extended by the Montreal 
 Branch to the Association to make this city the place of 
 meeting for this year if possible; and, further, that the 
 President be empowered to immediately cable the President 
 of Council and the President of the Carlisle Branch, for their 
 consent.” This was carried unanimously with much enthu¬ 
 siasm. In accordance with this resolution Dr. Roddick 
 cabled as follows : “ Henry Barnes, Cumberland Infirmary, 
 Carlisle,—Montreal Branch anxious to have British Medical 
 Association present year, August. Will Carlisle waive 
 rights ? Answer paid.—Sgd. Roddick, President.” A similar 
 message was sent to Dr. John Ward Cousins, President of 
 Council. 
 
 Notice of Motion. —Dr. Armstrong gave notice of motion to 
 increase the number of members of Council from three to 
 five. 
 
 Communications .1—Dr. Wyatt Johnston showed for Dr. 
 Kirkpatrick a specimen of Stomach and Intestine operated 
 upon December 6tli, 1894, for gastro-jejunostomy, giving com¬ 
 parative relief to pyloric obstruction for over ten months. 
 Dr. Johnston also exhibited specimens and slides taken from 
 a man who died of Tetanus. A small splinter of wood was 
 taken from the nose, and yielded the bacillus on examination 
 and culture, and also producing the condition in mice to a 
 marked degree. The antitoxin of the British Institute of 
 Preventive Medicine was used without avail. Dr. Adami con¬ 
 gratulated Dr. Johnston upon the immediate discovery of the 
 bacillus, and remarked that this was far from common.—Dr. 
 Johnston showed for Dr. Armstrong a specimen of success¬ 
 ful suturing for Perforating Typhoid Ulcer. The wound had 
 quite united ; the patient had died from other causes.—Dr. 
 Martin showed for Dr. D. J. Evans specimens of Purpura 
 Hemorrhagica of the new form, in which syphilis of the liver 
 and syphilitic type of pneumonia were present. A similar 
 case occurring at the same time in the Maternity Hospital 
 had recovered under treatment. 
 
 Vote of Thanks. —A vote of thanks to the officers of the past 
 year having been adopted, the meeting adjourned. 
 
 SPECIAL CORRESPONDENCE, 
 
 PARIS. 
 
 Secondary Effects of Antitoxin. — Non-poisonous Matches .— 
 Parrots and Tuberculosis.—Congress of the French Association 
 for the Advancement of Science.—Funds for Laboratories.— 
 General Neivs. 
 
 M. Sevestre, at a recent meeting of the Soci6t6 M6dicale des 
 Hopitaux, referred to the secondary effects of Roux’s serum 
 when used in the treatment of diphtheria. Among these are 
 an urticarial eruption ; pain in the joints, accompanied by a 
 polymorphous eruption and serious general disturbance. These 
 phenomena are never observed in pure diphtheria, but only 
 when there is infection due to the presence of the strepto¬ 
 coccus ; they are analogous to the symptoms observed in 
 streptococcus infection independently of serum injections. 
 Roux’s serum appears to favour the development of the 
 streptococcus. In pure diphtheria M. Sevestre considers that 
 the serum treatment should invariably be adopted. lie also 
 advises it even when the streptococcus is present. When the 
 Loeffier’s bacillus is not present it should neyer be used. M < 
 Le Gendre and M. Gaucher referred to cases in which the use 
 of anti-diphtheria serum was followed by serious complica¬ 
 tions. M. Gaucher proposed that the Society should send 
 circulars to the medical men in France asking them to notify 
 
March 7, 1896.] 
 
 THE BLACK FEVER OF ASSAM. 
 
 [ The British 
 Medical Journal 
 
 619 
 
 THE BLACK FEVER OF ASSAM. 
 
 The Need for Further Scientific Inquiry. 
 
 During the past fifteen years a remarkable and veiy fatal 
 disease has been prevailing in some parts of the province of 
 Assam, which has been locally termed' kala-azar, or black 
 fever. The symptoms of this malady have been made the 
 subject of observation by a succession of medical officers, 
 administrative and executive, and in the year 1891 Dr. G. M. 
 Giles, an officer of the Bengal Medical Service, was deputed 
 to make a special investigation regarding the prevalence, 
 nature, and prevention of the disease. After a careful inquiry 
 he arrived at the conclusion that kala-azar was substantially 
 an anaemia caused by the presence of the nematoid parasite 
 doclmiius duodenalis, otherwise called ankylostoma duo- 
 denale, in the upper part of the small intestine. He denied 
 the malarious nature and origin of the malady, and held that 
 the symptoms and sequelae of malarious fever presented by 
 certain cases were accidental and only what might be ex¬ 
 pected in a very malarious country. Neither fever nor splenic 
 enlargement was, he maintained, an essential feature of kala- 
 azar, which was simply ankylostomiasis—the same disease 
 which had been described by Kinsey and others in Ceylon, 
 and which had been previously known there as beri-beri. 
 True beri-beri—the peripheral neuritis of Pekelharing and 
 Winkler—did not exist in Assam; but a spurious beri-beri 
 similar to the Ceylon disease did prevail extensively among 
 tea-garden cooli.es and the general population, and this was 
 simply the anaemia caused by the ankylostoma. He studied 
 the natural history of the worm, found that it lived and 
 underwent an intermediate phase of rhabditic development 
 in the soil, and he believed that infection was wrought by 
 contamination of food by the ova of the rliabditis, which the 
 habits of the people rendered very possible. 
 
 Dr. Giles’s conclusions have been questioned by a great 
 number of medical men who have seen and studied kala-azar 
 in Assam, and in the latest sanitary report of the province 
 there are observations by Surgeon-Colonel Stephen, M.B., 
 and Drs. Borah, Mullane, Campbell, Macnamara, and 
 MacNaught, which indicate that the question of the nature 
 of this disease is still unsolved. It may be admitted that 
 the ankylostoma duodenale is a very common parasite in 
 Assam, and that the invasion in force of the human intestine 
 by this worm does give rise to profound and fatal anfemia ; 
 but the researches of Dobson, MacConnell, and others indi¬ 
 cate that it is a very common parasite throughout India, and 
 that its presence in moderate numbers is quite consistent 
 with unimpaired health. On the other hand, cases of kala- 
 azar present phenomena which cannot be explained by 
 worms, and these have not been found in all cases of this 
 disease. 
 
 Dr. Mullane, who has studied the disease continuously since 
 it was first noticed in the Garo Hills in 1881, describes it 
 briefly as follows: 
 
 The disease commenced as an attack of malarial fever, either of the re¬ 
 mittent or intermittent type, but most frequently of the former. This 
 fever was allowed to run on unchecked, as the people refused to be treated 
 by European methods—hence the rarity of the disease among the more 
 enlightened and educated portion of the community. The result was 
 that enlarged spleen followed, then the fever usually left the patient. 
 Upon this enlargement of the spleen generally an anaemic condition, to¬ 
 gether with a peculiar dusky discoloration of the skin supervened, 
 caused perhaps by destructive disintegration of the haemoglobin of the 
 blood. Consequent upon this anaemic condition dropsy and oedema of the 
 body set in, and the illness was generally terminated by an attack of 
 dysentery or diarrhoea. The post-mortem appearances were—an anaemic 
 condition of all the tissues, enlargement and pigmentation of both spleen 
 and liver and intestines ; ankylostoma might or might not be present. 
 This certainly reads like a description of paludal infection, 
 and the other reporters agree in acknowledging that the 
 disease has a decided malarious complexion. Still, there are 
 circumstances connected with its history and phenomena 
 which seem to indicate that it differs from the ordinary mala¬ 
 rious fever of the province, and is, if malarious, a special and 
 unusually deadly form of paludism. 
 
 Assam is a narrow valley through which the Brahmaputra river 
 meanders. It is bounded to the north and west by the eastern continua¬ 
 tions of the Himalayan Mountains, and to the south and east by suc¬ 
 cessive ranges of hills—the Garo, Ivhasi, Jaintia, and Naga. From both 
 sides numerous spurs jut into the valley, and at the base of the hills is a 
 tract of terrai which is damp and jungly. The disease was first ob¬ 
 served in the year 1881 at the entrance to the Assam valley in the terrai 
 of the Garo hills, on the left or eastern side of the river. In 1862 it ex¬ 
 tended to the adjoining district of Goalpara, and crossed the river, 
 
 attacking several contiguous localities, but with less severity. In 1885 the 
 district of Kamrup, which lies next in the valley, was seized, and the 
 plague progressed upwards along the base of the hill range, until in 1892 
 it reached the further district of Nowgong, where the mortality is now 
 highest. About the same time a subdivision of the opposite district of 
 Durrung on the right bank of the river was invaded, and the mortality 
 there has reached 22 per 1,000; the highest mortality of any registration 
 area being that of the town of Nowgong, namely, 42.58. This was ex¬ 
 ceeded by the Goalpara municipality, where in 1882 the death-rate caused 
 by kala-azar reached 93 per 1,000. Dr. Mullane mentions the case of a 
 large village which was depopulated and abandoned through death and 
 fright, until it “lapsed into jungle.” While the disease has been thus 
 slowly progressing up the valley and invading fresh areas, it has dis¬ 
 appeared from its earlier haunts. The number of deaths attributed to 
 kala-azar in 1894 was 13,164. or 5.6o;per 1,000 of population against 10,247 or 
 4.36 in 1893. 
 
 The peculiarities of the disease, epidemiologieally con¬ 
 sidered, are (1) a definite commencement and starting point; 
 (2) a well-marked but very slow progress ; (3) a limited and 
 decided localisation; (4) a certain duration in each locality 
 successively visited; and (5) a very high mortality. The 
 places and times of worst prevalence are those most favour¬ 
 able to malarious infection, and the symptoms, sequelse, and 
 mode of death are those of paludism, first acute and then 
 chronic. It has been observed that the localisation of the 
 malady is so well defined that villages and parts of villages 
 have been affected, while others have remained free. 
 Quinine, arsenic, and other antimalarial remedies are said to 
 have no curative effect in advanced cases of kala-azar, 
 though treatment in the earlier stage would probably be more 
 successful. 
 
 Surgeon-Colonel Stephen and the civil surgeons, while 
 maintaining that kala-azar is essentially malarious in its 
 nature, contend that there is some additional element deter¬ 
 mining its peculiar malignity and mode of prevalence which 
 remains to be discovered. It resembles in many respects the 
 severe outbreak of malarial fever which moved slowly about 
 in certain districts of the Gangetic delta (Nuddea, Jessore, 
 Hooghly, Burdwan, Beerblioom, and Midnapore) in the 
 sixties and seventies. They strongly urge special inquiry. 
 
 The Assam Government resists this suggestion, on account 
 of its cost, remarking that the remedy of kala-azar is known, 
 namely, improved sanitation. This is to some extent true ; 
 but the disease unfortunately rages and kills, and dispensaries 
 have been established for the cure of its victims in infected 
 tracts. Are the-sick to be treated with quinine or thymol, 
 or both? And as regards protection, are not measures of 
 special sanitation feasible or imperative in anticipation of 
 that general sanitary reform which the Government contem¬ 
 plates, but which, in view of the nature of the country and 
 its inhabitants, must be an achievement of a remote future ? 
 It is bad policy to struggle with an unknown foe in the dark, 
 and if ever there was a case for special investigation, this is 
 one. We want to know more about the causation of these 
 slowly-moving invasions of malignant paludism, and the 
 present seems a most apt opportunity for endeavouring, with 
 all the aids of modern science, to solve the enigma presented 
 by kala-azar in the Assam Valley. 
 
 THE LONDON SCHOOL BOARD AND MEDICAL 
 CERTIFICATES. 
 
 At an adjourned meeting of medical men, to protest against 
 the action of the London School Board in regard to the super¬ 
 vision of medical certificates, held under the chairmanship 
 of Dr. Glover, on March 5th, at 20, Hanover Square, the fol¬ 
 lowing resolutions were unanimously passed:— 
 
 I. That this meeting of medical men interested in the question of 
 School Board certificates for Board School children, as affected by the 
 resolution of May 30th, 1895, records its opinion that the system so adopted 
 is offensive to the profession, and is likely to be disastrous to the health 
 of the children in the schools. 
 
 II. That this meeting is of opinion that, pending the alteration of this 
 system, medical men should decline to supply certificates to the children 
 attending Board Schools. 
 
 III. That the above resolutions be transmitted in the name of the 
 meeting by the Chairman to the Chairman of the London School Board, 
 with a respectful request that the policy of the resolution of May 30th be 
 revised by the Board so as to secure the hearty co-operation Of the 
 medical profession in protecting the children of the elementary schools 
 from infectious and other diseases, and securing the proper attendance of 
 the children. 
 
620 
 
 The British I 
 Medical JournaiJ 
 
 THE NEW PHOTOGRAPHY. 
 
 [March 7, 1896 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shutei' Scholar of St. Bartholomew's Hospital. 
 
 V. 
 
 A very great advance has been made this week, in the intro¬ 
 duction of a form of tube by the use of which it is possible to 
 do work with ease that before was very difficult or impossible. 
 This particular form is the result of the work that has been 
 done in London, and is perhaps the greatest advance that has 
 been yet made in the new art. It has been named the 
 “ focus tube,” from the fact that by means of a peculiar con¬ 
 struction a definite point of origin has been obtained for the 
 x rays instead of the diffuse surface of the wall of the tube 
 hitherto in use. 
 
 Fig. 1.—Skiagraph of elbow of Dr. Edward Gray’s case showing dis¬ 
 placement of radius and ulna outwards. 
 
 The resulting shadows are therefore far sharper than any 
 that have been as yet obtained, and the most minute detail 
 is readily seen. The exposure too has been very appre¬ 
 ciably shortened ; thus, in the case of such thick parts as the 
 wrist and elbow an exposure of three minutes is ample. 
 Messrs. Newton and Co., of Fleet Street, have put this tube 
 on the market. Curiously enough, I had independently hit 
 on an arrangement identical with that now being made, and 
 on calling on Messrs. Newton with a view to getting one made 
 was informed by them that they had been at work for a week 
 on producing the same arrangement. My tube was designed 
 for working with a Tesla current, and is consequently double 
 in all respects of the “focus tube.” Such good results are, 
 
 however, obtained with the single arrangement that I doubt 
 if the doubling for use with the Tesla current would be worth 
 the cost unless the difficulty that exists in getting tubes to 
 stand such high pressures can be overcome. 
 
 Among the cases I have investigated this week are the 
 following: 
 
 DISLOCATION OF ELBOW. 
 
 By Edward Gray, M.B., C.M., London. 
 
 On February 22nd a young man was brought to me having 
 slipped while playing football that afternoon, and fallen on 
 his closed fist while the arm was outstretched. On examina¬ 
 tion the elbow was found very much swollen, especially on 
 the inner aspect. No crepitation could be felt, and the fore¬ 
 arm could be freely flexed, pronated, and supinated without 
 causing much pain. I came to the conclusion that there was 
 no fracture, and was inclined to think there was no disloca¬ 
 tion ; but owing to the considerable amount of swelling I 
 could not be certain. I deferred putting him under an 
 amesthetic, as I thought it would be a good case in which 1o 
 test the value of the Roentgen rays, so evaporating lotions 
 were temporarily applied until the arm could be skiagraph!d 
 by Mr. Sydney Rowland. This was successfully done cn 
 February 29th (by which time the swelling had subsided con¬ 
 siderably), and showed a rare form of dislocation at the elbow - 
 joint, namely, of both bones of the forearm outwards. 
 Ericlisen states that the only instance with which he is 
 acquainted is one reported by Ndlaton. 
 
 The accompanying skiagraph (Fig. 1) represents the condi¬ 
 tion. No time was lost in reducing the dislocation under 
 chloroform. 
 
 Tliis case is one of great interest both because it is a step 
 in advance towards obtaining skiagraphs of deeper and 
 thicker structures than hitherto and because the diagnosis 
 cannot be obtained by any other means. 
 
 SKIAGRAPHY AS AN AID TO THE DIAGNOSIS OF 
 EPIPHYSIAL LESIONS OF CHILDHOOD. 
 
 (Under the care of Mr. John Poland, F.R.C.S.) 
 
 The patient, F. C., the son of a deceased medical man, is 
 now aged 17. Nearly three years ago he met with a very 
 rare form of injury to the index finger of his right hand after 
 a fall with a stick twisted in between his fingers, and was 
 sent to Mr. J. Poland by Dr. Atkins, of Sutton. Separation 
 
 Fig. 2.—Skiagraph of Mr. John Roland’s case. Note the separation 
 between the first phalanx and the metacarpal of index finger, 
 and displacement forwards of the epiphysial head of the 
 second metacarpal bone combined with subluxation of the 
 first phalanx was the diagnosis made at the time. The 
 epiphysis could easily be reduced and the finger placed in 
 good position; but, in spite of careful and repeated appli¬ 
 cation of plaster-of-paris and other splints, the epiphysis 
 again became a little displaced forwards towards the palm. 
 
THE NEW PHOTOGRAPHY. 
 
 ’ The British 
 LMedical Journal 
 
 621 
 
 March 7, 1896.] 
 
 In this position it finally united to the diaphysis. As a 
 result, at the present time the power of flexion at the 
 metaearpo-plialangeal joint is a good deal restricted and 
 the finger shorter than its fellow. 
 
 The skiagraph (Fig. 2) confirms absolutely the supposed lesion 
 of the distal end of the metacarpal bone. The space noticeable 
 between the first phalanx and the displaced posterior margin 
 of the epiphysis and the diaphysial end is probably occupied 
 by fibroid tissue, forming some portion of the new articular 
 surface between the bones. The epiphysial discs of the other 
 metacarpals as well as of the phalanges are clearly seen. 
 Mr. Poland believes the importance of obtaining skiagraphs of 
 certain forms of recent complicated injuries to the epiphyses 
 in children to be very great. At the lower end of the 
 humerus, for example, there are but few anatomical speci¬ 
 mens in museums to guide the surgeon in making an exact 
 diagnosis of the numerous and complicated lesions which it 
 cannot be doubted from daily experience must exist during 
 life. Could this knowledge be obtained by Roentgen’s 
 method, it will, he believes, materially assist the surgeon 
 in giving a decision as to immediate operative measures 
 in elbow-joint injuries of children, and in removing some of 
 the many instances of subsequent severe deformity and loss 
 of function of the joint and limb now so little creditable to 
 surgery. 
 
 Possibility of Skiagrapiiing the Fcetus in Utero. 
 
 With the idea of seeing if this were possible Mr. Rowland made 
 several attempts to obtain a skiagraph of a pregnant cat. There 
 was some difficulty in keeping the cat at rest, and an anaes¬ 
 thetic was rendered impossible by the fact that during a trial 
 with ether and another with chloroform the cat showed signs of 
 danger, so much so that Mr. Hobday, of the Royal Veteri¬ 
 nary College, who kindly managed the operation, and at 
 whose suggestion the cat was tried, deemed it inadvisable to 
 proceed. The difficulty was, however, partly overcome by 
 the use of hobbles and bandages, and an exposure of eight 
 minutes showed clearly the pelvis and vertebral columns, 
 and faint traces of the uterine cornua and their contents. 
 Had it been possible to maintain the animal quiet for a longer 
 time, Mr. Rowland had no doubt the experiment would have 
 succeeded perfectly. As it was it showed that intestine and 
 other abdominal viscera transmit x rays with fair facility. 
 
 The other cases Mr. Rowland had to record this week are 
 suspected fracture of lower third of radius, tuberculous dac¬ 
 tylitis in a child, lesion of wrist (nature doubtful), disloca¬ 
 tion of wrist and fracture, search for bullet in leg of man 
 (skiagraph successful, but bullet not found). From this list 
 it will be seen that the deeper structures are at last yielding 
 to the new process. 
 
 PROFESSOR SCHUSTER ON THE ROENTGEN RAYS. 
 Oi t r Manchester correspondent writes: Professor Schuster 
 gave in Owens College on March 2nd a lecture on Professor 
 Roentgen’s discovery. A skiagraph of an opaque object was 
 taken, and after it was developed it was exhibited to the 
 audience on the screen. Professor Schuster expressed the 
 opinion that the new rays are possibly, but not certainly, like 
 the rays of light. If they are, they are of very much shorter 
 length than any of those of which we at present have any 
 knowledge. The opacity of different bodies to these rays was 
 not, he said, a difference in kind but only in degree. Some 
 photographs taken at Owens College were shown, including a 
 hand, part of which had been photographed through a sove¬ 
 reign. The bone was distinctly visible through the gold. A 
 very interesting slide was that showing the bones in the hand 
 of a child 6 years of age. The epiphyses could be seen quite 
 distinctly, as cartilage is very transparent. Another showed 
 the presence of a needle in a girl’s foot. The usefulness of 
 the discovery will largely depend on the possibility of increas¬ 
 ing the intensity of the rays. The present method of using a 
 photographic plate was, he said, very clumsy, for by far the 
 greatest amount of the rays passed through the plate. 
 
 CASE OF DISLOCATION OF THE FINGER. 
 
 We are indebted to Mr. Frederick Page, surgeon to the 
 Royal Infirmary, Newcastle-on-Tyne, for the following case in 
 which a skiagraph enabled a diagnosis to be made. The 
 
 skiagraph was taken with an exposure of twenty minutes by 
 Messrs. Brady and Martin, chemists and surgical instrument 
 makers, Northumberland Street, Newcastle-on-Tyne. The 
 
 patient was a lad who had received an injury to the ring 
 finger of his left hand about fifteen months ago. When first 
 seen by Mr. Page three months ago it was not possible to 
 determine whether he had suffered a fracture or a dislocation. 
 As will be seen from the accompanying reproduction, the 
 skiagraph at once placed this bevnnd doubt. 
 
 ROENTGEN RA\ T S AND REFLECTED SOLAR LIGHT. 
 
 Sir,— As I have for the last fifteen years been engaged, 
 whenever opportunity offered, in investigating the effects of 
 sunlight on the human body, and especially the penetrating 
 effects of reflected rays from snow and other surfaces, I was 
 naturally led to inquire whether there could be any relation 
 between what I had observed and the observations of Pro¬ 
 fessor Roentgen. He finds that certain rays generated or 
 excited by electrical action penetrate most of the human 
 tissues and other substances, and are stopped by substances 
 of a different nature. I have, on the other hand, demon¬ 
 strated that reflected luminous or photo-chemical rays also 
 penetrate the human skin into the deeper tissues beneath, 
 and produce within them great and important changes. 1 It 
 will, I think, be interesting to compare a summary of facts 
 and conclusions of various phenomena observed by me from 
 time to time with those published by you on the x rays of 
 Roentgen. 
 
 1. That heat qua heat is not the cause of sunburn. 
 
 2. That there is strong evidence for believing that sunburn 
 is caused by the violet rays or ultra-violet rays of light 
 reflected from snow, which reflected heat is not necessarily 
 of the same quality as that which is incident. 
 
 3. Captain Abney finds that the violet or ultra-violet rays 
 are very strong at high altitudes, and believes that altitude 
 has much to do with sunburn. 
 
 4. That altitude alone does not explain sunburn, for one 
 
 1 Sunburn on the Alps. Alpine Journal, November, 1888 ; Sunburn on the 
 Alps, Edward Stanford, Cockspur Street, S.W., 1890; On the Influence of 
 Solar Rays on the Skin, British Journal of Dermatology, No. 58, vol. v; see 
 also British Medical Journal, September 29th, 1894, p. 694. 
 
622 
 
 The British 1 
 Medical JournalJ 
 
 ASSOCIATION INTELLIGENCE. 
 
 [March 7, 1896. 
 
 may be unburnt on rocks, say, at 10,000 feet, and yet become 
 immediately affected on descending to a glacier 3,000 or 4,000 
 feet lower down. 
 
 5. That sunburn and snow blindness arise from similar 
 causes, and that sunstroke and sun fever may be associated 
 with the effects of penetrating light rays. 
 
 6 . That rays from the electric light produce much the same 
 results as sun rays reflected from snow. 
 
 7. That the bronzing of the skin and the browning of the 
 wooden cMlets are probably produced by rays reflected from 
 snow. 
 
 8. That various pigments, but chiefly those containing red 
 and yellow, stop or alter reflected luminous rays and prevent 
 the physiological and pathological changes usually due to 
 them. 
 
 9. That freckles, which are but the milder effects of 
 luminous rays, stop the penetration of those rays through 
 the skin. 
 
 10. That the sometimes very serious inflammatory changes 
 in sunburn and in what Mr. Hutchinson designates “summer 
 eruptions ” are due to the penetration of reflected luminous 
 or photo-chemical rays through the skin to the deeper tissues 
 beneath. 
 
 11. Photography often demonstrates the existence of freckles 
 and, report says, various eruptions deep in the skin which are 
 perfectly invisible to the naked eye, showing that the luminous 
 or photo-chemical rays are by them stopped or altered, and 
 not reflected back, as no change is produced on the negative 
 —an effect which suggests that these photogenic rays have 
 penetrating powers as yet unknown. 
 
 12. That the wood of Swiss clnllets is burnt perfectly black 
 (carbonised) on its surface by rays reflected from snow, 
 which rays in time penetrate deeply into the substance of 
 the wood and change it to a dark brown colour. 
 
 13. That the first effect of snow rays on a new chalet is 
 shown by its action on the resin of the wood, which “sweats 
 out ” and leads more easily to the charring of the woody fibre 
 itself and the subsequent changes in the deeper parts. 2 
 
 14. Captain Maude, R.E., has shown from his own personal 
 experiences and from experiments on many friends, that direct 
 solar rays in India produced sun fever of a very serious kind 
 which was entirely prevented by the wearing of an orange 
 lining to all his clothes and inside his hat. These experi¬ 
 ments demonstrate the penetrating power of light rays 
 through clothes unprotected by colour, and their important 
 influence on health. In relation to this, I have shown that 
 a lady wearing a linen blouse with red and white stripes was 
 strongly marked with red and white stripes on her shoulders, 
 but the red line on her skin corresponded to the white lines 
 of the linen, that is, the red stripes had completely stopped all 
 rays from affecting the skin beneath them. 
 
 15. I have often shown that rays reflected from certain sur¬ 
 faces such as water, gold and silver lace, white walls, white 
 veils, certain clouds and mists, act quite differently to direct 
 light, and that some physical change hitherto unexplained 
 must take place in light during or after reflection. 
 
 16 . In relation with the foregoing are those marvellous 
 changes in the vegetable kingdom connected with the forma¬ 
 tion of clilorophyl and the deposition of starch. 
 
 From these and many other observations I cannot help 
 feeling that Roentgen’s x rays will be shown to be modifica¬ 
 tions only of ordinary light, and that their further elucida¬ 
 tion must go hand in hand with a further inquiry into the 
 profound changes caused by reflection to which I have above 
 referred. It need not necessarily be assumed that what we 
 call darkness implies an absence of all the forms of light.—I 
 am, etc., 
 
 Upper Brook Street, W., Feb. 17th. Robert L. Bowles. 
 
 2 Professor Thompson shows now that resin is transparent to Roentgen 
 rays (British Medical Journal, February 8th, 1896). 
 
 Inebriates and a New Police Order.— It was stated, 
 during the hearing of a charge at Greenwich Police-court 
 recently, that an order had been issued from Scotland Yard 
 to the effect that if a drunk person was seen attempting to 
 enter a public-house, a constable seeing him was to prevent 
 the person’s entrance. If, however, the intoxicated indivi¬ 
 dual effected an entrance the constable must inform the land¬ 
 lord of the newcomer’s state. 
 
 ASSOCIATION INTELLIGENCE, 
 
 NOTICE OF QUARTERLY MEETINGS FOR 1896. 
 
 ELECTION OF MEMBERS. 
 
 Meetings of the Council will be held on April 15th, July 
 8th, and October 21st, 1896. Candidates for election 
 
 by the Council of the Association must send in their 
 forms of application to the General Secretary not later than 
 twenty-one days before each meeting—namely, March 26th, 
 June 18th, and October 1st, 1896. 
 
 Any qualified medical practitioner, not disqualified by any 
 by-law of the Association, who shall be recommended as 
 eligible by any three members, may be elected a member by 
 the Council or by any recognised Branch Council. 
 
 Candidates seeking election by a Branch Council should 
 apply to the Secretary of the Branch. No members can be 
 elected by a Branch Council unless their names have been 
 inserted in the circular summoning the meeting at which 
 they seek election. 
 
 Francis Fowke, General Secretary . 
 
 LIBRARY OF THE BRITISH MEDICAL 
 ASSOCIATION. 
 
 Members are reminded that the Library and Writing Rooms 
 of the Association are fitted up for the accommodation of the 
 members in commodious apartments, at the offices of the 
 Association, 429, Strand. The rooms are open from ioa.m. to 
 5 p.m., Saturdays, 10 a.m. to 2 p.m. Members can have their 
 letters addressed to them at the Office. 
 
 BRANCH MEETINGS TO BE HELD. 
 
 South-Eastern Branch . East and West Sussex Districts.—A con¬ 
 joint meeting of members of the above Districts will be held at the Grand 
 Hotel, Brighton, on Tuesday, March 24th, at 3.30 p.m. Dr. A. J. Richard¬ 
 son will preside. The following communications have been promised :— 
 Dr. Eustace (Arundel) : The Treatment of Cancer by Drugs. Mr. T. J. 
 Verrall: Appendicitis—a Plea for Operating Early. Dr. Hinds (Worth¬ 
 ing): Notes of a Case of Ruptured Heart. Dr. Batterliam: A Case of 
 Cerebral Thrombosis. Dinner at 5.30; charge 6s., exclusive of wine.— 
 F. Hinds, M.D. (14, The Steyne, Worthing), J. W. Batteriiam, M.B. (Grand 
 Parade, St. Leonards), Honorary Secretaries. 
 
 South-Eastern Branch : East Kent District.— The next meeting of 
 this District will be held at Dover on March 19th; Dr. Welsford in the 
 chair. AgendaMr. R. II. Clarke : Copper Poisoning by Siphon Con¬ 
 tamination. Dr. Percy Lewis : The Rational Treatment of Scoliosis. Mr. 
 S. Wacher : Nasal Obstruction.— Thomas F. Raven, Honorary Secretary, 
 Broadstairs. 
 
 South-Eastern Branch : West Kent District. —A meeting of this 
 District will be held at the Asylum, Banning Heath, Maidstone, on 
 Friday, March 13th, at 4 p.m.. Dr. F. Pritchard Davies in the chair. The 
 dinner will take place at the Mitre Hotel, Maidstone, at 6.30 p.m. Charge 
 6s. 6d., exclusive of wine. All members of the SoutlnEastern Branch are 
 entitled to attend this meeting, and to introduce professional friends. 
 Gentlemen who reside at a distance, and wish to attend the meeting, are 
 requested to communicate with the Hon. Sec. on or before Wednesday, 
 March nth, in order that arrangements may be made for conveying them 
 to the Asylum. The Chairman will give an address on General Paralysis, 
 illustrated by cases in the wards.— Edward Ground, M.D., Honorary 
 Secretary, 1, Ashford Road, Maidstone. 
 
 South-Eastern Branch : East Surrey: District.— The next meeting 
 of the above District will be held at the Queen's Hotel, Upper Norwood, 
 on Thursday, March 12th, at 4 P.M., J. H. Galton, M.D., of UpperNonvood, 
 in the chair. Dinner at 6 p.m. ; charge 7s., exclusive of wine. All mem¬ 
 bers of the South-Eastern Branch are entitled to attend, and to intro¬ 
 duce professional friends. Nominations for representatives on the Coun¬ 
 cil of the Association will be received. Papers : Dr. Pye-Smith : The 
 Local Distribution of Diseases as an Aid in their Diagnosis. Mr. J. Bland 
 Sutton: On Wandering Spleens. Mr. A. H. Tubby: Some Painful Affec¬ 
 tions of the Foot. Members desirous of exhibiting specimens or reading 
 notes of cases are invited to communicate at once witli the Honorary 
 Secretary, Henry J. Prangley, Tudor House, Anerley. 
 
 Yorkshire Branch.— The next meeting of the Branch will be held at 
 Huddersfield, on. Wednesday.March 18th, at 3.45 p.m. Members intending 
 to read papers or to propose members of the Association as members of 
 the Branch, are requested to communicate at once with -the Secretary.— 
 Adolph Bronner, Honorary Secretary (pro. tem.), 35, Manor, Row, Brad¬ 
 ford. 
 
March 14, 1896.] 
 
 THE NEW PHOTOGRAPHY. 
 
 
 Skiagram of a case of tuberculous disease in the hand of a child ; there is extensive disease in the phalanx of the forefinger. This skiagram illus¬ 
 trates very well the possibilities the new method holds out of localising with great exactness the position and extent of necrotic areas in bone. 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shutcr Scholar of St. Bartholomew’s Hospital. 
 
 YI. 
 
 Working with the new form of tube described last week, I 
 have to record several cases which, although too late for the 
 reproduction of the skiagram, show very clearly how the new 
 process is becoming a definite instrument of diagnosis, and 
 how the deeper structures of the body are fast yielding to its 
 penetrating influence. 
 
 The cases are as follows : 
 
 Foreign Bodies in the Larynx. 
 
 By the kindness of Mr. Waggett I have again had the 
 opportunity of attempting the skiagraphy of foreign bodies 
 in the larynx. Mr. Waggett himself again sat for experi¬ 
 ment. A French nail and a fish bone were attached by plaster 
 to the side of the neck, in the exact projected position of the 
 ventricle. Exposure was made for six minutes, and both the 
 nail and fish bone showed clearly in the plate, thus demon¬ 
 strating conclusively the possibility of discovering foreign 
 bodies impacted in this region. The rest of the structure 
 of the neck showed very faintly or not at all, with the excep¬ 
 tion of the vertebral column and the hyoid bone. Being 
 mostly cartilaginous, they are very transparent to the x 
 rays. For the practical working of the method it will be 
 necessary, therefore, to draw up a projected chart of the 
 region so as to localise with greater exactitude the actual 
 position of anybody. I am at work on such a chart, and 
 hope to have it ready shortly. 
 
 Skiagraphy as an Aid to the Diagnosis of Lesions of the 
 Elbow, especially of an Epiphysial Nature. 
 
 1 have had several cases of diseased and deformed elbow to 
 investigate, and in every case a diagnosis was arrived at v ith 
 
 certainty. The method is especially useful for epiphysial 
 lesions and obscure dislocations. It lias not been found pos¬ 
 sible to give the cases in detail this week, but it is hoped to 
 do so next, together with the skiagraphs. 
 
 Case of Impacted Gall Stones. 
 
 By the kindness of Mr. F. C. Abbott, Resident Surgeon at 
 St. Thomas’s Hospital, I have had the opportunity of investi¬ 
 gating and experimenting upon some cases of great difficulty. 
 In one of these the diagnosis rested between malignant cystic 
 disease and a mass of impacted gall stones. The skiagraph 
 showed clearly the outlines of the ribs, so it is certain that 
 the rays had penetrated the thickness of the body, the 
 greatest, thickness as yet recorded. No evidence of any 
 opaque body was, however, to be seen on the plate. 
 Of course it is not possible to say as yet with any 
 certainty that there were no gall stones present, as this 
 is the first case of the kind I have tried. It is, however, of 
 great interest, as showing that it is possible to get the x rays 
 to pass through the entire thickness of the body, a result 
 hitherto not attained as far as I am aware. 
 
 Sarcoma of Tibia. 
 
 Mr. F. C. Abbott also very kindly placed at my disposal 
 a case of sarcoma of tibia, about which there was some doubt. 
 The skiagraph showed most clearly that the bone was itself 
 expanded, and that the tumour did not spring from the 
 side. 
 
 These cases show very clearly that the new method is. 
 capable of far greater application than has hitherto been 
 thought possible. 
 
 Some Practical Applications. 
 
 Mr. J. Lawson Russell, M.B., C.M.Edin. (Todmorden) sends 
 us some illustrations of the practical use of the x rays in 
 surgery. In the first case a skiagram was taken of the hand 
 of a lady who, when 11 years of age, had a needle run into 
 her wrist. The skiagram shows the point of the needle lying 
 at the base of the metacarpal bone of the little finger. The 
 lady is now upwards of 40. In the second case a gentleman 
 
6S4 
 
 The British "j 
 Medical Journal] 
 
 DIPHTHERIA AND THE ANTITOXIN TREATMENT. 
 
 [March 14, 1896. 
 
 received an injury of the hand by the smashing of a glass 
 bottle two or three years ago. It was thought from the pain 
 lie had suffered that there must be a fragment of glass in or 
 about the joint of the middle finger, but our skiagram shows 
 no glass; the pain is therefore likely to be due to a small 
 nerve implicated in the cicatrix. The third case is an ex¬ 
 ample of tuberculous disease of the bones of the forefinger, 
 under the care of Dr. Smithwaite Black, of Burnley. Dr. 
 Russell adds that within the past fortnight he has succeeded 
 in locating a bullet in the hand of a patient of Dr. Mantle, of 
 Halifax ; and in the case of a patient sent by Dr. Stewart, of 
 Batley, succeeded in finding a foreign body (fragment of 
 rusty wire) deeply situated in the wrist. He lias been aided 
 in the above work by a local firm of photographers, Messrs. 
 Lord and Brims. 
 
 DIPHTHERIA AND THE ANTITOXIN 
 TREATMENT. 
 
 (Continued from page U 16 .) 
 
 XIV. — William Arnold, M.R.C.S. (Crawley, Sussex).* 
 
 One case; Tracheotomy refused; Death. —The patient was a boy 
 
 aged 3J, who had been ailing four or five days before being 
 seen. The tonsils and soft palate were then covered with 
 membrane, the temperature was ioo°, the pulse 120, and the 
 breathing stridulous. Ten c.cm. of serum (Allen and Hanburys) 
 were injected; at night the temperature being 102°, the pulse 
 140, and the breathing unchanged, 10 c.cm. were again in¬ 
 jected. Next morning the breathing became more stridulous, 
 but the parents refused tracheotomy, and the child died at 
 midday. A slight trace of albumen was present, but no rash; 
 5 minims of tinct. ferri perehlor., and 2 gr. of pot. chlor. were 
 given every 2 hours. No membrane could be obtained, and a 
 post-mortem examination was refused. Mr. Arnold remarks 
 that the case was far advanced when he was called in, and 
 that the child never seemed to rally, but became gradually 
 worse. 
 
 XV. —P. Barnett-Bentltf, M.R.C.S., L.S.A., Honorary 
 
 Surgeon, Jersey Infirmary and Dispensary. * 1 * 
 
 Ten Cases: Three Deaths. —1. The patient was a girl, aged 
 2 years, who had been “ poorly ” for some days, and was suf¬ 
 fering from cough with slight fever. On examination the tem¬ 
 perature was found to be ioi°, the pulse 100, and the respira¬ 
 tions 20. There was nothing abnormal in the chest or throat, 
 but the bowels were confined and the tongue furred. Calo¬ 
 mel and a saline were ordered, but next day the child was 
 much worse, the breathing being noisy, stridulous, and 
 greatly obstructed. There was loss of voice, and the glands 
 at the angle of the jaw were enlarged and painful. The tem¬ 
 perature was ioi°, the respirations 40, and the pulse 160; 
 nothing could be seen in the throat. Laryngeal diphtheria 
 was diagnosed, and 10 c.cm. antitoxin were injected. There 
 was slight albuminuria. The child sank and died next morn¬ 
 ing of exhaustion. 
 
 11. The patient, a boy of 6, had been ailing for several 
 days, and was supposed to be suffering from a bad attack of 
 bronchitis. When seen the breathing was noisy and stridu¬ 
 lous, the glands at the angle of the jaw were large and pain¬ 
 ful, and there was great retraction of the intercostal spaces 
 and episternal notch. The temperature was ioi°, the pulse 
 160, and the respirations 60. The child was aphonic, and 
 practically moribund. There was a large membranous patch 
 on each tonsil and the back of the pharynx. As a forlorn 
 hope 15 c.cm. of antitoxin were injected, but the child never 
 rallied and died a few hours later. 
 
 hi. The patient was a child, aged 2, who complained of 
 pain in the throat. Examination showed patches of mem¬ 
 brane on each tonsil; the glands at the angle of the jaw 
 were large and painful. The temperature was 101.4 0 , the 
 pulse 120, and the respirations 35. The urine was not albu¬ 
 minous. Ten c.cm. of antitoxin were injected at once and 
 repeated next morning, when the child was no better. The 
 next day there was marked improvement, and the patches 
 on the tonsils were much smaller. From this time the child 
 rapidly gained strength ; five days after the first injection the 
 
 * Reports kindly forwarded by tlie Director of the British Institute of 
 Preventive Medicine. 
 
 1 See also British Medical Journal, January 18th, 1896, p. 156. 
 
 membrane had completely disappeared, and three days later 
 the patient was convalescent. 
 
 iv. The patient was a boy of 6, who had been ailing for 
 some days, and who was moribund when first seen. There 
 was great dyspnoea, with retraction of the lower part of the 
 chest. The temperature was 102°, respirations 50, and the 
 pulse uncountable. A large patch of membrane was seen on 
 each tonsil and at the back of the pharynx. Fifteen c.cm. of 
 antitoxin were injected, but the child died in six hours. 
 
 v. The patient was a boy aged 6, who had been suffering 
 from a “ cold ” for some days, and whose parents sent for the 
 doctor because he was “ nearly choked.” The breathing was 
 very stridulous ; there was a large membranous patch on the 
 right tonsil and the back of the pharynx, and the glands at 
 the angle of the jaw were enlarged and tender. The voice 
 was lost, the temperature ioi°, the pulse 150, and the respira¬ 
 tions 50. Poultices were applied to the throat, a steam spray 
 ordered, and 15 c.cm. of antitoxin injected. Next day the 
 patient was about the same ; the temperature was 101.2 0 , the 
 pulse 130, and the respirations 40; 10 c.cm. antitoxin were 
 again injected. The following day the child was much better 
 and the exudation less ; the temperature was 99.8°, the pulse 
 100, and the respirations 30. The urine was slightly albu- 
 binous. Tinct. ferri perehlor. inx was ordered every four 
 hours. Two days later the membrane had completely dis- 
 appeared, and on the ninth day from the first injection the 
 boy was convalescent. 
 
 vi. The patient was a child aged 3, who had not been well 
 for several days. When seen the throat felt sore, both ton¬ 
 sils were enlarged, and on the right was a patch of mem¬ 
 brane ; the temperature was 102°, the pulse 120, and the 
 respirations 30. There was complete aphonia with anorexia 
 and general malaise; 10 c.cm. of antitoxin were injected. 
 During the night patient was restless and “ choky” ; next 
 day the condition was about the same, and 10 c.cm. of anti¬ 
 toxin were injected. The following day the exudation had 
 markedly diminished ; the temperature was 99.8°, the pulse 
 100,'and the respirations 20; the urine was slightly albu¬ 
 minous. Twenty-four hours later the membrane had entirely 
 disappeared, and on the seventh day of treatment con¬ 
 valescence was established. 
 
 vii. The patient was aged 6 and brother to Case 1. When 
 seen he complained of sore throat, and had been ailing for 
 some days. There was a large patch of membrane on the 
 right tonsil and a small one on the left. The temperature 
 was ioi°, the pulse 120, and the respirations 35; 8 c.cm. of 
 antitoxin were injected. The next day the boy was better 
 and the exudation only half its former size. The urine was 
 slightly albuminous, the temperature ioo°, the pulse 98, and 
 the respirations 20. On the following day the membrane 
 had disappeared and the patient was convalescent on the 
 sixth day. 
 
 viii. The patient, a child aged 3, had not been well for some 
 days, and was suffering from complete aphonia and anorexia. 
 The temperature was ioi°, the pulse 130, and the respira¬ 
 tions 40. There was a membranous exudation on both ton¬ 
 sils and the back of the pharynx, with great dyspnoea and 
 retraction of the lower intercostal spaces and episternal 
 notch. The urine was slightly albuminous ; 10 c.cm. of anti¬ 
 toxin were injected. Next day the patient was much the 
 same, the temperature was ioi°, the pulse 130, and the 
 respirations 35 and stridulous; 10 c.cm. of antitoxin were 
 injected. The following day the general condition was better, 
 but there was still aphonia; poultices and good light food 
 were ordered. Next day the tonsils were less covered, and 
 food was better taken. Six days after treatment was com¬ 
 menced the exudation had disappeared, and three days later 
 the patient was convalescent. 
 
 ix. A sister of Case viii, had been ailing for several days, 
 and on examination was found to have a patch of membrane 
 on the right tonsil. The temperature was ioi°; 10 c.cm. 
 of antitoxin were injected. Next day she was much better, 
 and the membrane had almost disappeared ; there was slight 
 albuminuria. A day later the membrane had disappeared, 
 and next day she was convalescent. 
 
 x. A sister of Case 11, had had a “cold” for some days. 
 The temperature was ioo°, the respirations 50, and the pulse 
 130. The breathing was stridulous, with great retraction of 
 the lower part of the chest and patches of membrane on both 
 
Makch 21, 1896.] 
 
 THE BABY-FARMING SYSTEM. 
 
 I" The British 
 L Medical Journal 
 
 REPORT ON THE BABY-FARMING SYSTEM AND 
 ITS EVILS. 
 
 [Special Report to the British Medical Journal.] 
 
 ^ •—The Infant Life Protection Act in the Provinces. 
 In a previous article a full description was given of the work¬ 
 ing of the Infant Life Protection Act in London under the 
 Public Control Department of the County Council. It is 
 proposed now to deal with the administration of the Act in 
 the provinces. We are indebted to the chief constables of 
 the large towns in England for information on the following 
 points : (1) The number of licensed houses under the Act in 
 the district; (2) the system of inspection carried out; (3) the 
 known cases of evasion of the Act; (4) the defects in the Act 
 as proved by local experience of it. In all, twenty-nine chief 
 constables supplied the information asked for either partially 
 or in full, and we are glad to take this opportunity of acknow¬ 
 ledging our indebtedness to them. 
 
 While prosecuting inquiries for the purposes of this report 
 upon the baby-farming system, the assertion was made to us 
 that the Infant Life Protection Act was practically inopera¬ 
 tive out of London; that baby farms existed, independently of 
 the Act, to the number of 600 in the English provinces ; and 
 that the Act in its present form was powerless to prevent the 
 evils the suppression of which it has been designed to achieve. 
 The extent to which the truth of these statements is borne 
 out by the inquiry just held will be gathered from what 
 fohows. 
 
 Paucity of Registered Houses. 
 
 Among the twenty-nine towns—and this is inclusive of one 
 Scotch centre, namely, Edinburgh—the evidence shows that 
 only 2 houses are registered under the Act; that is to say, 
 that out of London the Act is operative in respect to the 
 registration of baby-farms in only two instances—there is one 
 registered house in Manchester and one in Bath. 
 
 Surprise was expressed in a previous article that there 
 should be only 38 houses registered in London. But it will 
 be admitted that this revelation in respect to the absence 
 of registered houses in the provinces is still more sur¬ 
 prising. It seems difficult to realise that in the towns in 
 question the Act is not enforced on the grounds that no 
 necessity for its administration exists. 
 
 Illegitimate Births. 
 
 In reflecting upon this matter, let attention be directed to 
 the number of illegitimate births in these large centres of 
 population. Excluding Manchester and Bath, the number 
 of illegitimate children born in the year 1894 in twenty-seven 
 of the large towns in England was approximately 5,000. To 
 this large total the Infant Life Protection Act has been shown 
 not to apply; practically, therefore, although the Act was 
 mainly expected to benefit the outcast offspring of illicit 
 intercourse, this inquiry emphatically demonstrates that, so 
 far as these children are concerned, the Act might never have 
 been passed. In the year 1894 the total number of children 
 registered as born out of wedlock in the metropolis was 4,934. 
 The returns for the same period of the number of infants' 
 under 1 year is 121 in registered and 275 in unregistered 
 houses. 
 
 For argument’s sake, let it be assumed that each child of 
 this number was illegitimate; the conclusion then is that the 
 circumstances of only 396 out of 4,934 illegitimate children in 
 the year 1894 became known to the inspectors under the 
 Infant Life Protection Acts, or not more than 8-J per cent. 
 The evidence of the inspectors, however, is to the'effect that 
 many houses—baby farms—exist in London of which they 
 have no direct knowledge. The Act, perhaps, may be com¬ 
 plied with, so far as the baby-farmer refrains from taking 
 more than one infant under 1 year; but, on the other hand, 
 it is practically certain that by means of the faulty clause 
 relating to the age of the children, and the concession as to 
 one child, in the present Act, many women are enabled to 
 carry on the business of baby farming without the knowledge 
 of the authorities, and without fear of molestation. In view 
 of these facts concerning London, it seems only reason¬ 
 able to conclude that a similar state of things may pre¬ 
 vail elsewhere. Must it be held that large towns such as 
 Birmingham, Leeds, Liverpool, Bradford, and other centres 
 in which no licensed houses under the Act exist, differ from 
 
 London in respect to the care and culture of their population 
 of illegitimate children ? In this connection, perhaps, valu¬ 
 able information might be obtainable were an inquiry to be 
 made respecting the mortality among the illegitimate 
 children under 5 years of age, say, for the last decade in all 
 the large towns in England in which no registered houses 
 exist. 
 
 Absence of Systematic Inspection. 
 
 The next point to which attention may be directed has re¬ 
 ference to the second query addressed to the chief constables 
 —namely, the system of inspection carried out. The majority 
 of the replies made no mention of this matter. In one the 
 answer was, “In strict conformity with the Acts of Parlia¬ 
 ment ; ” in others the word “Nil” supplied the information asked 
 for, and in two instances it was pointed out that the Society 
 for the Prevention of Cruelty to Children had an inspector 
 stationed in the town to whom the police looked to receive a 
 report in any case of contravention of the Act. Thus it would 
 appear that no systematic inspection is resorted to by the 
 police—that is to say, that no officials, as in London, are 
 especially made responsible for the inquiries respecting the 
 administration of the Infant Life Protection Act in the dis¬ 
 tricts. So far as the two registered houses are concerned, no 
 information was given with regard to the inspection carried 
 out in one, while in the other it was stated that the house 
 was visited by an inspector of police. 
 
 Evasion of the Act. 
 
 The replies received to the third query addressed to the 
 chief constables—namely, that referring to the cases of eva¬ 
 sion of the Act—was also in the main negative. In all direct 
 answers were received from eleven, and all save two were to 
 the effect that no instance of evasion of the Act had come 
 under notice. In the two cases mentioned it was stated that 
 the persons concerned discontinued their offence as soon as 
 the matter was pointed out to them. 
 
 Defects in the Act. 
 
 The last point to be dealt with in this connection concerns 
 the opinion of the chief constables upon the question of the 
 defects in the Act, as proved by their experience of it. In 
 nineteen of the replies no mention was made to the subject. 
 In three the answer was “ nil,” in one the opinion expressed 
 was ‘ ‘ as proved by my experience of it the Act is satisfactory ” • 
 in another, “ I have experienced no defects in the Act ” ; in 
 another, “The provisions of the Act (35 and 36 Vic., c.’38) 
 meet the requirements of my jurisdiction”; in a fourth, “I 
 cannot give any practical opinion on the working of the Act ” 
 In a fifth the answer was, “ The police keep a strict look-out 
 on all places of entertainment, etc., where the Act is likely to 
 be infringed, and I know of no case where the law has been 
 evaded in this borough since the Act came in force, 
 and I have, therefore, not experienced any defects in this 
 Act.” 
 
 Uselessness of the Act. 
 
 In reflecting generally upon the replies to the series of 
 questions above submitted, the conclusion is unavoidable that 
 the Infant Life Protection Act in its present form is, in the 
 provinces, clearly useless for the purpose of effecting its 
 objects. In Leeds, for example, the population was 222,154 
 m 1891; and in 1894 the births thereof 435 illegitimate children 
 were registered. But the report of the chief constable is to 
 the effect that in this large community no baby-farming is 
 practised. He further states that some years ago the matter 
 of the Infant Life Protection Act was taken in hand, but it 
 was found that there was little or nothing to supervise or 
 register, and thus the inquiry was comparatively dropped 
 The testimony also of the medical officer of health is to the 
 effect “ that it would appear that there is really nothing in 
 Leeds to register.” But with Leeds, as with other towns 
 throughout England, inclusive of the metropolis, the question 
 cannot be ignored—what becomes of the large number 
 of illegitimate children if they are not provided for in 
 baby-farms ? This is really so important a matter that 
 one would suggest to the chief constables of all the 
 large towns in England that they should depute an 
 officer or officers specially to inquire into the existence of the 
 houses in their districts in which children are taken for 
 
74 S 
 
 THE NEW PHOTOGRAPHY. 
 
 [March 21, 1896. 
 
 The 
 
 British 
 
 1 
 
 hire. Many such houses must exist, in the provinces 
 unknown to the police. The proprietors of them in all proba¬ 
 bility are careful to keep within the letter of the law, but the 
 fact nevertheless appears to be indisputable that the police 
 in the provinces have but little knowledge of the Infant Life 
 Protection Act, inasmuch as it fails to accomplish its objects. 
 It might be well that the Legislature should call for a return 
 from all the large towns in the kingdom, showing as nearly 
 as possible the number of unregistered houses to which the 
 present Act does not apply. If full details were forthcoming 
 in this particular, including the number of the children re¬ 
 ceived, their ages and the rate of mortality, the data would 
 undeniably be of use in showing how far the need for some 
 change in the Act was urgent as would appear to be the 
 case. 
 
 Administration op the Act in Edinburgh. 
 
 A few words may now be added respecting the administra¬ 
 tion of the Infant Life Protection Act in Edinburgh. Accord¬ 
 ing to the chief constable’s report, there are no licensed 
 houses under the Act in the city. Persistent and regular 
 steps are taken by the police to ascertain whether the Act is 
 evaded ; but we are informed that these steps are not of such 
 a kind as to make it desirable that they should be published. 
 Again the chief constable states that no cases of evasion are 
 known to him, but there are numerous cases in which several 
 children have been adopted by the same person, although no 
 cases are known in which the adoption of a child under 12 
 months of age has taken place until the others have passed 
 that age. Thus it may be gathered from these replies that a 
 good deal of care is exercised in administering the Act in 
 Edinburgh so far as its limited provisions will allow. The 
 further opinion is added : “ It seems to me that the Act should 
 be amended so as to embrace all persons who ‘adopt’ more 
 than one child, irrespective of the age of the children.” It is 
 curious to note that of all the replies received from the chief 
 constables, this wars the only one which contained any criti¬ 
 cism upon the working of the Act. 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shuter Scholar of St. Bartholomew’s Hospital. 
 
 VII. 
 
 It seems as if for the present the new process had reached 
 another stationary stage. The introduction of the focus 
 tube caused an immense advance—from the hand to the 
 limbs and joints—and now we must await the next stage— 
 the skiagraphy of the trunk. Such an advance, to be of 
 practical use, can be made in two directions—either by 
 increasing the power of the tube or by rendering the plates 
 more sensitive. Although with the methods at present in 
 use it is just possible to get through the entire body, yet 
 such a result is too uncertain and takes too long a time at 
 present to be of much practical use in diagnosis. 
 
 Conversion of Light Waves into ,r Waves. 
 
 The most interesting record of the week is the fact that it 
 has been found possible to convert light rays into x rays. 
 
 M. Troost has stated to the Paris Academie des Sciences 
 that the blende hexac/onale artificielle, or hexagonal zinc 
 sulphur, can replace Crookes’s tubes used by Roentgen. The 
 artificial “ blende” thatM. Troost and M. HenriSainte-Claire 
 Deville obtained in 1861, having the form of hexagonal prisms, 
 is transparent, either colourless or faintly yellow, and is cap¬ 
 able of becoming phosphorescent under the influence of the 
 sun. These crystals, placed in a cardboard box, M. Troost 
 has substituted for Crookes’s tube with success. A number of 
 photographs were submitted to the examination of the mem¬ 
 bers of the Aeaddmie des Sciences. This method is more 
 easily applied in clinical observations. It is inexpensive, 
 and when the apparatus is fixed on the region to be photo¬ 
 graphed, covered with a sheet of black paper, the patient can 
 move about. M. Lannelongue has obtained from Professor 
 
 Troost further details of the manner of preparing the crystals 
 as described at length at the time, T. 11, p. 983, of the 
 Comptes Hendus de VAcademie des Sciences. 
 
 The New Tube. 
 
 Fig. 1 shows a section of the “focus” tube. The kathode 
 plate k, is a concave disc of aluminium, which focuses the 
 
 kathode rays at a point near the centre of the bulb. The 
 anode plate, a, is a small piece of platinum foil placed at an 
 angle a short distance beyond the focus of the kathode rays. 
 Curiously enough, the cathode rays do not cross like rays 
 of light at the focal point, but behave rather like a number of 
 fluid jets coalescing at the focal point, and proceeding thence 
 onwards as a solid parallel jet. The point where the rays 
 impinge on the platinum still retains its small dimensions, 
 though the plate is placed some distance beyond the focal 
 point. 
 
 Platinum is known to be one of the most opaque substances 
 for the kathode rays, and thus very little of the radiation 
 passes through the platinum foil. The greatest part of the 
 radiation is absorbed by the platinum, and given out as x rays 
 from the luminous point by a kind of diffuse reflection. The 
 anode plate, a, being set at an angle, the best part of the 
 radiation is directed downwards through the sides of the 
 bulb, where it can be conveniently utilised to produce the 
 photograph in the usual way. The tube, h, through which 
 the bulb is exhausted, is shaped so as to permit the tube to 
 be fixed in a stand at the required height. The anode and 
 kathode plates are connected to the terminals of the induction 
 coil by platinum wire fused through the glass. 
 
 Progress in England. 
 
 Accounts continue to come in of the successful application 
 of the method by practitioners in this country. They are too 
 numerous to mention in full, but show the extent to which 
 the adoption of the process has already gone, and the advan¬ 
 tages to be gained from its use. 
 
 The Cryptoscope. 
 
 So much difficulty has been experienced in making the 
 fluorescent screens for this instrument that as yet it is not 
 capable of practical use. There is great difficulty, too, in 
 maintaining them in working order, and when once prepared 
 they do not last. Until these difficulties are overcome the 
 instrument cannot be of any practical use. It is confidently 
 hoped, however, that before long this most useful of the 
 applications of Professor Roentgen’s discovery will be in a 
 condition fit for practical use. 
 
 SKIAGRAPHY IN DETERMINING THE POSITION OF 
 FOREIGN BODIES IN THE LARYNX. 
 
 The laryngologist is not infrequently called upon to give an 
 opinion as to the presence or absence in the pharynx or larynx 
 of a foreign body which has undoubtedly passed beyond the 
 fauces. His examination is usually rendered difficult on 
 account of the nervous state of the patient, abnormal sensi¬ 
 bility of the parts, and excessive secretion of mucus, while his 
 knowledge of the fact that a scratch or abrasion may give rise 
 to misleading subjective impressions often renders a decided 
 opinion impossible. At a later stage, when acute symptoms 
 have subsided, a foreign body embedded in the soft tissues 
 
March 21, 1896.J 
 
 THE NEW PHOTOGRAPHY. 
 
 [ The British 
 Medical Journal 
 
 may easily escape detection, and many instances have occurred 
 in which, after repeated examination with the mirror, finger, 
 or pi'obang, the offending body has been unexpectedly ex¬ 
 pelled after a long interval. It is obvious that in doubt¬ 
 ful cases—doubtful as to position as well as actual pre¬ 
 sence—the skiagraph and the cryptoscope should be of the 
 greatest service. Thanks to the kindness of Mr. Rowland I 
 have been able to show that the x rays are capable, as was to 
 be expected, of penetrating the soft tissues of the neck and 
 the cartilages of the larynx, and of casting a clear shadow of 
 substances relatively opaque to these rays. With an exposure 
 of four minutes a distinct picture was obtained of a small iron 
 nail attached externally by means of strapping, the throat 
 being presented in profile. 
 
 The outline of a fish-bone also was faintly indicated, and it 
 seems not unlikely that after experiments with various ex¬ 
 posures, those suitable for the particular substances of which 
 foreign bodies in the throat are usually formed, may be 
 determined. As suggested by Dr. Felix Semon it is not 
 impossible that with short exposures the limits of a laryngeal 
 neoplasm may be defined, and finally it seems more than 
 likely that the cryptoscope may be found to excel the skiagraph 
 as a diagnostic agent, and even prove an aid during intra- 
 laryngeal operation. 
 
 During the last few days considerable improvement has 
 been made in the technical details of the apparatus, and I 
 hope before long to be in a position to record, in conjunction 
 with Mr. Rowland, what will be of practical interest to the 
 laryngologist. 
 
 Park Street, W. Ernest WAGGETT. 
 
 THE DETECTION OF NEEDLES IN THE EXTREMI¬ 
 TIES. NEEDLE IN HAND: REMOVAL. 
 
 The patient, a girl, aged 16, ran part of a needle into her 
 right hand on May 12th, 1894. The point of entrance was on 
 the outer side of the thenar eminence just below the first 
 carpo-metacarpal joint, and the direction downwards and 
 inwards. She had had pain in the palm of the hand ever 
 since, and had been under treatment for this at various 
 times, but the presence of the needle could never be demon¬ 
 strated. She was first seen by me on February 25th ; she had 
 then been attending at the hospital for some weeks on 
 account of the pain indefinitely referred to the centre of the 
 palm ; for this various anodynes had been applied. Neither 
 by palpation nor by elicitation of pain could the presence of 
 a needle be detected. A skiagraph was taken the same day 
 by Professor Poynting, of Mason College, with an exposure 
 of ten minutes with half-minute intervals, and the needle 
 was seen lying obliquely in the second metacarpal interspace, 
 one extremity apparently sticking into the periosteal tissues of 
 the middle metacarpal bone, which in a second plate seemed 
 slightly thickened at this point. Even now when the exact 
 position was known the presence of the needle could not be 
 detected by manipulation. On February 27th an incision was 
 made on the dorsum of the hand between the second and 
 third metacarpal bones, the interosseous muscles were sepa¬ 
 rated, and a piece of needle an inch long was extracted, the 
 eye of the needle being fixed in the periosteal tissues on the 
 palmar side of the mid-metacarpal bone. The wound 
 healed by first intention, and in a few days the hand was all 
 right. 
 
 This case is an excellent illustration of the surgical use of 
 skiagraphy. Without it the needle could not possibly have 
 been removed, and the pain and disablement would have 
 been permanent. 
 
 F. Marsh, F.R.C.S., 
 
 Surgeon to the Queen's Hospital, Birmingham. 
 
 NEEDLE IN HAND: REMOVAL. 
 
 Mrs. E. B. came to the Queen’s Hospital, Birmingham, on 
 February 14th for the purpose of having a needle removed 
 from her hand. Whilst scouring the floor a fortnight previ¬ 
 ously she ran a broken needle into her hand, and, although 
 she attended at the hospital at the time, no signs of the 
 needle could be detected except the entrance puncture on 
 the ulnar border of the hand, about one inch above the little 
 finger. On February 13th Dr. Hall-Edwards obtained a skia¬ 
 gram of the hand, which he kindly sent me as a guide. The 
 position of the fragment of needle was clearly indicated, and 
 
 it corresponded with the line of the superficial palmar arch. 
 A small incision was made in the palm a short distance 
 below (erect position) the line indicated, in order to avoid 
 wounding the arch, and through the incision sinus forceps 
 were inserted and passed backwards and upwards, beneath 
 the palmar fascia and flexor tendons, when the needle was 
 readily detected lying in close contact with the metacarpal 
 bones, exactly in the position indicated by the skiagram. 
 With a little manipulation the fragment was seized at the 
 one end and withdrawn through the incision. The fragment 
 measured one inch, and the remaining portion was found in 
 the scouring cloth. 
 
 J. Hazelwood Clayton, 
 
 Casualty Surgeon, Queen’s Hospital, Birmingham. 
 
 EFFECTS OF A LESION OF A PHALANGEAL JOINT. 
 The photograph shows the fore, middle, and ring fingers of 
 the right hand of a boy, aged 16. When 8 years old an injury 
 was inflicted on the terminal joint of the middle finger. At 
 the present time the terminal phalanx cannot be voluntarily 
 
 1 
 
 4th 3rd. 2nd. 
 
 moved by the muscles acting on the finger. There is no- 
 osseous ankylosis. The phalanx can be flexed and extended 
 mechanically. The exposure given was six minutes. The 
 print is reversed as shown by the numbers on the print. 
 
 Charles A. Kohn, Ph.D., B.Sc. 
 
 University College, Liverpool. 
 
 The following points in the above case are clearly demon¬ 
 strated by the photograph : 
 
 1. The middle finger has a normal proportion in length, as 
 compared with the fore and ring fingers. 
 
 2. The length of the second phalanx of the middle finger is 
 disproportionately increased. 
 
 3. The terminal phalanx of the middle finger is dispro¬ 
 portionately short and broad. 
 
 4. The interval between the second and terminal phalanges- 
 of the middle finger is very much less than in the fore and) 
 ring fingers. 
 
 The case is of peculiar interest as showing: (1) The way in 
 which a compensating elongation has occurred in the second! 
 phalanx by growth at its epiphysial end so as to bring the 
 
75 ° 
 
 The British “I 
 Medical Journal] 
 
 FACTORY LEGISLATION. 
 
 [March 21, 1896. 
 
 middle finger to its normal length. (2) The result of the 
 injury to the last phalangeal joint, including the absence of 
 epiphysial growth, and an (apparently) excessive circum¬ 
 ferential, periosteal, bone formation. 
 
 A. M. Paterson, M.D., 
 
 University College, Liverpool. Professor of Anatomy. 
 
 AN EXAMPLE OF THE VALUE OF THE NEW 
 METHOD IN DIAGNOSIS. 
 
 A woman consulted Dr. James Adam, of Hamilton, some time 
 ago with the following history : Four years ago a needle 
 passed into the tissues near the wrist-joint, but no great in¬ 
 convenience was experienced until one year ago, when the 
 middle finger began to swell at the point and apparently 
 without any cause. This increased until there was stiffness 
 of the ultimate joint of the finger ; then pain and tenderness 
 began to be felt particularly at a spot on the side of the finger 
 on the palmar aspect and near the nail. The patient was 
 under the impression that the needle was there, and came 
 seeking relief. Dr. Adam sent the case to Dr. Macintyre, who 
 photographed the hand, but found no needle in it, although 
 there was distinct evidence of irritation of the ultimate 
 phalanx. Dr. Adam and Dr. Macintyre were cpiite of opinion 
 that it was periostitis from a totally different although un¬ 
 known source. A second photograph was taken of the fore¬ 
 arm, when a distinct image of the needle was got about an 
 inch and a-lialf above and to the inside of the styloid process 
 of the ulna. 
 
 The interesting point in this case, of course, is the difficulty 
 which would have been experienced in finding the needle 
 ■without the new art. With such a history as above men¬ 
 tioned, and the patient seeking relief, the surgeon might 
 have been tempted to open the finger near the point where 
 the patient herself expected the needle to come through. 
 The experiment has revealed two distinct and different path¬ 
 ological conditions: one causing discomfort, and the other, 
 the needle, evidently causing none. 
 
 John Macintyre, M.B., F.R.S.E., 
 
 Glasgow. 
 
 James Adam, M.A., M.B., 
 
 Hamilton. 
 
 EXPERIMENTAL OBSERVATIONS ON THE DEAD 
 SUBJECT. 
 
 Perhaps an account of the following experiment with the 
 new photography may interest the readers of the British 
 Medical Journal. It shows that a fragment of needle em¬ 
 bedded under the bone will show clearly in a skiagraph. 
 The skiagraph was taken by Professor Wertheimer, Principal 
 of the Merchant Venturers’ Technical College. 
 
 I tried to pass a fragment of needle through the palmar 
 aspect of the last joint of the great toe in an amputated foot. 
 The fragment became so deeply and firmly embedded that I 
 could not feel any portion of it, nor could another medical 
 man, who also examined the foot. The photograph, taken by 
 Professor Wertheimer, with three-quarters of an hour’s ex¬ 
 posure, showed the needle clearly and also several other 
 foreign bodies embedded in the foot. On dissection of the 
 foot afterwards I found the needle had just missed the joint, 
 and had passed through the inner corner of the distal end of 
 the first phalanx, and onwards beneath the bone, leaving 
 only a small portion embedded within the phalanx. The 
 skiagraph was taken with the dorsal aspect of the foot upper¬ 
 most, so that the needle lay completely under cover of the 
 overlying phalanx. This is of great interest, and shows that 
 the shadow of the bone does not obscure that of the needle. 
 In order to ascertain the relative position of the needle and 
 bone, two skiagraphs would have to lie taken, one with the 
 dorsal surface uppermost and one with the plantar surface 
 uppermost. If the one with the dorsal surface uppermost 
 gave a darker shadow than the other we should have an in¬ 
 dication that in this position the needle was nearest the 
 plate, for the shadow is darker the nearer the body is to the 
 plate, as with light shadows, and therefore on the plantar 
 aspect. If the needle shadow were equally dark in both 
 positions, then the needle must lie exactly midway between 
 the dorsal and plantar aspects. 
 
 Charles A. Morton, F.R.C.S., 
 
 Clifton. Surgeon to the Bristol General Hospital. 
 
 Examination of a Mummy. 
 
 The following note appears in the Neue Freie Presse ‘of Vienna: At 
 the initiative of Dr. Dedekino, custodian of the Egyptian section 
 of the Artistic-Historical Museum of Vienna, an experiment has 
 been made in photographing the interior, by the aid of Roentgen 
 rays, of an ancient hitherto unopened Egyptian mummy. This 
 mummy, which lias externally the form of a human corpse, was con¬ 
 sidered to be a “ collective ” mummy of the old Egyptians who worshipped 
 the ibis, but the view had not been proved, and as it was unique in its 
 kind, it was not desirable to unswathe it, but the contents might be 
 proved with the Roentgen rays. The mummy was therefore, with the 
 permission of Count Trauttmansdorff, brought into the photo-chemical 
 laboratory of the institute, where the part corresponding to the human 
 head and shoulders was illuminated with the Roentgen rays. The nega¬ 
 tive and prints showed clearly the outlines of knuckles of birds, and that 
 it contained no human remains. In this manner the contents of the 
 mummy were proved in a manner which leaves no doubt of its being a so- 
 called “ibis mummy,” and the whole process shows clearly the utility 
 of the new discovery for similar purposes. 
 
 FACTORY LEGISLATION FOR 1895 , AND THE 
 MEDICAL PROFESSION. 
 
 A perusal of the excellent special reports of the Factory 
 and Workshop Acts, prepared by the Medical Officer of 
 Health and the City Engineer of Bristol for the guidance of 
 the Sanitary Committee of that city, gives us the opportu¬ 
 nity of drawing attention to what Parliament has done 
 within the last few years to improve the condition of factory 
 labour in this country. It was in the latter half of last 
 century that England, fast outdistancing her Continental 
 neighbours as a producing power, became able to meet the 
 increasing demands made upon her cotton and woollen fabrics 
 by the improvements in spinning introduced by Thomas 
 Hayes and Richard Arkwright. Although at this period the 
 motor power employed in mills was water, yet factories of 
 considerable size were already in existence, and large 
 numbers of huipan beings were daily massed within their 
 walls. The life of these in many instances was one 
 lengthened day of almost abject servitude. The physical 
 hardships they had to encounter are now a matter of his¬ 
 tory, yet they did not altogether escape the attention of the 
 Government of that period. The Factory Acts are the out¬ 
 come of the labours of such men as Sir Robert Peel, Owen, 
 Oastley, and Lord Shaftesbury (then Lord Ashley), and they 
 are the necessary consequences of the great stimulus given 
 to our industries by the introduction of steam as the motor 
 power. We hear a good deal from time to time about 
 “ paternal and grandmotherly legislation,” but it is admitted 
 on all sides that the care of a State for the health of its work¬ 
 people is not the least important of its duties. 
 
 At the beginning of this century the necessity for State 
 interference was only too apparent. The hours of toil were 
 unduly protracted, and the conditions of labour for children 
 of tender years and women such as raise even now a feeling 
 of shame when they are detailed to us. It was to meet these 
 and diminish concomitant evils that the first Factory Act 
 was passed in 1S02 and that subsequent Parliaments have 
 passed additional Acts. The Factory and Workshop Acts of 
 1878, 1891, and 1895 are instances of the efforts put forth by 
 successive Governments to deal with evils that have arisen 
 under the influence of growing capital, increasing production, 
 and keener competition. The assertion of State authority 
 over individual freedom suits all of us best when it is 
 graduated. It is to these circumstances and the exigencies of 
 political parties in this country that must be attributed the 
 number of Factory Acts at present in existence. 
 
 In our review of this subject it is unnecessary to go further 
 back than the year 1878, when an Act was passed which 
 allowed inspectors of factories to complain, but did not give 
 them the power to enforce. The placing of workshops under 
 regulations different to those applied to factories has doubt¬ 
 less, in many instances, tended to create difficulties. The 
 primary distinction between a factory and a workshop is that 
 in a factory steam, water, or other mechanical power is used 
 to move machinery employed in preparing, manufacturing, 
 or finishing, whereas in a workshop no such mechanical 
 power is employed. The Act of 1891 placed the sanitary con¬ 
 dition of workshops under the local authority, and it 
 
March 28, 1896.] 
 
 THE NEW PHOTOGRAPHY. 
 
 I Thb British 
 LMbdical Journal 
 
 807 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shuter Scholar of St. Bartholomew's Hospital. 
 
 [ With Double-page Illustration.'] 
 
 a VIII. 
 
 r- Application of the Method to the Trunk 
 il L P ^ SS - blllt vi of skia S ra Phing the deep visceral region of 
 £ *od y is well exemplified in the full-sized skiagraph of the 
 skeleton of an infant reproduced in the plate issued with thia 
 number of the British Medical JouSl, Xch marks a 
 "^ er st 4 e i? 1 m * application of this new resource of medica'l 
 st lence. Although no disease is present in the body of the child 
 nVtf° ne th , e ! . ess interesting from a scientific and medical point 
 of view as being the first step towards the application of the 
 method to the diagnosis of spinal and other deep affections 
 
 tl.o r.f^m Srap +i Was taken . in fourteen minutes, and the age of 
 t le child was three months. The tube employed was the new 
 focus tube, and it was placed some 8 inches from the surface 
 
 nlnte b r°i d ' y ?0 + aS t °. obtam sufficient spreading to cover the 
 plate. It is interesting to observe that the positions of some 
 of the soft organs are indicated; thus the heart and Ws 
 fnW' Gar y sl l houetted > and curiously enough the coils of 
 pied bytlie^tomach^ 6 aW them iS evidentl y <* a t occu- 
 
 the Ir hw!l lia f,i nderSOn ’ / 4 C - S " Professor of Anatomy in 
 ti 7 Academy, and Lecturer on Anatomy at St 
 Thomas s Hospital, to whom an early proof of the plate has 
 been submitted, writes as follows : “Mr. Rowland is to be con- 
 gratulated warmly upon his success. The skiagraph is ad- 
 
 of tLe 6 ’ and °P en f U P a world of speculation as to the utility 
 of the process m the medicine and surgery of the future Tim 
 most noticeable features are the clear definition of the ossific 
 centres m the vertebne, the sharp line of the dianhv^s 
 
 parency of UC thl “ah- coif / 1 ^ Une ’ the comparative trans- 
 u- i tle , air-containing viscera, the lun^s etc 
 and the dimly shown outline of the liver and heart ’ It, is 
 
 Tm°+ US tbat the 1 ] iac crest doPS not throw a good shadow 
 Uw transparency of the bone shadow itself is weH exemnlV 
 fled in the crossing of the radius and ulna.” pU 
 
 As I have received so many applications for copies of the 
 P otographs which have been reproduced in these reports I 
 have placed all the negatives with the London Stereoscopic 
 Company, from whom photographs may be obtained. P 
 
 Detection of a Coin lodged in the Intestine 
 In another case I have been able to obtain a negative of 
 the pelvis vertebral column, and lower part of the thorax of 
 a much older child. The case will be published L full at a 
 j ate 7 r P pnod - The child, aged 6 years, swallowed a halfpenny 
 in November last; since that time she has had constant 
 symptoms pointing to the retention of the coin The 
 skiagraph showed the halfpenny lying on the right iliac bone 
 it had evidently lodged at the ileo-csecal valve. & ’ 
 
 S “®f HOP THE Elbow-Joint: Subluxation of Radius 
 
 THE pS enT 11 ^a° r tV S fr ° mDr : .{• D - Cree(W. Hampstead): 
 ioTni? L ^ H ’’ a , tllin boy with exceptionally extensible 
 °‘ nt -, now. nearly 13 years of age. Two years and a-half 
 ago, whilst climbing a tree, he fell and injured his riMit 
 elbow-]omt He was not seen till several hours after the 
 accident, when the swelling prevented diagnosis. After this 
 swelling hail somewhat subsided a dislocation of both bones 
 backwaids was discovered, which was reduced. No further 
 fniiV Was reco ? msc 5 d - -Patient never completely regained 
 full flexion or extension of the joint, although nearly so and 
 tL 0 a P T f ( °r f r lts de ^ibility I may mention that a year after 
 the accident II. gained a medal at his school for gymnastics 
 A “ ondl a go my attention was called to ILj as it was 
 oticed that his elbow-joint was not so freely movable as 
 formerly, and that he was acquiring the habit of usino- his left 
 hand on occasions, such as in drinking, when before he would 
 
 have used his right. On examination I found pronation 
 and supination normal, but flexion and extension greatly 
 diminished from what was possible a year ago. There was no 
 marked tenderness to be made out. The head of the radius 
 seemed to be enlarged and partially displaced outwards 
 By measurements I found the distances between the external" 
 and internal condyles and between the olecranon and the 
 
 jSfofi&&&*»' ndius '«“ <«•*«*— 
 
 Tanking this to be a case in which Roentgen’s x rays 
 nught be a great aid to diagnosis, and prove or disprove an 
 early tuberculous lesion or some injury to the epiphysis, ? 
 biought H. under the notice of Mr. Sydney Rowland who 
 very kindly made three skiagraphs for me. 
 
 from^before tjackwards!’ CXtended as much a ® possible, seen 
 n f - beft elbow-joint semiflexed, seen from before backwards. 
 (In this my attempt to obtain a shadow, thrown with an 
 failed) 3 ^ &nS 6 t0 th&t from the bones of the right arm, has 
 
 3. The right elbow-joint, flexed as much as possible, seen 
 from without inwards. ’ 
 
 offh^S^fi the . t 7? skiagraphs the outward subluxation 
 ?, the head, of the light radius is at once apparent. Beyond 
 “ s ] . sa , gei \ eral enlargement of all the bones forming 
 the elbow-joint; but this may be accounted for in part 
 by parallax the two arms were not in an identical posture 
 nor was the Crookes s tube in the same relative position 
 ti°o C i aC u ar m dmmg the exposure. This is shown best in 
 the heads of the radii—in the left, the epiphysis is seen end 
 on whilst m the right an oblique view is obtained 
 
 these skiagraphs I think that any diagnosis beyond 
 hypothltical 3 Subluxatlon of the head of the radius would be 
 
 J^±?f[ aph -’ f i the K ft an< ? uninj ured elbow is interesting, as 
 iy it from the epiphysial nuclei of the lower end of the humerus 
 ie age of the patient can be verified. The nucleus for the 
 trochlea which appears in the nth or 12th year is small 
 but distinct, whilst that for the external condyle, which 
 should develop 111 the 13th or 14th year, is absent. 
 
 THE DETECTION OF NEEDLES IN THE EXTREMITIES. 
 Localisation and Extraction of Needle deeply 
 
 „ ... . SEATED IN THE FOOT. 
 
 mil owing case furnishes a good illustration of the value 
 nLufn a' F botography m diagnosis and in determining the 
 position of foreign bodies when too deeply seated to be 
 ascertained definitely by the usual methods 
 On the night of November 8th, 1895, about n p.m., a lady 
 
 was staying with some friends, after retiring to bed, got 
 up and walked across her room for some cough lozenges that 
 were on the dressing table. In doing so she caught her foot 
 a , galn f a ru f ’ and an acute pain in the sole of her foot 
 close to the ball of the big toe. She struck a light, and after 
 
 fin a d C the g o 0 thp, he f fl00r f0 f nd m piece of needle > but could not 
 find the otliei fragment. There was blood oozing from a 
 
 puncture m her foot, and she suspected the missing piece 
 was left in it. About 2 a.m. she awoke with excruciate 
 pain in the big toe joint, and could not sleep again. Next 
 W cmlfnH 6 consulted a surgeon, who, after examining the 
 Si an op'aion that there was no niedle 
 
 i the foot, and that she was suffering from gout. She was 
 tieated for tins complaint for over three weeks without 
 home 1 benefit S ° far ES pain and swelling went, and’returned 
 
 , d T wa ? as ked to see her the following day, and after listening 
 to the history came to the conclusion tliat there was apiece 
 feeHthv th P tbe b ? 1 ° f f h , e toe, but it was not possible to 
 H wnt Jnl 14 ca i' eful palpation. I explained to her that 
 t would be rash treatment to cut down and explore for it 
 without having a definite idea of its position, and pursued a 
 oothing and expectant treatment. When a few weeks ago the 
 new photography astonished the world, I at once decided to 
 Hr V I r !i' pi? Photographed. This was successfully done by 
 Di. Ha 1 Edwards, of Birmingham, and plainly showed the 
 need le lynig obliquely against the metataiso-phalangeal joint 
 of the big toe. On this I proceeded to operate. The position 
 of the needle being clearly defined in the photograph there 
 was no difficulty 1,1 marking its site on the skin by means of 
 
So8 
 
 The British 1 
 Medical Journal J 
 
 THE BATTLE OF THE CLUBS. 
 
 [March 28, 1896. 
 
 a pencil. A puncture was then made with a tenotomy knife 
 transverse to the direction of the needle, when the edge of 
 the knife struck it at once. An incision was made in the line 
 of the needle, which was very deep, owing to swelling and 
 rather tieshy foot and lying against the bone. It was then 
 seized with a dressing forceps, and, not being possible to take 
 it out through the wound, one end was made to project 
 against the web of the foot between the big and next toe; a 
 small incision was made over it, and with some force it was 
 drawn out. After being in four and a-half months it had 
 become very firmly fixed and oxidised. Its length was just 
 under an inch. 
 
 Ashby-de-la-Zoucli. Chas. It. WILLIAMS, M.B., C.M.Edin. 
 
 Determination of the Position of Broken Needles in 
 the Hand. 
 
 On February 27th A. E. came to me with the history of having 
 a piece of needle in her hand. Some months before she had 
 dropped a needle on the carpet, and in feeling for it the eye 
 end ran in her hand and broke off, leaving about half an inch 
 in it, but as it could not be seen it was left, in the hope that 
 it would work to the surface. She had very little pain, 
 except in grasping anything. 
 
 Messrs. Newton and Co., of Fleet Street, kindly photo¬ 
 graphed the case for me with their new focus tube, and the 
 result is very interesting, as showing the great improvements 
 that have already been made ; exposure, two minutes. The 
 piece of needle was situated right in front of the third meta¬ 
 carpal bone diagonally from the surface to the bone. The 
 hand was placed with the palmar aspect downwards, so that 
 the .?• rays had to penetrate the bone before reaching the 
 needle, which they did most perfectly. 
 
 Another point of interest is that the structure of the bone 
 can be readily seen, and the nails are also easily seen. The 
 position being so clearly shown, I made an incision only 
 three-eigliths of an inch in length, and with a small pair of 
 forceps seized the end of the needle and drew it out. 
 
 Crouch End. Al t G. C. Dove, M.D. 
 
 On March 16th Professor Barrett, assisted by Mr. Jefcote, at 
 the Royal College of Science, Dublin, took skiagraphs of a 
 woman, a patient of mine, who had a needle in her hand for 
 the past two years and a-half. She consented to its removal 
 when its position was defined, and I accordingly removed it 
 with comparative ease from the hand, making the incision 
 parallel to the little finger metacarpal bone, and going under 
 the muscles of the little finger. The skiagraph had shown 
 that it was on the palmar side of the hand. The history is 
 shortly as follows : 
 
 J. E., a housemaid, when dusting a press two years and 
 a-half ago, felt a needle run into her hand; the sharp end 
 broke off, and the eye end run into the muscles of the hypo- 
 thenar eminence. Under cocaine I at the time endeavoured to 
 find the fragment in the hand, but failed to do so. I poulticed 
 and stuped the hand in hopes the needle would come out 
 through the enlarged wound, but it did not. The wound 
 healed quickly, and the woman only complained of shooting 
 pains up the arm and into the little and ring fingers, and at 
 times cramps in the muscles of the hand, causing her to cry 
 out and drop anything she was holding. For about the past 
 twelve months these pains and cramps were less frequent, 
 may be once or twice a month, until recently, when they be¬ 
 came more frequent. The pain latterly was referred always to 
 the base of the fingers proper on the palmar surface, or the 
 wrist proper (also palmar surface), or up the arm, but near to 
 where the skiagraph pointed out the needle to be situated, and 
 where it was accordingly found at the operation. I was 
 assisted at the operation by my colleague Mr. Swan, and Mr. 
 E. Hamilton and Mr. Bennett, Consulting Surgeon to the 
 hospital, were also present; Dr. W. Hamilton gave the anaes¬ 
 thetic, and Messrs. Burke and Piers-Smith (my dressers) also 
 gave able assistance. Richard Bolton M‘Cadsland, 
 Sen. Mod. T.C.D., M.D., F.R.C.S.I., 
 
 Dublin. Surgeon to Steevens Hospital. 
 
 Needle embedded in Hand; Extraction after Localisa¬ 
 tion by Means of the Roentgen Rays. 
 
 I send a note of this case, not because of any intrinsic value 
 that the rays had in facilitating the removal of the needle, 
 
 for it could be quite plainly felt, but on account of the ex¬ 
 cellence of the skiagraph, for which I am indebted to the 
 kindness of Mr. H. Jackson, of the Chemical Laboratory. It 
 shows that the point of the needle is embedded on the 
 anterior surface of the base of the fifth metacarpal bone—a 
 condition verified at the time of removal. Mr. Jackson, 
 rotating the hand between the tube and his luminous screen, 
 enabled 11s to see that the needle had run in front of the 
 bones, and not behind—a point that could not otherwise be 
 made out, as the end of the needle could be felt in the middle 
 of the inner border of the hand, and it was not possible to say 
 into which side, palmar or dorsal, of the hand the point had 
 gone. The patient, who was intensely interested in the pro¬ 
 ceedings, was sent me by Dr. T. D. Manning, of Reigate. 
 
 F. F. Burghard, M.S.Lond., F.R.C.S., 
 
 Assistant Surgeon to King's College Hospital. 
 
 Needle in Hand : Removal. 
 
 L. D., a dressmaker, some weeks ago ran a portion of a 
 needle into the thenar eminence of her right hand. When 
 she came to my surgery next day there was no trace of the 
 needle to be found ; since then she has complained of a large 
 amount of pain along the side of the forefinger. On Tuesday 
 last, by the kindness of Mr. C. M. Dorman, we took a skia¬ 
 graph by the new process. The needle showed plainly. Tak¬ 
 ing the metacarpal bone as a guide, we cut down parallel 
 with the bone and removed the needle. 
 
 Patricroft. W. M. Hamilton, M.D. 
 
 Wanted—a Name. 
 
 Dr. David Walsh (Temple, E.C.) writes: Your interesting editorial of 
 March 14th drew attention to the want of a comely and convenient term 
 for what is now known as “ the new photography. Perhaps I may ven¬ 
 ture to suggest “ shadowtype” or “ shade picture” as possible names. 
 The word " shade print,” again, could be made to cover a good deal of 
 the ground. At any rate, the use of such expressions as “shadow 
 printing" or “shade printing” a fracture, or “a needle was shade- 
 printed in such and such a position ” would be less barbarous than 
 many of the cumbrous periphrases now springing into vogue. 
 
 M. D. T. C. D. suggests! “rotography” or “ rotography” as a name for the 
 new process of pourtraying the unseen. The proposed term has the 
 advantage that it is easy to pronounce, and implies no theory as to the 
 nature of the process ; indeed, as far as we can see, it is open only to 
 one objection, but that appears to us to be fatal. To place in the hands 
 of the habitual punster sucli a weapon of offence as “rot-ography,” 
 would be to make a serious addition to the minor miseries of life. 
 
 THE BATTLE OF THE CLUBS. 
 
 Pendleton Provident Dispensary. 
 
 The Honorary Secretary of the medical staff of this institu¬ 
 tion is of opinion that justice lias not been done to them in 
 our comments. We may observe that it has never been im¬ 
 plied that “ no reform at all ” has taken place at Pendleton ; 
 it was only suggested that the reform has not been sufficient. 
 Although it is constantly reiterated that this institution 
 “has departed from the rules which govern the Manchester 
 and Salford Provident Dispensaries’Association,” the Pendle¬ 
 ton Provident Dispensary appears still to figure as one of the 
 Branches of that Association, and it appears to be understood 
 that out of its own reserves it supplements the finances of 
 other Branches. So long, therefore, as so intimate a connec¬ 
 tion appears to be maintained between this institution and 
 the Manchester and Salford Dispensary Association, it will be 
 impossible to exonerate the former from all the faults of the 
 latter. If this be a misstatement it has not, so far as we are 
 aware, been publicly contradicted, nor has our correspondent 
 produced any evidence to refute it. If, as a matter of fact, 
 a series of provident dispensaries show profits in proportion 
 to the general prosperity of the population in the district 
 where they are established, that is to say, if where the people are 
 mostly well-to-do they can form a reserve fund but where 
 they are poor the result is a deficit, it can hardly be argued 
 that such a fact is not relevant, as calling in question the 
 efficiency of the wage limit practised at all these Branches. 
 It is stated, also, that the supporters of the Pendleton Branch 
 are derived chiefly from the well-tc-do classes, while its re¬ 
 serve fund (^430 5s.) would appear to be the largest of all the 
 Branches ; so that it is not altogether irrelevant for it to show 
 either that the alleged fact is erroneous, or that it lias no 
 relation to its own material prosperity. 
 
April 4, 1896.] 
 
 PROFESSIONAL SECRECY. 
 
 matter might be different; but as it is we constantly find 
 
 has S be V en told^ If tb , e law of the laild to reveaTwhft 
 reasons 0/ dee P est confidence, not for grave 
 
 reasons of State, but because some blackguard who has 
 
 tTi? 7 lfe t0 , evn worses chooses to ask g for a divorce 
 
 sU ch a ^aRrf?e?sof r ?n mS i tanCeS ’ are to admit that for 
 bucn a paltry leason the law can demand that the seal of 
 
 l\ e ™ C i ^ ha f be -i b /°a ken ’ and if such a demand is to be looked 
 upon and admitted as a “ higher claim,” who can deny the 
 stil higher claim of parental duty. y 6 
 
 The fact would seem to be that the law after all has a 
 
 rnfluencedW 0 ^ 0 ? UbH f opinion, and that public opinion is 
 nttuenced by the view taken by the law. In England then 
 where the law frequently insists on the violation of the sacred¬ 
 ness of professional confidences between doctor and patient 
 such confidencecannot.as in other countries“beLldinvfolate^ 
 other reasons besides the dictum of a judge must 
 be admitted as absolving one from the operation of a rule of 
 
 o„1£7.S- i0l I "’T of “ s wh0 ciih?f "ot thought much 
 
 l subject, or have not been awakened by rude experience 
 have been perhaps too apt to look upon as universaRy bfnd- 
 g on every member of the medical profession.—I am etc 
 -March 30th. S C s' 
 
 a general practitioner of medicine for forty-five 
 yeais, and quite independent of the College of Physicians I 
 have ever fe!t strongly and adhered rigidfyto the “ King 
 duty of medical secrecy.” In medico-legal cases I have 
 
 thI b y ox de and e fs fb° Pe i nmy m ° uth ,f eithei si de till put into 
 uie dox , and as the lawyers could not know what I should 
 
 then say they seldom troubled me to go to the court and 
 thus I was enabled to attend to my own business instead of 
 being bored with other people’s and legal quibbles Youn^ 
 piactffmners may be glad of this hint, by 1 which they wilf 
 free to^ook ^ aste ,o f . tlme dangling about the courts, and be 
 am, ttc , k ftei ’ theU ’ patients at home ^th regularity.- I 
 
 Worthing, March 30th. John J. Merriman. 
 
 RETAINED PLACENTA, 
 your report of this trial, Sir John Williams is 
 stated to have said : “ In the case of a woman with Sned 
 placenta, he would expect to find frequent and constant 
 bleeding. Her periods would be irregular He would not 
 tlon!” 4 t0 fiUd a penod where there would be no menstrua 
 
 When I was on the staff at St. Bartholomew’s Hospital a 
 patient came under my charge for sudden and profuse uterine 
 haemorrhage. She had “seen nothing,” she statld since 
 eight months previously, when she had nassprl a ' f,> 
 between the third and fourth month of pregnancy f re 
 moved what I believed to be the entire plaSente wldch had 
 been letained, and remained completely attached till then 
 Its appearance differed widely from that of a fresh placenta 
 and accorded with the changes described by those who o-ave 
 evidence in the trial on Dr. Playfair’s behalf This uncom 
 
 that fhp 6 ’^ ? eei f S to , me ’ sll0uld be mentioned, as showing 
 that the whole placenta may be retained for as long a period 
 
 I am S etc m ° nthS ’ CaUSmg arrest of the catamenial function.— 
 Grosvenor street, w., March 3 ist. Clement Godson. 
 
 [ The British 
 LMedical Journal 
 
 873 
 
 PROFESSOR VIRCHOW ON MEDICAL EDUCATION. 
 
 nfpf d<? bate on matters relating to medicine in the Prussian 
 diet, an interesting speech on medical education was 
 
 of ell thp' ed t b J P f ofessor Y irch °w- He said that the education 
 ot the students was of paramount importance—not their 
 examination, on which, in his opinion, too much stress was 
 at present laid. Before the era of hospitals the medical 
 teachers were simply practitioners, who took their pupils 
 with them when visiting their patients. This practical 
 teaching could only be carried through in towns, and its 
 trace might still be found in the word policlinic, which was 
 not derived from much, but from town : towm 
 
 chnic, ambulatory clinic. The speaker said that, at the time 
 01 ins own studies, policlinics were few and unimportant ; 
 
 the stationary hospitals enjoying almost exclusive considera- 
 tl ° n -.. He was glad to say that lately the necessity of 
 establishing more and more policlinics had been recognised • 
 they were of the greatest use in preparing the student for 
 general practice. He next drew attention to a weak point in 
 the Prussmn examination system, the drawing of lots In 
 each blanch the important points are formulated as ques¬ 
 tions, and these questions published beforehand. At^ the 
 examination the students draw lots for their questions, and 
 the examiners may not ask them any others. This he said 
 was the worst arrangement possible, and was a direct incitel 
 hfHV l cr , ammmg -. Speaking of the distribution of subjects 
 in the higher examinations, he expressed a fear that undue 
 prominence was given to anatomy and physiology. “ Ana¬ 
 tomy and physiology,” he said, “are necessary studies no 
 one has spoken more strongly on the subject than I haw° 
 but even here there must be a certain limit-the limit comes 
 
 cal reflecHon ’° n T r ° m anato “ y and physiology to true medi¬ 
 cal reflection. In answer to a remark of the Government 
 representative, Professor Virchow further said- “After all 
 internal medicine is the same intrinsically as externa 
 medicine; they both grow on the same stem. Sly 
 inasmuch as the one applies itself to visible, the other fo 
 invisible organs, they have developed slightly divergent 
 methods of treatment, which, however ‘ aufond,’ mearf the 
 same. Medical science is a unity, though it develops and 
 throws off different branches.” Further, he said, “ Pathology 
 and pharmacology are the two fundamental disciplines ■ upon 
 these two every practitioner must build up his medical con¬ 
 victions.” And, again, “In our days the domain of internal 
 medicine has been narrowed more and more through the 
 poweiful and fully-justified raids of surgery. Surgery has 
 done great things, and its achievements have all grown out 
 of the experiences based on general pathology and formulated 
 anew. I cannot agree with the Government view of the 
 centra 1 importance of internal medicine. I am of opinion 
 that the normal course should be to consider the scientific 
 bianches-anatomv and physiology-as indeed fundamental • 
 but to take pathology and pharmacology as the central point of 
 instruction, which should be specially dwelt on ; while prac- 
 
 the poHc d inic!”° U ° n aHke in the hospital aild in 
 
 The number of hospital cases of small-pox in Gloucester 
 on March 26th was 369 with 90 deaths. Of the 90 deaths 
 
 btJnnl tb H Se 0f un Y ac oinated persons, and the remaining 16 
 had only been vaccinated in infancy. 0 
 
 ^f JV ro DIC o°' P f 1 Y ^ 0L P GICAL Association.— The spring meeting 
 bllfi , e t l°-m h ' W i eS i ern Hivision of this Asssciation wRl bf 
 held at Bailbrook House, Bath, at 2.30 p.m. on Tuesdav Anril 
 
 bthlv Jnfv Pep0rt -? f U , le Committee on Criminal R&sponsi- 
 biht y will be considered. A discussion on the Nursing Staff 
 in Asylums will be opened by Dr. P. W. MacDonald Dr 
 
 Ce,-Hfi?it art WlP i' e ld notes 0n the Special Reports and 
 Certificates required by Section xxxviii of the Lunacy Act 
 
 1890, and Section vn of the Act of 1891. y Ct ’ 
 
 . Sunburn and Reflected Solar Light.— At a recent meet- 
 mg of the Camera Club Dr. Bowles gave an address on sun- 
 buin, snowburn snow blindness, sunstroke, and sun fever 
 and contended that they are not due to the heat rays con¬ 
 tained in sunlight, but to the violet or ultra-violet rays which 
 undergo some unexplained change during or after reflection 
 from snow, water, mist, etc., and then behave very like .r ravs 
 °- f penetl 'ating deeply into animal tissues. By 
 them the skin is bronzed and the wood of the Swiss chalets 
 surfed T brown , and often carbonised for inches below the 
 surface. In one bad case of sunburn in the Alps he found the 
 fi k I n K S ^ 01 ^ten, red, und deeply pitted, with a minute freckle at 
 the bottom of each pit. The freckle had clearly stopped the 
 * if ray ®AT lucp dl d the mischief to the tissues lying 
 pp^ e f tb ‘ dY® 1 ? tbl . s and other observations he came to the 
 conclusion that coloured screens or pigments, particularly 
 “f’ red . or brown umber a little deeper than flesh colour 
 would be quite efficacious in preventing sunburn. Experi¬ 
 ence had fully confirmed the correctness of the inference. 
 
874 
 
 T^» British "I 
 Medical JournalJ 
 
 THE NEW PHOTOGRAPHY. 
 
 [April 4, 1896. 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shuter Scholar of St. Bartholomew’s Hospital. 
 
 x rays, it is seen to light up with a vividgreenlight. Given that 
 some object capable of obstructing the rays is placed between 
 the source of these rays and the screen, it is obvious that a 
 dark shadow of the object is cast on the screen, and is seen as 
 such by the eye, the screen having converted x rays into 
 light rays, as evidenced by its fluorescence. 
 
 On the accompanying diagram the effect is rendered clear. 
 
 B 
 
 IX. 
 
 THE CRYTTOSCOPE. 
 
 The report that Professor Salvioni, of Perugia, had found it 
 possible to convert Roentgen’s x rays into ordinary light rays 
 has received abundant confirmation, but none so absolute as 
 the actual production of the instrument by an English firm 
 of opticians. 
 
 Professor Roentoen’s Original Experiment. 
 
 It will be remembered that the original experiment of 
 Professor Roentgen which led to his discovery of the x rays 
 consisted in an observation that paper coated with barium 
 platino-cyanide lit up with brilliant fluorescence if brought 
 within the sphere of influence of an excited Crookes’s tube 
 covered with black paper. From this discovery Roentgen 
 argued the existence of certain rays which were able to 
 traverse black paper, and by inference other opaque sub¬ 
 stances, as evidenced by their affecting the barium platino- 
 cyanide, which deduction has been so strikingly sub¬ 
 stantiated by the vast amount of work that has been done 
 in the field of the new photography. And in no direction 
 has the discovery borne such practical and important fruit 
 as in its application to medicine and surgery. 
 
 Some few weeks after the discovery of Roentgen, Professor 
 Salvioni, of Perugia, announced that he had (apparently in¬ 
 dependently) arrived at this property of the platino-cyanides 
 of fluorescing under the influence of x rays, and had turned 
 it to practical account by the construction of an instru¬ 
 ment called a cryptoscope. 
 
 Salvioni’s cryptoscope consisted simply of a surface of some 
 substance opaque to light, but capable of transmitting the 
 x rays, coated thickly with the fluorescent salt—in his case 
 barium platino-cyanide. Since this announcement reached 
 England—now some six weeks ago—the same fact has been 
 reported over and over again by several workers. It is curious 
 to note the zeal with which the newspaper reporter has seized 
 on these successive announcements and magnified them into 
 fresh discoveries. This craving for exciting news has been 
 at no time better exemplified than in the extended and 
 ‘ ‘ booming ” reports that were circulated as a result of Edison’s 
 simple telegram to Lord Kelvin. The facts of the case are, 
 that very many substances behave as do the platino-cyanides, 
 and that Edison simply telegraphed that he had found 
 tungstate of soda to fluoresce more brilliantly than salts that 
 had hitherto been tried. Whether this is so or not remains 
 to be proved in this country. But great as has been the 
 success of observers in other countries, it has remained for 
 England to produce the instrument in its perfected and 
 simplified form, and for Mr. Herbert Jackson, of King’s 
 College, to fix on the particular salt which give the best 
 results—results besides which all previous attempts are cast 
 into the shade. The salt he employs is the platino-cyanide 
 of potassium. 
 
 Construction of the Instrument. 
 
 In its latest and most perfect form the instrument simply 
 consists of a circular sheet of black cardboard covered on 
 one side with the salt above named, and protected by a glass 
 plate. To prepare the salt for spreading on the card so as to 
 ensure the best results is a work of considerable difficulty, 
 and it is only within the last few days that these difficulties 
 have been overcome. The method that has been found to 
 answer best is as follows:—A sufficiency of the salt is ground 
 to the finest powder in an agate mortar. The finely divided 
 substance is then made into a thick cream with enough gum 
 arabic to produce a mass of the requisite viscidity to adhere 
 to the card. On the card the mass is then spread in as even 
 a layer as possible, and the instrument is complete. 
 
 Explanation of Effect Produced. 
 
 When such a prepared screen is placed in the path of the 
 
 The object casting the shadow is, for simplicity’s sake, repre¬ 
 sented on a perforated sheet, but the same effect would ob¬ 
 viously be produced when the object is the human hand, for 
 example. In this case the flesh, being transparent, casts no 
 shadow, while the bones, being relatively opaque, cast a 
 definite and clear image. 
 
 It must not be forgotten that the success of this instru¬ 
 ment depends on having at command a definite and minute 
 point of origin for the x rays. Such a point is furnished at the 
 place where the kathode rays from the concave electrode of 
 the focus tube strike the platinum plate. Thus it is largely 
 owing to the invent ion of this tube that the apparatus has suc¬ 
 ceeded so well in this country. 
 
 What it can Do. 
 
 Such being the instrument and its mode of action, it only 
 remains to describe shortly what are its use and possible 
 developments. For rapid and easy diagnostic purposes in 
 medicine and surgery it will certainly take the place of the 
 far more cumbrous photographic method. The object is seen 
 at once, and without the trouble or skill required for develop¬ 
 ing sensitive plates. Thus the process is reduced to its 
 simplest elements. 
 
 Thanks to Messrs. Newton and Co. I have been enabled to 
 test practically the capabilities of the new instrument. With 
 it any of the bones of the extremities can be seen with 
 marvellous clearness. This alone holds out sufficient prospect 
 of practical utility, and the prospect is greatly enhanced by 
 the fact that it is fairly easy to “see through” the larynx and 
 diagnose the position of a foreign body therein. When 
 the instrument is working at its best it is just possible to 
 make out the outline of the vertebral column looking through 
 the entire thickness of the abdominal wall; but results in 
 this direction are as yet too uncertain to prophesy any special 
 value to new development in this direction. Seeing that it is 
 possible to examine the bones and joints of the extremities 
 with facility by its aid, however, this alone is sufficient 
 guarantee of its practical utility. 
 
 Possibilities. 
 
 It is almost impossible, therefore, considering the early 
 and undeveloped stage which the new process must be con¬ 
 sidered to have reached, to predict what will be the ultimate 
 outcome of this invention. It is not too much to say, however, 
 that it will probably, to a large extent, in the near future 
 replace all other methods in the diagnosis of bone diseases. 
 
 A number of cases have been investigated and diagnosed 
 by our Commissioner during the week, illustrating the prac 
 tical uses of the new photography and of the cryptoscope 
 
The Relative Opacity of Calculi. 
 
 but as they are for the most part similar to others which 
 have already been published and illustrated in the columns 
 of the British Medical Journal, it is unnecessary to refer 
 to them, in detail. Arrangements are in course by the London 
 Stereoscopic Society, Regent Street, for a skiascopic room, 
 where such cases can be received when desired, under the 
 supervision of Mr. Sydney Rowland. 
 
 The Relative Opacity of Calculi. 
 
 Mr. John T. Leon, M.R.C.S., of St. Mary’s Hospital, London, 
 sends us a skiagraph which is here reproduced to illustrate 
 the relative opacity of various substances. The point of 
 special interest which is brought out is the great transparency 
 of gall stones to the x rays. This was already known, but it 
 is made very conspicuous by Mr. Leon’s skiagraph. The skia¬ 
 graph appears to show also that a uric acid calculus is more 
 transparent than other vesical calculi, among which there 
 appears to be little difference. These calculi were approxi¬ 
 mately of the same thickness, and a finger and a coin are 
 shown on the same plate for purposes of comparison. The 
 exposure was three minutes, and the tube used was one of 
 Newton’s “focus ” tubes. 
 
 DEMONSTRATION BY PROFESSOR SILVANUSj 
 THOMPSON AT THE CLINICAL SOCIETY. 
 
 An overflowing audience assembled at 20, Hanover Square, on 
 Monday evening to witness a demonstration before the 
 Clinical Society of the method of obtaining skiagraphs by 
 Roentgen’s rays, which was given by Professor Silvanus 
 Thompson, F.R.S. 
 
 The President of the Society (Dr. T. Buzzard), in intro¬ 
 ducing the lecturer, remarked that physical science had 
 during the last half century greatly assisted medicine and 
 
 surgery both in the diagnosis and treatment of disease, but 
 not one of its many discoveries had more seized upon the 
 imagination than the development of electrical science now 
 indelibly associated with Professor Roentgen’s name, which 
 appeared likely to lead to great advances in the treatment of 
 diseased conditions. The public, however, must not over¬ 
 estimate those advantages, as they appeared inclined to do. 
 In arranging for that meeting, the Council had decided that 
 they should ask the highest authority possible to introduce 
 the subject, and that they should devote a special evening to 
 its consideration. 
 
 Professor Thompson said that what he had to show divided 
 itself into two parts: (1) the actual process of obtaining 
 photographs by the new method ; (2) the theory of their pro¬ 
 duction-under which he would describe the apparatus used, 
 and show how it was used. The apparatus consisted of an 
 electrical battery, a Ruhmkorff’s coil capable of transmitting 
 a spark 4 or 5 inches long, and a Crookes’s tube, all properly 
 connected. A gentleman with a portion of a fish hook im¬ 
 bedded in the terminal phalanx of one finger for the past year, 
 and who had had other fingers of the same hand crushed in a 
 mill some years ago, next had his hand photographed. The 
 exposure was of a minute’s duration, the dry plate being en¬ 
 veloped in a case of black cardboard. The plate was removed 
 to be developed in another room, and eventually proved ex¬ 
 cellent, exhibiting the piece of the fish-hook in position, and 
 the other deformed phalanges. Professor Thompson explained 
 meanwhile that a sheet of aluminium placed above or below 
 the hand- -that is, between the Crookes’s tube and the dry 
 plate—would have made no difference in the result, except 
 that five seconds longer exposure might have been necessary, 
 as the aluminium choked off some of the rays. 
 
 The lecturer next described the investigations in regard to 
 electrical discharges in vacuum tubes which have been under- 
 
876 
 
 The British “I 
 Medical Journaij 
 
 OBSTETRIC HOSPITALS AND MIDWIVES. 
 
 [April 4, 1896. 
 
 taken for many years by experimenters, especially by Mr. 
 Crookes; and showed the very varying behaviour of such a 
 spark when transmitted through a tube, first open, then 
 closed, and exhausted by an air pump until the attenuation 
 of the air became almost as great as in a Crookes’s tube, and 
 finally slowly refilled with air. He remarked that if the ex¬ 
 haustion were made absolute, the tube would not act, because, 
 in the complete absence of particles of air, the spark refused 
 to pass into it. The tube must, however, be very highly 
 though not completely exhausted. He described the focus 
 tube with a kathode concave disc of aluminium, and an 
 anode plate of platinum, from which lattter the electric 
 emanations were reflected to the exterior of the tube. 
 
 These Roentgen rays could be deflected to one side by a 
 magnet, but nothing yet known will focus them. These rays 
 are not light, nor ultra-violet light, for the latter absolutely 
 refuses to go through aluminium. Various salts were shown 
 to be luminous when light, or ultra-violet light, played upon 
 them, and the phenomena of phosphorescence and fluor¬ 
 escence were demonstrated-by many beautiful'experiments. 
 Various photographs of hands, feet, etc., taken by the 
 Roentgen rays were exhibited on a screen; and the leg of a 
 man with a small leaden shot in his calf was photographed 
 by the x rays, but the bullet was not visible in the resultant 
 picture. Finally the cryptoscope was explained, the lecturer 
 remarking that the platino-cyanide of potassium was far 
 more efficient as a paint on the screen than calcium 
 tungstate, which had lately been highly recommended in 
 America for the purpose. 
 
 A thoroughly good tube was required to enable the crypto¬ 
 scope to act well. By means of this instrument the bones of 
 the operator’s hand and forearm, a coin and ring in a leather 
 purse, the metallic surgical instruments in a wooden box, an 
 iron magnet and other small shapes of metal in a block of 
 wood 3 inches thick, and a pair of spectacles in their leathern 
 case were all rendered perfectly visible by their shadows, 
 whilst the flesh around the bones, the purse, box, block of 
 wood, etc., were all rendered more or less transparent. Pro¬ 
 fessor Thompson described a binocular cryptoscope, with which 
 he hoped it might be possible to obtain two shadowgraphs, 
 at slightly different angles, and thus see things in their 
 proper relation to one another, and so determine the proper 
 order of their superimposition. In reply to queries, he said 
 that almost any dry plates would do for the photography, 
 that the Roentgen rays could not be refracted, that glass was 
 hardly at all transparent to them, and that in photograph¬ 
 ing through the trunk of any thick part of the body the dry 
 plates should be placed next to the part to be photographed— 
 for example, for gall stones the light should enter at the back 
 and the plate be placed over the gall bladder. 
 
 A hearty vote of thanks, proposed by the Chairman and 
 carried by acclamation, was accorded to Professor Thompson 
 for his most interesting demonstration. 
 
 RECOGNITION OF SCRAP OF METAL NEAR ELBOW. 
 J. L., aged 18, was admitted into the Corbett Hospital at 
 Stourbridge on March iStli, suffering from a traumatic 
 aneurysm of the left brachial artery just above the inner 
 condyle of the left humerus. The patient is employed at a 
 large ironworks, and on March 4th, while holding a hammer 
 on a wedge, a fellow workman struck it with another hammer; 
 a piece of steel must have come off the head of one of the 
 hammers and struck the patient on the arm, causing a free 
 flow of blood. He was taken to Dr. R. Eagar, of Stourbridge, 
 and attended to. On March 18th I saw him, at Dr. Eagar’s 
 request, and sent him up to the Corbett Hospital, where he 
 was seen also by my colleague, Mr. D’Arcy Ellis. No steel 
 could be detected by any of us. On March 19th I took the 
 patient to Dr. Hall Edwards, of Birmingham, and under the 
 Roentgen rays a piece of metal was discovered lying on the 
 inner side of the condyle of the left humerus. I think this 
 case is interesting as illustrating that the Roentgen ray will 
 detect the presence of metallic bodies which would otherwise 
 escape detection. 
 
 Stourbridge. II. Hammond Smith. 
 
 Wanted, a Name. 
 
 Paul Pet writes: You want a name for Koentgen photographs. Why 
 , will not Ngrapli do ? It is short, better than any combination of Rot, 
 
 and what is much to the point nowadays, a novel combination. 
 
 OBSTETRIC HOSPITALS AND TREATMENT BY 
 MID WIVES. 
 
 The Liverpool Ladies’ Charity, with which is incorporated 
 the Lying-in Hospital, is an institution which has just cele¬ 
 brated its hundredth anniversary. The century during which 
 it has existed has seen Liverpool advance from the status of a 
 second-rate provincial, town to that of the second city in the 
 kingdom, and all that time the Ladies’Charity has! steadily 
 kept pace with the needs of the increasing population, carry¬ 
 ing on quietly and unostentatiously a work whose value it is 
 scarcely possible to estimate. 
 
 To maintain the honour and efficiency of such an institu¬ 
 tion might be almost regarded as a sacred trust by those to 
 whose hands its government is assigned, and it is painful to 
 have to record that the present Committee of Management 
 have entered on a course of action with regard to the medi¬ 
 cal staff’ of the Lying-in Hospital which, if persisted in, will 
 certainly detract from its value, and will probably before 
 long lead to its extinction. The Ladies’ Charity and the 
 Lying-in Hospital—formerly independent organisations — 
 have for some years been combined, and now form one 
 charity under the same Committee of Management. 
 
 The work of the institution may be described as consisting 
 of an outdoor and indoor department. For the purposes 
 of the former the city is divided into ten districts. Each 
 district is provided with trained midwives, and with an 
 honorary medical officer, who has charge of the district, and 
 is called upon by the midwives when they meet with cases 
 requiring medical aid. The Lying-in-Hospital, the indoor 
 department of the charity, is officered by three obstetric 
 physicians, each of whom in turn takes active duty in the 
 wards for a period of three months at a time. 
 
 The Committee of Management now propose to change the 
 laws of the hospital in such a way, that the patients, when 
 admitted, shall come under the sole care of the matron, and 
 shall not be seen by the medical officer at all unless she sees 
 fit to send for him. A philanthropy which would designedly 
 withhold from poor women in their hour of need the skilled 
 aid which competent medical men are able and willing to 
 render unasked is difficult to comprehend. Surely it is in 
 the interest of both patient and practitioner that the latter 
 should be able to ascertain for himself, at the earliest possible 
 moment, whether any special difficulties are likely to arise. 
 It is worth noting that the Committee seem not to 
 have had the courage to propose these alterations in 
 the laws at the annual meeting, which was, as usual, held 
 in the town hall, under the presidency of the Lord Mayor, but 
 are about to bring them forward at a special meeting which 
 will be presided over by the chairman, who is himself one of 
 the promoters of the proposed changes. The consequence of 
 what has occurred is that the whole medical staff, comprising 
 the consulting members, the medical officers to the hospital, 
 and the district medical officers, with three exceptions due 
 to absence or illness, have handed in their resignation. 
 Tt has always been among the best traditions of the 
 medical profession that the sick should have free access 
 to the physician without the intervention of nurse or any 
 other person, and the invariable practice in hospitals is in no 
 way at variance with this tradition, but the medical officer of 
 a hospital is directly and personally responsible for the well¬ 
 being of those who enter the wards, no less than in the case 
 of his private patients. 
 
 The Committee of Management of the Lying-in Hospital 
 now propose to abrogate this rule, and to place the patients, 
 in the first instance, under the care of an unqualified person, 
 with whom shall rest the decision as to whether they shall 
 have the benefit of medical assistance or not. No conscien¬ 
 tious practitioner can be expected to give countenance to any 
 such proposal, and the medical staff' have adopted the only 
 proper course in resigning, and thus declaring effectually that 
 they will be no parties to the scheme. 
 
 A discussion on the Factory and Workshops Acts and the 
 powers and duties of sanitary authorities with regard to 
 workshops will be opened by Dr. .T. F. J. Sykes, M.O.H. St. 
 Pancras, at the sessional meeting of the Sanitary Institute on 
 April 15th. 
 
April 18, 1896.] 
 
 THE NEW PHOTOGRAPHY. 
 
 [ The British 
 Medical Journal 
 
 997 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Sliuter Scholar of St. Bartholomew’s Hospital. 
 
 X. 
 
 The Recognition of Foreign Bodies in the Larynx. 
 Some weeks ago I stated that one of the possible uses 
 for the new process would be in localising and discovering 
 the nature of foreign bodies in the larynx. In conjunction 
 with Dr. Ernest Waggett I have been steadily pursuing this 
 line of work with the results that I think are satis¬ 
 factory. It is now possible not only to skiagraph the foreign 
 body, but by aid of the cryptoscope actually to see it, and, 
 what is more important, by the aid of this latter instrument 
 it is easy after a little practice to use extraction forceps or 
 other instruments actually in sight during the operation, and 
 thus to direct accurately the instrument to the body and 
 ensure its being caught within its grasp. At the Laryngological 
 Society on April 15th the following paper was read by Dr. 
 Waggett, in which our methods are described in detail. 
 
 THE SKIAGRAPH AND CRYPTOSCOPE IN THE DIA¬ 
 GNOSIS AND TREATMENT OF FOREIGN BODIES 
 IN AND ABOUT THE LARYNX. 
 
 In a letter published in the British Medical Journal of 
 March 21st, I mentioned that Mr. Rowland and myself had 
 been able to demonstrate that it was possible to obtain skia¬ 
 graphs of foreign bodies in and about the larynx. In subse¬ 
 quent experiments made with a “focus” tube of known 
 efficiency, we find that the best results are to be obtained by 
 an exposure of five minutes, and by such exposures we have 
 produced sharply-defined shadow pictures of coins and fish 
 bones attached to the surface of the neck, as well as of the 
 hyoid bone. The method we have adopted is to allow the 
 patient to rest the head in a natural and comfortable position 
 as he sits in an armchair, with a small-sized rapid sensitive 
 plate, wrapped in light proof paper, bandaged closely to the 
 side of the neck. A Crookes’s tube, directing the rays trans¬ 
 versely through the neck, is fixed 2 inches from the surface of 
 the latter, the connecting wires being carefully insulated in 
 glass tubes to prevent discharge to the shoulder. 
 
 Inasmuch as the cartilages of the larynx are transparent to 
 the x rays, and afford no clear landmarks in the picture^ we 
 have constructed projection charts of the region, by reference 
 to which the position of any given point may be determined 
 with fair accuracy in spite of the distortion of the image due 
 to the near proximity of the source of the rays. The side on 
 which and the depth at which any opaque body lies may also 
 be determined by taking a second skiagraph, directing the 
 rays through the neck more or less antero-posteriorly. As 
 one of the most important ends to be attained by this 
 method is the proof of the non-existence in a particular 
 situation of a foreign body alleged by the patient to be 
 present, and of which ordinary examination reveals no sign, 
 we have determined the relative opacities of a number of 
 those bodies (coins, bones, glass, various buttons, etc.), 
 which are likely to become accidentally lodged in the upper 
 air and food passages. Exclusion will not be satisfactory 
 and final in the case of some small and but slightly opaque 
 bodies, but in the majority of instances it will be possible to 
 prove definitely the absence or presence of a foreign body, 
 when after trial with a series of various exposures a picture 
 is produced in which the more transparent tissues of the neck 
 are represented by a deposit on the negative of a density 
 equal to that of the standard. If this density is obtained 
 after full development, and no evidence of an opaque body is 
 to be made out in the negative, one may presume that no 
 substance equal in thickness and opacity to those which 
 stand out clearly in the standard picture, is present in the 
 tissues of the neck. In doubtful cases more than one “posi¬ 
 tion’’must be taken, in order as far as possible to exclude 
 overshadowing by the hyoid bones. 
 
 The cryptoscope, although not so sensitive as the photo¬ 
 graphic plate to slight shades of opacity, has proved, never¬ 
 
 theless, highly satisfactory. The instrument employed is a 
 circular screen, about 6 inches in diameter, of platino-c-yanide 
 of potassium, a salt which, as is now generally known, becomes 
 luminous under the influence of the x rays. The rays are 
 sent transversely through the neck from a “focus” tube 
 placed about 5 inches from the surface, and such as penetrate 
 tissues reach the screen, which is held as near the neck as 
 possible. In a dark room the parts in front of the spinal 
 column show up as a half shadow, varying in luminosity in 
 different regions, while the hyoid bone appears as a sharply- 
 defined black shadow, which ascends on deglutition. If a 
 coin is placed in the pyriform fossa or a silver probe is passed 
 into the larynx, their shadows are seen with perfect distinct¬ 
 ness. On passing the card of standard objects between the 
 tube and the neck, the majority of them can be seen, clearly 
 defined, on the luminous image. 
 
 The cryptoscope is then of real value in the removal as well 
 as in the detection of foreign bodies. Where manipulation 
 in a darkened room is considered undesirable, an assistant 
 making use of a light tight box or velvet cloth can, by watch¬ 
 ing the movements of the shadow of the forceps, direct the 
 operator as to the relative positiomof his instrument and the 
 foreign body. As a rule, no difficulty will be experienced 
 in working in a room momentarily darkened, and under these 
 circumstances the operator, sitting, if need be, in the usual 
 position in front of his patient, may himself judge of the 
 necessary manipulations by observing the cryptoscopic 
 image reflected towards him by a mirror fixed to the screen 
 at a suitable angle. He will probably find no difficulty in 
 standing at the side of the patient and watching the screen 
 directly. Ernest Waggett, M.B., B.C.Camb., 
 
 Pathologist London Throat Hospital. 
 
 DETAILS IN THE CONSTRUCTION OF THE TUBES 
 AND SCREENS. 
 
 Dr. Dawson Turner (Edinburgh) writes that everything 
 seems to depend upon the kind of glass of which the Crookes’s 
 tube is made. He has had several blown for him, both of the 
 correct focus and of other patterns, which he has exhausted 
 thoroughly—some so thoroughly that the electrical discharge 
 preferred a 3-incli or even 4-inch air gap rather than go 
 through the tube, and yet many of these tubes were quite 
 useless for skiagraphy because not made of the right sort of 
 glass. The right sort of glass to use is soft German contain¬ 
 ing no lead, and even of this there are many varieties, some 
 good and some bad. The least trace of lead is fatal because 
 of its opacity to the x rays. There can be little doubt that 
 the rays start from the kathode, receive reinforcement by 
 reflection from the anode, and are not generated at the surface 
 of the glass at all. He would therefore repeat the suggestion 
 of the employment after Lenard of a small aluminium window 
 inserted into the wall of the tube at the place where the rays 
 strike. Dr. Dawson Turner is experimenting in this direc¬ 
 tion. Dr. Turner finds tungstate of calcium quite as effective 
 as the platino-eyanides for the preparation of fluorescent 
 screens ; it certainly has the advantage of being enormously 
 cheaper. Using such a screen he has been able to get a 
 shadow of the vertebral column. This fact certainly places 
 the tungstate of calcium on a level with potassium platino- 
 cyanide, with which a similar experiment has been made. 
 
 THE CRYPTOSCOPE. 
 
 Dr. Lawson Russell finds that a very good modification of 
 the cryptoscope can be made in the following way. Rub down 
 the crystals of platino-cyanide of barium in a glass mortar, 
 wet the powder with absolute ether (0.720), then pour on 
 flexile collodion, mixing gently to avoid bubbles of air. Now 
 pour the fluid over the surface of a celluloid film, floating it 
 evenly over the entire surface, keeping the film moving till the 
 collodion dries. The film so prepared should, after drying, be 
 pressed against a glass plate of equal size, and kept in contact 
 with it by a light wooden frame, the coated surface towards 
 the glass. The frame is then fitted into the bottom of a box 
 (cardboard or wood); eyeholes are then pierced in the lid of 
 the box, and fitted with tubular eye-pieces. In making his 
 he has utilised portions of a binocular field glass, removing 
 the lenses. The celluloid film may be either quarter or half¬ 
 plate size, and glass of course to match; a quarter plate makes 
 the most convenient size to work with. The glass plate is 
 
998 
 
 The British "1 
 Medical JournalJ 
 
 THE BATTLE OF THE CLUBS. 
 
 [April 18, 1896. 
 
 towards the eye in using the instrument, and the uncovered 
 side of the celluloid film is towards the tube producing the 
 x rays, with the bottom of the box intervening. 
 
 With such an appliance it is possible to distinctly see the 
 following things : 
 
 1. A fine needle through the palm of the hand, laid trans¬ 
 versely to the metacarpal bones. The hand was that of an 
 adult. 
 
 2. A threepenny piece through a block of wood four inches 
 thick. 
 
 3. Surgical instruments through their cases (leather or 
 wooden) with the utmost distinctness. 
 
 4. The bones of the foot through a heavy-soled boot. 
 
 5. The bones of the fingers through a volume of the 
 British Medical Journal. 
 
 INJURIOUS EFFECTS ON THE SKIN. 
 
 Dr. L. G. Stevens draws attention to the fact that workers 
 on the new method often suffer from a variety of skin affec¬ 
 tions. In a case under his notice a gentleman, who had been 
 assiduously experimenting with the Roentgen x rays ever 
 since the announcement c£ their discovery, and who has been 
 working chiefly with the cryptoscope, called attention when 
 visiting his laboratory to the condition of his skin. The 
 upper and lower eyelids of both eyes, the alie nasi, and upper 
 lip were all swollen, and the seat of an erythema which was 
 not itchy but very painful. The affection was also present on 
 the hands and wrists, and on the prepuce. On the back of 
 the hands were some raised and hard spots. There was no 
 constitutional disturbance. This and the seat of the eruption 
 point conclusively to irritation as the cause of the eruption. 
 The substances with which he has been working are barium 
 platino-cyanide, potassium platino-cyanide, and tungstate of 
 calcium. 
 
 These facts have been observed before, but their true inter¬ 
 pretation is, perhaps, a little different from the conclusions 
 arrived at by Dr. Stevens. The same phenomena have been 
 observed by other workers, and by workers who have not been 
 using platino-eyanides. From this fact, and from the com¬ 
 munication already made to the British Medical Journal 
 on snow blindness, it seems more probable that the observed 
 rash is more of the nature of a sunburn. If this is so, it 
 seems to indicate the presence of x rays as a normal consti¬ 
 tuent of sunlight, as has already been asserted by Continental 
 observers. 
 
 THE LOCALISATION OF MURPHY’S BUTTON IN THE 
 INTESTINE. 
 
 The suggestion has been made to us that skiagraphy may 
 afford valuable information as to the position of Murphy’s 
 button after intestinal anastomosis. The new process is un¬ 
 doubtedly capable of proving the presence of the button in 
 the abdominal cavity, but it can give no accurate information 
 as to the particular piece of intestine in which the button is 
 lodged, and this for two reasons : First, no measure of depth 
 is given in a flat projection such as a skiagraph is, and, 
 secondly, owing to peristalsis, the locality of the piece of in¬ 
 testine within which the button lies is constantly liable to 
 alteration. Still, while not affording absolute localisation, 
 the new process is certainly capable of giving valuable in¬ 
 dications directing a proposed search. 
 
 ITS APPLICATION TO INJURIES AND DISEASES OF 
 THE LOWER LIMBS. 
 
 Dr. G. A. George (Bournemouth) writes: I have been for 
 some time working at the so-called “ new photography,” and 
 I am pleased to say with excellent results. Working with 
 the new focus tube of Messrs. Newton and Son, of Fleet 
 Street, London, I have obtained very good skiagraphs of 
 the hand, foot, wrist, and elbow-joint in three, three and 
 a-half, and four minutes for the hand, according to thickness, 
 in six minutes for the foot, in eight minutes for the wrist, 
 and in fifteen minutes for the elbow-joint of a pretty muscular 
 lad. 
 
 I was asked by a medical friend whether I could take a 
 skiagraph of a fractured femur accompanied with considerable 
 swelling of the limb in a muscular young man. My friend 
 did not feel perfectly satisfied, as on account of the swelling 
 and tenderness it was very difficult to be sure that the ends 
 
 of the fractured bone were in perfect apposition, and when 
 the patient’s friends suggested that an attempt should be 
 made to obtain a skiagraph of the seat of the fracture, he 
 very readily fell in with their views and asked me to under¬ 
 take it. 
 
 In order to get some information as to the length of time 
 required, I attempted on April 9th to obtain a shadow picture 
 of a portion of my own femur, and in an hour I succeeded, 
 but the result was very faint. The same evening I experi¬ 
 mented on the femur of a friend, and gave an hour and 
 a-quarter’s exposure. The result was unmistakable, but still 
 very faint. When I made an attempt to get a skiagraph of 
 the fractured femur on April 1 ith I gave an exposure of an 
 hour and three-quarters, and the result was as successful as 
 I could have hoped, considering the difficulties of the case. 
 The skiagraph showed that instead of the ends of the bones 
 being in apposition there was a longitudinal displacement of 
 an inch and a-half, and a transverse displacement of at least 
 half an inch. The picture also gave some information as to 
 the shape of the broken ends. My medical friend expressed 
 himself as more than satisfied with the result of the experi¬ 
 ment. 
 
 This application of the “ new photography ” is, I believe, 
 original, and suggests a wide field of usefulness for Professor- 
 Roentgen’s wonderful discovery. Many surgeons will doubt¬ 
 less avail themselves of the help of the x rays to satisfy them¬ 
 selves that they have done the best for their patients, and 
 probably many patients will be curious enough to seek to ob¬ 
 tain for themselves similar information. 
 
 SKIAGRAPHY IN BULLET WOUNDS AND FRACTURES 
 OF THE HAND. 
 
 Dr. Patrick S. O’Sullivan (Cork) sends us a good 
 skiagraph of a hand in which is embedded a bullet. 
 This skiagraph is interesting from the fact that it was ob¬ 
 tained by means of very simple apparatus. A G inch spark 
 coil and Roentgen’s pattern of tube, with an exposure of twenty 
 minutes. The carpal bones are clearly defined, and some 
 detail of bone structure is discernible. 
 
 Dr. Howard Sturge (Folkestone) sends a skiagraph taken by 
 Mr. J. W. Stainer, illustrating a case of compound fracture of 
 the terminal phalanx of the right index finger. The injury was 
 caused in December last by the finger being caught between 
 the chain and cog-wheel of a bicycle. The cog was forced 
 through the nail, fracturing the bone below. The joint was 
 uninjured. In six weeks the wound had healed, but some 
 displacement or enlargement of bone is felt, and there is some 
 pain on firm pressure, but it is difficult to be certain of any 
 abnormal movement. The exposure was for fifteen minutes, 
 five minutes having proved insufficient in a previous at¬ 
 tempt. 
 
 We have been asked to state that Dr. A. P. Laurie is the author of the 
 skiagraph illustrating Mr. John T. Leon’s case, published in the British 
 Medical Journal on April 4th. 
 
 THE BATTLE OF THE CLUBS. 
 
 Medical Men and Friendly Societies. 
 
 At the National Conference of Friendly Societies, held 
 recently in London, one of the subjects discussed was the 
 action of the medical profession towards the friendly societies, 
 and, according to the Friendly Societies' Recorder , the speaker 
 who introduced the matter “had many sympathetic listeners 
 to the charges he brought forward.” Another gentleman 
 “ spoke very strongly against the action of the doctors. He 
 said that whereas the doctors were their servants they were 
 fast becoming their masters, and every attention should be 
 paid to the question and a stop put to what was becoming an 
 anomaly.” Apparently to show the extent to which the 
 doctors will go in their claims, it is pointed out by the 
 Friendly Societies' Recorder that the friendly societies of Dundee 
 have hitherto paid their doctors 2s. 6d. a year for medicine 
 and attendance, and the doctors are now agitating for an 
 increase to 4s. 6d. ; that the Stockport doctors, who had also 
 accepted 2s. 6d., now demand 4s. 4d., and that the Trowbridge 
 doctors propose that working men earning 30s. a week, or 
 paying ^io a year rent, shall pay for their doctoring in the 
 ordinary manner. 
 
April 25, 1896.] 
 
 THE BATTLE OF THE CLUBS. 
 
 [ The British T n C O 
 
 Medical Journal AU jy 
 
 “4. That the Grand Jury thoroughly endorse the remarks of 
 the Deputy Recorder in his charge to them, and strongly urge 
 the immediate vaccination of all children, and revaccination 
 of adults as the only means of stamping out small-pox in the 
 city.” 
 
 This very clearly sets out what is needed, and if only the 
 advice given were seriously acted upon throughout the 
 country, we might ere long practically banish small-pox from 
 our midst. 
 
 THE BATTLE OF THE CLUBS. 
 
 Lincoln. 
 
 In the British Medical Journal of April 4th, p. 859, we 
 published a series of resolutions adopted at a meeting of the 
 medical practitioners residing in Lincoln specifying the rules 
 and scales of fees which ought to be adopted in all the 
 medical clubs under the Friendly Societies’ Act and in ali 
 medical aid associations. 
 
 The scale of fees has come in for some unfavourable com¬ 
 ment from correspondents of the Journal on the ground 
 that in certain instances the payments proposed are too low, 
 but the clubs in the city have rejected the very moderate 
 proposals made. The Oddfellows’ Medical Institute refuses 
 “either to accept the conditions or to recognise” the right 
 of the medical practitioners in Lincoln “ to dictate them.” 
 The Lincoln United Friendly Societies Dispensary has 
 declared “its inability to recognise in any way the mani¬ 
 festo of the medical men of Lincoln or any outside pressure 
 attempted to be put upon the committees of friendly 
 societies.” 
 
 This last resolution very clearly expresses the point upon 
 which we have insisted frequently. The managers of burial 
 clubs have got into the way of thinking that they are entitled 
 to dictate the terms upon which they are to receive the 
 services of medical officers. They seem to forget that if the 
 members of the societies have the right to combine to obtain 
 the services of medical men, medical men have a right to 
 combine in order to secure fair remuneration. 
 
 It is sincerely to be hoped that the medical profession will 
 combine to insist upon being parties to the bargain, and not 
 the mere servants of these organisations. We are informed 
 that Dr. D. Johnston, the senior medical officer of the Odd¬ 
 fellows’ Medical Institute, and Drs. Whitwell and W. J. 
 McDade, medical officers of the Lincoln United Friendly 
 Societies Dispensary, have sent in their resignations of these 
 offices, in consequence of the hopelessly unconciliatory cha¬ 
 racter of the resolutions adopted by the executives of the 
 clubs. We regret to hear a rumour that one medical officer 
 concerned has not so far carried out the understanding that a 
 refusal of the scale and rules by the clubs should entail the 
 severing of the connection of the medical officers with them. 
 We shall hope to hear from him that this rumour is unfounded. 
 
 The clubs will now probably cast about for new medical 
 officers to supply the places of those who have resigned. We 
 would earnestly invite any young medical men who may see 
 their advertisements to read the rules and scale of fees pro¬ 
 posed by the medical practitioners in Lincoln, published in 
 the British Medical Journal of April 4th, p. 859, and to 
 consider well before they allow themselves to be made pawns 
 in the Battle of the Clubs. 
 
 State Aid to Friendly Societies. 
 
 Mr. T. Wilson Parry (Youlgreave) suggests that in the same way as 
 Government subsidises education, so it might also furnish funds to 
 assist properly conducted Friendly Societies, and one of the conditions 
 of the grant might be that the doctor was adequately paid; that national 
 thrift and a provision for sickness and old age on the part of the in¬ 
 dustrial population are fully as important to the State as education, and 
 might very properly be assisted out of the national exchequer. He con¬ 
 cludes by saying: “ If the clubs themselves could be brought to see the 
 importance of a step like this, and, acting in unison, exert themselves to 
 importunately urge Parliament to give them suchgrants, they would not 
 only better themselves in an important and dignified way, but they 
 would greatly add to the position and to the respect they should have 
 for their medical officer.” 
 
 The suggestion is worthy of consideration, but the possibility of it 
 being carried out is scarcely in the vista of practical politics. 
 
 Donations and Bequests. —The late Mr. John Lysacht has 
 bequeathed /250 each to the Bristol General Hospital, the 
 Bristol Royal Infirmary, and the Bristol Dispensary, 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shuter Scholar of St. Bartholomew’s Hospital. 
 
 XI. 
 
 Cases of Tubercle of Bone.—Old Excisions .— Ununited Fracture. 
 
 —Fracture into the Knee.—Application to Field Surgery .— 
 
 Multiple Exostoses, etc. 
 
 I have to record this week several cases having features ’of 
 novelty. The following are those of greatest interest with 
 which I have been occupied at the request of the medical men 
 in charge of them : 
 
 Case of Suspected Calcified Tuberculous Glands in a Child. —A 
 good negative was obtained showing the pelvis and vertebral 
 column, but there was no evidence of any calcifications. This 
 case is interesting as showing the facility with which it is now 
 possible to obtain skiagraphs of the spinal column and pelvic 
 bones in subjects not too thick. 
 
 Case of Tuberculous Knee. —The excellent skiagraph obtained 
 showed a clear patch in the upper end of the tibia—pre¬ 
 sumably an abscess cavity. This opens up a new field of 
 usefulness in the diagnosis of abscess in bone. 
 
 Case of Fracture into the Knee-joint .—This case I did at the 
 Netley Hospital, and for the notes of it I am indebted to 
 Surgeon-Colonel Stevenson. It is hoped to publish the skia¬ 
 graph, together with full notes of the case and the result of the 
 treatment which the skiagraph indicated at a later date. 
 Surgeon-Colonel Stevenson writes: “A fracture of the femur at 
 about 3 inches above the condyles was produced in a man, 
 aged 33, by indirect violence. On the day after the accident I 
 examined the case, and found the signs of the injury at the 
 point above named to be very evident. There was no shorten¬ 
 ing, no depression of the upper end of the lower fragment 
 inco the popliteal space, and no increase of width across the 
 condyles. Ten days later Mr. Sydney Rowland made two 
 skiagraphs of the case, one from side to side, and another 
 from the front to the back, with an exposure of fourteen minutes 
 and ten minutes respectively ; at this time one inch shorten¬ 
 ing could be measured. From both pictures together the 
 condition of the fracture could be perfectly seen. The first 
 one, from side to side, shows the shortening and the partial 
 separation of the fragments, and the second shows a line of 
 splitting from the site to the fracture into the joint through 
 the intercondyloid notch. The advantage of the new photo¬ 
 graphy in this case, both as regards prognosis and treatment, 
 can hardly be overrated.” 
 
 Four Cases of Excision of Knee-joint and one of Excision of 
 Elboiv, under the care of Dr. Ward Cousins, were skiagraphed 
 by me at Portsmouth, showing the state of things some years 
 after operation. 
 
 A Case of Ununited Fracture of both Bones of Forearm in 
 which non-union was supposed to have been due to impaction 
 of soft tissue. The skiagraph here revealed unexpected con¬ 
 ditions, which will modify the further surgical proceedings, for 
 it showed great displacement and overlapping of fragments to 
 the extent of quite half an inch, without impaction of soft tissue. 
 
 THE VALUE OF THE NEW PHOTOGRAPHY IN 
 MILITARY SURGERY'. 
 
 The authorities of the Army Medical Department are taking 
 active steps to introduce the new method into use in 
 the approaching African expedition. The value of the method 
 for the discovery of bullets is undisputed ; the only diffi¬ 
 culties to be encountered in practical work being that 
 of so arranging the apparatus that the whole process may be 
 worked in a field hospital. But such difficulties are of the 
 nature of arrangement only, and can be overcome with a 
 little ingenuity. At Netley Hospital I attended on the 
 invitation of Surgeon-Colonel Stevenson, and gave a demon¬ 
 stration of the process and skiagraphed the case above 
 alluded to. I may be allowed to state that preparations are 
 in active progress and that in all probability a skiagraphic 
 outfit will form part of the equipment of future expedi tions 
 in which bullet wounds are to be dealt with. 
 
/ 
 
 The British 
 Medical Journ 
 
 THE NEW PHOTOGRAPHY. 
 
 LAi •R1L 25, 1896. 
 
 A CASE OF MULTIPLE EXOSTOSES. 
 The accompanying skiagraphs are from a 
 case of multiple exostoses under the care 
 of Dr. Dawson Williams at the Shadwell 
 Hospital for Children, who has furnished the 
 following notes: 
 
 The patient was a girl aged 9. There was 
 no history of any similar bony deformities in 
 previous generations, nor among her brothers, 
 of whom there are three. The child had 
 “rickets of the head” when an infant, but 
 walked early. When between 2 and 3 years 
 old she was treated for “dropsy” at King’s 
 College Hospital. The mother first noticed 
 lumps on the child’s legs about August, 1895, 
 and lumps and some distortion of the hands 
 in November. 
 
 The distribution of the exostoses is gene¬ 
 rally symmetrical, but their size and form do 
 not correspond completely on the two sides. 
 The largest is on the right femur, about 3 
 inches above the knee-joint. On palpation 
 it appeared to occupy the inner and posterior 
 aspect, and to be rounded in form with a 
 broad base. The skiagraph shows, however, 
 that it is conesliaped, and also that there is 
 another similar growth on the outer side, 
 just above the epiphysis. 
 
 It is noticeable that both these growths 
 appear to have been somewhat more trans¬ 
 parent to the x rays than the shaft of the 
 bone. On the left femur, on the inner as¬ 
 pect, about 2 inches above the inner con¬ 
 dyle, a smaller growth can be felt. 
 
 The skiagraph shows also a bony nodule 
 on the inner aspect of the right tibia, a little 
 below the internal tuberosity, and there is a 
 similar but much smaller nodule at the 
 corresponding part of the left tibia. There 
 are also three small nodules at the base of 
 the inner malleolus on this side. 
 
 On the inner aspect of the left humerus, 
 about an inch below the head, are two 
 nodules, the lower rather posterior to the 
 upper, connected by a ridge. On the right 
 humerus is a single nodule corresponding 
 to the lower of the two nodules on the other 
 side. A small sharp-pointed nodule is to 
 be felt on the left ulna, on its inner as¬ 
 pect, most easily recognised when the hand 
 is midway between pronation and supination. 
 It was not noticed when the child was 
 first seen, and she believes that it has made 
 its appearance since the attack of illness 
 mentioned below. 
 
 The hand shown in the other skiagraph 
 from this case presents an interesting de¬ 
 formity of which the cause is clearly dis¬ 
 played. At the base of the first phalanx of 
 the little finger is a bony growth which has 
 displaced the whole finger inwards, and it is 
 curious to note that a compensatory curve at 
 the last interphalangeal joint appears to 
 have been established. This exostosis also 
 is seen to have been more transparent than 
 the rest of the phalanx. This fact seems 
 to render it probable that the growth is com¬ 
 posed of cancellous tissue. There is_ also 
 some overgrowth connected with the inner 
 aspect of the first phalanx of the index 
 finger, which has displaced the two terminal 
 phalanges outward. There is a similar de¬ 
 formity to be felt at the outer side of the 
 base of the middle phalanx of the middle 
 finger on the opposite side. 
 
 This skiagraph of the hand shows very 
 well the condition of ossification at tins age 
 (9 years). In particular the epiphysis at the 
 proximal extremity of the metacarpal bone of 
 
April 25, 1896.] 
 
 THE NEW PHOTOGRAPHY. 
 
 T The British 
 I Medical -Journal 
 
 1061 
 
 the thumb is very conspicuous. It is seen, also, 
 that the epiphysis of the proximal phalanx of 
 the little finger is not involved in the exostosis, 
 which has, in fact, formed a spur on the outer 
 side, so that the epiphysis lies in a kind of cup. 
 In the wrist the bones which are largest and 
 possess most nearly their adult form are the os 
 magnum, the unciform, and the cuneiform. In 
 all these bones the ossification begins before the 
 third year (first, second, and third years respec¬ 
 tively). The semilunar and trapezium, in which 
 ossification begins in the fifth year, are small and 
 have not their characteristic form and shape. The 
 diminutive size of the scaphoid bone, which begins 
 to ossify in the eighth year, is striking, while the 
 pisiform in which ossification does not commence 
 until the eleventh or twelfth year does not show 
 at all in the skiagraph. The trapezoid bone is 
 more conspicuous than in most skiagraphs of the 
 wrist, and larger than might have been expected 
 in view of the fact that ossification does not usu¬ 
 ally commence in it until the eighth or ninth 
 year. It is interesting to compare the condition 
 of the wrist in this skiagraph with that shown in 
 the wrist of the infant of whom a skiagraph was 
 published in the British Medical Journal of 
 March 28th. In the infant there are no signs of 
 any ossification in the wrist, nor are the lower 
 epiphyses of the radius, and ulna visible, whereas 
 in the wrist of the child they are of considerable 
 size. 
 
 When first seen on December 4th, 1895, the child 
 was suffering from adenoid growths of the pharynx, 
 and these were removed a few days later. Shortly 
 afterwards she was taken ill and came under the 
 treatment of Dr. H. C. Powell, of Forest Gate, 
 who has been good enough to furnish the follow¬ 
 ing notes: “She was complaining of pain in all 
 her joints, especially the knees and ankles; any 
 movement caused her great pain ; these joints were 
 also swollen. She had a temperature of 102°. She 
 remained in this condition for about a week when 
 the temperature began to fall, and the pains get¬ 
 ting less severe she gradually recovered, and at 
 the end of about three weeks was nearly well. 
 During the first week it was almost impossible to 
 move the child in bed, as it caused her so much 
 pain. During the illness I did not detect any 
 heart mischief. I do not know if this organ bears 
 any evidence of her illness now, as I have not seen 
 her since. Under the usual treatment for rheuma¬ 
 tism she soon got well. I have not attended the 
 child for any other illness.” Though there are 
 no grounds for connecting this attack either with 
 the operation or the multiple exostoses, its oc¬ 
 currence appears to be worthy of record. It may 
 be added that the exostoses do not appear to 
 bear any relation to the points of insertion of 
 muscles. 
 
 In answer to numerous applications for prints 
 of his skiagraphs, Mr. Sydney Rowland wishes to 
 state that he has handed all his negatives to the 
 London Stereoscopic Company, from whom prints 
 may be obtained. 
 
 The French Ophthalmological Society will hold 
 its annual meeting this year in Paris on May 4th 
 and three following days. 
 
 .Medical Magistrate.— Mr. Thomas Beamish, M.R,C.P.I. 
 has, on the recommendation of the Earl of Brandon been 
 appointed to the Commission of the Peace for the county of 
 Cork. 
 
 Presentation.— At a recent meeting of the Nelson Branch 
 of the New Zealand Medical Association, Mr. G. H. Cressey, 
 M.R.C.S., L.R.C.P., who for more than nine years had acted 
 as Honorary Secretary, was presented, on his leaving for 
 England, with two handsome silver gilt fruit dishes, bearing 
 a suitable inscription. 
 
 Dr. J. A. MoLONEy, formerly Medical Officer of the Stairs 
 Expedition to Katanga, has just returned to England on the 
 completion of his expedition to the hitherto unexplored por¬ 
 tions of the Chartered Company’s territories in Northern and 
 Southern Augoniland, to the west of Lake Nyassa. He did 
 not find it necessary to fire a single shot during the whole of 
 his journey. The territory had been visited by Dr. Living¬ 
 stone, and is inhabited principally by people of Zulu origin, 
 who have conquered the original inhabitants. Powerful 
 chiefs rule the country. 
 
/ 
 
 1062 
 
 The British I 
 Medical Journai | 
 
 ASSOCIATION INTELLIGENCE. 
 
 LITERARY NOTES. 
 
 Sir B. VV. Richardson is about to bring out, through Messrs. 
 Longman, a species of autobiography containing his reminis¬ 
 cences of his professional life and an account of some of the 
 aims of his career. There will be added a number of essays 
 on scientific and philosophical themes. 
 
 A new cheap edition of Home Nursing and How to Help in 
 Cases of Accident, by Samuel Benton, L.R.C.P., M.R.C.S., has 
 just been published by Messrs. Abbott, Jones, and Co. 
 
 We have delayed too long calling attention to the 
 appearance of the eighth issue of the Annual of the Universal 
 Medical Sciences, edited by Dr. Charles E. Sajous. It forms 
 five large octavo volumes, and is by far the most comprehen¬ 
 sive annual published in the English language, if, indeed, it 
 would be possible to find its parallel in any other language. 
 The editor announces various changes in his staff of associate 
 editors and contributors, and, in fact, the first article in the 
 Annual, that on Diseases of the Lungs and Pleura, has been 
 undertaken by Professor Wilson, of Philadelphia, with the 
 collaboration of Dr. Eshner, of the same city. A special 
 feature of the Annual is the number of excellent woodcuts 
 and lithographs by which it is illustrated. The series is one 
 which should find a place in every library of reference, and 
 will be found extremely useful also by practitioners. 
 
 ASSOCIATION INTELLIGENCE. 
 
 NOTICE OF QUARTERLY MEETINGS FOR 1896. 
 
 ELECTION OF MEMBERS. 
 
 Meetings of the Council will be held on July 8th and 
 October 21st, 1896. Candidates for election by the Council 
 of the Association must send in their forms of application to 
 the General Secretary not later than twenty-one days before 
 each meeting—namely, June 18th and October 1st, 1896. 
 
 Any qualified medical practitioner, not disqualified by any 
 by-law of the Association, who shall be recommended as 
 eligible by any three members, may be elected a member by 
 the Council or by any recognised Branch Council. 
 
 Candidates seeking election by a Branch Council should 
 apply to the Secretary of the Branch. No members can be 
 elected by a Branch Council unless their names have been 
 inserted in the circular summoning the meeting at which 
 they seek election. 
 
 Francis Fowke, General Secretary. 
 
 LIBRARY OF THE BRITISH MEDICAL 
 ASSOCIATION. 
 
 Members are reminded that the Library and Writing Rooms 
 of the Association are fitted up for the accommodation of the 
 members in commodious apartments, at the offices of the 
 Association, 429, Strand. The rooms are open from ioa.m. to 
 5 p.m., Saturdays, 10 a.m. to 2 p.m. Members can have their 
 letters addressed to them at the Office. 
 
 BRANCH MEETINGS TO BE HELD. 
 
 Metropolitan Counties Branch. —A meeting of this Branch will be 
 held at the Geological Museum, Jermyn Street, on Tuesday, May 12th, 
 1896, at 8.30, subject—The Amendment of the Laws relating to Certificates 
 of Death and Coroners’ Inquests.— Andrew Clark and Isambard Owen, 
 Honorary Secretaries. 
 
 South-Eastern Branch : East Surrey District. —The next meeting 
 will be held at the Greyhound Hotel, Croydon, on Thursday, May 14th, at 
 4 p.m. ; W. Rosser, M.D., of Croydon, in the Chair. Dinner at 6 p.m.; 
 charge, 7s., exclusive of wine. All members of the South-Eastern Branch 
 are entitled to attend, and to introduce professional friends. Agenda : 
 The Adoption of the Duties of Medical Defence by the British Medical 
 Association. The Civil Rights Defence Committee. Mr. William Ander¬ 
 son : The Surgical Treatment of Lupus and Tuberculous Disease of the 
 Skin. Mr. Sydney Rowland, B.A. : Demonstration on Skiagraphy.— 
 Henry J. Prangley, Honorary Secretary, Tudor House, Anerley, S.E. 
 
 South-Eastern Branch : West Sussex District.— The next meeting 
 of this District will be held at the Worthing Infirmary on April 30th, at 
 3.30 P.M. Dr. Charles Arkle (London) will read a paper on the Open-Air 
 Treatment of Phthisis. Dr. Morris (Bognor) will read notes on two cases 
 of Rare Nervous Disease. Mr. W. S. Simpson (Worthing) will read notes 
 of a case of Internal Strangulation of the Bowel. A communication on 
 the subject of Medical Defence will be read and the resolution sub- 
 
 [ April 25, 1896. 
 
 mitted : “ That it is desirable that the duties of medical defence be under¬ 
 taken by the British Medical Association.” Dinner will be at the Marine 
 Hotel, Worthing, at 6 p.m. — Frank Hinds, Honorary Secretary, Worthing. 
 
 South-Eastern Branch : East Sussex District.— The next meeting 
 will be held at the Queen’s Hotel, Eastbourne, on Tuesday, May 12th, at 
 3.30 p.m. Dr. A. P. Sherwood will preside. Notice of papers, etc., should 
 be sent to the Honorary District Secretary, J. W. Batterham, Bank 
 House, Grand Parade, St. Leonard's. 
 
 North of England Branch. —The spring meeting will be held at 
 Durham on Thursday, May 21st, at 4.30 p.m. The questions of medical 
 defence, and of a local ethical committee will be taken up. Members 
 wishing to exhibit patients or specimens, or to read papers, are requested 
 to send notice to the Honorary Secretary of the Branch. The dinner 
 after the meeting will take place at the Ceunty Hotel at 6 p.m. ; 6s 6d. 
 each, exclusive of wine.— G. E. Williamson, F.R.C.S., Honorary Secre¬ 
 tary, 8, Eldon Square, Newcastle-on-Tyne. 
 
 South Wales and Monmouthshire Branch. —The spring meeting 
 will be held at Tenby on Saturday, May 16th. Notices of motion, papers", 
 etc., to be sent in before Thursday, April 30th. —Alfred Sheen, M.D. ; 
 D. Arthur Davies, M.B., Honorary Secretaries. 
 
 Shropshire and Mid-Wales Branch.— The spring meeting of this 
 Branch will be held at the Salop Infirmary on Tuesday, May 12th, at 
 3 p.m. Members who wish to bring forward any business, to read papers, 
 to showcases or specimens, or to propose any new members are requested 
 to communicate with the Honorary Secretary not later than Friday, 
 May 1st.—H. Willoughby Gardner, Honorary Secretary, Shrewsbury, 
 
 Bath and Bristol Branch.— The fifth ordinary meeting of the Session 
 will be held at Bath on Wednesday evening, April 29th, at 7.30, Carey 
 Coombs, M.D., President. The Branch will be invited to express an 
 opinion on the question whether medical defence shall be undertaken by 
 the Association (vide British Medical Journal, February 8th, 1896, pages 
 348 and 353). The following communications are expected:—Dr. G. A. 
 Bannatyne and Dr.£F. R. Blaxall: Specimens and Cultures of the Bacilli 
 of Rheumatoid Arthritis. Dr. Preston King: Classification in Chronic 
 Joint Affections. Mr. S. E. Rigg: (1) Intussusception with Specimen; 
 (2) Spina Bifida witli Specimen.—W. M. Beaumont (Bath) and J. 
 Michell Clarke (Clifton), Honorary Secretaries. 
 
 ABERDEEN, BANFF, AND KINCARDINE BRANCH. 
 An ordinary general meeting of the Branch was held at 
 Aberdeen on April 15th, Professor Stephenson in the chair. 
 
 New Members. —Dr. H. M. W. Gray, Royal Infirmary, and 
 Dr. W. Rattray Pirie, 49, Holburn Street, were balloted for 
 and unanimously admitted members of the Branch. 
 
 The Neio Photography. —A few items of business having 
 been disposed of, Dr! M‘ Kenzie Davidson gave a further 
 demonstration of the Roentgen skiagraphy. He first showed 
 the Newton focus tube and described its method of action. 
 A large number of skiagraphs was then exhibited, including 
 plates showing needles, pieces of glass, and bullets which 
 had been localised and successfully removed. Very interest¬ 
 ing plates were shown of a fractured cervix femoris, and of 
 bullets in the head of a cadaver. Dr. Davidson also exhibited 
 several views of normal and diseased joints and hands of two 
 children, aged 7 and 8 years, showing the epiphysial cartilages 
 and varying degrees of ossification of the carpal bones. He 
 then exhibited fluorescent screens of potassium platino- 
 cyanide, of crystallised tungstate of lime artificially pre¬ 
 pared, and of slieelite, the latter two being much inferior to 
 the platino-cyanide in luminosity. The members had an 
 opportunity of seeing the bones of the hand and forearm 
 through the screens. 
 
 Vote of Thanks. —On the motion of the Chairman, a cordial 
 vote of thanks was awarded to Dr. M‘Kenzie Davidson for his 
 very interesting demonstration. 
 
 ABSTRACT OF PROCEEDINGS OF COUNCIL. 
 
 At a numerously attended meeting of the Council, held in 
 the Council Room at the offices of the Association, 429, 
 Strand, W.C., on Wednesday, April 15th, 1896, Dr. Ward 
 Cousins, President of the Council, in the Chair, it was 
 Resolved: That the financial statement for the year ending 
 December 31st, 1895, as certified by the auditors, be approved 1 
 and published in the British Medical Journal in accord¬ 
 ance with By-law 26. 
 
 \The remainder of the Proceedings of the Council ivill appear in 
 a future number of the British Medical Journal.] 
 
May i 6, 1896.J 
 
 THE NEW PHOTOGRAPHY. 
 
 [ The British 1 9 9 C 
 
 Medical Journal 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Shuter Scholar of St. Bartholomew’s Hospital. 
 
 XII. 
 
 Demonstration of a Bone Abscess. 
 
 The following case, under the care of Mr. R. W. Parker of 
 the German Hospital, is one, I venture to think, of novelty 
 and of unusual interest, and shows the value the new method 
 will have in diagnosing and locating carious areas in bone. 
 Mr. Parker has kindly sent the following note : 
 
 “ Taken from a boy suffering from what appeared to be a tuber¬ 
 culous elbow-joint. The skiagraph revealed disease of theupper 
 
 Skiagraph showing (Janes ol Ulna (Sydney Rowland). 
 
 end of the ulna. The subsequent operation confirmed what the 
 skiagraph indicated, namely, a defect in the bone of the size 
 of a large almond, filled with carious d-ebris, exactly in the 
 position shown; the joint was apparently free.” The important 
 points in this case are(i) that the presence of the defect in the 
 bone was not suspected; (2) that the diagnosis was indicated 
 entirely by the skiagraph, and that subsequent operation 
 entirely confirmed this. 
 
 The skiagraph which is reproduced herewith shows very 
 clearly the appearance which such a carious area presents. 
 The fact that lesions of this character are clearly indicated by 
 the new method opens up a very wide field of usefulness, 
 and I have already had the opportunity of skiagraphing 
 other cases of a similar nature with equally satisfactory 
 results, such as abscesses due to carries of spine under the 
 charge of various surgeons, who have brought them to me 
 with the desire of having the assistance of the new method in 
 their diagnosis. In cases not well marked it requires some 
 
 experience to distinguish between light areas due to disease 
 and similar areas due to the intrinsic structure of the bone, 
 but when the skiagrapliic appearance of the various bones of 
 the body is once familiar, there is not much risk of error. 
 
 Recent Developments. 
 
 There are now so many workers engaged in investigating 
 the physical properties of the x rays, and such a large litera¬ 
 ture has already grown up in connection with them, that it 
 is very difficult to select from and condense the numerous 
 papers that have appeared without running grave risk 
 of omitting what in the end may turn out to be the 
 most important. The following summary contains, it is 
 hoped, a fair selection of the work that has recently been 
 done. 
 
 Much of the work has been directed towards reducing the 
 exposure necessary for skiagraphing deeper parts. Winkel- 
 mann and Straubel of Jena have found that by backing the 
 plate with an inexpensive material they are able to obtain 
 negatives of the finger bones in about ten seconds, using a 
 3-inch spark. It is very difficult to judge from this report 
 how far these observers have succeeded. It is first necessary 
 to know what variety of Crookes’s tube was employed. With 
 the focus tube the same result is quite possible, and Dr. 
 Macintyre has gone further and obtained a fair negative with 
 a single flash obtained by one vibration of a mercury com¬ 
 mutator. In this connection, too, it may be noted that all 
 forms of tubes which I have examined work with a far 
 greater intensity for the first few seconds, after which they 
 fall off to a much lower standard. What the explanation of 
 this phenomenon is is not quite clear; it may be that the 
 molecules, after the tube has been resting, are uniformly 
 distributed through the tube, and so are more available for 
 the bombardment, whereas after the tube has been in action 
 for some time this state of things changes into a less favour¬ 
 able one. 
 
 New Methods of Shortening the Exposure. 
 
 Much of the work in shortening the exposure has been 
 directed along the lines of placing a fluorescent screen either 
 in front of or behind the plate, and results in this direction 
 seem more promising. From the fact that it is possible to 
 obtain several records of the same object by using in place of 
 the photographic plate a pile of rapid bromide paper it is 
 evident that very little of the energy of the rays is absorbed 
 in effecting the change in the silver salt which produces the 
 image. If we can save the extra energy which is thus wasted 
 when a single plate is used it is obvious that the time of ex¬ 
 posure must be considerably shortened. Fluorescent screens 
 seem the most effective means of doing this. The only 
 drawback at present is that the substances of which they are 
 composed are at present so expensive that to make a screen 
 large enough for a 10x8 plate would cost a sum that few 
 would care to pay. Edison’s calcium tungstate has not 
 yielded such good results in this country as the original 
 platino-cyanide screens. Some substance easily prepared, 
 cheap, and permanent, which will fluoresce under the in¬ 
 fluence of x rays, is most urgently needed at present. 
 
 Some Successful Applications of the Method. 
 
 Numerous reports have come to hand of cases successfully 
 diagnosed by the help of the new method. They are too 
 numerous to publish in full, but the following extracts will 
 indicate the class of cases in which most benefit is being 
 derived : 
 
 G. E. Williamson, M.A., F.R.C.S., Surgeon to the Royal 
 Infirmary, Newcastle-on-Tyne, sends notes of a case of which 
 Mr. Havelock and Professor Stroud produced the skiagraph. 
 The skiagraph represents the appearance of a tibia some 
 years after excision of the shaft, and bears testimony to the 
 completeness with which the bone has been reformed. This 
 case opens a new field for the use of the x rays. It is quite 
 possible and may be found most useful to examine periodic¬ 
 ally, either by the screen or skiagraph, the progress being 
 made in similar cases and the rate at which new bone is 
 being formed. 
 
 Dr. L. Howard Sturge, Folkestone, sends an excellent 
 skiagraph of a hand showing very clearly a fracture of the 
 terminal phalanx of the first finger. This skiagraph shows 
 beautifully the detailed structure of the bones, the rays 
 
1226 
 
 The Bpitish “| 
 Medical JournalJ 
 
 OBSTETRIC HOSPITALS AND MIDWIVES. 
 
 [May i 6 , 1896. 
 
 having traversed the bones entirely and revealed their 
 internal condition. 
 
 Dr. G. W. Tawse, Whitehaven, sends a skiagraph of a foot 
 in which a needle is embedded. By the aid of the picture 
 the needle was removed under ethyl chloride. 
 
 Dr. Thelwall Thomas, Liverpool, also sends a similar case 
 in which a needle was removed from the hand by the aid of a 
 skiagraph after a fruitless search had been made with the 
 ordinary means. 
 
 From Mr. Walter Ridley, F.R.C.S., of the Royal Infirmary, 
 Newcastle-on-Tyne, comes the report of a successful removal 
 of a fragment of metal embedded in the hand. 
 
 For the information of numerous correspondents who ask 
 which is the best form of battery for use in working coils, I may 
 say that my experience has decided in favour of the Lithanode 
 •element; the electromotive force is exceedingly constant, 
 and, the internal resistance being very low, enables the bat¬ 
 teries to be discharged at very high rates, without any mate¬ 
 rial variation in the potential. Another point in their favour 
 is that for unit capacity they are lighter and smaller than any 
 other accumulator with which I am acquainted. Owing to 
 the form of construction, there is little or no local action in 
 the elements, and therefore the cells will retain their current 
 for a very long time. One other point in their favour is that 
 the discharge is exceedingly uniform, and there is practic¬ 
 ally no variation in the potential during the whole of the dis- 
 oharge. 
 
 Sir, —In the British Medical Journal for February 29th, 
 51896, p. 559, in a letter on “ Therapeutic Use of Roentgen's 
 Rays,” Professor Sheridan Del6pine concludes that the x rays 
 have not much germicidal action, because various organisms 
 in test tubes were not affected by them. Does this evidence 
 warrant the conclusion, considering the fact that the glass of 
 which the tubes are made would almost entirely prevent the 
 transmission of the rays ?—I am, etc., 
 
 Nottingham Place, W., April 7th. T. WAKEFIELD. 
 
 IMPROVEMENTS IN ROENTGEN’S PHOTOGRAPHY. 
 
 Sir,- -It is highly desirable that the exposures necessary 
 for obtaining good results by means of Roentgen’s photo¬ 
 graphy when applied to the human body should if possible be 
 reduced. This is not so important when it is merely a ques¬ 
 tion of photographing the extremities, for which the neces¬ 
 sary exposures are in any case now not very prolonged. Even 
 in these instances in the case of children shorter exposures 
 would be an advantage, but the question of reducing the ex¬ 
 posures becomes of real importance, more especially in con¬ 
 nection with the thicker portions of the body. Indeed, in 
 order to ensure convenience and certainty in detecting 
 •calcareous deposits in the interior organs for photographing 
 the spine and such-like purposes, a considerable reduction in 
 the exposures now required is a sine qua non. 
 
 Happily there is every prospect 01 great improvements in 
 this respect. The chemical action of the Roentgen rays upon 
 a photographic film may be either a direct action or may be a 
 secondary effect, due to fluorescence of the film itself or of its 
 support. In either case only a very small portion of the 
 energy in the rays is photographically utilised under 
 •ordinary circumstances. This is clear, from the fact that a 
 large number of photographs may be taken at once by 
 means of superimposed films, and also by the fact that if 
 .a photographic film mounted on celluloid be observed 
 through a cryptoscope, it will be seen to be exceedingly 
 transparent. 
 
 Nearly three months ago, in some remarks that I made at 
 the close of Mr. Porter’s demonstration at University College 
 on January 30th, I suggested as a means of more completely 
 utilising the energy of the rays, and thereby shortening the 
 necessary exposure, the use of suitable fluorescent material 
 applied either in the form of a screen behind the photographic 
 ■film, or introduced into the substance of the film itself. 
 
 Since then I have made numerous experiments in the 
 ■direction indicated, and some weeks ago obtained conclusive 
 •evidence that by means of a screen thickly coated with potas¬ 
 sium platino-cyanide and gum, placed behind a celluloid 
 photographic film, the necessary exposure could be greatly 
 reduced; also that in a less degree the same result could be 
 
 obtained by the similar employment of a screen coated with 
 powdered fluorspar. 
 
 The chief objection to this method lies in the fact that it is 
 very difficult to avoid granular results. Unless the fluores¬ 
 cent material be in a finely-divided condition its grain shows 
 distinctly, and marks the detail of the finished picture. The 
 platino-cyanide does not work so efficiently when finely 
 powdered as when in moderately coarse crystals, but good 
 results can be obtained by thickly coating a thin celluloid 
 film with an emulsion of this salt ground to fine powder in 
 collodion, and using the screen so prepared with its celluloid 
 surface in contact with the sensitive surface of the photo¬ 
 graphic film. I have obtained considerably better results 
 with a finely-ground sample of tungstate of calcium, pre¬ 
 pared for me by Messrs. Hopkins and Williams. This may 
 be used either in loose powder, or made up with gum into a 
 paste and dried. With this substance it is easy to obtain 
 sharp and fully-exposed negatives of the hand in from five to 
 ten seconds with a moderately-excited tube, with which 
 with ordinary arrangements one to two minutes’ exposure 
 would be necessary. 
 
 I have also tried some special plates prepared for me by 
 Messrs. Marion into the sensitive emulsions of which fluores¬ 
 cent substances such as powdered fluorspar and calcium 
 tungstate were introduced before application to the glass. 
 Though the results so far obtained by this method are not 
 very satisfactory owing to granularity, the presence of the 
 fluorescent substance in the photographic film appears un¬ 
 doubtedly to increase its sensitiveness to the rays. Apart 
 from the question of granularity, the introduction of fluores¬ 
 cent material into the film does not appear to take away the 
 sharpness of the result, and the same may be said with regard 
 to the application of a fluorescent screen behind the film 
 vided the surface of such a screen is even, and is in very close 
 proximity to the sensitive gelatine. No doubt much experi¬ 
 menting remains to be done in order to obtain the best pos¬ 
 sible results.—I am, etc., 
 
 Victoria Street, S.W., April 22nd. A. A. C. SwiNTON. 
 
 OBSTETRIC HOSPITALS AND TREATMENT BY 
 MID WIVES. 
 
 A meeting of the members of the medical profession in 
 Liverpool and the neighbourhood was held at the Medical 
 Institution on May nth, to consider the subject of the 
 Ladies’ Charity and Lying-in Hospital, and the recent posi¬ 
 tion taken by the Committee of the institution, which has 
 involved the resignation of the entire medical staff. Up¬ 
 wards of 200 practitioners were present. The debate was of 
 an animated character ; all the speakers were unanimous in 
 condemning the action of the Board of Management; any 
 difference of opinion that was expressed having reference 
 only to the exact wording of the resolutions which should be 
 submitted to the meeting. The resolutions, which were 
 finally approved and carried with only one dissentient, who 
 agreed on the main principle, were as follows : 
 
 1. That this meeting of the medical profession views with much indigna¬ 
 tion the recent action of the Board of Management of the Ladies’ Charity 
 towards the medical staff of the charity, and desires to express its warm 
 approval of the action of the staff in refusing to hold office under the con¬ 
 ditions proposed to them. 
 
 2. That this meeting trusts that while the present regulations are in 
 force at the charity no member of the medical profession will accept office 
 at that institution, or will give assistance on or after May 19th to its 
 officials either gratuitously or for gain, thus rendering the Board of 
 Management responsible to the public and to the law for any dangerous 
 consequences that may occur to patients treated by its officials. 
 
 The resolution was proposed by Mr. W. M. Banks and 
 seconded by Mr. W. H. Manifold. 
 
 The latter clauses of the second resolution, it was explained 
 by Mr. Banks, are not intended to debar any practitioner 
 from rendering aid to any woman in labour who is being at¬ 
 tended by a midwife in the service of the charity if he is 
 sent for either by the patient herself or her friends. The 
 clauses are necessary to prevent the Board of Management 
 from attempting to carry on their district work without ap¬ 
 pointing any regular medical officers, relying on the assist¬ 
 ance of any practitioner the midwife may choose to call to 
 
June 6 , 1896.] 
 
 THE NEW PHOTOGRAPHY. 
 
 [ The British 
 Medical Journal 
 
 141 I 
 
 visiting the Grey Mare’s Tail and St. Mary’s Loch, where 
 lunch will be provided, and two hours allowed to inspect the 
 beauties of the district. On returning to Moffat the Moffat 
 Hydropathic Company will entertain the party to dinner in 
 the Hydropathic Institution at 6 o’clock. Afterwards the 
 party will return to Carlisle by train. 
 
 REPORT ON THE APPLICATION OF THE NEW 
 PHOTOGRAPHY TO MEDICINE AND 
 SURGERY. 
 
 [Report to the British Medical Journal.] 
 
 By SYDNEY ROWLAND, B.A., 
 
 Late Sliuter Scholar of St. Bartholomew’s Hospital. 
 
 XIII. 
 
 An Improved Form of “Focus” Tube. 
 
 After several experiments I have been able to introduce a 
 modification in the present form of the “ focus” tube which, 
 I think, is of considerable advantage. It consists in replacing 
 
 the platinum reflecting plate in the usual form of tube by a 
 paraboloid of polished platinum, pierced at one side with a 
 small aperture. By this means the large amount of wasteful 
 scattering of rays from the platinum plate is very much re¬ 
 duced. When working, the glass opposite the open end of 
 the paraboloid is seen to fluoresce, within a circumscribed 
 area, with a brilliant green fluorescence, the rest of the 
 tube remaining nearly dark. Working with a fluorescent 
 screen there is, I find, a very solid gain in its brightness. 
 A corresponding gain is found when photographic plates are 
 used. 
 
 Recent Applications. 
 
 Among the cases under the charge of various practitioners 
 which I have recently had the opportunity of skiagraphing, 
 and in which new features are present, are the following : 
 
 A case of obscure injury to the foot caused by a fall from a 
 height onto the feet. This case, which had previously been 
 unsuccessfully dealt with elsewhere, turned out to be a down¬ 
 ward displacement of the cuboid bone, a diagnosis of great 
 clinical nicety. 
 
 A case in which it was important to confirm the absence of 
 bony displacement or lesion of the shoulder-joint. Here the 
 skiagraph showed the Absence of any bony mischief, and 
 saved the patient from the hands of a bonesetter. This is a 
 class of case in which the new method ought to prove of the 
 utmost value. A similar case having a medico-legal bearing, 
 but of which it is not advisable to speak of in greater detail 
 at present, indicates another line along which further develop¬ 
 ments may be expected. 
 
 A series of cases of club foot. This series, which I am 
 skiagraphing for Mr. R. Barwell, F.R.C.S., will be published 
 separately when completed. 
 
 Results by Workers in England. 
 
 The amount of material communicated by practitioners 
 shows no sign of abatement. [It is quite impossible to pub¬ 
 lish in full the whole of this.— Ed.] The following cases 
 have been received. 
 
 Dr. J. Kerr Love sends three skiagraphs of deformity of 
 t he hands and feet. The cases are from the Glasgow Insti¬ 
 tution for the Deaf and Dumb, and “ illustrate the kind of help 
 the new photography may be expected to give in diagnosis 
 and treatment of deformity.” 
 
 Dr. James Taylor, of Chester, sends two cases of injury to 
 the wrist. Dr. Taylor describes them as unusual, and can 
 find no similar case described. 
 
 Dr. Edwards Phillips, of Coventry, sends skiagraphs 
 illustrating a point of interest in fractures of metacarpal 
 bones. The skiagraphs were taken by Dr. Hall Edwards. 
 
 Dr. G. W. IT. Tawse, of Whitehaven, sends skiagraphs of a 
 needle in the foot, indicating its position with great exact¬ 
 ness. 
 
 Some of these it is hoped to publish as opportunity may 
 arise. 
 
 Errors of Interpretation. 
 
 Not a little experience is required successfully and cor¬ 
 rectly to interpret the skiagraphic appearance of a part in all 
 cases. Omitting the difficulty of resolving a flat projection, 
 such as a skiagraph is, into a solid structure, and such diffi¬ 
 culties as arise from distortion due to varying distances from 
 the photographic plate, which difficulties are a matter of 
 anatomical knowledge, there remain certain appearances which 
 are very difficult of explanation, and which, if hastily acted 
 upon, might lead to serious results. 
 
 In one case a medical man of middle age came to me for a 
 skiagraph of a certain region of the abdomen. He had been 
 suffering from symptoms which had been variously referred 
 to renal and intestinal causes. On a skiagraph being ob¬ 
 tained a buckle was found clearly to have cast an image on 
 the plate. Thinking some mistake had arisen I again skia- 
 graphed the region, and with the identical result. And the 
 same appearance resulted in five successive plates. The con¬ 
 clusion was almost inevitable, from a skiagraphic point of 
 view, that the subject had swallowed the buckle, and that it was 
 present in the intestine at the time of taking the skiagraph. 
 Such a possibility seemed too remote to be true, and no 
 immediate steps were taken. Some weeks afterwards another 
 attempt was made, and this time nothing abnormal was dis¬ 
 covered. Evidently the particular batch of plates used had 
 in some unknown manner been impressed with the image of 
 the buckle. Had steps been taken on the strength of the 
 appearances it might have led to an unnecessary operation. 
 
 Another class of cases are those in which iodoform has been 
 used for dressing or injection in the form of an emulsion. 
 Iodoform I have found is very opaque to x rays, and may thus 
 lead to very erroneous interpretations. I have had two cases 
 of a similar nature communicated to me ; one by Dr. Hall 
 Edwards, and another by a German correspondent. In cases 
 of suspected foreign bodies crystals of iodoform might easily 
 be mistaken for particles of metal or even shot, and so lead to 
 unnecessary incisions. 
 
 Mr. Charles Coppinger, F.R.C.S.I., writes as follows: 
 
 In last week’s number of the British Medical Journal 
 Mr. Howard Marsh made the following remarks in reference 
 to Roentgen photography: 
 
 “ In cases of injury to the long bones, and especially of 
 injuries involving the articular ends of the bones, and when 
 it is a question what the precise injury which has been sus¬ 
 tained may be, the method will often be valuable in the 
 highest degree.” 
 
 I entirely concur in the above prediction of such a well- 
 known authority on the subject, and have no doubt, from my 
 own practical experience of the method in surgery during the 
 last month, that we will soon be in a position to settle many 
 vexed questions in surgical pathology and diagnosis, such as, 
 for instance, the impaction or non-impaction in Colies’s frac¬ 
 ture of the lower end of the radius, the precise conditions 
 which prevail in intractable dislocations of the first meta- 
 carpo-plialangeal joint, etc. As a step in that direction, the 
 following case seems worthy of a brief record: 
 
 J. R., aged 12, was admitted to the Mater Misericordise 
 Hospital on the morning of May 21st, with an injury to his 
 right wrist, caused about an hour before by a fall from the 
 horizontal bar at a gymnasium. The boy had fallen to the 
 ground palm downward, and the existence of a fracture was 
 at once apparent. The deformity, indeed, was great and un¬ 
 mistakable, the dorsal and palmar elevations producing the 
 usual appearance of undulation at the wrist. There was, 
 however, no appearance of rotation, the displacement of the 
 carpus being directly backwards, so that the deformity 
 resembled that caused by a dislocation of the wrist in that 
 direction. The absence, moreover, of the curved outline of 
 the radial border of the arm characteristic of Colles’s fracture 
 was noticed by my colleague, Mr. Llayes, and by myself. 
 
1412 
 
 The URIT18B 1 
 MeDTCAX JoURNAlJ 
 
 CONGRESS OF GERMAN SURGEONS. 
 
 | Junk 6, 1896. 
 
 A Roentgen photograph of the wrist was taken without 
 delay but with some difficulty on account of the 
 patient’s restlessness ; a rapid Paget plate and a focus tube, 
 energised by means of an accumulator and a 6-inch Ruhm- 
 korff coil, being made use of. 
 
 The negative, though not fully exposed, shows, when com¬ 
 pared with a radiograph of the normal wrist, that the injury 
 was really a displacement at the epiphysial line, and not the 
 well-known fracture of Colles, or the far more rare dislocation 
 of the wrist backwards. The facility with which the deformity 
 was subsequently reduced by simple traction, and the 
 absence of bony crepitus during its reduction, seemed to con¬ 
 firm the diagnosis. 
 
 I enclose a print from the untouched negative, and purpose 
 taking another radiograph of the boy’s wrist at any early date 
 for comparison. 
 
 The New Method in Hospital Practice. 
 
 A Roentgen Laboratory has been established in the Glas¬ 
 gow Royal Infirmary. The electrical apparatus in the hospital 
 is now very complete, having everything required for medical 
 and surgical purposes, and an electric lantern microscope has 
 been provided. Photographs with the Roentgen apparatus 
 have already been taken in the hospital, and it will now form 
 a part of the ordinary work of the electrical department. 
 
 THE TWENTY-FIFTH CONGRESS OF GERMAN 
 SURGEONS. 
 
 [From our Berlin Correspondent.] 
 
 Jubilee Meeting. 
 
 The Surgical Congress, which meets annually in Berlin, 
 always an important medical event, was of special interest 
 this year, for this was a jubilee meeting, the twenty-fifth 
 since the Society of German Surgeons was founded by Bern- 
 hard von Langenbeck under the impression of the teirible 
 lessons taught by the war of 1870-71. The club house which 
 the Society has built for itself, and which bears Langenbeck’s 
 name, was en fete —brave with flags, and flowers, and wreaths 
 —for the reception of the members and their guests. Mem¬ 
 bers had come from all parts of Germany ; not a university, 
 not a hospital of note was unrepresented, and delegates were 
 sent by many of the German medical societies. Delegates 
 came, too, from other countries. From England came Mr. 
 Reginald Harrison, Vice-President of the Royal College of 
 Surgeons, and Mr. John Langton ; from France, Professor Felix 
 Guyon, President of the Congres de Chirurgie, and Dr. Pique; 
 from Russia, Professor Sklifossowski and Dr. Ebermann; 
 from Italy, Professor d’Antona and Professor Bottini. And 
 here among the guests of honour was Sir Spencer Wells, 
 observed of all observers, admired and feted wherever he 
 appears ; and Professor Ollier, from Lyons, whose portrait has 
 just been added to the collection of eminent surgeons in the 
 Langenbeck ETouse. 
 
 Opening of the Congress. 
 
 The first meeting (a so-called “ Fest-sitzung ”) was opened 
 by Bergmann, President of the Congress, who welcomed the 
 guests of honour and deputations. He gave a short history 
 of the Society, and announced that Professor Ernst Gurlt 
 had been elected an honorary member. Gurlt, he said, was 
 thus the eight honorary member of the Society. He 
 named the other seven: Langenbeck, Ollier, Paget, Spencer 
 Wells, Lister, Billroth, Thiersch, and said these were the 
 men on whose shoulders stood modern surgery. 
 
 Professor Esmarch on Artificial An2emia. 
 
 After a few words from the Prussian Cultus-Minister, Dr. 
 Bosse, who greeted the Congress, and thanked the Surgical 
 Society in the name of the Government, Professor Esmarch 
 (Kiel) read a paper on his invention of artificial anaemia in 
 operations. In some introductory remarks on the wonderful 
 advance of surgery in his own lifetime, he spoke of the 
 enthusiasm with which Morton’s discovery of ether narcosis 
 was received by the medical world. This was just fifty years 
 ago, and he (Esmarch) was at the time Langenbeck’s assistant. 
 Then, he said, a year later, came Simpson’s great chloroform 
 discovery. And then he named another Englishman, who, 
 
 in the history of surgery, had immortalised himself—Lister. 
 Speaking of his own invention, Esmarch said that as early 
 as the fifties he was in the habit, when operating on an 
 extremity, of binding it firmly in linen bandages first, so as 
 to force out as much of the blood as possible. But it was not 
 till 1873 that an operation, trifling in itself, pointed the way 
 to his discovery. In that year a lady whose finger was very 
 much swollen, asked him to remove her ring. He bound a 
 strong piece of string tightly round and round the finger, 
 from the apex down to the ring, drew the end of the string 
 through the ring, and then unwound the string very quickly, 
 when the ring slipped off easily. This gave him the idea of 
 forcing out blood by means of caoutchouc bandages before 
 operations. 
 
 After Esmarch, Professor Bruns (Tubingen) read a paper on 
 the development of modern goitre treatment; Professor 
 Koenig (Berlin) followed with a paper on the development 
 of the doctrine of local tuberculosis, and Professor Woelfler 
 (Prague) brought the proceedings to a close with a paper on 
 the history of the surgery of the stomach and intestines. 
 
 Banquet in the Kaiserhof. 
 
 The first meeting was followed by a banquet in the Kaiser¬ 
 hof Hotel, at which Minister Bosse had the place of honour, 
 on his right Sir Spencer Wells, on his left the President of 
 the Congress (von Bergmann). There were several after- 
 dinner speeches. Von Bergmann proposed “The Health of 
 German EmperorMinister Bosse drank to the German Surgi¬ 
 cal Society; Professor Gussenbauer (Vienna) to the honorary 
 members. Sir Spencer Wells responded in the name of the 
 latter, and Professor Ollier drank a health to von Bergmann ; 
 Professor Gurlt, Professor Guyon, Harrison, Sklifossowski , 
 and d’Antona also made speeches. 
 
 Communications. 
 
 The following days were filled up by meetings, at which so 
 many papers were read that it is impossible even to enumerate 
 them all in a short letter. Professor Sonnenburg, of the 
 Moabit Hospital, spoke on operations on the processus vermi- 
 formis ; Professor Angerer (Vienna) on modern nerve opera¬ 
 tions and their results; Dr. Petersen (Heidelberg) on the 
 treatment of malignant tumours with bacterial poisons ; 
 Professor Olshausen (Berlin) on the principles of vaginal 
 extirpation of uterine carcinoma. There were discussions on 
 the diagnostic value of Roentgen rays, and on the treatment 
 of congenital dislocations of the hip. 
 
 Surgical Tableaux Vivants. 
 
 The evenings were as usual devoted to amusement and 
 festive gatherings. On the evening of the 28th a brilliant fete 
 given in Kroll’s Theatre was honoured by the presence of the 
 Emperor and Empress. A series of tableaux vivants repre¬ 
 sented the rise and development of surgery from the earliest 
 (Druidical) times to the present day, each tableau being intro¬ 
 duced by appropriate verses. All the performers belonged to 
 the medical profession—even the ladies, as they were the- 
 daughters or sisters of members of the Congress. 
 
 The Empress gave an audience to the President and Com¬ 
 mittee and the guests of honour of the Congress. 
 
 An International Surgical Congress. 
 
 At the last meeting the question of the proposed inter¬ 
 national surgical congresses was discussed, and it was 
 announced that the pourparlers of the Committee with the 
 committees of other surgical societies had resulted in the 
 choice of London for the first International Surgical Congress 
 in 1900. The official languages are to be English, German, 
 and French. 
 
 The President of the next Congress. 
 
 Professor Bruns (Tubingen) was then elected President of 
 the next year’s German Surgical Congress. 
 
 Donations and Bequests. —The late Mrs. Elizabeth Anne 
 Tanton has by her will bequeathed considerable sums to 
 various charities, among them being the British Medical 
 Benevolent Fund and University College Hospital, each of 
 which take a legacy or share of about ,£2,040, while Dr. 
 Astley’s Small-Pox Hospital at Dover benefits to the extent o£ 
 over £1,300. 
 
 SO %