350 



MEDICINE, RECENT ADVANCES IN. 



fever to less than one-quarter of that of the epi- 

 demic year of 1900. 



The Light Treatment. Phototherapy, al- 

 though by no means a new idea, has only re- 

 cently come to have a recognized standing m 

 medicine as a legitimate therapeutic agent. It 

 has long been known by physicians that plenty of 

 sunlight is beneficial in some diseases and harm- 

 ful in others, but until Prof. Finsen, of Copen- 

 hagen, published his first paper on phototherapy, 

 in 1893, little use was made of these facts. In 

 smallpox the eruption normally passes into a 

 suppurative stage, and it is as a result of these 

 ulcers that the hideous scars on face and hands 

 remain. Finsen's idea was that, as this scarring 

 is always most pronounced on the face and hands, 

 it is in a measure due to the irritant action of 

 light; and especially to the ultra-violet portion of 

 the spectrum, which contains the chemically 

 active rays. He suggested that smallpox patients 

 should be kept in rooms from which these rays 

 were excluded by the use of .red glass and red 

 curtains. The treatment met with considerable 

 success; in many cases the eruption was much 

 modified and little or no scarring resulted. He 

 next turned his attention to the curative action 

 of light as a direct irritant. He found that ani- 

 mals that normally live in the dark are much irri- 

 tated by exposure to the chemical rays of sun- 

 light, and not at all by the other portions of the 

 spectrum. It had already been shown by several 

 investigators that these chemical rays have con- 

 siderable germicidal power, and it now occurred 

 to Finsen that they might be of value in treating 

 bacterial diseases of the skin. 



One of the most incurable of these is lupus 

 (tuberculosis of the skin), and he went to work 

 at it on this theory. As lupus is especially a dis- 

 ease of the face, it was obvious that ordinary 

 sunlight is not powerful enough to kill the germs, 

 so he tried the effect of concentrating the light 

 by means of lenses, and cutting out the less active 

 portion of the rays with blue glasses. He used 

 an apparatus that made the light about fifteen 

 times stronger than ordinary unconcentrated 

 sunshine, and subsequently found that he could 

 obtain rays of similar intensity by using a pow- 

 erful arc light (30,000 to 35,000 candle-power). 

 He soon discovered, in working with these con- 

 centrated rays, that the blood flowing through 

 the tissues exercised a marked effect in prevent- 

 ing their penetration beneath the surface. While 

 it required fully five minutes to blacken a piece 

 of photographic paper placed behind the ear, 

 if the ear was first compressed so that the blood 

 was squeezed out of it the paper was blackened 

 in twenty seconds, the absence of the red color- 

 ing matter of the blood permitting the rays to 

 penetrate almost instantly. 



Finsen's apparatus for treatment of lupus by 

 the sun's rays consists of a hollow plano-convex 

 lens filled with an ammoniacal solution of copper 

 sulfate (for cutting out the red rays). The lens 

 is so mounted that it can be turned at various 

 angles. It is used for concentrating the sun's 

 rays on a part in connection with a compression 

 apparatus, consisting of two plates of rock crys- 

 tal fixed in a metal ring. Through this, which is 

 pressed against the skin, is passed a current of 

 cold water, further to decrease the circulation in 

 the part. The compression disk is held against 

 the skin by the nurse. Only a small area, about 

 the size of a ten-cent piece, is treated at each sit- 

 ting. Each treatment lasts one hour. Prof. Fin- 

 sen has also devised an electric-light apparatus. 

 A large arc-lamp is arranged in a sort of hood 

 from which radiate 4 long cylinders, like tele- 



scopes. These tubes concentrate the light, and 

 the lower portion is arranged so that a current of 

 cold water can be continuously passed through 

 them, to absorb the heat rays. The compression 

 disk is placed, as in the sun apparatus, at the 

 focus of the light. Rock-crystal lenses are used 

 in the telescopes, as ordinary crown glass cuts 

 off a considerable portion of the chemical rays. 

 The immediate effect of the light treatment is 

 simply a slight redness of the skin. In the course 

 of seven or eight hours this redness increases, 

 and some swelling and slight blistering occur. 

 The application of the light is continued until 

 all the diseased area has been treated, sometimes 

 requiring many months. It is hence very expen- 

 sive. The cost of running one lamp a year at the 

 London Hospital, Whitechapel, is $2,000. The re- 

 sults in treating ordinary lupus (lupus vulgaris) 

 are excellent. More than 500 cases have been 

 treated at Finsen's light institute in Copenhagen, 

 many of them with excellent and lasting results. 

 Dr. Malcolm Morris, of St. Mary's Hospital, Lon- 

 don, considers it " the best remedy for lupus that 

 has yet been found." The obvious advantages of 

 the method are its painlessness and its lack of 

 actual destruction of tissue, as in operations. It 

 also is said to produce wonderfully good cos- 

 metic results, a hideously scarred and ugly skin 

 frequently being transformed into a soft, supple, 

 healthy tissue which can hardly be distinguished 

 from the surrounding healthy skin. 



Several cases of superficial cancer have been re- 

 ported as much benefited by the Finsen treat- 

 ment. 



At the recent meeting of the British Medical 

 Association the method was discussed in consid- 

 erable detail. Dr. Sequeira, of the London Hos- 

 pital, Whitechapel, who is in charge of the largest 

 installation of the light plant used for therapeutic 

 purposes in Great Britain, where 60 or 70 patients 

 are treated every day, expressed his strong belief 

 in the great value of the treatment. He also re- 

 ported good results in a case of leprosy treated 

 by it. Dr. Malcolm Morris gave the following sta- 

 tistics resulting from eighteen months' use of it. 

 Sixty cases were treated 36 lupus vulgaris, 6 

 lupus erythematosus, 14 rodent ulcer, 2 alopecia 

 areata, 1 keloid, and 1 epithelioma. Eight of the 

 lupus patients were cured, in 9 the treatment had 

 been abandoned, and the remainder were still re- 

 ceiving it. Seven of the rodent-ulcer cases were 

 cured. Regarding the keloid and epithelioma 

 cases, nothing definite could yet be said. Dr. 

 Morris also said that the remedial action of the 

 light was directly proportional to the reaction 

 caused by it that is, the more irritation and in- 

 flammation it causes, the more effective it is. 

 He had also found that brunettes are not as good 

 subjects as blonds, and the darker their skin the 

 less amenable they are to the treatment. 



Drs. Noire" and Sabourand, of Paris, reported 

 cases of skin-disease successfully treated by Fin- 

 sen's method at the St. Louis Hospital. A 

 modification of Finsen's apparatus, devised by 

 Drs. Lortel and Genoud, of Lyons, was described 

 at this meeting. It treats an area 1| inch in 

 diameter at each sitting, and requires only fifteen- 

 minute applications, instead of sixty minutes. 



The X-rays have also been used to a consider- 

 able extent in the treatment of skin-diseases, in 

 many cases with considerable success. But the 

 Finsen method is said to be much more effective, 

 and the X-rays are now recommended by Dr. Mor- 

 ris chiefly for use in situations where the Finsen 

 light can not be applied in the interior of the 

 mouth and nose, for instance. Although the light 

 treatment is still in an early experimental stage, 



