536 
NATORE 
[APRIL 7, 1904 
and when the electric light is used by also passing 
the rays through a cylinder containing distilled water, 
which is kept cool by a water jacket, similar to that 
used in the Maxim gun. Another point of importance 
is that the area under treatment should be rendered 
bloodless, for the red colouring matter of the blood 
prevents the passage of the chemical rays to the deeper 
parts of the skin. This was shown by a simple little 
experiment of Finsen. If a piece of sensitised paper 
be placed behind the lobule of the ear and a powerful 
light be concentrated upon it, so that the rays have 
to pass through the ear, the paper will not be blackened 
at the end of some minutes; but if the ear be com- 
pressed by two glass slides, so as to render it bloodless, 
and the light be concentrated as before, the sensitised 
paper is blackened at the end of twenty seconds. In 
practice the apparatus which is used to cool the 
surface is used to compress the area under treatment, 
and it is held in position by an attendant. Various 
means have been tried to do away with this constant 
personal attention, but no mechanical means yet de- 
vised can replace it, for the parts treated must be kept 
in accurate focus. 
The light is applied for an hour at a time, and six 
to twelve hours after treatment the part becomes red | 
and inflamed, and a blister commonly forms. The 
inflamed, blistered area heals under simple dressings. 
It will be noticed that the effect of light is very different 
from that of heat. The application of intense heat to 
the skin causes an immediate inflammation, a burn, 
while the inflammatory reaction to light does not 
appear for some hours. As a result of the inflamma- 
tion set up, and also of the specific germicidal action 
of the actinic rays, the bacilli in the tissue are killed, 
and after successive treatments the diseased area is 
replaced by a pale, soft, supple scar. The cosmetic 
results of this treatment are unequalled. The process 
is essentially a conservative one. All other methods of 
treatment, such as removal by the knife, scraping or 
cauterising, are destructive and tend to produce grave 
disfigurement, an important point, as the disease 
commonly attacks the face. The disadvantages are, 
however, serious. In the first place, the length of 
time required for the satisfactory treatment of even 
small areas is considerable. Secondly, the apparatus 
is expensive, and each patient requires constant skilled 
attention, and this is an important item in the cost. 
Lastly, it is often impossible to reach the disease when 
it involves the interior of cavities such as the nose and 
mouth. In some cases also of long standing, the area 
involved is so extensive that the method is too slow 
to keep pace with the spread of the disease. With 
early cases a cure can be completed in a few weeks, 
but in some instances a cure cannot be effected in less 
than a year or two. A large number of cases are now 
on record in which patients have been free from the 
disease for five years and upwards, and many un- 
fortunates who were debarred from obtaining work 
by their disfigurement are now in regular employment. 
Certain other affections of the skin of parasitic origin 
can also be treated successfully by Finsen’s method, 
notably a form of baldness; and some superficial navi 
have been removed. 
The use of light baths has many advocates. As 
commonly applied, the whole body or an affected limb 
is subjected to the radiations from a number of in- 
candescent electric lamps in a closed chamber. This 
produces local or general perspiration, and the effect 
is that of a Turkish or Russian vapour bath. | By 
another method the patient is exposed to the light from 
powerful arc lamps, and these appear to influence 
nutrition by their powerful stimulation of the skin. 
To Prof. Réntgen’s brilliant discovery medical 
science owes an incalculable debt of gratitude, for not 
NO. 1797, VOL. 69] 
only are the Roéntgen rays of the greatest value in the 
diagnosis of injuries and diseases of the bones, in the 
localisation of foreign bodies, such as needles, bullets, 
&c., in the tissues, and in the demonstration of calculi, 
and even of diseases of the lungs and great blood 
vessels, but they have been found to possess thera- 
peutic properties of immense value. In the early days 
of X-ray work operators and patients occasionally 
suffered from a peculiar form of inflammation, a so- 
called burn, occurring days and sometimes weeks after 
exposure to their action. This power has been turned 
t> practical account in treatment. Schiff and Freund, 
of Vienna, showed that certain cases of lupus could 
be cured, at any rate temporarily, by their means, and 
other superficial diseases of the skin have also been 
found to be benefited. The results are not so certain 
or sO permanent as those achieved by Finsen’s 
method, but in some cases, as already indicated, the 
latter are inapplicable. 
Not long after Schiff and Freund’s discovery the rays 
were applied to cases of rodent ulcer, a_ locally 
malignant disease, starting in the skin and often de- 
stroying deeper structures, and even bone. Rodent 
ulcer usually attacks the face, and its treatment by 
older methods was so frequently unsatisfactory that it 
had received the name of noli me tangere. It was 
| demonstrated that the peculiar cells of the rodent 
growth are destroyed by the Réntgen rays, and that 
they are replaced by healthy scar tissue. Recurrences 
do happen after apparent cure by the rays, but such 
recurrences are as a rule easily removed by a further 
application. The rays are applied to the diseased 
tissue for ten to twenty minutes at a time. There is 
| little or no discomfort to the patient, and in most cases 
improvement is at once manifest. 
The success which attended the X-ray treatment of 
rodent ulcer led to the hope that in it would be found 
the cure for cancer. But there are essential differences 
between rodent ulcer and cancer. Rodent ulcer is 
peculiarly a local disease, while the characteristic of 
cancer is the spread of the disease to and the involve- 
ment first of the glands and then of internal organs. 
The Rontgen rays have an undoubted influence upon 
many cancerous growths. Superficial tumours have 
disappeared when exposed to their action, ulceration 
heals, and pain is relieved, but not by any means in 
all cases; in some, even when the growth appears to 
be localised, the glands and internal organs are already 
involved, and there is no hope of a cure by such a 
purely local measure. One thing is certain, and that 
is that where it is possible to remove a cancer by 
operation that procedure should be adopted in prefer- 
ence to ray treatment; but where operation is out of 
the question suffering may be relieved by the appli- 
cation of the rays, and possibly the cancerous develop- 
ment may be checked, but cure is not to be expected. 
Some surgeons are now applying the rays after oper- 
ation, so that any outlying cancer cells which have 
not been removed may be destroyed. It is as yet too 
early to say how far such measures are likely to prove 
successful. 
Another therapeutic application of the X-rays de- 
mands a few words. The rays have the power of re- 
moving hair, and for this purpose are used in certain 
diseases where the hairs are attacked by parasites. 
One such disease is ringworm. The difficulty in treat- 
ing this and similar diseases lies in the difficulty in 
thorough epilation. The rays do not kill the parasites, 
but they remove the infected hairs, and in that way 
hasten a cure. If applied for a short period only, the 
roots of the hairs are not destroyed, and after a time 
the area treated is covered with new healthy hair. 
The removal of superfluous hair which is so often a 
disfigurement by the X-rays is not to be recommended, 
