months' duration, and shall continue my experiment by endeavoring to regain the weight lost on an exclusive diet of fruit. Experiment has already proved to me that on this food, given a reasonably healthy digestive tract, it is possible to gain weight when much below the normal, at the rate of two pounds a day, with extraordinarily enhanced powers of endurance.

ESKHOLME Wade.

400 W. 57th St., New York.

[We immediately replied to Mr. Wade that neither the MEDICAL BRIEF nor any of its readers were narrow-minded enough to care about the professional or non-professional source of useful information, provided it was the outcome of genuine and careful experimentation, carried out in an intelligent and scientific fashion, and offered in a catholic spirit. We therefore hope to present our readers next month with the detailed results of Mr. Wade's investigations, and his conclusions therefrom. We may not all agree with all of them, but at least they will undoubtedly throw some new light on old truths, and give rise to profitable discussion.-ED.]

HEART MURMURS IN TUBERCULOSIS. Heard More Over Chest Than Back, and Left of Median Line.

Charles M. Montgomery, in the American Journal of the Medical Sciences, states that murmurs over the chest not demonstrably dependent on cardiac or vascular disease, when listened for carefully, under favorable circumstances and repeated examinations, are found frequently in tuberculosis. They were heard in nearly three-fourths of our advanced cases. These murmurs usually systolic in time and faint in intensity, in our cases three-fourths being faint. They are generally soft and whifflike in character, though they may be quite loud and harsh. In the majority

are

of cases, these murmurs are heard repeatedly, and usually intermit only temporarily. The areas where they are most commonly heard, and where their maximum intensity most often occurs, are at the base of the heart, chiefly to the left of the median line, at the cardiac apex (a little over half as often as at the base), and at the inferior scapular angles posteriorly, more often on the left side.

These murmurs are more frequent over the front of the chest than the back; they are more frequent and more widely distributed over the left side in front than the right. They are heard in a relatively small number of cases in the axillæ. They may be very limited in extent or may cover nearly the entire chest. In our cases, the murmurs were usually heard best during the quietest part of the respiratory act, that is, during expiration or the respiratory pause, and during suspended respiration; less often they were limited to the end of inspiration and beginning of expiration, and rarely they were heard during inspiration only. These murmurs are modified at times by position, more often by excitement and exertion. With the possible exception of the left side in front, murmurs in advanced cases are heard more frequently over normal or hyperfunctionating tissue than diseased tissue, this being particularly noticeable at the bases posteriorly.

The etiology of these murmurs is usually obscure, and causes probably responsible in a certain proportion of all cases are hard to establish in individual cases. In about 7 per cent of our cases with murmurs, mitral regurgitation dependent on weakness of the heart muscle was diagnosticated. For prognosis and treatment, little is gained from these murmurs of undetermined origin. Even when they seem to depend on the advance of the tuberculous process, they furnish little information unobtainable in other ways.

RELIABILITY OF MANUFACTURERS.

In all walks of life we must depend upon the honesty and integrity of those we come in contact with. Nowhere is this truer than in the purchase of apparatus, particularly electrical apparatus. The physician is entirely at the mercy of the manufacturer. He can not look inside of the case and know what materials have been employed in its construction. He can only take the dealer's word for it. Worthless apparatus enclosed in a handsome and attractive case will often sell more readily than honest goods, especially if the price is noticeably lower than the established rate.

However, we must consider carefully the reputation and integrity of the maker more than the price or appearance of the machine.

If a manufacturer is known to turn out reliable goods and to make them right if any defect should by chance. occur, then he should have the patronage of the physician.

If, on the other hand, his reputation is that of being tricky and availing himself of trivial excuses for not carrying out his promise or guaranties on goods, then the less the profession has to do with him the better.

As stated heretofore, if the physician had a more thorough knowledge of electricity before purchasing apparatus he could not be fooled as readily as otherwise, but even granting him the necessary knowledge he can not go into the vitals of the apparatus and know the quality of material employed, hence it is first and last the question of the manu

facturer's honesty, integrity and reliability.

CHEAP APPARATUS EDITORIAL
APPROVED.

"DEAR DOCTOR: I noticed your article in the MEDICAL BRIEF for the month of May, 1910, and I want to congratulate you on its contents, and with your permission will reprint it, giving you full

credit.

"The trouble has been and is as you state in doctors purchasing useless apparatus which has been strongly recommended by traveling salesmen, who are working for their commissions, and the result is that their success is nil.

"The great trouble in most doctors is that they know little or nothing of the subject of the physiological effects of the current on tissue. Anyone who has the price can purchase a fine outfit of surgical instruments, even a man who digs in the street, but that would not make a surgeon of him, and if he undertook to use them in surgical cases without the knowledge of anatomy and pathology, as well as the long years of teaching and experience, you can imagine what the result would be.

"The same thing is true of the party purchasing electro-therapeutic apparatus, expecting it to take care of itself and give him success without either knowledge or experience. Of course, results are failures and it hurts electrotherapeutics. You know as well as ! that electricity in intelligent hands is. one of the greatest and most efficient remedies we have had, but in the hands

of those who are ignorant of the different currents and effects on tissue only failure can result.

I

"High frequency treatment has been greatly injured by the cheap outfit. saw one in a doctor's office which was not high frequency at all, only a small, cheap induction coil that would light up a Geisler tube. Of course, this would light up a vacuum tube, but all you felt was a slight vibration, no heat and nothing that goes with a high frequency. I asked the doctor if he had had any results, and he said no, but that he had bought it cheap. I asked him if he considered it cheap and told him he had better have taken his $10.00 and thrown it in the street, as someone might have picked it up and put it to good use. This instance is only one of thousands, which you well know.

Yours fraternally,

H. E. WAITE, M. D.

[Dr. Waite strikes the nail on the head when he says that the doctor who uses electro-therapeutic apparatus without properly understanding it more often does harm than good. Also that inefficient apparatus is not cheap at any price, but on the contrary very dear.-ED.]

LOCAL ANESTHESIA BY CATAPHO

RESIS.

A writer in the Lancet uses a solution chloride two consisting of adrenalin drachms, cocaine muriate five grains and water one-half ounce. Lint is folded in a pad of four layers, soaked in the solution and placed under the positive electrode.

A large negative electrode is applied elsewhere and a current of fifteen to thirty milliamperes is employed for some five to fifteen minutes. The surface may then be washed with ether and any superficial operation performed painlessly and also practically without hemorrhage.

DEATH OF DR. KASSABIAN. Another name was added to the list of those medical pioneers who have sacrificed their lives in the cause of science. when Dr. Mihran K. Kassabian, an eminent specialist in X-ray work, died in the Jefferson Hospital, Philadelphia, of burns that he received from the mysterious rays during years of continuous research and investigation.

Dr. Kassabian, who had experimented with the X-rays for many years, received the first injury in 1902, when the finger nails on his hands were burned. He placed himself in the care of physicians.

Operation Unavailing.

The second operation proved as futile as the first, and it was considered urgent to subject the patient to a third operation consisting of the removal of certain muscles on the left side of his chest. This was accomplished about four months ago, and, serious though it was, Dr. Kassabian appeared to some extent to rally from it. Indeed, he continued his work with almost the same vigor as if he had been in the best of health. About ten days ago, when the scientist went to the Jefferson Hospital to have the wounds on his chest dressed, he collapsed, and it was found necessary to remove him to a private room in the hospital. Though attended constantly by the most skillful physicians, his condition became worse each day until he passed away.

Dr. Kassabian's Work.

As an acknowledged authority on the subject of X-rays Dr. Kassabian was chosen to represent the United States at conventions of X-ray experts that were held several years ago in London and in Paris. Among his works are several books treating of his favorite subject. The most important of these, "Electrotherapeutics and the Roentgen Rays," is now used as a text-book in leading medical colleges. Among his inventions was a method for improving skiagraphs. Originally these pictures, photographs of the interior of the human body, produced an effect as if the ribs were lying flat against the spine. There was no effect of rotundity. Dr. Kassabian invented an appliance for the skiagraph apparatus whereby the desired effect of roundness was produced.

Dangers Now Minimized.

Dr. Kassabian was one of the early operators and added much to the science at a time when its dangers were unknown. He worked faithfully at the Medico-Chirurgical Hospital, both night and day, whenever a patient needed his care. During those early years many of

the examinations were made fluoroscopically instead of by plates. This necessitated exposure of the operator during all the time that any of the patients were being examined. In this way he got thousands of times as much exposure as any one patient would get, and by continuing for a long time he did irreparable damage to his skin. During all this time. none of the patients to whom he gave his services suffered from the effects of the exposure. Today absolute precautions to both operator and patient are possible, and the specialists who are thoroughly equipped make these examinations with very short exposures, using seconds where formerly minutes and even hours were necessary. The rays are absolutely confined to the parts under examination, and we know of no record of injury from the rays during an examination in recent years, when such examination was made by a skilled operator who was thoroughly equipped.

A posthumous interest is added to the sad event by the announcement, just received from the Lippincott Company, of the publication of a new revised edition of Dr. Kassabian's "Electro-Therapeutics and Roentgen Rays."

THE PERMANENCY OF X-RAY
STERILITY.

Some years ago the reports published by various writers who had investigated the conditions of different operators was to the effect that the X-ray produced permanent sterility.

That this does sometimes result there can be little doubt, but recent investigations indicate that in many of these cases the sterility was temporary, and that with subsequent protection from the ray a considerably number of cases regain the normal condition.

Certainly there is no serious risk run in a few short treatments about the generative organs, nor to the operator who exercises a little common sense and keeps out of the active field of the tube.

There is no need of further protection than that offered by the tube shield.

Of course, if one is constantly making skiagraphs and employing tubes of considerable penetration, as in operating a Roentgen laboratory, then it behooves. him to have a lead shield to stand behind, and other protective devices.

ZINC-IONS IN OPHTHALMIC NEONATORUM.

According to Ramsden Kay, ophthalmia neonatorum may be successfully treated by zinc-ions.

The technique employed was to evert the eyelid, place the positive electrode, which has been previously covered with cotton and saturated with a 2% solution of zinc sulphate, in contact. The negative pole is placed in the child's hand.

Two treatments a day of three minutes each were given, employing a current of 1⁄2 milliamperes. Healing commenced after two days.

CARE IN USING URETHRAL HIGH
FREQUENCY TUBES.

Under this caption, I am not referring to the sterilization of the tubes, but to the care which must be exercised in order that they may not be broken off accidentally in the urethra..

The vacuum high-frequency tubes for use in the male urethra are made of unusually strong glass and will stand a good deal of force applied before breaking, but obviously they should be used with extreme care to avoid this possibility.

Not only does this apply during the introduction of the tube where no particular leverage should be employed, but afterwards it must be remembered that any sudden or accidental jerking of the connecting cord may break the tube.

I have heard, indirectly, of these tubes being broken off in the canal, but I am certain that if care is used there is no great likelihood of this occurring during the introduction of the tube.

Certainly common sense would tell us that we would not expect to use the same degree of force on these tubes that might be used with the steel sound.

GONORRHEAL CYSTITIS.

The late Augustin H. Goelet, in a posthumous article published in American Medicine, considers that gonorrheal cystitis is either rare in the female or the possibilities of demonstrating gonorrheal infection of the bladder is difficult. We may, however, conclude that it is due to gonorrheal infection when a cystitis is found associated with urethritis. It is probably more rare in the female than in the male, perhaps because urethritis in the female is so often unrecognized and hence not treated or maltreated.

Bierhoff has tabulated 92 cases of cystitis, of which number 67 were catarrhal and 25 suppurative cystitis. Gonorrheal cystitis was found only among the latter (the suppurative type) and there were only five cases in which gonococci were discovered in the urinary sediment.

Gonorrhea is undoubtedly a cause of cystitis, both in the acute and chronic forms, though it may not be actually demonstrable always by the microscope or by culture. Culture of the gonococcus from the urine is certainly difficult, if not impossible. Hence, if the infection is revealed by the microscope in the urinary sediment in conjunction with its presence in the urethral secretion, we may hold this as sufficient evidence of the nature of the infection. The cystoscope is rarely required for the diagnosis of cystitis and should not be used in the acute stage of the disease. The microscopic findings are quite sufficient to establish the diagnosis of all varieties of cystitis. The cystoscope may, however, be required to locate circumscribed areas of ulceration when the conditions prove to be obstinate.

Most frequently cystitis due to gonorrheal infection is confined to the base of the bladder, involving the trigone. It is rarely diffuse, and when so it is probably due to a mixed infection.