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dition showed a marked change for the better. Theadministration of the soda and glucose solution by thetube was continued for three more days and, in the intervals,the tube was clamped. His condition from the fourth dayon gradually improved ; the discharge from the drainageopenings decreased and finally ceased. The jejunostomytube was removed on the eighth day and no leakage ofintestinal contents took place. Finally he was dischargedon the thirty-first day in quite fair condition.

I have performed jejunostomy on two other almostidertical cases of. septic peritonitis, due to infectionfrom tumours of the pelvic colon. One died and theother made a good recovery, although for the firsttwo days following operation he was almost pulseless,intensely toxic, and apparently moribund.CASE 2.-A boy, aged 16, was sent to the Royal City r

of Dublin Hospital on the evening of Jan. 6th, 1925, byDr. P. Gavin of Moynalty. He stated that on the night of the3rd he was seized with sudden severe pain in the right lowerabdomen and vomited a great deal; the pain continued for t

two days but had eased off somewhat during the 24 hourspreceding admission, being to some extent replaced by a i" soreness " across the whole lower abdomen ; he had

vomited three or four times each day, and the bowels hadnot moved since the morning of the 3rd ; there was somepain on micturition. On examination his aspect wasmoderately good, face flushed and anxious but not pinched;the tongue was furred and moist, temperature 102° F., pulse112. The respirations were almost entirely thoracic; thelower abdomen was distended, the upper limit of distensionbeing quite sharply marked at the level of the umbilicus ;he was tender all across the hypogastrium, especially soin the right iliac fossa. Rectal examination confirmed thediagnosis of pelvic peritonitis and an operation was per-formed immediately through a right paracentral incisionand revealed a diffuse purulent peritonitis of the lowerabdomen. The coils of intestine in the pelvis were intenselycongested and dilated, and lay in a bath of pus. Theintensity of the congestion and the quantity of purulentexudate gradually diminished as the abdominal cavityproper was reached, so that the coils immediately under-lying the umbilicus were dilated but not congested. A

perforated pelvic appendix, gangrenous in its middle third,was removed ; a large tube was placed in the pelvis and ajejunostomy performed into one of the dilated loops ofthe small gut, lying just above the level of the umbilicus.Instructions were given to place the patient in the Fowlerposition and to run six ounces of soda solution through thejejunostomy every four hours, the tube in the interval toto be left unclamped and draining into a bottle beside thebed. Rectal salines were also ordered. The conditionsfound at operation in this case were such that I gave a veryguarded prognosis and anticipated a very stormy con-

valescence, so I was more than pleased next morning tofind the lad looking well and to hear that he had not vomitedsince the operation. The tube was working well, a goodquantity of dark fluid escaping ; his temperature had fallento 99° and pulse to 100. It is unnecessary to give detailsof the convalescence ; suffice it to say that he steadilyimproved from day to day, the outflow from the tubebecoming clear in 24 hours and the tube itself coming awayon the seventh day, no fistula resulting. He finally madean excellent recovery although his discharge from hospitalwas delayed until the fortieth day owing to the developmentof a small secondary abscess in the right iliac fossa, whichdischarged through the scar of the original drainage opening,

Three other cases of diffuse peritonitis originatingin the pelvis and extending into the abdomen properwere similarly treated and made good recoveries.In two the cause of infection was a gangrenousappendix, and in the other a rupture of a pyosalpinx.I have also employed jejunostomy in the followingcases. (1) Pelvic peritonitis due to a gunshot woundtraversing the pelvis and puncturing the rectumin two places. This man made a rapid recovery,the peritonitis not extending. (2) Acute intestinalobstruction by a band. This man was intenselytoxic and great quantities of dark foul-smelling fluid

Bdrained from the tube for four days. After that timerecovery was uneventful. (3) Acute pneumococcalperitonitis. This patient died from a general pneumo- Icoccic septicaemia.

References.1. THE LANCET, 1923, ii., 62.2. Brit. Jour. Surg., October, 1915, p. 161.3. Arch. Middlesex Hosp., 1910, xxi., 39.4. Brit. Jour. Surg., 1925, xii., 417.5. Annals of Surgery, 1917, lxvi., 568.

Medical Societies.ROYAL SOCIETY OF MEDICINE.

I SECTION OF ELECTRO-THERAPEUTICS.A MEETING of th’s Section was held on April 17th,

Dr. STANLEY MELVILLE, the President, being in thechair.

The Organisation of a Light Department for SurgicalTuberculosis.

Sir HENRY GAUVAIN read a paper on the organisa-tion and work of a light department in a surgicaltuberculosis hospital. He said that though he had used1eliotherapy for some years, it was only since thewar that a light department had been establishedn the hospital of which he had charge at Alton,ind that was owing to the munificence of Sir WilliamFreloar. He explained that he meant by " lightLreatment," treatment by light produced artificially’ts opposed to sunlight; he objected to the termartificial sunlight." Theories which had been.advanced as to the biological action of light were-contradictory, sometimes confusing. He was con-.

vinced as to the value of light in surgical tuberculosis,,but this form of treatment was very expensive,as large amounts of current were consumed, theservices of skilled electricians must be secured,experimental work must be done, numerous accessoriespurchased, and a staff of nurses specially trainedmust be maintained. An equipment for giving lighttreatment was urgently needed, especially for casesof lupus. At Alton there was already an admirablegenerating plant, and the resident engineer skilfullyadapted the new plant without extra expense.Finality in this matter had not yet been reached,and he believed much that was important would bediscovered in the near future, therefore room shouldbe left for possible modifications. Accordingly theward for this work was a wooden structure, placedquite near to the power-house, to save cost of cable,and risk of fire was reduced by covering foorand walls 4 feet high with asbestos. There weretwo cables, one to convey a current of 70 volts,the other one of 110 volts. He took as his model the-Finsen Institute in Copenhagen, which he visitedtwice and for which he had unstinted praise. Therethe lamp used for general light baths and local treat-ment was the carbon arc lamp. Lupus remained themost common form of tuberculosis treated. Ahighly-educated woman came from the Copenhageninstitution to Alton to’ instruct the nurses there,and remained six months. At Alton eight ambulantcases could be treated simultaneously by means ofthe 75-ampere carbon arc lamps, and there were twqwater-cooled carbon arc lamps for local treatment.

The Use of Ultra-Violet Rays. .

Sir Henry Gauvain said he also made provisionfor testing and employing any other form of radiationwhich seemed to promise success, and much attentionhad been given to the subject of ultra-violet radiation,.The value of this, especially in rickets, had been amplydemonstrated ; and it raised the bactericidal power-of the blood. The tendency nowadays was to use,in increasing degree, the short rays of the spectrum,-but- many " artificial sun " lamps were rich in rays.not to be found in the solar spectrum. He had usedmercury-vapour, tungsten arc, iron arc, and other

lamps, also numerous electrodes, and’ they were-serviceable for certain local conditions, but in a generalway for surgical tuberculosis they had not ’come ’upto his expectations. He preferred the Finsen lamps’,Clinical experience still remained, the most reliableguide. The tendency to employ short wave radiationindiscriminately was not without danger. - In, ’acuteneuritis of undiscovered cause, however ; these ’ray’squickly produced a’very striking relief... "t!.On the physical side it was possible to ’prdd1iH,

an almost infinite variety of radiant. energy, ’ltitthere was still, so much to learn coneerning’ it&

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biological effect that there was need of skilledlaboratory workers in connexion with light depart-ments. In such a department there must be completeand responsible supervision during the treatment ;all the work was visible to the charge nurse, andthere were no cubicles, though privacy was securedwhen certain areas of the body were being treated.At the conclusion of treatment the whole departmentwas cleaned out, and all lamps, lenses, and compressorsreceived careful attention. At the present time28 patients were having arc treatment each day,and 56 persons had light baths every alternate day.Goggles were worn, each patient having his or herown. Water was drunk during the treatment.The exposure was half an hour for new patients,and was increased to a maximum of two and a halfhours. It induced free perspiration, and at theconclusion the ambulant cases had a shower-bathand rub down. The patient’s head was protectedfrom the heat by asbestos masks. For local treat-ment the part concerned was first exsanguinated bymeans of compressors, and no further treatmentof the area was carried out until the local reactionhad subsided. Most of the patients had graduatedSeaside baths at Hayling Island, and the beneficialeffect of this was very marked.

For surgical tuberculosis Sir Henry Gauvainregarded the light treatment as an accessory, thesuccess depending on the skill with which it wasblended with the other means. For this form oftuberculosis the air-cooled mercury - vapour andtungsten arc lamps were not so valuable as the carbonarc lamps, and their value diminished after a fewapplications. They had been found to be good forsinuses, suppurating and discharging glands, scrofulo-derma, &c. The water-cooled iron arc lamp wasgood for local lesions, and it had the merit of beingcheap. Infra-red radiations were of limited value,but in patients whose blood possessed high bactericidalpower they hastened cure. Sir Henry Gauvainsaid he was now engaged in perfecting a lamp designedfor giving light treatment to patients who could notbe brought to the hospital. Some of the requirementswere that the lamp should be readily portable, simplein application, and adaptable to the ordinary wall-plug for electrical supply. He said he felt gravemisgivings as to the use of a powerful source of ultra-violet light in the hands of the inexperienced. Certaindisease conditions derived greater benefit from oneform than from others, and some only received themaximum help from both forms of radiation, supple-mented by physical aids to cure. Work was nowbeing done at Alton which, without the aid thatthe newly-installed department gave, could not havebeen done at all. He had frequently cut out portionsof tissue which had been irradiated and shown thatthe tubercle bacilli in them were dead.

Selection of Apparat’lJ,sfor Producing Artificial Sunlight. IDr. G. MURRAY LEVICK said the time had not yet

arrived for laying down hard-and-fast rules on thissubject, as experience was brief. " Artificial sun-

light " should be understood to mean the applicationto the body of rays such as were found in sunlight,but not necessarily in the proportions occurring innature. By using the mercury-vapour lamp withthe long-ray lamp he had obtained better resultsover a large range of cases than by the use of. theopen arc lamp. He had successfully used the latterwith carbons which were impregnated with nickel,especially for cases of general debility without apparentcause, neurasthenia, and chronic rheumatism. Butthe open arc lamp with carbon terminals did not givesuch good results in the case of rickety and tuberculouschildren as did the mercury-vapour combination,and the latter permitted of accurate dosage, an

important matter, as elderly subjects with rheumatoidconditions showed an extreme sensitiveness to light,and experienced a reaction, as evidenced by achingpains, headache, and a slight rise of temperature.Recently there had been placed on the market self-exhausting tubes, and it was not yet known how

long they would last. A 2000-candle power mercurytube sufficed for all general purposes. The chieffaults were inaccessibility of the reflector and thedifficulty of accurate focusing ; he was designing anapparatus in which these would be overcome.He had found that the red rays were of great value

in promoting nutrition and the power of local repair,probably through local stimulation of the sympatheticnerves. These rays penetrated very deeply, andquickly promoted growth of muscles. Heat rayswere interrupted by water. A disadvantage of themercury-vapour lamp for general use was that, onaccount of the intensity of the radiation, it requiredskilful handling. It was most important that thepatient should be stationary during the application,so as to preserve a uniform focus. He pleaded forexactitude in the administration of radiation. Heagreed that the arrangement, organisation, andworking of the Copenhagen institution were masterly.

Dr. P. R. PEACOCK referred to the work which hadbeen done by Prof. Russ and himself on the physics ofultra-violet irradiation. He said that pigmentationfrequently resulted from exposure of the skin to therays. It was agreed that there were unaccountablevariations in the response of different people whenexposed to the same kind of treatment, some pig-menting, others merely freckling. Clear skinsfluoresced better than did dark ones. Certain partsof the body were fluorescent ; sweat and blood werenon-fluorescent. Sebum was the most brilliantlyfluorescent, and melanin absorbed the whole visiblespectrum. From the ultra-violet point of view,fluorescence seemed to be a protective phenomenon.Skin which had been treated with vaseline withstoodthree and a half times the radiation of normal skinbefore showing reaction. Pigmentation occurredonly as a result of considerable exposure, and itmight be taken as an indication that fluorescencehad failed to protect the tissue. Hence if applicationof the treatment could be made without producingpigmentation the effect might be much better, aspigmentation protected the skin against the action ofthe very rays which it was sought to influence it by.

MANCHESTER MEDICAL SOCIETY.

A MEETING of this Society was held on April 1st,Prof. G. R. MURRAY, the President, being in the chair.

Dr. D. E. CORE opened a discussion onENCEPHALITIS LETHARGICA.

He began by describing a typical case of averageseverity in a man of 24, and then dealt with certainsymptoms in detail. As regards the diagnosis ofencephalitis lethargica, he said it was important toremember that often enough the condition escapedrecognition as an illness by the patient and his friends ;it might only be revealed as such in the light of theafter-course. The idea of establishing a diagnosticscheme based upon symptoms was in his minduntenable, and the present-day tendency to do so

was responsible for the number of erroneous diagnoses.Apart, however, from objective signs of implicationof the nervous system, he had been increasinglyimpressed by the interesting relationship betweenthe symptoms and the patient’s consciousness. Innormal life there was a reasonably close parallelismbetween objective behaviour and the personality ofthe individual ; a man who acted in an uncontrolledway usually showed signs of mental uncontrol; onewho seemed to be profoundly unconscious was asa rule unconscious ; and a delirious patient was notin general aware of his surroundings. In encephalitislethargica, however, this association did not appearto obtain. The most restless and uncontrolledpatient was quite commonly capable of giving aremarkably clear and logical account of his sensationswithout any evidence of psychical uncontrol ; it wasnotorious that the patient somnolent to the pointof coma was not only often, but was usually able toanswer questions and give information demandingconsiderable concentration ; and the same phenomena