There are a few skin diseases, and only a few, in the writer's opinion, in which the X-ray is to be preferred to all other therapeutic measures. The X-ray seems especially indicated in affections where epilation is desired, such as ringworm, favus and sycosis. It has certainly proved an exceptionally valuable agent in sycosis, a disease so often intractable to all other methods of treatment.

The case which forms the basis of this report was a very obstinate one of sycosis of 10 years' duration, which the writer recently pre-. sented before the dermatological section of the Academy of Medicine. The patient is 33 years old, married, born in the United States, a clerk by ocupation. He suffered from measles and scarlet fever as a child. Since the attack of scarlet fever the eyelids have always been more or less red and inflamed. With the exception of the diseases of childhood above mentioned, the patient's general health has always been excellent.

The eruption first appeared 10 years ago upon the chin. It then gradually spread upon the left side of the cheek and neck, and within six months had attained its maximum development. In another six months it had spread upon the opposite side of the cheek and neck until the two sides were practically symmetrical in appearance. For the following seven years the eruption varied in intensity, being at times SO severe that shaving was impossible. At other times the patient was able to shave twice a week with comparative ease. The actual discomfort which the patient has suffered, though at times severe, has been small in comparison with the mental depression caused by the unsightliness of the disease. The patient has often felt himself socially ostracized on account of his affliction. The subjective symptoms have consisted of burning and stinging, especially severe after shaving. Three years ago, during a second attack of measles, the eruption disappeared completely for three weeks and then

relapsed to its former condition. With the exception of this short interval the lesions never completely disappeared till X-ray treatment was begun.

Two years ago the patient consulted an experienced and well-known radiologist of this city. He was given 28 exposures of the X-ray within a period of four and a half weeks. At the end of this time a brilliant result had apparently been achieved. The hairs of the affected area had fallen and the skin appeared white and smooth. Two weeks later, on account of a slight relapse, the physician was again consulted. A second course of X-ray treatment was begun, consisting of two to three exposures a week for a period of six weeks. At the end of this time the eruption had become much worse than it had ever been before. had spread down upon the neck so far that a low collar could not be worn with comfort. The eruption on the cheeks had extended and a few new lesions has appeared upon the lips. The patient then gave up the X-ray in despair and returned to the other methods of treatment that he had formerly used, namely, epilation and various ointments and lotions. The lesions were even curetted a number of times. Nothing but temporary improvement, however, ever resulted from any of these procedures.

It

A year ago, after having previously treated the patient for a few weeks with ointments, I decided to give the X-ray one more trial, being firmly convinced of its usefulness in sycosis. I had some hesitation, however, in again trying the means that in the hands of my experienced colleague had apparently failed. The patient was given two treatments a week for the first two weeks. Since that time the intervals between the treatments have varied from 10 days to three weeks, the patient having been of necessity somewhat iregular in his visits. In all about 30 exposures have been given. A high tube has been used giving a spark gap of light to 10 centimeters on a static machine.

lip (only slightly rayed). With this exception the eruption can be said to be practically cured. Treatment of the lip will be continued to the point of permanent epilation, and for a time occasional exposures will be given to the cheeks and neck, that now appear to be healthy. While it has taken a long time to effect a cure in this case by the X-ray, it must be admitted

acute inflammatory symptoms lessened and the infiltrated areas flattened and disappeared. At the same time the subjective symptoms abated. Their method did not require a dermatitis to produce results. As soon as a reaction appeared the treatment was stopped. After 7 to II sittings the hairs loosened and fell, and in 10 to 12 days all redness had disappeared.

dition of the skin and telangiectases are inevitable. Even were this condition inevitable, it would be preferable in many cases to the more disfiguring original disease.

In 1901 Freund had already succeeded in curing 17 cases of sycosis. Successful results in cases of less than a year's duration are reported by Pusey and Cauldwell, Spiegler, Gaston and Nicolau. Excellent results were obtained by Török and Schein in two cases of two to three years' duration. Of two cases reported by Kienböck, one received an X-ray burn which was later followed by tetangiectases. This condition was, however, preferred to the more disfiguring sycosis. Fleig reports four cases. One of theme of seven years' standing was improved by treatment. Cases of two to four years' duration were sucessfully treated by Belot. Zeisler reports four successful cases, one of two and one of four years' duration.

After six treatments a case that had lasted five years was cured by Morton. Stopford Taylor reports a case of five years' standing cured after two and a quarter hours of total treatment. Gottschalk reports three cases of three, seven and eight years' duration, respectively, that were successfully treated. Gassmann and Schenkel cured a case of 13 years' standing after nine treatments. Eight months later there had been no relapse. Hahn and AlbersSchönberg succeeded in finally curing a case of sycosis of the upper lip of 30 years' standing. There were later several relapses, which were cured by iodine. Successful results are also reported by Grouven, Lancashire, Lion, Rinehart and Williams.

In conclusion, I would say that for the more acute cases of sycosis the X-ray is the best therapeutic agent at our command; for the extremely chronic and obstinate cases it is the only reliable means of treatment.

Allen, C. W. Radiotherapy, phototherapy, radium and high-frequency currents, 1905, p. 273.

Belot, J. Radiotherapy in skin disease, 1905, p. 250. Fleig, G. La radiothérapie en dermatologie; technique, indications, résultants; Thèse de Paris, 1906, p. 84.

Freund, L. Elements of general radio-therapy, 1904, p. 269.

Freund, L. 2 Fälle von Sycosis mit Röntgenstrahlen behandelt, Archiv für dermatol., 1903, vol. LXVI, p. 200.

Freund, L., and Schiff, E. Weitere Anwendungsgebiete der Radiotherapie: Fortschritte a. d. Geb. der Rontgenstr., 99-1900, p. 109.

Gassmann, A., and Schenkel. H. Ein Beitrag zur Behandlung der Hantkrankheiten mittelst Röntgenstrahlen; Fortschr. a. d. Geb. der Röntgenstr., 98-99, vol. 2. p. 121.

Gaston and Nicolau. Quelques cas d'affection pilaires (trichophyties, sycosis, folliculitis) traitées par les rayous X, Bull de la Soc. Française de dermat. et de syph., 1902, p. 341.

Gottschalk, E. Die Röntgentherapie nach ihrem heutigen Stande, 1907, p. 32.

Hahn, R., and Albers-Schönberg.

Die Therapie

des Lupus und der Hautkrankeiten mittelst Röntgenstrahlen, Münch. Med. Wochenschr., 1900, p. 363. Kienböck, R. Radiotherapie, Physikal. Therapie, Heft 6, 1907, p. 122.

Lancashire. G. H. The therapeutic employment of X-rays, Brit. Med. Jour., 1902, i, p. 1328. Lion. Verhandlungen der deutsch. dermatol. Gesellsch., 7. Congress, 1901, p. 52.

Morton, W. J. Some cases treated by the X-ray, Med. Record, 1903, p. 125.

Pusey, W. A. The principles and practice of dermatology, 1907, p. 981.

Pusey and Caldwell. The Röntgen rays in therapeutics and diagnosis, 1904, p. 363.

Rinehart, J. F. Treatment of epithelial skin cancers and sycosis non-parasitaria with the X-ray, Phil. Med. Jour.. 1902, p. 221.

Schmidt, H. E. Uber die bisher vorliegende Ergebnisse der therapeutischen Anwendung der Röntgenstrahlen, Berliner Klinik, July, 1907.

Spiegler, E. Archiv für Dermatol. und Syph., 1901,

p. 131.

Stern, S. Report of 800 dermatological cases treated with X-ray and high-frequency currents at the Mt. Sinai Hospital (Dr. Lustgarten's clinic), Jour. cut. dis., Oct., 1907.

Taylor, G. G. Stopford. Clinical records of light and X-ray therapy, 1904, p. 28.

Török, L., and Schein, M. Die Radiotherapie und Actinotherapie der Hautkrankheiten, Wien. Med. Wochenschr., 1902, p. 955.

Zeisler. J. Radiotherapeutic observations, Jour. Am. Med. Assoc., 1903, p. 511.

Gentlemen, I have the pleasure to show you two patients suffering from the same disease. The first patient, Mr. R. B., age 22 years, had rheumatism four years ago, and now has fleeting pains in his legs. He has never been ill, except that he has had measles when he was a child. His family history is negative.

Habits. For the past six months he drank beer excessively; took his meals, which were mostly cold, at irregular times, and, as he states, the food being of a poor quality. The disease first appeared on the anterior surface of both knees in the form of red papules covered with whitish scales. Soon similar papules appeared on his back and on the extensor surfaces of his forearms. In many places where a number of papules appeared closely together they coalesced and formed the patches present and which are so profusely covered with scales that are easily removed, leaving a red inflamed. infiltrated base. The lesions are nonpainful, but they itch occasionally. The physical examination does not reveal any organic disease of the internal organs. His eyes show signs of slight jaundice: the tongue is heavily coated and the breath has an offensive odor. He complains of eructations of large quantities of gas; the bowels are constipated, having only two movements in a week's time. The other patient, Mr. J. S., age 21 years, has had no illness since his childhood days, when he had measles, diphtheria and scarlet fever. He is well nourished. Physical examination reveals no abnormal condition of his internal organs.

*Clinical Lecture delivered in the Amphitheater, Medico-Chirurgical Hospital.

When he is dressed, with the lesions all covered up, he has the appearance of a perfectly healthy man. He claims that the family history is entirely negative as regards rheumatism, tuberculosis and

cancer.

Six months ago he first noticed a few small papules appear on both of his elbows, and in the course of a few days more similar lesions appeared on the extensor surfaces of his forearms. The lesions are situated closely together, forming the larger areas present on the arms and legs. You will notice this patient has not so many large patches of involved skin as the other one, but his back is profusely covered with papules the size of a large pea, which are covered with thick, whitish scales that can be picked off readily, leaving the characteristic infiltrated base. The cause of this patient's disease is undoubtedly due to his excessive indulgence of rich foods. He eats large quantities of meats and pastries and drinks from five to six cups of coffee daily. His bowels are regular; appetite too good.

Diagnosis. The disease in these two patients is undoubtedly psoriasis. The diagnosis can be clearly made from the characteristic red papule covered with the silvery white scales, the coalescence of the papules forming patches of infiltrated skin covered with the scales, and the involvement with preference of the extensor surfaces. The papules and patches are sharply defined in outline, the skin, which is dull red in appearance, thick and infiltrated. In the abscence of other constitutional symptoms and pathological conditions of the internal or