INTESTINAL OBSTRUCTION FROM GALL-STONE. 85

evade pressure; they must either become stretchedor compressed. For that reason root-pains are theearliest and most constant symptom which youexpect in spinal compression. The tumour growsand catches the roots. Next it displaces thecylinder of cerebro-spinal fluid. That does notproduce very much in the way of symptoms. Thenit squeezes through the fluid cylinder and com-presses the spinal cord itself. When it does so, itproduces venous engorgement below the level ofthe lesion. This venous engorgement causesexudation of blood below the level of the lesion,and consequently there is pigmentation of thefluid, and in the fluid, too, there occurs an excessof albumin, so great in some cases as to causespontaneous coagulation. This is commonlydescribed as Froin's syndrome--xanthochromiaand spontaneous coagulation, a condition whichis pathognomonic of spinal compression. It waspresent in both of these cases. Lastly, as thetumour grows, the cord itself becomes flattenedout, and then we get signs of disease of the longtracts which run through the cord. So thesymptomatology of the condition is quite easilyunderstood. (To be concluded.)(To be conclttded.)

INTESTINAL OBSTRUCTIONFROM GALL-STONE.

"GALL-STONE ILEUS."A PITFALL FOR THE PRACTITIONER.

BY

G. GREY TURNER, M.S., F.R.C.S.,NEW'CASTLE-UPON-TYNE.

(Concluded fromo p. 73.)

-TREATAIENT.AT one time enormous doses of belladonna were

given with the intention of relieving the intestinalspasm, and in the hope that natural cure mightbe thus brought about. One reads of cases wherestones have been voided, and the treatment hasbeen given the credit. I was amused at theaccount of a case in which the attendant claimedthat he had cured a case in which the patientpasse(l a stone .3" X 1", and another in which,after abdominal manipulation, a stone the sizeof a ping-pong ball was voided naturally. Isuspect that in all these cases treatment has beena coincidence, and that but for the grace of Godthe patients might have suffered oblivion.The most charitable and practical way to look

at the matter is to say that in these days probablysurgical intervention with all its risks is much saferthan the other plans that have been popular fronttime to time. The form which intervention shoul(dtake may admit of some discussion in the latecases. Sometimes an enterostomy has been per-formed above the stone, with the idea that theobstruction having been relieved, the stone would

safely pass on and Jead to spontaneous cure,leaving only the intestinal fistula to be dealt withby a paistic operation (Fig. 12). The relief of theobstruction in this way removes the only stimulusto effort on the part of the intestine and destroysthe last chance of the stone being propelled alongthe bowel. In the cases in which I have seenthis carried out, the result has been disappointingand the patients have died, either as the resultof continued exhaustion, or from peritonitis, orfrom the rupture of an ulcer (see Case 2 in appendix).The experiences of the treatment of this typeof obstruction have confirmed what has beenlearnt from other cases of obturation, and I havenow come to look upon enterostomy as onlyv anadjunct in the treatment of obstruction and neveras a method by itself.

I would say, therefore, that if a diagnosis ofgall-stone obstruction is made, the best chancefor the patient lies in early laparotomy for thepurpose of searching for and removing the causeof that obstruction.The question may arise as to where the operation

should be carried out. Generally speaking, I amstrongly of the opinion that operations should beperformed in properly equipped institutions; butI do think that there are many emergencies whichhave a better chance if they are not disturbed ii;the way that such removal may imply. Cases, forinstance, under consideration are always elderly andsometimes gravelyill, and I believe that their chancesare sometimes better if they are dealt with in their.own homes. I am always thankful to have learnta great part of my emergency surgery in the smallindustrial houses of Tyneside, and cannot be toograteful to my doctor friends who have so ablyassisted me and seconded my efforts in every way.Very often these patients are actually regurgitatingand vomiting intestinal material, and this may bea very grave complication when the question ofanoesthesia arises. Under these circumstances it isusually better to empty the stomach before anansesthetic is administered, or, if that is not done,the stomach tube should certainly be passed assoon as the patient is unconscious.The question of the ansesthesia is very important.

In the early stages there can usually be no validobjection to carefully-administered general anaes-thesia, but if for any reason the patient has to beoperated upon in the stage when toxeemia hassupervened, then general anaesthesia should cer-tainly be avoided. Local infiltration of theabdominal wall will nearly always suffice, andshould unexpected complications be met with,general ansesthesia can be administered. Theoperation is always simple. It consists in openingthe abdomen in the middle line below the umbilicus.In most of my cases a couple of fingers introducedinto the peritoneum have almost at onceencountered the piece of intestine containing thestone, and when it has not been so, a short searchhas soon disclosed its whereabouts. It is best tofollow the collapsed intestine, and it is well to

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86 INTESTINAL OBSTRUCTION FROM GALL-STONE.

remember that as it approaches the obstructedarea it becomes reddened. Once the stone hasbeen located, the piece of bowel containing itshould be gently withdrawn from the abdomen.The searching of the peritoneal cavity and thewithdrawal of the intestine may both be a littlepainful, so that they must be done with thegreatest of gentleness. After the loop containingthe stone is withdrawn, it should be surrounded

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A large gall-stone lying loose in the Ileum. The patient wasa feeble woman of 65 who was very ill from obstruction.For this reason only an enterostomy was performed, but inspite of the relief thus afforded she gradually sunk and died12 d,ays later.

i)y gatuze, preparatory to incisionl. I have usuallyfound that the stone is so grasped by the intestinethat its position cannot be easily altered withoutrisk of damaging the bowel wall, and I have alwaysmade the incision directly over the calculus. Suchincision should be made in the long axis of the guton the antimesenteric border. As a rule, it neednot be more than one inlch in length, but there isno object in ilncreasing the difficulty of extractingthe stone by limiting the incision of the bowelwall. When of sufficient length, the stone canbe very readily squleezed out, and will usually beaccompanied by a good deal of mucous. Thefingers of the assistant control any unwantedescape of intestinal contents. The incision is thensutured in the opposite direction, that is to say,the transverse axis of the bowel. so as to avoiddiminishing its lumen.The surgeon should take care that the closure

is efficient without being too tedious. Personally,I rely on two continuous sutures, one through allthe coats of the bowel to be haemostatic and water-tight, and the other a continuous Lembert. It is,next, wise to examine the bowel in the immediatevicinity for any further calculus, though I wouldcertainly never make a prolonged search oreviscerate the patient for this purpose.

We ought to consider mhether or not the gall-bladder region should be systematically examined.This step is really quiite unnecessary. It onlyhalf-satisfies the curiosity of the surgeon and itdoes not help the patient, because I am satisfiedthat it is seldom necessary to interfere with thegall-bladder regionl, and, if such is indicated, itis much better done at a second operation. Theafter-history of my own patients, and indeed ofmost cases, shows that subsequent gall-stone troubleseldom occurs, and the fact that stones have escapedinto the intestine shows that nature has provided aroute for the evacuation of any small stones ordebris that may be left. Of my six patients whosurvived, one has been so recently operated uponas to make the information of little value, one Ihave not been able to trace, and in the othersthere has been no recurrence of any trouble whichcould be attributed to the gall-bladder region. Inthe after-treatment the less that is done thebetter. Purgatives must be avoided, and the onlvindication is to treat the toxeemia that may exist.The history of many cases shows that during thisperiod a further obstruction due to stones mayoccur, and if this is suggested, the surgeon must nothesitate to reopen the abdomen, for the cure ofthe patient will again depend upon early inter-ference.

APPENDIX OF CASES.A. C. Age 72. Female. (Reg. No. 1,513, Case l.) April,

1908. Impaction of calculus in small intestine. Acuteobstruction of three days' duration. RemnDval by operation.Recovery.

History.-On a Saturday morning at 2 A.M. the patientwas seized with sudden pain over the umbilical region;at 8 A.M. she began to vomit, and this continued at intervalsuntil Tuesday night, when the patient was admitted tothe Newcastle Infirmary. The vomiting was copious andfrequent, and had a bad smell, and the patient describedit as of a dark brown colour and with a taste like sulphur.The vomiting attacks persisted right up to the time ofoperation. The bowels were moved on Friday morning andagain on Ttesday afternoon after some medicine, but noflatus was passed. The patient was seen by a doctor oIIMonday, who gave her some medicine, but it did not relieveher. Two years ago she had a similar attack which lasteda week: there was the pain, vomiting, and constipation,but at the end of that time diarrhcea came on, and hersymptoms were relieved. The patient fancies that duringthat attack her eyes were rather yellow, but she did notnotice any discoloration of the skin. There is no historyof any other attacks, but the patient stated that she usedto become unaccountably distended sometimes.WVhen seen late on Tuesday night this patient was found

to be a stout woman in quite good general condition, andobviously suffering from obstruction, for the vomitedmatter was undoubtedly intestinal in character. Theabdomen was quite flaccid, and there were no physicalsigns pointing to the cause. A diagnosis of gall-stoneileus was arrived at by exclusion, and the patient wasadmitted to the Infirmary for operation. This was carriedout in the early hours of the morning. On account ofthe frequent vomiting local infiltration anaesthesia wasemployed. The abdominal cavity was opened by anincision in the middle line below the umbilicus,a little cloudy yellow fluid escaping. The finger wasintroduced, and on feeling towards the pelvis a massin the small intestine was at once detected. This piece ofbowel was drawn outside the abdomen. The rounded masswas impacted in the bowel, which was distended andslightly inflamed above it, but collapsed below. On

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INTESTINAL OBSTRUCTION FROM GALL-STONE. 87

incising the gut directly over the mass, a gall-stone wasfound. The wound in the intestine was closed and theabdominal wall resutured. During the operation the patientonly complained of the discomfort of lying on the table,and not of pain. The next day she vomited four times,but afterwards recovery was uneventful. The calculusmeasured ki" x 1", and weighed 113 gr. (Fig. 13). Ithad originally been faceted, but the corners were roundedoff and the faceted surfaces were not smooth, suggesting

FIG. 13.

·;·· ·:i:::.···:·

Gall-stone removed fromsmall intestine in Case 1.It weighed 113 gr.

FIG. 14.

.:··:

(;;all-toelc froul lherile2l7il.,>-w '2. It wcighel 2';;3 gr.

that it had not been in contact with its fellows for somelong time.The history suggests that in the attack of two years

previously the distended gall-bladder had leaked into thebowel, thus explaining the relief of symptoms and theattack of diarrhcea which accompanied the cure. At thistime the other faceted stones may have escaped into thebowel, leaving the larger stone which slowly entered thelumen of the bowel by the process of ulceration which hasbeen described.

This patient died 12 years later from bronchitis, andwithout at any time suffering from a return of abdominalpain.,1. M. Age 70. Femnale. (Reg. No. 1,744, Case 2.) August,

1908. Impaction of calculus in ileum. Acute obstructionof sezven days' duration. Toxcemia. Elnterostomy. Death.History.-About 14 years previously she had a severe

abdominal illness, which laid her up for five or six weeks;at that time she was given up, but gradually got better.There was jaundice, and she passed several gall-stoneswhich were like peas. For several months recently shehlad complained of sudden pains in the upper abdomen,for which she had to lie down for a few hours. She wassaid to be " bothered with the wind," though the bowelsuwere regular. There was no diarrhocea, and she did notpass blood. A month ago, after one of these attacks, gall-stones were voided. At the same time an abscess betweenthe breasts formed and burst. Exactly seven days beforeadmission to hospital she was suddenly seized with a mucinore severe pain, which made her cry out and vomit.The vomiting had continued ever since; on one occasionshe brought up two basinfuls of green material; the vomitedmatters have become offensive. Since the onset of theattack the bowels have not been properly moved, and shehas become progressively weaker.On admission this patient was exceedingly ill. The pulse

was 140 and small. The face was grey and sunken, andthe hands had a tendency to be cold; the tongue wasthickly furred and very dry; and there was almost constantvomiting of intestinal contents. The abdomen was notmuch distended, but intestinal coils could be felt contractingin the right iliac fossa. There was nothing to be made outon pelvic examination, and there was no external hernia.In the light of the history a diagnosis of gall-stone obstruc-tion was suggested. Operation under eucaine anmesthesia-an incision was made in the right iliac fossa and a loop ofvery distended small intestine was opened, large quantitiesof fluid faeces escaping. A mass could be felt in the pelvis,

but was not interfered with, as the condition was desperate.The patient went on fairly well for about three days.During this time the hands remained cold and the pulsecontinued to be very quick and feeble, but towards theend of the time she was obviously picking up, the tonguebecoming moist and the vomiting ceasing. Then, withoutwarning, she had a sudden severe attack of pain, after whichthe condition became rapidly worse, and death soonfollowed.At the nlecropsy the peritoneal cavity was found to be

full of pus. A.stercoral ulcer in the small intestine 2 ft.above the enterostomy opening had leaked, in spite of thefact that it was covered by adherent omentum. A largegall-stone was found impacted 18" beyond the enterostomyopening, and had evidently been the cause of the obstruc-tion. This point on measurement proved to be 8 ft. belowthe duodenojejunal junction. The intestine above theenterostomy was distended, and its walls were sodden,while the mucous membrane was thickly studded withulcers lying between the valvulme conniventes, and it wasone of these ulcers which had given way. The intestineimmediately above the stone was much thickened, butnot very distended, while below the stone it was very muchcollapsed. At the site of the impaction of the stone therewas no ulceration of the mucous membrane. There weremany adhesions between the gall-bladder, the hepaticflexure of the colon, and the duodenum, and a hole wasfound between the gall-bladder and the duodenum about1" beyond the pylorus. It had a ragged, sloughy edge,and would just admit the tip of the fore-finger, but didnot appear large enough for the transit of the stone, whichwas found in the intestine. The gall-bladder was shrivelledand did not contain any other stones. The calculusmeasured 1" x 1", and weighed 273 gr. (Fig. 14).R. B. Age 63. Male. (Reg. No. 5,280, Case 3.) December,

1912; Impaction of calculus in small intestine. Sub-acute obstruction of nine days' duration. Bowel growthsuspected. Removal of stone by operation. Recovery.History.-On a Saturday a week before admission this

patient was very well, and attended a football match. Hewent to bed at 11 and slept until about 3 A.M., when hewas awakened with a feeling of sickness. He vomited,which relieved the small amount of pain from which hesuffered. From this time and up to his admission he hadconstantly recurring discomfort in the upper abdomen,with nausea and vomiting which temporarily relieved him.The bowels were never moved from the time of the onset,nor did he pass flatus, though he was not troubled withwind. Medicine and enemata were both without result.He felt as if there were an obstruction, and as the week woreon it seenmed to move a little lower down. He does Ilotremember ever having an abdominal illness except perhapsonce or twice a bilious attack, and in 40 years he neverdrew sick benefit until this illness. Not troubled withindigestion and never had " windy spasms " or jaundice.On admittance he was found to be a very lealthy-looking

old man in good condition, but rather toxic. Temp. 98°.Pulse 80. Tongue a little dirty. There was some generaldistension of the abdomen, but this was not very marked.No growth or mass or tender area to be felt. There wasno external hernia and nothing to be felt per rectum, norcould anything abnormal be seen with the sigmoidoscope.There was no result from a hospital enema, but poulticesgave some relief to the abdominal discomfort. Forty-eighthours after admission it was decided to operate becausethe patient still had discomfort, and there had been noaction of the bowels and no passage of flatus. Thoughnot in pain, he readily agreed.

It was proposed to make a preliminary c3ecostomy fora supposed growth in the large bowel beyond. An obliqueincision was therefore made over the caecal region, but thelatter was not distended, though there was a small amountof free fluid in the peritoneum. The incision was enlarged,and with the hand the whole of the colon was palpated,but no growth could be felt. A hard mass was felt aboutthe position of the hepatic flexure, but on further investiga-tion this was made out to be adhesions about the gall-bladder. The importance of this finding was not appreciated

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88 INTESTINAL OBSTRUCTION FROM GALL-STONE.

at this stage. As no growth could be found in the largebowel, the hand was passed into the pelvis among the smallintestines, when a hard body was at once found. On with-drawing this it proved to be something inside a' loop ofsmall intestine. The bowel was fairly tightly contractedon this body, and was neither distended above nor undulycontracted below, but just looked as if a foreign body werebeing grasped in its passage through the bowel. The bodywas firm but could be crushed to some extent between thefingers. As the site of impaction-though not clearlydetermined-was a considerable distance from the ileo-cmecal valve, no attempt was made to push the body oninto the caecum, nor was it broken up for fear of damageto the intestine. The gut was incised in its long axis,what proved to be a gall-stone removed, and the openingclosed in the transverse axis. The abdomen was closedwith through and through silkworm sutures. The patientstood the operation perfectly well, he was never sick after-wards, and fiatus very soon passed naturally and thebowels moved of their own accord. Recovery was quitesatisfactory, and for some time he was known to be well.Unfortunately, the later after-history could not be obtained.The mass removed had all the appearance of a single

large gall-stone undergoing a process of disintegration bymaceration. On analysis it proved to be a bilirubin-calcium stone. Bile constituents and calciumwere detected,but no cholesterin was found.

ill. M. Age 70. Female. (Reg. No. 11,790, Case 6.) April,1919. Gall-stone impacted in pelvic colon. Acuteobstruction of four days' duration. Removal of stone byoperation. Recovery.History.-Five years previously patient had what was

said to be ";' chill on the liver." It began with pain duringthe night, and she was laid up for two weeks. The samesort of illness recurred two years later, and this time wasfollowed by jatmdice. The present illness began four daysbefore she came under my observation, when she wassuddenly seized with great pain at the pit of the stomachwith sickness. From this time there had been recurringspasms attended with vomiting. She had not been ableto take food, and there had been absolute constipation.

Condition on admission. When seen at the end of thisfour days' illness she looked quite well, was perfectly clearmentally, and gave an accurate account of her illness.The tongue was clean and moist and the pulse was just 100.The abdomen was not distended, nor was there any sugges.t-ion of enlarged coils of gut. There was a little tendernessover the right iliac fossa, but no mass could be felt there orelsewhere. The hernial sites were negative, and nothingcotuld be made out on rectal examination. My notes donot say whether or not I made a diagnosis of the cause ofthe obstruction.

Operation.-Under general anaesthesia the abdomen wasopened, and a large stone was found tightly impacted inthe upper part of tlle pelvic colon. The bowel over thestone was much thinned and damaged, that above was alittle distended and thickened, and the bowel below wascontracted. The stone could not be moved from itsposition, and lhad to be extirpated by direct incision overit. The wound in the bowel was made in the longitudinaldirection and sutured in the transverse. The small intestinewas not distended. On palpating the gall-bladder it wasfound to contain stones, but it did not appear to be adherentto surrounding viscera. The stone removed was quadri-lateral, becoming rounded, and measured j" x 7"The patient ma(le an uninterrupted recovery, and has

had no ftuther attacks of abdominal pain.

Mr.s. 1l. ll. Age 74. (l'eg. No. 15,779, Case 7.) January,1924. (tall-stone impacted in s.mall intestine. Acuteobstruction of three (lays' duration. Removal by operation.Recovery.

History.-For four or five years she had been troubledevery three montlhs with severe attacks of gall-stone colic.The attacks were relieved by morphia, and on one occasionseveral small stones were passed. The patient was con-sidered to be too old for operation. The present illness oeganthree days before operation, and was at first considered

to be a recurrence of the gall-stone trouble. But the painwas different, and was lower in the abdomen, and thebowels could not be got to act. There was intermittentcolic and vomiting with remissions. A diagnosis of gall-stone ileus was made.

Operation.-Under general anaesthetic the abdomen wasopened below the umbilicus and a calculus found tightlyimpacted in the small intestine. It was removed by directincision, the gut being stitched in the opposite direction.The patient made an uninterrupted recovery, and was aliveand quite well twelve months later. There had been norecurrence of the previous attacks.

Additional Case.Because of the many unusual features of interest,

I append the notes of a last case which I only encoun-tered in the post-mortem room. It is not, however,

FIG. 15.

,,

p -- AL

-s ....z

Specimens from a case wherea gall-stone had become Im-pacted above an intlammatorymass in the sigmoid, the resultof sacculitis. The calculusulcerated through the bowelwall and was found free inthe reeto-vesical pouch.A, Portion of pelvic colonand rectum removed afterdeath; x, hole through whichthe gall-stone escaped; B, alongitudinal section showingsome of the saccules; c, gall-stone found in the recto-vesical pouch.

unique, for gall-stones have several times been fotmndimpacted above a previously existing obstruction in thebowel, whether due to new growth or some other cause.

This patient, a man of 57, was sent into hospital lateone night in June, 1902, with a diagnosis of gall-stonesand retention of urine, further complicated by injury tothe intestines from an attempt to empty the bladder bysuprapubic tapping. The following history was obtained.He was working up to seven days before admission, when hewas seized with sudden abdominal pain, and had symptomsof intestinal obstruction with vomiting. For some littletime he had experienced difficulty with micturition, andduring this illness he had retention. His doctor tried topass a catheter, but was not successful in drawing off urine.A suprapubic trochar was therefore used, but only fsecescame out.On admissionl the man was very ill, with signs of general

peritonitis. Per rectum a hard mass could be felt. Hewas never considered to be in a fit state for operation, anddeath occurred about 48 hours after admission.

Necrop.sy.-CGeneral septic peritonitis, the abdomen beingfull of liquid faeces. The trochar opening in the belly wallcorresponded with two hloles in a loop of small intestine

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UTLTRA-VIOLET LIGHT. 89

lying just above the pubes, and intestinal contents wereissuing from these holes. A large gall-stone (1" ;x 1")was found lying free in the recto-vesical pouch. Tlih6reewasa large mass of carcinoma in the rectum (lst part), and justabove this a ragged hole in the wall of the bowel, from whichthe stone had evidently escaped. The gall-bladder wassmall and contracted, and the hepatic flexure of the colonand the duodenum were adherent to it. There were holesbetween both colon and duodenum and gall-bladder, anda gall-stone in the latter projected slightly into both partsof the bowel. No other stone was found in any part of thebowel. The liver was enlarged and markedly cirrhoticThe specimen from this case was put aside labelled

"Carcinoma Rectum with impaction of gall-stone and escapeof gall-stone by ulceration." Amid an abounding wealthof pathological material it was neglected until the year1908 when I was especially interested in this question ofgall-stone ileus. On re-examination I found that thesupposed growth was simply inflammatory thickeningassociated with a typical'diverticulitis, as is well shown inthe illustration (Fig. 15).

ULTRA-VIOLET LIGHT.ITS PROPERTIES AND THERAPEUTIC

USES.*(ABSTRACT.)

BY

F. M. ALLCHIN, M.B. LOND., M.R.C.S. ENG.,I).M.R.E. CAMB.,

HON. ELECTRO-THERAPIST, -WESTMINSTER HOSPITAL; HON.RADIOLOGIST, ROYAL NATIONAI, ORTHOP.IEDIC HOSPITAL.

IN a brief talk such as this it is not possible forme to cover the whole field of light therapy, butI shall endeavour to place before you as conciselyas possible what I consider to be the main principlesunderlying the subject.

In order that we may appreciate fully thetherapeutic values and limitations of such anagent as ultra-violet light it is essential that weshould first understand something of its natureand of its physical and biological properties.

Ultra-violet radiation is of the same nature aslight-i.e., visible light-X rays, gamma rays ofradium and Hertzian (wireless) waves. These areall due to electro-magnetic disturbance of the ether-which disturbance is transmitted in the form ofwaves. The velocity of transmission is the same ineach case-namely, the velocity of light (186,000miles per sec. or 300,000 km. per sec.)-but thewave-lengths differ widely, ranging from thelong waves of wireless telephony of 20 km. inlength or more domn to the heat waves and theinfra-red rays-i.e., those rays just above the redend of the visible spectrum-followed by oneoctave of what we appreciate as visible light (anoctave being so called because the waves at oneend are twice the length of those at the other),then three octaves of ultra-violet light graduallymerging into the X rays, of which there are 14octaves, and, finally, the extremely short waves ofradium.

* A Post-Graduate Lecture delivered at the VestmlinsterHospital on Sept. 24th, 1926.

As all these rays travel at the same velocity,it follows that the short waves repeat themselvesmuch more frequently than the long-i.e., thefrequency is greater. The frequency of a gamnmaray is indicated by a figure stretching to 21 units,and that of wireless wave by five figures only.

Hertzian waves .. .. .. 20 km.Heat waves-infra-red .. .. 8000 Au.Visible light .... .. 7900-3800 Au.Ultra-violet light .... .. 4000-1000 Au.X rays .. .. .. .. 12-0-15 Au.Radium rays .. .. .. 0 1-0.015 Au.

(Au = 1 ten-millioneth of a imm.)It may be of interest to consider briefly the

steps by which this long series of waves has beenbuilt up. Newton made the first discovery whenhe named the colours of the visible spectrum in1666, and for over 100 years these were the onlyrays known, until Herschell announced the existenceof the infra-red in 1800. Shortly after this, in 1801,the first mention was made of ultra-violet rays byRitter, who noted the effect produced upon silverchloride by the violet end of the spectrum. Maxwell,in 1868, stated that there were rays beyond theinfra-red, and Hertz shortly afterwards discoveredhow to generate them. Then in 1895 came thegreat discovery of X rays by Rontgen, leaving agap between these and the ultra-violet, which wasfinally filled by Millikan as recently as 1921. Thegamma rays were brought into use by the discoveryof radium by Becquerel and the Curies in 1896and after. Even now fresh discoveries are beingmade, and as recently as last year Prof. Millikanhas stated that there are rays capable of penetrating6 feet of lead.The band of radiation -hich we make use of in

our work extends from 4000-1500 A.U. approxi-nately-the various wave-lengths being determinecdby analysis through quartz and fluorite prisms.These rays obey the same laws as light rays-namely, they are transmitted in straight lines illa uniform medium--they are capable of reflectionand refraction, and they can be polarised. Again,the intensity of radiation on a given surface variesinversely as the square of the distance from thesource-that is, the radiation falling on a surfaceat two-feet distance is one-quarter of that fallingon the same surface at one-foot distance from thesource of radiatioi. This is of great importance.The natural source of ultra-violet light is, of

course, the sun, but the pure sunlight containsonly half an octave of this kind, and we have,therefore, to resort to artificial means to producethe rays in greater quantity. The use of sunlightas against that of ultra-violet light has been some-what aptly compared to the use of crude drugsand their synthetic products, for instance, opiumand morphia.When we consider that only a fraction of the

sun's radiation ever reaches the earth's surface,and that of this fraction only 75 per cent. on aclear day reaches an altitude of 18,000 feet, ancd50 per cent. reaches sea level (according to LeonardHill), it is seen that systematic heliotherapy is.

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