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well known surgical procedure to a special region. As the general surgeon has had t o contend with substitutes, so have we contended with local and interplicated methods, such as sewing the pillars together or using a needle to carry the thread around the artery and through the tissue, a more difficult and dangerous operation than that of simply grasping the artery with a forceps and tying in the ordinary way. From the fact that the capsule throws numerous filaments along the ente!*ing arteries, they do not contract as readily as the ordinary artery, hence are more apt to bleed freely. In the epipharynx, after the removal of the adenoids, one may sometimes have troublesome bleeding. About a year ago, a very able surgeon related a case in which a child lost its life in this way, he not having been notified of the bleeding until after the child's death. Last summer, eight hours after an operation, I was called to the hospital for a similar case and after giving anesthesia. by drawing the uvula forward, I readily discovered the bleeding vessel and tied it, after which there was no mere bleeding, and in a few days the child had entirely recovered from the operation and the loss of blood. Allow me to emphasize this dictum: Never allow a patient to l a v e the operating table until all bleeding is controlled, which is to be done by tying every bleeding vessel. There is no other safe method; one may perfect oneself by{ practising with a handkerchief in a turrhler, grasping it with a forceps, and THE ELI hf IN X TION OF SOLUBLE FWDIUM SALTS TAKEN INTRAVENOUSLY AND PER OS. cutaneous injection of the s a l t into dogsrwas studied in two cases by Qrill'$nn'd&ebner. (j),and the data in Tables I and XI represent, their results : SWBCLTANEOVSLYI MTOA DOc'WdmHiNG 9 KO. Radium (element) content of Per cent. of tbeinJectcd Day. niicrogramr mlcroqrsmr Feces. .Urine. Feces Urine radium. Radium (element1 content o f Per ceo ~of total Feces Crinc radium injected. micrograms. micrograms. Feces. Urine. From these dht&Rcill!'amd Zehner conclude that ELIMINATION OF Rd DICJI. of Brill and Zehner are a ures are not very concord The intravenous solut form of radium chlo used for administrati of radium chloride i feces and urine. TmLe 111. Perratecent Day. Feces. C'rine. Combined. remlning. radium. Micrograms radium element in radlum nation of . I . ............Injection too micrograms radium elemmt. The radium determinations were made by the radium emanation method, using aGquot parts of the feces and urine. Cold concentrated nitric acid w 3 S zdded to the,.f,eces samples, and after the first violent reaction was overy'the saInple was heated with more nitric a d d . Sulphuric acid was then added. a i d the clear solution heated until free from nitrlc acid. The urine samples were similarly treated to cccu're a clear solution in strong sulphuric aci$ The samples were diluted with pure sulphuric a c d and aliquot portiorx of the sulphuric acid solution served 'for the radium analyses. This method o f preparing the samples is superior to incineratio11 since rhere is no loss o t raciium salt by volatilizatior1. From the data in Table m, it is clear that at first there is a rapid elimination o f the radium, rnain'lv in the feces.- The absolute amounts oi radium eliminated from day to day will depend somewhat on the quantities of feces and urine excreted. Since the radium salts are not volatile, the only other manner in which they might be eliminated is in the &in secretions. ,. The radium eliminated in the urine :.. so much lessmarl t b t in the feces that it is not U!I-
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SELL, VIOL. AND GOHDO?J: 0 expect that the amount elimiiiated skin will be very small. This point is ned and will be reported on later. Rarelated chemically to nation of the rapid of the radium present during the less than one per cent. of the racf. last column in Yicrograms radium in radium nation of Day. Feces. L'rine. Combined. remaming. radium. Micrograms radium in radium nation of Day. Feces. Lrine. ('ombined. remaining. rzdium. I............. Radium taken about midniqkt. Radium taken into the body is continually disiiitegrating with the ionnation of the gaseous radioactive substance, radium emanation. This gas is carried by the blood to the lungs, where the emanation passes out of the blood by diffusion, and is lost from the body in breathing. The amount of emanation in the exhaled air was measured after the first experiment on radium taken by mouth, the data in Table VII being a record of the results. Radium emanation per lifer Day. Hour. microcuries. units. Taken by mouth, a much greater part of a soluble radium salt is eliminated during the first three or iour days, but aiter that, the rate of elimination is 5ensibly the same as when the radium is-introduced by intravenous injection. The main part of the radium is eliminated in the Eeces. \+'hen the radium is taken by mouth, a smaller proportion of the excreted radium is found in the urine than when the radium is injected intravenously. From twenty-five to thirty-five per cent. oi the radium taken by mouth remains in the body four or five days aiter ingestion. From fifty-five venously remains in the body lour or five days after the injection. From this time on, the elimination proceeds at about the same rate in each case. By the tenth day aiter taking the radium, the rate oi excretion is iess than one Ter cent. This results in a n exceedingly slow elimination of the last oi the radium, the process goiiq on for months. T h e first rnpitl elimination takes place before the radium has Ixen "tixed" in the tissues. .I\fter that has taken $ace. the excretion is much slower, anti even the :imount of emanation Lvhich is given 08, is less. I t is a \vel1 knokvn fact thnt solution of radium < ; t l t i ian be complctelv Ileenianated by passing a current of air through the solution. Even the (try radium divi(1ed. holds the emanntion very strondy. + leqs than5re per xiit.oi the emanation e
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From the foregoing results, a rational method for maintaining a certain amount of radium in the system can be suggested. If for example, it is desired that fiout fifty micrograms of radium be maintained in the body-an intravenous injection of about 100 micrograms is made, and after ten days, it will suffice to take two micrograms of radium by mouth, every few days, in order to make up for the radium being lost. Radium sdutions taken repeatedly by mouth have a cumulative effect. However, the elimitiation o t radium taken by mouth is about twice as rapid as when the radium is injected intravenously. Therefore, there will be required about twice as much radium to produce a given result when the radium is taken by mouth. This is in accord with the clinical findings of many workers, who have obtained results more rapidly with smaller total quantities of radium injected intravenously than with larger total quantities of radium taken by mouth. I. Eerl. Mia. Wochenschr. 27. 1912. z. CAMERON and VIOL: PETIT, and JABOIN: Compte.? rrndus de l'acadnnw der sciences. BACILLUS BULGXRICUS IN DLABETES Remom for Failure in Its Use. I have read with no little regret the conclusions set iorth in an article entitled, Diabetes Mellitus Treated with F h i d Cultures of the Lactic Xcid Bacillus, published in the Journal ,4. M. A . for February 6, rgrg, based on the very slim premises afforded by four cases, treated for a period averaging between two and three weeks. IYhile the scrutinizing thinker will immediately recognize the weak- . ness of the premises on which those conclusions are based. many a hasty reader will be led t o deprive himself of a valuable adjunct to the treatment o f so unresponsive and serious a condition as diabetes. -is two papers of mine were referred to in the opening sentence of the article, I feel it my privilege as well as my duty to the profession, to make some comment on the data set forth. In the paper which I read before the .Academy of Medicine of S e w York, May 19,.1914, dealing with to2 cases of diabetes, I took special pains to emphasize to mv colleagues the fact that I had found it impossible to attain satisfactory results with either the use oi Bacillus bulgaricus independently of the proper diet, Qr the use of the proper diet without the bacillus. 1 can produce fifteen cases to every one of the iour set forth, to show that the combination of the proper diet and the proper dose of Bacillus bulgaricus will produce positive results. \\.'hiIe the writer ot' the article referred to appears to lay great stress on diet, the adaptation o i the diet to the particular case in hand seems to have been not considered at all. -\gain. the adequacy ot' the dose o i Bacillus bulgarjcus to the particular case. seems to have been entirely ignored. .4 case that in iounded. Four cases are gi rowed from another physi pears to be a modification been the proper dose if the sible ior the ultim The amount oi iat allowed in the diet was, in my tone and diacetic acid'in Cases I and 11. Anyom ter a dav, iour ou ounces of cheese, about half an oun basing the doses on my experience in Over 300 ~ 1 2 ~ treated with Bacillus butgaricus. No ment ' l ~ n is made o i the nincunt o i fat permitted. tinless o'lt' !' to iuppose rhat the regulatmn ,mount adVOi3tz'f \ b r r t h the von Soorclen diet has bcen iollo~eclliere 'he liarn as t n the treatment .ird rliet are too 'O perniit o i nnal>sis o i this coqe.