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applicator unscreened or screened with a layer of rubber for thirty minutes and we have cured many. Small beginning basal cell epitheliomata we have treated in the same manner-usually giving them a deeper treatment after the skin has healed entirely from the irritative action.

When the lesions are deeper or papillomatous in character, more prolonged treatments are given using screening of one or

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Rodent ulcer, 25 years duration. Scar from former ulceration seen anterior to ulcer. This picture was taken after ulcer had begun to heal.

two milligrams of brass, silver or rubber. In such cases it is necessary to use a rubber screening between the metallic screen and the skin in order to shut off the irritating secondary rays set up in the metallic screen. Of course this is true of any use of radium and our results have been very good. For example: Mr. S., age 61, with a history of an ulcerating lesion on right

side of face for twenty five years, face now has entirely healed over with a smooth scar. When first seen he had a 2x4 centimeter deep ulceration in front of right ear. Mrs. C., with a typical castor bean sized basal cell epithelioma of the skin on the chest, after two prolonged treatments is now entirely healed and scar has almost disappeared.

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Same, after 195 milligram hours of radium, showing small amount of scar formation.

One patient, age fifty-two, with a pea-sized lesion of the lower lip, we felt justified in treating with radium alone, as it was only of several months' duration and there seemed to be no glandular involvement. The lesion has healed very nicely and as yet there has been no evidence of recurrence. Out of twentytwo cases of basal cell epithelioma, eighteen cases are entirely well and in many of them the point of the disease cannot be de

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tected. The remainder of them are cases still under treatment.
Radium is the remedy par excellence for the basal cell epithe-
lioma as seen so often on the face. It is painless, easily applied,
easily controlled, and leaves very little scar formation. Its action is
not disfiguring and there is no nerve paralysis. It is to be
recommended in all such cases. In only one case has there been
any evidence of recurrence and this was in the case of a woman
with a 1x2 centimeter lesion on the neck, and it was entirely
the fault of the patient in not returning for two final treatments
as advised. We have thus far treated two physicians with X-ray
keratoses of the hands. In one case the patient was an old X-ray
man with severe keratoses from a static machine, and he has been
much benefited even though the treatments have been rather irreg-
ular. The other physician, with keratoses of the palm due to
severe X-ray treatments of hyperidrosis, is practically well at
time of writing. We do not pretend that radium is a "cure-all,"
nor are we overly enthusiastic, yet we have had some nice results
and feel that it has a place in dermatology that can be filled by
no other means. We would seriously condemn the man who will
attack anything with a small amount of radium, feeling that he
is doing harm not only to the patient but also to the profession
and to the radium itself. However, when it is properly and con-
servatively used it is a very valuable remedy.
2073 E. 9th St.

The American Journal of Syphilis.-The publication of the first number of a new quarterly journal under the above title is announced for January, 1917, to be devoted to the study of syphilis in all its phases. Original articles dealing with the work of investigators will be featured, and it will be the purpose of the editors to make the magazine cover the field of syphilology in a thorough and timely manner. Social hygiene workers will be specially interested in the department "The Social Aspect of Syphilis" of which Wm. A. Pusey, M. D., of Chicago, is editor. The Journal is to be published by the C. V. Mosby Company, St. Louis, Mo. Loyd Thompson, M. D., Hot Springs, Ark., is managing editor.

A REPORT OF THE COMPLEMENT FIXATION TEST FOR GONORRHOEA

By T. P. SHUPE, M. D., Cleveland

The phenomena of complement becoming inactive when micro-organisms are mixed with their homologous antisera, has been known since 1901 and was first discovered by Bordet and Gengou. That the complement becomes inactive may be seen by the absence of hemolysis when sensitized erythrocytes are added to the mixture. It was not until 1906, however, that Mueller and Oppenheim first used this method for the detection of antibodies in the blood serum of patients infected with the gono

coccus.

From that time on many men have reported on this test with quite variable results. In 1911 Swartz and McNeil established the fact that the gonococcus family was a heterogeneous one. They, therefore, used a number of different strains of the gonococcus in their antigen and reported a greater percentage of positives in persons infected with the gonococcus than had heretofore been found. A great many of the negative results from early reports were a direct consequence of using only one culture of the gonococcus. If the patient happened to be infected with another strain the results were, of course, negative.

The same principle of complement fixation has been used quite extensively in the Wassermann reaction and while not a truly specific reaction, yet its immense value in the diagnosis and guide to therapy has never been disputed.

The fixation of complement in the gonococcus test is a result of the interaction of antigen and its own antibody. While it would seem that this latter test would be absolutely specific, yet there are a number of factors which make it quite more difficult to perform than the Wassermann. Among these factors may be mentioned the multiplicity of strains of the gonococcus, the infrequency of the infection being in the blood-stream, and the frequency with which it is limited to a very small portion of the body.

Practically the greatest difficulty lies in the small amount of antibodies produced by the disease in an uncomplicated form. The ordinary technique, as applied to the Wassermann, will hardly work out to the best results if applied directly to the test in ques

tion.

The following report and conclusions are based upon a little over 1000 tests. The first 200 were performed and reported in 1913 by Dr. H. L. Rockwood. These tests have all been done in the laboratory of Dr. Lower and the material has been gathered mainly from Lakeside Dispensary and private patients.

General Technique and Materials

Two methods for measuring the reagents were used, namely, the metric and the drop method. The one in favor at present is the drop method, as by means of properly and finely drawn out pipets a finer division can be made than by the graduated ones with their blunt ends. The graduation of the amboceptor needs to be especially watched, as it will allow no such variation as in the Wassermann. The antibody content is quite small and needs. a finely adjusted amboceptor not to miss it. The antigen and its preparation is one of the most important steps in the performance of the test. Three different preparations have been used in this series. Those of Parke, Davis & Co., Mulford & Co., Dr. Warden's Fat Extract of the Gonococcus.

Theoretically a patient's blood should be tested against an antigen made from a culture of his own infecting organism, but as one does not see a person from the onset to the end of the disease, this procedure is impossible. A good gonococcus antigen should contain at least 12 different strains suspended in a sterile salt medium to which has been added a small amount of preservative. The antigen prepared by Parke, Davis & Co. and found on the open market, is the most satisfactory antigen used. It has been found necessary to titrate each new box. Some have been rejected as anti-complementory. The usual titration lies between 1-10 and 1-20. It has been found best to use the largest amount of antigen which will inhibit haemolysis in a positive serum and yet give a negative inaction with a negative serum.

An anti-sheep haemolytic system has been used throughout and fresh guinea pig serum diluted 1-10. The amboceptor is titrated each day of the test and one unit of the smallest amount of amboceptor which will cause complete haemolysis is used. We have found that it is more difficult to prevent complete haemolysis in slightly positive sera than to get a positive result with negative

sera.

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