THE NATURE OF OSTEITIS DEFORMANS (PAGET) AND ITS RELATION TO MALIGNANT NEOPLASIA
1543 approximating to a purin-free diet, and a common form of diet such as the exclusive meat diet are each capable of producing good results in gout, that both, if carefully regulated to the digestive capacity of the individual, tend to eliminate the chief causative factor-viz., auto-toxsemia. I am in complete accord with Dr. Young in thinking that 'intestinal derangement is the primary factor in gout. This view is one to which I have sought to draw special attention for many years past. At
... same time I cannot agree with him in regarding it as in any way an explanation. When it is analysed it explains nothing. What we have to consider is the varying liability to certain types of intestinal derangement.which we see as clinicians, and to ascertain so far as possible on what these depend. My explanation may or may not be the right one ; it is at any rate based on new facts obtained from experimental investigation. Briefly stated, my position is as follows. We have in gout a disorder of protein metabolism ; the thyroid glacd has long been known to be specially concerned in the metabolism of protein foods ; my observations have shown that the structure and function of this gland are modified by diet, and specially that meat is primarily a stimulant and later a depressant of its activity ; my clinical experience of gouty disorders is in harmony with that of those who find that in some cases a lacto-vegetarian diet and in other cases a diet rich in proteins is of special value in treatment ; and I believe that the favourable effects of the dietetic treatment in both instances are due to a large extent to the influence of the diet on the thyroid gland. SIR,-I think the following case should prove of interest, showing, as it does, that fibroid of the uterus may be successfully treated by being subjected to the influence of X rays. A woman, aged 37 years, married, one child, came to me with the following history. Two years previously she had been -curetted for the relief of menorrhagia due to a fibroid, but the relief obtained was only of a temporary nature. A year ago she again went into hospital with a view to operation. She was told, however, that the only cure would involve a removal of the uterus, and, failing that, the next best thing would be to curette again, the latter course being eventually carried out. I saw her for the first time about four months after she had been curetted and the monthly haemorrhages were again becoming excessive. I tried the usual routine treatment of ergot, hot douches, and rest, but with only moderate success, until finally her con--dition grew so grave that it became necessary to recommend operation. Before doing so, however, I determined to try the effect of treatment by exposure to X rays, and Dr. W. Ironside Bruce very kindly consented to carry it out. The fibroid at this time was of the size of a pigeon's egg and was situated in the anterior wall of the cervical canal. In view of the position of the tumour irradiation was carried out with the patient in the knee-elbow position, the rays being directed from below upwards in the axis of the pelvic brim ; a filter composed of several layers of felt was placed between the skin and the tube, thereby all risk of X ray dermatitis was obviated. Each irradiation lasted ten minutes, and three sittings were given in the week.