more diagnostic ability, perhaps, and the treatment in competent hands is more thorough, but neither in diagnosis nor treatment are the conditions properly met by a large class of physicians.

Knowing the horrors of the disease, the shame in its name, the often loathsomeness, the insurance ban in the family history, every physician should view with suspicion and treat either with the greatest tenderness or the most vigorous and radical measures lesions or growths evidently malignant. Above all things, irritating applications and stimulating manipulations must be avoided. Treatment should be absolutely soothing and protective until eradication can be attempted or competent advice can be obtained. Excise where practicable, with a reasonably wide margin of apparently healthy tissue, including suspicious glands and tissues intervening. Change knives on slightest suspicion of contamination, for fear of transplantation. In operating on open lesions, sterilize the surface, sew gauze over it, if necessary, or thoroughly cauterize before beginning. In using caustics or the cautery, destroy more than the visible disease.

Do not trust X-rays alone, save in the smaller cases, the cases which patients refuse to have treated otherwise, and where other methods can not succeed. In these cases the results will not disappoint as often as with other methods.

Recurrences are the rule in cancer, whether through diseased cells left after treatment or a development de novo in the cicatricially changed tissues. In this latter possibility I have strong belief.

Nodules appearing in the skin at a distance from a cancer, as of the breast, or its former site, are probably secondary lesions and often occur beyond the margins of the widest possible Halsted operation. But even with these recurrences, we shall often have prolonged the pa

tient's life, and added comfort to the few remaining days, by proper operation.

In those cases where even palliation can not be expected from severe measures, we must rely upon X-rays when available, cleanliness, supporting constitutional treatment and remedies for the relief of pain.

The suffering victim, doomed to drag out even a few more days or weeks of life and pain, with hope all gone, should be allowed to put his affairs in order and then be kept as profoundly under the influence of opiates or other anodynes as may be necessary for the alleviation of his misery. The time for fear of the morphine habit is passed; morphine or cocaine locally, and any other means of relief should be afforded, urged ad libitum. The pain will shorten life and wrack the nervous system far more than drugs will injure the patient, and they alone provide the lethe to which he is entitled.

DISCUSSION OF PAPER BY DR. HUTCHINS.

Dr. Westmoreland: I have listened with great pleasure to Dr. Hutchins' paper, and I think he struck the keynote when he stated that diagnosis early was the point rather than treatment. You can not cure by any method in the late stages, no matter what method you employ. Take for instance, a small round cell sarcoma; any method in the late stages amounts to about the same thing as pouring kerosene oil on a fire.

In regard to radium, I think we will find that it will not accomplish what the X-ray will do.

I was glad to see the doctor take such a conservative view of the X-ray cases. In some cases you can accomplish more with it than with the knife, but you have to select these cases and the patient must be in the hands of one who understands the use of the X-ray and what he intends to accomplish with it. The X-ray in the hands of the general

practitioner and the general surgeon, I think, is one of the most serious harms to the patient. And I think the same of it for diagnostic purposes. I do not use it myself but send all my patients to one who does know how to use it.

I think primarily that in the use of the X-ray it should be in the hands of some one who knows something about it, and especially a man who knows whether it should be used or not. It is now used indiscriminately by those who know nothing about it.

Dr. Stewart: I have used the X-ray for about five years, and it is of very limited use in tubercular troubles. In regard to its uses in treating epithelioma and certain other forms of cancer, it is of some value, but as regards general use it resolves itself down principally to its use as a diagnostic agent.

Dr. McRae: This is one of the most important subjects before this Association at this session. I am very glad to hear Dr. Hutchins bring out the disuses of the X-ray. I think the treatment of cancer has been more retarded by the use of the X-ray by quacks than good has been accomplished. I do some surgery and the greatest sorrows that I have are the people who come to me with cancer who have been treated by incompetent quacks with the X-ray until they are utterly helpless and hopeless, and I have to tell them that nothing can be done. However, it is a great satisfaction in those cases that something can be done to lengthen their lives. Also, it is one of the greatest comforts to refer suitable cases to Dr. Hutchins, who treats them conscientiously.

There is one other thing that I want to mention, and that is the causative relation of X-ray to cancer. There is no doubt that constant X-ray irritation will produce cancer, and cases are on record of X-ray burns developing into epithelioma. This has been stated by competent authority. Dr. Hutchins (in closing): I did not intend to read an

X-ray paper. I have been gradually drifting into this unhappy work, and it is the most distressing of all work to have to deal with these patients. I have had considerable experience with the X-ray, and I believe in it in some cases more than ever. I agree thoroughly with Dr. Westmoreland and Dr. McRae as to the harm done with it by those who do not know how to use it. I saw a case recently of a woman with an X-ray burn of the labia, clitoris and down to the anus. The incorrect use of the X-ray interferes with subsequent operation when such is advisable; for if these cases are first X-rayed you have a tissue which is half dead and which will not heal well after an operation. I have not had a burn in three years' practice, which I did not want. I have had to produce some in some cases to save the life of the patient. The average cancer case which is treated by some one who does not understand the pathology of the disease is worse off than if no treatment had been used.

As to the production of cancer, I believe that constant irritation will largely aid in its development.

The main idea of my paper was to avoid any sort of treatment which would produce any stimulation of the cells. I have now a case which would not have been so distressing if it had been left alone. The treatment has to be radical, or it were better to leave it alone.

I thank the gentlemen for the interest they have shown in

my paper.

THE MORAL AND RELIGIOUS SIDE OF THE

MEDICAL PROFESSION.

BY E. MORGAN, M.D., VIDALIA, GA.

There is no other man who occupies so lofty and responsible a position as he who follows the medical profession; the mightiest king upon his throne is an infant in power by the side of the physician who is familiar with his duties and has the moral courage to execute them in a godlike manner. The matters entrusted to their keeping are the most important of all earthly possessions; for they are life itself, and along with life health, the necessary conditions of almost all temporal enjoyments.

No other class of men are entrusted with more weighty earthly interests, hence the physician's responsibility is very great; so the common good requires that he be eminently faithful and conscientious.

If a physician's purpose was only to make money, his task would then be to multiply diseases and infirmities; he would then be as great a curse to mankind as he is really intended to be a blessing.

There are certain claims, great and weighty, resting upon him which he can not shake off; they grow out of those indissoluble relations which he sustains to society, and those invaluable interests social, civil and religious.

He should consider that he was not made for himself alone, but for society, for mankind, and for God.

He should consider that he is a constituent, responsi