in the house, including kitchen. I went away to Europe and left this patient to die, and came back and found her so well and in such flesh that I didn't know her and had to be introduced to her. I have examined her lungs every year for the last six years, and she has remained well. She is married now and the mother of children. Still I kept sending my patients away until last year I went to California myself, and put up at hotels all over California, waited upon by waiters all coughing a good deal, had plates that had been washed by tuberculous waiters, and I began to get uneasy about California and California climate. (Laughter.) I talked with a good many doctors there in regard to the advisability of sending patients to California. I have three cases which I sent to Florida, but they did not come back cured. These doctors in California told me if you have patients that are not able to spend at least $1,000 a year, don't, for Heaven's sake, send them to California, keep them at home, take your chance even in the most miserable tenements you have, but don't send them to California, where, unless they have money, they get homesick, and nostalgia carries them off soon in spite of the climate." You get just as good results in Massachusetts as in Florida, even with the great unwashed. I saw any quantity of patients in California that were worth their millions. In Pasadena I saw one street where it was said nobody could live unless he was a millionaire, for they have to have a million before they are allowed to build on that street, and you must not build a house costing less than $10,000 to $50,000. They were coughing just the same; you, couldn't walk that street without hearing them cough and wheeze. In fact, I saw nothing there but dust. I could not breathe myself; I could not talk without coughing; I could not walk without leaving my tracks on the sidewalks; there wasn't wind enough to blow the dust away and there wasn't rain enough to settle it. I didn't get what you might call a very high opinion of California as a climate for tuberculosis. When you complain about irritating the throat and larynx with that California dust, they will tell you you have got to have the dust fever, "stay here a year or two and you will get over it." In other words, in a year or two you will get acclimated, and then when you come back here you have to get re-acclimated, and all that seems like a great farce. When we talk about open air, I don't know why you can't get it in our New England hills just as well as in California or Florida.

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You go to Florida, and I have been there too, but not for tuberculosis, for I fortunately haven't had it, but I have been there for rest, and have seen the tuberculosis patients crawling around on those Florida sands up and down the St. John's river, growing yellow, getting malaria, getting pickled with it, and finally coming back to get over malaria. Take the native "cracker" in Florida, and what does he look like? There is not a healthy looking native in Florida, you can't find one, and if you go down there and stay three years you will have to come back here to get your health. (Laughter and applause.)

Dr. Alvin E. Barber (Bethel): Gentlemen, I had resolved to keep still, but I have had an experience for the last 40 years. I graduated in 1854 and settled on Long Island in July, 1855. After I had been there seven years, working hard, I was taken with pneumonia. I tried to stay. My friends said, go to Colorado, you are going to have consumption. I laughed and went up to the Berkshire Hills, spent one week, came back over my cough. I went to work and worked harder than ever for the month following. My cough came on again, and I finally sold out to a young M.D. who is there now. I went to New York for rest, and matriculated at the College of Physicians and Surgeons. (There were no postgraduate courses then.) I got over my cough and was well. I was requested to come back to my practice, but said no, I have given it up and won't practice there after April, 1866. I left there in April, 1866, and thought I could stay by the salt water. I stayed one year in Bridgeport, and coughed pretty much all the time. I left and went back into the interior and weighed 145. I am settled there now, and have been 35 years, weighing over 180. It was rest in the first place I wanted, continued rest. I didn't go to Colorado. I had a family (a wife and two children), and wanted to stay and die with them. I didn't live out of doors, either, as they do now; it wasn't fashionable. (Laughter.) I have had no cough since. I have lived pretty well, not by stimulants (laughter), and not by smoking. I have practiced medicine all these years, but don't much now. I go away on vacations annually and try to live fairly well, for a poor country doctor, but don't believe much in sleeping outdoors. It was rest I needed. I was better away from the salt water, and don't look much like dying of consumption. I had a friend who went to the Adirondacks, and he said he was better when he got back, because he was rested, but he didn't believe in going up there again. I didn't die of tuberculosis forty years ago, I don't know but I may forty years hence. I am only 75 years old now, but probably tuberculosis won't get a very strong hold on me. (Laughter and applause.)

Dr. David R. Lyman (Wallingford): There are a few points in Dr. Stoll's discussion which I would like very much to emphasize, and thank him for having brought them out. One is the importance of absolute rest in bed, and the quicker and much better results you get with that than you do with comparative rest, if you can persuade the patient to take it and stick to it for a little while. And the other point was the importance of the examination of the other members of the family where there has been a chronic case of tuberculosis for several years.

About three days ago I was talking with the physician in charge of the medical clinic at the University of Maryland. He said he never saw a case of incipient tuberculosis there at all until last year he got a nurse to go out and look after his tuberculosis cases. He got a very good nurse, and the result was that often another member of the family that showed no suspicious symptoms at all was found in an incipient stage. Now he has more

incipient cases of tuberculosis than advanced cases.

He finds the nurse will seek the early cases, get hold of them, and do something with them.

There are a few that still claim that climate is everything, but I think we are all getting more and more to the idea that it is not climate that is the chief factor. It is what you do more than where you do it. There is also the problem, as Dr. Foster said, of the great unwashed. We can reason with the others, and the rich people can look after themselves. But we have not only got to find where the poor can go, but to control them. The whole problem of the treatment of tuberculosis is control. The unwashed can't control it themselves properly, and at present, where there are no institutions you can put them in, you have just got to do with them at home as best you can. It is only by constantly keeping at them and after them and making them co-operate, that you really can accomplish anything.

Roentgenization in the Treatment of Cancer.

With an Exhibition of Cases in Which the Evidences of Malignant Disease Have Disappeared Under Roentgen Radiation.

CLARENCE EDWARD SKINNER, M.D., New Haven.

One of the burning questions before the medical profession today is, "How shall we treat our cancer cases?" The first thought that responds is, "With ablative surgery;" the second brings before us the disheartening proportion of hopeless recurrences that follows such management and which varies from sixty to eighty per cent. in different hospitals. The third invokes the Roentgen ray; the fourth, destruction of the affected tissues by caustic pastes; and the fifth, destructive sterilization of such tissues by massive. mercuric cataphoresis.

Of the last mentioned, not enough is generally known as yet to render possible the formation of reliable conclusions, but the results obtained by the father of this method, Dr. G. B. Massey, of Philadelphia, and a few others, are such as to give ground for the belief that it is destined to play a not unimportant part in the future management of malignant disease. Caustic pastes are rationally applicable only to superficial processes, and failures and recurrences are by no means uncommon. This narrows down the choice of procedures in the vast majority of these cases to employment of the knife or the Roentgen ray, or a combination of both.

The possibilities and limitations of ablative surgery in cancer have been pretty thoroughly determined and are very generally recognized and admitted; those of the Roentgen ray are fairly well understood and generally admitted among properly qualified roentgenotherapeutists, but the rest of the profession are very much in the dark as regards this agent, and it is of the utmost importance to sufferers from this disease that knowledge of the subject should

be widely disseminated. To attempt such dissemination by word of mouth alone, however, involves such a strain upon the credulity of those not familiar with the subject, that I shall precede my statements today by an ocular demonstration of the results which have been attained upon a few patients who have undergone roentgenization for cancer during the past four years. Results speak for themselves, and one undeniably positive result speaks louder and more significantly than a dozen negative ones.

The first patient to whom I desire to call your attention is a man fifty-five years old, farmer by occupation. Several members of his family have had cancer.

About eight years ago he first noticed a small scab on the side of his nose opposite the inner canthus. It increased in size and ulcerated. Various remedies had no effect upon it and when he first consulted me, on February 12, 1903, it was three-eighths of an inch in diameter, deeply ulcerated with raised, indurated edges, and discharging profusely.

From this time until April 4th, a period of two months, he received eighteen Roentgen ray applications with complete healing as a result. There has been no recurrence and no treatment of any kind applied to the part since, and, as you can see, the cosmetic result is perfect.

The second patient is a man sixty-six years of age, farmer by occupation, whose mother, aunt, and one sister suffered from

cancer.

About five and one-half years ago he noticed a small brown spot on his left temple, which was accompanied by itching, gradually grew larger and finally ulcerated. He consulted a physician who recommended the use of a caustic plaster, the application of which was not followed by any beneficial result. The lesion continued to increase in size and the pain in severity, and he finally consulted a surgeon, who told him that the case was inoperable.

He consulted me first on April 29, 1902, about a year and a half after having first noticed the growth; it was then the size of a silver dollar, with raised, indurated edges. From this date up to June 30th, a period of two months, he was roentgenized twenty times with complete disappearance of the lesion as a result. This