was four years ago, lacking one month; there has been no recurrence and he has had no treatment of any sort since. The cosmetic effect, as you can see, is irreproachable.

The third patient is a man sixty years old, painter by occupation.

There is no history of cancer in his family.

About ten years ago he noticed an itching mole on the right side of his nose which broke down and increased in size for three months, at which time he applied a caustic plaster which did not cause it to heal, however. He then went to the New York Cancer Hospital where the growth was removed surgically by Dr. Parker Syms. It shortly recurred and increased in size until at the time of his consultation with me, it was the size of a twenty-five cent piece, discharging profusely, and deeply excavated with raised, indurated edges. Here is a photograph which was taken at that time, but it does not show the depth of the ulceration as, through a misunderstanding, the photograph was taken when the lesion was covered with a scab. (See cut.)

He received his first Roentgen treatment on March 10, 1903, and during the next four weeks was roentgenized eight times. During this period the only change observable was that the scab formed more rapidly than before, there was slight lessening of discharge, and slight redness of the healthy tissue about the lesion.

At this time he was forced to discontinue treatment by an attack of acute rheumatism which kept him at home for six weeks. He then called upon me again, but the lesion had entirely healed during this interval and has never recurred or been treated in any way since. As you can see, the cosmetic result is very satisfactory.

A peculiarly interesting feature about this case is the striking way in which it exemplifies the cumulative action of the ray. Almost no change of a reparative nature was observable at the time he received his last application, but during the following six weeks the transformation resulting from the treatment developed rapidly.

Permit me to call your attention to the fact that all three of these cases have been well and free from recurrence between three and four years.

It was my intention and desire to exhibit some breast cases also, but practically all of my cases are private patients and I have been

unable to persuade any of them to appear here, for obvious reasons; I shall therefore confine my remarks upon cancer in this situation to the statement of my belief that the best interests of the majority of such patients demand immediate, radical extirpation, to be followed, in every case, by roentgenization after the wound has healed. It is but fair to state, however, that some operators with greater experience in mammary cancer than myself, regard roentgenization alone, at least in primary, localized cases, with more confidence than the knife, either alone or in conjunction with the ray, and that their results are such as to render the point a justly debatable one, and positively determinable only by future investigation.

The last case to which I desire to call your attention was reported in full by me to the Electrotherapeutical Section of the International Electrical Congress at St. Louis, in September, 1904, and constitutes, as far as I have been able to ascertain, the most remarkable exemplification of the curative power which the Roentgen ray exercises upon malignant disease, thus far observed; certainly no case so striking has been reported up to the present time.

The patient is a school teacher, thirty-nine years old, upon whom an hysterectomy and ovariotomy was done eight years ago for what was supposed to be a fibroid tumor of the uterus, but no microscopical examination was made. About two and one-half years after this operation she noticed a hard tumor in the lower abdominal wall in the region of the cicatrix. There was no pain and no discomfort, but rapid growth.

She consulted Dr. Maurice H. Richardson, of Boston, who referred her to Dr. W. B. Coley, of New York, for treatment by the erysipelas toxins. During the next ten months she was treated with the toxins which caused the growth to decrease in size during the earlier part of this period, but they then lost their power, and at the end of this time, in January, 1902, when she was referred to me by Dr. C. A. Bevan, of West Haven, the mass measured ten inches from side to side at the level of the anterior superior spines of the ilia, eight inches vertically in the median line, and about five inches antero-posteriorly in the median line.

Microscopical examination of sections removed from the tumor while she was under Dr. Coley's care, demonstrated it to be a

fibro-sarcoma, and the mass was rapidly increasing in size. The patient was losing flesh, markedly cachectic, very weak, and complained bitterly of pressure symptoms.

Roentgenization was commenced on January 28, 1902, and during the next four months she received forty-six applications. Her general condition commenced to improve at once, but the tumor itself had increased somewhat on the right side, but decreased slightly on the left side; on the whole, the tumor was slightly larger at this time than it had been when we started, and the only feature about the case that encouraged me to continue the treatment was the marked improvement in her general condition.

She then went to her home in Massachusetts for a short visit and when she returned there was noticeable a decrease in the size of the tumor of about 20%, which had rendered it necessary for her to shorten her waist bands and the fronts of her skirts to keep them from dragging on the ground.

From June 17th to September 3d, a period of two months and a half, she received thirty-one roentgenizations. Her general health continued to improve and the tumor steadily decreased in size, and at the end of this period she resumed her occupation of teaching school, which had been interrupted for about a year and a half.

To make a long story short, the whole treatment of this case extended over a total period of two years and three months, during which time she received one hundred and thirtysix applications of the Roentgen ray, more than one half of which were given during the first eight months. She received her last roentgenization on May 20, 1904, at which time no trace of the tumor was discoverable nor had it been, according to the testimony of her family physician, for several weeks previously. The fact of its disappearance at this time was confirmed by examination by Dr. C. A. Bevan, of West Haven, and in July by Dr. W. B. Coley, of New York, so that this patient has been perfectly well, without any evidences of recurrence, for more than two years. At the present time she weighs more than she has ever weighed in her life before, is apparently perfectly well in every way, and has taught school uninterruptedly since September, 1902.