When I first saw him the sore was about three-quarters of an inch in diameter, consisting of a central depression surrounded by a ring of nodules, several of which were covered with moist yellow scabs, there was more or less induration about the sore, but no particular tenderness. Five treatments with a high tube, anode one foot from face, were given on alternate days with little other apparent result than a drying of the scabs.

Before his next appointment I learned from his physician that he was desperately sick with some intestinal disturbance, which at first was feared to be appendicitis. His condition, while not of this nature, was so serious that a consulting surgeon was called, and the patient was given to understand, whether directly or by inference, I am unable to state, that his illness. was in some mysterious way attributable to the driving in of the cancer; but judging from his report of his condition to me later, together with the fact that some five days after he was taken he vomited some spinach eaten before his illness, it seems more probable that his condition was one of acute indigestion with auto intoxication from the gastro-intestinal tract.

Immediately following his illness he went to his country place for the summer, first coming to my office to report that while he was in bed all signs of disturbance of the face had apparently disappeared, but that should there be any recurrence of disturbance he would return for further treatment. Late in October he came back to me.with some evidence that the trouble was not entirely gone. There was little or no induration, the majority of nodules had disappeared, but there were two small elevations covered by a yellow scab. Following two treatments there was a decided irritation of the whole cheek with some swelling and a good deal of burning pain. This persisted for a week or more, since which treatments have been resumed at weekly intervals, and at the present time there is one dry scab with no surrounding irritation or induration, and treatment is suspended until this shall drop off that underlying conditions may be more accurately observed.

Possibly this report may be a little premature, but it showed so beautifully in its earlier portion the cumulative effect of the

X-ray, and the inference as to metastasis expressed by his physicians makes such a good text for a short sermon upon caution in condemning that with which one is little familiar that I cannot refrain from presenting it now. I have consulted all available printed authority and I cannot find that in the judgment of those who have had wide experience, metastasis can or does occur from removal of so small a lesion by means of the X-ray.

Case IX. A young married woman came to my office November 29th with the following conditions: For some more than a month she had noticed that she was having an undue amount of discomfort from her collars, which were of the prevailing stock pattern, and that from pressure on the neck, even from lying down there was a suffocating sensation. Just before her coming to me she discovered in the neck quite a sizeable lump, which was the immediate cause of her visit. In trying to remember the first signs of discomfort she could recall that early in September, while having a garment fitted, there seemed to be an undue tightness about the neck, which necessitated alterations being made. I found the right lobe of the thyroid enlarged to the size of a fig, the circumference of the neck over the tumor being 13% inches. The tumor was freely movable, rising with deglutition, not tender at all and no signs of general disturbance. Diagnosis of simple goitre was made and treatment for ten minutes with a high tube, the anode at one foot from tumor, followed by five minutes of brush discharge was given. This was repeated at intervals of three days, increasing the time of exposure to fifteen minutes. Up to December 10 six treatments in all were given.

At the time for the seventh treatment there were present the following conditions which made it seem advisable to postpone: a dull congestive headache with pressure at the base of the brain, attacks of vertigo and occasional attacks of palpitation. There was also a return of an old endometritis which had not shown itself for more than a year previously. The headache and pressure continued for a week, gradually lessening and general disturbance disappearing altogether with the exception of an occasional attack of palpitation. At Christmas time, no further treatments having been given, the tumor was percep

tibly less, the circumference of the neck having been reduced to 121⁄2 inches and the general discomfort much lessened. Treatment was resumed January 6 and has been continued up to the present day (February 7) at intervals of five days. The first two treatments were accompanied by a slight circulatory disturbance, but there has been no such effect from later ones. The diameter of the neck is now 12% inches, the hypertrophy of the right lobe has disappeared, but there is present a slight enlargement of the isthmus perceptible by palpation and slight ly noticeable upon deglutition and even this is noticably less at each treatment.

The symptoms in this case so closely resembled the physiological effects following the administration of thyroids that it seemed as though they might have been produced by the rapid absorption of that gland within the body. I shall await with some impatience the opportunity of observing the effects upon a goitre of older growth, both as to the possibility of rapid reduction and the appearance of similar conditions of general disturbance.

Case X. This patient, a college girl, was referred to me for recurrent cervical adenitis. There was enlargement of the right cervical glands to the size of a small hen's egg, which has been present for about three months. It was painful, sensitive to the touch, and there was a condition of general debility present, which made it necessary for her to give up her work in part. The complete history of her trouble was as follows: Early in the spring of '97, following a general run-down condition, the enlargement first appeared, persisting for some months, reducing from treatment which improved general conditions. It reappeared in the spring of '99, subsiding to reappear in 1900 following at attack of tonsilitis; once more it yielded to general treatment, but recurred in 1902 subsequent to measles, this time for the first time showing signs of tenderness and yielding still more reluctantly to treatment. Its fifth appearance was was early in the present year, brought on this time by exhaustion from over study; it was decidedly painful and failed to respond to measures which had heretofore been successful in removing

Right side of neck showing lock of hair about 3 inches long, which appeared

it, and the question of operative measures was seriously considered, but it was decided first to make a trial of the X-ray.

The first treatment was given for ten minutes with a high tube, the anode at one foot distance, which was followed in a few hours by a bright flushing of the neck over the area exposed, lasting for some ten or twelve hours. This peculiar flushing followed all subsequent treatments, sometimes appearing before she reached her home from the office and persisting sometimes for twenty-four hours, but at no time was it at all irritating, resembling more the tonic effect of friction. From the very first application the tenderness began to disappear and at the end of half a dozen treatments the process of reduction was apparent. Between March 5 and July 25 eighteen treatments were given, with the result that in addition to the removal of all tenderness the circumference of the neck had decreased from 131⁄2 inches to 12 inches, and while to palpation the gland was still somewhat enlarged, it presented little or no visible deformity. Meanwhile the general health was much improved and she was able, without other than normal fatigue, to assist actively in the preparations for the National Teachers' Convention held in Boston during the month of July, a work which was a severe mental and physical tax for all concerned in it.

further

During her summer vacation there was a still reduction of the gland and her general health continued to improve, as shown by a gain of twelve pounds in weight. In the fall she was able to take up her complete college work. I did not see her again until the middle of December, when I found conditions much improved since I had last seen her and there had been one remarkable result not laid down in the books. During the summer a new growth of hair had made its appearance, extending downward along the posterior border of the sterno-cleido-mastoid for an inch or more lower than on the opposite side, and which had attained a length of nearly two inches when I first saw it. There was also a more vigorous growth of hair along the lower border of the right cheek, although the face had been carefully screened with sheet lead and rays could have reached it only by diffusion. It seems