parts were left sensitive to light, heat, etc. They, for a time, caused them to redden and peel in furfuraceous scales. My left hand was much involved; hundreds of minute abscesses formed upon the dorsum and the integument exfoliated many times. The nail of the ring finger came off but was renewed. The nails of all the digits except the thumb, became deformed, brittle and deficient in their usual luster. The shape of the hand was permanently changed, the ruga of the skin, the ridges on the nails, the knuckles and palmar arch are more prominent than they were formerly. Yawning caused muscular spasm of the fingers. Inflammatory mounds with their white caps and crater-like openings, came and went in the usual dilatory manner. Five months after the onset of the attack, the parts had healed but were so sensitive to the Roentgen rays that a fifteen minutes' exposure about one yard from the tube in a strong, high tension field, caused a secondary dermatitis. The period of inoculation, usually from one to two weeks, was reduced to as many days. The secondary dermatitis cleared up several large ugly patches of skin disease left them from the primary attack. 'Tis true that the X-light may, in a measure, prove to be a remedy for its own indolent process and sequelae. Eight months after the onset of the primary attack, improvement slowly but surely continued in the newly formed skin, the atrophic changes remained the same, but the hypertrophic changes had diminished. The skin was tolerant of all forms of actinic rays. The vaseline and starch dressing was still employed at night, but the wearing of gloves during the daytime was no longer necessary. In the primary attack, the right hand was less severely affected than in the left. Tenderness extended up both arms into the axillae. I suffered with malaise daily chill and fever (mild) headache, sore throat (mild), nausea and vomiting (severe but short), probably from cardiac impairment of function. There was a fine rash like that of typhoid fever, scattered over the entire body. Whether an attack of erysipelas sustained in both hands, about twelve years previous, predisposed me to X-ray inflammation, modified its course or prevented cancerous sequelae, I am unable to determine. Certain it is the

two diseases (X-ray dermatitis and erysipelas) have many symptoms in common.

THE SEQUELAE OF X-RAY INFLAMMATION.

(1) More or less loss of integument with its appendages, hair, hair-follicles (alopecia), nails, sebaceous and sudirific glands.

(2) Disfigurement of parts involved, such as hands, face and head, by scars, pits, warts, pigmentation, baldness, a shave that requires no repetition, skin diseases, etc.

Small cicatrices form at the labial commissures, drawing the angles of the mouth downward, giving the operator a sad expression of countenance. Dr. Wagner of Chicago suffers with disfigurement of the face. A French operator is reported to have nearly lost his nose. Clarence Daily (case to be reported later) has scars upon his face and loss of hair. One entire hand and four fingers of the other have been removed. Dr. Early of Dayton, Ohio, has lost one finger. Dr. Kassabian has many small scars upon his face. Pigmentation has rendered his face much darker than its normal condition. A light streak separates the pigmented portion of his features from the hair of his head, giving him somewhat the look of a person wearing a mask. A picture of his hands is shown elsewhere. Girdwood, Grubbe, Kassabian, Skinner, Price, Waite, Platt, Detwiller and about one-third of the prominent operators and instrument dealers, well known by the writer, have hands which have been more or less severely injured. Blacker (case to be mentioned later) has gone on "the long journey to that bourne from which no traveler ere returned."

(3) Chronic scaly skin diseases and other conditions of the parts result because some of those little functionaries, the sweat and oil glands, that have moistened and lubricated your skin from the days of your inception are gone forever.

(4) Horny papillary thickening of the ends of the fingers, beneath and around deformed nails, crowding the nails away from their matrices. Horny ridges, lumps, nodules, warts or callous in other localities. Some of these formations mark the site formerly occupied by inflammatory mounds. Most of these formations can be softened and stripped off, but they

usually form again in the same places. Their subsequent degeneration into cancer will be considered later.

(5) Purpura hemorrhagia and punctate clots in the newly formed skin. The bleeding probably comes from the nutrient arteries of the defunct follicles.

(6) Erythema, either circumscribed in small irregular spots, in the skin and beneath the nails or diffused over the entire surface.

(7) Hyperaemia or anaemia, usually the former, the latter being confined to circumscribed areas.

Case I. Dermatitis, second month, showing exfoliation of epidermis; inflammatory mounds; one white cap over the carpus; other mounds with crater like openings on index and little fingers, also one on dorsum of hand. The rugae of the skin are very pronounced.

(8) Pigmentation or blanching of the tissues, either temporary or permanent. The surface may be left with a pigmented border and white center as shown in an accompanying picture.

(9) Hyperaesthesia to all forms of radiant energy and traumatism. This condition slowly decreases.

(10) Increased vaso-motor activity.

(II) Diminution or loss of the sense of touch in circumscribed areas. This sequel is rare.

(12) Small abscesses at the roots of the teeth (rare). See report of such a case, Philadelphia meeting.

(13) Temporary decrease of sexual power.

(14) Erratic or redundant growth of hair. See report of Dr. Girdwood and others.

(15) A tendency to spasmodic muscular contraction, and oedema.

Case II. Dermatitis, fourth month, the nail on the ring finger growing outwards as it is thrown off from its matrix. The skin has thickened about the other nails. A horny nodule can be seen on the index finger; desquamation still continues; the hair has been thrown off. Many papules can be seen on close inspection.

SECONDARY, TERTIARY, QUARTANARY DERMATITIS.

From careful observations, made upon patients and myself, I conclude that each attack of X-ray inflammation leaves the parts more predisposed to subsequent attacks, consequently, after several repetitions, from a given volume, strength, tension, and duration of exposure, the period of incubation decreases, while the inflammation developed will be more and more intense. One hand of the operator may develop dermatitis in a few days, while the other hand, which has been less frequently, or less severely, attacked, requires a week or more for its appearance, the former will be severely, the latter slightly, affected.

Even the different fingers of the same hand may have a different period of incubation and degree of action, according to their relative susceptibility. After repeated attacks, the period of incubation may be entirely wiped out, the reaction with a sensation of warmth or stinging and an inflammation more or less profound taking place immediately. Conversely a period of rest from raying, limitedly, decreases susceptibility. WHY THE HANDS ARE SO FREQUENTLY INJURED AND WHY UPON THE DORSUM.

(1) They are not protected by clothing.

(2) They are usually a little nearer the tube than other portions of the body, dorsum outwards.

(3) It is a common practice, with operators, to employ the hand in front of the fluoroscope, dorsum presented to the tube, as an X-radiometer, judging by the translucency of the bones, etc., the degree of penetration of the X-light.

When the operator is right-handed he will instinctively hold the fluoroscope in that member, consequently the left hand will, in the course of time, be more seriously injured. The reverse is true if left-handed. When ambidextrous, both hands will be nearly equally affected.

OTHER DANGERS OF THE X-RAY OPERATOR-IMPAIRMENT OF
VISION.

At the Chicago meeting of this society Dr. Scott of Kansas City reported that he had been so afflicted, attributing the same to the Roentgen rays.

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