TABLE.

(The asterisks refer to cases either too recent to know the results, or that have been lost sight of by removal from the city or other causes.)

Epithelioma.

No recurrence after one Had returned four months after former

operation.

DISCUSSION.

DR. D. D. TALLEY, JR, Richmond: I merely wish to say that I think the Society should be grateful to Dr. Gray for a paper of this kind, inasmuch at it represents a series of consecutive cases, and not merely a few picked cases in which brilliant results have been obtained. It is only in this way that we can hope to put the X-ray on its true basis and find out its exact value; and in the face of the miraculous claims for cures we have heard from all parts of the country, I think it is especially valuable to have a report from a man who is conservative, and whom we know treats his cases intelligently, and particularly with the properly regulated dosage.

DR. MARK W. PEYSER, Richmond: It is rather comforting to hear Dr. Gray speak of the good results obtained from X-ray treatment of mucous-membrane cancer. Heretofore we have believed that there was not much to be done in these cases. Of course,

it requires a long time to get any results whatever in them. The only ones that I have treated did not respond, possibly because I became disheartened too soon.

I wish to report a case of general tubercular adenitis in a young boy who showed marked improvement while under the use of the rays. There had been no breaking down, the treatment having been begun early enough to prevent that; but it was interrupted because the little chap became homesick and wished to go to his home some distance from Richmond. During the time he was away, the trouble became worse than Soon after he returned, he choked to death from an enlarged mediastinal gland. Another case was post-operative raying after radical removal of the breast. I had no opportunity to give treatment previous to operation. After it, the wound became infected, and during treatment general sepsis ensued. Raying was, therefore, interrupted several times while the patient lay in bed. Nevertherless, after about thirty treatments she seemed entirely cured.

ever.

The following is not really germane, but Dr. Gray spoke of the X-rays in the treatment of exophthalmic goitre, and I wish to report a case that bears also on the papers read on this subject yesterday. For a long time the patient puzzled me because the symptoms could be traced to no demonstable lesion. There was no exophthalmos or any enlargement of the gland so far as could be seen by careful examination. The diagnosis was made accidentally some time after onset of symptoms. Called to see the patient, I found her sitting up on a couch with her gown open at the throat and the light falling from a window on it in such direction that the slightest enlargement could be barely seen. Here, was the key to the whole situation. After much persuasion, reiterated through several months, the patient finally began treatment with the high-frequency current and was markedly benefited, though the exophthalmos has not much diminished. The difficulty in this case is that the patient stops treatment as soon as she becomes comfortable, thereby interfering with what I believe would prove to be a cure.

DR. A. L. GRAY, Richmond (concluding the discussion): I simply want to emphasize one or two points, one of which has been brought out in Dr. Talley's discussion of my paper, i. e., the matter of conservatism. Dr. Talley has referred to me as a conservative operator. I believe that in the X-ray we have a most valuable agent, but this thing of claiming to cure pulmonary tuberculosis and all kinds of ills, when a patient happens to get better after a few X-ray treatments have been given-all sorts of wild ideas-do not occur to me as being in the least scientific, and those who claim things of that sort I am afraid of.

I think the only way we can arrive at the real value of any agent is by watching carefully, and reporting the bad as well as the good. I have had bad results and I have given them to you in this consecutive series of 100 cases taken from my records.

Dr. Peyser has referred to cancers of the mucous membrane. I do not know why it is, nor does any one else, though various theories are advanced, but many consider an epithelioma involving the mucous membrane, and especially the lower lip and the mouth incurable, or if cured, the cure only results after a long series of exposures. It has been my luck, I will say, because I do not claim to be any better than those others who have failed, but it has been my good fortune to discharge as cured a number of cases involving the vermillion border of the lip, some involving the mucous membrane down to the bottom of the sulcus between the lip and gums. The two cases that I referred to were apparently typical epitheliomata. They were not incised, and consequently not examined microscopically, but they were, to the eye, clearly epitheliomata. Both of them have been sent home with as smooth, clean lips as any member of this assembly.

A number of these cases were of the eyelid, involving the mucous membrane, especially of the lower eyelid. In nearly every instance I have succeeded in either curing these cases, or improving them to the extent that they were sufficiently satisfied to quit and would not keep up their treatment.

SYPHILIS AND THE AMERICAN NEGRO-A MEDICO-SOCIOLOGICAL

STUDY.

By THOMAS W. MURRELL, M. D., Richmond, Va.

Any study of a disease as applied to an entire branch of a race must necessarily take up the sociology of that race. The knowledge of syphilis as affecting the Caucasian, however profound, will not give one an insight into the conditions confronting the negro; and the chief reason for attempting this paper is the lack of statistical material on the subject and the therefore general ignorance that exists in what might be called the white zones of our country.

About seven-eighths of the entire American Negro race live in our Southern States, and the Southern man is a practical authority on the subject of conditions that oppose the black's man's rise in the world. This knowledge is, however, of but little value to the world at large, because it is not down in black and white. This lack of statistics about the negro is at once a great harm and reproach to the South. It is a well known fact that the most ardent of Northern theorists, after a sojourn of some time on Southern soil, become advocates of the Southern white man in his dealings with the negro problem, and it is more than probable that half of the misrepresentations that the South has had to suffer would have never occurred had there been a proper system of vital statistics registration. More than this, in the proper co-operation with the National Census Bureau lies one of the greatest and most obtainable of the means of settling the race question, for a white man is a white man, North or South, and knowledge power. The census department has no figures that Europe will accept in vital statistics except an area known as the registration area. That area holds only 13.4% of the negro population and no part of that area is south of the Ohio or Potomac rivers. Figures, however, cannot paint individuality, and since the world must know, the Southern man and doctor must write, and that, copiously.

The negroes of Richmond, Virginia, are of the highest type of the race in the South. Many of them are educated and property owners, men who are at the head of large banking and insurance institutions; successful ministers, teachers, physicians and lawyers. These men, though quite a respectable number, indicate a possibility rather than a promise. They are the triumphs of civilization in the individual and not a type of the possibilities, much less the probabilities of the race.

To thoroughly understand what dissipation and disease have done for the negro, let us consider the terrible changes fifty years have wrought; let us consider, first, the negro of 1859, then the negro of 1909.

The negro of 1859 was not a free-agent, and only valuable as a form of energy. He was a business proposition and, to get an interest on his investment, it was the business of his owner that this machine should be able to run at a proper potentiality. To this end he was not allowed to abuse his body, but, on the contrary, was made to preserve it. His cabin was well ventilated and his clothing was warm and sufficient. The food was plentiful and nourishing and his life was one of well regulated sobriety. When sick, his master's own physician attended him and by a forced system of hygiene, the negro's body as a piece of property, was not allowed to deteriorate.

True, education was not encouraged, and everything tended to make the negro of that time a physical man. With as good hygiene, and less dissipation, he outstripped the white race in fecundity, for from 1800 to 1860 his increase was 346.1%, while the white increase was 312.9%. After 1808 this increase was a natural one as the importation of slaves was made illegal at that time.

When the curse of slavery, for it was a curse, was removed from the white man's shoulders, misguided theorists transferred it under the name of freedom, to the unready negro-and it crushed him. Whatever the motive that guided the pen of absolute suffrage, it stands as one of the world's great tragedies, for now he was free, not to live but to die, and he took advantage of his freedom. He was free, indeed, free as the birds of the air, free to get drunk with cheap political whiskey and shiver in the cold because his scanty savings went to purchase flashy and flimsy garments; free to never bathe and sleep in hovels where God's sunlight and air could not penetrate-absolutely free to gratify his every sexual impulse; to be infected with every loathsome disease and infect his ready and willing companions; and he did it, he did it all. The result is the negro of 1909-the negro of to-day.