that, owing to the large death-rate from hemorrhage during excision, it is considered a very grave operation by many authors, and, hence, they have condemned the operation unless it is absolutely required. When we read the literature upon this subject we find a number of cases of goitre reported which, having increased rapidly and are pressing upon the trachea, have produced death from suffocation. Now, while I believe there are many drawbacks to the operation, if many of these cases reported had been promptly operated upon, a number of them Iwould have been saved.

This was eminently a case that was not only justifiable for an operation but one which, in my own opinion and those of the physicians who were in charge, would inevitably have died if we had not operated when we did. The symptoms of suffocation were getting more and more alarming, as also was his inability at deglutition. Again, this was a radical cure, as we can safely promise that the cyst will never return, it having been completely removed, and, hence, impossible to return. I would, therefore, recommend, seeing that those cases where suffocation begins to take place and the fact that if they are left alone will prove fatal, an early removal should be effected, even though the patient's condition should be unfavorable.

There is one point more and I have finished. This growth was very rapid, commencing about the middle of June and increasing until the operation, July 20, 1893. Could this be cancer? I reason not. 1st, Because there is no history of cancer in his family and there is no cachexia present in the patient. The greatest amount of pressure was due to the cyst and from pressure upon surrounding structure. I believe enlargement of left lobe took place from inflammation; and, finally, no symptoms of any cancerous condition have been noticed in the patient during his convalesence. I am, then, of the opinion that this was a benign growth and that the patient will not again be troubled with a recurrence.

It being pretty well established at the present time that extirpation of the thyroid gland will be followed by myxedema, I left in situ as much of the gland tissue as I deemed safe.

CONCENTRATED RAYS OF THE SUN (SOLAR CAUTERY) AS A REMEDIAL AGENT.*

BY O. V. THAYER, M.D., OF SAN FRANCISCO, CAL.

Many years ago I commenced a series of experiments in the treatment of diseases of the skin and its appendages, and have continued them from time to time up to the present. My first experiments were with the use of heated needles which I had seen used by the late Professor Valentine Mott, M.D., of New York City, while a student at the Medical Department of the University of New York. The heated needles were applied for the destruction of erectile tumors and other morbid growths, For some time I continued the use of the needles whenever I could find a patient willing to submit to this delicate treatment. Many were the wails sent out on high and sometimes sent to the regions below as the victims squirmed under the torture of this method of treatment. This was attended with only partial success at first. But with more experience in the use of the needles and selecting my patients with more care and better judgment the treatment proved more successful and satisfactory.

Medicated Needles.-My next experiments were with needles. dipped before using into acids, alkalies and astringents, then thrust into the morbid tissues. I treated many cases of nævi, or, more properly, capillary aneurism, in this way, using liquor ferri persulphatis, carbolic acid, etc. The needles were pushed through and through the vascular tissues. Inflammation followed, adhesions of the walls of the minute vessels supervened and the circulation was cut off, leaving the surface a more natural color. It was necessary to repeat these operations in order to produce a permanent cure. This treatment was attended with considerable pain and nervousness, consequently it became unpopular, especially amongst its victims.

Endermic Injections.-My next step was the use of the endermic syringe by which the medicated fluid was introduced di

*Read before the San Francisco County Medical Society, April 11, 1898.

rectly into the morbid tissues, in the quantity desired. Many cases were treated in this way, resulting in few permanent cures. The injected fluid generally destroyed the vitality of tissues, cutting off nutrition and sloughing followed. After cicatrization an unsightly scar remained to remind the surgeon, as well as the patient, ever afterwards that the treatment was unsuccessful and far from satisfactory. There was also more or less danger attending the partial coagulation of the blood in the vessels.— Coagula might be detached and enter the general circulation, resulting in embolism and death. When I realized the number of operations of this character I am more than surprised that no accident followed this treatment.

Croton Oil.-I also tested the value of croton oil in the treatment of birthmarks and other discolorations of the skin. I used an instrument invented by a German physician, consisting of a cylinder holding the oil, at the bottom of which was a porous membrane pierced with some twenty fine short needles; these were connected with a spring. By applying the instrument to the part to be operated upon and pressing the spring the needles entered the skin carrying with them more or less oil. A vesicular eruption followed, adhesive inflammation intervened obliterating the capillary vessels, leaving the skin a more natural color. If necessary the application could be repeated until the cure was complete. Carbolic acid can be used in the same manner and purpose. I also used in my experiments ethylate of sodium and potassium for the removal of discoloration of the skin. The part is lightly covered with the ethylate which soon changes the skin to a dark brown color, after which a crust is formed. Within a few days this will loosen and come off, leaving the skin much lighter in color. The application can be repeated until the skin resumes its natural color. I have tried the freezing process; the skin is frozen, then with a scalpel the part is cut in paralled and oblique lines the sixteenth of an inch apart; press immediately upon the cut surface white thick blotting paper to absorb any blood that may ooze out. The object in view is to cut across the small vessels and destroy them; this treatment was attended with more or less success.

It has required much time, patience and perseverence in testing the value of these several remedial agents and great pains

were taken in securing suitable cases for treatment. Great care and much caution was needed in the applications to avoid, if possible, any permanent injury. These experiments have not proved altogether satisfactory, although many cases were treated successfully. Still I am compelled to acknowledge numerous partial or complete failures. More or less trouble was experienced in getting patients to submit to the treatment, especially women and children and the more timid of the sterner sex. The old adage, "A burnt child dreads the fire," deprived me of the opportunity of repeating the operation which was absolutely necessary to success. On the whole, however, much valuable knowledge has been obtained which can be utilized in future practice.

We come now to the most important and instructive portion of this paper. The application of the concentrated rays of the sun (solar cautery) in the treatment of the following diseases, to wit: capillary aneurisms, varicose veins, indolent, chancroidal and rodent ulcers, epithelial cancers, birth, India ink and powder marks, bleeding vessels and surfaces, hemorrhoidal and erectile tumors, morbid growths, such as warts, moles, small wens and all diseases of the skin of a parasitic nature.

Many years since I commenced the use of the concentrated sun's rays (using a common sun-glass) in the treatment of diseases of the skin and its appendages. I was led to the use of this treatment by the merest accident. My first experiments were directed to the removal of moles and warts and were crowned with perfect success. I soon realized the necessity of obtaining larger and more perfect lenses, which I obtained in New York City. I then widened the field of operations, working carefully and cautiously, and watching every step of the process that no permanent injury might result from the use of so positive a remedy.

During this time I searched the medical literature of this and the old world for some notice or hint that the concentrated rays of the sun had been utilized in surgical practice, but in vain. Soon after the War of the Rebellion I came across a short article in the London Lancet in which the use of the sun's rays as a cautery was noticed. A surgeon whose name I have forgotten succeeded in removing a wine-mark from the face of a

lady and had also succeeded in destroying a malignant growth with the same remedy. The wound had healed readily and up to the time the article was published there had been no symptoms of the disease returning. This renewed my confidence and zeal. I continued the treatment whenever an opportunity presented itself. Success attended a large majority of the cases operated upon.

One drawback to this treatment, especially in the Eastern States, where I resided many years before coming to this coast, is the uncertainty of sunny days. For more than six months of the year sunny days are an exception. I have been compelled to keep patients waiting for more than two weeks for a bright sunny day, as we could not operate in any other. What a contrast to this sunny clime! "Old Sol," with his bright, effulgent face, is ever smiling upon his creatures, imparting life and energy to all animated nature. During a practice of more than a quarter of a century I have found no caustic or cautery to compare with solar heat in its beneficial results. Unlike other caustics it can be applied with perfect safety upon the most delicate tissues and is at all times under the control of the operator. It has other advantages-the system receives this treatmeat kindly. The irritation and inflammation following its application is surprisingly slight and of short duration. Another point in its favor, the pain subsides immediately upon the removal of the lens. I have burned the skin of nearly the whole of one side of the face at one sitting, destroying the cuticle; within five minutes the burned surface would be free of pain. There is a curative power in the chemical rays of the sun yet unexplained. I avoid blistering, carrying the burning beyond this point, carbonizing the tissue.

In the treatment of morbid or malignant growths, we destroy most fully the morbid products. Upon this depends the success of the operation. The morbid tissue having less vitality than the normal, succumbs to the cautery before the natural structures adjoining are injured. This enables us to attack boldly the malignant or morbid growths without any fear of injury to the healthy tissues surrounding them.

In the primary treatment of chancre, or chancroids, this treatment stands unrivaled. Within the space of two minutes the