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Wolfgang Janni (Herausgeber)

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Frank Giordano und Frederik Wenz (Hrsg.)

Strahlentherapie kompakt

3., neu bearbeitete Auflage

Weitere Autoren: Dr. Markus Bohrer, Mannheim; Dr. Daniel Bürgy, Mannheim; Dr. Sven Clausen, Mannheim; Dr. Katharina Fleckenstein, Mannheim; Univ.-Prof. Dr. Christoffer Gebhardt, Hamburg; Mario Grimm, Mannheim; PD Dr. Carsten Herskind, Mannheim; Prof. Dr. Katja Lindel, Karlsruhe; Dr. Christian Neumaier, Mannheim; PD Dr. Nils Nicolay, Freiburg; Univ.-Prof. Dr. Philipp Nuhn, Mannheim; Dr. Martine Ottstadt, Mannheim; Dr. Anna Simeonova-Chergou, Mannheim; Dr. Elena Sperk, Mannheim; Dipl.-Ing. Volker Steil, Mannheim

Vorwort

Liebe Leserinnen, liebe Leser,

für die neue Auflage dieses Kompaktlehrbuches haben wir uns zum Ziel gesetzt, die Kapitel nicht nur umfassend zu aktualisieren, sondern sie – wo möglich und angebracht – auch mit persönlichen Noten und Einschätzungen zu versehen. Es war uns dabei ein großes Anliegen, Ihnen nicht nur Fakten zu vermitteln, sondern Sie aktiv in aktuelle Gedanken und Diskussionen miteinzubeziehen.

Sicherlich bestand die große Herausforderung darin, die wesentlichen Neuerungen der vergangenen 15 Jahre kompakt und dennoch verständlich zusammenzufassen. Insbesondere den enormen Wandel

Danksagung

Unser Dank gilt allen beteiligten Co-Autoren, die zu dieser Ausgabe maßgeblich beigetragen haben. Sie haben, oft in ihrer Freizeit neben der klinischen Tätigkeit, in mühevoller Kleinstarbeit primäre und sekundäre Literatur recherchiert, Leitlinien interpretiert und an vielen Stellen neue Denkanstöße gegeben.

Danken möchten wir auch den Mitarbeiterinnen und Mitarbeitern des Elsevier-Verlags, allen voran

Abbildungen

Carsten Herskind, Mannheim (Abb. 33.1) Thomson Digital, Noida, India

der Bestrahlungsplanung (von der 2-D- zur 3-D-Bestrahlungsplanung, von der reellen zur virtuellen Simulation, von der 3-D-konformalen zur intensitätsmodulierten Bestrahlung), der grundlegende Änderungen von Zielvolumenkonzepten zur Folge hatte, galt es adäquat abzubilden.

Auch war es uns ein Anliegen Verknüpfungen zur jeweiligen Leitlinie herzustellen, wobei wir vor allem bei neuerer Datenlage auf Unterschiede zur jeweils gültigen Fassung hinweisen.

Mannheim, im Herbst 2018

Frank A. Giordano

Frederik Wenz

Frau Uta Lux und Herrn Alexander Gattnarzik. Beide haben uns sehr erfahren und geduldig bei der Erstellung dieser Auflage angeleitet.

Mannheim, im Herbst 2018

Frank A. Giordano

Frederik Wenz

Herausgeber

PD Dr. med. Frank Giordano

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3

68167 Mannheim

Autoren

Dr. med. Markus Bohrer

Praxis für Strahlentherapie

Auf dem Sand 75–77 68309 Mannheim

Dr. med. Daniel Bürgy

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3

68167 Mannheim

Dr. sc. hum. Sven Clausen

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3 68167 Mannheim

Dr. med. Katharina Fleckenstein

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3

68167 Mannheim

Univ.-Prof. Dr. med. Christoffer Gebhardt

Universitätsklinikum Hamburg-Eppendorf

Klinik für Dermatologie u.Venerologie

Martinistraße 52 20251 Hamburg

Prof. Dr. med. Frederik Wenz

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3

68167 Mannheim

Mario Grimm

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3 68167 Mannheim

PD Dr. rer. nat. Carsten Herskind

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3 68167 Mannheim

Prof. Dr. med. Katja Lindel

Städt. Klinikum Karlsruhe

Klinik für Radioonkologie und Strahlentherapie

Moltkestraße 90 76133 Karlsruhe

Dr. med. Christian Neumaier

Universitätsklinikum Mannheim

Klinik für Strahlentherapie und Radioonkologie

Theodor-Kutzer-Ufer 1–3 68167 Mannheim

PD Dr. Dr. Nils Nicolay

Klinik für Strahlenheilkunde

Department für Radiologische Diagnostik und Therapie

Vorwort

Liebe Leserinnen, liebe Leser,

für die neue Auflage dieses Kompaktlehrbuches haben wir uns zum Ziel gesetzt, die Kapitel nicht nur umfassend zu aktualisieren, sondern sie – wo möglich und angebracht – auch mit persönlichen Noten und Einschätzungen zu versehen. Es war uns dabei ein großes Anliegen, Ihnen nicht nur Fakten zu vermitteln, sondern Sie aktiv in aktuelle Gedanken und Diskussionen miteinzubeziehen.

Sicherlich bestand die große Herausforderung darin, die wesentlichen Neuerungen der vergangenen 15 Jahre kompakt und dennoch verständlich zusammenzufassen. Insbesondere den enormen Wandel

Danksagung

Unser Dank gilt allen beteiligten Co-Autoren, die zu dieser Ausgabe maßgeblich beigetragen haben. Sie haben, oft in ihrer Freizeit neben der klinischen Tätigkeit, in mühevoller Kleinstarbeit primäre und sekundäre Literatur recherchiert, Leitlinien interpretiert und an vielen Stellen neue Denkanstöße gegeben.

Danken möchten wir auch den Mitarbeiterinnen und Mitarbeitern des Elsevier-Verlags, allen voran

Abbildungen

Carsten Herskind, Mannheim (Abb. 33.1) Thomson Digital, Noida, India

der Bestrahlungsplanung (von der 2-D- zur 3-D-Bestrahlungsplanung, von der reellen zur virtuellen Simulation, von der 3-D-konformalen zur intensitätsmodulierten Bestrahlung), der grundlegende Änderungen von Zielvolumenkonzepten zur Folge hatte, galt es adäquat abzubilden.

Auch war es uns ein Anliegen Verknüpfungen zur jeweiligen Leitlinie herzustellen, wobei wir vor allem bei neuerer Datenlage auf Unterschiede zur jeweils gültigen Fassung hinweisen.

Mannheim, im Herbst 2018

Frank A. Giordano

Frederik Wenz

Frau Uta Lux und Herrn Alexander Gattnarzik. Beide haben uns sehr erfahren und geduldig bei der Erstellung dieser Auflage angeleitet.

Mannheim, im Herbst 2018

Frank A. Giordano

Frederik Wenz

Hackerbrücke 6, 80335 München, Deutschland

Wir freuen uns über Ihr Feedback und Ihre Anregungen an books.cs.muc@elsevier.com

ISBN e-Book 978-3-437-29869-1

ISBN Print 978-3-437-23292-3

Alle Rechte vorbehalten

3. Auflage 2019

© Elsevier GmbH, Deutschland

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Bibliografische Information der Deutschen Nationalbibliothek

Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://www.d-nb.de/abrufbar.

Der Urban & Fischer Verlag ist ein Imprint der Elsevier GmbH.

19 20 21 22 23 5 4 3 2 1

Für Copyright in Bezug auf das verwendete Bildmaterial siehe Abbildungsnachweis.

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Um den Textfluss nicht zu stören, wurde bei Patienten und Berufsbezeichnungen die grammatikalisch maskuline Form gewählt. Selbstverständlich sind in diesen Fällen immer Frauen und Männer gemeint.

Planung und Konzept: Uta Lux, München

Projektmanagement und Herstellung: Alexander Gattnarzik, München

Redaktion und Register: Michaela Mohr/Michael Kraft, mimo-booxx|textwerk., Augsburg

Satz: Thomson Digital, Noida, Indien

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Aktuelle Informationen finden Sie im Internet unter www.elsevier.de

Literatur zu Giordano/Wenz: Strahlentherapie kompakt, 3. Auflage

Kap. 1

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Kap. 3

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R, Ensley JF, Thorstad W, Schultz CJ, Yom SS, Ang KK. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1198–205.

Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004 May 6;350(19):1937–44.

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Another random document with no related content on Scribd:

I knew well enough that my hair did not need cutting, and was about to say so when he butted in with:

“It’s Christmas to-morrow, you know, Mr. Henderson,” and while he was saying it he was pulling out the headrest. It was Christmas Eve, and I did not want to make him feel bad, so I let him go ahead. One thing I liked about him, he did not seem to be one of the talking kind; that is to say, he did not say much, but what he did say you felt that he meant. After he was through cutting my hair, he laid my head back, and, with those long swipes of his, laid the lather on all parts of me that showed above my collar. Then he commenced on me with his razor. He was long at this. He would lay his razor on above my cheekbone, and with one swipe would rake down over my cheek and land under the tip of my chin. I fairly held my breath. After he had given me a couple of swipes of that kind he stopped to wipe his razor.

“Look here,” said I; “what did you work at before you struck the barber trade?”

“Stock Yards,” said he, taking a swipe down the other side of my face with that infernal razor; “used to be a ripper,” he added. And before my mind’s eye came a long row of hogs strung up by the hind legs and my friend of the razor going down the line giving each one a slash down the middle. Again I held my breath, and, after a few more of those swiping cuts, I was washed off and jerked into an upright position.

“Singe?” I heard him say, and, before I could utter a protest a blaze of fire was dancing about my head. This was another case of hold your breath. Then I was thrown on my back again, and lengthy was massaging my face. He was handling it as though it was a piece of putty, and I wondered if I would know myself if I ever got a chance to look in the glass again. Then I was bounced into an upright position again, and I heard him say something about the danger of taking cold. The next I knew those long fingers were going through what was left of my hair, executing what he called an alcohol shampoo. There was nothing further he could do for me, but, as he presented me with my check, he slipped a bottle of hair tonic into my pocket.

“Greatest tonic on earth,” said he. “There are indications that your hair will begin to fall out in a few years, and you should be prepared.”

The check was two dollars and forty cents. I handed him three one dollar bills.

“Thanks!” said he, looking at the bills. “Sixty cents is the smallest tip I have had today, but it is all right, old man. Come in again.”

I clinched the bottle of hair tonic in one hand and a strong desire came to me to kill that barber on the spot. I took a step towards him. He had put the money away, had gotten hold of his razor with his right hand, and was stropping it on the palm of his left. A vision of those slashed hogs came before me, and I walked out, but if I ever meet that man separated from his razor, there is going to be trouble.

I am keeping a little book now and putting in it the things to be avoided. One of the first things down is to avoid a hotel barber shop on Christmas Eve. You can never forget that it is Christmas time. They commence telling you about it a week before Christmas, and don’t let up until a week after New Year’s.

When you first come into a hotel the boy shows you to your room, and after setting down your grip in the only place in the room where you would rather not have it, he fixes the windows. They most likely don’t need fixing, but he fixes them anyway. If they are shut, he opens them, and if they are open he shuts them. Then, if you don’t notice him, he stands on one foot awhile, then changes off and stands on the other. Then he coughs, and, if that doesn’t fetch you, he says:

“Anything more I can do for you?”

You say “No,” and he puts you down for a cheap guy and then goes down and tells the news to the rest of the bell hops.

The one who showed me up at this place wasn’t to be put off so easy. After he had worked all the old grafts he said:

“It’s going to be fine weather for Christmas.”

“All right,” said I. “If you will pull off a good sunshiny day, you can come to my room and get a half a dollar,” and then the little beggar asked me if I was going to be here Christmas. I got rid of this boy for the time being on a promise, but I knew that half would have to be paid if Christmas brought in a cyclone.

The elevator boy sprung a new one on me. He handed out a catchpenny Christmas box and said:

“Ain’t that a peach?”

“Sure,” said I, wondering what he would say next.

“Then put a stone in it,” said he. That cost me a quarter.

In the dining-room each waiter wished me a “Merry Christmas,” and then you would see his hand slide out toward you as though he could not help it. Every chambermaid on my floor swore that she had waited on me at some other hotel, but the boy at the coat room took the palm. He wiped off my boots with a cloth, helped me on with my coat and brushed it, then as I was walking away, said:

“Thank you, sah; thank you, very kindly.”

“What in H—— are you thanking me for; I didn’t give you anything.”

“No, sah; no, sah!” said he, hesitatingly; “I only thanked yo’ cause yo’ let me bresh yo’ off, sah.”

What a fellow needs is one of those change-holders that the street car conductors use, with a place for each kind of a coin. But he would need more than that. He would need a national bank to keep the thing supplied.

Yours, Jack.

“HOLDING PEOPLE’S HANDS THAT YOU HAVE NEVER BEEN INTRODUCED TO.”

Swearing Off.

Swearing Off.

Philadelphia, 19—.

Dear Billy:—

The New Year’s days have come, the saddest of the year—when every dub a fellow knows swears off on booze and beer. Oh, say! But doesn’t it make you tired—this swearing off business?

I went down the line on New Year’s morning, from the Malton to the Singum House, and every man I asked to take a smile cocked his eye, shook his head and croaked “water wagon.” I went back to the Malton, pulled Dug out of bed, and could hardly wait for him to dress before I hurried him into the bar for a morning’s morning. D— a man, I say, who doesn’t know when he has enough. That was the toast we drank to, and before we had worn that toast out we certainly had enough and we knew it.

We did some great calling on New Year’s day, but a fellow can’t call at every booze joint in the Quaker City without having a load he can feel. In our wanderings for new booze joints to conquer, we accidentally got into a barber shop. I think it was the bottles of colored fluid that attracted us. We were trying to find an excuse for coming in when I saw a sign which read: “No one allowed to tip the barbers.”

“Good,” said I to myself; “here is one place where we play even.” I called Dug’s attention to it, and we planted ourselves in chairs. That was the slickest shave I ever got, and the barber I had—why, he ought to have been a trained nurse: he was so solicitous of my health and comfort.

“This not allowing you chaps to take any tips is a great scheme,” said I. “How do you like it?”

“Like it,” said the barber; “it’s great. And we make more this way than we did before.”

“More pay, I suppose?”

“No, we get the same pay.”

“Then how can you make more?” The barber laughed.

“Then you ain’t on?” said he. “It’s the slickest ever. You notice that little fancy cup on the shelf?”

I told him I had noticed it.

“Well,” commenced he, “that cup does the business. We are not allowed to receive any tips, and we tell everybody so, and we also tell them about the fancy cup, and tell them we cannot help it if they want to send a present to our baby, and it is a nervy guy who will toss in less than a quarter on a plea like that. It looks small, you know. Besides, my baby has not been feeling well for the past few days.”

“So you are married and got children?” said I.

“Well, no; not exactly. I am not married, and of course haven’t any children, but I have the sweetest baby you ever saw. She is about twenty-seven summers old, and if any one should ask you, she is about the warmest baby in the bunch, and she does need money. Say, my friend, a chap came in here yesterday that put a dollar into that fancy little dish and he said, as he did it:

“That’s for the baby.”

I got out of the chair. As I did so he handed me the fancy cup. This made me mad, and I said to him:

“Look here, you tonsorial lobster, you and your baby will be obliged to worry along without anything from me for a while longer,” and I looked him fair in the eye that he might understand I meant business.

“That’s all right, my friend. You do exactly as you please, of course. Should be pleased to have you call again, and will treat you the best I know.”

He certainly was the limit and was trying hard to make me feel like a two-cent piece. As I turned my eyes from him they encountered a very fetching pair of eyes that belonged to the manicure lady. She not only had a fine pair of eyes, but she knew how to use them. I had always thought I would like to have one of those chiropodist ladies

hold my hand for me, but I always hated to have it happen before a lot of barbers; but this one was different. She could have held my hands sitting on the sidewalk on Chestnut Street, with all the shoppers loose on the street. She made me put one of my hands in water and soak it up for a while, and then she commenced to get in her work. Say, but she had the softest hands and the most delicate touch. Oh, my! It just took my breath away for a minute. After a while I began to get a little used to it and found myself able to talk.

“You are an awfully sweet girl to be wasting your time sitting around a barber shop,” said I; “holding people’s hands that you have never been introduced to.”

“Oh, I don’t know!” said the Queen. “This is no ordinary shop, and my customers are all very nice.”

“They can’t be nice enough to you,” said I, “and it’s a wonder to me you stay here.”

“What do you think I ought to do?”

“You ought to get a position where you would only have one pair of hands to take care of,” said I; and then for fear she would not understand me I said:

“Why don’t you get married?” She laughed.

“I don’t know any one who would have me.”

“Did you ever advertise?”

“No,” said she. “I never thought of that. I am doing pretty well here.”

“How much do you get for holding hands like this?”

“Fifty cents is the regular price, but sometimes I put in a little more work and then my customers give me more.”

“Then” said I; “you just throw in a squeeze or two and I will make this job two dollars.”

She smiled, which showed her dimples in good shape, and when she caught hold of me again I could feel the effect clear up my back. This was a new deal for me, but it was worth the money.

“Look here, little queen,” said I. “Why can’t you meet me after you get out tonight and have a nice little supper somewhere?”

“I would like to awful well, but I am afraid I couldn’t do it. You see, I have a steady, and I couldn’t afford to break with him just for one evening with a stranger.”

“Just my luck,” said I, “I never saw anything yet that I really wanted that some guy didn’t have a prior claim to it.”

Just at this time Dug pulled away from the barber who had him under control and coming over to where I was, said:

“Cut that out, Jack; let’s get out of this.”

The queen cut her work short, but she froze on to the two dollars just the same, and worse than that she handed it to the barber whom I had refused to tip, saying as she handed it to him:

“Here’s two bucks for you, Charlie,” and then turning to me she added, “that’s my steady.”

The d— lout of a barber got my money after all. I met the queen on the street once afterwards. Her eyes were not working, some one had bruised them for her.

“What’s the matter, little one,” said I, “who has been trying to put your lamps out?”

“That steady of mine,” said she, “he accused me of holding out on him.”

“Why don’t you quit him, little one?”

“Oh, I couldn’t do that. You see he is always good to me when he doesn’t booze or he gets it into his fool head that I am flirting with some one.”

And still we wonder at crime.

The little queen has passed out of my life, and me—have I sworn off on queens? Well, not exactly, but if I know it I have sworn off on barber’s queens.

Dug and I were out on the Germantown road the other evening. We were out to see some friends and had taken a few bowls with Hank and a few bowls with Jim, and when we got ready to start home we were feeling rich, good natured and prosperous, and Germantown road, Billy, doesn’t run the same as the other streets in Philadelphia, but looks as though it had been taken from some other city and dropped into Philadelphia crossways. This plays hob with

the street corners and a fellow never knows where the street cars are going to stop.

We stationed ourselves at a corner, where we figured they ought to stop, and waited. When the car came it went by us like the wind and the motorman was motioning us to get to the next corner. By the time we got to the next corner, the car was half way down town. Dug was mad, but I reminded him that we had all night to get to the hotel in, and that we were safe for the next car. It was late and the cars did not run often, but one came at last. The first thing I noticed when the car hove in sight was the motorman gesticulating with all his might for us to get back to the corner where we were before. This made Dug madder than ever and he would not stir and, of course, the car went by us again. I laughed, which did not improve Dug’s temper.

“Think you are smart, don’t you?” said he. “Now, I am going to make you pay for this. I will bet you a sawbuck that the next car stops right between these points,” indicating the two corners where we had missed before.

I took the bet, taking a chance that his scheme, whatever it was, would fail. We both took our places at the point where Dug said the car would stop and awaited results. In a few minutes another headlight showed us that another car was coming. There was a cab standing by the curb with a tag on it marked “Public Cab,” and when the car was about a block and a half away, Dug grabbed the whip out of the socket and caught the horse by the bridle, and with a little cussing and whipping, brought the cab directly across the car track. Unbeknown to us the driver was sleeping inside the cab, the movement of the cab awakened him and about the time the wheels struck the car track, the driver fell out of the door of the cab and landed on all fours in the street. He regained his feet and as soon as he saw Dug at the horse’s head a sulphuric string of oaths rolled out of his mouth that it is not often the privilege of a white man to hear.

“You blankety blank fool,” said the driver, “what are you trying to steal my horse for?”

“Hold on there, young fellow,” said Dug, “your horse was running away and I caught him at the risk of my life. You ought to thank me, not curse me.”

“You are a liar,” said the cabbie, “that horse can’t run.”

This was too much for Dug and he promptly knocked the cabbie down. By this time the car had stopped with the fender touching the wheels of the cab. The cabbie had regained his feet and was hollowing “Bloody murder” at the top of his voice. Dug let go of the bridle and hit the horse a couple of cuts across the rump. This set him off on a dog trot down the road and the cabbie took after him. Dug and I boarded the car, the conductor gave the signal to go ahead and this closed the incident so far as we were concerned. I guess the cabbie caught his horse, anyway he wouldn’t be much loss.

It cost me ten dollars, but it put Dug in good humor and he tells now that if I want something else to swear off on I can swear off on betting against a sure thing.

Yours, Jack.

“A DUFFER WINKED AT HER.”

Grafting.

Jack Henderson.

Grafting.

Indianapolis, Ind., 19—.

Dear Billy:—

Grafting is tipping on a large scale. The average man kicks because the porters, bell boys and waiters hold him up for his small change, but the chances are if you should find out all about the kicker you would find he was a grafter and one of the worst kind.

At the St. Louis exposition I wandered into a dancing hall where the Turkish dancers were going through their agonies, and in looking about the audience, I saw a bumpkin taking in the show. Beside him was his Sunday girl, who was trying to be shocked by the performance. After one or two looks she dropped her eyes and would not be comforted. The guy, who was grinning all over his face, had to take her out, but she was only doing what the grafter often does, playing to the grand stand. If that girl was my wife I would put a detective on her trail right from the start. She reminded me of a woman I saw in Los Angeles once.

This woman was married and very modest, but she got stuck on a friend of mine who was a good deal of a rounder, and she used to come down town to meet him two or three times a week. One day she was coming down in the car and a duffer winked at her. She was wild with indignation, shed tears in the car and demanded that the car be stopped and the conductor call a policeman. The masher left the car, the modest lady kept her appointment with her sweetheart and telephoned to her husband from their trysting place that she was home darning his socks.

The telephone is a great thing, Billy, and by the way it is the bellwether as a grafter. Just show this to the president of the old

company in Chicago, he knows it. It doesn’t do to judge from appearances, Billy. Things are not always as they seem. Speaking of grafting, it doesn’t always mean money, but it costs money to go the pace. I was in a town not a hundred miles from this one a short time ago when I ran across Johnny Morgan. You remember Johnny, he was always one of the good boys. He was so d——d good it used to make me mad and I licked him often just because he was so good that it worried me. When Johnny got big enough he went to work instead of living on the old man, like you and I did, and I laid it up against him as much as I did his being good. It seems Johnny has gotten to be a crack salesman and is traveling for a school book house. Easiest thing in the world to sell, I should think, if a fellow has the best, but Johnny says not.

Perhaps I am not learning a lot about tips, or graft, as it is called when it gets into society. You see in order to get his books introduced, Johnny is obliged to present his case to the superintendent of schools. If he succeeds in getting him coming his way, the next thing to do is to tackle the school board. Johnny got this far in telling his story to me and it struck me he was making a strong drink out of a weak one.

“Look here, Johnny,” said I, “what better do you want than that you have an intelligent, educated lot of men to deal with who are after the best thing that can be had for the interests of the school?”

“One minute,” said Johnny, and he swelled up with his superior knowledge of the business, “it is not the educated, intelligent side of the board I have to deal with, but it is the same side that the graft aldermen in the Chicago City Council shows when you want to get a bill through.”

“Do you mean,” said I, “that these school boards have to be seen?”

“Do they? Well, I should say they do, and if they are very intelligent or very well educated they have to be seen two or three times.”

Wouldn’t that knock an educated pup off the balance pole, Billy?

“How are you getting along in this town?” said I.

“That’s just it, Jack, I am not getting along at all. I have them all but one on my side, but he has sort of taken a dislike to me and I can’t budge him an inch. I thought perhaps you might help me out as

you are something of a schemer, besides you owe me something for the lickings you used to give me when we were kids.”

“All right, Johnny, I will help you, but not on account of the lickings. They helped to make a man of you.”

Just then a lady came up the street who attracted my attention. She was just my style, tall, slim, dark and handsome, and had eyes that talked in spite of herself. She gave me a look that went under my vest and hurt. Johnny had to shake me before I woke up.

“Isn’t she the whole works, Johnny?” said I.

“Not exactly, Jack. Her brother is the part of the works I can’t make go.”

“Johnny,” said I, grabbing him by the hand, “now I am in dead earnest. We will land that order if it takes the last drink in the bar.”

“How do you propose to do it, Jack?”

“I don’t know yet,” said I, “but you hold the bunch together that you have and I will agree to land the other duffer—what is his name, anyway?”

“Doctor Davidson,” said Johnny, brightening up at my earnestness, “but I don’t think you know what you are up against.”

“Never mind what I am up against, I have given you my promise and Jack Henderson never goes back on his word.”

I had no idea as to how it could be done, but I had decided that the first thing for me to do was to get acquainted with Miss Davidson. Did it ever strike you, Billy, how hard a chap will work to get acquainted with a woman who strikes his fancy? I don’t know of anything he will work harder at unless it is to get rid of one that he has taken a dislike to. I never had much experience in that line, but I was willing to try—no, not willing, for when I thought of those eyes I felt that I must try. I went to work in earnest and found out that she was the doctor’s pet sister, that she lived with him and that her front name was Laura. Billy, I never knew that was such a pretty name before. I actually reformed some, I quit drinking before breakfast.

The next thing I did was to watch my chance and meet her good and fair. I bowed and smiled, but she gave me the busy signal and passed on, then I waked up to the fact that men did not get acquainted with this kind of a girl in that way. Then it came to me

that I had heard that society people always had to be introduced and I realized I was up against it right. I could not help but think of what Dug and Konk would say if they knew I had gone nutty on account of a pair of brown eyes and a smile.

My next stroke was a bold one, but it worked. I dropped in at a church social after I had seen Miss Laura enter the church. It is a fact, Billy, though—if I knew how, I would blush to tell it—I really went into a church after those brown eyes. After I got in there I felt as much out of place as I ever did in school; the only familiar face I saw was Laura’s, and I did not dare to look at her. The minister came along and I overheard a little conversation that put me on to the right track. A lady commenced it by saying:

“I enjoyed your lecture last night very much.”

“I am glad you liked it,” said the preacher, “I remember seeing you —your husband was with you.”

“Oh, no, Mr. Parker, my brother was with me; don’t you remember I introduced him to you after the lecture?”

“Yes, yes, certainly,” said Mr. Parker, “but there were so many introductions,” and I knew by the way he said it he was lying and did not remember her nor her brother. This gave me my cue; I got out of that part of the church and waited until the Rev. Mr. Parker came my way again, then I pounced upon him. I shook hands with him as though he was an uncle whom I expected would die soon and leave me a fortune.

“Mr. Parker,” said I, “you remember me, Mr. Henderson, I was introduced to you last night just after your lecture. I was deeply impressed by the way you handled your subject.” I had heard someone else say that to him, so I knew it must be the proper caper. He shook hands with me warmly,—he had to, I was doing the shaking and others were talking to him, but I still hung on. Pulling him towards me I said:

“Mr. Parker, I want you to introduce me to Miss Davidson.” With this I walked him across the room to where I felt she was watching us, and the deed was done.

“Miss Davidson, allow me to present Mr. Henderson,” and the preacher was released and gone. I put out my hand, but there was nothing doing—not with her hands, but her eyes sparkled with fun.

“Mr. Henderson, allow me to congratulate you on your wonderful nerve,” said she, and don’t you know, Billy, that was a body blow for me. I was down and nearly out and I know I must have looked foolish. I was not counted out, though, for I recovered before anyone could have counted more than nine.

“Miss Davidson,” said I, “I tried to be square and get acquainted without an introduction, but you wouldn’t have it that way, so I did the best I could.”

“Yes,” said she, “and you trapped a preacher into being your tool to carry out your plans.”

Say, Billy, but those brown eyes were the only lights in the room, but she had the hooks into me good and proper and I was squirming and gasping for breath. I felt that I could not hurt my case any and I spoke out just as I felt and just as I caught another glimpse of those eyes, I said:

“Miss Laura, I would have gone to the hot place and asked the devil to help me if I could have gotten there quicker than the way I went to work.”

“I believe you would, Mr. Henderson, and I am glad to know that you are honest even if your language is forceful.”

“Call me Jack,” said I, “and you can walk on my face.”

Say, Billy, wasn’t I gone to the bumpers, though?

“Sit down here, Mr. Jack,” said she, “I want to talk to you.”

We sat down, some one came around with refreshments, cake and ice cream.

“No pot wash for me,” said I, “haven’t you any—” I was going to say bug juice, but just then Miss Laura stuck a pin into my leg and said to the attendant:

“Mr. Henderson says he does not feel like eating ice cream, but will take something later.”

The attendant passed on; ain’t she a trump, though.

“Look here, Mr. Jack,” said she, “did you ever see Mr. Parker before tonight, or did any one introduce you?”

“You have sized the case all right, Miss Laura, but what of it? I had to do it.”

“A song by Miss Davidson,” said some one, and Miss Laura turned to me and said:

“Either get your hat and go or else don’t speak to any one while I am gone.”

“Call me Jack,” said I.

“Jack.”

“I’ll be here.”

She was on to my curves all right. She knew if I tried to talk to any of that bunch I would spill. A fellow with a shock of tan colored hair worked the piano for her and she sang something that made me hold my breath. They gave her the hand and then she sang “Home, Sweet Home” in a way that would bring tears from a deaf mute. When she came back to me the tears were running down my cheeks, but I didn’t know it until she laughed.

“You are a good-hearted boy,” said she, “but don’t you think you had better go now? I must not spend all my time with you, you know, and I want to talk to some of the other people.”

“No,” said I, “this may be my last chance of heaven and I am going to see you home.”

She looked startled for a moment and then said:

“All right, you wait here a few minutes.”

She came back in a few minutes with her things on. I went home with her and don’t remember to have hit the ground but three times walking the four blocks. I don’t know what she said to me, but she called me Jack and in some way made it plain to me that I was outclassed. I stayed up with the bartender until he closed up that night, and we got awful chummy with a dub from New York, who had invented a new drink. He called it a “sleeper,” and I guess it was, for I did not wake up until twelve o’clock the next day. When I came down the first man I met was Johnny Morgan. He shook my hand as though he had not seen me for a year, and said, with tears in his voice:

“You are a brick, Jack, you’re a brick; how did you do it? At a meeting of the board this morning the doctor not only voted for my books, but he talked for them.”

Johnny insisted on my taking twenty-five dollars. I hadn’t said anything about the books, neither had I thought of them, but it was a case of graft. Anyway, I took the twenty-five.

Yours, Jack.

“CAPT. JONES, I AM PLEASED TO MAKE YOUR ACQUAINTANCE.”

The Long Salesman.

The Long Salesman.

Wichita, Kans., 190—.

Dear Billy:—

Since I wrote you last I have learned a new lesson in tipping. I used to think that tipping was confined to porters, waiters and congressmen, but I have struck a new lead and I begin to think now that the man doesn’t live who is not either giving or taking tips, and the majority of them do both.

While stopping here at the Carrie Hotel I made friends with a traveling salesman for a lumber concern. My first meeting with him came near being my last; the little slim Jim stepped on my foot and I pasted him one in the jaw, then for a few seconds there was nothing doing and then there was. That little duffer jumped to his feet, pulled a thirty-two from his pocket and fired at me. The bullet went wide of the mark and before he could think to fire again, I had taken his gun away and was holding him and his gun apart, one in each hand. That one shot cleared the barroom of all but we two and the bartender, and he was lying full length on the floor behind the bar. The salesman and myself had both been drinking more than was good for us, but the shot had sobered me and I guess it had done as much for him. I gave him back his gun.

“You are a damned poor shot,” said I, “put up the popgun and let’s take a drink.”

We stood up to the bar and I called for the bartender, who managed to get up after a time and set out the red liquor. When the police arrived we were touching glasses and in answer to an inquiry as to where the man was who did the shooting, I answered:

“Couldn’t tell you, old man, we just came in; will you have a drink?”

The bartender, after he had waked up to the situation, explained that the man the police wanted had left by the rear door and that was the last we saw of the cops. The bartender then turned to us and ejaculated:

“Well, you two fellows do extract the sweet all right. Here you are chumming together and you don’t even know each other’s names. Just you have one on the house while I introduce you,” which we did and as we clinked the glasses, the bartender said:

“Bless you, my children! Harry Monroe never fired a truer shot than when he drew bead on Jack Henderson, for he brought down a friend—get together there,” and we drank and shook hands.

That was my introduction to Harry Monroe, and a whiter rounder never lived. The only trouble with him was he was obliged to divide his time between living and earning money to live on. Harry got to telling me about his selling lumber on the road and how he did it, but it looked a little punk to me and I told him so. After I said that there was nothing for me to do but to make a trip with him and see how it was done.

He was going to make a trip over a route that he had never traveled before, and he told me it would give me an insight into life that I couldn’t get in any other way. I went and the first town we struck was a little place up in northern Kansas, and the first office we got into was plastered all over with temperance signs. I took a look at Harry to see how he took it, but it never feazed him. He introduced himself to Mr. Brown, the proprietor, and then introduced me as his cousin and said I was traveling for my health. Then he dropped into a chair by the side of Brown and reeled off a string of temperance talk that would have put the average temperance lecturer in the ditch. I never knew what a fearful thing drink was before. Harry fairly cried when he told the dealer how his father and three sisters went to the bad on account of drink. Then Harry told him a story about a man who sold his wife’s washboard for drink, and, said Harry:

“Just think, she was the only support of her husband and six little children;” then they both cried. We spent two hours in that office and when it was almost train time Harry mentioned his business and

took an order for eight cars of lumber. We made a quick get-away to catch the train, and I want to say right here that I was feeling sort of punk about that story of Harry’s three sisters. After we got seated in the car and I found I could not keep the destruction of Harry’s family out of my mind, I said to him:

“Harry, is your father dead?”

“Dead, well I should say not! He is preaching down in Swampscott, Massachusetts, and holding his own with the best of them.”

“And those sisters of yours?” I added.

“Oh, yes, those sisters, I see now. Well, you see Jack, I never had any sisters, that’s why I can put them to the bad so easy. It’s like this, Jack, every one you meet has to have what they call down south, ‘Lagniappe;’ in the north we call it perquisites or graft. In reality it is a tip given by one person to another. Now, a salesman is called on to give out more kinds of tips and give them out in more different ways than any other man that travels. Sometimes we give cigars, sometimes it’s a drink or a dinner, and sometimes soft-soap, and other times its tears, but to be a success on the road you must give something.”

“Don’t you ever make a mistake in giving?” said I.

“Never did but once.”

“Tell me about it.”

“Not much to tell, Jack. I gave a man the measles once and lost his trade.”

He was so nervous about that I felt for a moment that he had walked into some fellow’s office and handed out a package marked “measles,” expecting to make a hit by doing it.

The next dealer we struck was a little, under-sized, florid man, who had a twinkle in his eye that put you in good humor at once. This time Harry introduced me as a druggist out of a job, and Mr. Wise, the dealer, asked me if I was a good judge of spiritus frumenti.

“Try him,” said Harry, and Mr. Wise started for his sash house, motioning for us to follow. We went to the farther end of the sash house and there down inside a pile of sash Mr. Wise fished out a bottle of whiskey. I tasted of it.

“It’s rotten,” said I, and it was. Harry laughed and pulling a pint flask from his pocket, said:

“I told Jack to say that so I could offer you a pint of the best that’s made.”

It was good, and although Mr. Wise did not know the difference, he pretended he did and we didn’t do a thing to that pint bottle between us in about ten minutes. The talk of the morning had made me so dry I could hardly stand it. Harry got an order for three cars at that place and then nothing of real worth turned up for a couple of days.

It was always “nuts” to me to see Harry deal out the tips, as he called them, and when we struck a new lead and were working up a new game, he would say:

“I wonder what this geezer will take, cigars, whiskey, or soft-soap?”

One morning about eight o’clock we came in sight of a lumber yard with a small office; standing above on the top of the office was a signboard on which was painted Capt. J. J. Jones. I called Harry’s attention to it and said:

“How is that for conceit?”

Harry commenced counting on his fingers:

“One, two, three, four, five. That’s the checker, Capt. Jones, J. J., you are my meat. He needs the army tip and I’m the boy who can tip him.”

We walked into the office, there were three men there. Harry never hesitated a moment but walked up to one of them, held out his hand, and said:

“Captain Jones, I am pleased to make your acquaintance. There is not a man who ever fought in the Civil War that I would not go miles to see. I have always felt sorry that I did not live in those stirring times. What regiment were you in, Colonel?”

“The—the——Pennsylvania,” said Mr. Jones, “and there was no finer regiment in the service.”

The other two men had gone out of the office.

“Colonel,” said Harry, “it must have been grand to have led such a regiment as that on the field of battle; it must have been aweinspiring to have sat there on the different horses that were shot

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