THE
PRESENT POSITION THERAPY.*
RADIUM
OF
BY
Sylvia
B.
Radium
Wigoder, Officer,
M.D., Ph.D., D.M.R.E.,
National Radium Centre, Bristol.
Radium has been described (I have forgotten by whom,) as the most potent element which has been yet discovered for the
production
of discontent in the
profession. It was hailed at first as a panacea for all ills. Although it has not fulfilled the hopes based upon it by those early enthusiasts, it has opened up new fields in the treatment of disease, especially malignant disease, but even there, despite improved medical
I do not think that radium is at
technique,
substitute for surgery.
looked upon, a
not
partner and
an
as a
present
a
The radium needle should be
competitor
to the
added weapon in the
knife, but
as
fight against
cancer.
Radium cases
great
or
therapy should be restricted
those
cases
risk, such
as
inoperable operation is attended by Wertheim's hysterectomy, or
where
associated with mutilation, such
tongue. *
A
Society, Vol. L.
as
removal of the
inoperable cases those that are advanced with widespread metastasis, bony Of
very far
to
the
read at a Meeting of the Bristol held in the University of Bristol on 10th
Paper
No.
190.
Medico-Chirurgical May, 1933.
Dr. Sylvia B. Wigoder
234
involvement, much sepsis and marked wasting
generally
unsuitable ;
while
patients suffering
are
from
diabetes, nephritis, syphilis or tuberculosis do not, as a rule, respond well to radium treatment. In addition, the of its lesion, accessibility proximity to vital structures and its histological type modify the results. considered radio-resistant and
Adeno-carcinomata
are
well-differentiated
squamous-celled
less
carcinoma
resistant, while non-differentiated epithelioma and the basal-celled carcinoma or rodent ulcer are radio-
Many of the sarcomata, especially lymphosarcoma, are extremely radio sensitive, but unfortunately these growths tend to recur either locally or sensitive.
-
elsewhere very soon after irradiation. Roughly about 50 per cent, of the malignant treated
by
radium
are
free at the end of
achievement, from
a
as
cases
locally well, mostly symptom-
year. This is a considerable majority of these cases are hopeless one
the
surgical point
of
view, and
so,
were
it not for
radium treatment, most of them would have been dead and certainly none of them would have been
symptom-free William Mayo
at
the end of
a
year.
There
is,
as
says, a great difficulty in evaluating radium treatment, since it is used so largely in treating
following operation, where expected is palliation. The thoughtless, therefore, give radium little credit for what it actually accomplishes in these cases and, disappointed that the impossible has not been accomplished, minimize its value. I mention one year as the period of freedom from symptoms, not
inoperable
cancer or cancer
the most that
can
be
because I believe that one
year
or
not at
recurrences
either
occur
within
all, but because the patient and
The Present Position
of
Radium Therapy
235
his doctor are more interested in the immediate effects of radium treatment and are less concerned with "what will happen five years hence; and secondly,
techniques
rapidly within the last five-year statistics are difficult
have altered
few years that reliable
so
to obtain. At the outset I should like to make it clear that
the results mentioned in this paper results obtained from
Watson, I know, has of
carcinoma are
of the
exceptional,
results
less
are
the average
number of centres.
Gordon-
good results in carcinoma Geoffrey Keynes's results in
obtained
rectum, and
the
a
are
breast and
at
promising
are
the
excellent;
majority
when
these
but these of
centres
regions
are
treated.
knowledge of the biological and physical properties of radium, the conditions governing the vulnerability of normal and Malignant cells are still, to a large extent, problematical, and we still do not know why two apparently similar cancers with apparently similar histological structure In
Will
spite
react in
of advances in the
a
dissimilar
manner
to
radium.
The
cytologist have worked long and hard problem, and the solution, I think, now lies in the hands of the bio-chemist and bio-physicist. However, just as the majority of practitioners do not consciously think of the exact modus operandi of the drugs they use, we radiologists use radium even if the processes initiated in the tissues by radiation are far from being understood. There are four main radium techniques. The in which radium first is that of interstitial needling, is inserted the diseased into tissues. This surgically
histologist at the
and
Dr. Sylvia B. Wigoder
236 method is but
that
requires
most
often
employed
general anaesthetic;
a
at
present,
the
lesion
is
by needles which are left in place for six to fourteen days, depending on the histological type of lesion, the strength and filtration of the needles. The second method, the intracavitary method, is that in which radium is placed in a natural cavity of the body, for example, in the body of the uterus or This treatment rarely lasts for in the oesophagus. a than week. The third method, that of surface longer
surrounded
treatment, consists of covering the surface of the lesion with to
radium, which may be directly applied it or separated from it by J- to 4 cm. of some material
Treatment here may last from a few hours up till ten to fourteen days, depending not only on the type of lesion and the concentration of
such
the
as wax or
rubber.
radium, but also
on
the distance of the lesion from
A small
the radium.
have the radium
superficial lesion will, of course, closely applied to it. The fourth
method of treatment is the much discussed distance radium
or
containing
mass a
inches
some
irradiation
therapy,
large quantity of from the body.
when
radium is There
conscientious enthusiasts who advocate the bomb
:
equally
Continent
have,
of
success
in
to
our
many the
on
decry
it.
a
placed are use
Results
whole, been good.
bomb at
many of the
on
the
The lack
have been due
England may, perhaps, proficiency with smaller units, but it seems to me that before we can use huge quantities, such as 15 grammes, we will want not only larger hospitals to house the radium, but bigger and stronger patients to stand the treatment. There is no definite therapeutic difference between the use of element lack of
The Present Position
of
Radium Therapy
237
radium and its emanation
being
a
can
gas,
radon, except that radon, be collected, compressed and sealed
in small containers known
Shortly
after the
as
seeds. of radium treatment
beginning
the lesion becomes covered with
yellow
fibrinous
membrane, when it
replaced
exudate not
a
smooth, greenish-
unlike
a
diphtheritic
which increases for about three
weeks,
gradually fades away from the edge, being by healthy tissue. When radium is applied
to the unbroken
skin,
e.g. in the treatment of
a
deep-
seated mass, this reaction is preceded by reddening of the skin and desquamation. This typical reaction is not a burn, although when it appears on what was unbroken skin the uninitiated may refer to it burn. Sometimes, however, the reaction may last longer, and in the case of over-dosage may persist
formerly as
a
for months with the formation of necrotic ulcer out
edge
reaction.
or
ulcer.
The radio-
burn has
instead of the It
an
occurs
usually a sharp, punchedsmooth edge of the normal
at the centre of the site
treated,
deep, and is often very painful. The best treatment is removal by diathermy. The presence of a may be
radio-necrosis
is
not
always
due to bad
technique,
any trauma, intense heat or cold, etc., may and it may occasionally be due to a
idiosyncrasy on
the
it, personal
cause
part of the patient.
Lesions of the Skin may be treated by either surface or interstitial radium. Results on the whole
equally good. These lesions are usually radiosensitive, and, provided bone is not involved, good and lasting results may be expected in the majority of cases. Radium therapy here is definitely superior are
to surgery, since there is
no
mutilation, the lesion
Dr. Sylvia B. Wigoder
238
being replaced by
supple
a
Should
scar.
glandular
part of the body
lesion in any it should be dealt with surgically.
Epitheliomata
old
metastasis arise in association with
results,
as a
on
great
lupus
number of them
Sometimes it is worth while but
as
rapidly, results
do not
a
give
recur
treating
such
after
good
a
year. this recurrence, another occurs
the skin is very devitalized, or necrosis In rodent ulcer the appears. excellent and
are
superior
to any other form
of treatment. Lesions of the surface
Lip
may also be treated bj' either The results here are
interstitial treatment.
or
and up to three-quarters of even the most advanced cases may be alive at the end of the year.
good,
very
opinion of most gynaecologists is that radium preferable to surgery in carcinoma of the Cervix The
is
Uteri, since there is very little risk and advanced and
cases
discharge
derive benefit.
become
As
appreciably
the most
even a
rule
less and
bleeding frequently
cease, and about half of the cases treated are alive Sometimes an apparently at the end of the year.
This may be due involvement of the ureters in fibrous tissue, a
cured to
case
of backache.
complains
the
which
g3H8ecologist can sometimes Treatment usually consists of intra-uterine relieve. and vaginal applications for about seven days, either continuously or in separate applications spread out condition
over
three
to
six
weeks.
Sometimes
interstitial
X-ray therapy has increased the number of good results. Unfortunately, results of radium treatment are disappointing in this region if the patient is under forty, and if the case
needling
is
used.
Post-radium
The Present Position is
it is advisable to
operable
on
the value of radium the
Body of equal
body
Uterus.
Some
of
differ
in carcinoma of the
centres
by regard uterus as being
the
239
report results
surgery, but I think the adeno-carcinoma of the
of centres
carcinoma of the
Opinions
operate.
therapy
to those obtained
majority
Radium Therapy
of
radio-resistant.
In
therapy gives
bad
Vulva radium
of the
results.
growth is Temporary disappearance frequently obtained, but, possibly due to interference with the blood supply, the dose sufficient to kill the growth usually causes a necrosis of the tissues with the formation of a deep, sloughing, painful ulcer. In carcinoma of the results
encouraging,
are
mortality,
Mouth, Tongue and Tonsil as, with
about half of the
negligible primary
a
cases
are
alive at the
end of the year. If, however, there is bony involvement radium treatment may result in a slow and painful necrosis.
the
When
palliation and
some
tongue
relief from
is
absolutely fixed, pain is sometimes
by applying very large doses of radium for length of time. In extremely advanced cases
obtained a
short
radium
is, I think, contra-indicated,
as
a
certain
amount of oedema and pain follow treatment, and so, for no useful purpose, the patient's discomfort is
aggravated. of the Cheek so
The seem
majority
of lesions
to arise from
the results here
are
on
the inside
old
leukoplakia, and disappointing, and less than an
50 per cent, are said to be symptom free at the end of one year. Treatment usually consists of interstitial needling, but occasionally surface applicators are used.
The latter
are
give better results. Anus, being a squamous-celled
said to
Carcinoma of the
Dr. Sylvia B. Wigoder
240
radium, and even in very advanced cases treatment may produce temporary and local relief. Carcinoma of the Rectum, however, being an adeno-carcinoma, gives on the whole bad results, although occasionally after radium an inopercarcinoma, responds well
to
operable. In this site radium may be inserted interstitially into the growth or a central radium applicator may be passed into the rectum, but the latter method is not frequently used nowadays. able
case
becomes
The radium treatment of carcinoma of the Bladder is still
good
more or
less in
an
results have been
Memorial
Because
Hospital.
radon seeds
are
experimental stage, but reported from the New
more
of
their
suitable than needles.
usual method of treatment consists of bladder and the
growth,
or, in the
inserting of
York size
The
opening the
the radium into the base of
where it remains for about
case
small
some
seeds, for
eight days,
ever.
The value of radium treatment of carcinoma of the Prostate is still
figures are available from any of the larger centres, although quite good results have been reported by individual surgeons. Needles are usually inserted interstitially through the perineum or bladder. on
trial, and
no
In the treatment of carcinoma of the Breast radium
hopes, and operation is still the method of choice, perhaps combined with radium. In inoperable cases, or those showing one or two bony
has not realized
our
earlier
nodules, radium (either used in the form of
a
surface
interstitially) sometimes produces temporary palliation with disappearance of the mass, but very advanced cases with marked skin or glandular application
or
involvement derive
no
benefit.
The Present Position
of
Radium Therapy
Intrinsic carcinoma of the Larynx
gives
has been obtained in
palliation
good
very
results when combined with fenestration and
241
operation,
some
extrinsic
carcinomata. The results from radium treatment of carcinoma of the Antrum are gradually improving, due perhaps to a closer co-operation between the radiologist and
the surgeon. Treatment consists, as a rule, of opening the antrum and the distribution of needles or seeds around surface
the
growth. application on
may be followed the outside of the face. This
by
Organs and of respond badly to radium. oesophagus disappearance of
Carcinomata of the Internal Tract
Alimentary carcinoma
of the
growth has sometimes occurred, but it six
recurs
a
the In the
in about
months, and similar benefit may be obtained by
the insertion of
a
Souttar's tube without the
use
of
radium. It is not
only
in
has proved of benefit. of
usefulness
haemorrhage,
Indeed, if it had
except its ability it would be
that basis alone.
agent uses, it has on
such
as
disease that radium
malignant
a
to
no
control uterine
remarkable
But,
other field
therapeutic
in addition to these
proved of benefit in many skin lesions tuberculous ulcers, warts and corns, and is at
tried out, with some measure of success, in other conditions, such as painful bursas, goitres, present
being
etc.
writing this paper I have kept in front of me the advice of Pasteur: "Your enthusiasm, which is the fruit of your earlier years, keep it, but let it be attended by a rigorous self-control"; and In
1
have
tried
to
show
you
the
real
worth
of
242
The Present Position
radium
by being undufy pessimistic.
neither
of
Radium Therapy
unduly optimistic
nor
Whatever may be the ultimate place that radium will gain and hold in the armoury of the surgeon and the radiologist, it has already certainly proved to be a
most
useful
curative value
palliative agent in a good many
and has cases.
a
definite
PRESENT POSITION THERAPY.*
RADIUM
OF
BY
Sylvia
B.
Radium
Wigoder, Officer,
M.D., Ph.D., D.M.R.E.,
National Radium Centre, Bristol.
Radium has been described (I have forgotten by whom,) as the most potent element which has been yet discovered for the
production
of discontent in the
profession. It was hailed at first as a panacea for all ills. Although it has not fulfilled the hopes based upon it by those early enthusiasts, it has opened up new fields in the treatment of disease, especially malignant disease, but even there, despite improved medical
I do not think that radium is at
technique,
substitute for surgery.
looked upon, a
not
partner and
an
as a
present
a
The radium needle should be
competitor
to the
added weapon in the
knife, but
as
fight against
cancer.
Radium cases
great
or
therapy should be restricted
those
cases
risk, such
as
inoperable operation is attended by Wertheim's hysterectomy, or
where
associated with mutilation, such
tongue. *
A
Society, Vol. L.
as
removal of the
inoperable cases those that are advanced with widespread metastasis, bony Of
very far
to
the
read at a Meeting of the Bristol held in the University of Bristol on 10th
Paper
No.
190.
Medico-Chirurgical May, 1933.
Dr. Sylvia B. Wigoder
234
involvement, much sepsis and marked wasting
generally
unsuitable ;
while
patients suffering
are
from
diabetes, nephritis, syphilis or tuberculosis do not, as a rule, respond well to radium treatment. In addition, the of its lesion, accessibility proximity to vital structures and its histological type modify the results. considered radio-resistant and
Adeno-carcinomata
are
well-differentiated
squamous-celled
less
carcinoma
resistant, while non-differentiated epithelioma and the basal-celled carcinoma or rodent ulcer are radio-
Many of the sarcomata, especially lymphosarcoma, are extremely radio sensitive, but unfortunately these growths tend to recur either locally or sensitive.
-
elsewhere very soon after irradiation. Roughly about 50 per cent, of the malignant treated
by
radium
are
free at the end of
achievement, from
a
as
cases
locally well, mostly symptom-
year. This is a considerable majority of these cases are hopeless one
the
surgical point
of
view, and
so,
were
it not for
radium treatment, most of them would have been dead and certainly none of them would have been
symptom-free William Mayo
at
the end of
a
year.
There
is,
as
says, a great difficulty in evaluating radium treatment, since it is used so largely in treating
following operation, where expected is palliation. The thoughtless, therefore, give radium little credit for what it actually accomplishes in these cases and, disappointed that the impossible has not been accomplished, minimize its value. I mention one year as the period of freedom from symptoms, not
inoperable
cancer or cancer
the most that
can
be
because I believe that one
year
or
not at
recurrences
either
occur
within
all, but because the patient and
The Present Position
of
Radium Therapy
235
his doctor are more interested in the immediate effects of radium treatment and are less concerned with "what will happen five years hence; and secondly,
techniques
rapidly within the last five-year statistics are difficult
have altered
few years that reliable
so
to obtain. At the outset I should like to make it clear that
the results mentioned in this paper results obtained from
Watson, I know, has of
carcinoma are
of the
exceptional,
results
less
are
the average
number of centres.
Gordon-
good results in carcinoma Geoffrey Keynes's results in
obtained
rectum, and
the
a
are
breast and
at
promising
are
the
excellent;
majority
when
these
but these of
centres
regions
are
treated.
knowledge of the biological and physical properties of radium, the conditions governing the vulnerability of normal and Malignant cells are still, to a large extent, problematical, and we still do not know why two apparently similar cancers with apparently similar histological structure In
Will
spite
react in
of advances in the
a
dissimilar
manner
to
radium.
The
cytologist have worked long and hard problem, and the solution, I think, now lies in the hands of the bio-chemist and bio-physicist. However, just as the majority of practitioners do not consciously think of the exact modus operandi of the drugs they use, we radiologists use radium even if the processes initiated in the tissues by radiation are far from being understood. There are four main radium techniques. The in which radium first is that of interstitial needling, is inserted the diseased into tissues. This surgically
histologist at the
and
Dr. Sylvia B. Wigoder
236 method is but
that
requires
most
often
employed
general anaesthetic;
a
at
present,
the
lesion
is
by needles which are left in place for six to fourteen days, depending on the histological type of lesion, the strength and filtration of the needles. The second method, the intracavitary method, is that in which radium is placed in a natural cavity of the body, for example, in the body of the uterus or This treatment rarely lasts for in the oesophagus. a than week. The third method, that of surface longer
surrounded
treatment, consists of covering the surface of the lesion with to
radium, which may be directly applied it or separated from it by J- to 4 cm. of some material
Treatment here may last from a few hours up till ten to fourteen days, depending not only on the type of lesion and the concentration of
such
the
as wax or
rubber.
radium, but also
on
the distance of the lesion from
A small
the radium.
have the radium
superficial lesion will, of course, closely applied to it. The fourth
method of treatment is the much discussed distance radium
or
containing
mass a
inches
some
irradiation
therapy,
large quantity of from the body.
when
radium is There
conscientious enthusiasts who advocate the bomb
:
equally
Continent
have,
of
success
in
to
our
many the
on
decry
it.
a
placed are use
Results
whole, been good.
bomb at
many of the
on
the
The lack
have been due
England may, perhaps, proficiency with smaller units, but it seems to me that before we can use huge quantities, such as 15 grammes, we will want not only larger hospitals to house the radium, but bigger and stronger patients to stand the treatment. There is no definite therapeutic difference between the use of element lack of
The Present Position
of
Radium Therapy
237
radium and its emanation
being
a
can
gas,
radon, except that radon, be collected, compressed and sealed
in small containers known
Shortly
after the
as
seeds. of radium treatment
beginning
the lesion becomes covered with
yellow
fibrinous
membrane, when it
replaced
exudate not
a
smooth, greenish-
unlike
a
diphtheritic
which increases for about three
weeks,
gradually fades away from the edge, being by healthy tissue. When radium is applied
to the unbroken
skin,
e.g. in the treatment of
a
deep-
seated mass, this reaction is preceded by reddening of the skin and desquamation. This typical reaction is not a burn, although when it appears on what was unbroken skin the uninitiated may refer to it burn. Sometimes, however, the reaction may last longer, and in the case of over-dosage may persist
formerly as
a
for months with the formation of necrotic ulcer out
edge
reaction.
or
ulcer.
The radio-
burn has
instead of the It
an
occurs
usually a sharp, punchedsmooth edge of the normal
at the centre of the site
treated,
deep, and is often very painful. The best treatment is removal by diathermy. The presence of a may be
radio-necrosis
is
not
always
due to bad
technique,
any trauma, intense heat or cold, etc., may and it may occasionally be due to a
idiosyncrasy on
the
it, personal
cause
part of the patient.
Lesions of the Skin may be treated by either surface or interstitial radium. Results on the whole
equally good. These lesions are usually radiosensitive, and, provided bone is not involved, good and lasting results may be expected in the majority of cases. Radium therapy here is definitely superior are
to surgery, since there is
no
mutilation, the lesion
Dr. Sylvia B. Wigoder
238
being replaced by
supple
a
Should
scar.
glandular
part of the body
lesion in any it should be dealt with surgically.
Epitheliomata
old
metastasis arise in association with
results,
as a
on
great
lupus
number of them
Sometimes it is worth while but
as
rapidly, results
do not
a
give
recur
treating
such
after
good
a
year. this recurrence, another occurs
the skin is very devitalized, or necrosis In rodent ulcer the appears. excellent and
are
superior
to any other form
of treatment. Lesions of the surface
Lip
may also be treated bj' either The results here are
interstitial treatment.
or
and up to three-quarters of even the most advanced cases may be alive at the end of the year.
good,
very
opinion of most gynaecologists is that radium preferable to surgery in carcinoma of the Cervix The
is
Uteri, since there is very little risk and advanced and
cases
discharge
derive benefit.
become
As
appreciably
the most
even a
rule
less and
bleeding frequently
cease, and about half of the cases treated are alive Sometimes an apparently at the end of the year.
This may be due involvement of the ureters in fibrous tissue, a
cured to
case
of backache.
complains
the
which
g3H8ecologist can sometimes Treatment usually consists of intra-uterine relieve. and vaginal applications for about seven days, either continuously or in separate applications spread out condition
over
three
to
six
weeks.
Sometimes
interstitial
X-ray therapy has increased the number of good results. Unfortunately, results of radium treatment are disappointing in this region if the patient is under forty, and if the case
needling
is
used.
Post-radium
The Present Position is
it is advisable to
operable
on
the value of radium the
Body of equal
body
Uterus.
Some
of
differ
in carcinoma of the
centres
by regard uterus as being
the
239
report results
surgery, but I think the adeno-carcinoma of the
of centres
carcinoma of the
Opinions
operate.
therapy
to those obtained
majority
Radium Therapy
of
radio-resistant.
In
therapy gives
bad
Vulva radium
of the
results.
growth is Temporary disappearance frequently obtained, but, possibly due to interference with the blood supply, the dose sufficient to kill the growth usually causes a necrosis of the tissues with the formation of a deep, sloughing, painful ulcer. In carcinoma of the results
encouraging,
are
mortality,
Mouth, Tongue and Tonsil as, with
about half of the
negligible primary
a
cases
are
alive at the
end of the year. If, however, there is bony involvement radium treatment may result in a slow and painful necrosis.
the
When
palliation and
some
tongue
relief from
is
absolutely fixed, pain is sometimes
by applying very large doses of radium for length of time. In extremely advanced cases
obtained a
short
radium
is, I think, contra-indicated,
as
a
certain
amount of oedema and pain follow treatment, and so, for no useful purpose, the patient's discomfort is
aggravated. of the Cheek so
The seem
majority
of lesions
to arise from
the results here
are
on
the inside
old
leukoplakia, and disappointing, and less than an
50 per cent, are said to be symptom free at the end of one year. Treatment usually consists of interstitial needling, but occasionally surface applicators are used.
The latter
are
give better results. Anus, being a squamous-celled
said to
Carcinoma of the
Dr. Sylvia B. Wigoder
240
radium, and even in very advanced cases treatment may produce temporary and local relief. Carcinoma of the Rectum, however, being an adeno-carcinoma, gives on the whole bad results, although occasionally after radium an inopercarcinoma, responds well
to
operable. In this site radium may be inserted interstitially into the growth or a central radium applicator may be passed into the rectum, but the latter method is not frequently used nowadays. able
case
becomes
The radium treatment of carcinoma of the Bladder is still
good
more or
less in
an
results have been
Memorial
Because
Hospital.
radon seeds
are
experimental stage, but reported from the New
more
of
their
suitable than needles.
usual method of treatment consists of bladder and the
growth,
or, in the
inserting of
York size
The
opening the
the radium into the base of
where it remains for about
case
small
some
seeds, for
eight days,
ever.
The value of radium treatment of carcinoma of the Prostate is still
figures are available from any of the larger centres, although quite good results have been reported by individual surgeons. Needles are usually inserted interstitially through the perineum or bladder. on
trial, and
no
In the treatment of carcinoma of the Breast radium
hopes, and operation is still the method of choice, perhaps combined with radium. In inoperable cases, or those showing one or two bony
has not realized
our
earlier
nodules, radium (either used in the form of
a
surface
interstitially) sometimes produces temporary palliation with disappearance of the mass, but very advanced cases with marked skin or glandular application
or
involvement derive
no
benefit.
The Present Position
of
Radium Therapy
Intrinsic carcinoma of the Larynx
gives
has been obtained in
palliation
good
very
results when combined with fenestration and
241
operation,
some
extrinsic
carcinomata. The results from radium treatment of carcinoma of the Antrum are gradually improving, due perhaps to a closer co-operation between the radiologist and
the surgeon. Treatment consists, as a rule, of opening the antrum and the distribution of needles or seeds around surface
the
growth. application on
may be followed the outside of the face. This
by
Organs and of respond badly to radium. oesophagus disappearance of
Carcinomata of the Internal Tract
Alimentary carcinoma
of the
growth has sometimes occurred, but it six
recurs
a
the In the
in about
months, and similar benefit may be obtained by
the insertion of
a
Souttar's tube without the
use
of
radium. It is not
only
in
has proved of benefit. of
usefulness
haemorrhage,
Indeed, if it had
except its ability it would be
that basis alone.
agent uses, it has on
such
as
disease that radium
malignant
a
to
no
control uterine
remarkable
But,
other field
therapeutic
in addition to these
proved of benefit in many skin lesions tuberculous ulcers, warts and corns, and is at
tried out, with some measure of success, in other conditions, such as painful bursas, goitres, present
being
etc.
writing this paper I have kept in front of me the advice of Pasteur: "Your enthusiasm, which is the fruit of your earlier years, keep it, but let it be attended by a rigorous self-control"; and In
1
have
tried
to
show
you
the
real
worth
of
242
The Present Position
radium
by being undufy pessimistic.
neither
of
Radium Therapy
unduly optimistic
nor
Whatever may be the ultimate place that radium will gain and hold in the armoury of the surgeon and the radiologist, it has already certainly proved to be a
most
useful
curative value
palliative agent in a good many
and has cases.
a
definite
