CARCINOGENESIS BY IONIZING RADIATIONS 



1149 



tion, and he died with metastases (Brown, 1936). Elizabeth Fleischman 

 Aschheim was one of the first, if not the first, clinical fmoroscopist. Her 

 exposure to X radiation began in 1897, and she died in 1905 with squam- 

 ous carcinoma of the fingers (Brown, 1936). Another early American 

 martyr of irradiation was Kassabian. He wrote sixteen papers on effects 

 of X irradiation and a textbook of roentgenology; the latter reached a 

 second edition in the year of his death (1910). 



Porter and White (1907) reviewed the first eleven verified fatal cases 

 of X-irradiation cancers in man. The sequence of events in their first 

 patient is characteristic. Although he stopped all X-radiation work for a 



Fig. 18-1. A pioneer roentgenologist fully exposing himself to X rays while examining 

 a patient and testing the setup by observing the opacity of bones of his hand {after 

 Brown, 1936). 



year, ulcers developed upon his fingers, and after the first demonstration 

 of cancer in 1902 malignant degeneration occurred in eight different 

 areas. Porter and White were impressed by the multiplicity of cancers 

 produced by X irradiation. 



When Rowntree (1909) gave the Hunterian lecture on cancer induction 

 by X irradiation, it was already well established that dermatitis caused 

 by repeated exposures to small doses of X radiation was frequently 

 followed by the development of squamous cell carcinoma (Rowntree, 

 1908). X-radiation burns usually began with blistering of the skin, after 

 which the exposure was discontinued temporarily. In the course of time 

 warts appeared, some of which became larger and their base thickened. 

 Some warts ulcerated and fell off, but at their base malignant cells 

 extended into the surrounding tissue. Nearly all such cancers were 

 multiple and occurred on both hands. Rowntree pointed out that chronic 

 irritations can be caused by many other agents, but these are seldom 



