NA TURE 



;63 



THURSDAY, JANUARY 19, 1911. 



RADIO-THERAPY. 



Diseases of the Skin, including Radiotherapy and 



Radiumtherapy. By Prof. E. Gaucher. Translated 



and edited by Dr. C. F. Marshall. Pp. xii + 460. 



(London : J. Murray, 1910.) Price 15s. net. 



A FULL account of the use of X-rays and radium 

 - *• in the treatment of various diseases of the 

 skin is given in this volume. The most recent de- 

 velopments in radium treatment are described by 

 Wickham, Degrais, and Dominici. X-ray treatment 

 is described by Gastou and Zimmern. The illustra- 

 tions are mostly from wax models in the St. Louis 

 Hospital Museum and from Prof. Gaucher's private 

 collection. 



The treatment of vascular naevi by radium is fully 

 described and illustrated. The radium salt mixed 

 with finely powdered sulphate of barium is spread 

 with varnish in a thin layer on a metal plate. The 

 treatment consists in the application of this apparatus 

 to the naevus, the dosage being- regulated according 

 to the form and depth of the naevus. In flat naevi large 

 doses may be given by direct application for short 

 periods, the dose being timed to cause a certain degree 

 of curative inflammatory- reaction. Another method 

 is to give smaller doses filtered through screens which 

 absorb the less penetrating rays, longer exposures 

 being given in this case. There is no reference in the 

 book to the new method of treatment by the applica- 

 tion of sticks of solid carbon dioxide. 



In cavernous naevi containing large blood-vessels 

 the doses used must not be sufficient to produce in- 

 flammation of the surface. The results are very satis- 

 factory, the naevi being decolorised and levelled, and 

 the final results on the whole better than those ob- 

 tained by am- other known means. 



In the treatment of cheloid, or scar tissue tumours, 

 very favourable results are obtained both bv X-ray and 

 by radium treatment. Radium is less liable to cause 

 dermatitis, and may therefore eventually supplant the 

 X-rays in the treatment of cheloid. 



Coming now to the important subject of the treat- 

 ment of cancer, the ven,- malignant form of growth 

 known as sarcoma, though occasionally greatly re- 

 duced in size by X-ray treatment, is seldom cured, 

 and this treatment should on no account be relied 

 upon where there is any chance of success from opera- 

 tive removal of the growth. Treatment by radium 

 "lay also be tried, but its value remains to be proved ; 



jparent improvement is frequently obtained bv its 

 use. 



Coming to the skin cancers, or epitheliomata, elec- 

 tricity may be applied in various ways — the electric 

 >park, X-ray treatment, and fulguration. The electric 

 spark treatment is applied by connecting a naked 

 electrode with a high-frequency resonator. The 

 method has been successfully employed in small epi- 

 theliomas of^the skin. Its action is mainly destruc- 

 tive, while it has the advantage of promoting repair 

 by cicatrisation. The procedure consists in riddling 

 the diseased tissue with small, verj- short sparks. 

 NO. 2 15 I, VOL. 85] 



Fulguration is a method of using the sparks from 

 a high-frequency resonator by means of Keating- 

 Hart's special electrode for the treatment of growths 

 which are widely and deeply ulcerated, and too great 

 in extent to be destroyed by the cautery. The opera- 

 tion is painful, and must be performed under local 

 or general anaesthesia. The special electrode consists 

 of a hollow metallic rod sliding in an ebonite sheath, 

 and a bellows for blowing a current of carbonic acid 

 gas or air through the rod to prevent the excessive 

 production of heat. The ulcerated surface is sub- 

 jected to the action of sparks which are usually 7 or 

 8 centimetres in length. This causes the blood-vessels 

 of the healthy surrounding parts to contract, while 

 the tumour itself is softened within a few minutes. 

 Surgical treatment is then applied, the softened 

 masses of growth being cut or scraped away. The 

 sparking is then repeated carefully and energetically 

 until all growth has been destroyed. A single applica- 

 tion is usually sufficient, but any focus of recurrence 

 must be treated again. The results of this treatment 

 are not so good as appeared from the first accounts 

 of patients treated in this way, and the use of the 

 method does not appear to be extending. 



The X-ray treatment of cancer is fully treated, the 

 various fgrms of apparatus for the production of the 

 high-tension current necessary to excite a Crookes's 

 tube being described. The methods of regulating and 

 measuring the dose are also given in full. The 

 author finishes by stating that 



" the most ardent partisans of radiotherapy recognise 

 that the X-rays are not always successful in the treat- 

 ment of epithelioma. Some epitheliomas are rapidly 

 modified by radiotherapy, while others remain un- 

 affected. In the results published, it is necessary to 

 take into account the age of the tumour, its surface, 

 extent, and depth, its situation as regards accessibility 

 to the action of the rays, and also the technique 

 employed, which varies with different operators. In 

 short, radiotherapy may be used in certain cases on 

 the chance of a successful result, provided it is not 

 employed too late ; but we must not have too much 

 confidence in this method." 



Radium treatment of cancer is fully described by 

 Dominici. 



The properties of the alpha-, beta-, and gamma-rays 

 are described, and also the method of eliminating the 

 less penetrative rays by filtration through sheets of 

 lead of various thicknesses. The salts of radium are 

 used mixed in small or large proportions with a salt of 

 barium (sulphate or bromide). This is mixed with 

 varnish and spread on metal cm- linen. In some cases 

 discs or square sheets of metal are covered with the 

 varnish containing radium ; in others rods are used, 

 the ends of which are bulbous, oval, cylindrical, or 

 spatulate. Applications can thus be made to surfaces 

 of various form or to the interior of passages. Another 

 form of apparatus consists of discs or squares of lint 

 covered on one side with the radium varnish and 

 enclosed at the borders in a metal frame ; these can 

 be adapted to the shape of the affected region. " 



The radio-activity of radium is usually compared 

 with that of uranium. If uranium be taken as the 

 unit the activity- of pure radium is two million. In 

 the case of a mixture of radium and barium salts, the 



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