238 



NATURE 



[November 6, 1919 



into hollow org-ans with the object of determining- 

 their outlines and of observing- abnormalities of 

 size, shape, or function has opened up an entirely 

 new extension of the science of radio-diagnosis. 



An "opaque meal" consisting- of a heavy in- 

 soluble salt, such as carbonate of bismuth, is 

 gfiven in a dose of 2—4 oz. Its progress is ob- 

 served through the (esophagus into the stomach 

 and duodenum, and observations are continued at 

 intervals to note the position and beha\ iour of 

 each part of the small and large intestine as the 

 bismuth passes through. Bv this means much 

 new information is being gained concerning the 

 physiology and the diseases of the alimentary 

 tract. Our views regarding the causation and 

 nature of many of the affections of the digestive 

 system have had to be reconsidered and modified. 



Medical and surgical text-books of a few years 

 ago contained separate chapters devoted to 

 individual diseases, such as gastric ulcer, duo- 

 denal ulcer, gall-stones, and appendicitis, but 

 when radiologists were called upon to aid in the 

 diagnosis of these various diseases they tendered 

 evidence that showed conclusively that these 

 diseases were not isolated morbid affections of the 

 organs concerned, but "end-results" of a more 

 general derangement of the digestive system. In 

 •other words, the stomach or appendix does not 

 "go wrong" by reason of any intrinsic vice, but 

 because it is in an environment which has become 

 vitiated or unhealthy. 



An entirely different aspect of our subject is 

 the application of X-rays to the treatment of 

 disease. From observations upon the far-reaching 

 consequences of undue exposure to the action of 

 X-rays, radiologists were led to explore their 

 possibilities for therapeutic purposes. 



It is well known that the first workers in the 

 field of radiology were destined to pay a heavy 

 price for their devotion. The repeated exposure 

 of the skin to the action of the new rays set up 

 a disease in skin known as X-ray dermatitis. 

 Gradually the skin and even the deeper tissues 

 of the hands and other parts that had been ex- 

 posed to the action of the rays were destroyed. 

 Extensive and painful sores appeared which pene- 

 trated deeplv and resisted all attempts to induce 

 healing, and in some cases cancerous change set 

 in, necessitating the loss of a limb, and unfor- 

 tunately, in a few cases, leading to a fatal ter- 

 mination. It was natural to surmise that an agent 

 with such terrible powers for evil as X-rays 

 possess might, in suitable small doses, be con- 

 verted into a means of salvation, in the same 

 •way as many deadly poisons — strychnine, opium, 

 digitalis, and mercury — have become the 

 physician's most potent and useful remedies when 

 rightly administered. 



It was found that certain diseases of the skin 

 yielded very readily to carefully administered 

 applications of X-rays; and to-day ringworm, so 

 difficult to eradicate by ordinary methods of treat- 

 •ment, is almost universally treated by X-rays. 

 Prior to this treatment primary schools were 

 deprived of numbers of their pupils for long- 

 NO. 2610, VOL. 104] 



periods, averaging: two years for each child, but 

 now the disease is usually eradicated in three 

 months. 



Other diseases which have been treated with a 

 large degree of success by irradiation are : Tuber- 

 culous glands ; other g-Iand enlargements, such 

 as occur in lymphadenoma (Hodgkin's disease); 

 uterine fibroids; exophthalmic goitre ((iraves\ 

 disea.se) ; blood diseases, such as leukaemia ; and 

 some forms of gout, rheumatism, and neuritis : 

 in these painful disorders X-ray treatment 

 relieves pain even when it cannot achieve a 

 cure. 



In view of the successful application of X-rays 

 in dispelling enlarged glands, the question natur- 

 ally aro.se : Have we here a therapeutic agent 

 which can cure that most dreaded of all diseases 

 — cancer? The answer to this important question 

 was sought with diligence, and at first with much 

 promise. But its limitations soon became ap- 

 parent, and to this day the results of X-ray triat- 

 ment of cancer have not fulfilled our greatest 

 hopes. True, many cancerous masses can be 

 destroyed and made to disappear by this treat- 

 ment, vet a genuine cure does not always follow . 

 Other growths may appear in inaccessible plates, 

 or general dissemination of cancer may set in. 

 Early removal by operation is still the safest 

 method of dealing with a cancerous growth. The 

 removal mav, however, be advantageously fol- 

 lowed bv the svstematic irradiation of the opera- 

 tion area, so as to destroy any cancerous cells 

 that mav have "been left behind. We must not 

 (nay, we dare not) despair of the successful treat- 

 ment of cancer. Recent researches, howexer, 

 lead to the conclusion that the road to salvation 

 is in the prevention rather than in the cure of 

 the disease. In these researches X-ray observa- 

 tions of the digestive system occupy a prominent 

 place. They have taught us that particular 

 sections or points in the gastro-intestinal tract 

 become so altered from their healthy state as to 

 be specially liable to take on a cancerous change. 

 We have learnt that toxic products, absorbed 

 from the intestinal canal into the general circula- 

 tion, give rise to deterioration of the tissues and 

 render them liable to become cancerous as the 

 result of some slight source of continued irritation 

 such as would do no harm to healthy tissues. 



The effects of X-ray exposures on white blood 

 corpuscles are receiving increased attention, and 

 to-dav results are being obtained which are of 

 great interest. Wc know, for instance, that the 

 white cells of the blood play a leading part in 

 the struggle with invading microbes. If particular 

 kinds of white cells can be increased in numbers 

 and in activity, we shall have gained a notable 

 step in treatment. -Xlreadv there are reports from 

 more than one part of the world of promising- 

 results from treatment on these lines in cases of 

 pulmonary consumption. 



It will be seen from the foregoing brief account 

 that important developments in the functions of 

 X-rays in the direction both of diagnosis and of 

 therapeutic application can be hopefully awaited. 



