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THURSDAY, APRIL 13, 1916. 



IRRADIATION : ITS PHYSIOLOGY, PATHO- 

 LOGY, AND THERAPEUTICS. 



Radium, X-Rays, and the Living Cell. W'hh 

 Physical Introduction. By H. A. Cohvell and 

 Dr. S. Russ. Pp. x + 324. (London: G. Bell 

 and Sons, Ltd., 1915.) Price 125. 6d. net. 



THE authors' object is "to describe some of 

 the main experimental facts which have 

 been established as to the effects of the X-rays 

 and the rays from radium upon living- cells." The 

 first part of the book is devoted to physics, and 

 contains a trustworthy account of the properties 

 of the X-rays, primary and secondary, and of the 

 radio-active substances, with the characters of 

 the various forms of radiation and the changes 

 brought about by their action. The measurement 

 ;of ionisation is described, the distinction between 

 ["hard" and "soft " rays — recognised clinically by 

 I all radiologists — is explained on physical lines, 

 jand the methods of measuring doses of X-rays 

 I are discussed. The empirical method of 

 jSabouraud of judging the dose by the change of 

 icolour of a pastille is still in vogue, and those 

 iwho use the method are aware that they must 

 jkeep all the conditions constant (state of vacuum 

 jof the tube, length of the parallel spark gap, 

 reading of the milliamperemetre, etc.) ; the authors 

 lare wise, however, to point out anew that the 

 l^ame change of colour, if produced by soft rays 

 In one case and by hard rays in another, may give 

 "ise to results widely different in the two cases. 



In describing the characters of radium emana- 

 i.ion, the use of the " Emanatoria " is discussed, 

 rhese institutions are founded on the fact that 

 adium emanation, when breathed mixed with air, 

 ijradually makes its way into the circulation 

 >y solution and diffusion, and so reaches all the 

 lissues of the body. The air of the Emanatorium 

 breathed for two or three hours at a time, and 

 s found that a state of equilibrium is reached 

 ^ half an hour, while nearly all the emanation 

 ;>o per cent.) has disappeared from the system 

 ne hour after removal into fresh air. The emana- 

 on, while circulating in the body, is continually 

 )rming the active deposit, which is not lost by 

 •ay of the lungs as is the case with the emana- 

 on. These Emanatoria have been extolled for 

 •le "scientific " treatment of g-out, on the principle 

 apable of laboratory demonstration) that the 

 soluble monosodium urate can be broken up by 

 dium D into several simpler bodies, which are 

 ninated as carbon dioxide and ammonia. The 

 hors point out, however, that the concentration 

 the emanation in the blood in patients sub- 

 ted to Emanatorium treatment never reaches 

 pre than one ten-millionth of that used in the 

 J^pratory experiments; hence it seems unlikely 

 <at any appreciable decomposition of mono- 

 9dium urate can take place in the blood, 

 ^'lobulin solutions are used in experiments to 

 >w that o radiation may produce results differing- 

 NO. 2424, VOL. 97] 



in degree and in kind from those due to ^ and 7 

 rays. 



The effects of the irradiation of bacteria is dis- 

 cussed with the aid of conclusive experiments, 

 and it is shown that a bactericidal result can be 

 attained, though the dose required is a very strong 

 one from a clinical point of view. In local condi- 

 tions a solution of radium emanation might be 

 useful, but the choice of a solvent is important, 

 and most of the fluids having high coefficients 

 of absorption cannot be used for injection into 

 the body. Liquid paraffin is the most suitable 

 solvent; its coefficient of absorption is high, and 

 its viscosity keeps it at the site of injection. 



The changes produced in the skin by irradia- 

 tion are only too well known to those who were 

 pioneers in the chnical use of the X-rays. The 

 histological changes are described in detail, and 

 illustrated by photomicrographs. These changes 

 are both atrophic and hypertrophic, and the latter 

 tend to culminate in cancer. 



The blood changes are of great interest, and 

 in certain blood diseases a very favourable result 

 is produced by irradiation. This is notably true 

 of leukaemia, a disease in which the white cells 

 are enormously increased in number, while many 

 of them are abnormal in type. The red cells are 

 decreased in number. The result of X-ray treat- 

 ment is to restore the blood more and more nearly 

 to a normal state, both qualitatively and quantita- 

 riv ely 



Of sp>ecial interest to the medical profession, 

 and also to the public, is the discussion of the 

 effect of irradiation of cancerous cells. This sub- 

 ject receives full attention, an account of the 

 results on experimental cancers {e.g. in mice) 

 being followed by a description of those on spon- 

 taneous cancers in man and in the lower animals. 

 It is found that young, actively-dividing cancer 

 cells are most susceptible to irradiation, and that 

 in some of these cases (especially in the grafted 

 cancers of mice), while a large tumour may dis- 

 appear rapidly, its destruction may cause the 

 death of the animal by the toxins evolved during 

 the disintegration of the mass. 



Another aspect of the cancer question is the 

 converse one, of the way cancerous change may be 

 produced in healthy tissues by repeated small 

 doses of soft X-rays. This topic has been touched 

 upon already in the case of the hands of radio- 

 logists. 



The question of idiosyncrasy is a difficult one, 

 and radiologists of repute differ, even now, as to 

 whether cases of real hypersensitiveness to X-rays 

 exist. Every careful radiologist of experience 

 will, we believe, agree with the authors that the 

 same dose does not produce exactly the same 

 effect in different persons, or even in the same 

 person at different times. Another point is made 

 by the authors when they show that a large dose 

 acting for a short time is not equivalent to a 

 small dose acting for a long time. 



The book closes with a short but lucid chapter 

 on the selective and differential action of the rays. 

 In the case of the protozoa, it is shown that a 



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