888 THOMAS ORDWAY AND ARTHUR KNUDSON 



now well known. The action of x-rays may also result in the develop- 

 ment of cancer, even with metastases (Tyzzer and Ordway). The more 

 acute constitutional effects of radiations have also been the subject" of 

 research. 



Edsall and Pemberton have described a toxic constitutional reaction 

 following exposure to x-ray and advanced a theory which they believe 

 to be the basis of this reaction, that is, that the tissue destruction accom- 

 plished by Roentgen rays involves chiefly tissues rich in nucleoprotein. 

 The decomposition products of this form of protein are especially rich 

 in substances that are more or less toxic and difficult to metabolize and 

 excrete. The intoxication does not seem to be dependent directly upon 

 alterations of the excreting power of the kidneys because examinations 

 of the urine of two patients showed no evidence of retention. It is prob- 

 able, however, according to the view of Edsall and Pemberton that in many 

 cases after a time the kidneys do become overtaxed by the added labor 

 thrown upon them and their excreting power fails to a greater or lesser 

 degree and this may increase the toxic symptoms. 



Hall and Whipple suggest that Roentgen ray intoxication is due to 

 a disturbance in protein metabolism. They have produced this in dogs 

 by deep massive doses of hard Roentgen rays. The dogs were given lethal 

 doses of x-rays and showed remarkably uniform and constant general 

 constitutional reaction. There was usually a latent period of twenty-four 

 hours or longer when the dogs appeared perfectly normal. After this 

 there were vomiting and diarrhea ; death usually occurred on the fourth 

 day. Upon post-mortem examination the spleen of these animals was small 

 and fibrous; the intestinal mucosa was congested and mottled and there 

 was evidence of epithelial injury. The crypts occasionally showed in- 

 vasion of polymorphonuclear leucocytes. The epithelium showed re- 

 markable speed of autolysis. The authors believe that this injury to 

 the small intestine explains the general intoxication. They find no 

 support for Roentgen ray anaphylaxis or hypersensitiveness to a second 

 properly timed exposure, but there was on the other hand some evidence 

 of a slightly increased tolerance to a second dose. There was no evidence 

 of a Roentgen ray nephritis. The severity of the constitutional reaction 

 was greatly increased by widening the spark gap. The long, latent period, 

 even three weeks, was not explained by these investigators'. 



Dennis and Martin in experiments on rabbits limited the exposure 

 to various areas of the body and found that toxic constitutional reactions 

 were produced only in animals exposed over areas in which some portion 

 of the intestine was included. Even those rabbits exposed over areas 

 containing only a small portion of the intestinal tract developed toxic 

 symptoms after a rather long latent period, while a particularly severe 

 reaction followed radiation over an area which contained none of the 

 viscera other than portions of the intestinal tract. The animals radiated 



