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the case ;
added to the long list of hopeless remedies ;- reaction is of a necrotic character, and ultimately and if I can only succeed in showing you to- produces extensive and deep-seated sloughing night that it is something more than this, and action. In the early stages X-ray dermatitis, convincing you that it is worthy of your serious as it is called, is very similar in appearance to attention and critical enquiry, then I shall be erysipelas. The action takes several days, a quite satisfied that I have not wasted my time week or more, to develop, being slower in this this evening. At the same time I will endea- respect than that produced by the Finsen light, vour to bring before you in as impartial a and seems to be of a cumulative character, a manner as I can the disadvantages and point that often makes it very difficult to judge difficulties connected with this mode of treat- the correct amount of exposure to give. ment, as I do not wish to mislead you into 4. When exposure to X-rays is extended over supposing that we have an easy method of a length of time it produces an atrophying curing all cancer cases, because, although
effect on the skin and appendages, nails and sometimes a cure is effected with a few applica- hair. This effect may occur without any pretions, and very easily, yet this is not generally liminary inflammation, and is often seen on the on the contrary, as
a rule, the
hands of those working daily with the X-rays, treatment is tedious, difficult and somewhat especially if they are in the habit of testing expensive to carry out. These are the most
their tubes by observing their hands in the serious drawbacks to it at present.
screen, although only a few seconds' exposure Now, why should X-rays cure cancer ? I occur in each case. It also tends to produce a will endeavour to answer this question by first contraction in the capillary circulation, and by mentioning the more or less well-known facts means of this fact I have removed from the regarding the properties of X-rays, and then face those large superficial nævi commonly the various theories or conclusions that can be known as port wine marks. It is quite possible drawn from them; and in regard to some of to do this without producing any inflammation, my theories I must caution you that, although although great care is required to avoid it, and I think my facts are all pretty well authenti- it takes some time and many exposures to cated, yet I cannot say the same for my theories, do it. which are mainly my own, and I cannot give
5. I find these X-ray effects vary exceedingly you any authorities to support them.
in individuals and in different parts of the body. The facts on which I am going to explain the
Briefly, the conditions I have found to influence action of X-rays are briefly these :
them are dependent on the health and vigour 1. These rays have the power of penetrating
of the parts, and also the blood supply; that is, all substances in inverse proportion to their
any part that is freely supplied with blood, and density and their atomic weights, and are
in a healthy, vigorous condition, is very resistant capable of exerting chemical action after doing
to X-rays, and will stand a lot of exposure to a so, in this respect being different to any other
powerful tube before any reaction can be
produced ; and, on the contrary, if the part is rays that we are acquainted with.
in a diseased and weakened condition a reaction 2. X-rays exert a decided action on living can often be produced after a single exposure. cells, as shown by their action on the human I think anything that tends to lower the vitality skin, mucous membrane, and any portion of the of any portion of the body renders it more body. It is quite possible that they also exert susceptible to this X-ray reaction, and if care is a bactericidal action on living micro-organisms, not exercised most violent inflammation, and but the evidence on this latter point is at present sloughing even, may result. very contradictory. This is a very difficult
6. Now, in regard to the nature of cancer, I question to decide, as, unless the experiments
do not want to go too deeply into this. Thero could be conducted under similar conditions to
are several here this evening that could probably what exist in the human body, merely negative
tell you more about the latest theories than I results can have but little value. For instance,
can; but I think I can safely say that from a even a thin glass cover would be quite sufficient
histological point of view it consists of a proto considerably modify the effects of the rays,
liferation of cell growth of a very active nature and unless the experimenter was experienced
which intrudes itself amongst the healthy and in working with X-ray tubes in a state of
normal cells, and inducing wherever it spreads therapeutic activity-a point I shall come to
an extension of the same class of cells. Now, presently—the X-rays he might use may have
this tissue is characterised like all other diseased little effect.
tissue with a lower vitality than normal healthy 3. The action on living tissue appears to be structure; consequently, upon any injury or first of an exciting or inflammatory nature, and the slightest cause, it breaks down, sloughs, and if the action is persisted in long enough the sets up suppurative action.
Whether micro-organisms are present and, if the normal and healthy resisting for a much so, whether they are the cause of cancer, is, as longer period. I think you can quite underyou know, still a very disputed point. So far stand, under these circumstances, how a canas I am aware, I do not think their existence cerous growth and
cancer infected tissue has yet been conclusively proved. Now, these might behave, the unhealthy diseased cells are the main facts on which we have to build perishing, but the healthy surviving; and that our theories to account for the curative effect this action, fortunately due to the penetrative of X-ray in this disease. The first and most power of the X-rays, is not only, as is sometimes natural explanation is that the action is a supposed, a superficial one, but is carried on, bactericidal one, that the rays destroy the though with diminishing effect, to a fairly conmicro-organism, and then the cancer breaks up; siderable depth, although howdeepit goes I do not but as it has not yet been proved that X-rays know at present. Even in the case of lupus, which are capable of exerting such an action, and we know to be due to parasitie micro-organisms, neither has it been proved that any germs are I am inclined to believe that this is the ex: the cause of cancer, it is a theory that at present planation of the cure, and not necessarily the there is no evidence to support; neither do I destruction of the micro-organisms. That is to think that is the true explanation.
say, I think in this case the X-rays destroy the I venture to think myself that the effect is
diseased cells that form the host that the due to what I might term, for want of a better
parasite lives in, and owing to the death of its expression, the necrotic effect of the X-rays on
host the micro-organism perishes also. the cell life, and that the diseased cells possess
The fact that erysipelas has been known to ing a much lower vitality than the healthy, it
cure cancer, and the great similarity between destroys them first and leaves the healthy
X-ray dermatitis and erysipelas is a very normal cells, the diseased cells being ultimately
suggestive fact, which I will only just allude to absorbed, and the normal cells going on to
as worthy of further study. Another theory reparative action, restore the tissue to as near
which I will mention, although I do not believe as possible its former condition. In an excel- it is the correct explanation, is one founded on lent article, which you will find in the British
the blood supply. There are some who conMedical Journal of May 31st, by Mr. G. N.
sider the growth of cancer as dependent on or Lancashire, he expresses a somewhat similar
very much influenced by this, and those in view in these words: “It would appear reason
favour of this theory will find something to able to conclude, in the present state of our
support their views when the action of X-rays knowledge, that the good effects of 'raying?
on the capillary come to be more closely studied. are due to the mechanical stimulation of normal
The well-marked effect on all classes of cell activity, whereby morbid tissue is either cancer of the X-rays, commencing often after thrown off or absorbed by the healthy. In
the first application, are in the order they take other words, the process partakes of the nature
place : of an inflammation. It is the control of this
1. Cessation of pain. inflammation that calls for the nicest judgment." 2. Gradual disappearance of the offensive In support of the above views I will mention
smell. this experiment that I once tried. I exposed 3. Clearing up of the surface. in the same individual, and at the same distance 4. Cessation of the cancer growth. to the X-rays, a small epithelioma, a wart, and
This is followed after a few weeks' treata small area of healthy skin; each of these
ment bywere carefully shielded around with sheet lead.
5. Diminution of the cancer growth. After daily exposures of about five minutes each, the following was the result:-The 6. Discharges, if existent, becoming less. epithelioma showed the reaction after only two 7. Finally, a gradual healing commences exposures, and started to break down after the
at the edges, and the ulcerated surface third ; after that it steadily broke down more
heals. and more, forming crusts and peeling away, There are two other symptoms we get in besides getting very inflamed, till it finally nearly all cases of cancer, viz., loss of weight and disappeared. The wart resisted the action the depressed, nervous, apprehensive condition much longer, and finally seemed to atrophy, that these cases nearly always exhibit. One of but did not get inflamed for a week; and the the first signs of improvement that the patient normal healthy skin held out a little longer, himself feels after usually only two or three apabout two weeks, before any reaction was plications is, he says, " he feels a lot better in apparent. I think this little experiment illus. himself.” The loss of weight is usually stopped trates what I mean: the cancer tissue of low
at once, even in tongue and mouth cases, where vitality perishing easily under the X-rays, but much difficulty exists in taking food.
I now come to the particulars of the methods down considerably after two or three minutes' employed, and as most of this will only be of consecutive work. The greatest difficulty is interest to those who have already had expe- with the tubes, and if there is any secret in the rience with X-ray work, I will be as concise as success it lies with this. Most of the work possible.
has up to the present been done with X-ray First, the foundation of the whole treatment
tubes constructed for radiographic purposes, is the coil, the source of your electrical energy,
and most of these are unsuitable. In the first and I strongly recommend for this class of
place more than half of those in common use work the most powerful class of coil you can
have very little therapeutic activity; they have command. An induction coil should be
been constructed for a very different purpose, regarded as an electrical transformer, the
and some of these tubes I believe you
could means by which you transform a low voltage give any amount of exposure and get absowith an enormously high one ; and the bigger lutely no result
. As a broad, general rule the the coil the larger the current you can safely
tube that is most active is generally a new one, put through it, and the greater the volume or a soft tube, or one that has been quite recently
exhausted. The reaction is obtained with amperage of the discharge in your secondary. Now most unfortunately for this, I think all
these most readily, but must be used with X-ray work coils are made and sold by the
greatest caution, as they sometimes produce length of spark, and it is quite possible by using
most alarming X-ray burns. A safe tube to very thin wire and other methods known to
use is one with an equivalent spark resistance the trade to produce a coil giving a long spark,
of 6 to 7 inches, and deeper penetration can and yet the output in the secondary may really
be obtained, especially with a much harder be only a poor one. The best class of coil for
tube. A plan I have adopted is to take a very this work is one with a large primary of low
hard tube and make it very hot over a large resistance, and a certain proportion of larger
Bunsen flame. The tube should be able to wire than is usually used in the secondary, and
stand this and yet not go below 6-inch resistyou will be able to obtain a splendid discharge.
If this is run for three minutes, then I attach some importance to
heat it up once again as hot as the tube will and several observers have come to the stand. A good reaction can thus be got with conclusion that all coils
much deeper penetration than given by a soft able for this work. I usually work with
tube. Unfortunately, one of the greatest diffia 20-inch coil, and seldom go beyond 10 or 12
culties is that there is no easy method of judging inch spark, though occasionally up to 15 inches.
the therapeutic activity of anytube, and these vary A 10 or 12 inch spark from this coil is quite a
very much, and unfortunately never remain different thing from the spark of a 10 or 12
constant for any long period. The great difficulty inch coil, and gives off from a powerful X-ray
is that a tube may be too active, and as you may tube a much larger volume of X-ray, which is
not find it out, and you are giving daily exposures what is wanted in these cases. I used a
the full effect of which do not show for a week, mercury break of the McKenzie-Davidson
at the end of this time you are suddenly surprised pattern, which is very adjustable in many
at the very serious reaction you get. The reverse ways and gives a great variety of speed. The may be the case, and you may work a week or electrolytic break has been used with much
two and get absolutely no result. You can only success by some workers, but I should antici- judge by your daily experiences, and working pate considerable trouble in maintaining the
with a good variety of tubes, that you have most suitable vacuum in the tubes, which is
some idea of their relative peculiarities. There always a great difficulty and is a most essential are special tubes now being made for this work, point. I work with a voltage of from 8 up
and I am trying some. Of course you must use to 20, according to the effect I am trying to
some method of screening Sheet-lead is the get, but the point that requires watching most
only absolutely reliable material that I have carefully is the actual amperage passing through
worked with. Lead-foil may often be used if the coil. I usually use from 5 or 6 up to as
care is exercised, but remember in a long case much as 12 and even 15 amperes, which is a
the rays will ultimately get through it, although much larger current than usually used. I
this sometimes may be an advantage. always run the current through an ammenter For beginners, the safest role is to keep the in series with the coil, and by watching that tube at a safe distance. I have never seen any can tell pretty well what effect to expect. The injurious effects follow when you fix the tube current I obtain from accumulators, by far at a distance of 12 inches and upwards. The the steadiest and most reliable current to work time of exposure I vary, the same as the with. I cannot recommend primary batteries current, according to the degree of reaction for this work; they are not constant, and run I wish to obtain, from as
minute up to 15 minutes. Cases at first recur; it simply indicates further treatment should be treated daily, nothing less is required. It is probable, I think, that the any use-even twice a day would be an patient will most likely be cured, and in as advantage; but once the reaction is obtained, good a condition as before the attack, but he and patient on road to recovery, then two or can hardly expect to be better than that, and three times a week is sufficient. Finally, I cancer did come on once it proves the recommend a long period of once a week, existence of a cancer diathesis, and therefore which I think does much to ensure against a he must stand a certain risk of getting it again. recurrence. Another feature in my treatment I quite expect to hear of cases recurring, has been this, as you will notice in some of the because it must happen sometimes that the cases I am going to show you : I have not treatment is not efficiently applied nor conin serious cases trusted entirely to the X-rays tinued for sufficient length of time. So I alone, but have been very glad to avail should not take too much notice of solitary myself of the surgeon's skill. In this way cases recurring. Time and experience can only I am convinced I have shortened the case, prove what will happen in the majority of them. made the
to be attained easier, I will now conclude my lecture by bringing and in no small degree contributed to the under your notice a few selected cases in which ultimate success. It might be objected by a this treatment has been successful, and also a superficial critic that on this account I cannot few still under treatment; and in regard to fairly claim these cases as being due to the some of these cases I must in justice observe X-rays. So far as that goes I feel the greatest that whatever success I have attained is in no indifference whether the surgeon or myself small degree due to the valuable advice and takes the credit of the cure. I am quite willing surgical assistance that I have received from to admit “honours are easy,” but at the same Mr. O'Hara and Dr. Cooke, who have all time I will ask any experienced surgeon to through shown the keenest interest and readicarefully observe the exact nature of what has ness to help me in the treatment of these cases, been done in the cases I will show you, and he and I must admit that but for this help I could will see that it is of such a nature that no not have undertaken cases of so serious a surgeon would dare to perform such a little character by means of this treatment alone. I excision of tissue; the amount cut away is so have also to thank Dr. Kelvington for the small that the patient is left in as good a trouble he took in preparing the microscopic condition as before. As most of you know, if specimens, and his careful reports on the same, such a kind of operation were done in a which perfectly accorded with the histories of similar case without the X-ray treatment, these cases.
In regard to the diagnosis of all recurrence would be so prompt and rapid that these cases, they are all, in my opinion, the operation would be worse than useless. I undoubtedly cases of cancer; in most of them will ask you to take particular note of this when the diagnosis is beyond all possible dispute, and I bring these cases before you.
where any room for question of diagnosis In regard to the question of recurrence, of exists, I have endeavoured by the aid of course this treatment is far too new to tell yet microscopical examination of experts to obtain what our experience is going to be. I will only all the possible evidence on this point. I say
that up to the present I have not yet read of will commence with rodent ulcer, which, as you any case recurring that has been completely
all know, is now generally recognised as of a cured; neither have I yet seen it myself. My malignant nature, and I would remind you that own opinion is that this will not occur provided
this was the first kind of these classes of disthat the treatment has been thoroughly effi- eases to be treated by X-rays, and so far cient and kept up at increasing intervals for
with uniform success. some time after recovery. I have not time to A.B.—This case was sent me by Dr. Cooke. go fully into this, but I will just point out this The patient, aged 75, in very feeble health, with is not such a serious question as it looks, a typical rodent ulcer of five years' duration over because the position will be totally different the left temple, about the size of a sixpence, and to recurrence after an operation when the exactly over the anterior branch of the temporal disease recurs in a worse position than before, artery. The patient was not in at all a favourand the next operation must be a more serious able condition for getting any ulcer to heal, and one; whereas under this treatment the position his case proved a very obstinate one; over 70 or will be not only no worse, but probably less 80 applications were required, and at last I got it difficult to treat than before. If you cured it completely healed up. The treatment lasted once, probably you could do so again.
from January 11th till the end of March. It has thinks any the less of the successful treatment remained perfectly healed ever since, and, as you of acute rheumatism because of its tendency to see now, the ulcer has quite disappeared.
C.D.- This was a similar case of rodent ulcer, diagnostic point of view, but a lucky thing for in the left side of the nose, extending to the the patient. What I do feel keenly is this : corner of the eye. His age is 42, and the the sad, hopeless cases that are sent to me of ulcer had existed for over six years.
He did advanced cancer being operated on once and not receive more than a dozen applications recurring badly—these I look upon now as from me in all. It healed without any difficulty; quite hopeless, yet, perhaps, 12 months or two the only thing that occasioned him any trouble years ago what a very different result this at all was the remedy, and you will see the treatment would probably have effected. A effects in his case. Although he has quite case of cancer cannot possibly be treated too recovered now, I would like to direct your early by X-rays, and if well advanced I must attention to the present condition of the skin tell you it is well-nigh hopeless. on that side of his face. This case should act G.H.—This patient, a man of 65 years, had an as a warning to anyone who may imagine that ordinary epithelioma on the end of his nose X-rays are a mild sort of remedy.
completely removed by Dr. Schlessinger about E. F.—The patient, an old man over 70, two years ago. It returned in last December, came to me with a small suspicious growth
and grew vigorously. His brother died of cancer, forming just under the front of his tongue in
and he has a bad family history in this way. the frænum. It was just in that doubtful When sent to me by Dr. Schlessinger, at the bestage that no one would care to say what it ginning of July, he had an epithelioma growing was, except, taking all the symptoms and facts strongly, although being treated with escharotics; of the case into consideration, it seemed most the surface was partly burnt down, but it was probably malignant. I only gave him one
still the size of half a walnut. It presented strong application of the rays, and that is more such a striking appearance that I asked him to than a year ago, and not having the confidence have it photographed, which unfortunately was in it then that I have now I did not care for done by an amateur, and I fear the result a the patient to run any risk, but sent him back failure. I forgot to mention there were nodules to his medical adviser, Mr. Rudall, with a view of the disorder disseminated through to skin to having it removed, intending to apply the
nearly over the nose, and barring the X-ray X-rays again afterwards. Mr. Rudall took
treatment there was no other course left but such a serious view of the case that he was the removal of the entire nose, which probably inclined to remove the whole tongue, as he told would only postpone the usual inevitable end. me in his experience these partial operations In one or two ways it was not a favourable case, on the tongue were always failures. The patient and was a recurrent case. On the other hand, was so strongly adverse to losing his tongue it was most favourably situated for this that he consented merely to remove the growth,
treatment. I applied and he did so. I have never seen the patient average about three times a week, and at first since, but I learnt on enquiry a few days ago
for ten minutes each time, gradually reducing that there has been no return of it. I attached
it as the desired reaction was acquired. It has but little importance to it at the time, but I
behaved in the usual way of diseased tissue ; have had two very similar cases since, which, the cancerous growth broke down, and, as having only recently occurred, are not so suit- you will see, now has gradually perished. In a able for my illustration; but in both these short time nothing but healthy tissue will be cases two or three applications seemed to quite
left, and I shall then allow it to heal
I clear up all appearance of the malignancy, and regard it as practically cured now. it quite disappeared, and I now can see nothing H.I.-- This is a woman, ayed 45, from whom impossible in one strong application of X-rays Dr. Cooke removed a small epithelioma on the to an early and doubtful malignancy and end of her tongue in February of this year. It acting in this manner, especially if the growth started to return about June, and I saw her was removed at the same time. Now, my moral first on July 12th. The scar of the former is this, and this I take to be the key of the operation had healed well, but evidence of whole difficulty: I believe all cancers have recurrence in this scar was unfortunately an early stage in which the growth is very apparent, and the patient felt a return of the small and malignancy is in an undecided state, uneasiness in the tongue. I gave her a few or rather, I mean, cannot be determined posi- preliminary exposures, and Dr. Cooke operated tively in diagnosis. Now, I am convinced that again in July, removing only a very small in all these cases where it is so situated that portion-nothing appreciable—and since then I the X-rays can be effectively applied that an have been treating her with the X-rays. Giving easy cure could be effected and the patient it her rather strong, the reaction has been somewould never know for certain whether it was what severe, and it is too soon yet to be able to malignant or not; very unsatisfactory from a pronounce on the success or otherwise of the