A MONTHLY RECORD OF THE

Progress of Medical Science.

THE THERAPEUTIC USE OF THE X-RAYS.*

By CHARLES H. MELLAND, M.D. (Lond.), B.Sc. (Vict.), M.R.C.P., Honorary Physician to the Ancoats Hospital, Manchester; Assistant Director of the Clinical Laboratory, Manchester Royal Infirmary.

DURING the year ending March 2nd, 1904, thirty-four cases have been under treatment by means of the X-rays at the Manchester Royal Infirmary. Of these twenty-eight have been discharged cured, relieved or unrelieved, whilst seven are still under treatment.

Total under

RESULTS OF TREATMENT: ALL CASES.

Discharged:

Still under Treatment: Discharged: Treatment. Cured or much improved. Improving. Unimproved. Unrelieved.

Classification of cases treated.

Of the thirty-four cases there have been:

11 Cases of Rodent Ulcer......

Unrelieved.

0
1

Cured or improved.

11

4

*A Report on the year's work of the department for the treatment of patients by means of the X-Rays, at the Manchester Royal Infirmary, from March 3rd 1903, to March 2nd 1904. Published at the request of the Medical Board.

The length of time that the patients have been under treatment has varied much: One has been under treatment the whole of the twelve months, another for 9 months, another for 7 months, another for 6 months, another for 5 months, the others for shorter periods running from one or two attendances up to 3 months.

The great proportion of the patients have been out-patients who have customarily attended twice a week for treatment, and the duration of each exposure has been as a rule 12 or 15 minutes. Tubes of rather high vacuum have been employed, those in which the vacuum has become too high for radiography being made use of for therapeutic purposes. The tubes have been placed at a distance of 3 to 5 inches from the part under treatment and currents of low amperage-2 to 21 ampères--have been employed. The areas around those exposed to treatment have been protected by sheets of lead foil, in which openings have been cut, roughly outlining the area of treatment. The main desideratum has been to protect the eyes from the effect of the rays. In no case has any "burning" been produced or any similar untoward result

occurred.

It will be seen that the cases that have reacted most successfully to treatment have been those of rodent ulcer, in every one of which cure or improvement has been effected. The cases of lupus have also been much benefitted, but their progress has been much slower than that of the rodent ulcers. All the carcinomata and epitheliomata treated have remained unbenefitted, with the single exception of a small and rather superficial epithelioma of the lower eyelid which disappeared completely under treatment. Some of these cases appear indeed to have advanced more rapidly during the exposures. Of the miscellaneous cases, a case of paralysis of the ulnar nerve following trauma, in which, however, there was a distinct neurotic element to be taken into account, was completely cured, and another of keloid in a scar was much improved. Two others, a case of syphilitic ulceration of the nose and one of neuralgia around an operation wound were unaffected.

With regard to the question of recurrence, it is as yet too soon to speak with certainty. A number of the cases of rodent ulcer and lupus, as well as the cured case of epithelioma have remained without recurrence for some months, whilst others, apparently

cured, are again showing signs of activity and are requiring further exposures.

The following is a brief synopsis of the cases under treatment:

Eleven Cases of Rodent Ulcer :

(1) James Briggs, age 55. Treatment commenced March 3rd, 1903. Rodent ulcer on left side of face, just outside the angle of the mouth, and implicating the mucous membrane at the angle. Six years' duration; considerable increase in size during the last 12 months. Extent 2in. x 12in.; superficial in character. He improved steadily under X-ray treatment, and by July 20th was completely healed. He had two applications weekly till July 6th, and after that one a week. Ulceration, however, recurred under the less frequent application, and on January 7th, 1904, the bi-weekly applications were resumed, and have been continued up to the present, and he is now steadily improving again.

(2) Alice Watson. Treatment commenced March 30th, 1903. Rodent ulcer on forehead of 20 years' duration; superficial; extent 2in. x 24in. Has slowly spread over the whole period, although under treatment all the time. Remained under treatment till June 4th, and then stopped attending. It had improved very much as the result of the X-ray treatment, although her attendances had been somewhat erratic.

(3) Thomas Reynolds. Treatment commenced July 2nd, 1903. Small rodent ulcer of left ala nasi, in size about in. × in. Thirty years' duration. Two applications a week up till August 27th, after that once a week till October 1st. The ulcer was healed by September 4th, and continued so till treatment was completed on October 1st. He was to report himself if any sign of recurrence appeared, but as nothing has been heard of him the cure is probably maintained.

(4) Joseph Duckworth. Treatment commenced July 6th, 1903. Rodent ulcer on right side of nose, rather larger than a shilling in size. Five years' duration. The nasal bone is exposed at the base of the ulcer, the edges are but slightly thickened. He had applications twice a week and steadily improved, more rapidly after the necrosed bone lying in the floor of the ulcer was

removed on August 24th. By September 24th it was completely cured, and treatment was stopped on October 15th.

(5) Darby Shaughnessy. Treatment commenced July 23rd, 1903. Rodent ulcer at inner angle of right eye, area about that of a half-crown. Of decidedly exuberant character. Duration 17 years. Steadily improved under applications twice a week. The prominent masses became absorbed, the portions cicatrised over steadily becoming flattened. From November 2nd onwards he had applications only once a week, and by February 4th, 1904, it was completely cured and further treatment was stopped.

(6) William Leonard. Treatment commenced August 10th, 1903. Very small rodent ulcer on left ala nasi. Started as a pimple six months ago; some pain in it, especially at night. Under applications twice a week it healed up, and he was discharged on September 14th cured, though there was still some. itching and irritability about the scar at times, especially when the weather was wet.

(7) Zimri Smith. Treatment commenced October 5th, 1903. Large rodent ulcer in middle of forehead. Appeared four years ago in the scar of an old wound, and has been gradually spreading, with occasional partial recoveries. The edges were removed and the base scraped about a month before the first application. Applications twice a week up to November 9th, after that once a week till December 10th, when treatment was stopped, cure appearing complete.

(8) James Burgess. Treatment commenced December 3rd, 1903. Extensive but superficial rodent ulcer, affecting almost the whole of the nose, advancing towards the inner canthus of each eye, and also invading the right nostril. Has had applications twice a week up to present date. The greater part of the ulcerated surface is now healed.

(9) William Morton. Treatment commenced December 21st, 1903. Rodent ulcer on right side of forehead of five years' duration. Was excised, leaving a wound about 12in. x 24in. This was treated by applications twice a week, and by January 28th he was discharged as completely healed.

(10) Rachel Aaronson. Treatment commenced February 4th,

1904. Small tumour on upper lip, probably rodent ulcer, but with no ulceration. Has become smaller and softer as result of applications twice a week.

(11) Thomas Pickles. Treatment commenced February 25th, 1904. Rodent ulcer, destroying a considerable portion of right ala nasi. Of only three months' duration. Has had applications of 7 to 10 minutes daily up to the present date (March 2nd), and already shows signs of improvement.

Six Cases of Lupus:

(1) Mary Roxburgh. Treatment commenced April 20th, 1904. Small patch of lupus on back of hand. Was scraped about six weeks before commencement of X-ray treatment, and there were still some active points of lupus, but no ulceration. Steadily improved under applications twice a week up till July 20th, and after that once weekly till September 10th.

(2) John Scanlon. Treatment commenced May 21st, 1904. Small patch on right ala nasi and another on right side of nose just above the first. Another also on the left cheek, beneath the eye. Has had applications twice a week, many of them of 20 minutes' duration, and the two patches on the right side of the face are completely healed, these having had the greater part of the exposures; that on the left cheek is now rapidly improving.

(3) Florence Booth. Treatment commenced September 10th, 1903. Patch of lupus on back of hand of 10 years' duration. Treatment applied twice a week up till November 23rd, and once a week thereafter till December 21st, when, as the condition appeared to be improved, it was stopped, and there has been no further sign of activity.

(4) Charles Allen. Treatment commenced November 26th, 1903. Patch of lupus on inner aspect of left thigh, of 10 years' duration; size about 24in. × 12in. Patient only attended for one application.

(5) Matthew Brady. Treatment commenced January 21st, 1904. Patch of lupus on right cheek. Has been already scarified and cauterised, but has recurred. Exposures twice weekly up to the present date; already commencing to improve.