and apparently checking the relapse in some cases, ROENTGEN RAY EPITHELIOMA, CURABLE transfusion has often initiated a remission. The BY RADIUM remission, it is true, may be very incomplete in nature, yet the accompanying improvement in general con¬ AN APPARENT PARADOX dition is marked. If the red count is rising or if the patient is holding his own and is in good condi¬ ROBERT ABBE, M.D. tion, we felt that it was safe to operate with a red NEW YORK of over count anything 1,500,000. At a section meeting of roentgenologists at the The which was done in all five cases operation by British Medical Association meeting two years ago one of us was a left (Vincent) performed through I was impressed by the large proportion of this noble rectus incision without special incident. Following body of workers who had suffered from all degrees the operation there was surprisingly little shock or of Roentgen-ray injuries, from simple and was case. hyperkeratosis discomfort, recovery rapid in-every to amputation of one or more fingers, or one hand, or both. SUMMARY AND CONCLUSIONS I to them the of the The immediate results of in this series presented possibility curing splenectomy disease in its stage by radium. Most of them of five cases of anemia was a early pernicious prompt post¬ seemed but I found one from a of the skeptical, physician operative recovery and definite remission Australia who had and who had found in his disease in case. suffered, every own that radium had his hands well, The remissions were much more marked than is experience kept as he had it in this type for seen in anemia. In four of the repeatedly applied early usually pernicious some years. I showed photographs and spoke of cases five cases the red counts rose to from 4,000,000 to which I will here quote. 5,000,000. The remissions occurred so that constantly two years I have been more we are inclined to attribute them to the of During past, deeply operation impressed with its importance, as I have treated more splenectomy. cases. it is clear that if all of the vast of marked Logically, Our study shows that in spite improve¬ number of senile keratoses and of the blood still exhibits the early epitheliomas ment, picture accepted the face and hands can be cured with anemia with the certainty by characteristics of pernicious excep¬ then the of the tion of the color which has been altered from radium, early Roentgen-ray growths index, same type to well. or low. in three of the ought yield equally high to normal Furthermore, It is in the advanced stage of when the five cases, evidence of increased blood destruction was epitheliomas of cells invades and the squa- several months after as shown downgrowth envelops present splenectomy, mous cell layer followed by growth of pearls, lym¬ the urobilin estimation. These facts we can inter¬ — by phatic invasion and gland métastases that no effi¬ as evidence that the disease is not cured. — pret only cient action of radium, so far as we can yet see, is It cannot as yet be stated that the improvement beneficial. Then, short of or about this means will last than the anything amputation brought by longer clean excision is without value. to the remissions which come and which may Subsequent spontaneously early stage, however, most sacrifices of and over a of years. From the very nature fingers persist period hands have taken It is to this I wish to of the it will be before the exact place. point disease, many years direct attention, for in the I shall show that value of can be determined. early stage splenectomy cure may be assured. The only conclusions we may safely draw from first case so treated was in 1903. Five these cases combined with the reports of other writers My years after the use of the the are : beginning Roentgen ray, a of the 1. is not a very serious in patient developed typical epithelioma back of Splenectomy operation the left hand. One of radium pernicious anemia, and it offers a definite means of application cured it, and there has been no recurrence after twelve inducing a remission. years. a maker 2. The remission thus brought about is more marked Three years ago well-known of Roentgen- tubes came to me with a terrible exhibition of in the majority of the cases than any other known ray therapeutic procedure. Roentgen-ray cancer of the chin, chest and both hands. One finger had been amputated and much useless surgery done on the other Both hands had on the parts. The School of Bagdad.—It is not surprising then, that them scores of of sizes and school of became celebrated. physicians seem epitheliomas varying Bagdad Jewish A recurrence showed in the of the to have been most prominent in its foundation, and the most heights. stump with an distinguished product of it is Isaac Ben Emran, almost as amputated finger enlarged epitrochlea lymph, mass of half the size of an and in the axilla and celebrated as a philosopher as he is as a physician. One of egg, his expressions with regard to the danger of a patient having subclavian region of that side, a conglomerate mass two physicians whose opinions disagree with regard to his resembling a large clenched fist. Hopeless as it all illness has been deservedly preserved for us. Zeid, an Emir seemed, he wished me to excise the lymph and other of one of the chief cities of the Arabs in Barbary, fell ill of related scar growth, and apply radium as well as pos¬ a tertian fever and called Isaac and another physician in sible, at least for experiment. This I reluctantly did consultation. Their opinions were so widely in disaccord much to his delight. During the convalescence he refused to and when the that Isaac prescribe anything, Emir, asked me to what radium would do on the cuta¬ who had confidence in demanded the reason, he try great him, neous which as he the of two is more deadly epitheliomas were, said, just replied, "disagreement physicians the trouble started. than a tertian fever." This Isaac, who is said to have died way original I used in 799, is the great Jewish physician, one of the most impor¬ one strong specimen of radium from my col¬ tant members of the profession in the eighth century. His lection, and told him I had no doubt they would all principal work was with regard to poisons and the symptoms caused them. This is often medical writers in Read before the Section on Surgery, General and Abdominal, at by quoted by the Sixty-Sixth Annual Session of the American Medical Association, the after time.—Walsh, Makers of Medicine. San Francisco, June, 1915. Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/01/2015 be cured by applying it from half an hour to one hour After the fourth week, he asked me to excise and skin each. In thirty days every one dried up and fell off, graft the thick scar, as it was on his mind and wor¬ leaving a smooth healthy soft scar beneath. Even ried him. It gave a good opportunity for careful one with a half-inch base and three-quarters of an microscopic demonstration that no trace of-disease was inch in height cornified on top and very vascular left, but only the subsiding radium inflammation which at the base was— absolutely cured in the same time. would have gone in another fortnight. He remains The effect of— buried radium in the operated field of perfectly well. the large axillary cancerous masses was, as I expected, In another surgeon's hands the thick crusted and of no value. The patient lived some months and suc¬ ulcerated knuckle of his disabled finger has healed cumbed to the cancer saturation, though no recurrence after the use of radium, with a soft flexible scar. of the epithelial growths took place. Other surgeons, who were much handicapped in Many men are living to-day, who have served their their work, report the same happy termination of their profession and the public nobly, who have hanging anxiety and pain. over them this fate, which has befallen many whom we It seems almost a paradox of radiology that the all know. These may all share the "exhilarating sen¬ accepted use of a heavy gamma radiation from a timent of hope" through radium. Roentgen tube will cause a diseased condition of the It is. to these that the cases now described will skin, which a similar radiation from a tube of radium appeal. Two or three examples will suffice. will cure. This becomes intelligible when we know One physician, illustrating a type of severe injury that the output of the Roentgen-ray tube is almost of the hands of one of the pioneers and foremost wholly composed of hard, penetrating, irritating authorities in Roentgen-ray work, came to me two gamma rays. The radium discharges the beta ray in years since with both hands covered with patches of great quantity, as well as the gamma ray. It is the thick epitheliomas and crusted skin, cracked and sore, beta ray that has been proved beyond question to be compelling him to use gloves and cerates for even the efficient curative power, and it is only the secondary decent comfort. During several years he had fore¬ betas generated by the gamma when striking any stalled the dangerous second stage by having surgeons resisting substance, that give it its value in the excise and skin graft several parts.