X-RAYS IN THE TREATMENT OF CANCER.

Otago Witness, Issue 3512, 5 July 1921, Page 26

X-RAYS IN THE TREATMENT OF CANCER.

RECENT DEVELOPMENTS. A cablegram from London states that a new X-ray apparatus has been installed in the West London Hospital by tbe aid of which the authorities claim to be able to cure 80 per cent, of cases of cancer. The invention comes from Bavaria, and employs rays of a wave length hitherto unattained. This cablegram almost certainly refers to the Erlangen method of treating cancer, of which reports have been coming to hand iji the latest technical journals. Dr Reginald Morton is the radiologist to the West London Hospital, and in the British Medical Journal of January 29 last he gives an 'account of his visit to Erlangen, and the methods and results obtained there, by Professors Seitz and Wintz. Presumably the West London Hospital has obtained an Xray plant specially designed for this new method. To understand this subject clearly, we must iirst state the broad physical facts concerning therapeutic radiations. Both X-rays and radium have been used for the treatment of cancer with considerable success, alone and in conjunction with surgery. X-ravs are electro magnetic waves of very short wave-length, the length being variable over wide limits by altering the voltage applied to the tube which generates the rays. The longer waves have iittle penetration, being absorbed by the skin, while the shorter ones go deeper into the tissues before they are extinguished. Radium emits three radiations—the alpha, beta, and gamma. The first is believed to be an atom of helium; the second is an infinitely small particle, electrically charged; and the third is a true electromagnetic wave Exactly similar to the X-ray but very much shorter, and therefore very much more penetrating. We know that the long X-rays that are absorbed by the skin give rise to the disastrous “ X-ray burn,” so when it is desired to reach deep-seated growths these rays are cut off by a metal filter, allowing only the short ones to pass and penetrate deeply. Similarly the alpha and beta radium radiations are cut off for deep work. The Erlangen method consists of administering massive doses of very short X-rays, using very high voltages, with heavy filters, and taking the exposures to the limit of safety. These radiations, however, are still much longer -and less penetrating than the gamma ray of radium. Quoting Dr Morton’s article: —“Special apparatus and tubes have been designed to give a type of radiation having qualities of penetration and intensity combined such as has been hitherto unattainable, with facilities for reproducing this standard type, of radiation at will. Dosage thus becomes a matter of calculation and time, and the results are uniform and successful to a degree that would be surprising were it not quite in keeping With theoretical considerations. . . . Working under the standard conditions it is found that with the proper filter, etc,, the maximum dose the skin will stand without: Serious injury will be given in about 35 minutes. This is what is called the unit skin dose. Taking this unit skin dose as 100, it has been “found that a cancer cell requires 110 per cent, of this to ensure its destruction. ... If. however, a dose of only 40 per cent, of the unit skin dose is given to a cancerous growth, the latter is stimulated, causing it to increase rapidly, with serious, possibly fatal, results. Herein lies the explanation of some of our failures in the past.” As a proof of results Dr Morton says “In the year 1918, 24 cases of cancer were treated with X-rays alone. At t-ae presentmoment 20 of those are quite well, being at least clinically cured. In one case the treatment had no appreciable effect, for reasons that are not quite clear. In the other three, dissemination had begun, though there was no eviiknce of this at the time. The primary lesions had disappeared, hut the patients died from distant extensions.’' Ho much for the Erlangen method; but to prevent misconception and disappointment it is necessary to show the other side

of the case. The results tabled show 80 per cent, of apparent cures, but these were evidently cases specially selected in the early stages of cancer. The others, where the disease had already spread to other parts of the body, proved failures. The new method lias excited a considerable amount of criticism. Dr F. Hernarnan Johnson, in the British Medical Journal of April 2 last, writes; “I have been careful not to apply opprobrious terms to tho Erlangen method, for I have found it a good rule to believe that whenever an earnest and intelligent body of men consistently advocate a particular method there is something, and usually a good deal, in it. One has to remember that when a patient is operated on for cancer he has a surgical risk to face; and lie may be cui’ed whether any X-ray treatment is given or not. Tire big dose method is admittedly dangerous. If it is used as an alternative to surgery its risks may legitimately be faced; but why should we submit to fresh dangers a patient who has successfully come through an operation? Only the most positive proof that the divided dose is useless, as well as harmful, could lead us to abandon it, whereas a vast body of clinical and experimental evidence points to its value.” Tho Erlangen method takes, to use a musical -analogy, one high-pitched note in the wave scale as the best. Dr Knox, of the Cancer Hospital, London, suggests that it may be that, each particular tumour has its own “note.” Other workers have found that excellent results have been obtained by using the low “note” of the beta radium ray. where the tube of radium could be buried in tile heart of the diseased mass. This method obviates the danger to the skin of the patient, and may indicate the secret of the therapeutic effect of all these radiations. Professor Bragg maintains that the X-ray is in itself ineffective, and owes all its activity—physical a.nd chemical—to the electrons which it produces when arrested The only purpose the X-ray serves in therapeutics is to plant the action deeper in the body. We may add some recently published remarks by one of the foremost American radiologists. lie says: “There has been much notoriety given to a supposed new discovery with regard to the use of X-rays in the treatment of cancer. This, like so many similar announcements, depends more upon tho flight -of someone's imagination than upon facts. The X-rays have been used in the treatment of cancer for over 20 years with more or less success. With improvements in skill and apparatus, and with increased knowledge of the nature of the disease, even deep cancers have been brought under control by the X-rays, especially when combined with radium properly. Even when used most skilfully, and with the best equipment and combination with radium, all cancers will not be cured. Probably most can be accomplished by combining radiation with surgery. Xo really new discovery has been made. It simply consists of further development of well-known principles. The careful scientific physician take? up these advances, which are made in the hone of accomplishing more for the cancerous patient, and I believe much progress wiil be made; hut such wild flights of the imagination in newspaper print can only arouse false hopes on the part of patients and their friends.” This is rather trenchant criticism, but it mav be readily agreed that along such lines as those which are criticised great advances lie. We know that apparatus capable of generating even more penetrating rays is being elaborated outside of Bavaria, and it is not too much to hope that the conquest, of career may yet be attained.

Although Sir Robert Baden Powell was the initiator of the world-wide movement, the Boy Scouts, it was left to New Zealand to give to tho world scouting ftc girls. This interesting fact was stated by Brigadiergeneral Andrews at -a meeting of citizens at Wellington on Tuesday afternoon. Pi nee the movement for the girls was inaugurated in this country, Australia, South Africa, India, Japan, Honolulu, the United States, and Great Britain have followed in our footsteps.