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1216 a second similar series may be given, and a third after yet another three months. Inoperable Cases.-The tumour with its lymphatic field is treated with similar doses as stated in the preoperative series, and this is carried on until the tumour does not respond by further diminution in size. Then the primary growth is excised with diathermy, making no attempt to form flaps. A large raw area is left, and this is allowed to granulate over, a process which may take some time. In addition, sterilisation by large doses directed against the ovaries is performed, and thyroid is given by mouth. Palliative results over several years have been obtained on these lines, and in a few cases even an apparent cure. Recurrences.-In cases with recurrences and meta- stases extensive radiation is not highly valued, since the patient, as a whole, can too easily be damaged. As a result the recurrences are treated either by surface application or by intubation with radium. Rib and bone secondaries respond quite well to this form of treatment, and where possible radium at a distance is often employed. When secondaries occur in the spine, hip, or pelvis the analgesic effect of X rays is valuable, and, in a few cases, relief for some years has resulted. The lines of treatment, as given above, are preferred to other measures, such as burying radium round the primary tumours and glands, but when sufficient is available the use of radium at a distance has definite possibilities. Uterine Cancer.-For carcinoma of the cervix operation at the Radiumhemmet has been abandoned, and all cases are submitted to radium treatment. Without anaesthesia, and following routine cystoscopy, an intra-uterine applicator with 3 mm. Pb. screen of about 40 mg. is inserted into the dilated cervix. The vaginal applicators to total about 77 mg. are packed round the cervix, great care being taken to protect the vaginal wall, and so prevent rectovaginal fistulae. These are left in about 20 hours, and the treatment is repeated in 1 to 3 weeks. Treatment on the same lines is carried out in England with con- siderable success. This branch is under the control of Dr. Heyman, who combines the roles of gynmco- logist and radiologist. Skin.-Skin cancers, including rodent ulcers and epitheliomata, give good results when treated by surface application and intubation. The doses are so applied as to produce a good scar. Sarcoma of bone, muscle, and melanomata are treated extensively by radium and X rays, but the results are very disappointing. Carcinoma of the oesophagus and stomach are occasionally treated by cross-fire with X rays, but with no hope of other than temporary palliation. Carcinoma of the rectum is preferably treated by the surgeon, but if X rays are used a preliminary colostomy is deemed to be essential. The burying of radium round the growth demands so wide an exposure to obtain a successful result that practically the standard radical operation has to be performed to ensure its proper application. In conclusion, I should like to state how much I was impressed with the clinical knowledge of tumours during the course of treatment, and with the balanced judgment of each worker in regard to the prognosis. EAST HAM ISOLATION HOSPITAL.-The Ministry of Health last week held an inquiry into the application of the East Ham town council to borrow 242,000 for the enlargement of the council’s isolation hospital, which is badly overcrowded. Dr. W. Benton, the medical officer of health, stated that to comply with the standard laid down by the Ministry there should be 88 beds only, whereas there are at present 132. It further appeared that some of the nurses sleep in an old army hut, " unbearably hot in summer and very cold in winter," and that an old corrugated iron hut, formerly a store-shed, is used as a dormitory for members of the domestic staff. THE MEDICAL USES OF RADIUM. THE Medical Research Council publishes this week a summary of the results of research work carried out at various institutions with the stock of radium salt entrusted by the Government to the Councih As the preface points out, from being a doubtful, empirical palliative measure for inoperable cases, radium therapy haf, during the last eight years, become a curative method of primary value and in some instances is superseding surgery. The Radiology Committee of the Council have allocated the radium at their dis- posal to the following centres : the Middlesex Hospital; University College Hospital ; St. Bartholomew’s 8 Hospital; King’s College Hospital; St. Peter’s Hospital; the Marie Curie Hospital; the General Hospital, Birmingham ; the Royal Infirmary, Cardiff ; the Royal Infirmary, Aberdeen ; and the Irish Radium Committee, Dublin. The committee sound a note of caution in their introduction, for they feel that there is danger lest the general expectation of the public should outrun the real probabilities of radium therapy. " Radium should at present be looked upon," they say, " as an agent for the treatment of localised cancer, and the more limited the region affected the more chance there is of success. Once the disease is generalised the use of radium is mainly palliative." As in previous years, the reports are conveniently gouped under the headings of regions of the body. Cancer of the Breast. The Middlesex Hospital has obtained the best results by using radium at a distance of several centimetres, so that no skin damage has been caused. They suggest the application of greater quantities at still greater distances. For small superficial nodules three or four applications of 10 mg. (gamma rays only) to the square centimetre, half a centimetre away, for four to six hours, usually proved sufficient. Larger nodules were treated from a distance of 2 cm. They have not found that small doses for a long time constitute a good treatment for breast cancer. The usual deep therapy has been a suberythematous dose throughout the area of disease at two or three three- weekly intervals; wide variations in quantity, concentration, distance, and time all gave satisfactory results. Most of the patients at St. Bartholomew’s Hospital were treated by radium needles screened by 0-5 mm. of platinum ; a good result was obtained in 45 out of 67 patients so treated. In Dublin2 needles containing 5-10 me. radon in 0-4 mm. of platinum or 0-3 mm. of gold were embedded circumferentially around the primary growth and left until 2 mc. per c.cm. of neoplastic tissue had been dissipated. X rays were applied to the glandular regions in divided doses over a week. The early results were satisfactory. . Cancer of the Uterus. The report of 1927 suggested that better results were being obtained from the Stockholm technique than from any other ; this suggestion has been confirmed by the figures for 1928. Of 579 inoperable cases only 139 are alive, but it may be concluded that the radium treatment of operable cases is likely in proper hands to give lasting relief. The difficulty with inoperable cases is that some parts of the disease cannot possibly receive anything like a lethal dose. At St. Bartholo- mew’s Hospital the Brussels technique has been modified by substituting needles for tubes. The external growth is first treated vaginally, and when it has disappeared and all ulceration healed, the abdomen is opened, the liver, pelvic organs, and aortic and iliac glands are examined, and the uterus pulled forward ; the needles are inserted, so that only the eye protrudes from the peritoneum, 1-1 cm. apart, from one 1 Special Report Series No. 144: Medical Uses of Radium, Summary of Reports from Research Centres for 1928. H.M. Stationery Office. 1929. Pp. 28 and viii. 1s. 2 Report published in Sci. Proc. Roy. Dub.Soc., 1929, xix., 277.
