Treatment

Sabouraud's pastilles consist of small disks of platino-cyanide of barium. This chemical compound has a bright yellow-green colour when freshly prepared, and changes through gradations of yellow to a brown colour when exposed to X-rays. The pastilles are supplied in a book with which a permanent tint of colour is supplied, to indicate the colour change in the pastille which cor responds with a quantity of X-rays equal to the maximum dose which the healthy skin will stand without inflammatory conse quences. This is often spoken of as a "pastille dose." As the amount of irradiation needed to produce the change of colour is considerable, the salt is fixed, during the treatment, at a point half way between the source of the rays and the skin surface under treatment. During an exposure the chemical salt, in the form of a small disk of the material on cardboard, is adjusted in the re quired position by means of a pastille holder, and it is examined at intervals during the course of the exposure, until it has reached the required tint. When in the holder the pastille must be pro tected from light, and should have a piece of metal as a backing.

In X-ray treatment some protection of the surrounding healthy parts is usually necessary. With this object various methods of shielding were devised, either covering the patient by imperme able materials, or enclosing the tube in an impermeable box with suitable windows for the passage of the pencil of rays which is to fall upon the part under treatment.

Effect on Tissues.

The effect of the rays on healthy tissues is in the main a destructive one, but some of the cells of the tis sues are more sensitive to the rays than are others ; and this permits of a selective effect being obtained, with the destruction of some cells and not of the whole tissue. Young cells, and ac tively growing cells, are the most susceptible, and for this reason it is possible to influence the glands of the skin and the papillae of the hairs with a dose which will not destroy the skin itself. The art of successful working with X-rays is based upon a careful adjustment of the dose so as to secure a selective destruction of the morbid elements, and to avoid wholesale damage to the part treated. The effects of excessive doses of X-rays is to produce an inflammation which may result in painful sores which obsti nately refuse to heal for many weeks or months. In the case of "soft" rays a quantity up to double that of the usual maximum or pastille dose may be employed in urgent cases without risk of any serious inflammation. In the treatment of ringworm the exact pastille dose must not be exceeded or the fall of the hair is likely to be followed by permanent baldness.

The distance of the skin surface from the centre of the tube must be known, and the pastille arranged in place accordingly. Fifteen centimetres is a usual distance, and at this distance a tube working with a current of a milliampere should give the full thera peutic dose or "pastille dose" in about 15 minutes. In general X-ray treatment it is quite usual at the present time to proceed by the method of full doses at rather long intervals. From the experience obtained by Sabouraud in numerous cases of ring worm it has been found that a full dose must not be repeated un til a month has elapsed.

Treatment of Abnormal Growths.

A great amount of work has been done with X-rays for the treatment of cancer, but it is now recognized that the X-rays do not cure a cancer, although they are of value for the relief of pain. Diminution of size in cancerous growths has frequently been observed, and in some instances sarcomatous tumours have completely disappeared under X-ray treatment. Sooner or later, however, the cancer or sarcoma returned either in the original site or elsewhere, and the patient died of the disease. How far the use of intensely hard X-rays produced by currents of some 15o KV, as in the Erlangen method of treating cancer, will prove effective, is doubtful.

X-ray treatment is of service for the treatment of enlarged "strumous" glands in the neck. When these glands are in the early stages, and there has not been any softening or breaking down of the gland tissue, the application of X-rays, a few times repeated in moderate doses, will determine the subsidence of the enlargement and may effect a complete cure.

In the massive glandular enlargements of lymphadenoma a great reduction of the tumours can be brought about by heavy doses of X-rays, but the results are to give a symptomatic rather than a real cure, for fresh glandular growths take place internally, and the usual course of the disease is not fundamentally modified.

So too in leukemia, the symptom of excessive abundance of white cells in the circulating blood can be surprisingly altered for the better by X-rays, but generally without real cure of the underlying condition. The effect appears to be due to a direct destructive action upon the leucocytes of the blood.

The use of X-rays in fibroid tumours of the uterus has been advocated, particularly in France and in Germany. The action of the rays seems to be in part due to their influence upon the activity of the ovaries and in part to a direct effect upon the growing fibroids themselves, causing decrease of activity, relief of symptoms and reduction of the tumours. Not all varieties of fibroid are suitable for this kind of treatment. (H. L. J.)