RODENT ULCER.
This must be recognised as a form of true cancer and treated accord ingly; a very considerable advance has been made within the past few years in the methods of dealing with this most obstinate disease. The plans of applying caustics and the thermo-cautery have been totally abandoned, and even the knife has been almost laid aside since the curative powers of Radium and the X rays have been demonstrated. When the ulcer is small and situated on the side of the nose, temple or cheek without having involved the eyelids, complete excision by the scalpel is certainly the most rapid method of dealing with it, but skin-grafting may be neces sary, and in all cases a more or less unsightly scar remains, since not only the ulcerated surface, but its " rolled " or rounded ridgelike border must be included well within the sweep of the incision, otherwise a return is certain. As a rule also it will be advisable to employ the X rays in order to insure a complete cure.
For early cases the X ray is the ideal form of treatment. Three or four applications may be sufficient, and the subsequent cicatrix is scarcely noticeable. For more extensive ulcers the treatment may run into weeks or months, a very serious consideration with poor patients living at a distance from the institution at which this treatment is carried out. The period necessary for treatment depends on the thickness of new cell formation, hence the duration of treatment may he much curtailed by a preliminary curetting, or excision, done under local anesthesia; this aids the action of the rays and shortens the period from months to weeks. As the ulcer is usually situated in proximity to the orbit, great care must be exercised in the protection of the skin of the eyelids and of the con junctiva by a layer of sheet lead or by the use of special focussing tubes. As the treatment should never he undertaken except by the X-ray specialist, it is therefore unnecessary to go into details regarding the various forms of apparatus employed.
Recurrences are frequent, these being due to some portion of the thickened margin escaping the full action of the rays, hut such event need not be regarded as a grave omen, since further exposure after curetting will effectually meet the new requirements.
Neglected cases which were formerly regarded as outside the reach of surgery may he successfully dealt with by the above method, but when the cavity of the orbit has 'become invaded the best procedure will be to enucleate its entire contents before applying the rays. When the bones and cartilage of the nose have become invaded by the ulceration, the rays afford the only means of checking the progress of the destruction in these tissues.
Radium emanations have proved almost, and in some cases quite as satisfactory as the X rays, and Wickham states that their penetrative power is greater than that of the rays when employed as an auxiliary to surgical treatment. The emanations from a 5-milligramme sealed glass tube or mica button may be easily obtained by placing either form of appliance in contact with the ulcerated surface for about 3o minutes at a time at intervals of about 3 weeks. There is less danger of injury to healthy parts than with the use of the X rays, and the emanations have been successfully employed for the cure of the burns caused by the rays. In many cases complete cure of rodent ulcer has been obtained by as few as five applications of this agent.
Harris employs the rays in combination with Zinc Ionization, using the rays after the zinc has penetrated the cells, thus utilising the secondary radiations emanating from the zinc molecules. Roberts obtains similar results by employing the secondary radiations from thin plates of Silver or Copper placed between the tube and the ulcer. The Finsen lamp, Ultra-violet Rays, Fluorescent light, High-frequency currents, Cytolysis, Fulguration and Cataphoresis have all been employed with some degree of success, but the results are in no sense comparable with those obtained by the X rays and Radium. Carbonic Snow has been employed success fully in some cases and is easy of application. In small ulcers it gives very satisfactory results.