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R a d i u m 187
courting disaster by not determining in advance whether it is a basal cell
epithelioma; and that is not always readily determined clinically. Dr.
Ranson has brought forth the necessity of making careful microscopic
study before you institute procedures to bring about its cure. Now,
if you want to use radium, you want to use it not only locally, but in all
anatomically related lymph glands. The surgeons have long since learned
that procedure, and it is only because radium gives better cosmetic results
that it is to be preferred. Now. it is perfectly possible to take a
curet, or a knife, or caustic, or paste, and eradicate a basal cell epithelioma,
wherever it may occur. But the tendency of anyone working about
the face is to save as much tissue as possible, and wc are always trying
to keep within the best possible procedure, and not eradicate them all.
With the use of radium, this can be obviated, because you can use it over
a wider scope of territory than any excision would permit, and for this
reason radium is undoubtedly the method of choice in dealing with basal
cell epitheliomas wherever they may exist. The use of radium, however,
in the case of the prickle-cell variety, is not always the method of choice.
because of the impossibility of being sure of eradicating the base by
radium alone. We know that many times it is very, very resistant to
radium, as Dr. Ranson has pointed out in his paper. Therefore, the
amount of radiation required to destroy some prickle-cell epitheliomas
is so excessive as to require the use of a dosage which would be destructive
to an extent which would contraindicate its usage. Now, I
have had the opportunity of observing for the last two or three years
the work of Dr. Ranson and Dr. Withers along these lines, and 1 have
been very much impressed, as I know they have, by the surgical dictum
that has long since been laid down, that the hope of every cancerous
individual is an early diagnosis, and that applies no more to the use of
radium than it does lo the use of surgery, and we must forever be* on
the lookout to impress our patients with the necessity of applying for
diagnosis at the earliest possible moment.
I should like to emphasize again the necessity of determining, as
absolutely as it is possible to 'lo, the character of the growth with which
we are dealing, and that can only be done by a very careful microscopical
examination. That was brought out very clearly in the last picture the
doctor showed. One of those cases presented epithelioma of the ear.
Clinically that was a typical basal epithelioma which responded very
promptly to small doses of radium, but within three months it was evident
that it was a prickle-cell epithelioma. Now, it is possible that enough
radiation cannot be employed in this case to eradicate the glandular
involvement, but that would have been done at the expense of a very
serious loss of tissue and function in the region involved. Here it is possible
to lay down a law that may be subject to some exceptions, but there
are very few exceptions. If you take any individual and draw a line
from the angle of the mouth to the upper tip of the ear, it can be accepted
almost without qualification that any growths that occur below that line
are almost certain to be prickle-cell in their character, and procedure
should involve a treatment of the anatomically related lymph glands.
Epitheliomas below the lip are almost invariably prickle-cell in their
character, and no procedure is proper, or is fulfilling the duty and obligation
of the physician to his patient, that does not involve, however
small the initial growth may be, a proper radiation of all the anatomically
related lymph glands. Above that line, almost without exception,