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68 R a d i u m
is merely a collective expression that includes as many distinct clinical
diseases as there are organs which it attacks. Each of these diseases
is a particular entity, differing from the others in its tissue reactions.
its methods of metastasis, its anatomic relationships, its amenability
to radium or surgery, and in many other ways. Moreover, cancer appears
in manifold types, each of which exhibits specific variations in
the organ in which it is located. An adequate knowledge, therefore,
of all the organ-cancers in the body is requisite for the universal radiologist
who is setting out to treat cancer in general.
Furthermore, in undertaking so important a vocation he should be
familiar with the treatment of organ-cancers by other means than radium.
Until the advent of radium, cancer had been preeminently a surgical
disease. Although radium has done wonderful things, and in some
cases accomplishes what surgery cannot, nevertheless it has not supplanted
surgery by any means, nor at present indications is it likely to,
desirable as such an outcome might be. There are occasions, even in
treating those lesions in which radium is most efficient when operation
is the procedure of choice, and there are many other conditions in which
radium is imperatively contradindicatcd, in favor of surgery.
It would seem, therefore, that the radiologist should possess not
only a thorough knowledge of ihe pathology of the organ-disease which
he is treating but also the ability to treat it surgically if need be.
Of no small importance is the technical expertness necessary for
making applications of radium in the various cavities of the body ihat
give access to specific organ-cancers. It is a grave mistake to suppose
as some do that the technical use of radium is a simple matter and one
easily learned. On the contrary, the skill necessary for properly applying
radium to some organs is quite comparable to that required for
surgery of the organ. When one hears of an inexperienced operator
undertaking to treat cancerous disease in general with irradiation, one
wonders what work will !>e made of those instruments used in manipulations
of the bladder, vagina, nose, ihroat. etc.. skill in which it has
required Ihe specialist years to acquire. It is not uncommon even to
see mistakes of omission or commission made because an operator has
had insufficient skill to remove tissue for microscopic examination. It
is as blameworthy to apply radium to a normal organ on an unfounded
suspicion of cancer, as it is to perform a radical operation on similar
grounds.
It must be admitted, therefore, that radium should be entrusted
only to those who have a competent surgical knowledge of the organs
which they are to treat. This does not necessarily exclude the general
radiologist but it does impose upon him the duty of making a very complete
clinical preparation for his work.
Having called attention to the possibilities of harm from the indiscriminate
use of radium, we shall now direct our criticism to those who.
like the reader, have employed radium as specialists.
Of the various gynecologic conditions which react dangerously to
the influence of radium, ihat of pelvic inflammation is of supreme importance.
Everyone who treats gynecologic cases is familiar with the
serious damage that may be done in the presence of pelvic inflammation
by such intrauterine instrumentation as curettage, the wearing of
stem-pessaries, artificial insemination, insufflation of the tubes, etc. This
same danger of lighting up an old inflammation exists and is greatly
intensified after the insertion of radium lubes in the uterine cavity; for