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72 R a d i u m
rence when it doe- take place is apt to be internal and unassociated with
the offensive discharges and fistulaethat were formerly universal in the
final stages.
It is in ihe so-called operable case that the question of the indication
or contraindication of radium arises. Though not a few surgeons
have discarded operation altogether in favor of radium, we have not
yet personally come to a final conclusion. At first convinced that it was
the duty of the surgeon to operate on every operable case instead of
taking the more comfortable path of irradiation we have nevertheless
made certain concessions to the radiologist. We have, for example,
greatly modified our classification of cases. We have changed the term
"operability" to "curability by operation," which has quite a different
significance. Whereas we formerly over a period of many years operated
on about 60 per cent of all cases, we now subject to operation only
about 20 per cent. During the last five or six years we have carried on
parallel scries of operated and radiated cases, in which the disease IS
limited io the cervix and frankly curable by either operation or radium.
Such patients have been chosen for irradiation as. on account of obesity
or constitutional weaknesses, incurred a special risk in operation. Sufficient
time has not elapsed to draw authoritative conclusions from this
series, especially as the operated cases greatly exceed the others in
number.
Nevertheless a recent comparison of the two types of cases of less
than five years' duration shows a similarity of results that, it must be
confessed, has been somewhat surprising to the writer and encouragingly
favorable to the use of radium.
198 Commonwealth Avenue.
DISCUSSION
Dr. John G. Clark.—Dr. Graves has pointed out salient contraindications
to the employment of irradiation in the wrong class of cases.
In all novel procedures there is a great tendency, and I believe this applies
with particular force to our American colleagues, for the ill-advised
use of all new therapeutic remedies. Pioneer workers may point out the
dangers of a remedy which has been based upon carefully noted objections
and yet all too often the novice who could so easily avoid these
obstacles will steer head on into them, although these hazards have been
charted accurately. As Dr. William Mayo has said, there are innumerable
physicians and surgeons buying a nickel's worth of radium and
doing a million dollars worth of harm with it. Possibly the lure of dividends
from a new investment may at times becloud therapeutic judgment.
Because I am so constantly licing consulted bv those who have
been badly advised in the use of radium and arc seeing the disasters of
a good remedy injudiciously used. I particularly favor therefore all articles
which point out the dangers of this remedv. Keene and I have
dwcalt at length upon these points on several occasions when this issue
has been up for discussion. Given a radiologist who is not a surgeon,
or a surgeon who is not a radiologist, these patients will certainly not
get a square deal with either, but I frankly believe that less harm will
be done by such a surgeon than by the radiologist. As all of these tumors
should primarily be passed upon by the gynecologist, likewise their treatment
by irradiation should be controlled by him.
A history of present or past inflammatory involvement of the ad-