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R a d i u m
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from going below the stricture. The radium capsule and bard wax disc
are covered with paraffin to give a smooth nonconductive coat.
Dr. H. H. Bowing, Rochester, Minn.— I do not know whether our
results are any better than those of Dr. Case, but certainly they are
better than those of Dr. Schmitz. These patients get a wonderful amount
of relief from the dilatation alone. 1 recall one patient who returned
to his work and lived for three years. His only symptom, when last
seen, was a chronic cough, and the x-ray examination of the chest showed
multiple metastatic areas. If we had given him irradiation we would
have credited this improvement to the treatment. We can probably
give the majority a longer lease on life with treatment than without it.
We use the string method described by Dr. Case. With the string
in position the sound may be passed along its course with the least chance
of injury to the diseased esophagus. We always begin with a small olive.
and increase the size until we get one that enters with some difficulty;
then we know we have an olive that will help to hold the radium applicator
in position. The applicator itself is about 7.5 cm. long and it will
hold two tubes of radium.
The upper end of the applicator is fittedwith a large olive that will
not go beyond the obstruction. The smaller olive will just go through
the tumor and will not be regurgitated; the large olive is fittedwith a
whalebone bougie. The latter has previously been marked in order rhat
the depth of the lesion from the incisor teeth is known. When the applicator
is in position we can withdraw the whalebone bougie and to this
we have attached several strands of strong fish line. We are absolutely
sure the patient will not swallow the applicator and that it can be withdrawn.
The patient can tolerate the applicator without any signs of
difficulty, but I have found that there is a great amount of trouble with
excessive salivary secretion; this is distressing and can be controlled
with morphin and atropin.
We are not satisfied with our results, but I know we can apply the
radium in the esophagus with some assurance that it will stay put. and
the patient can wear the applicator for twelve hours or longer without
much discomfort.
Dr. W. H. B. Aikins, Toronto. Ont.—The appliance described in
detail by Dr. Case may, I trust, result in greatly modifying the hitherto
unfavorable results so far obtained in the treatment of carcinoma of
the esophagus; and we look forward to hearing from him to that effect.
Prof. Lars Edlini;. Lund, Sweden.—I have treated a small number
of cases of carcinoma of the esophagus. I think not more than 10.
In those I had a good result in 3 cases; in 2 I have observed a very
good result; 2 cases I have observed after about two years in each case.
One case was treated four years ago and that patient lived for at least
two years afterward. I have heard that she has since died, but I do not
know just how. The other case was treated three years ago and I sawthat
patient last March, when she was quite well. 'The third patient was
treated early this year and is still alive, feeling well and can cat. The
tumor was in the upper third of the esophagus and that, of course, makes
the treatment very much easier, especially in regard to combining the
x-ray treatment which has been used in all cases.
I have used for the puq>ose of applying the radium a common sound
made of two catheters placed together so as to have the length requited
I have a joint in the upper end so that the radium tube may be placed
within the capsule. The radium tube is of lead with 1 mm. of gold. The