RADIUM.

Dominion, Volume 7, Issue 2012, 20 March 1914, Page 11

RADIUM.

REPORT BY DR. HABBfffiX SMITH

A PURCHASE ORQBIK

EXPENDITURE OF £5000 SUGGESTED.

Radium and the question as to whether the Wellington Hospital and Charitable Aid Board should place a sum of money on this year's estimates fof the purchase of a supply thereof formed the subject of a report furnished to the board yesterday by Dr. fit. Bardtviek Smith (Medical Superintendent of the Wellington Hospital). The report, which was a lengthy one, is to- be discussed at the next meeting of the hoard.

"Before stating whether the. board should placo a certain amawt'of money on their next year's estimates for the acquiring of radium, three- questions must be answered," said Dr. Hardtfiolc Smith. "1. Is the treatment hy radium still in the experimental stage P "2. Has tho treatment by radium passed that stage, and does' it .-actually cure cancer and other diseases? ''3. If the second question is an* swered in the_ affirmative, ).$ it -wise for the Hospital Board to proc-ure Tadium ? "I will take each question an turn and attempt to answer it to your satisfaction. Some three years a-go I replied to an able paper by Mr, Wilson, at the Congress of Hospital Boards held in Wellington. The gist of nyy reply was that radium then was still ift the-experi-mental _stage, and that it was- Jittt wlsa to obtain an amount at that time. Btit during these last three though the treatment by radium is sti'H in the expejimental stage, it has advaneed considerably. A Cure of Malignant Disease, "In' England such mm as. Sir Fred. Treves, Lazarus-Barlow, and Sir Alfred Pearce Gould speak in favottr of its use and give instances of its ability to cure malignant disease. I will quote more especially from Sir Alfred Pearce Gould* because he is one who has made a special study of malignant disease and its cure by radiiim. Another reason why I quote him is that I know him to ho absolutely reliable in his Words. He errs rather on the side of caution, and, though an enthusiast,: speaks logically, giving duo 1 weight to both' sides of his question* Such a man should he suffieient guide for us to follow. He says: 'If cancer is thus.unknown in its exact nature, and extreme!.? variable in its clinical course and manifestations, what can we say of radiu'iii? It is'potont; - it is wonderful; chemists place it amongst metals; the physicist caii for a short time store its active emanations' in liquid air, but it remains one of Nature's mysteries, and its influence upon living tissues is unexplained and variable, nnd at twesent not within our eontrol._ Evidently then wlWit we have to consider'the action of liiftnowrt and variable radium upon unknown and very variable cancer, it is ineninbeivt upon us to speak with great reserve, and tobe Constantly checkina our obsftTvations. with what is known of the ftiititrnl history of tho disease. The selective.power of radium, as I may call it. enables us to use it to remove the colls of a ma-, lignant-growth and to leave behind the healthy tissues—in practice wc some, times come short of this ideal, both in j tho'way of failure to remove'a.H citnecr cells, and' also in tho injury or destruction of other than cancer eells*.' ' "These above remarks by 'Sir Alfred Pearce Gould will enable you to see how it.man who has had larcrc experience in the treatment of malignant disease viows tho present state of affairs. Bijt I must continue by, statins that Sir Alfred then gives several eases of patients suffering from advanced cancer and sareonfa _who were cured by apj»M. cation of radium. "I.will'iiot quote the eases." continued Dr. Hnrdwick Smitfi, "but, from a medical point of view they were tin* questionably malipnant and nasi cure bv surgical methods alone. Sir Alfred, after quoting tho cases, fobs on to ssv: 'So far as I .bavo had the oppnrtimity of studying the effects .of rrtdiwm on ennnor «n to the present, tho exteiit of its influence has appeared to lie very variable and ofteii quite limited.' Radium Not a Ciirft-all. "The above words .by such a man would lead us to be guarded ift <Hlt viows, and to realise thnt ■rarlwHn. is not the curc-iill that it is. quoted to be; at the same time, though We re.aMsfi its limitations, wo can see that it at times cures where surgery cannot. That hcing so, then it has become a necessity in treatment of disease." The report went oil to quote author* itics to provo that radium had a decided curative action on cancer, soma* times alone, hut more often with the help of X-rays and surgery, and that radium had been used with varyirij; success in the treatment of many -other diseases. Finally the report suggested: "That it is not wise for rndinm institutes to bo dotted about the counttv. I think that the Government should he asked to subsidise one institute in New Zealand. That one institute would at nrcspiit act for both North . and South Islands." "My reasons are these," s'akl "Dr. Hardwick Smith:— '.. "1. Itadium is not aVure-itll* audits results are still variable, just ' as are those of the X-rays; in fact, it is still in an experimental stasc. "2. AVhen such an.(lnstitute liasbeen inaugurated, medteal. meii in- , terested in the treatment of disease by X-rays and radium can come and work in the institute add so learn tho uses of radium arid Xrays. These men. will bo -of use' to tlie other hospitals in the Dominions when the time coaips for radium to ho placed in other centres. '3. The price of radium is at present high, nrobably £20 per hi.*. I consider 200 ni.u. to he a sufficient amount for the proper treatment ' of the disease; 250 fn.g. would be ample. That frouid cost £5000. I suggest this larger amount because several treatments can then hc_ conducted at the same Irnic. I think a still larger amount spent" at the present time would bo a piece of gross extravagance, and unnecessary. Remember that tlie ' figurrs T give you are not mine, but those of men of long experience. "4. An expert must he obtained in administer the radium treatment. Without one the treatment will, to a great extent, bo nullified, ni-xlat times clangorous. I. will quote some of the dangers experienced even by experts when using radium:—(!) Danger to,the operator bv burns: (2) sloughing of tlm tissues and formation of' deep ulcers, so much so s that at times, when the radium is placed in the affected tumour, it may cjnise sloughing of the. tissues around and cause irreparable harm; (3) clotting of blood in the blood-vessels near the tumour, which has caused death; (4) haemorrhage from the tumour in which the radium is inserted • (51 persistent pain, at times follows the use of radium in the nart affected. "T might add that such an espert should, if possible, be an X-ray expert also, and that where the radium is

.placed an up-to-date X-ray plant should tie there ais-o. TUB Superintendent's Recommendations. "Now, as to the position in the I>o--1 minion. It is difficult to say who shall have the honour--of having inaugurated such a treat-meist-. 1 woitkl suggest that it be one of the four een'tres, because it will ho the greatest good for the greatest number, m that more will bo able to reeeivo treatment- at- their own dser. The four centres contain largo hospitals, sneh hospitals would be able- to -contain - tho patients who come for treatment, without the necessity .of building an expensive institute. The ~ four large has'pitals contain good X-raj plants, which can lie used for treatment , in confunetimi with radium. Surgery is often a, necessary part of the treat--1 ineiit of malignant disease. A patient ! suffering from advanced malignant di- ■ sea-se cannot as a rule take long journeys., and tho four main centres are more accessible than tho smaller centres. Radium emanations could be more ea.sily distributed from a main centre than from an inland town.- This is, I think, of some importance, because the stored emanations weaken with time. "To sum ■ up, I recommend: 1. .Radium he obtained for oho centre, and that centre be one of the- four large ones. .(If I had to Dame a centre, I would prefer Duiiedin, because, the. students would' then benefit,) The only argument ■ against Dunediii is that it is not eewtrally situated. 2. That an estpert be obtained, 3. That £-5000 worth of radium bo the amount obtained, and no-6 more, 4. That existing institutions, he used, if possible, for the treatment • rather than that a new institute be built; this for economical reasons. 5. That, radiiim. emanations be sent to the medteal men who wish to Use them, but it would bo wise ■ for medical men to be allowed to. study for a little time under the' ra-dium -expert before utilising these means. "Finally, I do not- for Mi© above, -reasofts» think that it is wise for the hoard to phtee money on the estimates, because, if Wcllhigtcm, by any chance, (vera chosen as this centre, the .public would respond gladly. Of. Herbert's Advice. ■ ®i. Herbert, who' returned to New Zealand this week, after a professional toqr of twelve months in America, Great Britain, -and Europe, told a reporter, who,approached hini'tffl the subject, thai ho. had taken every opportunity to wateh : the applieation and. .results of radium t-reatmeivt wherever he visited. Be was greatly indebted to the kindness of the medical director of tlie &adii»m Institute in London, who showed him over the institution and made hi* acquainted ivitia ninny of his results. At present all that could he said, was that the prospects ahead of radium treatment were exceedingly encouraging., Some of the results were really wonderful. A very great deal had still to bo. learned about r&diirni, 'however, and it would he at- lea-st two year? before a final pro-iioti-iiceinent could he given erf its therajoetttie values. Dr.- -Herbert expressly asked the medical director- of the .Hndittm Institute what his advice would he to local bodies in 'a country like New Zealand as to scouting radium for medical purposes. His answer was "Wait. • Wait lor two years. Then you will have the benefit of oiir reports, andj profiting hy oar results, you will he able- to guard against 'our failures and obtain radium much cheaper." Radium is an exceedingly dangcr-otis sttbstiuice,. and must be. kept in the hands-Of experts (continued-U'r. -Efcroert-)-.. These 'experts are a-iid. far bet-Ween at present. Take .thc"'wimls of the medical director himself, "who said, "I have been five years working at radium practically night and day, and' '■I'"eah v sa'.vthat ,1 know little about- it."-■ Tlie director was eloqtfont on the; dangers ef so powerful a -substance if put into the hands of any other than exports." • -, '