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most carefully analysed statistics, a number of facts remain unstated. The
relief that can be given to a patient during the last few months of his life is of immense
importance to the patient, and the clinician finds it difficult to express this in statistical
form. There is a further point that must be kept in mind in dealing with
statistics of disease, and that is that such statistics cannot show the general constitution,
etc., of the patients in whom the disease occurs. Many of the earliest
cases of carcinoma that have been treated at the radiotherapeutic clinic have only
been seen at this clinic because they have been in such poor general health that other
clinics have not considered it within their province to treat them.
During the year the X-ray department of the clinic has been extended by the
provision of two generators, each working a tube at 200 K.V. in a cannon of the
Holfeldor type. This apparatus has been so constructed that the two generators i
can be used to work a 400 K.V. tube in a cannon of the same type. This latter tube
has been in use during the year, but there have been several interruptions, and
treatment with it has not yet become a regular feature of the clinic. The X-ray
work of the clinic is done, therefore, by three Holfeldor cannons working at 195 K.V.
with a Thoreas filter (0.5 mm. copper, 0.4 mm. tin and 1 mm. aluminium) at intensities
varying from 5 to 15 r. per minute, and two 200 K.V. Holfeldor cannons with
the same filter and same intensities. Throughout the year we have continued to
treat unselected patients at varying intensities, and it is hoped that we shall soon
have a large enough number treated at each intensity to enable us to make a reliable
comparison. As the cases for these different intensities are not in any way selected,
it will be necessary to have a very large number before any reliable conclusions
can be drawn from statistical compilation about them. It may be noted, however,
that as a means of palliation in advanced cases, the lower intensities are clearly
more useful than the higher ones.
There has been no radical change in the general principles of treatment at the
clinic during the year, but small modifications are continually being made to make
use of new suggestions and ideas.
The superiority of the results obtained by surface applications of radium when
the distance of the radium from the surface is considerable, has led us to increase,
as far as the radium at our disposal allows, the distance of surface applications.
A great variety of materials have been used in the making of these surface applications,
Columbia paste, dental composition, sponge rubber, cardboard boxes,
wooden blocks and other materials all play their part, and are used as may be most
convenient for any particular case.
A growing use has been made of surface applications of radium combined with
X-ray treatment, and this is particularly true of those surface applications in which
the surface is within a cavity of the body, such as the mouth, oesophagus, rectum
and uterus. In all of these cases it is the rule to use X-ray therapy followed by a
surface application. When surface applications cannot be used, if the tumour is
accessible, it is treated by X-ray therapy followed by interstitial needling of the
tumour ; or, when the tumour has disappeared during the X-ray treatment, needling
of the tumour site. X-rays alone are only used for those tumours which are too
deep for any form of surface application and too inaccessible for radium needling.
The majority of all carcinomatous ulcers can be made to heal by X-rays or
radium, or both, but in a certain number recurrences at the site of the primary growth
occur, and in a still greater number distant metastases form, if the patient lives
long enough. To secure the final and complete disappearance of the tumour all
that is needed is that we should obtain the most accurate information about the
radiosensitivity of the tumours we are treating, and methods of delivering to every
part (that is to say to every cell) of the tumour the amount of radiation that is
necessary to effect a " cure." Great progress has been made in both these directions.
Firstly, although the histological study of tumours is disappointing and seldom of
much value to the clinician, a careful clinical study of tumours and of the tissues
in which they occur, is affording considerable information as to the amount of
irradiation necessary to be delivered under any special circumstances to ensure the
destruction of the tumour. Secondly, during the year there have been published