THE TREATMENT OF MALIGNANT TUMORS WITH

ELECTRICAL METHODS *

BY DR. ARTHUR F. HOLDING

Electrologist to Cornell Cancer Research Laboratories, General Memorial Hospital, New York City

In a recent article 1 I reported the results of 140 cases of malignant tumors treated by various methods with and without surgery. To recapitulate: I divided malignant tumors into three classes.

In malignant tumors of the first class it was shown that all cutting procedures were contra-indicated, as lesions of this superficial character could be cured by physical methods, without surgery, with less danger and better cosmetic results (Figs. 1, 2, and 3).

In malignant tumors of the second class it was advisable that a definite program of four steps should be carried out in all cases: (1) A massive dose of deep Röntgen rays delivered in one day. (2) Thorough radical operation on the following day. (3) Fulguration into the open wound immediately after the operation. (4) Postoperative deep röntgenotherapy or radium therapy to be instituted as soon after operation as the patient could be moved from her room to the Röntgen room (usually two or three days after the operation).

In malignant tumors of the third class, which comprise the main bulk of cases referred by X-ray or radium treatment, the cases were absolutely hopeless. These are the cases that are sure to die, and, naturally, the last agent used on such a case is discredited. The attempts to treat such cases account to some extent for the widespread discredit attached to the use of Röntgen rays for such maladies. Any improvement at all in these cases should be regarded as illustrating the inhibitory effect of radium and Röntgen rays, and if this action is obtained we should neither discredit ourselves by becoming too optimistic, nor allow ourselves to be discredited because of ultimate

* Read before the First District Branch.

1" The Treatment of Cancer by Electrical Methods," New York Medical Journal, Sept. 19, 1914.

failure to cure, as the disease is so far advanced, when the patients present for treatment, that sufficient inhibition cannot be obtained to control the condition (Figs. 4, 5, and 6).

It is the purpose of this communication to describe some of the physical methods indicated and technic employed in treating this third class of patients, including the Coolidge tube and tintometer.

The Coolidge X-ray Tube.—The Coolidge tube is an X-ray tube the vacuum of which is about one hundred times more perfect than the vacuum of the ordinary X-ray tube. All the contained metal is tungsten or molybdenum. The penetration of this tube is controlled at will by means of a rheostat, which in turn controls the amount of heat that is generated in a tungsten wire filament incorporated in the cathode of the tube. The penetration of the tube is readily increased to two or three times that of the ordinary tube, so that it is not only possible to take röntgenographs of the densest parts of the human body, but also to make röntgenographs of plates of iron or steel, thereby enabling one to definitely show defects in the metal. The life of the tube is indefinitely long, barring accidents or breaks in the tungsten filament. To puncture it is almost impossible. A glass somewhat heavier and thicker than that usually found in the ordinary X-ray tube is used for its manufacture.

A new model of the Coolidge tube is being made which will back up a parallel spark gap of 15 inches, requiring an electric capacity of 150,000 volts to actuate it, and the rays are expected to rival the penetration of the most penetrating gamma rays of radium. With the new tube a much larger dose of deep penetrating X-rays can safely be administered than was possible with the old type of tube, and the six- to ten-minute period of time previously required to administer fifteen to twenty Kienböck units can be diminished to two to three minutes. The appearance of the Coolidge tube is totally unlike that of the ordinary tube, as no zone of fluorescence is visible, and the only way one can tell that the tube is generating X-rays is by watching the fluoroscopic screen, by observing that the internal metal parts become red-hot or incandescent, and by noting the registration on the milliamperemeter. With this tube backing up a parallel spark of 10 inches, passing 7 milliampères through the tube at a focus skin distance of 6 inches through a filter of 3 millimetres of

Case of first-degree malignancy, cured by röntgenotherapy without cosmetic blemish. Cases of first-degree malignancy can be cured by either Röntgen rays or radium. Any cutting operation is contra-indicated. (Case treated by H. W. Dachtler, Toledo, Ohio.)

A and B. Mycosis fungoides-before. C. Surgical result. D. X-ray and radium result. Case of first-degree malignancy. Mycosis fungoides. Diagnosis confirmed by microscopical examination. The right temporal region was treated by surgical procedure. The remaining lesions were treated by massive röntgenotherapy, radium, and desiccation. There was a prompt recurrence in the area desiccated. This case illustrates that in cases of the first-degree of malignancy cutting operations are contra-indicated, because non-cutting physical methods give better cosmetic results with less shock and risk.

B

D

Case of first-degree malignancy. The growth had been cut out, with resultant scar and deformity. Recurrence in the wound. The second illustration shows the recurrence completely controlled and the scar softened by massive röntgenotherapy. Had this latter method been employed instead of surgery in the first place the condition would have been controlled without the resultant scar.

Case of third-degree malignancy. Lymphosarcoma. Diagnosis confirmed by microscopical section. Treated by various methods, including mixed toxins, without material improvement. Under massive, deep röntgenotherapy the following result was obtained. The patient subsequently died of an intercurrent disease.