Book Review

MaIignant Disease and Ita Treatment by Radium. By Sir Stanford Cade. 2nd ed., vol. 1, 383 pages. Balti- more, 1948. The Williams & Wilkins Company. Price $12.50.

The first edition of this book appeared in 1940 as a single volume of 1,280 pages. The present edition is to be published as four separate smaller volumes. The first volume is subdivided into two parts, “The Radio- activity of Radium” and “Biological Effects of Radiation.” The material is of rather broader interest than the titles of the book or its part might indicate. The stated object is first, an account of malignant disease, second, to indicate the choice of treatment and only third, to detail the methods of radium therapy. Throughout much of this volume one might read “radiotherapy” for “radium” for it is repeatedly emphasized that x-rays and radium produce a similar response in tissue.

The chapter on general considerations offers a healthy orientation concerning the choice of treatment in malignant disease. The author believes that success here lies in coordinated teamwork and not so much in the method as in its efficient application.

There is an excellent survey of the dura- tion of untreated cancer. This should be the measure of the value of any method of treatment, but information on this aspect of the disease is not common knowledge. The life expectancy of a patient with untreated carcinoma of the breast is 3.25 years, a figure which should temper satisfac- tion with early good results in treated patients.

The chapters dealing with physics and dosimetry cover fundamental aspects with adequate references for sources of specific and detailed information. The section on interstitial therapy, radium plaques and teletherapy are by C. W. Wilson, L. H. Gray and H. T. Flint. Information on dosage to radium workers by stray radiation and on protection is included.

Under a discussion of the effects of radia- tion on normal tissues the description of skin reaction is worthy of close attention. The stages of skin reaction are clearly

described with serial histologic illustrations. A knowledge of the essential changes in skin in patients receiving intensive radia- tion therapy would be helpful to the clinician concerned with the possibility of radium or x-ray burn. The section dealing with the hematopoietic tissues offers detailed information on patients and radium workers, applicable to radiation effect from any source. This is a concise account useful to any who may anticipate a need to care for patients exposed to radioactive materials.

The chapter ‘LTissue Culture and Experi- mental Radiology” is a new addition to the book. In the hands of the pathologist tissue culture has become an important aid in establishing the diagnosis in undifferenti- ated tumors. Apart from its wide applica- tion in clarifying the biologic action of radiation, the method may also be useful in determining the prognosis in a given case while the patient is still under treatment.

The last chapter “Dangers of Radium and Protection” is perhaps the most valu- able section of the volume. Here the author presents twenty detailed case histories of radium burn. This represents a part of experience that is not proportionately reported in the literature. Radionecrosis is not necessarily an ill result for in some instances it has been the price of a favorable outcome in an otherwise incurable disease. The course of this complication may be prolonged and difficult of management and it would be of great benefit if more informa- tion of this nature were available.

Although this extensive review of ex- perimental and clinical observation is docu- mented with 575 references, occasional information of some importance lacks nota- tion of source or basis. The sterilization dose for the human ovary is given as 280 r for x-rays generated at 180 kv. (p. 231) and as 840 r for radium (p. 336). These values are not necessarily conflicting but some amplification concerning the time factor and technic would be necessary for practical application.

V.P.C.

$3 AMERICAN JOURNAL OF MEDICINE