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RADIUM AND RADON BIOLOGICAL REACTIONS COMPARED
1048 in the blood-stream by some mechanism operating during pregnancy. Nevertheless, when the products of conception die, the placenta ceases to produce not This only oestrogens but also progesterone. conjecture is substantiated by the recent work of Browne et al. (1939), who found a gross fall in the output of pregnandiol in missed abortion. The uterus then is released from the all-powerful influence of progesterone and can react to oestrogens by expelling the dead products of conception. Hormone induction of abortion or labour when the foetus is dead is therefore possible in a large percentage of cases ; the technique is easy and the subsequent evacuation of the uterus unattended by complications. The results justify the adoption of this method as the standard treatment in these cases. SUMMARY
(1) Intra-uterine death of the products of conception is followed by a decrease in the amount of oestrogens in the blood-stream. Administration of oestrogens to patients with missed abortion and missed labour so increases the sensitivity of the uterus that its evacuation is usually promoted. (2) The method of induction described here was successful in 48 out of 55 consecutive cases. Expulsion of the products of conception was free from complications such as uterine haemorrhage and infection. (3) The rationale of the use of cestrogens in these The routine adoption of this cases is discussed. medicinal method of induction should make surgical intervention, with its attendant risks, rarely necessary. The following proprietary oestrogenic preparations were used : CEstroform, CEstroform B. (British Drug Houses), Progynon B. (Scherings), Dimenformone (Organon), Stilbcestrol (British Drug Houses), Syntestrin (Gedeon Richter). I am indebted to these firms for their various products, which were supplied free or at reduced cost. Most of the patients were treated in the Liverpool Maternity and Women’s Hospitals, and I am grateful to colleagues on the staffs of these hospitals for permission to direct the treatment and to record the results. REFERENCES
where Q is the number of milligrammes of radium, Qo the number of millicuries of radon, and X==0’18 day-1, the length of treatment (t) being kept the same ; or the time of treatment may be extended to T, the quantity Q being kept the same, according to the equation
Q
’
Browne, J. S. L., Henry, J. S. and Venning, E. H. (1939) Amer. J. Obstet. Gynec. 38, 927. Frank, R. T., Goldberger, M. A. and Spielman, F. (1933) J. Amer. med. Ass. 101, 266. Polonsky, J. (1936) Lpool med.-chir. J. 44, 58. Robinson, A. L., Datnow, M. and Jeffcoate, T. N. A. (1935) Brit. med. J. 1, 749.
SUMMARY
carried out on the action of radium on the rabbit’s ovary were repeated with radon. On the whole the effects produced were remarkably similar.
Experiments previously
The Lancet 100 Years
RADIUM AND RADON BIOLOGICAL REACTIONS COMPARED
Hospital, London) THosE who have consistently used radium in treatment are apt to question how far it is possible to substitute radon for radium, in view of the significant change in strength of radon with the length of treatment. This question became important last September, when radium all over the country was put into safe custody ; radon quickly became available, but no doubt some have refrained from using it because of uncertainty about how far it can take the place of radium. In 1932 we investigated the action of radium on the ovary of the rabbit,! and it now seemed worth while to repeat the experiments with radon. These be duplicated only in the sense doses of radiation could be given. This can be done in one of two ways : either the; initial quantity of radon can be increased, according’ to the equation
Qo (1 — e - &lgr;t ) =
,
&lgr;Qt,
1. Russ, S. and Scott, G. M. Brit. J. Radiol. 1932, 5, 814.
Ago
June 6, 1840, p. 371. From the evidence
BY S. RUSS AND G. M. SCOTT the Barnato Joel Laboratories at the Middlesex (From
experiments could that equal physical
(1- e -&lgr;T) = &lgr;Qt.
We chose prolonging the time of treatment to compensate for the decline in the strength of the radon rather than increasing the initial strength of the source. The initial strength of the radon source was 6 millicuries, and it was left in situ for 11’1 days, the corresponding interval with 6 mg. of radium element being 4-8 days. So the question narrows down to whether there is any significant change in the reactions of the ovary of the rabbit when irradiated with radium and with radon, the initial sources being of the same strength but the time of exposure lengthened from 4-8 to 11-1 days. (The Paris technique for the treatment of cervical cancer with radium extends over 5 days.) Complete details of the technique adopted need hardly be given here ; it is enough to say that radon in platinum tubes was stitched on either side of a rabbit’s ovary and removed after 11.1 days. The rabbit was allowed to live for another six weeks ; it was then killed, and the ovaries were removed for examination. In two rabbits the radiation was screened by 0-6 mm. of platinum ; in a third the screenage was 0-3 mm. of platinum. The sections prepared showed that extensive damage had been done to the irradiated ovaries. In the rabbits in which 0-6 mm. platinum screens were used, the extent and degree of this damage could not be distinguished from that produced by the same dose of radium with the same screen. When the screen was 0-3 mm., the resulting damage appeared to be rather greater than that caused by radium under the same conditions ; it is likely that this difference in the effects produced by radon and by radium is due to the extra degree of screening brought about by the radium itself inside the platinum container. A radium salt within a platinum tube is a little more screened than a radon source inside a similar tube.
of Sir Richard Dobson before a Royal Commission:: Do you think it would be of great advantage to the service, if, instead of calling those gentlemen physicians, they were called surgeons of the fleet ?-Most unquestionably, because, after a battle, those gentlemen who are physicians of the fleet will not use any instrument, and never do. As the thing is at present, a physician to the fleet has his right hand tied behind his back, it being incompatible with his title to operate.... Without meaning the slightest disrespect to any man on the list of physicians, I can say that if there be any blockheads amongst the surgeons of the navy there is is so great a blockhead as to think himself
not not
one
who
perfectly
qualified for the duties of a physician ; but when physicians would have the operations of an hospital to perform they would rather feel their disqualification. I am of opinion that a hospital surgeon ought to be higher paid than a physician, inasmuch as his duties are more laborious, and neither less difficult nor requiring inferior
well
qualifications. At a physician testimony of it. seen ;
all events, if a surgeon blunder, it is may prescribe wrong, but there is no
In consequence of the evidence of Sir R. DOBSON, and of other witnesses, the commission have recommended that the rank of physician should be abolished in the naval service."
(1) Intra-uterine death of the products of conception is followed by a decrease in the amount of oestrogens in the blood-stream. Administration of oestrogens to patients with missed abortion and missed labour so increases the sensitivity of the uterus that its evacuation is usually promoted. (2) The method of induction described here was successful in 48 out of 55 consecutive cases. Expulsion of the products of conception was free from complications such as uterine haemorrhage and infection. (3) The rationale of the use of cestrogens in these The routine adoption of this cases is discussed. medicinal method of induction should make surgical intervention, with its attendant risks, rarely necessary. The following proprietary oestrogenic preparations were used : CEstroform, CEstroform B. (British Drug Houses), Progynon B. (Scherings), Dimenformone (Organon), Stilbcestrol (British Drug Houses), Syntestrin (Gedeon Richter). I am indebted to these firms for their various products, which were supplied free or at reduced cost. Most of the patients were treated in the Liverpool Maternity and Women’s Hospitals, and I am grateful to colleagues on the staffs of these hospitals for permission to direct the treatment and to record the results. REFERENCES
where Q is the number of milligrammes of radium, Qo the number of millicuries of radon, and X==0’18 day-1, the length of treatment (t) being kept the same ; or the time of treatment may be extended to T, the quantity Q being kept the same, according to the equation
Q
’
Browne, J. S. L., Henry, J. S. and Venning, E. H. (1939) Amer. J. Obstet. Gynec. 38, 927. Frank, R. T., Goldberger, M. A. and Spielman, F. (1933) J. Amer. med. Ass. 101, 266. Polonsky, J. (1936) Lpool med.-chir. J. 44, 58. Robinson, A. L., Datnow, M. and Jeffcoate, T. N. A. (1935) Brit. med. J. 1, 749.
SUMMARY
carried out on the action of radium on the rabbit’s ovary were repeated with radon. On the whole the effects produced were remarkably similar.
Experiments previously
The Lancet 100 Years
RADIUM AND RADON BIOLOGICAL REACTIONS COMPARED
Hospital, London) THosE who have consistently used radium in treatment are apt to question how far it is possible to substitute radon for radium, in view of the significant change in strength of radon with the length of treatment. This question became important last September, when radium all over the country was put into safe custody ; radon quickly became available, but no doubt some have refrained from using it because of uncertainty about how far it can take the place of radium. In 1932 we investigated the action of radium on the ovary of the rabbit,! and it now seemed worth while to repeat the experiments with radon. These be duplicated only in the sense doses of radiation could be given. This can be done in one of two ways : either the; initial quantity of radon can be increased, according’ to the equation
Qo (1 — e - &lgr;t ) =
,
&lgr;Qt,
1. Russ, S. and Scott, G. M. Brit. J. Radiol. 1932, 5, 814.
Ago
June 6, 1840, p. 371. From the evidence
BY S. RUSS AND G. M. SCOTT the Barnato Joel Laboratories at the Middlesex (From
experiments could that equal physical
(1- e -&lgr;T) = &lgr;Qt.
We chose prolonging the time of treatment to compensate for the decline in the strength of the radon rather than increasing the initial strength of the source. The initial strength of the radon source was 6 millicuries, and it was left in situ for 11’1 days, the corresponding interval with 6 mg. of radium element being 4-8 days. So the question narrows down to whether there is any significant change in the reactions of the ovary of the rabbit when irradiated with radium and with radon, the initial sources being of the same strength but the time of exposure lengthened from 4-8 to 11-1 days. (The Paris technique for the treatment of cervical cancer with radium extends over 5 days.) Complete details of the technique adopted need hardly be given here ; it is enough to say that radon in platinum tubes was stitched on either side of a rabbit’s ovary and removed after 11.1 days. The rabbit was allowed to live for another six weeks ; it was then killed, and the ovaries were removed for examination. In two rabbits the radiation was screened by 0-6 mm. of platinum ; in a third the screenage was 0-3 mm. of platinum. The sections prepared showed that extensive damage had been done to the irradiated ovaries. In the rabbits in which 0-6 mm. platinum screens were used, the extent and degree of this damage could not be distinguished from that produced by the same dose of radium with the same screen. When the screen was 0-3 mm., the resulting damage appeared to be rather greater than that caused by radium under the same conditions ; it is likely that this difference in the effects produced by radon and by radium is due to the extra degree of screening brought about by the radium itself inside the platinum container. A radium salt within a platinum tube is a little more screened than a radon source inside a similar tube.
of Sir Richard Dobson before a Royal Commission:: Do you think it would be of great advantage to the service, if, instead of calling those gentlemen physicians, they were called surgeons of the fleet ?-Most unquestionably, because, after a battle, those gentlemen who are physicians of the fleet will not use any instrument, and never do. As the thing is at present, a physician to the fleet has his right hand tied behind his back, it being incompatible with his title to operate.... Without meaning the slightest disrespect to any man on the list of physicians, I can say that if there be any blockheads amongst the surgeons of the navy there is is so great a blockhead as to think himself
not not
one
who
perfectly
qualified for the duties of a physician ; but when physicians would have the operations of an hospital to perform they would rather feel their disqualification. I am of opinion that a hospital surgeon ought to be higher paid than a physician, inasmuch as his duties are more laborious, and neither less difficult nor requiring inferior
well
qualifications. At a physician testimony of it. seen ;
all events, if a surgeon blunder, it is may prescribe wrong, but there is no
In consequence of the evidence of Sir R. DOBSON, and of other witnesses, the commission have recommended that the rank of physician should be abolished in the naval service."