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the hard x ray, but of shorter wave length and more powerful penetration. Therefore we have, in the therapeutic apphcation of radium four factors to consider: amount of radium, screening, length of exposure, and Cialis Tadalafil 100 Mg 30 Tablet distance between the radium and the area to be treated. A fifth factor might be men- tioned — personal idiosyncrasy. In the use of the X rays we take into consideration the voltage and amperage Cialis Tadalafil 100 Mg 30 Tablet of the current used instead of "quantity" as with radium, the other factors being the same. So far as is definitely known the action of both radium and x rays is purely local. They have no effect, favorable or adverse, on metastases, nor will the treatment of a primary lesion effect a secondary growth of some other part of the body; the rays must Cialis Tadalafil 100 Mg 30 Tablet be applied to the circumscribed area involved. Noted research workers, both at home and abroad, have proved and recorded these laws of radium : near the location of a tube of radium, a complete local destruction of all tissues is efTected, if so desired, depending upon screening, length of ex- posure, etc. ; at slightly increased distance there is more or less gradual destruction of malignant cells with increased growth of connective tissue ; beyond this there is only partial destruction of cancer cells with less overgrowth of connective tissue; still fur- ther on there is a stimulating effect to the malignant cells; after which, the radium has no eflfect. The changes produced in the tissues by x rays are similar to, but not identical with, those pro- duced by radium, notwithstanding evidence to the contrary by a number of x ray and radium workers of more or less Cialis Tadalafil 100 Mg 30 Tablet repute. Wickham and Degrais (i) say: "If a current of electric sparks be passed into and split up in Cialis Tadalafil 100 Mg 30 Tablet a glass vacuum tube (Crook's tube), it is filled with special fluorescence, and certain rays, such as anode, cathode, and x rays are produced respectively analogous to, but not identical with, the alpha, beta, and gamma rays of radium." My own experience leads me to believe that there is a diilference in the biological effects of the two agents and that a radium dermatitis or ulcer heals much more readily than one produced by x rays. .Ad- mitting that there is a close similarity between the effects of radium and x rays, there would still be clear cut indications for both their separate and conjoint use. This is especially true in gj'necologi- cal work, and in the treatment of malignant condi- tions involving cavities. Generally speaking, where there is a large area to be treated, as in carcinoma or sarcoma of the breast or a large area of obstinate eczema, the x rays are to be desired; while in the treatment of uterine conditions, or in epitheliomata of the mucous surfaces radium is preferable be- cause of its ease of application and because it can be brought into close proximity with the part to be treated. It might be saiil in this connection that, in my opinion, their combined use is often better than either when used alone. Undoubtedly as we gain in knowledge and experi- ence we will understand more clearly the varying and equal properties of these two great agents. We will no longer look upon them as rivals, but as partners ; we will Cialis Tadalafil 100 Mg 30 Tablet no longer madly advocate one be- cause we possess it, but will endeavor to utilize it to its greatest capacity, and when necessary call upon the other. As our technic improves we will doubt- less discover that in a great many conditions one is as applicable as the other. 'i he X ray was first given great prominence in the treatment of epitheliomata, and although its first ardor of enthusiasm is passed, it is not only holding its own, but is constantly gaining ground in the treat- ment of malignant conditions of the cutaneous sur- face. In the hands of competent workers the rela- tive percentage of cures is contesting strongly the [>ercentage cured by radium. In several cases 1 have been able to obtain apparent cures with radium th.at had resisted treatment with x rays by some of the most capable rontgenologists of the South. Perha-ps the experience of other men may prove the reverse. It may be pointed out here that after all it might iiave been the combined use that did the work suc- cessfully, and that had radium been used in the be- ginning it might have been necessary, or at least ad- vantageous, to follow with X rays. In the treatment of ngjvi, small eczematous patches, celoids, etc., the consensus seems to favor radium as the agent of choice. In the field of gynecology both radium and x rays arc of inestimable value, and are going to be used more and more as Cialis Tadalafil 100 Mg 30 Tablet our technic improves and results become known. In cancer of the breast unless hopelessly inoperable, a thorough dissection is always advisable, followed by thorough x ray or radium radiation. The x ray Cialis Tadalafil 100 Mg 30 Tablet is preferable because of the possibility of irradiating a large area more homogeneously than if done with radium. The x rays are also preferable, in my opinion, in the treat- ment of large pelvic or abdominal grow'ths for the same reason. For thirty years and more the surgical cure of cancer of the uterus has been the aim of some of the brightest minds of the profession ; tire- less efforts have been exerted to prevent, by surgical methods, the extension of the disease. The dif- ferent methods of hysterectomy and in involvements of the cervix, amputation and cautery, all have been trieil with varying degrees of success, but even in carefully selected cases the lumiber of fatalities has been appallingly large. Even with present improved methods, and in the hands of most skillful opera- tors, more than half of the cases fail to Cialis Tadalafil 100 Mg 30 Tablet respond. Admitting these things as true, surgery still has precedence in a large number of cases. The opera- tive treatment of malignancies confined to the fun- dus is always advisable. When the involvement is general it is a mooted question as to whether opera- tion is best ; it is impossible to remove all of the diseased tissue ; tissues that formerly clung to the central organs are forced to retract back upon their posterior anchor, the pelvic wall. The pressure upon the sacral nerves is thus intensified sometimes March i6, 1918.] WEED: LOCAL APPLICATION OF RADIUM AND X RAYS. 497