Discussion on Paper of Dr. Henry Schmitz

Abstract

HomeRadiologyVol. 1, No. 2 PreviousNext Discussions of PapersDiscussion on Paper of Dr. Henry SchmitzPublished Online:Oct 1 1923https://doi.org/10.1148/1.2.110MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDr. Albert Soiland, Los Angeles, California: This paper of Dr. Schmitz's is perhaps one of those which we like least to hear, and yet it is one of the things which is brought home to each of us who has done any amount of irradiation. When I open my morning mail I always look at the envelopes to see if there is a letter from some attorney, for people have become educated to the fact that the radiologist is a fertile field for remuneration. However, that does not exonerate us when we injure the skin. With our present knowledge of the physics of the thing there is no longer any excuse for injuring the skin, but we are taking a chance with every patient we treat. I make this statement in spite of our knowledge of the skin and of the X-ray measurements. We can measure everything under the sun but the human animal. As a rule we can strike an average which is reasonably safe, but with that knowledge we must remember that the patient will come, upon whom you will apply a safe dosage and yet that particular patient will develop, within a few months or a few years, a radiation injury. I hope we will all take Dr. Schmitz's paper very much to heart because it gives us information which we must always bear in mind. As Dr. Schmitz enumerated the various forms of treatment he has used, for the most part unsuccessfully, it shows that there is no real treatment for X-ray burns. We have to treat the individual; if the condition can be removed surgically that is the thing to do. That is the quickest way out of the mess. The medical treatment is merely palliative, useful in some cases but entirely useless in others.Our present-day knowledge of the question of irradiation is of considerable help in that we do not now see the bad cases of radiodermatitis that we saw several years ago. There is always the possibility of the delayed reaction and that I am unable to explain in any way. This thing was brought to my mind in a patient I saw just two days before leaving home for this meeting. That patient was treated for uterine fibroid some eight years ago by a man who was careful and knows his business, and yet that patient developed a dermatitis and had necrosis of the skin eight years later. It is the typical case of pigmentation which remains eight years after the treatment and in that mass of pigment is the telangiectasia and the ulcers which can only be treated by the surgeon. That is the longest period between treatment and effect that I have ever heard of. We have a patient in our office who was treated two years ago with a small skin applicator of radium. She has two punched-out square ulcers 1 cm. deep just about the size of the applicator. They are painful and can be relieved only by surgery. These things must be kept in mind, but I think this should not deter us from our efforts to make use of these agents, for the longer we use them the better we will know how to handle them and the more infrequent will be these accidental conditions.Article HistoryPublished in print: Oct 1923 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 1, No. 2 Metrics Altmetric Score PDF download