History of radiation therapy
Encyclopedia
The history of radiation therapy or radiotherapy can be traced back to experiments made soon after the discovery of x-rays (1895), when it was shown that exposure to radiation
produced cutaneous burn
s. Influenced by electrotherapy
and escharotics — the medical application of caustic substances — doctors began using radiation to treat growths and lesions produced by diseases such as lupus
, rodent ulcer
, and epithelioma
. Radiation was generally believed to have bactericidal properties, so when radium
was discovered, in addition to treatments similar to those used with x-rays, it was also used as an additive to medical treatments for diseases such as tuberculosis
where there were resistant bacilli
.
Additionally, because radiation was found to exist in hot spring waters which were reputed for their curative powers, it was marketed as a wonder cure
for all sorts of ailments in patent medicine
and quack
cures. It was believed by medical science that small doses of radiation would cause no harm and the harmful effects of large doses were temporary.
The widespread use of radium in medicine ended when it was discovered that physical tolerance was lower than expected and exposure caused long term cell damage that could appear in carcinoma
up to 40 years after treatment. The use of radiation continues today as a treatment for cancer in radiation therapy
, where it is applied with strict safety precautions.
properties of x-rays were discovered, their practical use for research and diagnostics was immediately apparent, and soon their use spread in the medical field. X-rays were used to diagnose bone fractures, heart disease, and phthisis. Inventive procedures for different diagnostic purposes were created, such as filling digestive cavities with bismuth
, which allowed them to be seen through tissue and bone.
and Eduard Schiff, who, only a month or two after Röntgen's announcement, suggested they be used in the treatment of disease. At approximately the same time, Emil Grubbe
began experimenting in Chicago with medical uses of x-rays. Escharotics by this time had already been used to treat skin malignancies through caustic burns, and electrotherapy
had also been experimented with, in the aim to stimulate the skin tissue.
The first attempted x-ray treatment was by Victor Despeignes, a French physician who used them on a patient with stomach cancer. In 1896, he published a paper with the results: a week-long treatment was followed by a diminution of pain and reduction in the size of the tumor, though the case was ultimately fatal. The results were inconclusive, because the patient was concurrently being given other treatments. Freund's first experiment was a tragic failure; he applied x-rays to a naevus in order to induce epilation
and a deep ulcer resulted, which resisted further treatment by radiation. The first successful treatment was by Schiff, working with Freund, in a case of lupus vulgaris
. A year later, in 1897, the two published a report of their success and this provoked further experimentation in x-ray therapies. Thereafter they did a successful treatment of lupus erythematosus
in 1898. The lesion took a common form of a 'butterfly-patch' which appeared on both sides of the face, and Schiff applied the irradiation to one side only, in order to compare the effects.
Within a few months, scientific journals were swamped with accounts of the successful treatment of different types of skin tissue malignancies with x-rays. In Sweden, Thor Stenbeck published results of the first successful treatments of rodent ulcer
and epithelioma
in 1899, later that year confirmed by Tage Sjögren. Soon afterwards, their findings were confirmed by a number of other physicians.
The nature of the active agent in therapeutic treatment was still unknown, and subject to wide dispute. Freund and Schiff believed it to because of electrical discharge, Tesla argued they were because of the ozone
generated by the x-rays, while others argued that it was the x-rays themselves. Tesla's position was soon refuted, and only the other two theories remained. In 1900, Robert Kienböck
produced a study based on a series of experiments that demonstrated that it was the x-rays themselves. Studies published in 1899 and 1900 suggested that the rays varied in penetration due to according to the degree of vacuum in the tube.
rays when separated out by a system of quartz
crystals, and thereafter created a lamp to sift out the rays. The so-called Finsen lamp became widely used in for phototherapy, and derivatives of it became used when experimenting with other types of radiotherapy. Modifications were made to Finsen's original design, and it found its most common forms in the Finsen-Reyn lamp and Finsen-Lomholt lamp .
By 1905, it was estimated that fully 50 percent of the cases of lupus were successfully healed by Finsen's methods. Fisen was soon awarded a Nobel
prize for his research.
By 1900, there were four well established classes of problems that were treated by x-ray, based on a set of five classes initially outlined by Freund: 1. in hypertrichosis, for the removal of unwanted hair; 2. in the treatment of disease of hair and hair follicles in which it was necessary to remove hair; 3. in the treatment of inflammatory affections on the skin like eczema and acne; 4. and in the treatment of malignant affections on the skin in cases like lupus and epithelioma.
Additionally, x-rays were successfully applied to other appearances of carcinoma
, trials were done in treating leukemia
, and because of the supposed bactericidal properties, there were suggestions it could be used in diseases such as tuberculosis. Experiments were also done using x-rays to treat epilepsy
, which had previously also experimentally been treated with electrical currents.
in 1898 by Marie Curie
, there was speculation in whether the radiation could be used for therapy in the same way as that from x-rays. The physiological effect of radium was first observed in 1900 by Otto Walkhoff, and later confirmed by what famously known as the "Becquerel burn". In 1901, Henri Becquerel
had placed a tube of radium in a waistcoat pocket where it had remained for several hours; a week or two after which there was severe inflammation of his skin underneath where the radium had been kept. Ernest Besnier, a dermatologist, examined the skin and expressed the opinion that it was due to the radium, leading to experiments by Curie which confirmed it. Besnier suggested the use of radium for therapy along the same purposes as x-rays and ultraviolet rays.
Becquerel for this purpose loaned some radium to Henri-Alexandre Danlos
of the hôpital St.Louis in Paris in 1901. Danlos successfully treated a few cases of lupus with an admixture of radium
and barium chloride
. Further trials of radium therapy began, though at a much slower pace than did those using x-rays because radium was expensive and difficult to obtain.
), and the use of radium salts.
One method using emanation was through inhalation, where it was mixed with air. Radium inhalation had been most studied in Germany, where regular inhalation institutes were established, and the goal was to target the lungs. That was done either to treat lung diseases, like tuberculosis, or to be absorbed through the surface of the lung to the blood, where it could circulate through the body. It was claimed that the beneficial effects produced by radium water baths were the result of inhalation of the vapors.
Another method of treatment was to condense the emanation at liquid air temperature on substances such as vasoline, glycerine, and lanoline, to apply externally to the part affected; or on quinine, bismuth, subnitrate, and arsenic, to be consumed or applied internally.
Radium emanation was also passed into glass or metal tubes or flat glass-tight applicators and applied in the same way as radium tubes. In other cases was also deposited on metal points or flat surfaces of metal using electrical devices, which had the same level of radioactivity as the parent radium, but lasted a shorter duration. One way of treatment was to then drive the deposits of radioactive material into tissue using galvanic current. It was also a method of applying radium emanation to a specially designed applicator constructed to suit the needs of the patient, who could later take it home.
Dilute solutions of radium salts were also made, meant to be used internally. Patients would be prescribed regular dosages. More rarely, the salts were also suspended in liquids to be injected in subcutaneous treatments, which could be applied locally to affected tissues. That was considered the most expensive method, because the radium used was irreparably lost.
Like with radium emanation, solutions of free radium salts were also placed in tubes; in this case, the tubes were made from platinum. In metal tubes, the radium could be employed in a number of ways: externally; to the interior of the body in places like the mouth, nose, esophagus, rectum and vagina; and into the substance of a tumor through incisions.
Inspired by this, using preparations of radium salt in bath water was suggested as a way for patients to be treated at home, as the radio-activity in the bathwater was permanent. Radium baths became used experimentally to treat arthritis
, gout
, and neuralgia
s.
, particularly because they could be applied more specifically to tissues than with x-rays. Radium was generally to be preferred when a localized reaction was desired, while for x-rays when a large area needed to be treated. Radium was also believed to be bactericidal, while x-rays were not. Because they could not be applied locally, x-rays were also found to have worse cosmetic effects than radium when treating malignancies. In certain cases, a combination of x-ray and radium therapy was suggested. In many skin diseases, the ulcers would be treated with radium and the surrounding areas with x-rays so it would positively affect the lymphatic systems.
had disappeared. Inhalation of iodine alone had been an experimental treatment for tuberculosis in France between 1830 and 1870.
Radium had commonly been put into bath salts, waters, and muds was in low-grade preparations, due to the expense, and their usefulness in curative solutions was questioned, since it had been agreed upon by physicians that radium could only be used successfully in high doses. It was believed that even radiation emanation at higher doses that were useful would cause no harm, because the radioactive deposits were found to have been absorbed and released in urine and waste within a period of three hours.
Many products which imitated emanation activators were more broadly marketed to the public. One such product was the Revigator, a "radioactive water crock." A dispensing jar made of radium-containing ore, the idea was that radon produced by the ore would dissolve in the water overnight. It was advertised: "Fill jar every night. Drink freely . . . when thirsty and upon arising and retiring, average six or more glasses daily." The American Medical Association
(AMA) was concerned that the public was being fleeced by charlatans. In response, the AMA established guidelines (in effect from 1916 to 1929) that emanators seeking AMA approval had to generate more than 2 μCi
(74 kBq
) of radon per liter of water in a 24-hour period. Most devices on the market, including the Revigator did not meet that standard.
cures and patent medicines were sold on the market. Radithor
, a solution of radium salts, which was claimed by its developer William J. A. Bailey
to have curative properties. Many brands of toothpaste were laced with radium that was claimed to make teeth shine whiter, such as Doramad Radioactive Toothpaste
. Ostensibly, this would be because the radium would kill the bacteria in a person's mouth. One item, called "Degnen's Radio-Active Eye Applicator" manufactured by the Radium Appliance Company of Los Angeles, California, was sold as a treatment for myopia
, hypermetropia, presbyopia
and heterophobia
. Face creams and powders were sold, with names like 'Revigorette' and 'Tho-radia'. It was also sold as a supplement to smoking cigarettes. Companies also marked radioactive pads and compresses for the treatment of illnesses.
by California Senator John D. Works
as early as 1915. In a floor speech he quoted letters from doctors asking about the efficacy of the products that were marketed. He stressed that radiation had the effect of making many cancers worse, many doctors thought the belief radium could be used to cure cancers at that stage of the development of therapy was a "delusion" — one doctor quoted cited a failure-to-success rate of 100 to 1 — and the effects of radium water was undemonstrated.
Around the start of the 1920s, new public health concerns were sparked by the deaths of factory workers at a radioluminsecent
watch factory, later referred to as the Radium Girls
. In 1932, a well-known industrialist, Eben Byers
died of radiation poisoning from the use of Radithor
, a radium water guaranteed by the manufacturer to contain 2 µCi of radium. Cases sprung up of the development of carcinoma in patients who had used conventional radium therapy up to 40 years after the original treatments.
Robley D. Evans made the first measurements of exhaled radon and radium excretion from a former dial painter in 1933. At MIT he gathered dependable body content measurements from 27 dial painters. This information was used in 1941 by the National Bureau of Standards to establish the tolerance level for radium of 0.1 μCi
(3.7 kBq
).
By 1934, Coutard had developed a protracted, fractionated process that remains the basis for current radiation therapy. Coutard's dosage and fractionation were designed to create a severe but recoverable acute mucosal reaction. Unlike previous physicians, who believed that cancerous cells were more effected by radiation, he assumed that the population of cancerous cells had the same sensitivity for regeneration as normal cells. Coutard reported a 23% cure rate in the treatment of head and neck cancer. In 1935, hospitals everywhere began following his treatment plan.
.
The three main divisions of radiation therapy are external beam radiation therapy or teletherapy, brachytherapy or sealed source radiation therapy, and systemic radioisotope therapy or unsealed source radiotherapy. The differences relate to the position of the radiation source; external is outside the body, brachytherapy uses sealed radioactive sources placed precisely in the area under treatment, and systemic radioisotopes are given by infusion or oral ingestion. Brachytherapy can use temporary or permanent placement of radioactive sources. The temporary sources are usually placed by a technique called afterloading. In afterloading a hollow tube or applicator is placed surgically in the organ to be treated, and the sources are loaded into the applicator after the applicator is implanted. This minimizes radiation exposure to health care personnel. Particle therapy
is a special case of external beam radiation therapy where the particles are protons or heavier ions. Intraoperative radiation therapy or IORT is a special type of radiation therapy that is delivered immediately after surgical removal of the cancer. This method has been employed in breast cancer (TARGeted Introperative radiation therapy or TARGIT
), brain tumors and rectal cancers.
Radioactive idiodine, as developed in 1911, survives today primarily in the treatment of thyrotoxicosis (hyperthyroidism) and some types of thyroid cancer that absorb iodine. Treatment involves iodine-131
(131I), or radioiodone, an important radioisotope of iodine.
Radiation
In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...
produced cutaneous burn
Burn
A burn is an injury to flesh caused by heat, electricity, chemicals, light, radiation, or friction.Burn may also refer to:*Combustion*Burn , type of watercourses so named in Scotland and north-eastern England...
s. Influenced by electrotherapy
Electrotherapy
Electrotherapy is the use of electrical energy as a medical treatment In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of...
and escharotics — the medical application of caustic substances — doctors began using radiation to treat growths and lesions produced by diseases such as lupus
Lupus
Lupus most commonly refers to the disease systemic lupus erythematosus.Lupus may also refer to:-Medicine:* Lupus erythematosus, a chronic autoimmune disease with several different forms...
, rodent ulcer
Rodent ulcer
Rodent ulcer is a large skin lesion of nodular basal cell carcinoma with central necrosis. and is type of Basal cell carcinoma...
, and epithelioma
Epithelioma
Epithelioma is an abnormal growth of the epithelium, which is the layer of tissue that covers the surfaces of organs and other structures of the body.-Classification:Epitheliomas can be benign growths or malignant carcinomas...
. Radiation was generally believed to have bactericidal properties, so when radium
Radium
Radium is a chemical element with atomic number 88, represented by the symbol Ra. Radium is an almost pure-white alkaline earth metal, but it readily oxidizes on exposure to air, becoming black in color. All isotopes of radium are highly radioactive, with the most stable isotope being radium-226,...
was discovered, in addition to treatments similar to those used with x-rays, it was also used as an additive to medical treatments for diseases such as tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
where there were resistant bacilli
Bacilli
Bacilli refers to a taxonomic class of bacteria. It includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens like Bacillus anthracis .-Ambiguity:...
.
Additionally, because radiation was found to exist in hot spring waters which were reputed for their curative powers, it was marketed as a wonder cure
Panacea (medicine)
The panacea , named after the Greek goddess of healing, Panacea, also known as panchrest, was supposed to be a remedy that would cure all diseases and prolong life indefinitely...
for all sorts of ailments in patent medicine
Patent medicine
Patent medicine refers to medical compounds of questionable effectiveness sold under a variety of names and labels. The term "patent medicine" is somewhat of a misnomer because, in most cases, although many of the products were trademarked, they were never patented...
and quack
Quackery
Quackery is a derogatory term used to describe the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or...
cures. It was believed by medical science that small doses of radiation would cause no harm and the harmful effects of large doses were temporary.
The widespread use of radium in medicine ended when it was discovered that physical tolerance was lower than expected and exposure caused long term cell damage that could appear in carcinoma
Carcinoma
Carcinoma is the medical term for the most common type of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during...
up to 40 years after treatment. The use of radiation continues today as a treatment for cancer in radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
, where it is applied with strict safety precautions.
Early development of radiotherapy (1895–1905)
When the imagingMedical radiography
Radiography is the use of ionizing electromagnetic radiation such as X-rays to view objects. Although not technically radiographic techniques, imaging modalities such as PET and MRI are sometimes grouped in radiography because the radiology department of hospitals handle all forms of imaging...
properties of x-rays were discovered, their practical use for research and diagnostics was immediately apparent, and soon their use spread in the medical field. X-rays were used to diagnose bone fractures, heart disease, and phthisis. Inventive procedures for different diagnostic purposes were created, such as filling digestive cavities with bismuth
Bismuth
Bismuth is a chemical element with symbol Bi and atomic number 83. Bismuth, a trivalent poor metal, chemically resembles arsenic and antimony. Elemental bismuth may occur naturally uncombined, although its sulfide and oxide form important commercial ores. The free element is 86% as dense as lead...
, which allowed them to be seen through tissue and bone.
Discovery of the therapeutic potential of radiation
During early practical work and scientific investigation, experimenters noticed that prolonged exposure to x-rays created inflammation and, more rarely, tissue damage on the skin. The biological effect attracted the interest of Léopold FreundLeopold Freund
Leopold Freund -January 7, 1943 was an Austrian-Jewish radiologist, considered the founder of medical radiology and radiotherapy....
and Eduard Schiff, who, only a month or two after Röntgen's announcement, suggested they be used in the treatment of disease. At approximately the same time, Emil Grubbe
Emil Grubbe
Emil Herman Grubbe was probably the first American to use x-rays in the treatment of cancer. He was born in Chicago, and received his medical training at a homeopathic institute: the Hahnemann Medical College of Chicago...
began experimenting in Chicago with medical uses of x-rays. Escharotics by this time had already been used to treat skin malignancies through caustic burns, and electrotherapy
Electrotherapy
Electrotherapy is the use of electrical energy as a medical treatment In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of...
had also been experimented with, in the aim to stimulate the skin tissue.
The first attempted x-ray treatment was by Victor Despeignes, a French physician who used them on a patient with stomach cancer. In 1896, he published a paper with the results: a week-long treatment was followed by a diminution of pain and reduction in the size of the tumor, though the case was ultimately fatal. The results were inconclusive, because the patient was concurrently being given other treatments. Freund's first experiment was a tragic failure; he applied x-rays to a naevus in order to induce epilation
EPilation
EPilation is the first full-length release from Brisbane musician Tara Simmons. Although a full-length, EPilation contains no new material and is a compilation of Tara's first two EPs Pendulum and All The Amendments...
and a deep ulcer resulted, which resisted further treatment by radiation. The first successful treatment was by Schiff, working with Freund, in a case of lupus vulgaris
Lupus vulgaris
Lupus vulgaris are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around nose, eyelids, lips, cheeks and ears. The lesions may ultimately develop into disfiguring skin ulcers if left untreated...
. A year later, in 1897, the two published a report of their success and this provoked further experimentation in x-ray therapies. Thereafter they did a successful treatment of lupus erythematosus
Lupus erythematosus
Lupus erythematosus is a category for a collection of diseases with similar underlying problems with immunity . Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs...
in 1898. The lesion took a common form of a 'butterfly-patch' which appeared on both sides of the face, and Schiff applied the irradiation to one side only, in order to compare the effects.
Within a few months, scientific journals were swamped with accounts of the successful treatment of different types of skin tissue malignancies with x-rays. In Sweden, Thor Stenbeck published results of the first successful treatments of rodent ulcer
Rodent ulcer
Rodent ulcer is a large skin lesion of nodular basal cell carcinoma with central necrosis. and is type of Basal cell carcinoma...
and epithelioma
Epithelioma
Epithelioma is an abnormal growth of the epithelium, which is the layer of tissue that covers the surfaces of organs and other structures of the body.-Classification:Epitheliomas can be benign growths or malignant carcinomas...
in 1899, later that year confirmed by Tage Sjögren. Soon afterwards, their findings were confirmed by a number of other physicians.
The nature of the active agent in therapeutic treatment was still unknown, and subject to wide dispute. Freund and Schiff believed it to because of electrical discharge, Tesla argued they were because of the ozone
Ozone
Ozone , or trioxygen, is a triatomic molecule, consisting of three oxygen atoms. It is an allotrope of oxygen that is much less stable than the diatomic allotrope...
generated by the x-rays, while others argued that it was the x-rays themselves. Tesla's position was soon refuted, and only the other two theories remained. In 1900, Robert Kienböck
Robert Kienböck
Robert Kienböck was an Austrian radiologist who was a native of Vienna.In 1895 he earned his medical doctorate at the University of Vienna, and spent the next year abroad. He returned to Vienna as an assistant to Leopold von Schrötter , a laryngologist, and began working in the new science of...
produced a study based on a series of experiments that demonstrated that it was the x-rays themselves. Studies published in 1899 and 1900 suggested that the rays varied in penetration due to according to the degree of vacuum in the tube.
Niels Finsen and phototherapy
Niels Finsen, a Faroese-Danish physician, had by that time already pursued interest in the biological effects of light. He published a paper, Om Lysets Indvirkninger paa Huden ("On the effects of light on the skin") in 1893. Inspired by the discovery that x-rays could have therapeutic effects, he extended his research to examine directed light rays. In 1896, he published a paper on his findings, Om Anvendelse i Medicinen af koncentrerede kemiske Lysstraaler ("The use of concentrated chemical light rays in medicine"). Finsen discovered that lupus was amenable to treatment by ultravioletUltraviolet
Ultraviolet light is electromagnetic radiation with a wavelength shorter than that of visible light, but longer than X-rays, in the range 10 nm to 400 nm, and energies from 3 eV to 124 eV...
rays when separated out by a system of quartz
Quartz
Quartz is the second-most-abundant mineral in the Earth's continental crust, after feldspar. It is made up of a continuous framework of SiO4 silicon–oxygen tetrahedra, with each oxygen being shared between two tetrahedra, giving an overall formula SiO2. There are many different varieties of quartz,...
crystals, and thereafter created a lamp to sift out the rays. The so-called Finsen lamp became widely used in for phototherapy, and derivatives of it became used when experimenting with other types of radiotherapy. Modifications were made to Finsen's original design, and it found its most common forms in the Finsen-Reyn lamp and Finsen-Lomholt lamp .
By 1905, it was estimated that fully 50 percent of the cases of lupus were successfully healed by Finsen's methods. Fisen was soon awarded a Nobel
Nobel
Nobel can mean:*Nobel Prize, awarded annually since 1901, from the bequest of Swedish inventor Alfred NobelThe Nobel family:*Alfred Nobel, , the inventor of dynamite, instituted the Nobel Prizes...
prize for his research.
Röntgenotherapy
From initial therapeutic experiments, a new field of x-ray therapy was born, referred to as röntgenotherapy after Wilhelm Röntgen, the discoverer of x-rays. It was still unclear how the x-rays acted on the skin; however, it was generally agreed upon that the area affected was killed and either discharged or absorbed.By 1900, there were four well established classes of problems that were treated by x-ray, based on a set of five classes initially outlined by Freund: 1. in hypertrichosis, for the removal of unwanted hair; 2. in the treatment of disease of hair and hair follicles in which it was necessary to remove hair; 3. in the treatment of inflammatory affections on the skin like eczema and acne; 4. and in the treatment of malignant affections on the skin in cases like lupus and epithelioma.
Additionally, x-rays were successfully applied to other appearances of carcinoma
Carcinoma
Carcinoma is the medical term for the most common type of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during...
, trials were done in treating leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...
, and because of the supposed bactericidal properties, there were suggestions it could be used in diseases such as tuberculosis. Experiments were also done using x-rays to treat epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, which had previously also experimentally been treated with electrical currents.
Further development and the use of radium (1905–1915)
Because of the excitement over the new treatment, literature about the therapeutic effects of x-rays often exaggerated the propensity to cure different diseases. Reports of the fact that in some cases treatment worsened some of the patients' conditions were ignored in favor of hopeful optimism. Henry G. Piffard referred to these practitioners as "radiomaniacs" and "radiografters". It was found that x-rays were only capable of producing a cure in certain cases of the basal cell type of epithelioma and exceedingly unreliable in malignant cancer, not making it a suitable replacement for surgery. In many cases of treatment, the cancer recurred after a period of time. X-ray experiments in pulmonary tuberculosis proved useless. Aside from the medical profession losing faith in the ability of x-ray therapy, the public increasingly viewed it as a dangerous type of treatment. This resulted in a period of pessimism about the use of x-rays, which lasted from about 1905 to 1910 or 1912.Radium therapy
Soon after the discovery of radiumRadium
Radium is a chemical element with atomic number 88, represented by the symbol Ra. Radium is an almost pure-white alkaline earth metal, but it readily oxidizes on exposure to air, becoming black in color. All isotopes of radium are highly radioactive, with the most stable isotope being radium-226,...
in 1898 by Marie Curie
Marie Curie
Marie Skłodowska-Curie was a physicist and chemist famous for her pioneering research on radioactivity. She was the first person honored with two Nobel Prizes—in physics and chemistry...
, there was speculation in whether the radiation could be used for therapy in the same way as that from x-rays. The physiological effect of radium was first observed in 1900 by Otto Walkhoff, and later confirmed by what famously known as the "Becquerel burn". In 1901, Henri Becquerel
Henri Becquerel
Antoine Henri Becquerel was a French physicist, Nobel laureate, and the discoverer of radioactivity along with Marie Curie and Pierre Curie, for which all three won the 1903 Nobel Prize in Physics.-Early life:...
had placed a tube of radium in a waistcoat pocket where it had remained for several hours; a week or two after which there was severe inflammation of his skin underneath where the radium had been kept. Ernest Besnier, a dermatologist, examined the skin and expressed the opinion that it was due to the radium, leading to experiments by Curie which confirmed it. Besnier suggested the use of radium for therapy along the same purposes as x-rays and ultraviolet rays.
Becquerel for this purpose loaned some radium to Henri-Alexandre Danlos
Henri-Alexandre Danlos
Henri-Alexandre Danlos was a French physician and dermatologist born in Paris. With Danish dermatologist Edvard Ehlers , the Ehlers–Danlos syndrome is named, which is a group of inherited connective tissue disorders.He studied medicine in Paris, and during the early part of his career performed...
of the hôpital St.Louis in Paris in 1901. Danlos successfully treated a few cases of lupus with an admixture of radium
Radium
Radium is a chemical element with atomic number 88, represented by the symbol Ra. Radium is an almost pure-white alkaline earth metal, but it readily oxidizes on exposure to air, becoming black in color. All isotopes of radium are highly radioactive, with the most stable isotope being radium-226,...
and barium chloride
Barium chloride
Barium chloride is the inorganic compound with the formula BaCl2. It is one of the most common water-soluble salts of barium. Like other barium salts, it is toxic and imparts a yellow-green coloration to a flame. It is also hygroscopic....
. Further trials of radium therapy began, though at a much slower pace than did those using x-rays because radium was expensive and difficult to obtain.
Methods of application
Radium was soon seen as a way to treat disorders that were not affected enough by x-ray treatment because it could be applied in a multitude of ways in which x-rays could not. Different methods of applying radium had been tested, which fell into two categories: the use of radium emanation (now referred to as radonRadon
Radon is a chemical element with symbol Rn and atomic number 86. It is a radioactive, colorless, odorless, tasteless noble gas, occurring naturally as the decay product of uranium or thorium. Its most stable isotope, 222Rn, has a half-life of 3.8 days...
), and the use of radium salts.
One method using emanation was through inhalation, where it was mixed with air. Radium inhalation had been most studied in Germany, where regular inhalation institutes were established, and the goal was to target the lungs. That was done either to treat lung diseases, like tuberculosis, or to be absorbed through the surface of the lung to the blood, where it could circulate through the body. It was claimed that the beneficial effects produced by radium water baths were the result of inhalation of the vapors.
Another method of treatment was to condense the emanation at liquid air temperature on substances such as vasoline, glycerine, and lanoline, to apply externally to the part affected; or on quinine, bismuth, subnitrate, and arsenic, to be consumed or applied internally.
Radium emanation was also passed into glass or metal tubes or flat glass-tight applicators and applied in the same way as radium tubes. In other cases was also deposited on metal points or flat surfaces of metal using electrical devices, which had the same level of radioactivity as the parent radium, but lasted a shorter duration. One way of treatment was to then drive the deposits of radioactive material into tissue using galvanic current. It was also a method of applying radium emanation to a specially designed applicator constructed to suit the needs of the patient, who could later take it home.
Dilute solutions of radium salts were also made, meant to be used internally. Patients would be prescribed regular dosages. More rarely, the salts were also suspended in liquids to be injected in subcutaneous treatments, which could be applied locally to affected tissues. That was considered the most expensive method, because the radium used was irreparably lost.
Like with radium emanation, solutions of free radium salts were also placed in tubes; in this case, the tubes were made from platinum. In metal tubes, the radium could be employed in a number of ways: externally; to the interior of the body in places like the mouth, nose, esophagus, rectum and vagina; and into the substance of a tumor through incisions.
Radium baths
In 1903, the discoverer of the electron, J.J. Thompson, wrote a letter to the journal Nature in which he detailed his discovery of the presence of radioactivity in well water. Soon after, others found that the waters in many of the world's most famous health springs were also radioactive. This radioactivity is due to the presence of radium emanation produced by the radium that is present in the ground through which the waters flow. In 1904, Nature published a study on the natural radioactivity of different mineral waters.Inspired by this, using preparations of radium salt in bath water was suggested as a way for patients to be treated at home, as the radio-activity in the bathwater was permanent. Radium baths became used experimentally to treat arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
, gout
Gout
Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
, and neuralgia
Neuralgia
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...
s.
Röntgenotherapy vs. radium therapy
X-rays and radium were noted by physicians to have different advantages in different cases. The most marked effects produced with radium therapy were with lupus, ulcerous growths, and keloidKeloid
A keloid is a type of scar, which depending on its maturity, is composed mainly of either type III or type I collagen. It is a result of an overgrowth of granulation tissue at the site of a healed skin injury which is then slowly replaced by collagen type 1...
, particularly because they could be applied more specifically to tissues than with x-rays. Radium was generally to be preferred when a localized reaction was desired, while for x-rays when a large area needed to be treated. Radium was also believed to be bactericidal, while x-rays were not. Because they could not be applied locally, x-rays were also found to have worse cosmetic effects than radium when treating malignancies. In certain cases, a combination of x-ray and radium therapy was suggested. In many skin diseases, the ulcers would be treated with radium and the surrounding areas with x-rays so it would positively affect the lymphatic systems.
Tuberculosis and iodo-radium therapy
After using radium in the surgicial treatment of tuberculosis, researchers including Béla Augustin and A. de Szendeffy soon developed a treatment using radioactive metholated iodine, which was patented under the name dioradin (formed from "iodine and radium") in 1911. Application of this treatment was referred to as iodo-radium therapy, and involved injecting dioradin intramuscularly. It seemed promising to the developers, because in several cases, fever and hemoptysisHemoptysis
Hemoptysis or haemoptysis is the expectoration of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs Hemoptysis or haemoptysis is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs Hemoptysis or haemoptysis ...
had disappeared. Inhalation of iodine alone had been an experimental treatment for tuberculosis in France between 1830 and 1870.
Commercialization, quackery, and the end of an era (1915–1935)
Widespread commercial exploitation of radium only began in 1913, by which time more efficient methods of extracting radium from pitchblende had been discovered and the mining of radium had taken off.Commercial products
Radiation emanation activators
Radium emanation activators, apparatuses that would apply radium emanation to water, started being produced and marketed. Scientifically constructed emanators were sold to hospitals, universities, and independent researchers. Certain companies advertised that they would only give them out to others on a medical prescription and would guarantee the strength of radium in each dose.Many products which imitated emanation activators were more broadly marketed to the public. One such product was the Revigator, a "radioactive water crock." A dispensing jar made of radium-containing ore, the idea was that radon produced by the ore would dissolve in the water overnight. It was advertised: "Fill jar every night. Drink freely . . . when thirsty and upon arising and retiring, average six or more glasses daily." The American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) was concerned that the public was being fleeced by charlatans. In response, the AMA established guidelines (in effect from 1916 to 1929) that emanators seeking AMA approval had to generate more than 2 μCi
Curie
The curie is a unit of radioactivity, defined asThis is roughly the activity of 1 gram of the radium isotope 226Ra, a substance studied by the pioneers of radiology, Marie and Pierre Curie, for whom the unit was named. In addition to the curie, activity can be measured using an SI derived unit,...
(74 kBq
Becquerel
The becquerel is the SI-derived unit of radioactivity. One Bq is defined as the activity of a quantity of radioactive material in which one nucleus decays per second. The Bq unit is therefore equivalent to an inverse second, s−1...
) of radon per liter of water in a 24-hour period. Most devices on the market, including the Revigator did not meet that standard.
Patent medicines
Many other quackQuack
A quack is a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess.Quack may also refer to:* Quack , an independent-comics series published by Star Reach in the 1970s...
cures and patent medicines were sold on the market. Radithor
Radithor
Radithor was a patent medicine that is a well known example of radioactive quackery. It consisted of triple distilled water containing at a minimum each of the radium 226 and 228 isotopes.-History:...
, a solution of radium salts, which was claimed by its developer William J. A. Bailey
William J. A. Bailey
William John Aloysius Bailey was a Harvard University dropout who falsely claimed to be a doctor of medicine, and who promoted the use of radioactive radium as a cure for coughs, flu, and other common ailments...
to have curative properties. Many brands of toothpaste were laced with radium that was claimed to make teeth shine whiter, such as Doramad Radioactive Toothpaste
Doramad Radioactive Toothpaste
Doramad Radioactive Toothpaste was produced until 1945 in Germany by Auergesellschaft of Berlin. The toothpaste contained small amounts of thorium, though later analysis showed its radioactivity levels to be very low....
. Ostensibly, this would be because the radium would kill the bacteria in a person's mouth. One item, called "Degnen's Radio-Active Eye Applicator" manufactured by the Radium Appliance Company of Los Angeles, California, was sold as a treatment for myopia
Myopia
Myopia , "shortsightedness" ) is a refractive defect of the eye in which collimated light produces image focus in front of the retina under conditions of accommodation. In simpler terms, myopia is a condition of the eye where the light that comes in does not directly focus on the retina but in...
, hypermetropia, presbyopia
Presbyopia
Presbyopia is a condition where the eye exhibits a progressively diminished ability to focus on near objects with age. Presbyopia’s exact mechanisms are not known with certainty; the research evidence most strongly supports a loss of elasticity of the crystalline lens, although changes in the...
and heterophobia
Heterophobia
Heterophobia describes reverse discrimination based on sexual orientation and implies an irrational fear of, aversion toward, or discrimination againist heterosexual people and institutions...
. Face creams and powders were sold, with names like 'Revigorette' and 'Tho-radia'. It was also sold as a supplement to smoking cigarettes. Companies also marked radioactive pads and compresses for the treatment of illnesses.
Joachimsthal radium spa hotel
In light of the supposed curative properties of radioactivity, a spa was opened up in Joachimsthal, the place at which Madame Curie gathered some of her original samples of radium from spring waters. Radon inhalation rooms were set up, where air tubes carried the gas up from a processing tank in the basement; the visitor would then use it through an inhalation apparatus. Baths were set up which were also irradiated, and irradiated air was also filtered through a trumpet like pipe for inhalation.Public health concerns
Concerns about radium were brought up before the United States SenateUnited States Senate
The United States Senate is the upper house of the bicameral legislature of the United States, and together with the United States House of Representatives comprises the United States Congress. The composition and powers of the Senate are established in Article One of the U.S. Constitution. Each...
by California Senator John D. Works
John D. Works
John Downey Works was a U.S. Senator representing California from 1911 to 1917.John Downey Works was born in Indiana and attended private schools there. As a young man he served in the American Civil War as a member of the Tenth Regiment of the Indiana Volunteer Cavalry...
as early as 1915. In a floor speech he quoted letters from doctors asking about the efficacy of the products that were marketed. He stressed that radiation had the effect of making many cancers worse, many doctors thought the belief radium could be used to cure cancers at that stage of the development of therapy was a "delusion" — one doctor quoted cited a failure-to-success rate of 100 to 1 — and the effects of radium water was undemonstrated.
Around the start of the 1920s, new public health concerns were sparked by the deaths of factory workers at a radioluminsecent
Radioluminescence
Radioluminescence is the phenomenon by which luminescence is produced in a material by the bombardment of ionizing radiation such as beta particles.-Tritium:...
watch factory, later referred to as the Radium Girls
Radium Girls
The Radium Girls were female factory workers who contracted radiation poisoning from painting watch dials with glow-in-the-dark paint at the United States Radium factory in Orange, New Jersey around 1917....
. In 1932, a well-known industrialist, Eben Byers
Eben Byers
Eben McBurney Byers was a wealthy American socialite, athlete, and industrialist. Byers earned notoriety in the early 1930s when he died from radiation poisoning after consuming a popular patent medicine made from radium dissolved in water.-Biography:The son of industrialist Alexander Byers, Eben...
died of radiation poisoning from the use of Radithor
Radithor
Radithor was a patent medicine that is a well known example of radioactive quackery. It consisted of triple distilled water containing at a minimum each of the radium 226 and 228 isotopes.-History:...
, a radium water guaranteed by the manufacturer to contain 2 µCi of radium. Cases sprung up of the development of carcinoma in patients who had used conventional radium therapy up to 40 years after the original treatments.
Robley D. Evans made the first measurements of exhaled radon and radium excretion from a former dial painter in 1933. At MIT he gathered dependable body content measurements from 27 dial painters. This information was used in 1941 by the National Bureau of Standards to establish the tolerance level for radium of 0.1 μCi
Curie
The curie is a unit of radioactivity, defined asThis is roughly the activity of 1 gram of the radium isotope 226Ra, a substance studied by the pioneers of radiology, Marie and Pierre Curie, for whom the unit was named. In addition to the curie, activity can be measured using an SI derived unit,...
(3.7 kBq
Becquerel
The becquerel is the SI-derived unit of radioactivity. One Bq is defined as the activity of a quantity of radioactive material in which one nucleus decays per second. The Bq unit is therefore equivalent to an inverse second, s−1...
).
Coutard method
At the International Congress of Oncology in Paris in 1922, Henri Coutard, a French radiologist working with the Institut Curie, presented evidence that laryngeal cancer could be treated without disastrous side-effects. Coutard was inspired by the observations of Claudius Regaud, who found that a single dose of x-rays sufficient enough to produce severe skin damage and tissue destruction in a rabbit, if administered in fractions, over a course of days, would sterilize the rabbit but have no effect on subcutaneous tissues.By 1934, Coutard had developed a protracted, fractionated process that remains the basis for current radiation therapy. Coutard's dosage and fractionation were designed to create a severe but recoverable acute mucosal reaction. Unlike previous physicians, who believed that cancerous cells were more effected by radiation, he assumed that the population of cancerous cells had the same sensitivity for regeneration as normal cells. Coutard reported a 23% cure rate in the treatment of head and neck cancer. In 1935, hospitals everywhere began following his treatment plan.
Radiation therapy today (1935—)
Treatments of cancer by x-ray today generally follows Coutard's fractionated process, while radiated rods are used in brachytherapyBrachytherapy
Brachytherapy , also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment...
.
The three main divisions of radiation therapy are external beam radiation therapy or teletherapy, brachytherapy or sealed source radiation therapy, and systemic radioisotope therapy or unsealed source radiotherapy. The differences relate to the position of the radiation source; external is outside the body, brachytherapy uses sealed radioactive sources placed precisely in the area under treatment, and systemic radioisotopes are given by infusion or oral ingestion. Brachytherapy can use temporary or permanent placement of radioactive sources. The temporary sources are usually placed by a technique called afterloading. In afterloading a hollow tube or applicator is placed surgically in the organ to be treated, and the sources are loaded into the applicator after the applicator is implanted. This minimizes radiation exposure to health care personnel. Particle therapy
Particle therapy
Particle therapy is a form of external beam radiotherapy using beams of energetic protons, neutrons, or positive ions for cancer treatment. The most common type of particle therapy as of 2009 is proton therapy. Although a photon, used in x-ray or gamma ray therapy, can also be considered a...
is a special case of external beam radiation therapy where the particles are protons or heavier ions. Intraoperative radiation therapy or IORT is a special type of radiation therapy that is delivered immediately after surgical removal of the cancer. This method has been employed in breast cancer (TARGeted Introperative radiation therapy or TARGIT
TARGIT
TARGIT is a technique of giving radiotherapy to the tissues surrounding a cancer after its surgical removal. The technique was designed in 1998 at the University College London...
), brain tumors and rectal cancers.
Radioactive idiodine, as developed in 1911, survives today primarily in the treatment of thyrotoxicosis (hyperthyroidism) and some types of thyroid cancer that absorb iodine. Treatment involves iodine-131
Iodine-131
Iodine-131 , also called radioiodine , is an important radioisotope of iodine. It has a radioactive decay half-life of about eight days. Its uses are mostly medical and pharmaceutical...
(131I), or radioiodone, an important radioisotope of iodine.