X-rays tubes and radium
By the 1920s radiotherapy was well developed with the use of X-rays and radium. There was an increasing realisation of the importance of accurately measuring the dose of radiation and this was hampered by the lack of good apparatus. The science of radiobiology was still in its infancy and increasing knowledge of the biology of cancer and the effects of radiation on normal and pathological tissues made an enormous difference to treatment. Treatment planning began in this period with the use of multiple external beams. The X-ray tubes were also developing with replacement of the earlier gas tubes with the modern Coolidge hot-cathode vacuum tubes. The voltage that the tubes operated at also increased and it became possible to practice ‘deep X-ray treatment’ at 250 kV. Sir Stanford Cade published his influential book “Treatment of Cancer by Radium” in 1928 and this was one of the last major books on radiotherapy that was written by a surgeon.
Lung Cancer and Ralston Paterson
The great radiotherapist Ralston Paterson writes (Paterson BJR 1928; 1(3): 90-96) on the X-ray treatment of lung cancer. Surgery for lung cancer had yet to develop and radiotherapy was the only hope for treatment. Paterson stated that “in spite of the fact that life is not prolonged, roentgen-ray treatment gives marked temporary palliation.” Paterson was writing from the Mayo Foundation in Rochester, Minnesota where he was working as a Fellow in Radiology. By the 1920s there were starting to appear radiologists who specialised primarily in diagnosis or therapy. In the earlier period radiologists practiced both diagnosis and therapy and this combination continued for a long time particularly on continental Europe.
Harold Burrows gives an interesting account in 1928 (Burrows BJR 1928; 1(2): 59-60) of the development of a basal cell carcinoma as a complication of previous radiotherapy for ringworm. Radiotherapy was use to treat ringworm of the scalp (a fungal skin disease) at a time when the development of anti-fungal agents was in the far future and having ringworm had serious social consequences with exclusion of affected children from school.
Image source: Burrows BJR 1928; 1(2): 59-60