1930s radiotherapy

Neville S Finzi

Neville S Finzi gave the Mackenzie Davidson Memorial Lecture in 1933 (Finzi BJR 1934; 7(73): 9-20) and looked to the future of radiotherapy. The words of this pioneer are always worth reading.  Of particular interest were his comments about the increasing costs of radiotherapy with the development of higher voltages and larger masses of radium. Neville Finzi spent most of his time in the practice of radiotherapy and it was from about 1930 that full-time radiotherapists were appointed. The Radium commission had been set up in 1929 to make sure that this valuable and scarce resource was utilised optimally. Radium centres were set up with whole time medical “Radium Officers.” These Radium officers also took over the X-ray treatments and so whole time medical radiotherapists were established.

The pioneer radiotherapist Gösta Forssell gave the 10th Mackenzie Davidson Memorial Lecture in 1929 and his paper (Forssell BJR 1930; 3(29): 198-234) and summarised the current state of radiotherapy. For example, in Sweden the gynaecologists were solely using radiotherapy for carcinoma of the cervix.

Radiotherapy Cancer Treatment 

Image source: Forssell BJR 1930; 3(29): 198-234

Walter Levitt (Levitt BJR 1930; 3(31): 304-315) wrote on modern developments in X-ray therapeutic techniques. He summarised the development of radiotherapy starting with Leopold Freund in Vienna in 1896 and goes up to the present period (1930s).

Robert McWhirter from Edinburgh looked at radiosensitivity in relation to time intensity in May 1936 (McWhirter BJR 1936; 9(101): 287-299). This was of importance since at that time there was controversy over the merits of high and low intensity in the radiotherapy. The problem had economic consequences and was of clinical importance.

Frank Ellis, who was at the Sheffield National Radium Centre, made many contributions to the development of radiotherapy during his long life. In June 1939 he contributed a study on the radiosensitivity of malignant melanoma (Ellis BJR 1939; 12(138): 327-352).

 

Breast cancer

The techniques for the treatment of breast cancer were advanced in the 1930s. JEA Lynham from Mount Vernon Hospital gave the opening paper to the 3rd International congress of Radiology in Paris in July 1931 (Lynham BJR 1931; 4(47): 534-560). Whilst local control of breast cancer could be achieved in the 1930s the problems of metastatic disease had yet to be dealt with. The problem of metastatic disease was well discussed by Francis Hernaman-Johnson from Croydon General Hospital in August 1933 (Hernaman-Johnson BJR1933; 6(68): 468-476).

 

Ringworm 

S Cochrane Shanks from Charing Cross Hospital wrote on the X-ray treatment of ringworm in October 1932 (Cochrane Shanks BJR 1932; 5(58): 761-767). The incidence of ringworm was slowly falling however radiotherapy was still used. Cochrane Shanks had personally treated 2,600 patients with ringworm of the scalp.

 

Radium 

The pioneer medical physicist Major CES Phillips was BIR President in 1930-31 and wrote an interesting paper on how radium was to be obtained for medical use (Phillips BJR 1931; 4(42): 254-255). There were a series of papers on radium in the June 1931 BJR. J Murdoch from Brussels wrote a long and well illustrated account on radium dosage that is worth reading (Murdoch BJR 1931; 4(42): 256-284). There are illustrations of moulds/masks to hold the radium and clinical photographs. The use of interstitial needles and tube for use in cervical cancer are well illustrated.  

Columbia face mask applied to patient

Image source: Murdoch BJR 1931; 4(42): 256-284

The Silvanus Thompson Memorial Lecture for 1932 was given by Viscount Lee of Fareham on the therapeutic uses of radium and the need for national control (Lee BJR 1934; 6(61) 7-23). Lord Lee was chairman of the Radium Commission and gave a full account of current and desirable practice. The quack medical uses of radium were reviewed and the case for national control was well made. An example of the quack medical use of radium was the radium emanator and PJ Gillespie and J Lyle Alexander described, illustrated and studied an old  “Lar’s Radium Emanator” in February 1974 (Gillespie and Alexander BJR 1974; 47(554): 161-12). There was a common idea in the early 20th century that radium and radiation were beneficial in low doses. Radium could be used in creams, shampoo, and toothpaste or for drinking as the emanation. The ‘Radium-Émanateur’ was distributed by the Office Français du Radium and was recommended for many uses including gout, rheumatism, circulatory and digestive problems. In Britain such emanators were manufactured by Radium Utilities Ltd and the Radium-Vita company. The Radium-vita manufactured creams and ointments containing radium until the mid 1950s.

Sadly the use of these emanators was not without considerable risk. The saddest case was that of the Pittsburgh millionaire Eben McBurney Byers who was recommended to drink Radiothor in 1928. He became a keen advocate of the rejuvenating treatment and gave it to his friends and also to his horses. He developed signs of radium poisoning and died of a brain abscess and aplastic anaemia at the age of 52 in 1932.

In the December 1931 there were papers on the measurement of radiation intensity around a radium source (Mayneord BJR 1931; 4(48): 693-710) and radon seeds (Souttar BJR 1931; 4(48): 681-689) by W V Mayneord and HS Souttar respectively.  This was an important topic at that time since the knowledge of dose distributions around radioactive sources in different tissues was poor.

The radium apparatus reached a high degree of sophistication and in February 1937 LG Grimmett from the Radium Institute in London described a 5-gram radium unit with pneumatic transference of radium (Grimmett BJR 1937; 10(110): 105-117) with full illustration of the workings of the unit.

 Pneumatic Unit

Image source: Grimmett BJR 1937; 10(110): 105-117

 

Plastic surgery and late effects of radiation

Two of the great names in UK plastic surgery wrote an important paper in March 1933 on the use of plastic surgery for chronic radio dermatitis and radio necrosis (Gillies and McIndoe BJR 1933; 6(63): 132-147). Sir Harold Gillies was then plastic surgeon to St Bartholomew’s Hospital having previously worked in WW1 at Queen’s Hospital (later Queen Mary’s Hospital) in Sidcup. His co-author A H McIndoe was then at the Hammersmith Hospital and later went on to work at East Grinstead Hospital with airmen suffering from burns. The paper illustrated a selection of injuries including burns in patients and in X-ray workers. 

The next paper in March 1933 was by the pioneer radiologist N S Finzi (remembered by the Finzi Prize of the Radiology Section of the Royal Society of Medicine) on the late effects of radium and X-ray treatment (Finzi BJR 1933; 6(63): 148-161).  Finzi said that at that time such cases of radiation injury were very rare.

Hand exposure to UVR 

Image source: Finzi BJR 1933; 6(63): 148-161

 

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