CURATIVE VALUE OF X-RAYS
In my Little Blue Book on Radium (No. 1000), it is shown that the
“emanation” and the “gamma rays” of radioactive substances are being
used to great advantage in our hospitals, but that certain dangers to
the patient’s normal cells attended employment of these radiations.
It is gratifying to note that successful X-ray treatments are now
being given in cases of cancer, rays being produced—under high-tension
currents—that are almost identical with the gamma rays of radium.
Moreover, the X-rays have a double value in medicine. In the first
place, they are used as an aid to diagnosis, forming those branches of
radiotherapy known as radioscopy and radiography. Then they are also
used to great advantage in the alleviation or cure of certain maladies.
By means of radioscopic or radiographic examination it may be found
that there is a tumor in the chest, and as a result of that diagnosis
it may be decided to institute treatment (radiotherapy) by means of
X-rays or radium rays or the two combined.
The method of employing extremely penetrating X-rays—under high voltage
and amperage—seems to have been first used in Germany, during the World
War, but was soon developed to a high degree of efficiency in France,
England, and the United States, especially by Dr. William Duane,
professor of biophysics at Harvard.
As early as 1919, Professor Dessauer, in Germany, produced the
penetrating X-rays by means of a high-tension current ranging from
170,000 to 240,000 volts. It was later found, that rays at 200,000
volts became homogeneous, so that a further increase was considered as
of no therapeutic value.
In March, 1923, Dr. I. Seth Hirsch, head of the X-ray department of the
Bellevue Hospital in New York, gave a drastic treatment—for cancer—of
four periods of 16 hours each with the X-rays at 250,000 volts,
apparently with satisfactory results. The patient suffered no pain or
inconvenience during the treatment with the exception of occasional
nausea. A year later an experiment was made in a Philadelphia
laboratory where an X-ray treatment of 300,000 volts was used. It seems
that alleviation rather than cure has been the result of nearly all
cases where cancer had been well advanced.
Other important improvements, meanwhile, were being introduced by the
German specialists, during the World War and later, among which was
the just mentioned method of giving large tissue-destroying doses,
requiring from ten to 15 hours; to this was added careful filtration
of the rays, and the invention of the _ionto_—a quantimeter for exact
measurements. A number of malignant diseases is reported to have
yielded to this new system of massive doses under higher voltage. But
Professor Duane has stated that neither X-rays nor the gamma rays of
radium should be considered as a permanent cure for cancer.
Until recently the tubes in which X-rays are produced have always been
made of glass. The latest discovery is a tube made of fused silica, or
vitreosil. Vitreosil permits the passage of the short rays, will stand
a much higher temperature than glass, and is much stronger. This means
more continuous service from X-rays.
According to Dr. Francis C. Wood, director of the Crocker Institute
of Cancer Research of Columbia University, a marked advance in the
treatment of cancer has been made possible by a new type of X-ray
tube, the invention of Dr. C. T. Ulrey, of the Westinghouse Company.
The new tube has a higher emissive power—in other words, it is as if
the candle-power of an ordinary lamp were increased six-fold. It is
besides designed for use with higher voltages than have previously
been practical in Roentgenology. The result is to reduce the necessary
exposure from two or three hours per patient to 20 minutes, and to
increase the life of the tubes. Incidentally, the new tube gives a
greater proportion of the type of rays that cure certain forms of
cancer, and less of the sort that attack healthy tissue.
A revolutionary discovery by Dr. Jacques Forestier, of Aix-les-Bains,
France, for which a gold medal was awarded him in 1925 by the French
Academy, has made possible a method of exact diagnosis by X-rays
heretofore deemed by many workers impossible of attainment.
As is well known, it is not difficult to make an X-ray picture of
the bones of the body. They are so much denser than the soft parts
of the body that, even with the ordinary photographic plate, it has
been possible to photograph them fairly well. By pumping the stomach
full of gas or air—which are highly transparent to the X-rays—and
then applying the X-ray, it has sometimes been possible to locate the
beginnings of cancer of the stomach, and the place of malignant growth.
Another method in common use is to give the patient about a pint of
some substance opaque to X-rays, such as bismuth carbonate, thus making
it possible to record the passage of the mixture, the outline of the
stomach and the intestines thus being made visible. In this way ulcers
of the stomach have been frequently located.
Bismuth and similar substances could not be injected into the brain
or spinal cord, on account of their poisonous effect on the highly
sensitive cells of these regions. Now, thanks to the method discovered
by Dr. Forestier, the cavities of the brain and spine can be safely
explored, as well as the network of bronchial tubes in the lung—the
so-called “bronchial tree.”
In an interview with Mr. David Dietz, Dr. Forestier said (in part):
“I make use of a French oil called lipiodol. It is a chemical compound
composed of poppyseed oil and iodine. The chemical previously had been
used as a treatment for certain diseases, such as goiter. But no one
had ever thought of using it in X-ray work.
“I noticed that where patients had been treated with lipiodol opaque
spots appeared when X-ray pictures were made of the treated parts. It
occurred to me, therefore, that lipiodol could be used as a means of
making photographs.
“Accordingly, in company with Dr. Sicard of Paris, I began to
experiment. We worked with animals until we were convinced of the
correctness of our method. When we were sure that it was safe we tried
it on human beings. I have used it in more than 5,000 cases in Europe
without having a single adverse result.
“The lipiodol is injected into the brain cavity or the canal of the
spinal cord or the bronchial tubes and then a regular X-ray photograph
is made. The oil renders the injected part opaque to X-rays and they
show up as sharp black images in the photographs.
“The method is of particular value when a patient is suffering from
paralysis which has been caused by a pressure of a tumor or growth
somewhere along the spinal cord. In this case a drop of the oil is
injected into the spinal canal at the base of the brain. In a healthy
patient it would immediately travel to the base of the spine. But
in the paralyzed patient it only travels as far as the point of
compression. The X-ray picture therefore reveals the drop of oil as a
black spot. The surgeon then knows the exact spot at which to operate
in order to find the growth causing the pressure, which in turn results
in paralysis.
“In diagnosing the lungs with the use of lipiodol the injection in the
bronchial tree enables the X-ray worker to tell at once whether the
patient is suffering from diseases of the bronchial tubes themselves,
or from diseases of the lung tissue, such as tuberculosis.”
It is gratifying to be able to relate that along with the improvements
already described, progress has also been made in the preparation of
photographic plates required by the radiographer. Until recently no
photographic plate had been made which fully met the requirements of
X-ray work, and there was little contrast in X-ray photographs. They
were all much too sensitive to the longer (visible) wave lengths, and
produced blurring effects.
Early in 1921 an excellent photographic plate, 25 times more rapid than
anything previously known, was invented by Dr. Leonard A. Levey, a
prominent member of the Roentgen Society. It makes an X-ray photograph
of the vital organs of the living body whose movements have hitherto
blurred the images on the ordinary photographic plate. Distinct
pictures of the heart, lungs and stomach can now be made. Dr. Levey has
made snapshot photographs of the heart, lungs and kidneys. All were
taken in a flash with the X-rays on the new plate.
Dr. H. Becher has called the attention of Americans to the achievement
of Dr. Schleussner, an eminent German authority in photochemical
matters, who has succeeded, after years of investigation, in
sensitizing photographic plates for X-ray use by an addition of certain
organic salts which are absorbed by the grains of silver bromide on the
photographic plate. The plate thus formed is very responsive to the
soft rays of an X-ray tube. The soft rays are relatively longer than
the hard Roentgen rays. One could compare the soft rays to blue-violet
light, if their effects on this new photographic plate are used for the
comparison. Photographs taken with such plates give very contrasting
effects.
On the “Neo-Roentgen plate” the effect of the yellow light was almost
nil. For this reason, developing the plate is considerably facilitated,
as the plate can be exposed to yellow light and the attendant, who need
not be a skilled operator, can examine the plate in a rather brilliant
light without necessarily guessing at possible results. The examination
of the plate under a ruby light is, therefore, completely done away
with. It follows that if the new X-ray plate should come into general
use, much clearer X-ray photographs would be possible; the time of
exposure could be decreased; an unskilled operator could develop the
plate in a room flooded with yellow light. Such improved plates are now
being extensively used.
While not attempting to enumerate all the special affections to which
X-ray therapy is now being successfully applied, a few uses may be
mentioned.
X-RAYS CURE WHOOPING COUGH
In a preliminary report published in the _Medical and Surgical Journal_
(Boston), Dr. Henry I. Bowditch and Dr. Ralph D. Leonard express the
belief that a valuable cure for whooping cough has been found in X-ray
treatment of this disease, which has stubbornly resisted most, if not
all, of the other remedies applied.
Definite improvement was noted in most of 26 cases of active pertussis
(whooping cough) treated with the X-ray, the subjects of which ranged
in age from three months to 40 years, with disease stages from one to
ten weeks. The physicians added that they could not give any rational
explanation of the action through which the X-ray appeared to produce
beneficial results. The report said:
“Each patient received three or four applications of the X-ray at
intervals of two or three days.”
Many of these cases have not been observed sufficiently long to
determine the final result. Nevertheless, “it is evident to us that
there resulted a definite improvement in these patients which cannot
be explained by mere accident.... It does not seem likely that [the
beneficial result] is due to any direct bactericidal property of the
X-ray.
“We feel warranted in classifying a small percentage of these 26 cases
under the heading of “prompt cures.” By this we mean that after two or
three applications of X-rays, covering a period of six days, the spasms
and whoops entirely disappeared and the patients were clinically well,
except for, possibly, a very slight cough.
“The bulk of the cases, however, we have classified as relieved. This
group consists of perhaps 70 percent of the total. By relieved we mean
that there has been a gradual diminution in the number of spasms.
“There is a small percentage of cases, perhaps 10 to 15 percent, which
apparently were not relieved. In this group are included one moribund
case and one rather difficult feeding case.
“While our evidence so far is not sufficient to warrant any definite
conclusions, we have the feeling that the X-ray at the present time may
be of more value in the treatment of pertussis than any other form of
treatment, including serum.”
X-RAYS FOR MALARIA
An Italian physician, Dr. Antonio Pais, of Venice, has since 1916
been successfully treating malaria by means of X-rays. This treatment
is, however, not employed as a substitute for quinine, but merely to
reinforce its action. The X-rays are directed toward the region of the
spleen, and the effect is to reduce its enlargement. At the same time
the composition of the blood is modified. The success obtained by Dr.
Pais has, according to the _Bibliothèque Universelle et Révue Suisse_
(Lausanne), been so great that the Italian Government decided to
introduce his method of treatment into the military hospitals.
Since the war the treatment has been studied by Prof. B. Grassi, who
made a report, at an Italian scientific meeting, in which he declared
the action of X-rays upon chronic malaria to be “truly marvelous.” The
_Bibliothèque Universelle_ says, regarding earlier treatments:
“The attempt was made by them to destroy the parasite contained in the
spleen. But it is now known that the X-rays employed for therapeutic
action have no effect upon micro-organisms, although they may be
injurious to the elements of the blood. In the method devised by Dr.
Pais, the X-rays are employed to stimulate the functioning of the
spleen, of the marrow, and of the lympathic elements by means of
slight but prolonged excitation; they are employed in infinitesimal
doses—homeopathically, so to speak. Thus the result is absolutely
different as well as the method.”
Dr. James B. Murphy demonstrated that accompanying cancer grafts on
immune animals there occurs a general increase in the circulating
lymphocytes and hyperplasia of the lymphoid tissue. When the lymphoid
tissue of immune animals was destroyed, the immunibility was annulled.
Two methods of increasing the lymphocytes have been found, namely,
diffuse small doses of X-rays, and dry heat. Mice with lymphocytosis
induced by these agents show Increased resistance to replants of their
own tumors. The results afford ground for hope of human application.
(Reported in _Scientific American Monthly_, January, 1920, page 96.)
It has been found that actively growing tissue, whether normal
or pathological, is the most susceptible to X-rays, and it is
comparatively easy to sterilize a number of species of animals
without otherwise injuring them. (Prof. James W. Mayor, _Science_,
September 23, 1921.) C. R. Bardeen found that X-rays prevent worms from
regenerating lost parts. Observations of the effect of exposure to
X-rays on the fertility of animals were described in a paper by Prof.
L. H. Snyder of the North Carolina College of Agriculture. Exposure of
male rats to X-rays, he said, had rendered them sterile at the end of
two months, the animals regaining fertility when no longer subjected to
the rays.
If not handled with due caution and skill, X-rays may do more harm
than good, provoking malignant growths as well as retarding their
development. As early as 1911, Otto Heese published a record of 54
cases of cancer caused by means of improper handling of these powerful
rays.
In the early days of X-ray therapy the nature and effects of these
radiations were wholly unknown. Operators did not hesitate to test
and adjust their tubes by throwing the shadow of their hands on the
flouroscope. X-rays do not make objects visible to the human eye, and
to see the effects of them it is necessary to interpose a special
screen between the eyes and object through which the X-rays are to
penetrate. The cardboard screen is coated with a fluorescent substance,
such as barium-platinum-cyanide, or calcium tungstate. This screen is
best placed in one end of a black wooden or pasteboard box, against the
other end of which the eyes are placed when in use.
This screen under the influence of X-rays becomes luminous and enables
one to see shadows or silhouettes of objects of denser material
interposed between the eyes and the X-ray tube, when the tube is in
operation.