The Impact of Radioactivity on Medicine between 1900 and 1949

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The Impact of Radioactivity on Medicine between 1900 and 1949

Overview

In 1896 Antoine Henri Becquerel (1852-1908), a professor at the Ecole Polytechnique in Paris, France, discovered radioactivity in uranium when he was investigating fluorescent crystals for x rays. He shared the Nobel Prize for physics in 1903 with Marie and Pierre Curie (1867-1934 and 1859-1906, respectively). It was mathematician Henri Poincaré (1854-1912) who told Becquerel that the x rays were emitted from a fluorescent spot on the glass cathodetube used by Wilhelm Röntgen (1845-1923) when he first detected x rays in 1895. The era of artificial radioactivity—in which humans make more radioactivity than is naturally existing in the Earth and its atmosphere—had begun in earnest by the start of the twentieth century. But despite the fact that radioactivity devices such as the early "fluoroscope" x-ray machines developed by Thomas Edison (1847-1931) were becoming rapidly available to the general public, scientists did not actually understand what was making them work so that they could take photographs of the bones inside the human body, or indeed of bullets that had been shot into people.

Background

X-ray machines were offered as entertainments and curiosities throughout the United States in department stores such as Bloomingdale's at the turn of the century, and people lined up to have their hands or their feet x rayed so that they could see their bones. When Wilhelm Röntgen had first detected x rays, he showed his fellow scientists what he could do by sending photographs of his x ray of his wife's hand, showing only her bones and wedding ring but no tissues. When she had seen this photograph, Frau Röntgen said she felt she was looking at her own death. It took several years for the scientists and the public to realize that the burns many people working with x rays were suffering were not from the electrical charge in the apparatus but from the actual rays themselves, the radioactivity. This also caused people's hair and teeth to fall out because there was no realization in the first years of the twentieth century that it was necessary to using shielding materials such as lead to protect both the patient and the operator (increasingly known as the "Röntgenologist" and then the "radiographer") from getting too much radioactivity for their bodies to cope with.

But even with this major disadvantage, the use of x rays was becoming widespread in medicine, particularly when metal objects such as bullets had entered the patient's body and had to be located in order to be removed by surgery. Within ten years of Röntgen's discovery, primitive x-ray machines were being used by British, Italian, and American military doctors in conflicts as far afield as Abyssinia, the Balkans, Afghanistan, and Egypt. They were widely used in the Spanish-American War in 1898, and many soldiers' lives were saved by the operations the new x-ray technology made possible, together with other new developments such as antiseptics and anesthesia.

Still, however, it was not understood that the very use of the x rays might be killing some of the patients, and even the operators. Thomas Edison was one of the first experimenters with x-ray technology to realize that his own burns, particularly to the hands and fingers that had handled the radioactive materials, were due to the rays themselves. One of his assistants, Clarence Dally, lost his mustache and beard together with his eyebrows and eyelashes—and then all his fingers and his left hand, which had held the substances causing the x-ray effects. Edison said Dally "died by inches," finally succumbing to his dreadful injuries in 1904. He was the first of many radiographers (such as the Army radiographer Elizabeth Fleischmann) to suffer such serious injuries in the first third of the century before the cause was realized and strict protection measures instituted. But before then, the very burning effects of radiation—which often begin only slightly with a reddening of the skin like sunburn—were used to treat acne and excema, with dreadful effects. The trouble was that weeks later deep ulcers developed that could not be treated. Amputation was often the only solution to stop the intense pain. Even so, x rays were widely used in both medicine and dentistry, particularly in the United States, within a decade of Röntgen's discovery. Even U.S. Customs officials started using x-ray machines at the turn of the century. X-ray photographs were already being used as evidence in court in shooting cases and similar incidents of personal injury in the first years of the century.

Impact

Some scientists working with radiation also began to realize that it could make people and animals sterile. To some this was seen as an advantage in the early years of the century when the "eugenicists"—those who believed that human reproduction should be managed so that only the fit, clever, and healthy reproduced themselves—were considered respectable. Still, scientists such as Marie and Pierre Curie went on working with uranium to understand its radioactive properties. Pierre Curie died in 1906 in a road accident, but his wife suffered many burns to her hands before succumbing to anemia and leukemia like so may other of the early radiation workers. But she had been awarded two Nobel prizes, one for discovering "polonium" (named after her native Poland) and radium.

The realization that different substances had different levels of radioactivity, and indeed different types of radioactivity, enabled their adaptation for different medical uses. The field of medicine called "nuclear medicine" arose from the ability of doctors to feed patients radioactive substances that could then be traced in their bodies with x-ray machines to detect if there were cancerous blockages or other medical problems. Eventually, the radioactive substances would themselves be developed as therapies and medicines, relying on their capacity to target cancerous cells and kill them. While surrounding healthy cells would also be in jeopardy, they would be able to "repair" themselves more quickly than the cancers, and so people would survive and benefit from radiotherapy.

The administration of these therapies in twentieth-century medicine was made safer by the development of lead suits and aprons to shield the health workers and the patient from excess exposures to the radiation. The "scattering" effect of radiation rays also came to be understood and devices were developed to "collimate" the rays to the desired focus and to protect the people and equipment surrounding the patient from receiving too much radiation. The film badge dosimeter was developed utilizing the known effects of radiation on photographic film to serve as a measure and monitor of how much radiation individual nurses, doctors, radiologists, and radiographers were receiving.

Radiographic equipment manufacture was big business by the 1920s, and major companies such as Siemens, General Electric Company, and Kodak were constantly refining the devices as the safety issues were increasingly understood. The professions of radiographer and radiologist grew with great rapidity, especially after the First World War when radiation scientists such as Marie Curie contributed greatly to the war efforts of their countries by developing more mobile and effective x-ray units that could be taken to the battlefronts. Training schools for people to operate these units were set up during the War, and many women found it possible to embark on a new career in this field. The soldiers who were the beneficiaries of these x-ray units came to expect them to be available to them in civilian life, and this also hastened the acceptance of this new field of medicine in the first half of the century. Two thirds of U.S. hospitals had their own x-ray departments by the 1920s, and the rest depended on private practitioners who were offering the service from their own offices and clinics.

William David Coolidge had developed smaller, quieter, more efficient systems of generating x rays, and these came into wide use particularly by the U.S. Army when it entered the First World War. By now the technology was useful not only for locating metal objects such as bullets but also for examining the state of patients' chests. The chest x ray became a widespread technique in both civilian and military medicine by mid-century, particularly to detect tuberculosis. If anything, it was over-used (some servicemen being x rayed annually), as there was still a reluctance on the part of enthusiasts to acknowledge that the technology that was providing such a marvelous view into the human body was itself very dangerous. It even became common practice to x ray fetuses in the womb to check that they were developing properly, and it was not until the 1950s that scientists determined that this was extremely hazardous to the fetuses, as the youngest tissues are those most vulnerable to radiation damage. Since infants and children are also undergoing more rapid cell division than the grown adult, it is now also understood that they are more susceptible to radiation damage than a mature human. X rays were also used to treat excessively heavy bleeding in women's menstrual cycles before it was realized that the uterus and ovaries are particularly susceptible to radiation damage.

Radiology was declared a specialty within American medicine in 1934. Various Röntgen societies existed around the world, and they began to realize the need to reach agreed safety standards for the practice of nuclear medicine. This involved the definition of units of measurement, the first of which was named the Röntgen. The concept of a safe dose of radiation was increasingly debated, and doctors and scientists around the world tried to agree on where the limits for human exposures of both patients and health workers should be set. When the Second World War broke out in 1939, the technology of the xray industry again went into fast gear, and most of the fighting forces were well served by increasingly effective and more mobile equipment. It is one of the great ironies of the twentieth century that the use of radioactivity, which had been such a dangerous but wonderful resource in medicine, was adapted in the next four years to become a weapon of mass destruction when it was used as part of the atom bombs dropped on Hiroshima and Nagasaki in Japan in 1945.

SUE RABBITT ROFF

EARLY USES (AND MISUSES) OF RADIATION AND RADIOACTIVITY

The years immediately following the discovery of radiation, radioactivity, and radioactive elements such as uranium, thorium, and radium were heady ones for the practitioners of radiation science. They had given medicine the ability to see within the body and, it seemed, to heal many diseases, because it was soon found that high doses of radiation could kill cells, including cancers. To be sure, in high doses that were applied inappropriately, radiation caused injury, but this was true of many phenomena, including electricity and steam.

In those days of excited experimentation, a number of things seem, in retrospect, particularly ill-advised. However, it should be remembered that, at that time, radiation did not carry the stigma it now does and most of these experiments and uses were well-intentioned efforts to help people.

One use of radiation was to remove unwanted facial hair, primarily in women. This was discontinued when it was found that, improperly applied, scarring could result that was even more unsightly. Radiation in the form of radium inserts were used to try to clear up sinus problems, and many companies sold devices that "invigorated" water by infusing radium or radon into it. Thomas Edison tried to x ray the brain to see if any insights into thought could result, and others tried to locate or cure criminal behavior in a similar manner.

One of the more interesting anecdotes, however, came from the World War II years when Allied intelligence agents discovered that a German company was trying to buy the world's stocks of thorium ore. At first thinking that the Germans had somehow discovered how to make a nuclear weapon from thorium, it was later discovered these stocks were purchased by a toothpaste company that used thorium for putative extra whiteness—the company was trying to corner the post-war market to keep competition at bay.

P. ANDREW KARAM

Science and Its Times: Understanding the Social Significance of Scientific Discovery