Radiotherapy
BY W. KERR RUSSELL.
THE present is a time of great change in nearly all human activities, and this is especially true of medical practice. Probably the most striking change is the increasing attention which is being paid to the different physical methods of treatment, such as the use of the various radiations, electrical current; and baths, such as wax, sand, foam and peat, external and internal douching, exercises, manipulations, &c. Drug therapy no longer occupies the omnipotent position it once used to hold. A strong reaction has taken place against the idea that the bottle of medicine is the essential weapon in the conquest of disease.
Modern theory suggests that all matter is made up. of positive and negative electricity, and that the universe is composed of electricity and radiations caused by the movements of these electrical particles. It is, therefore, only a rational procedure to make use of these different energies in the treatment of disease.
Some startling discoveries were made during the last decade-- of - the 'nineteenth century. The mysterious X-rays were discovered by Röntgen in 1895, and three years later M. and Mme. Curie isolated radium: The se two agents are playing a -very important part in modern medicine.
Radiotherapy is that section of medicine which is devoted to the utilization of the various rays of the electro-magnetic spectrum for the treatment and cure of disease.
The different rays or waves which are now known are the wireless waves, the Hertzian waves, the infra-red rays, visible rays, ultra-violet rays, Grenz rays, X-rays, gamma rays of radium, and finally the cosmic rays. These rays together form the electro-magnetic spectrum and though- they are apparently so different in their properties, they have a number of common characteris- tics. They all have a common velocity travelling through space at the rate of 186,000 miles a second ; they can all be reflected by suitable, though differing, mate- rials, and they can all be absorbed. Their wave-lengths- i.e., the distances, between the crests of two adjacent waves—vary enormously, those used in wireless having a wave-length of hundreds of yards, whereas the average wave-length of X-rays used in medicine is roughly the 20,000,000th part of the diameter of a pin's head. Their power of penetrating the human body also varies enor- mously ; the wireless, hard X-rays and radium rays can pass readily through the body, whereas the ultra-violet rays have very little penetrating power, and none are able to pass further into the body than the deeper layer of the epidermis ; the red visible rays, however, can penetrate as far as the superficial muscles. Some of the infra-red rays may reach the subcutaneous tissues.
The rays principally used for medical purposes at the present time are the X-rays, radium rays, ultra-violet rays, visible rays, and infra-red rays. X-rays are formed by passing an electric current of very high pressure or voltage through a specially designed tube which has been almost entirely evacuated of air. The rays are formed by the impact of the stream of electrons on the metal target of the tube. Radium, on the other hand, is a rare, unstable metal, which slowly disintegrates and gives off rays. Radium is very costly on account of its rarity and the great difficulty experienced in isolating it. The chief source at the present time is the Belgian Congo.
X-rays have proved invaluable as a diagnostic agent, and by means of them photographs can be obtained of many of the structures and cavities of the body ; but they have also been freely used in the treatment of disease, especially in such conditions as inoperable cancer, a large number of -skin diseases, simple tumours of the womb, exophthalmic goitre and certain other glandular affections. Many cases of arthritis have also been benefited. Radium has proved useful in many similar types of case, especially in the treatment of cer- tain conditions of the body cavities, where the introduc- tion of the small metal tubes containing the radium presents little difficulty.
Radon or radium emanation, a gas formed by the slow disintegration of radium, is now widely used in the treatment of rheumatic disorders. It is applied in baths and compresses, and also in drinking water. The benefit derived from many spa waters has been found to be due to their radio-activity.
Certain rays of the electro-magnetic spectrum are present in sunlight—all the visible rays and some of the ultra-violet and infra-red rays. In recent years, there has been a dramatic realization of the value of these health-giving rays and of the penalties that we have hitherto paid for our neglect of them. One of our greatest errors has been our failure to bathe our bodies in the sun's rays, which are essential-for perfect health. The wearing of unsuitable and unnecessary clothing, and the filling of the atmosphere over so many of our cities with smoke, have been responsible for this deprivation.
Finsen, the- Danish scientist, was the first to use artificially produced ultra-violet rays for medical treat- - went. He found that ultra-violet rays can be produced by suitably designed electric arc lamps. He evolved -a method of curing lupus—that terribly disfiguring skin disease—by concentrating the rays from an electric arc on to the diseased part. The Finsen Institute in Copen- hagen is a magnificent memorial to his pioneer work. The treatment first given by Finsen was a local treatment. Some years later, however, a much more important development took place in the employment of the rays to irradiate the whole body and not merely a small local area. In the case of lupus, the percentage of cures with the combined method of treatment immediately rose from 60 to 90 per cent. It was soon found that general ultra- violet irradiation was a cure for a number of other diseases, especially of tubercular lesions of the glands, bone and joints. Just after the War, the striking discovery was made that rickets, one of the chief causes of bony de- formity, can be speedily cured, and even prevented, by treatment with rays from an ultra-violet lamp. It became obvious that rickets was a disease due to depriva- tion of sunlight, and that such was the explanation of its prevalence in our industrial towns.
It was also found that ultra-violet rays have a re- markable tonic effect on the body, and many other bene- ficent uses have been discovered.
One striking fact about the modern ultra-violet lamp is that it is possible, in so short a time as five minutes, to obtain the equivalent of several hours of strong sunshine. Another interesting point is that it is possible, by gradually increasing the exposure, to train the body to with- stand doses which, if given without preparation, would cause a most unpleasant skin reaction. Pigmentation of the skin gradually develops as the treatment progresses.
Visible rays are now being extensively used for the stimulation of cell growth in such conditions as wounds, ulcers, &c. ; and these rays also give relief from pain. The infra-red rays, the principal effect of which on the body is to raise the temperature of the part under treatment, are also being successfully used in a wide range of different conditions where pain is one of the chief symptoms.
The modern treatment of rheumatic disorders has incorporated these various physical methods, and it is a matter of congratulation that we are at last beginning to use them in this country on an adequate scale. We may look forward to the time, which cannot be far distant now, when physical medicine will form an important feature in the medical curriculum of all our medical schools. Only then will the charlatan and quack, who have been quick to employ these physical methods, be relegated to their rightful sphere.
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