Theories on the Effectiveness of Roentgen Therapy in Inflammatory Conditions

Leopold Freund, who first used x-rays for therapeutic purposes (1897), was also the first to report the disappearance of inflammatory symptoms after x-ray treatment (1904). Thus, following irradiation for diseases of the hair, such as sycosis, the furuncles so often accompanying that condition cleared up without further treatment. As a rule, however, an exacerbation of the inflammatory symptoms, such as edema and suppuration, was observed before the hair fell out. This gave rise to the assumption that irradiation invariably leads to a greater or less increase of an inflammatory process, and the conclusion was drawn that the presence of inflammation is a contraindication to radiotherapy. Although observations to the contrary were repeatedly published, this attitude generally prevailed up to 1924, when Heidenhain and Fried, and also Pordes, reported their results, about which Holzknecht informed American radiologists in 1926. Since that time it has been known that x-rays are able to exert a favorable influence on inflammatory conditions even in the most acute stage, provided very small amounts are given. A dose of moderately filtered rays ranging between 50 and 150 r has proved to be highly effective in a very large number of inflammatory conditions. Besides the smallness of the dose, the rapidity of the response is the most striking feature of this method of treatment. Within a matter of hours an appreciable alleviation often occurs and the infection clears up entirely in a few days. It is especially the inflammations caused by pyogenic bacteria which have proved highly amenable to radiation therapy. The following conditions are at present regarded as promising favorable results: (1) Streptococcic and staphylococcic inflammations, such as furuncles, carbuncles, cellulitis, lymphadenitis, lymphangitis, erysipelas, tonsillitis, periodontitis, mastitis, thrombophlebitis. (2) Gonococcic inflammations, such as epididymitis, prostatitis, salpingitis, parametritis, arthritis. (3) Pneumococcic inflammations, such as bronchopneumonia, lobar pneumonia, and pneumonia with delayed resolution. (4) Meningococcic inflammations, such as cerebrospinal meningitis. Several theories have been launched to explain the efficacy of rays in inflammatory conditions, the results being variously attributed to the effects on the microorganisms, on the blood, on the inflammatory exudate, and on the blood and lymph vessels. Effect on Microorganisms In the early days of radiotherapy, when the action on the tissues was not yet sufficiently understood, the simplest explanation of the effect of x-rays on inflammations appeared to be that it killed the causative agents. This conception was shaken when bacteria and other microorganisms proved to have extremely little radiosensitivity. Only enormous doses were able to destroy them in vitro, as shown by the experiments of Wolfenden and Ross, Muskatblit and Ouspensky, and many others.