Dosage and Method of Roentgen Therapy for Inflammatory Conditions

THE treatment of acute or chronic inflammations with roentgen rays dates back about thirty-five years. During the few years which followed Roentgen's discovery, the possible therapeutic value of the rays was first tested in connection with inflammation of the skin, tuberculous processes such as tuberculous adenitis, and cancer of the skin or of deeper structures. The idea of making such tests arose from the observation of cutaneous or other tissue changes which had occurred after certain diagnostic procedures. Then the action of roentgen rays (or radium) on different kinds of tissue was investigated experimentally, and these investigations rapidly increased our knowledge of the cellular effects of exposure to the rays. As the favorable action of the rays on the pathologic conditions mentioned became known, their therapeutic effect on other conditions was gradually put to the test. Thus it has been found that an increasing number of inflammatory conditions often responds favorably to suitable irradiation. As early as 1902, Williams included among the pathologic conditions which he had found to respond favorably to roentgen irradiation: herpes zoster, psoriasis, eczema, acne vulgaris and rosacea, prurigo, lichen planus, lupus vulgaris or erythematosus, and tuberculous adenitis or peritonitis. Some of these conditions had been treated with more or less success from one to five years earlier by different physicians, including Freund (1897), Albers-Schonberg (1897–1898), Gautier (1897), Rudis-Ji-cinsky (1898), Pusey (1900), and several others. According to the competent testimony of the famous French dermatolo-gist, Brocq, who wrote the preface to Belot's important book “Roentgen Therapy for Cutaneous Diseases” (published in 1904), “roentgen therapy already dominates the treatment of skin diseases.” Beside the disturbances mentioned by Williams as amenable to roentgen therapy, Belot added sycosis, blepharitis, rhino-phyma, and mycosis fungoides. Of course, since we are considering only inflammatory conditions, I shall not mention the early and extensive therapeutic tests made in relation to malignant growths of the skin as well as of other tissues. It was during the next fifteen years that the treatment of many other forms of inflammation was first investigated. And yet, many present-day radiologists are not even aware of these early investigations and reports, some of which are notable examples of painstaking work and keen observation. In those early days, much of our present knowledge of the action of roentgen rays on different kinds of cells did not exist. Judged by present standards, the methods of measuring dosage were crude, and the quality of rays then available was limited to wave lengths which could be produced by inferior tubes operating at low electrical potentials.