Posts tagged ‘x-rays’

Jan 16, 2022

Oncology – Scottish impact on cancer treatment and the perils of radium

Very many of us have had all too close experience of cancer either in our own lives or in those of family and friends. Cancer is not a new disease and historically surgeons cut out malignant growths to try to prevent their spread. It wasn’t until the very end of the 19th century and into the early part of the 20th century that there were major scientific developments that would revolutionise the treatment of malignant tumours – with the discovery of radium and x-rays.

Nowadays we bundle cancer treatments under the label oncology, an umbrella term for medical, radiation and surgical methods of dealing with cancers; the intensity of treatments dependent on the severity and stage of illness – frequently surgery is followed by radiotherapy or chemotherapy.

X-rays were discovered at the very end of the 19th century, in 1895, by the German engineer and physicist, Wilhelm Röntgen.  This must have seemed like magic. In 1896 the first patient with a cancer of the throat was irradiated in an attempt to stem the growth of his tumour. The following year Henri Becquerel discovered that uranium salts emitted rays similar to x-rays. That same year Marie and Pierre Curie announced to the world an element they called radium, extracted from radioactive uranite or pitchblende and in 1902 they isolated radioactive radium salts from the mineral.

In 1910 John R. Levack at Foresterhill Hospital in Aberdeen in Scotland sought out a supply of the much talked-about, radium. His request was turned down by the hospital board and then the Great War was upon them so it was not until 1922 that Aberdeen Royal Infirmary obtained a small stock of radium salts, as did a few other hospitals in the UK, which led for instance to their use treating women with cancer of the uterus.

A quantity of radium was provided to the University of Aberdeen’s science hub at Marischal College’s Department of Natural Philosophy (Physics). There radium was turned into radioactive gas, radon, and needles were loaded with radium for medical interventions. Given the hazardous nature of these radioactive substances a radium officer was identified who was given responsibility for their safety. In 1922 this was John Cruickshank, a lecturer in malignant disease. As well as the radium officer, several other new roles were created at the hospital and university relating to the handling of radioactive substances and in order to develop appropriate methods for dispensing radium treatments to the sick.  

Loaded needles were inserted into malignant tumours

New academic and medical departments were created along with a raft of national and international organisations on the back of radioactivity. The British Association for the Advancement of Radiology and Physiotherapy was formed in 1917, later known as the British Institute of Radiology. A UK radium commission was set up in 1929 to regulate the use of radium in Britain, leading to a handful of radium centres and local radium officers. 1. 

Radium requires very careful handling for it is inherently dangerous and at the onset of WWII a new problem arose – where to store the hospital’s supplies safely in the event of Aberdeen being bombed. It was. Aberdeen was the most bombed Scottish city during WW II. On the 21st April 1943 127 bombs fell in just 44 minutes killing 125 people and destroying and damaging a huge amount of property. Any direct hit on the city’s store of radioactive material would have spelled death to many more, to thousands potentially, and for years to come with lethal radioactive dust finding its way into people’s and animal’s bodies the nightmare would be long-lasting. What to do? The answer had to come quickly.

In anticipation of this arrangements were made to protect radium supplies. Burying the material underground, to a depth of 50 feet or more was recommended but given Aberdeenshire sits on fairly impenetrable granite this was problematic so where could a place of real depth but still within the vicinity of the city be found? Anyone with any knowledge of Aberdeen will know what comes next – Rubislaw quarry. Rubislaw is 142 metres (465 feet) deep and one of the largest man-made holes in Europe. Local supplies of radium in solution were taken out of their glass containers, dried and restored. (Supplies from Inverness were included.) They were protected with lead and steel and placed in part of the quarry wall that had been specially prepared and the opening plugged with heavy timbers. Gaining access to the hospital’s supplies during the years of the war involved someone being lowered deep into the quarry on a Blondin  – an aerial ropeway. Not for the fainthearted. None of the handling of these toxic substances was for the fainthearted. As it happened the Germany Luftwaffe did manage to find Rubislaw quarry with a bomb but fortunately little damage was done to the borehole containing the hospital’s deadly supplies, and so the good folk of Aberdeen lived to fight another day.  An additional small quantity of radium was also preserved west of Aberdeen at Torphins hospital. Why I don’t know. Could it be that was closer to Balmoral and potential needs of royalty?

The ‘laboratory’ at Cove quarry

Although it was risky having radium right in the heart of the city there was little option if it was to be available for delivering medical treatments given the very limited life of radon gas. It had to be produced near Foresterhill. This couldn’t take place in Rubislaw quarry and the place chosen was at Cove on the southern edge of Aberdeen. Here both electricity and water were available and the railway ran close-by which was to prove valuable. Cove’s Blackhill’s quarry had a face excavated to store glass bulbs filled with dried radium for making into radon gas when needed. In the same way as it was protected at Rubislaw what became the little laboratory at Cove consisted of the mineral, steel, lead and in addition sandbags and a shed. One bad winter a south-bound train carrying the university’s H.D. Griffith (its first medical physicist) and his staff was stopped close to the site so they could more easily get through the snow drifts to make up essential medical supplies.  

Each time radon was needed liquid oxygen and gas cylinders had to be carried in to the ad hoc lab at Cove. But it worked and between March 1940 and September1945 Cove’s little workroom supplied not only Aberdeen but Edinburgh, Glasgow and Newcastle hospitals with radon gas.

Every care was taken to protect and preserve this potentially lethal but medically beneficial substance but still radium did go missing: seven filled needles of it disappeared in 1932; years later a 50 mg tube was flushed down a toilet by a hospital patient and despite valiant attempts to trace the radium through the sewer system to its outlet at the Bay of Nigg nothing was found; a further 50 mg tube was inadvertently incinerated at Woodend Hospital which must have resulted in radioactive smoke getting out into the atmosphere in west Aberdeen but there were no reports of associated health impacts.

Aberdeen’s early foray into nuclear medicine led in 1950 to Britain’s first oncology unit being established at the city’s Royal Infirmary under Professor James F. Philip who had been the hospital’s radium officer from 1939 till then and was a founding member of the British Association of Surgical Oncology. The department initially known as the malignant diseases unit built on Aberdeen’s ground-breaking joined-up approach to nuclear medicine that would influence cancer therapies across Scotland. By the 1970s all Scottish hospitals were encouraged to setup their own units based on what had been operating at Foresterhill for 20 years.

The most stable radium isotope is radium-226 which has a half-life of 1600 years. Radon 222’s half-life by contrast lasts only 3.8 days. Needles of radium salts were able to be used indefinitely but radon within them built up and leakages were likely. Radon needles were designed for fast application and needed constant replacement but their radiation hazard declined quickly. Needles were inserted directly into tumours as opposed to irradiation from outside. Radium or radon are no longer used. In 1980 caesium-137 replaced radium in the treatment of cervical cancer and iridium wire replaced radium for solid tumours.

Establishing safe and effective doses of radium isotopes became the source of many conversations in the scientific world, as among everyone else. Their impact on patients must have been significant.

Finally, a number of years ago I found myself in Würzburg where Roëntgen carried out many of his x-ray experiments and having read there was a small museum dedicated to the great man I tracked down what I thought was the place. Everyone must have been hard at work in labs or offices for it took me quite a time to find anyone there and none of whom seemed to know about displays so I left as disappointed as they were confused. No idea where I was but it doesn’t seem it was the right place because there is a Roëntgen museum which is, thankfully, available online. Nothing to do with this whatsoever but the small private hotel I stayed in for a couple of nights offered the best breakfasts of any hotels I’ve been to. And I’ve been to lots.

https://wilhelmconradroentgen.de/en/

Finally, finally.  The perils of exposure to radium were not understood at the end of the 19th and start of the 20th centuries and even when its hazards were beginning to be apparent its potential for industrial applications were too great for commercial enterprises to ignore. Staff and customer safety were of no concern and very young women employed in the USA to paint numbers and hands onto watches and military instruments so they could be seen in the dark involved the women licking the paintbrushes to form delicate points. The women were not told of the dangers of handling this curious paint that glowed in the dark and happily messed about painting it onto their fingernails and even their teeth as they kidded about while working. They became known as the Radium Girls and they developed cancers and many died as a consequence.

Radium ‘girls’

A craze for all things radium early in the 1900s led manufacturers to lace all sorts of products with the stuff, for no reason other than they could – chocolate, cosmetics, playing cards, clothing, health tonics. Bizarrely radium was added to hen feed with the idea irradiated eggs would self-cook and perhaps self-incubate.  Sounds nuts to us today but it was all new then. On the subject of nuts – Brazil nuts contain radium, naturally. Two to three nuts daily is not a health risk but go canny with those moreish chocolate Brazils.

*

1.One eminent doctor whose name is permanently linked with the early years of radiology is Professor James Mackenzie Davidson one-time president of the British Association of Radiology (BAR) and the British Institute of Radiology (BIR).

Mackenzie Davidson’s parents were among the earliest Scots to emigrate to Argentina, in 1830. At least that was when his father went out there, aged 21, from St Martin’s in Perthshire. Don’t know about his mother because details about women are usually regarded as unimportant – I do know she was from Argyll. The Davidsons bought up pieces of land around the River Platte to farm sheep and cattle and did that successfully. Davidson senior survived many an adventure, including an attack by three gauchos who thought they’d killed him but it was Davidson’s horse that died, on top of him. When he was eventually able to extract himself from under the poor beast he was able, eventually, to find help and lived to experience several more adventures, apparently. The family were related to Marshall Mackenzie, the eminent architect from Elgin and Scotland remained important to the Davidsons who frequently sailed back from South America for visits. Their son, James, was educated at the Scottish School at Buones Aires and studied medicine at Aberdeen, Edinburgh and London. He graduated from the University of Aberdeen in 1882 and opened a medical clinic at West North Street in the city. From there, in 1886, he was appointed Professor of Surgery and lecturer in Ophthalmology at Aberdeen Royal Infirmary, the Sick Kid’s hospital and Blind Asylum. James Mackenzie Davidson became fascinated by the newly discovered x-rays and visited him at his workshop in Würzburg in Germany to learn more about x-rays and radiation and was able to carry out his own x-ray of a foot that had been pierced with a broken needle.  He devised the cross-thread method of localization to trace foreign bodies in the eye which proved of immense value for treating horrific eye injuries in WWI. Mackenzie Davidson was by this time in London, working with x-rays at Charing Cross Hospital’s Roëntgen Ray department. Following his death in 1919 an annual lecture in his honour was established by the British Radiological Society and a medal is presented for outstanding work in the field of radiological medicine.

H D Griffith Physicist ARI Zodiac Journal of Aberdeen University Medical Society Vol 1 p 190, Jan 1950.

Aberdeen Royal Infirmary: The People’s Hospital of the North-East. Iain Levack and Hugh Dudley, 1992.