X-rays for medical therapy

[Peter Crane <pgcrane@erols.com>]

The use of x-rays for medical therapy included not only treatment of
enlarged thymus and of acne, but also high doses to shrink tonsils and
adenoids as a substitute for removing them surgically.  Michael Reese
Hospital in Chicago irradiated something like 4400 children, especially
in the late 40's.  I am relying on memory, but I believe that the first
article to point to a link between head and neck radiation and thyroid
cancer was Hempelman's, in 1950.  The Michael Reese experience was
written up in an article by Arthur V. Schneider et al. in about 1974. 
By then, Michael Reese had made an effort to follow up all those who
were irradiated, and of those whom it reached, approximately 40% had
experienced thyroid abnormalities, of which about one third were
malignant.  (I was one of the children so irradiated; my parents told me
much later that the doctor who recommended the treatment to them, in
1948 or 1949, explained that there seemed to be a higher risk of bulbar
polio -- then the greatest of all terrors -- among children whose
tonsils had been removed surgically.)  In addition, there is a
well-studied population of DP children who received radiation treatment
to the scalp for tinea capitis on their arrival in Israel in the late
40's; this was linked, among other things, to behavioral problems in
later years.
    My understanding is that head and neck irradiation of this kind is
associated not only with increased rates of thyroid cancer and benign
thyroid nodules, but also with tumors of the salivary gland and the
parathyroids.
     When I was a high school student in the early 60's, it was not
uncommon to see girls with faces bright red from radiation treatment of
their acne.  I believe that it was not until the early 70's, with the
national publicity given to the Michael Reese outreach program, that
some of these medical uses of x-ray stopped.
     Something that may deserve to be studied is whether the Public
Health Service and the Atomic Energy Commission, which in those years
was supporting extensive research on the medical effects of radiation, 
did all they could and should have to make the medical community aware
of the hazards to patients.  Given all that was known by the mid- to
late 1950's about the risk of thyroid cancer in young adults exposed to
head and neck radiation in childhood, it is surprising that treatments
of this kind continued as long as they did.
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