Radiation oncology in Spain: Historical notes for the radiology centennial

Abstract

Cancer started to forge as a visible disease in the first third of this century (1). This means that it began to be considered as a conceivable illness by society, and above all, a concern for doctors. They were the social agents to persuade public and states of cancer curability. The lay reality was colonized by medical discourse, and individuals were assigned to be the assistants of doctors in the ideal frame of an industrial healthy society (2). This new medical mentality about cancer was a result of the professional commitment with social change, the improvement of surgery, and the perception of radioactive remedies as innovative therapeutical hopes. The process was linked to medical profession dynamics directed at the autonomization of radiotherapy as a new medical discipline. In western societies the concern about cancer and the rise of radiotherapy as a medical speciality was a process with common steps in its devolopment (3). In Spain, the therapeutic use of x-rays and radium was incorporated with a similar celerity to other countries. In the 30s the presence of radiological devices and instruments was significant in private practice medicine. According to the Spanish Medical Catalog (Anuario Medico de Espafia), from 1927 to 1931 the number of radiologists tripled (from 223 to 571) (4). This extraordinary increase did not mean a specialized type of radiological practice. Several medical specialists (surgeons, gynecologists, dermatologists) used radiological apparatus, particularly radium, due to its simple manipulation in clinics as an auxiliary therapy or, above all, as diagnostic methods. The practice of Radiotherapy as it is defined today lasted to be generalized, and for decades radiological medicine combined the practice of diagnostic and therapeutic use of this technology. In 1936, with the beginning of the Spanish Civil War, there was no regulation of the radiology practice, although in 1935 (Primer Congreso Promedico Espafiol) it was decided to name a Commission to study the legal implications and present a regulatory proposal to the health authorities. It was not until the 1930s when the health authorities of the Spanish government had a project to fight against cancer. Until then, some benefit cancer institutions, including individuals of the medical and social elite together with members of the government, were helped occasionally with financial support. These initiatives defined their objectives with the criteria of the doctors involved and in general were directed more toward the adquisition of radioactive material and its instrumentation requirements, more than to solve public education on the incurable problem. In 1909, the ComitC Central Contra el Cancer [Central Committee Against Cancer] and the Asociacion National Contra el CXncer were founded. Also the main proposals of campaigning were discussed, but following foreign experiences, difficult to carry on. The unique achievements for this period were the national enquiries (1902 and 1909) to know clinical cancer incidence, etiology, medical services available, and doctors knowledge about the disease. But the reply obtained was insignificant: 2O.ooO enquiries and 298 replies (1902) (5). The decline of international initiatives due to the war had a negative effect on Spanish institutions. In fact, except for the creation of a modest laboratory for cancer research at the Instituto Rubio (Madrid, 1909) and the discussion about radiumtherapy in the cancer campaign, nothing more was done In 1914 the Sociedad Benefica Radium-Barcelona arose, as a nonprofit institution. to provide radium to pri-