Radio-active Substances: Their Therapeutic Uses and Applications

Abstract

THE pathologic condition which I am about to discuss is known in medical literature under a variety of names. In England it is called Graves' disease; in Germany and on the Continent largely, morbus Basedowii (the malady of Basedow); here the same combination of symptoms and clinical manifestations is known as toxic goiter, exophthalmic goiter, hyperthyroidism, and by several other designations which do not come to mind at the moment. To the layman and the student this inexactness in nomenclature is highly confusing, and even physicians who are familiar enough with the condition in the variety of aspects which it presents, are more or less puzzled to know just how to name it so as to make themselves perfectly understandable to all hearers. To my mind, however, the term “hyperthyroidism” is the most precise, as this makes mention of the basic factor in the production of the disease, and covers alike those manifestations where there is no bulging of the eyes despite over-activity of the thyroid gland, as well as those cases in which the exophthalmos is the most striking symptom. Inasmuch as radium treatment aims to abolish this overactivity, thus secondarily eliminating the results of perverted function, it seems logical to speak of the radium treatment of hyperthyroidism, which covers all the lesser variations dependent upon this primary cause. It was apparently that enthusiastic pioneer in so many applications of radium, Robert Abbé of New York, who was the first to think of making use of the then new therapeutic agent, for the treatment of hyperthyroidism. Before this country boasted any periodicals devoted to radiologic topics, when, indeed, all the reputable medical journals looked decidedly askance at the “exploitation” of a new and somewhat doubtful therapy, he published in the Archives of the Roentgen Ray, a London scientific paper, the report of a case of “Exophthalmic Goiter Reduced by Radium.” This report is a remarkable document in many respects, for not only does it seem to be a record of the first attempt made to control thyroid hypersecretion with irradiation, but it also details a method of application at that time both unknown and untried under similar conditions, namely, the implantation of the radioactive agent directly within the tissue it is desired to affect. Abbé had previously used this method upon a giant-cell sarcoma of the lower jaw, and was far-sighted enough to argue that a similar procedure might be equally effective in so widely dissimilar a condition as enlargement of the thyroid gland. The patient upon whom he essayed the experiment was in such an advanced stage of the disease that he was fully convinced “the most ardent advocate of surgery would have refused to operate,” so that the use of radium was in this case, as in practically all others in those pioneer days, a last resort, when all other hope had failed.