Part 1. Whooping Cough: A Very Serious Disease
Lawrence W. Smith and his colleagues of the Boston Floating Hospital delivered the second report from their group on the subject of x-ray treatment of pertussis (whooping cough), with and without additional therapy by a vaccine. Their original paper (1924) had reported on 300 children treated. The current paper (1925) reports on a total of 850 cases of pertussis, which represents an increment of 550 cases treated.
For some perspective on this very serious disease of childhood during that period, we shall excerpt some comments from the paper of the investigators. At page 176:
"The roentgen-ray treatment of whooping cough seems to have passed beyond the experimental stage. The literature of the past year has had a considerable number of reports from Canada, various parts of the United States and Europe, all of which tend to corroborate the feeling which we have concerning its efficacy. Various suggestions as to the mechanism by which the clinical improvement takes place have been advanced, but the general feeling seems to be that it is due to a diminution in the nervous reflex from the pressure of the hilum lymph nodes by a reduction in their size ..."
"These preliminary studies of nearly a thousand cases justify the further investigation of means of treating this serious infection of childhood. It is our hope to extend this work to the various local boards of health, hospitals, and laboratories, with the ultimate expectation of securing a specific means of therapy for pertussis. By such a concerted attack, a thorough survey should be possible and much evidence could be accumulated which is impossible to do from one small group. The roentgen-ray treatment of the disease, which has gained the confidence and support of both the laity and the medical profession to a large degree, offers a means to this end, as it is possible to secure cases for study in this way which it has not been possible to do previously." And:
"For this reason we appeal to the medical profession for furtherance of this work. Whooping cough still occupies one of the chief positions in infant mortality figures. We feel that, by the roentgen-ray treatment of whooping cough, combined with vaccine, as well as the ordinary medicinal agents, we have gone a step forward." And:
"Our own part in this program is comparatively unimportant. Our chief function is to stir up curiosity and interest in whooping cough and to maintain that interest by a constant effort. If we can do this, whooping cough will follow in the footsteps of most of other recognized infectious diseases, as diphtheria, and now scarlet fever, have done."
It would be quite reasonable to suggest that this roentgen-ray therapy of pertussis was indeed in widespread use after all these optimistic reports of good response, and a low mortality. There were, as there always are, some real skeptics concerning the efficacy. We shall assume that the level of use comparable to that in Boston persisted for half of the 1920-1960 period, and slowly went into decline as the protection of an increasing segment of the population by pertussis-vaccination (part of the DPT vaccination program) drastically cut down the number of cases of clinical pertussis requiring management.
Laurie McGinley (Wall Street Journal, November 23, 1994) reports that in the 1930s, before there were widespread immunizations in the U.S., there were 5,000 deaths per year from pertussis.
Part 2. Calculations of the Radiation Dose in Therapy of Pertussis
o - Item 1: Place of Study: Boston, Massachusetts. Study at Boston Floating Hospital. This is in Suffolk County, Massachusetts. We cannot be sure that the Boston Floating Hospital was the only place where pertussis patients were receiving radiation therapy, but it must have been the major one. If we assume incorrectly that it was the only one, we shall thereby only underestimate radiation dose to the population --- part of our conservative underestimate of radiation dose to breasts.
o - Item 2: Total number of children treated is 850, distributed in age as shown in the tabulation box nearby. Our total is 851, because we had to read numbers from Smith's Figure 1.
o - Item 3: Suffolk County population in 1960 = 791,329. USA population in 1960 = 179,333,000. Therefore, for each age-year, to ascertain female children in Suffolk County we proceed as follows: (National number in age-year) x (791,329/179,333,000.) Final entries for female children for each age year are in the tabulation.
o - Item 4: Mean dose to breast-pairs: 100 R delivered anteriorly and 100 R delivered posteriorly. Total dose divided into 4 sessions.
Breast-pair dose, from anterior delivery, 100R x 0.693 rad/R = 69.3 rads.
Adjustment factor for supra-linearity is 0.707 (Chapter 8, p.58), if we approximate 20 rads at each of 4 sessions: 0.707 x 69.3 rads = 49 rads.
Mean dose to breast-pairs from posterior delivery, = 100 x 0.037 = 3.7 rads. Total medical rads delivered to breasts = 49 + 3.7 = 52.7 medical rads.
o - Item 5: This study provides the total number treated over 3 years. Therefore, the entry for one year is one-third of the total. And taking females as 1/2 of total group, we cut the number per age-year again in half. (See tabulation on next page.)
Tabulation of Data
Suffolk One-half
County Person- Average Average
Age-year Number Treated Only Number Rads Breast Breast
Treated per Year Females per age-yr Dose Dose
0 140 46.7 23.3 3995 1230 0.308 0.154
1 120 40.0 20.0 3940 1054 0.268 0.134
2 130 43.3 21.7 3937 1142 0.290 0.145
3 90 30.0 15.0 3934 791 0.201 0.100
4 103 34.3 17.2 3932 905 0.230 0.115
5 97 32.3 16.2 3930 852 0.217 0.108
6 69 23.0 11.5 3929 606 0.154 0.077
7 35 11.7 5.8 3928 307 0.078 0.039
8 15 5.0 2.5 3927 132 0.034 0.017
9 5 1.7 0.8 3926 44 0.011 0.006
10 5 1.7 0.8 3925 44 0.011 0.006
11 5 1.7 0.8 3924 44 0.011 0.006
12 5 1.7 0.8 3923 44 0.011 0.006
13 4 1.3 0.7 3922 35 0.009 0.004
14 4 1.3 0.7 3921 35 0.009 0.004
15 4 1.3 0.7 3920 35 0.009 0.004
16 4 1.3 0.7 3918 35 0.009 0.004
17 4 1.3 0.7 3916 35 0.009 0.004
18 4 1.3 0.7 3914 35 0.009 0.004
19 4 1.3 0.7 3912 35 0.009 0.004
20 4 1.3 0.7 3910 35 0.009 0.004
Total 851
Illustrative calculation, using data for 0 years of age.3,995 female children in Suffolk County in 0 year age group. Treated female children = 23.3 children. Mean Breast-Pair Dose in Medical Rads = 52.7 rads. Person-rads in 0 year age-group = (23.3 persons) x (52.7 rads) = 1,230 person-rads. Average breast dose = 1,230 person-rads / 3,995 total persons = 0.308 rads. Cut dose in half to account for decline in use of this therapy over time.
Final dose = 0.154 medical rads. Entries in this column are transferred to the Master Table Col.N, as entries for Pertussis (Whooping Cough) Therapy.
Note: Cases per age-year had to be read off from Figure 1 of Smith et al.
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Part 3
Preview of Another Use: Well-Baby Check-Ups
We must admit that we were quite seriously shaken up by what we learned from Dr. Hanson Blatz and Dr. James Pifer and the woman from New York City. And as we said (p.116), the story went west.
Dr. Franz Buschke and Herbert M. Parker published a very low-key bombshell, in the Journal of Pediatrics (1942) entitled, "Possible Hazards of Repeated Fluoroscopies in Infants." The paper had been read before the North Pacific Pediatric Society, in Seattle, Washington, January 31, 1942.
The opening paragraph follows:
"Recently we became aware of the fact that apparently a number of pediatricians include a fluoroscopy in the monthly routine examinations of infants in their care during the first and second years of life. Since we feel that such a procedure is charged with potential hazards, we welcome the opportunity of discussing the problem at your initiative in this group."
Their beautiful scientific paper has undoubtedly saved many women from breast-cancer's ravages. Such women will never know what they owe to the Buschke-Parker team of wide-awake serious, informed professionals in the radiation field. The details are in Chapter 31.