Working through the many patient case files of leading neurosurgeon Geoffrey Jefferson there are a number of particularly significant topics and themes that stand out as being of interest, which I will explore in various blog posts over the coming months beginning this week with the development of radiotherapy and brachytherapy as a therapeutic treatment in Manchester.
Wilhelm Rӧntgen discovered the effect of x-rays in November 1895 and the field of radiography developed very rapidly from this point onwards with investigations into the therapeutic uses of radiation beginning almost immediately. Efforts to treat cancer patients with radiotherapy and radium were experimented with in Manchester very early on, although somewhat tentatively at first, with the Manchester Radium Institute being founded in 1915 within the confines of the Manchester Royal Infirmary. By 1933 the Christie Hospital and the Holt Radium Institute had moved to share new buildings on the outskirts of Manchester. In 1931 James Ralston Kennedy Paterson (1897-1981) had been appointed radium director of both the Holt Radium Institute and the Christie Hospital and was seen to be the driving force behind the uniting of the two facilities and the creation of a centralised and standardised radiotherapy service in Manchester.
In the treatment of his patients Jefferson made liberal use of both radiotherapy and brachytherapy, as either complementary to surgical treatment or as an alternative, and in turn made numerous referrals to Paterson at the Radium Institute. A handful of his early cases demonstrate this, and undoubtedly a greater number and variety of cases will emerge as work to catalogue the later files progresses. Various methods were employed, with gold radon seeds implanted in some patients and casts formed to allow the radium to be placed externally at the site of a lesion in others. The economics of treatment come through in discussions of treatment, where initial wishes to apply radium to the whole vault of patient 1931/98’s head was deemed to be far too expensive and a more localised approach taken instead. More interestingly when discussing the possibility of using radiation to reduce salivary secretion in patient 89/1932 Paterson reveals he has tried this therapy experimentally on himself.
The negative side effects of radiation are evident in different ways in two of Jefferson’s cases. Firstly patient 1928/83, a 53 year old woman originally admitted in 1928 for treatment of a spinal tumour, returned to the MRI several years later in 1942 owing to a malignant basal cell carcinoma on her back that had formed as a result of the radiotherapy she received for the spinal tumour. Her file contains correspondence between Jefferson and Paterson discussing the best form of treatment and the benefits of radiotherapy with Jefferson saying “She has had a great deal of x-ray therapy, probably too much … Although x-ray may be the cause of this I think she has to thank radiotherapy for being alive.” Around a similar time, patient 1933/166 was receiving deep x-ray therapy between 1934 and 1943 for a frontal tumour, but following his death his son wrote to Jefferson and commented in an otherwise complimentary letter that “once when he attended Christies he was put under the x-ray lamp without any shield on his head and eyes at all. After that his eyes troubled him a lot.”
The University Library also holds administrative records and reports from the Christie Hospital and Holt Radium Institute including numerous reports compiled by Paterson and his colleagues. Together with the illustrative case studies found amongst Jefferson’s patient files there exists a considerable resource for the study of the evolution of a modern radiotherapy department in Manchester, the development of treatments in practice, their efficacy, and patient experiences.
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