Professional Development

History in ANZ

Early Use of Radium in Australia (New Zealand is further below)

(From Isotopes Imaging and Identity)

According to Sydney Hospital’s Radium Registrar, Sylvia D. Bray, who on 18 May 1939 wrote to the Medical Journal of Australia, the first reported medical use of radium in Australia was on 5 May 1911.

I would like to state that on 17 February 1911, twenty one pieces of radium, consisting of twenty plates of various strengths and one fifty milligram tube, were purchased by Dr Langloh Johnston for the Sydney Hospital, in all a total of 252.5 milligrams.

This radium was first used on 5 May 1911, and from this date onwards was used continuously in the treatment of all grades of skin carcinomata, and the tube was used for carcinoma of the female genital tract, breast cases and glands, as well as many other types of lesions, superficial and deep.

In the eight months of 1911, 163 new cases alone were treated at the clinic, and between 1912 and 1922 the annual total of new cases treated varied between 180 and 250.1

Radium was first purchased by the Commonwealth Government in 1928 and the department of health established the Commonwealth Radium Laboratory to act as both custodian of the radium and as the centre from which it could be distributed on loan to approved hospitals as required.

However, in a clinical context, the value of radium treatment for cancerous conditions was first demonstrated in France in 1901 and the first radium treatments in Australia were reportedly performed by a Melbourne dermatologist in 1903.

At the Royal Hobart Hospital, radium needles were used for the first time to treat patients suffering from tumours and ulcers in 1912, just eleven years after the action of radium on human tissues first became known. But the initial results were far from encouraging.

In 1913, encouraging results were obtained from radium treatment of certain cancer cases at the London Radium Institute, which issued its first report covering 539 cases treated from the opening of the institute on 14 August 1911 to 31 December 1912.

In the same year, Senior Resident Surgeon and Radiologist of the General Hospital Hobart, E. J. Roberts M.D., presented a paper to the Tasmanian Branch of the British Medical Association entitled ‘The therapeutic value of secondary rays produced from metal by the action of the Rontgen rays.’ Roberts’ paper was then published in the Australasian Medical Gazette on 13 September 1913.

I have not had an opportunity of practically comparing the therapeutic action of the secondary rays with that of the radium emanations, but a careful study of the radium literature has led me to think that for definite prognosis, convenience of manipulation and expense of instalment, the secondary rays are decidedly superior, while the therapeutic effects seem to be more reliable and satisfactory.2

However, it was not until 1924 that a radioisotope was employed as a diagnostic aid in blood circulation studies in the United States of America.

In 1928, the Commonwealth Government purchased 10 grams of radium, which, in 1929, was distributed to public hospitals in capital cities throughout Australia. It was at this time that the Commonwealth Radium Laboratory was established and its services were made available to radiotherapists who required advice on the physical aspects of gamma-ray therapy.

The use of radium applicators and needles were introduced by Dr W. P. Holman (Launceston Public Hospital) soon after his appointment as a Radiologist in 1925. Radium needles had been used in combination with radical surgery sporadically since 1926 and rather consistently from 1929 until the radium needles were replaced by radon needles in mid-1934. It was at this time that Holman felt strongly about the procedure and a review on its effectiveness was undertaken, culminating in a radical decision to develop a new and more appropriate method of placement of the needles allowing irradiation of the intercostal spaces and axilla as the previous method was completely ineffective in irradiating these critical zones.

In a small proportion of cases from 1926, and in all those regarded as operable from 1929, radium needles were implanted prior to closure of incisions in radical surgery for carcinoma of the breast. However, at the July 1934 Northern Division meeting of the Tasmanian Branch of the British Medical Association, the proportion of patients surviving for five years was reported to be much lower than expected (unpublished).

Holman concluded that a more conservative definition of operability was required and secondly, that the manner in which radium was being used in such breast cases was illogical and inefficient, it prolonged the operation, raised the risk of sepsis, and in certain areas caused radio-necrotic reactions in the traumatised tissues.

Holman's decision was augmented by the increased knowledge of physical measurements hitherto empirical knowledge of the fields around the needles, the availability of the newly developed radon needles and, finally, the stimulus and personal encouragement given by the work of R. Kaye Scott of Melbourne.

Holman carried out a number of experiments towards developing a new technique for the treatment of breast carcinomas in which he implanted the affected breast and adjacent axilla with planes of needles. This was achieved by using wooden swab sticks soaked in sodium iodide and implanted into the breast of a female cadaver. The area was x-rayed to check the accuracy of the implant, then the breast was removed surgically, as from a living patient, and the specimen examined to see whether all the tissue removed would have been irradiated adequately.

In the latter half of the 1930s, Holman submitted a peer-reviewed thesis to the Faculty of Radiologists in London entitled ‘Irradiation in the Treatment of Carcinoma of the Breast’; and for this work was awarded a Fellowship of the Faculty. Although the Faculty advised him to publish the paper, it was never submitted for publication.

However, in 1944, the only paper attributed to Holman was in conjunction with Clifford Craig. In phasing the history of surgical treatment of carcinoma of the breast, Holman and Craig considered that it was as yet too early to report on treatment including radiotherapy, both alone and in conjunction with surgery as, at that time, no universally-acceptable technique had yet been developed. (From Isotopes Imaging and Identity)

History in New Zealand

The following social history of Nuclear Medicine in New Zealand is based on that penned by Dr Allan W. McArthur and first published by the ANZSNM in December 1989.1 Allan was domiciled in Dunedin and was a qualified radiologist. He became a radiotherapy registrar and from there became involved in nuclear medicine. He was perhaps the most active member of the ANZSNM in New Zealand.

Allan died several years ago; however, his legacy to the history of nuclear medicine in New Zealand is reproduced in full as a reminder of the evolution of nuclear medicine in New Zealand. From correspondence with several nuclear medicine pioneers in New Zealand, further anecdotal notes are added to Allan’s original work.

The following presentation endeavoured to establish the origins and subsequent growth of the regional radioisotope clinics in New Zealand, thereby complementing Dr Harry Lander’s publication in November 1971. The period covered is from 1950 to 1970, an era never previously recorded and one regarded as the great pioneering epoch of nuclear medicine in New Zealand, and not dissimilar to that which also occurred in Australia. In New Zealand, although medical physics services created these isotope clinics, each unit chartered its own course into the turbulent milieu of disease metabolism and structure.

Christchurch was nominated by the National Radiation Laboratory to take command of this new discipline and, in doing so, accumulated many firsts: first prescription, first laboratory and several others. Meanwhile, Dunedin was earning its share of early triumphs and the other regional isotope clinics at Auckland, Palmerston North and Wellington were quietly utilising the available isotopes compatible with their locally available equipment. Unit personnel were formed into teams to bring a safe, reliable diagnostic branch of internal medicine to patients, thus fusing numerous diverse skills with scientific knowledge.

Nuclear medicine in New Zealand began in 1948, at Christchurch Hospital, when the late Jim Campbell, a radiotherapist, prescribed oral I-131, in the same year that artificial isotopes became available in the United Kingdom.

Hosted initially by Medical Physics Services, the radioisotope clinic in each hospital has charted its own course through disease metabolism and structure, resulting in the development of a wide spectrum of clinical interest in New Zealand. Nine clinics have been established, some being more robust than others. Geographically, these clinics are widely dispersed from Auckland in North Island to Invercargill in the far south.