125 years of head and neck radiotherapy: could organ-sparing radiotherapy of larynx cancer have prevented World War I?

PURPOSE: We aim to recapitulate the rapid development of head and neck radiotherapy in the context of otorhinolaryngology (ORL) medicine starting 125 years ago. This is put into context with the unsuccessful treatment of the laryngeal cancer (LC) of the German emperor Frederick III and its historical consequences. METHODS: The three-step process consisted in the analysis of (1) historical sources of the development of ORL radiotherapy from the discovery of x­rays and radioactivity until World War I, (2) course and treatment of Frederick's III LC, (3) political context with a special focus on the escalation towards World War I. Pertinent historical illustrations of technical developments of radiotherapy were summarized in a video. RESULTS: ORL radiotherapy initiated on 03 February 1896, only 65 days after the discovery of X­rays. By 1914, organ-sparing LC radiotherapy was established with a predominance of curietherapy over roentgentherapy. Correct diagnosis of Frederick III's primarily radiocurable cT1a glottic LC was delayed by one year, which resulted in advancement to a fatal pT4 pN1 Mx tumour stage. Historically, his successor, William II, was assumed to have contributed to the causes of World War I. CONCLUSION: ORL radiotherapy came only eight years late to treat Frederick III who might have impeded World War I. This illustrates the potential impact of modern curative radiotherapy on the future course of public life beyond the personal fate of the patient himself.

Claims of priority - The scientific path to the discovery of X-rays.

Shortly after Röntgen's publication about a new kind of rays, a dispute about priority claims began. Röntgen was not the first researcher to produce X-rays nor the first to take X-ray images. An analysis of the history of cathode ray research in the 19th century reveals ample evidence that researchers before Röntgen had already produced X-rays, albeit without knowing this. Most of them, for their part, did not claim any priority, some did so rather casually. The German-Hungarian physicist Philipp Lenard, a co-founder of German Physics, considered himself a "true discoverer". It remains to be said, however, that he, like many others before him, failed to recognize the character of the new radiation. It was Wilhelm Conrad Röntgen, with his three scientific publications on X-rays, who laid the foundations for their physical clarification and paved the way for the success story of their application in a variety of fields that continues to this day.

[Pioneers of medical physics--Theophil Christen (1873-1920)]. / Pioniere der Medizinischen Physik--Theophil Christen (1873-1920).

The Swiss mathematician and physician Theophil Christen was one of the first important pioneers in Medical Physics. He structured the previously confused field of physical concepts and definitions for medical applications of X-rays and paved the way for the modern understanding of dosimetry.

[Radiation exposure from shoe-fitting fluoroscopes]. / Strahlenexposition bei Schuhdurchleuchtungsapparaten.

It is 40 years ago that a very popular X-ray device disappeared in German shoe shops: the shoe-fitting fluoroscope or Pedoskop. Since the 1930s, these X-ray machines were an integral part of any good shoe business. Following the entry into force X-Ray Regulation (RöV 1973) the use of these devices was prohibited in Germany.