A St. Louis epidemic of tinea capitas, aka ringworm of the scalp, was treated with unshielded head X-Rays in the 1950s

first published in the Riverfront Times (St. Louis), Jan. 12, 1994

BY C.D. STELZER

In the middle of an asphalt schoolyard more than a half a century ago, I stood alone, doffed my skull caps and flung them in the air. Both homemade yarmulkes were secular creations — byproducts of the nuclear age — the outer one fashioned from a white cotton sock, its inner lining sewn from nylon hosiery.

To me, they were symbols of separateness at public elementary school that year. A year in which I had often been segregated from classmates. But now it was spring, a long-awaited reprieve had finally been granted. Health officials ruled my condition no longer posed a threat to other students. I could attend the coming school picnic with no chance of infecting others. On my way home that day, my 7-year-old bald head felt the wind and sun for the first time since the previous fall.

I missed more than a month of the school year in 1957 and 1958. But the unpleasant memories would be tossed away, forgotten like my discarded skull caps in the schoolyard, and the parental reprimand I received for not disposing of them properly. My hair would grow back. A summer of bicycles and hoola-hoops awaited.

My case of “tinea capitis” or ringworm of the scalp, as it is commonly called, sank into an abyss of statistical insignificance like an unknown factor within a lost equation. The fungi that had attacked my hair follicles were eliminated by what was then considered a normal medical procedure. But uncertainties that have since arisen from the X-ray treatment I received for this benign childhood disease will continue to shadow me for the rest of my life.

A decade after my own treatment at St. Louis’ Children’s Hospital, a scientific study estimated that the scalps of irradiated ringworm patients had been exposed to as many as 800 rads of unfiltered X-rays, with lesser amounts being absorbed by the brain, cranial marrow, head, neck, parotid, pituitary and thyroid glands.

My medical record shows I received five overlapping dosages of radiation, which each measured 353 roentgens. A roentgen calculates the air dosage, whereas a rad indicates the amount of absorbed ionizing radiation to the tissue. Other measurements have now supplanted these units, but according to one expert, administering multiple-doses of this degree was not uncommon. By contrast, a person who receives a diagnostic chest X-ray absorbs about .02 of one rad.

Ringworm patients in my category have been used for comparative analyses along side Japanese atomic bomb survivors and Marshall Islanders who were exposed to atmospheric testing of nuclear weapons. Subsequent scientific papers have indicated that over time there have been significant increases in tumors as well as skin, thyroid and brain cancers among those who received the X-Ray treatment. One study has also correlated more psychiatric problems among irradiated ringworm patients.

By 1959 — a little more than a year after I had contracted tinea capitis the accepted treatment for the disease had changed. An anti-fungal agent called “griseofulvin” became the standard remedy. X-ray therapy is no longer applied to those who have ringworm of the scalp. But before use of the method ended, an estimated 200,000 children worldwide underwent irradiation, with perhaps 10 percent of those cases originating in the United States.

Ringworm of the scalp is but one of a number of different related fungi, which adds to the confusion over the disease. A Hungarian bacteriologist isolated the cause in 1843 and named it “Microsporon Audouini,” after a French scientist who specialized in the study of silkworms. This false association distracted scientists for sometime. The painful cure for the disease back then involved pulling a child’s hair out by its roots. Later in the 19th century, another French researcher, Raymond Sabouraud, recommended X-ray treatments as a more humane alternative. The radiation procedure that began to be used in 1910 took the name of two later researchers and was called the Adamson-Keinbock technique. It was widely used to treat post-World War II epidemics.

After receiving my X-ray dose, a family doctor later diagnosed I had a thyroid condition. The physician, Eugene Hall, is now retired and has yet to be located. However, my hospital record includes a letter from my mother mentioning a rash that developed around the time of my X-ray treatment. A response from the hospital’s chief of clinics tersely dismissed her complaint that the rash still had not subsided seven months after the X ray treatment.

According to a scientific report published just last year (1993), “the association between thyroid cancer and exposure to ionizing radiation was suggested as early as 1950.” Nevertheless, Children’s Hospital continued the use the Adamson-Keinbock technique for at least another eight years.

Roy Shore, the author of the study, states that “thyroid cancer risks appear to be greater following irradiation at younger ages.” Shore, a professor of environmental medicine at New York University Medical School, has been involved in a series of follow-up studies on the subject since 1976. His most recent report concludes that “a lifelong risk seems probable since several studies have found excess risk in their irradiated groups for 50 years or more.”

In a telephone interview last week, Shore speculated on the reason why such X-ray treatments continued unabated through the 1950s. “Number one, there were probably not a whole lot (of physicians) who were aware of the potential for thyroid cancer. It was not a very prominent finding back then,” said Shore. “But secondly, I would think that most radiologists didn’t think there was any appreciable dose to the thyroid gland. Indeed, it’s very small compared the dose to the scalp itself.”