The Science Is Unsettling: Radiation Therapy for ‘Enlarged Thymus’

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In 1848, fifteen-year-old Hannah Greener of Newcastle, United Kingdom died minutes after being administered chloroform anesthetic for the removal of a toenail. As increasing reports of ‘sudden deaths’ during surgeries would make headlines and appear in medical journals throughout the late 19th century, this became a springboard to search for a ’cause’–other than chloroform.

While chloroform gathered some criticism, numerous commissions investigated chloroform for 50 years, and the results were always “inconclusive”. The medical community instead looked for a pathological cause–a physiological defect in children to explain their sudden death.

Alas in 1889, A. Paltauf of Vienna proposed that the cause for these “sudden deaths” was the result of an ‘enlarged thymus’ that could cause suffocation or strangulation at a moment’s notice–in young, healthy people. He coined this condition: status thymico lymphaticus. It was immediately widely accepted.

Each time a young person would die suddenly, especially during medical procedures, like the son of German Professor Paul Langerhans who died instantly after taking Diphtheria antitoxin in 1896: the answer would be status lymphaticus.

This, we now know, was a gigantic mistake. Because our early anatomical knowledge came from dissecting bodies of the poor, or bodies left unclaimed at the hospital — science only looked at shrunken and atrophied thymuses of the chronically stressed, impoverished and unloved/abandoned–and they mistook the atrophied thymuses of the poor, for the normal, healthy, larger thymus in a child.

The thymus is an organ of the immune system that is naturally large in infancy (as it’s making T cells protecting the body against infection) that shrinks naturally around puberty, called thymic involution. The thymus can also shrink temporarily due to extreme stress, like infections or malnutrition.

Status thymico lymphaticus would be the explanation for “sudden death” that exonerated clinicians, surgeons, anaesthetists and pathologists for the next 60 years. However, the consequences would be disastrous.

Doctors began treating infants and children for this “condition”. Surgery came first, but removing the ‘enlarged thymus’ had a fatality rate of about 33%, or 1 in 3 patients. This operation was performed on completely healthy children who had nothing wrong with them.

In 1907, the first child was treated with X-ray for status lymphaticus. It was a “success” and irradiation treatment became the treatment of choice. Every textbook of the period recommended this therapy, and it was suggested that all newborn babies should be irradiated as a prophylactic measure.

In 1925, Dr. C. Winfield Perkins wrote: “Many of the sudden deaths occurring during chloroform and ether anaesthesia have proved to be due to status lymphaticus.”

From the 1910s to the late 1950s, tens of thousands of infants around the world were treated with high doses of cancer-causing ionizing radiation for ‘enlarged thymus’. X-ray therapy became the standard protocol for a wide range of childhood ailments, including noisy breathing, cough, runny nose, wheezing in the chest, birth marks, moles, tonsillitis, asthma, ear infections, ringworm and cystic acne. Irradiation therapy would take place in hospitals, at doctors offices, and even at school clinics. It would be decades before they realized they were causing cancer.

A child undergoing an x-ray at University Children’s Hospital, Vienna, 1921.
A radiotherapy room for ringworm.

A typical treatment consisted of high dose x-ray exposures for several hours, twice a week, for many months. Treatments would begin as early as birth. Infants were exposed to a wide range of radiation doses: some as high as 1,400 rads, which is the highest amount of sublethal radiation possible.

Thymic irradiation also became a standard protocol for all infants who needed surgery for any reason. In 1932 the pathologist William Boyd wrote:

“The situation has come to such a pass that the surgeon who does not have the child with a wide shadow treated by irradiation before the administration of an anaesthetic may be held liable for malpractice if the child dies while under anaesthesia.

It would take decades for concerns about the safety of radiation therapy to be taken seriously. In 1949, two American doctors reported the case of a 5-year-old child whose thymus was irradiated soon after birth. The child developed cancer on the thyroid at the very point where the X-rays entered its body.

At Massachusetts General Hospital, doctors treated 5,000 children with X-rays for enlarged thymus, giving them 200-400 rads, which is equivalent to the peak radiation level recorded inside Fukushima plant, or the level of radiation used as criterion for relocating residents after the Chernobyl accident.

67,000 children in Maryland underwent nasal radium treatments in the 1940s, 1950s, and 1960s.

A study looking at 2,809 children treated with X-rays for thymic enlargement in an upstate New York County between 1926 and 1957 found that the treated children had a high incidence of tumors, particularly leukemia and thyroid neoplasms.

Another study looking at 2,657 infants in Rochester, New York who received thymic irradiation found that they had 7 times the cancer as their sibling controls.

Women exposed to this irradiation treatment as infants for enlarged thymus had 3 times the rate of breast cancer, and a 5-fold increase in thyroid cancer.

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By 1965, medical journals no longer included the condition known as status lymphaticus.

Clinical use of chloroform ceased in 1976, the same year the US Environmental Protection Agency listed it as a carcinogen.

Every generation is failed by the next generation’s science.