The Ringworm Irradiators

By Rebecca Kreston | March 31, 2015 1:08 pm

Ringworm is one of the most common and widespread childhood maladies. Deceptive in its naming, ringworm is no parasite but rather a fairly mild, though atrociously itchy, fungal skin infection that affects 300 million people worldwide. An infection with the contagious Tinea capitis fungus is usually summarily dismissed by means of antifungal medications, but for decades prior to the discovery of such cures in the 1950s, infections with ringworm and other species of fungus were as intractable and as challenging as their bacterial counterparts. The mid-twentieth century, as modern an era as it seems, marked the early days of effective antimicrobial treatments, and though practical pharmaceuticals for bacterial, viral, and fungal afflictions were on the horizon, they were still far from universally available.

Without successful and accessible treatments, ringworm could be a temporarily disfiguring infection. The fungus would  infect the skin, the scalp, or the nails, causing characteristic halos of intensely itchy and inflamed scaling of the skin, hair loss, and, occasionally, superimposed infections with bacteria. Eventually the infection would run its course without drastic systemic damage, but not before inflicting scarring and permanent hair loss.

A ringworm infection caused by a species of Tinea fungus on both the face and scalp. Image: CDC.

A ringworm infection caused by a species of Tinea fungus on both the face and scalp. Image: CDC.

Of the treatments that were available in the early-to-mid twentieth century, most tended to operate under a “scorched earth” policy of treatment rather than a curative one. Caustic and toxic chemicals such as carbolic acid, sulfur, wood tar, and mercuric chloride would be slathered on the skin and scalp, eliciting painful burns that eradicated the indwelling fungus along with much of the “good” skin surrounding it (1).

Visible ringworm infections invited reactions ranging from distaste to an open fear of contagion to, at times, outright ostracism. The skin fungus was so reviled and wickedly infectious that it was included on a list of diseases that debarred immigrants from entering North America. A publication from 1912 regarding the medical issues of immigration at the American border described ringworm infection as a “presence [that] excites abhorrence in others.”  In accordance with immigration law, those seeking to enter America while bearing the fungal infection were lumped in along with “imbeciles, the feeble-minded, the epileptics, the insane, [and] persons afflicted with tuberculosis of the respiratory, intestinal or genito-urinary tracts.” These afflicted immigrants were labeled “undesirable” and “defective,” and effectively prohibited entry.

The history of ringworm treatment radically changed, however, with Wilhelm Roentgen’s discovery of x-rays in 1895.  His cathode-ray contraption that emanated penetrating electromagnetic rays quickly captured the attention of the public, and scientists and physicians soon began exploring its possible applications. It would be used for both diagnosis as well as treatment of maladies that had once been hard to detect and impossible to treat, and by the early 1900s its applications had extended to include the treatment of acne, skin cancers, and fungal infections.

A radiotherapy room for ringworm. Image:  The Royal London Hospital Archives. Click for source.

A radiotherapy room for ringworm. Image: The Royal London Hospital Archives. Click for source.

Ringworm irradiation, as it soon came to be called, consisted of “cutting the hair and then administering several consecutive rounds of irradiation to the scalp. A temporary sterile cap was put on for 18 to 21 days. Subsequently, a cap of hot wax was put on the head and taken off immediately after the wax had hardened, leading to complete epilation of the hair” (2). The therapy had a dubiously variable cure rate of 50 to 100% but it was cheap, relatively painless, and quickly became medically and culturally en vogue. As one excited physician practicing in the “electrical department” at a hospital in Edinburgh wrote of the practice, “In no department of x-ray therapy have x-rays won a more decided triumph than in the treatment of tinea” (3).

By the 1950s, despite growing concerns about the long-term effects of x-ray exposure and the potential for malignancy, ringworm irradiation was so prevalent that it was considered the mainstream, state-of-the art treatment throughout the world. In some countries, ringworm irradiation became a cornerstone in public health initiatives in which tens of thousands of children infected with tinea capitis were irradiated  throughout Europe, the Middle East, and North Africa.

From ringworm infection to complete epilation of the hair due to irradiation in a child around 1905. Image: JMH MacLeod. Click for source.

A photograph from the turn of the twentieth century showing ringworm infection in a young child as well as complete epilation of the hair due to the irradiation process. Image: JMH MacLeod. Click for source.

Between January 1946 and December 1960, at the height of mass immigration into the fledgling state and with financial backing and equipment from UNICEF, Israel irradiated an estimated 20,000 children for ringworm infection (4). The majority of these children had immigrated from nearby Northern Africa and the Middle East, receiving the rigorous treatment in established “ringworm clinics” within days of arrival.

Former Yugoslavia also had one of the largest ringworm irradiation programs, with 24 treatment centers established throughout the country (5). An estimated 50,000 children from 1950 to 1959 were treated for ringworm infection. Ringworm irradiation also occurred in Syria, Morocco, Portugal, Ukraine, Poland, the United Kingdom and the United States. It’s estimated that ultimately as many as 200,000 children worldwide were exposed to x-rays for their fungal infections (6).

In 1959, a newly discovered pharmaceutical, griseofulvin, was found to be completely efficacious in the treatment of ringworm and far easier to administer than irradiation. It soon replaced x-rays as the treatment du jour. But just as this new treatment made its appearance in the medical field, soon came trickling reports of the deleterious effects of radiation exposure. In the late 1950s, the Japanese were reporting cases of malignant cancers among atomic bomb survivors in Hiroshima and Nagasaki. In the late 1960s and 70s, thousands of patients who had received ringworm irradiation treatment would also begin to present with cancers, localized to the site that received the greatest irradiation – the head and neck region. Carcinomas of the thyroid, salivary glands, skin, and the brain were commonly recorded.

To date, Israel has conducted the most research into the clinical outcomes of ringworm irradiation. In the early 1970s, a team of researchers tracked 11,000 former ringworm patients and published one of the first pieces of research on what would become the “ringworm affair” (7). They identified 27 cases of head and neck cancers and 22 other carcinomas, showing a significantly increased rate of malignancy relative to the population. It would be one of the “first definite demonstration[s] of the role of ionizing radiation in the etiology” of malignant and benign carcinomas. Later Israeli studies found that patients who were irradiated were 3.5 times more likely to develop a malignant brain cancer and more than 4 times more likely to develop thyroid cancer (8)(9).

Radiation is now widely recognized as a major environmental cause of carcinomas. But in the era of “x-ray treatments,” radiation was ultimately a form of medical experimentation, therapy that was grossly unfounded, untested, and unverified by scientific methods. Ringworm irradiation was a cheap and proactive fix for a social and microbial contagion. But in combating this fungal menace, hundreds of thousands of children were subjected to a procedure that was a more dangerous scientific trend than medical panacea, one that proved to be far more hazardous to one’s health than a benign fungal infection.

Previously on Body Horrors

Flowers, Fungi & Felines: An Unusual Epidemic in Brazil

Valley Fever, The Archaeologist’s Scourge

A Moldy Cantaloupe & The Dawn of Penicillin

Resources

Israel is the only country that has paid reparations to irradiation victims and has provided financial compensation to victims since 1995 (the article is behind a paywall).

We’re still deciphering the long-term effects of radiation exposure. Read “The Mushroom Cloud and the X-ray Machine” to learn more.

Learn more about ringworm from the CDC here.

References

1) A Homei A and M Worboys. (2013) Fungal Disease in Britain and the United States 1850–2000: Mycoses and Modernity. Basingstoke (UK): Palgrave Macmillan.

2) N Davidovitch and A Margalit (2008) Public health, racial tensions, and body politic: mass ringworm irradiation in Israel, 1949-1960. J Law Med Ethics. 36(3): 522-9

3) JG Graham (1922) The X-Ray Treatment Of Tinea Tonsurans. BMJ. 2(3221): 563

4) J Siegel-Itzkovich (1995) Israel Compensates For Ringworm Treatment. BMJ. 310(6976): 350-351

5) S Shvarts et al. (2010) The tinea capitis campaign in Serbia in the 1950s. Lancet Infect Dis. 10(8): 571-6

6) Shore RE et al. (2002) Skin cancer after X-ray treatment for scalp ringworm. Radiat. Res. 157(4): 410–8

7) B Modan et al. (1974) Radiation-induced head and neck tumors. Lancet1(7852): 277-9

8) E Ron et al. (1989) Thyroid neoplasia following low-dose radiation in childhood. Radiat Res. 120(3): 516-31.

9) S Sadetzki et al. (2005) Long-term follow-up for brain tumor development after childhood exposure to ionizing radiation for tinea capitis. Radiat Res. 163(4): 424-32

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Body Horrors

Body Horrors looks at the history, anthropology and geography of infectious diseases and parasites.

About Rebecca Kreston

Rebecca Kreston is an infectious disease scholar trained in microbiology and epidemiology. She obtained her Biology degree from Reed College and her Masters of Science in Tropical Medicine from Tulane University. She's lived in tropical jungles, beaches and deserts around the world and has been exposed to several of the diseases that she studies. She currently lives in New Orleans, is a fourth year medical student and regularly battles insects of the Diptera, Siphonaptera and Hymenoptera orders.

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