ELSEVIER Radiotherapy and Oncology 42 (1997) 203-211

Review article

Inauguration of radiotherapy as a new scientific speciality by

Leopold Freund 100 years ago

H. Dieter Kogelnik*
Institut fiir Radiotherapie und Radio-Onkologie, Landeskrankenanstalten Salzburg, Miillner Hauptstrasse 48, 5020 Salzburg, Austria

Received 23 September 1996; revised version received 19 November 1996; accepted 27 November 1996

Abstract

There is an increasing acceptance and knowledge of the fact that the inauguration of radiotherapy as a new scientific speciality was
performed by Leopold Freund 100 years ago. With a clear and logical rationale, Freund provided the first scientific proof of the
biological effectiveness of X-rays on a 5-year-old patient and performed the world’s first successful treatment with X-rays. Before
Freund’s historical experimental treatments, which started in Vienna on November 24th, 1896, there were several suggestions and
attempts at the therapeutic use of X-rays, however none of these mostly one-of-a-kind attempts was successful, and there was no
scientific proof of a therapeutic effectiveness of X-rays in these previous experiments. 0 1997 Elsevier Science Ireland Ltd.

Keywords:Radiotherapy; History; Foundation; Leopold Freund; Austria

1. Introduction radiotherapy as a new scientific speciality 100 years ago.

Freund’s original paperwas publishedon March 6th, 1897,
Rontgen’s discovery of X-rays on November 8th, 1895 in the Wiener Medizinische Wochenschrif [6]; an adden-
and their first use in diagnostic radiology are well known dum to this paper appearedon May 8th, 1897, in the same
world-wide and indisputably accepted. On the other hand, journal [7]. In the subsequentdecades, Freund further
there still seemsto be a lot of confusion and much less evolved his fractionated radiotherapy technique, which is
knowledge about the origins of radiotherapy and its foun- still in use today [ 111.
dation as a new scientific speciality. To finally settle any
controversies on this subject, it is necessary to clearly
distinguish between the early suggestions and mostly 2. Early suggestionsand attempts of the therapeutic
insufficiently documented one-of-a-kind attempts at the usesof X-rays before Freund’s fundamental treatment
therapeutic uses of X-rays, which did not provide any in November 1896
scientific proof of the therapeutic effectiveness of X-
rays, and the world’s first successfultreatment of a patient Before Freund founded radiotherapy as a new scientific
by Leopold Freund (fractionated radiotherapy of a hairy speciality [6], the earlier attempts to apply X-rays thera-
nevus). With his three experimental treatment set-ups(the peutically are characterisedby the following facts:
first one started on November 24th, 1896), Freund not only
1. All attempts of the experimenters were guided by the
performed the first successful X-ray treatment, but also
wish or desire that the new rays would show a thera-
provided the first scientific proof of the biological effec-
peutic benefit for the treated patients.
tiveness of X-rays and thus marked the inauguration of
2. None of these earlier attempts showed any scientific
proof of the therapeutic or biological effectiveness of
X-rays (in other words: none of these therapeutic
attempts was successful).
* Corresponding author. 3. Most of these early suggestionsat the therapeutic use

0167.8140/97/$17.00 0 1997 Elsevier Science Ireland Ltd. All rights reserved

PII SO167-8140(96)01887-7
204 H.D. Kogelnik / Radiotherapy and Oncology 42 (1997) 203-211

of X-rays were one-of-a-kind attempts with hardly any severe chronic dermatitis on the back of his left hand,
documentation, no firm scientific basis and rationale, followed by skin cancer [19]. When he presented his der-
and no further follow-up. matitis to some professors of the Hahnemann Medical
College of Chicago by the end of January 1896, the der-
The historical literature on these early attempts can be
matologist J.E. Gilman was very much impressed by the
essentially restricted to five persons: E.H. Grubbe, F.H. power of these new rays; he concluded that any physical
Williams, V. Despeignes, H. Gocht, and G. Voigt.
agent capable of doing so much damage to healthy tissues
might also offer possibilities in the treatment of patholo-
2.1. E.H. Grubbe’
gical conditions (e.g. cancer, lupus, indolent ulcers). The
fact that the Smithsonian Institution in Washington, DC
Emil H. Grubbe, a German emigrant living in Chicago,
has preserved the referring letters of the two patients, of
allegedly started the first X-ray treatment in the world on whom Grubbe claimed he had treated with X-rays, pro-
January 29th, 1896, as a medical student, on a female vides strong indirect evidence that the first one-of-a-kind
patient with postoperative recurrent carcinoma of the left attempts of radiotherapy in the world may indeed have
breast [ 181. This is ‘indisputably the first attempt at radio- been performed by Emil H. Grubbe.
therapy of cancer anywhere in the world’, as stated by de1
Regato [33]. In the recently published book Radiation 2.2. F.H. Williams
Oncology: A Century of Progress and Achievement, the
comment in this respect was: ‘This was the birth of radio-
Francis H. Williams, a pioneer radiologist from Boston,
therapy’ [4]. GrubbC claimed that he started the treatment marked the beginning of American Roentgenologic litera-
of a second patient with an exulcerated lupus vulgaris of
ture [21] with his book The Roentgen Rays in Medicine
the face on January 3Oth, 1896 [18]. and Surgery as an Aid in Diagnosis and as a Therapeutic
Unfortunately, there are severe problems in accepting Agent, which appeared in 1901 [42] (Antoine B&l&e
that Grubbe in fact performed the first radiotherapeutic translated this book himself into French). In this book he
attempts in the world. Firstly, the original source of infor- quotes the case of a 46-year-old female patient, who was
mation about these alleged treatments is the paper by repeatedly operated on for breast cancer. Williams
Grubbe, which he wrote 37 years later in preparation for attempted X-ray treatments on this patient in November
the Congress of Radiology in Chicago [18]; no original
1896. There was quick pain relief, however pains recurred
records exist, neither case was reported clinically by the
immediately, when the treatment apparatus could not be
referring physicians, ‘no dramatic results were obtained’,
used because of a defect for 12 days.
and both patients died within 1 month Grubbe himself did
In 1901, Williams published his cases of cured carci-
not mention his alleged treatments of January 1896 in any
noma of the skin and lower lip [41,42]; these patients were
of his previous publications, not even in his 1902 paper
presented previously to the Boston City Medical and Sur-
‘ ‘X-Rays in the Treatment of Cancer and Other Malignant
gical Society. In this respect, there is no argument in the
Diseases” [17], in which he refers to the origins of radio-
literature that the first cure of cancer patients with X-rays
therapy. Secondly, in the definitive biography of Emil H.
is credited to two Swedish pioneers, Thor Stenbeck and
Grubbe, which was written under a bequest made in his
Tage Sjogren, who independently and simultaneously
will (the prominent radiologist Paul C. Hodges was com-
reported successful skin cancer treatments with fractio-
missioned to write it), Grubbt is described as a publicity
nated radiotherapy at the meeting of the Swedish Medical
seeker who was ‘vain, boastful, incompletely truthful’, his
Society on December 19th, 1899 in Stockholm (published
use of X-rays was of ‘accidental, non-scientific and ill-
in 1900) [30].
advised nature’, and that he was an unreliable witness
concerning his own accomplishments [22]. Finally, in
2.3. V. Despeignes
the authoritative book The Rays: A History of Radiology
in the United States and Canada by F. Brecher and R.
Victor Despeignes can most likely be credited as the
Brecher [l] it is concluded that
author of the first article on radiotherapy [39]. His perti-
Grubbe’s story is so implausible, so lacking of con- nent publication “Observation concernant un cas de can-
temporary corroboration, and in such irreconcilable cer de l’estomac train5 par les rayons Riintgen” appeared
conflict with readily provable facts, and Grubbe’s on July 16th, 1896, in Lyon [3]. Because this publication is
untruthfulness in other respects is so readily demon- often brought to attention in connection with the question
strable, as to warrant the inclusion of his claims in of the priority of the introduction of radiotherapy, it
this postscript, rather than in the body of a history of deserves special interest. Freund extensively analysed
American radiology. this paper in his 1937 manuscript about the history of
the origin of radiotherapy (published 1948, 5 years after
On the other hand, there is no doubt that Grubbe was his death) [13].
one of the many X-ray pioneers and that he developed a Despeignes decided to treat a 52-year-old male patient
 H.D. Kogelnik /Radiotherapy and Oncology 42 (1997) 203-211 205

with an advanced cancer of the stomach with X-rays. The [6]. There was no mention of any skin reaction at all in the
tumour extended over the entire epigastrium, reached publication of Despeignes, which might have suggested a
inferiorly below the umbilicus and laterally to the low- more reliable biological effect at least on the skin of this
est ribs, and encased the right lobe of the liver. The patient patient.
was cachectic, looked jaundiced, showed symptoms of In conclusion, the depth of tissue penetration with the
cerebral anaemia, and developed melena on June 18th, earliest X-ray equipment as the one used by Despeignes
1896. He required several narcotics for severe pain. On in his therapeutic attempt was limited only to a few milli-
July 2nd, the patient received injections with an arti- metres (this is the reason that dermatologists were the first
ficial serum (formulation by Dr. ChCron). In addition, a to treat the various skin diseases during these first few
milk diet was used, and condurago wine (stomach bitter) years of radiotherapy). Therefore, with the X-rays used,
was given. From July 4th, until July 12th, 1896, the patient no biological effect at all was possible on the huge gas-
was also treated with X-rays twice a day, each irradiation tric neoplasm of this 52-year-old patient, and it is unne-
lasting half an hour. The treatment equipment consisted of cessary to further discuss the misinterpreted oncological
a pear-shaped vacuum tube, a six-cell battery (Radiquet- aspects of this case report. However, Despeignes may be
elements), and an induction coil (spark-over distance 5 credited as the author of the first publication on radiother-
mm). apy. Also, his attempt to outline the ‘borders of the
On July 12th, 1896, i.e. after an overall treatment time tumour’ on the skin of the patient before and after the
of 8 days, Despeignes noted a significant improvement in treatment deserves credit.
the condition of the patient. Opiates were no longer neces-
sary for pain control, the yellow colour of the face disap- 2.4. H. Gocht
peared, the cachexia no longer progressed, and the
palpable tumour mass regressed to about one half of.its In his publication on the therapeutic use of X-rays from
original size (Depeignes had outlined the tumour borders 1897198 [16], Gocht also presented two patients with
on the skin of the patient on July 4th and on July 12th, breast cancer. The first patient was 54 years old, and was
respectively). At this stage of the disease, Despeignes treated for 6 days in October 1896 because of an exulcer-
made his first publication [3]. ated inoperable lesion on the right side. Apparently there
In an addendum to this case report (which appeared in was a decrease in the pain, but on the seventh day an
the same journal, p. 503) [3], Despeignes stated that the extensive erysipelas developed with associated fever. Sub-
improvement of the patient’s condition only lasted 4-5 sequently, profuse bleeding occurred from the exulcerated
days. Then there was a rapid cachexia with abundant diar- cancer, and the patient died from cachexia and sepsis on
rhoea, and the patient died on July 24th, (12 days after the day 17.
end of the X-ray treatments). There was no autopsy. Des- The treatment of the second patient was started on
peignes concluded from his observations that the X-ray November 2Oth, 1896, in a 46-year-old female with recur-
treatment had improved the general condition of the rent breast cancer. Again, there was transient pain relief,
patient and prolonged his life for 2 weeks; the serum injec- but the cancer progressed and the patient died 3 months
tions also contributed to this improvement. In addition, the later. Only a mild erythema of the surrounding skin was
tumour pain became significantly reduced. As to the rea- observed, which was followed by a dry desquamation. In
son for the drastic decrease in size of the tumour mass, addition, on October 24th, 1896, X-ray treatments were
Despeignes himself was rather sceptical; he stated that in begun in a 19-year-old male patient with an extensive
the absence of an autopsy it is not possible to distinguish exulcerated lupus of the right cheek, and a definite
between an actual shrinkage of the tumour and the retrac- improvement was noted. Concerning pain relief in his
tion of a dilated stomach. patients, Gocht assumed that this might have been a sug-
In the light of our current knowledge it is obvious that gestive effect.
with the X-rays from this tiny apparatus there could have
been no biological effect at all on this large epigastric 2.5. G. Voigt
tumour mass of the patient, whatever the histology of
this neoplasm was. The equipment used was of the oldest There is no publication by Voigt dealing with his treat-
construction, characterised by a spark-over distance of ment with X-rays of a patient with a pharyngeal cancer,
only 5 mm. With such an apparatus, X-rays of up to 18 and the technical details as well as the rationale for this
kV can be produced [ 141. With such energies, at 2 mm treatment are not known. According to the early publica-
tissue depth there is only 50% of the surface dose, and at 1 tion by Gocht from 1897/98 [16], Voigt presented this case
cm depth there is less than 10% of the surface dose. In on November 3, 1896, to the Medical Society (Arztlicher
addition, the total X-ray exposure time applied by Des- Verein) in Hamburg, and there was a significant pain relief
peignes is less than half of that used by Freund in his for the patient after treatment with X-rays. Freund men-
first experimental set-up (in. which Freund achieved an tioned that the treatment by Voigt had evoked a heavy skin
epilation effect with mild transient erythema, see below) reaction (darkening of the skin), and because the patient
206 H.D. Kogelnik / Radiotherapy and Oncology 42 (1997) 203-211

died during this phase, the expected subsequent severe

dermatitis did not manifest itself [ 131.

3. Freund’s historical treatment and the foundation of

radiotherapy as a new scientific speciality

Leopold Freund (1868-1943) (Fig. 1) started his histor-

ical X-ray treatments in Vienna on November 24th, 1896
[6]. In his original publication from March 6th, 1897 (Fig.
2), he fully recognised the fundamental implications of his
three experimental treatments of a 5-year-old girl. With a prs. E6.6ahiR M I. 6lthtl.

clear and logical rationale, Freund thus provided the first

scientific proof of the biological effectiveness of X-rays in Ein mit Riintgen - Sh.ahlen behandelter Fall
a patient and performed the world’s first successful treat- ran Naevus pigmentosuspiliferns.*)
ment with X-rays (fractionated radiotherapy of a hairy Van Dr. LEOPOLD FEEUND.
nevus).
Yeioe im Folgenden mitgetheilten Versnche wnrden im
At that time, Leopold Freund was a 28-year-old physi- Jnni 1696._ dnrch_ eine Zeitna~snotie engeregt, deren Pro-
_
cian, who had graduated 1 year previously and worked
under E. Schiff in the dermatological department of the
I. ijffentliches Kinderkrankeninstitut in Vienna. He was Fig. 2. Freud’s original paper from March 6th, 1897 [6]. The top of the
front cover of this edition of the journal (above) and the title page of the
initially stimulated by a Viennese newspaper notice from
paper (below) are shown.
June 1896, which mentioned the occurrence of a dermatitis
and simultaneous epilation on the head of a man, who had
worked with X-rays. The report by Daniel from April 1896 [2] on the first incidental case of radiation epilation was
commentedon in the Wiener Medizinische Wochenschrift
on October 3 lst, 1896.
Schiff provided Freund with his first patient, a 5-year-
old girl, who had a 36 x 37 cm nevus pigmentosuspili-
ferns (hairy nevus) on her back (Fig. 3). None of the pro-
fessorsfrom the University of Vienna would allow him to
perform his proposed experiments within the university.
Finally, Freund received support from the director of the
Viennese Imperial Royal Institute for Researchin Photo-
graphy and Reproduction Procedures(K.K. staatliche gra-
phische Lehr- und Versuchsanstalt), Professor Dr. J. M.
Eder, to perform his experiments in the Rijntgen labora-
tory of this institution (Westbahnstrasse 25) [43].
Although Eder was rather sceptical of whether the experi-
mentsproposedby Freund would be of any value, he was
impressedby the insistent requestby this shy young man,
who definitely wanted to obtain the experimental proof of
the Viennese newspaperreport mentionedabove [5]. If his
experiments demonstrateda biological effectiveness for
X-rays, Freund wanted to use them for treatment of dis-
eases.
An example of the early radiotherapy equipment of
these pioneer years is shown in Fig. 4 [8]. To obtain an
approximate characterisationof the intensity of the X-ray
beam at that time, Freund statedthat at a distanceof about
15 cm a ‘Rontgen-photograph’ of a male hand was easily
performed in 1 min [6]; he used a treatment distance of
about 10 cm.
Freund performed three different experimental treat-
Fig. 1. Leopold Freud, 1868-1943 (Library of the Institute of History of ment set-upsfor his 5-year-old patient [6]. The first of
Medicine, University of Vienna). these began on November 24th, 1896 with X-rays and
 H.D. Kogelnik /Radiotherapy and Oncology 42 (1997) 203-211 201

Table 1
First experimental treatment set-up by Freund (November 24thDecem-
ber 3rd, 1896) [6]

n Treated region: Upper half

of the hairy nevus
n Daily X-ray exposure 2 h (for 10
consecutive days) at a distance
of about 10 cm*
n Total exposure time: 20 h
Clinical course
n Beginning epilation on December 3rd
(interscapular) with no skin erythema.
n Epilation further progressed until
December lOth, but then it continued
at a lesser rate for some time.
n December 1 lth (day 18): Nuchal
dermatitis with diffuse erythema and
patchy areas of moist desquamation
(heated in a few days with an ointment);
no skin erythema at all in the other
areas of epilation.

*At 15 cm distance: ‘Rontgen-photograph’ of a hand in 1 min.

nated the first experimental treatment and started this sec-

ond experiment. Freund treated a nevus on the right arm of
the samegirl with anoderays for 12 days, but no biological
effect at all appearedin this treatment field.
Freund started his third experimental treatment on

Fig. 3. Printed photograph of the back of the 5-year-old girl with the
hairy nevus before Freund’s X-ray treatments [6].

was directed at the upper half of the hairy nevus. Treat-

ment details are summarisedin Table 1. On December 3
(day lo), the first signs of the epilatory effect of X-rays
were noted by Freund. This day is rememberedby Eder as
follows [5]:

While I was working in may laboratory one day, the

door was suddenly flung open, and without being
announced,Freund stormedinto the room extremely
excited, dragging the little girl behind him, and
cried “Herr Direktor, Herr Direktor, sie fallen
aus!” (Director, Director, they are falling out!).
Indeed, he was right. There was a circular area of
epilation in the neck, which Freund had irradiated.

The secondexperimental treatment by Freund beganon

December 3rd, 1896, and was designed to exclude the
effects of anode rays as the biologically effective agent
for epilation. The reason for this second experimental
design was that Freund, by mistake, had used anode rays
for only 15-20 min aspart of the 2-h treatment on Decem-
ber 3rd. As this was the time that the epilation began, it
occurred to him that the anoderays could have causedthe Fig. 4. The early radiotherapy equipment as shown in Freund’s textbook
therapeutic effect. To make sure, he interrupted and termi- of radiotherapy from 1903 [g].
208 H.D. Kogelnik / Radiotherapy and Oncology 42 (1997) 203-211

Table 2

Third experimental treatment set-up by Freund (December 18th. 1896 to

January 15th, 1897) [6,7]

Purpose To exclude the effect of the electric current

(electric waves) as the possible biologically
effective agent of epilation
Treated region: lower half of the hairy nevus
21 treatments with X-rays
(until January 15th, 1897)
Total exposure time: 42 h

Clinical course Beginning epilation on day 8 (after 16 treat-

ment hours): slight erythema with progressing
epilation on January 5th (day 19)
Complete epilation and marked erythema
on January 18th, a few days later moist
desquamation
A necrotic ulcer developed in the center of
the field (February 6th-March 9th), which
healed later with a deep scar (but ulcer
recurred repeatedly)

December l&h, 1896, and treated the lower half of the

hairy nevus on the back of the girl with X-rays. The pur-
pose of this experiment was to exclude the effect of the
electric current (electric waves) as the possible biologi-
cally effective agent. He placed aluminum foil between
the X-ray tube and the skin, and connected the aluminum
foil with the tap of the water supply (to discharge the
electricity). To compensatefor the expected attenuation
of X-rays with this treatment set-up, Freund used a total
exposure time of 42 h (21 treatments, daily 2 treatment
hours in the morning). A summary of this third experi- Fig. 6. Printed photograph of the same patient as in Fig. 3, taken about 1
week after completion of irradiation of the lower half of the hairy nevus
mental treatment design is given in Table 2.
(thud experimental treatment set-up, see text) [7]. There is a huge area of
moist desquamation in the center of this lower treatment field.

The publication of Freund’s addendum to his original

paper, in which he mainly discussedthe consequences
from his third experimental treatment, appearedon May
8th, 1897 (Fig. 5) [7], and the photograph from this pub-
lication with the large area of moist desquamationin the
center of the treatment field in the lower half of the hairy
nevus is shown in Fig. 6. In connection with Freund’s
experimental treatments,Moritz Kaposi, the leading Vien-
nesedermatologist at that time, can be regardedasthe first
radiation biologist and pathologist [7,43]. Kaposi was also
one of the few advocates for Freund on the occasion of
Freund’s first report to the Viennese Medical Society
Nachtrag zu demArtikel ,,Eii mit RiMgen- (K.K. Gesellschaft der Arzte in Wien) on January 15th,
Strahlen behandelterFall von Naevua pi@!n- 1897.
tosus piliferus?) Fortunately it waspossibleto follow-up this patient, and
vonDr.LEOPOLD FE.mmD in wmn. the last report was made75 years after the treatment [25].
Der weitara Reaktioowerlsaf aa den der B 6 II t g e II- Photographsfrom the back of this 80-year-old woman are
Beleuehtang
._.r exponirten Eer~~llen
.. ergab
n mebrere
. 1 beper- shown in Figs. 7 and 8.
Freund concluded convincingly from his three experi-
Fig. 5. Freund’s addendum to his original paper from May 8th, 1897 [7]. mental treatment designsthat only X-rays (cathode rays)
The top of the front cover of this edition of the journal (above) and the were the responsible agent for the biological effect
title page of the paper (below) are shown. obtained [6]. He madeseveral further fundamental conclu-
 H.D. Kogelnik / Radiotherapy and Oncology 42 (1997) 203-211 209

life, although he was exposed to many attacks in the dec-

ades following his original treatment [ 121. He had to
defend the priority of his pioneering scientific work as
the founder of radiotherapy and its fractionated application
technique on several occasions [ 10,131.
Other researchers, such as the famous physicist Ludwig
Boltzmann and various French scientists, believed around
1898 that the electric field generated by the X-ray tube was
responsible for the biological effect [40]. Also Freund
temporarily came to doubt his original interpretation
about the effective agent in epilation. Finally, the defini-
tive experiments and observations by Kienbijck [26], and
to a lesser degree by Strater [37], terminated the debate on
this subject and the scientific community became con-
vinced that X-rays alone were the responsible agents in
epilation.
The scientific publications by Freund include more than
100 papers, of which he is the only author. In 1903, he
published the world’s first exhaustive 417-page textbook
solely devoted to radiotherapy with the title Grundriss der
gesammten Radiotherapiefiirpraktische &zte [8], and an
English edition appeared 1904 [9]. It is worth mentioning
that in 1901 E. Schiff wrote a 36-page book The Thera-
peutics of the Riintgen Rays, which although not very

Fig. 7. Photograph of the patient 75 years later. There is a complete

epilation of the entire hairy nevus on the back of the patient with multi-
ple residual pigmented spots. At the level of the lower lumbar spine one
can see a moderately florid radiation ulcer with extensive surrounding
scar-formation [25].

sions from his historical case report [6,7], for example that
the biological effects of the X-rays are different for various
tissues; the obtained epilation is temporary but can be
made permanent; changes in the pigmentstatus will
occur in the irradiated skin; there is a cumulative effect
of X-ray treatments, which starts after 16-22 hours of
exposure. Freund also stressed the importance of the dura-
tion of each treatment session and of the whole treatment
series to avoid undesirable side effects. He further deduced
the possibility of applying X-rays for diseases of deeper
situated organs, because he had obtained the desired bio-
logical effect (epilation) with an absent skin reaction in the
largest part of the entire nuchal field. Freund also stated
other important parameters such as the distance from the
X-ray tube to the skin, the ‘light intensity’ (as measured by
the strength of the emitted fluorescence), and the vacuum
of the X-ray tube. He was able to recognise slight skin
reactions as an early indicator of the application of a suffi-
cient therapeutic dose by reducing the daily treatment time
and by extending the overall treatment duration. Thus, he
suggested guidelines to achieve the desired effect without
severe complications. Freund continued to use fractionated
radiotherapy for thousands of his patients throughout his Fig. 8. Close-up view of the area of the ulcer in Fig. 7 [25].
210 H.D. Kogelnik /Radiotherapy and Oncology 42 (1997) 203-211

extensive, is the first radiotherapy publication other than a where. Freund obtained the title of university professor on
paper or pamphlet, following the discovery of X-rays [35]. March lst, 1915. He became an honorary member of the
The textbook by F.H. Williams, which was also published Austrian Rijntgen Society in 1934, and gave the festive
in 1901 [42], was devoted to X-rays as an aid to diagnosis lecture of the first congress of the Austrian Riintgen
and as a therapeutic agent. Society in Vienna in September 1936 [ll]. The president
Leopold Freund, Robert Kienbijck and Guido Holz- of Austria awarded him with the title ‘Hofrat’ during the
knecht received the Venia legendi (Privatdozent) of the same year, which was a special satisfaction for Freund
University of Vienna for medical radiology on May 6th, [40]. However, because of his Jewish origin, the inaugu-
1904, which documents the supreme position of that uni- rator of radiotherapy had to emigrate from Austria 1 year
versity at that time. Under the influence of Kienbock, later. Leopold Freund died impoverished from cancer in
Guido Holzknecht also became involved in radiotherapy Brussels in 1943.
[43]. In 1902, Holzknecht succeeded in developing the
first device to measure X-rays, the chromoradiometer
[23]. This was a milestone for exact dosimetry, enabling 4. Conclusions
the practice of radiotherapy to be placed on a firm basis.
Only a few years later, Kienbijck introduced his quanti- There seems to be an increasing acceptance and knowl-
meter [27], which marked the begin of film dosimetry. edge world-wide of the fact that Leopold Freund was the
These newly developed methods of measuring the X-ray inaugurator (founder) of radiotherapy as a new scientific
dosage, in conjunction with the availability of higher dose speciality [l-5,20,24,25,29,31,32,34,36,38]. He was the
rates, made it possible to perform X-ray treatments in one first person to provide scientific proof of the therapeutic
or a few sessions. One pertinent sentence by Holzknecht effectiveness of X-rays, and he performed the first success-
was quoted by Freund [l 11: ful treatment in the world with (fractionated) radiotherapy.
Earlier suggestions and attempts at the therapeutic use of
Freund has founded radiotherapy with the method X-rays by others were not successful and did not provide
of smallest fractional doses. Kienbijck developed any scientific proof of the therapeutic effectiveness of
from this the so-called expeditive method with these new rays.
four fractional doses, and Holzknecht denounced
the full (single) dose treatment with the original
chromoradiometer. References

In his textbook of radiotherapy from 1907 [28], Ul Brecher, E. and Brecher, R. The Rays: A History of Radiology in
Kienbiick differentiated between the primitive method of the United States and Canada. Williams and Wilkins, Baltimore,
1969.
Freund with the use of daily X-ray expositions, and the
PI Daniel, .I. Depilatory action of X-rays. Med. Rec. 49: 595-596,
expeditive method of himself and Holzknecht (Freund’s 1896.
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