Use of Thermography, or heat differentiation, to detect human ailments, has been documented throughout medical literature over the centuries. The first recorded use of temperature associated with disease, appeared in the Edwin Smith Papyrus. Considered the oldest medical text, this text concentrated on 47 individual case studies, six of which included temperature variations. Date of the Papyrus was 1700 B.C. This then, places the origin of Thermology during the age of the pyramids, with Imhotep, the first known physician in recorded history.
As early as 400 B.C., physicians would place wet mud or slurry of wet clay over the abdomen and where the clay dried first, was considered the site of disease. Hippocrates is quoted as saying “…should one part of the body be colder or hotter than the other, disease is present in that part.” The early Greek physicians regarded changes in temperature, as a reflection of change in the four basic elements (fire, water, earth and air). They also considered fever to be a specific disease entity as opposed to being only a symptom of disease.
In the second century A.D., Heron of Alexandria, developed a special bulb called a thermoscope. Although this was the first step in an attempt to quantify heat, additional advances in thermal measurement ceased until Galileo’s work in approximately 1592.
Galileo re-introduced the concept of the thermoscope, and with his friend, Sanctorio Sanctorius, converted the thermoscope into a crude thermometer. In order to correlate the relationship between body temperature and a patient’s state of health, the thermoscope was graduated into 110 arbitrary divisions.
In the early 1700’s, Herman Boerhaave established important clinical information at the University of Leyden, with a special thermometer made by Fahrenheit.
Additionally, specific determination of temperature reference points, including 32°ƒ as the melting point of ice and 96°ƒ as the standard human temperature, were set by Fahrenheit. Several years later the freezing of water was set by Celsius (an astronomy professor) at 0°C and the boiling point of water at 100°C.
Dr. Boerhaave’s students, Dr. Dehaen and Dr. Van Swieten in Vienna, prepared several volumes of data correlating temperature and disease. Many years after Dr. DeHaen’s death, thermometry continued to be investigated by numerous scientists and physicians, but failed to receive general medical recognition regarding its importance.
Sir William Hirshel, King George III’s Royal Astronomer, created the first thermogram, using colored filters in a large refracting telescope. The invisible rays of the sun were termed at that time, “Infrared” (beneath red).
The actual beginning of modern thermometry was in 1835, when Becquerel and Breschet evaluated temperature variances in different body areas. Their instrument was a thermo-electrical device, which they utilized to establish that temperature in inflamed regions was higher than in normal areas. It was also established, at this time, that 98.6°ƒ or 37°C was the mean healthy human temperature.
In 1844, Henri Roger recorded temperatures for several types of febrile diseases. His major contribution in thermology was that he recorded temperature variables in the diagnosis, prognosis and treatment course. In 1870 Allbutt introduced the self- registering mercury thermometer, which is the prototype of those used in clinics today.
Between 1851-1877, Dr. C.A. Wunderlich studied over 25,000 cases, correlating temperature variances and the patient’s state of disease. To do this, he relied on Allbutt’s mercury thermometer and based on his work, wide scale use of thermometry soon followed.
In the early 1920’s, research turned to the recording of the infrared spectrum in photography based on refraction and reflection of infrared (IR) waves from outside sources. At the 1924 Palmer Lyceum, a new approach to spinal heat evaluation was introduced to the chiropractic profession. The instrument was called an NCM (neurocollometer) and was invented by Dossa Evans, with clinical development by Dr. B. J. Palmer.
Research in infrared photography and the development of special infrared sensors continued to be refined throughout World War II and the Korean conflict. During this period much of the data and equipment developed was classified “Top Secret.” Military use of infrared included such applications as troop movement detection and the development of heat-seeking missiles.
In 1948, Dr. Leo Massopust took the first known clinical thermograms. His primary images were of vascular patterns in the extremities and breasts, but he did evaluate other skin surfaces, as well. A Canadian physician, Dr. Ray Lawson, established the first known medical application for modern thermography with extensive research regarding breast patterns. He published his first paper in 1956, entitled “Implications of surface temperature in the diagnosis of breast cancer.” Shortly after Dr. Lawson’s work, a good amount of thermographic information was de-classified by the military and research on medical applications for infrared imaging slowly began again.
In 1963, a composite of 28 papers on thermography were submitted for publication with the New York Academy of Sciences. In 1965, Dr. George E. Chapman published the first work on Dental and Facial Thermography. In 1968, the American Academy of Thermology was formed, noting this was the first organization of physicians utilizing Thermal Imaging. Also, research was beginning in breast thermography with Dr. M. Gautherie at the Louis Pasteur University in France.
In 1972, the Department of Health, Education and Welfare declared that thermography was beyond experimental in the following areas:
- 1. Evaluation of the female breast.
- 2. Vascular analysis.
- 3. Extracranial evaluations
- 4. Neuromusculoskeletal analysis
In 1974, a large national study of thermography was established regarding breast cancer. The study was seriously flawed, equipment was not standardized, technique was not controlled, data analysis was not consistent and very few individuals involved in the study were trained or utilized thermography in their practices. This study is frequently the one referenced by physicians, often radiologists, with competitive interests, in order to advance the value of mammography and MRI, as opposed to thermography.
Development of a specific analytical system for breast thermal imaging was established in France, at the Louis Pasteur University. The “TH” system was developed and refined and remains the cornerstone of breast thermal scoring today. In 1978, Clinical Thermography Associates Research Clinic was established under the direction of George E. Chapman and Barbara A. Britt with hundreds of research projects and published papers over the years. Additionally, over 500 physicians and technicians, have been formally trained and certified in thermography at CTA Laboratories to date. In the late 1970’s and early 1980’s C. Wexler and W. Hobbins also established research and diagnostic centers, helping to develop and train physicians and technicians.
In 1982, the first text was published with scientific techniques and protocols regarding medical thermography by Barbara A. Britt. This work provided specific standards for scientific reproducibility and controlled thermography. Also, in 1982 the Bureau of Medical Devices, Federal Drug Administration (FDA) classified medical teletherm-ography as a Category II device limiting its use to conditions where variations of skin temperatures might occur. The FDA suggests the following applications:
- 1. Abnormalities of the female breast.
- 2. Peripheral vascular disease.
- 3. Musculoskeletal disorders.
- 4. Extracranial cerebral vascular disease.
- 5. Abnormalities of the thyroid gland.
- 6. Various neoplastic and inflammatory conditions.
In 1983, the first college-approved thermographic course, receiving both re-licensure status and given C.C.E. approval, was presented in Pasadena by Dr. George E. Chapman and Barbara Britt.
Also, in 1983, multiple physicians groups were formed developing a foundation for training, certification and utilization of thermography. The more notable of the groups were the International Academy of Clinical Thermology, the International Thermographic Society, and the Neuromusculoskeletal Thermographic Society.
In 1984, Clinical Thermography was approved by the California Chiropractic Board of Examiners as being within a Chiropractors Scope of Practice. Thermography was also included into the California Workers’ Compensation program in that same year using the RVS code 76000. In 1985, Thermography was included into Medicare and specific codes were established for payment of breast thermal imaging. In 1988, the U.S. Department of Labor authorized the use of thermographic imaging for Federal Workers’ Compensation claims.
In 1988, the American Chiropractic Association established the first recognized College of Thermal Imaging and continues to be one of the recognized chiropractic specialties. The first recognized Diplomate credentialing program in thermography was presented at Cleveland College in 1989 under the direction of Dr. George. E. Chapman.
In 1991 thermography was listed in the ICD9cm Coding manual (International Classification of Diseases). In 1992, thermography was listed in the CPT Coding Book (Current Procedural Terminology), which is a publication of the American Medical Association. Both books continue to list thermography, noting that the coding has remained unchanged through 2008.
In 1992, the International Chiropractic Association established the International College of Thermography. In 1992, HCFA provided a limited review of thermography and indicated that it did not meet the criteria necessary for inclusion with Medicare. Breast thermography was then dropped from Medicare coverage and breast mammography was introduced. This appeared to be more of a political maneuver than a scientific one, noting that there were well over 4,000 articles written and published in peer reviewed journals and multiple texts and professional colleges of thermology with experts to provide input. It was a surprise to review the HCFA opinion, noting that only 77 references were listed, no experts from the colleges were included and no textbooks were reviewed for the published opinion.
In 1995, the British Medical Journal “Lancet” reported on problems with mammography and research that had been doctored or misrepresented. Papers indicating the dangers of mammography were beginning to be published and major concerns began to develop that mammograms were not as accurate or as safe as previously thought. Evaluation of mammography continued for the remainder of the 1990’s and a renewed interest developed in thermal imaging, with the advent of newer computerized digital equipment and high resolution imaging devices.
Today, thermography has gained the interest of patients and physicians, and many entrepreneurs. Clinical Thermography appears to have a bright future and is again finding a unique position in modern medicine.