At the end of “Radiation part 4,” I mentioned I wanted to move away from the public reactions and go back to the scientists to see what they were doing with x-ray radiation. Just as the x-ray radiation and radium craze was flourishing in the public eyes of Europe and in the U.S. in April 1896, the medical community also quickly began the practice of X-ray “therapy” by November 1896. Almost simultaneously, early discoveries were already being made of the damaging effects of x-ray on the human body. In 1898, William Roentgen, discoverer of the x-ray, warned A. W. Isenthal, representative of the English Roentgen Society, of the biological effects of the X-rays and shared a large portfolio which included pictures revealing the affects on skin. Upon Isenthal’s return to England, and his subsequent report of Roentgen’s warning, not much interest was evoked. Isenthal, however, claimed he personally took immediate precautions to protect himself as did a few other members of the Roentgen Society who consequently began to consider the possiblity of harmful effects. It should be noted that William Roentgen made his discovery of x-ray in Germany, and his warning was made to British scientists. It appears that in March 1896, Thomas Edison in the U.S. had already reported that his eyes were sore after experimenting with x-rays. In April 18, 1896, L.G. Stevens, an English physician reported in the British Medical Journal that “those who worked with X-rays suffer from changes of the skin which are similar in effect from the sun burn.” It did not appear that they were yet fully aware of the nature of damage to tissue, although it was becoming clear that there was some damage. T.C. Gilchrist of Johns Hopkins Hospital reviewed 23 cases of X-ray injury that had already been reported in literature in 1896. N.S. Scott of Cleveland reviewed 69 reports of X-ray injury. According to Richard F. Mould, author of A Century of X-rays and Radioactivity in Medicine, “review papers discussing the hazards of over-exposure to radiation continued to appear in the radiological literature in the first decade of this century, but in spite of these warnings of the dangers of superficial injuries though indiscriminate exposure to X-rays, the radiation protection facilities for many workers were rudimentary or non-existent for many years.” This was evident in the continued sales of products containing radium and radium dialpainters in the 1920 and 30s. Even Marie Curie and her husband, Pierre, experienced damage to their own hands, yet, it was their belief that it was a cure for cancer! While Thomas Edison and William Roentgen realized the dangers, others like Marie Curie believed x-ray and radium could be used to cure various illnesses.
Early x-ray therapy in 1907 was used to treat conditions such as cutaneous affections including lupus erythematosus, lupus vulgaris, alopecia areata, eczema, acne, pruritis ani, xeroderma pigmentosum, psoriasis, senile leg lulcers, varicose veins, leprosy and more. Malignant growths were also treated with X-ray along with leukemia, tuberculosis, and other miscellaneous affections like migraines, epilepsy, keloids, etc. While X-ray is still used today, the applications have changed a bit as the understanding of X-ray has become more complete.
X-ray imagery was implimented during wars as early as 1897. Germany supported the Turks in the Graeco-Turkish war in 1897 providing a hospital unit. During that war the British Red Cross was able to use fluoroscopes to aid in the location of fractures, bullets, and other projectiles. It was from this war that problems were revealed concerning lack of reliable electrical power to run the x-ray machines on the battlefields. This was later solved by “pedal power” and hand-operated Roentgen cabinets in 1898. X-ray was also used in the Boer War in 1899-1902. An ambulance is shown in this picture on the right. X-ray was also used on battlefields of Sudan at the Battle of Omdurman in 1898, the Spanish-American War of 1898, and the Russo-Japanese war of 1905. It wasn’t until WWI, that American military radiology was practised on or near the battlefield.
Finally in 1921 the British X-ray and Radium Protection Committee was formed followed by the International Radiation Protection Committee in 1928. It was the United States Advisory Committee on X-ray and Radium Protection in 1934, which initiated the principle of maximum tolerance dose of X-rays. However, according to Mould, “General acceptance of protection procedures was too late to prevent radiation injuries to superficial tissues, blood and internal organs of some of the early workers in the radiation field. Many of them are remembered by a monument erected by the German Roentgen Society in Hamburg in 1936 to the X-ray and radium martyrs. This memorial originally contained 169 names from 15 different nations, but by 1959, the total had risen to 360. Roentgen was not among them possibly because his experiments were mainly radiographic as opposed to fluoroscopic [The fluoroscope is an x-ray machine which leaves the x-ray beam "on" while the physician examines the motions of a patient's organs, and/or the motions of various instruments and catheters during surgical and other procedures], and his X-ray tubes were housed within a metal box. The memorial does, though, include Marie Curie.”
Prior to the development of the nationally accepted standard for the maximum tolerance of x-ray dose, self-exposure experiments were a common procedure used to determine patient exposure. The operator commonly used his own skin to test out the point at which the skin would turn red. The picture at the right is an example of x-ray damage to the hands from repeated exposure. This is an advanced stage. The early stages appear like dermatitis with a shrivelled and wrinkled look. The later progression starts to develop lesions, which after years progresses to what is shown in the picture at the right. Mould’s book, A Century of X-rays and Radioactivity in Medicine, has a few pictures showing the progression of radiation damage to Mihran Kassabian’s hands, a radiologist in Philadelphia in 1903, before his hands were amputated. Kassabian died in 1910 due to radiation induced cancer.
Further uses for X-rays have been old paintings and other museum artifacts. Radiographs of oil paints revealed metallic pigments, adjustments by the artist, damages and restorations. These findings help to determine authenticity of the artifacts. Archeological finds such as Eygptian mummies have also been subjected to radiograph to reveal more information about their conditions.
More history on X-ray in medicine can be read here.