The phonoscope (Nov 1896-Dec 1899)

14 THE PHONOSCOPE July, 1898 J^IRa^ litems The "X" Rays and their Safe Application By J. MOUNT Bleyer, M.D., L.R.. A.M.S., L.L.D. Discoveries of the properties of the X rays go on at a rapid pace and the scientific world is watching with the closest interest the experiments that are being made from their different aspects to determine the effect of these rays upon the human body. Since their discovery and their application in medico-surgical work reports soon startled and spread throughout the profession and lay public of a grave danger accompanying the use of these X-rays, owing to the fact that they produced so-called virulent burns by exposure to them. Records now hold among their files many cases — differing in degree, and some have proved fatal from a lingering exposure to them. Even records tell us of a recent murder trial in this State in which the chief question arose — whether the physician who made this X-ray exposure upon a patient was guilty of an act of negligence from which death followed. Let me say at the outset of my remarks, from what I gathered from my experimental work, that all your timidity in their future application can be allayed. I concluded that if the X-rays are applied under certain precautions and the proper apparatus used, no such conditions can be possible. I speak now from the actual employment of these rays daily to the chest wall for the aid in gaining early diagnostic signs of tubercular and other allied diseases if present. This investigation gives me the right of an opinion, and I freely make it before you, showing how we all have fallen into that fallacious position by calling this phenomena as produced by these X-rays, burns, when they are nothing less, nor more than an inoculation. Now that we know how to remedy the dangers connected with their use and how best to avoid repetitions from recurring, and if they occur, whether the physician or who so applied them, is to take the blame if the proper precautions as in an}' surgical operation are not observed. All these facts I shall refer to in a few moments. Let me eliminate from your minds that an X-ray application or the use of its photograph} is a dangerous procedure either on a long or short exposure. If this force is applied and handled by skilled hands and with suitable mechanism, there is absolutely no atom of fear in producing this phenomenon of inoculation known as X-ray burns. This inoculation is due, according to my observation from a series of experiments to several physical effects produced by the generation of these rays and the general conditions present. It is a known fact that the use of the Ruhmkorff coil in connection with the generation of these rays, is an apparatus which gives an exceedingly high electromotive force and amperage, and therefore such high discharges when exhibited, produce certain physical conditions surrounding the atmosphere of the patient or person who is exposed to these X-rays. To sum up these physical facts, we find that this high discharge is leveled against the subject — carrying with it from the surrounding septic atmosphere certain particles floating therein, also surcharged with bacteria and foreign material upon the clothing and skin of the patient which are at all times present setting up sometimes infectious, and at other times an inflammatory condition from these forced driven septic materials under the skin exposed to this phenomenon. This inflammatory or inoculated condition is the result of all these facts which I came upon during my crucial experiments and can be avoided without any difficulty now on the part of the operator by the adoption of a few rules gleaned from my practical experience which I shall give in the summing up of my remarks. I now bring before your notice a few most important facts which are also highly corroborative directly within my own investigation. Those facts cannot help being appreciated at this moment, as they come also from several late observers who studied the question of burns, due to fire and hot water, etc. and the causes of death therefrom. We already know that many deaths are due to burns produced from other causes than by the X-rays. This fact has puzzled scientists to account for deaths which occurred among persons suffering from other burns, even where the injuries received seemed wholly inadequate to produce fatal results. The havoc caused by the skin diseases might be much greater and a far larger surface of the skin attacked, but generally a cure could be effected, whereas in the majority of cases of severe burns the end would be fatal. That the X-ray burn always appears many days after the application of this force or light to a part of the body and does not show absolutely any early manifestation, as minutes or hours thereafter, but days elapse, even as late as eighteen days thereafter. These X-ray burns begin with a painful dermatitis slowly and symptoms resembling burns from heat or scalds. It is therefore that from the very outset and conditions the difference is apparent. How should we avoid this dangerous condition in the application of the X-ray ? To sum up in a few clauses the whole matter, let me say the following, viz. : » Above all supplant the static machine for the Ruhmkorff coil. This form of electricity or energy has not the physical properties of carrying foreign material into the depths of the tissue so readily as the other current. Static electricity gives only the high voltage with low amperage, while the other is productive of both high forces, making it an unnecessary and dangerous appliance. All parts to be either photographed or examined by means of these X-rays should have all clothing removed therefrom, and washed with an antiseptic solution or so prepared as if a surgical operation is to be performed. Also a room which is free from infectious material as possible, should always be made ready, or specially appointed for the purpose. Those are the cardinal rules and must not be deviated from in order to avoid a dangerous inoculation or poisoning. Should such an X-ray inoculation occur, from unforeseen causes or otherwise, sterilization of the affected part by means of electrolysis is the safest and quickest specific known to me — with the amputation of all loose tissue surrounding the parts. I found in my early work as far back as May, 1896, when I had been as unfortunate as others to inflict several patients with these inoculations ( burns ) that something more was present to deal with than an ordinary electro dermatitis. Experimental study of this question soon elicited facts that brought me to the discovery of the following remedial agent which I commend to your notice. Electrolysis or sterilization of the parts is a specific. The current decomposes all the infected material and changes them into some other nonpoisonous compound thereby relieving the system of poisonous products. This is accomplished by placing such parts of the body into a salty solution of distilled water and connecting the electrode with the negative pole of a galvanic battery with a mil-ampere meter. The positive pole may be placed on any convenient part of the subject, vessels of porcelain, wood or glass are best. The strength of this current should average 5 milampere to a square inch of surface to be sterilized — lasting at least one-half hour; after that time the polarity should be reversed for 5 to 10 minutes in order to set free the chlorine which will again react on all the external and internal exposed surface. Accurate measuring by means of a mil-ampere meter with the use of such current must be strictly adhered to — as serious conditions will arise unless one knows the exact amount of current passing and so as to judge the exact quantity of chemical action, thereby controlling its destructive effects, which if are not known will do serious injury to healthy surrounding tissue. I know of no more satisfactory and scientific methods in the treatment of these X-rays wounds, and in fact in all deep and superficial wounds and poisonings, than sterilization by electrolysis as advocated in my method as here stated. All wounds with pus should first be drained by incision, before the above procedure is undertaken. I must also state in my recommending sterilization by electrolysis to those that hereafter apply it, they should at least be acquainted with the fundamental principles involving electro chemistry. Good judgment is necessary as much damage can be done if proper precautions are not observed. The time of application must be always left to the discretion of the operation, especially in deep seated conditions. Reapplication can be always resorted to. There are no contra-indications for this treatment by electrical sterilization to any class of infected wounds and skin diseases presented to surgery. However, each case must be treated upon its own merits. After such treatment protective dressing of simple kind is necessary to keep the parts from further infections. To small wounds and infections a sponge electrode to suit the size, well saturated with salt solution, is a rapid way of applying electro-decomposition. I bring my new* and novel investigation before your notice for the first time in the history of antisepsis and hope that it will find its way into general surgery with as much and better satisfaction than the heretofore methods employed and give as good account of itself as it has in my hands. This work has been the outcome of my early results obtained from the experiments and treatment of tuberculosis and other inflammatory diseases of the lungs, etc., which still occupies my time, already with most fruitful results. My investigations brought me to a most important point, and that is that all microscopic crevices are cleaned of bacilli, their products, and pus cells, where in the use of antiseptic solutions, etc., a mere coating is effected therefrom and always liable to reinfection. This form of sterilization does not absolutely admit of such a condition ; as destruction takes place instantaneously by electro chemical decomposition also by reversing of the polarity of this current; these microscopical crevices are again closed completely by its electro dynamic action. Electro sterilization must, therefore, be highly recommended as a prime antidote also to all kinds of stings, dog bites or in fact to even venomous wounds produced by serpents. The current should be applied a much longer time than for ordinary cases. Wonder of the X=ray At the inspection of the Delaware State Hospital for the Insane on Thursday Dr. W. H. Haiicker, the superintendent, showed the visitors a number of X-ray photographs and permitted them to view the bones of their hands and arms by means of the machine. Dr. Hancker is deeply interested in the new field of research opened up by this machine and is expert in its manipulation. He showed the visitors a large negative of an X-ray photograph showing the human chest, the ribs and heart being visible