An Interesting Review of X-Ray Practice

Gold Foil Screen Described by Mr. Elliott Woods.

Many important experiments instructive to the surgeon and the manufacturer of X-ray apparatus — the author believes that the danger from the rays is exaggerated, and states that they are harmless under the precautions announced — bath of high-frequency currents beneficial for X-ray burns — Tesla’s valuable work in this new field.

To the Editor of Electrical Review:

Some publicity has been given by the daily press to an alleged discovery made by me of a method of making the X-ray harmless. In a local paper of this date considerable importance has been attached to an accidental chat with a reporter, and this so-called discovery magnified to a considerable degree. Now, to be exact and at the same time to aid, if possible, in the study of the X-ray phenomena, particularly in the application of the rays to surgical studies, I desire to correct these press reports to a considerable extent and state what really has been done.

First, nothing has been accomplished that is not the result, directly, of Mr. Tesla’s already published results; and my experiments are merely modifications of his methods. Mr. Tesla utilizes aluminum sheet or gauze. I use gold leaf, such as gilders use, and this only because aluminum sheet was not to be had in the city.

My experiments having brought me in contact with a number of surgeons in the city, who desired to note the condition of injured bones which had been treated by them, I felt a natural anxiety that the patients they presented for examination should not suffer from the much-heralded results of a continued exposure to rays generated by a powerful apparatus. Previous to the publication of Mr. Tesla’s article, wherein he details his experiments with tubes of platinum and aluminum anodes, and aluminum sheet or gauze earth connected, I had contented myself with brief exposures, both for photographic and visual purposes. I deemed this precaution necessary, for accounts were numerous of the effect of the rays and the patients were timid. On the other hand, from the date of Roentgen’s announcement, I have exposed my person freely, both in experimenting and for exhibition purposes, and as yet have failed to receive the slightest injury. The tubes used are the most powerful obtainable, excited by various coils and high-frequency apparatus. I will return to this later.

In the course of an examination made on the foot of a patient, to locate a broken needle, I placed the tube about 12 inches from the foot, and was surprised to note, after putting the tube into action, that a tolerably heavy spark could be drawn from the bottom of the foot. In frequent shifting of the foot, necessary to properly examine and sketch the position of the small piece of needle, the patient complained of the unpleasant feeling caused by the spark, but I learned that a “hot feeling,” which he mentioned early in the examination, subsided when I held his foot in my hand. It was evident that the foot in this case was the outlet for a considerable charge of electricity which the patient had been able to accumulate from the tube and wires, because of his well insulated position on the reclining-table used, and that he was relieved by the additional condenser added when I connected my body to his. Taking note of the two facts obtained in this examination, and remembering Mr. Tesla’s work with the aluminum screen, I carried on some experiments with the only metal sheet I had which was sufficiently transparent, and that was gold foil. I prepared a screen about 10 by 10 inches, and of cardboard, putting on it a temporary coating of gold foil. When not connected to earth, a considerable spark could be obtained from it, which spark entirely ceased, of course, when the foil was earth connected. Placing the hand of a volunteer assistant behind this foil screen, properly connected, no spark was secured. I gave my hand generous exposure under the screen and no ill effects have been noted. Placing the screen close to the tube so that my face could be brought within six inches, I failed to note the heating sensation which I nearly always feel when exhibiting my skull without the screen. Here I wish to remark that my cheek and that portion of the body between the shoulder blades are the only portions of the body which take note of this effect. Now, it would seem that whatever danger symptoms lurk in the rays, all are effectually stopped by an earth-connected screen of this kind and one made of gold leaf on cardboard is nearly transparent on account of the thinness of the metal leaf. In fact, I have failed to find any absorption produced by it on the platinum-barium screen. There might be more shown when using less powerful tubes, but with those used by me the absorption is inappreciable. There are no special claims for this “discovery” as published. To Tesla belongs everything that attaches to it, being as it is a modification of his method. I hope, however, that experimenters will not fail to try thoroughly the gold leaf or other thin leaf metal, which is inexpensive, readily procurable when aluminum may not be. This type of screen, while it has proved its security, as a makeshift, in the cases where it has been used by me, may not prove safe in other cases.

I hope every one who utilizes the X-rays for more than exhibition purposes merely will study these screening effects of leaf metal, and give surgeons who desire to install suitable apparatus relief from their fears, for these fears seem to be widespread, and patients are at the present day more fearful of the ray than of the knife. In any event, I would warn the handlers of powerful apparatus to take heed of the first sensation of heat when spoken of by the patient. It is likely to be the first sign of dissolution of tissue. While patients are apt, as a result of report, to be timid, it would be well to state frankly to them the possible sensations which might be felt and ask them to control their imagination sufficiently well to give their actual sensations.

Different persons appear to differ in their sensations when under the influence of a copious generation of the rays. Some are affected at the eyelids. Some feel the sensations of an electric discharge; while others state that their hands or faces are bombarded by invisible dust. These various sensations are worth consideration. They lead me to an opinion that the majority of persons, by reason of bodily state of health, are immune, at least to ordinary exposures. Some, according to my experience, are extremely sensitive, and it would be well for operating-surgeons to take carefully into account the nervous condition of the patient.

A nervous person — and by that I mean one naturally so — is a fit subject for the metal screen. Some tissues of the body appear to be more susceptible than others. Particularly does this appear to be the case with the tissues of the head. I can always experience that “hot sensation” in the head, and in that portion of the body between the shoulders, when I exhibit my heart on the screen. Other parts of my body are not susceptible. The sensations, when experienced, are unmistakable, and a sensible patient can readily give his operating surgeon the note of warning. The surgeon should know his apparatus thoroughly, and content himself with brief exposures; and here I would suggest, out of experience, that before a powerful apparatus is used, every means should be resorted to in becoming acquainted, not only with the coil used to excite the tube, but the tube also.

A coil excited by a battery, while ample for ordinary exhibitions, is apt to fluctuate in its output by reason of the fall in the exciting current. It is advisable, when the coil is to be used for surgical operations, that it be excited by a motor-generator giving a constant current and voltage, and operated by an electric lighting circuit. It is essential that the tube for such operations be of the very best adjustable vacuum type, for then the surgeon can be assured of a constancy in the generation and penetrating power of the rays. With these tubes the vacuum can be adjusted so that the rays may not, in cases of examination of the limbs, be of themselves dangerous. When adjusted for examination of the trunk, and the vacuum being maintained high to obtain great penetration, and a high voltage used in the exciting apparatus, the metal screen should be interposed. It is the indiscriminate, careless handling of the exciting apparatus that is responsible largely for accidents. The surgeon would never handle the lance except by the best and well studied method. The X-ray tube is worthy of the same study and careful manipulation.

By far the best exciting apparatus, either direct or high frequency (which can sometimes be charged by a direct-current coil), is that operated from a lighting circuit. The inconstancy of current is largely avoided and the vacuum of the tube having been adjusted can be readily maintained. This is of safe and great importance in surgical operations; and while I do not wish to cast slander on coils operated by batteries, I have found that it is hard to obtain these important items from a battery-driven coil. Confidence in your tube and coil and knowledge that the current and voltage will remain practically constant is a factor of safety to the patient.

I now beg to call the attention of surgeons to so-called burns produced by X rays. Their features are well known. The persistence against ordinary remedies, I believe, is now admitted. Some time ago I read in an article copied from the foreign press that high-frequency currents were found beneficial treatment. When, by exhibiting my skull, I experience the heating sensation mentioned before, I generally give my affected cheek a bath of high-frequency currents, from one terminal of the high-frequency coil. If a surgeon have a case of injury from the rays, let him try this remedy if he can find such a coil in the neighborhood. I do not say it will cure, but rather ask a trial of it; and if I may be permitted to wander from the subject a trifle, I would add to try these high-frequency currents for fresh colds, weakness of voice, and general affections of the throat, remembering that the application should be made with the hand, laying it on the throat first, then connecting the operating surgeon’s body to one terminal of a weakly excited, high-frequency coil. These coils are prolific generators of ozone. Excite the coil and let the patient inhale the ozone from either a funnel and tube held over the discharge, or by getting his mouth conveniently near. If an inhaling funnel is used, it should be of rubber to prevent shock, and the patient should be allowed to use it to suit the sensitive state of the affected membranes.

From a careful study of the effects of X rays on the tissue I am led to theorize that it is an electrical decomposition of the tissue, which can be prevented by the use of the metal screen. In treating a case of burn already produced, with high frequency currents, it would be well to use a spray discharge, avoiding carefully the spark which is apt to pass if the electrode is brought too near. I would suggest the spray of the static machine. But the main thing is to make the X ray harmless, and whether we believe with Tesla that the rays are projections of material particles, or whether they are mere electric waves, the virus — if I may so term it — seems to be extracted when we force them to pass through a metal screen. These carriers of decomposition, in whatever form we may choose to look upon them as possessing, become apparently harmless after such a passage. The surgeon knows the utility of the X ray, but many are fearful of the effect. Manufacturers of X-ray apparatus should, by all means, further their own interests by giving competent instruction to purchasers, based on the experience of users, and particularly on the splendid investigations of Tesla, which have been published. It would be good policy for colleges to train surgeons in the manipulation of apparatus, and the subject would hardly fail of interest where so much benefit is involved and some dangers due to carelessness to be avoided.

I am inclined to believe from my personal experience that the dangers are greatly exaggerated. I am more inclined to lay bad experiences, already in evidence, to bodily conditions. I hope to experiment on this feature for the benefit of surgeons. I earnestly hope that experiences may be noted by surgeons in the handling of the rays on persons of various temperaments and that they be published in the proper journals.

In any event, it appears that X rays are harmless under the precautions named.

Elliott Woods.
Washington, D. C., Sept. 6.