A Sketch

of the Technical
from
Department of Radiation

History
to 1920
Ph.D.
Medical Methodist

of Radiology

1896
Oncology,

Arnold

Feldman,

Center,

Peoria,

IL

This will necessarily be an incomplete sunvey, with an attempt to select some of the most important developments and to portray what was happening in radiology in the early years. No attempt will be made to settle the many claims of priorities, i.e., firsts. Some excelient sources exist for the history of radiology. The book of E.R.N. Gnigg, The Trail of the Invisible Light, is a treasure house of information (1). The Rays, by Ruth and Edward Brecher, is an interesting source with respect to the history of radiology in the United States and Canada (2). The Science of Radiology, a book published in 1933 by the American College of Radiology, is another valuable source of history up to its date of publication (3). Gnigg has divided the history into several phases. In this article, I shall be discussing developments in his first two stages: 1) The Era of Roentgen Pioneers, which extended from 1896 to about 1914, and 2) Transition I, which overlapped with the first stage and extended from about 1907 to about 1929. I shall arbitrarily
limit my discussion to events and developments

plication

of x rays to medical

diagnosis

was

technological shock. This development hit the world as a package, unlike any previous medical technology. Quoting Knight, some physicians viewed the advent of x nays as a signal that medicines machine age had finally arrived. X rays were the product of a real, concrete, scientific machine; this was perhaps the source of their greatest promise. In contrast
. . .

with

the

ill-defined

and

complex

workings

of

cooperative preventive medicine, dreamers could look to a future in which machines would
eliminate the work and, of public in an age health that planners.

Through
the

technology,

physicians

would

achieve
in

miraculous

believed

material progress more than in anything else, new and better machines seemed only a step away. (4) One of the first questions that had to be sorted out was: Who would practice what came to be known as radiology? The earliest x-ray examinations were performed by a vanety of people: photographers, electricians,

up to the year 1920. Diagnostic radiology will be the predominant subject, but some discussion of radiation therapy, radiation hazards and

radiation protection will be included. To begin with, as Dr. Nancy Knight has pointed out, the announcement of the discovery of x nays by W. C. Roentgen and the very rapid spread throughout the world of the ap-

and physicians. The settings included electnicians offices as well as hospitals and physicians offices. There were turf battles in the early days. An example, which seems odd to us now, is that what we now call radiology remained under the surgery service at the Johns

RadloGraphlcs Index terms: HISTORY OF RADIOLOGY IMAGING TECHNOLOGY

#{149} HIstory

Hopkins Hospital until 1942. Why did radiology ultimately become a specialty? A possible explanation is that by about 1920, it was realized that film reading was an art and that nadiology was not just a technical procedure that could be performed by technicians. The fact that in the early days, radiologists were not
willing to delegate the operation of their machines may have led to the general perception that radiologists were something lower

CumulatIve
RadIology

Index terms: and radIologIsts, technology

requests to Arnold Feldman. Peoria, IL 61636. Ph.D., Department

hIstory RadIography,
Address reprint

than

physicians,

more

like technicians.
Methodist Medical Center. 221

of Radiation

Oncology.

N.E. Glen Oak Avenue.

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Technical

history

of radiology

(1896-1920)

Feldman

To return to the technical history call that Roentgen made his original
tion on November 8, 1895. The tube

itself, reobservawas a Hit-

torf-Cnookes tube. He used a Ruhmkorff 50/20 cm coil and a Deprex interruptor with about 20 amperes primary current. He said that best nesuits were obtained when the spark gap (connected in parallel) was about 3 cm. The imaging medium was a barium platinocyanide

screen, which exhibited fluorescence, i.e., visible light emission. Roentgen made numerous observations using the fluorescence, but very soon he was producing images on glass photographic plates. He also stated in his first report that films may be used equally as well as glass plates. He used exposure times varying from 3 to 10 minutes. One well-known radiograph, or skiagram, as this type of image was called in the early days (translation: shadowgnam), was produced on December 22, 1895. It is believed to be an image of Mrs. Roentgens hand, and, because it showed density variations according to the tissues in the path of the radiation, the practical usefulness of radiographic images for medical and surgical diagnosis was immediately apparent. Roentgen made a written presentation to the Physical-Medical Society of W#{252}rzburg Deon cember 28, 1895 (He made no oral presentation, because there was no meeting during the holiday season). On New Years Day, 1896, he mailed copies of his paper along with some sample x-ray prints to several physicists in Europe whom he knew. This is what started the spread of the news. (2 p 9; 5, pp 52-60). The speed of technical developments and medical applications during the first 2 months (January and February of 1896) was amazing, even when account is taken of the fact that Crookes tubes and high-voltage generators

were being used all over the world, mainly for studies of the discharge of electricity through gases. Grigg writes that Alan Archibald Campbell Swinton, a Scottish engineer may well have been the first person after Roentgen to produce a noentgenogram of a hand; on January 13, 1896. Brecher and Brecher (2, pp. 26-28) list 46 North American experimenters or groups of experimenters who carried out experiments during February of 1896. Let us review in a general way how x rays were produced. Cnookes tubes, or similar tubes, were the sources of x rays. They were not highly-evacuated as modern tubes are, and they did not employ thermionic emission as a source of electrons. They were usually referred to as gas tubes. A high voltage was applied between two metal electrodes sealed in the glass wall of the tube, usually at opposite ends. Sometimes, as in Roentgens tube,

the anode was off to the side (Figure 1). Figure 2 shows an early type of x-ray tube, with anode-cathode geometry essentially as in all modern tubes. An electric discharge began,
with negative the ions moving toward the anode

(the positive
ing toward

electrode)
cathode the in the

and positive
(the negative

ions movelecelec-

trode).

The action
leaving

of the positive
cathode. tubes

ions resulted
These used

in electrons

trons were
plied voltage,

accelerated
and,

as a result of the apfor radi-

ography, the electrons usually struck the anode and produced x nays. The technical problems faced by the pioneers were mainly due to the inconstant and largely unpredictable behavior of the tubes. Some, however, were due to the limitations of the high-voltage generators.

Figure1 Sketch of a Crookes Tube

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Feldman

Technical

history

of radiology

(1896-1920)

__

__

Figure2 Sketch of an early type of x-ray tube Compare this with Figure 10 which was described in 1903 as a modern tube. The difference is mainly in the size of the glass bulb.

If the

gas

pressure

in the

tube

became

low

(one presumes due to adsorption of gas on the inner surfaces of the tube) the discharge current became lower, but those electrons that succeeded in striking the anode had suffened fewer collisions with gas molecules, and for this reason, the x-ray spectrum was shifted toward higher photon energies. Usually, when the discharge current decreased, a higher voltage had to be applied to maintain the discharge. This, of course, also made the beam more penetrating, albeit of less intensity, and would lead to reduction of subject contrast. In
this case, it was said the tube became hard.

As the tube became warm with use, gas was driven off its inner surfaces, the discharge current increased, and the energies of the electrons striking the anode decreased, resulting in a less-penetrating beam. The tube was then called soft Various tube designs with side tubes containing chemicals provided for some control (Figure 3). Heating the side tube by means of an external source or by a separate discharge through the side tube released gas and made the tube softer. Queen & Co. made and advertised a self-regulating tube, that became a best seller (Figures 4 and 5). Gnigg (1, pp. 53-56) has an interesting discussion of the tube and of Queen & Co. Incidentally, to obtain a perspective on the important involvement of manufacturers in the development of x-ray apparatus one has but to read the relevant sections in Gniggs book. What was going on was the free enterprise system at its very best! Advertisements from 1896 are shown in Figures 6 and 7.
.

Figure3 Sketch of a tube with a regulating device

Volume

9, Number

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November,

1989

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RadioGraphlcs

I I IS

Technical

history

of radiology

(1896-1920)

Feldman

the Queen Self Regifiafing

X#{149}Ray Cube
I-las

advantages
for special

possessed
circular.

by no

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Tube.

%sk
.,

Pc-

Ep.ci&i1y tngeniou.-Irof. Ir. W. (. Roentgen. Mo.tSsti.faetory.-Lord Kelvin. The beet I hsve yet ,een.-l)r. .. W. Goodepeed. Univ. P.. toperstor en me.ke it do exsctly se he de.ore,.-l)r. C. L. Leonard. niv. ls. lerfootly eatiefted in every reepeet.--llliott Wcsde,Wahington, I. #{149}it can take care of iteelf.-Dr. H. F. E3owlitch, harvard toilege. Self regulating feature a euccee..-lrof. [). 5. Miller, Case School. We make the LAIGEST and BEST ININJCTIOI4S COILS. Iscalizatise

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All

tor,
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Radiograpk
nw Ctslorue

Table.
ot X.Ray App;ua)oo.
0

eloped

by

Figure4 Queens self-regulating by Sagen.

QUEEN
tube; developed
T:g_;=_.

& CO.,
J_ C. GRAY, P.... 1010 Chestnut St.

Inc.,
.

/P5og

Philadelphia.

Pa.

Figure5 An advertisement
(1898)

for Queens self-regulating

tube

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Figure7 Advertisements

from 1896.

Figure 6 An 1896 advertisement

for x-ray apparatus

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Feldman

Technical

history

of radiology

(1896-1920)

I have

been

fortunate

enough

to receive

mastoid.

The majority

of the

tubes

we

used,

from Dr. Nancy Knight the text of an interview conducted in 1969 by Rosemary Longo with Mr. Ross Mitchell, who was the first radiology technician at Johns Hopkins (courtesy of Johns Hopkins University School of Medicine, Department of Radiology). This is worth reading in its entirety to learn what the practice of radiology was like in the early days. Because of space limitations I shall reproduce only a part of the text that deals with gas tubes. Speaker: Mr. Ross Mitchell (Mitchell) Interviewer: Rosemary Longo (RL)
Mitchell: I would always get out 7 or 8 or 9

were Machlett and Macallister Wiggins tubes; also, a few of the Greene and Bauer tubes.
In the early days of x rays, it was sight and sound. Now if you look at the manual written by Dr. Jerman you will find out, in those days that he had written that there was one man who did such beautiful lumbar spines and he tried to find out how he did them. He just turned the machine on, and when the cath-

ode streams started, the plate was exposed. He did beautiful work, but they had no other
meters other than ammeters in those days. Telling how much a tube could produce was by sight, that was the problem. Of course

gas tubes and heat them up a little bit to build them up for afternoon work. By heating these tubes and letting them set from 9:00 until we started around I : 15 or I :30 then you would have 8-10 tubes for the afternoon work. Because if youd have to have a tube for a heavy part, such as a pelvis or a spine, that tube then would be too soft to do another spine or a skull on a shoulder. You would then have to change the tubes and get out an additional tube and set another one aside.
RL: Once you used a tube for the day was it then put aside until it could build up again?

when you put a different tube into the tube stand, and you saw a sort of pinkish-green between the cathode and the anode youd know that the tube was too soft to do any kind
of work except maybe a face, but you dedays in

pended
would

upon

the color

of the tube.

Any room we would equip in those have racks which had a big hole

which you could put the tubes. There were always 6 or 8 tubes there, so if one tube was too
soft you just undid two clamps the glass bowl and put a new on either side of tube in and test-

ed that
used tube that

out. Now the thing

tube maybe the

was, too, after

next patient

you
for us-

Mitchell: You could do small parts, such as hands or an elbow or a wrist, but if you had to do a heavy part, you couldnt use that same tube for at least a couple of hours, it would take it that long to build up for the penetnating power that you needed. We had no meters. The only meter we ever had was an ammeter. You always looked at the tube. You would test it on the first three buttons of the rheostat that you had. And you would look at the color, and the color was what you judged, to determine whether the tube was hard or soft. Some tubes, when they were very hard, were light green, and sort of cackled when you put a current through it. Now I had one special tube that I used for sinus work. It was an old Greene and Bauer tube. I would start that to do a pananasal sinus, I would start that with a cackle and so forth, and let the machine run until I could see the cathode stream. After that
I knew that that would be enough to do a si-

was

a heavy

part and youd

So you

have

to change
depend upon

your

again.

couldnt

ing the same tube for two examinations, except probably if the first was for just a finger or a hand or then you could go to a spine, or if it was a spine you could probably do a hand or
a wrist after that with the same tube. Then you had a stomach case coming in, where had more penetration needed you would if you

have to change always at least

your tube again. There was 10 or 12 changes of tubes if

you were working for over an hour in the office. There was no set rule that you could use the same tube. Snook came out with a tube,

they
After

called
two

it the Snook
of these

Hydrogen
in the

Tube
office, why

exploded

we gave up on those and waited lidge came out with his Coolidge

until Cootube.

nus. That tube would be set aside then to do a lateral for the sphenoid sinuses or maybe a

High voltage was produced either by induction coils or by electrostatic generators. Static machines tended to be favored, but in-

Volume

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I I I7

Technical

history

of radiology

(1896-1920)

Feldman

duction coils were less expensive. An extremely important development was the intennupterless transformer developed by Homer C. Snook. This could only be used where alternating current was available, and in the early days this was an uncommon situation. The pninciple of the transformer (the so-called stepup transformer) is now well-known, but Snooks system included a cross-arm mechanical rectifier driven by a synchronous motor. This resulted in high voltage being applied to the x-ray tube near the peaks of the voltage cycle, and only in the correct polarity, this meant that the average voltage, while current flowed in the tube, was near the peak, a situation that yielded efficient production of x rays and used both halves of the voltage waveform. Similar results today are achieved by three-phase circuits with solid-state nectification. The first of the Snook systems was installed at the Jefferson Hospital in Philadelphia in June of 1907, and shortly thereafter, Johns Hopkins Hospital purchased one. The laffen, at least, was still in operation, being heavily used, as late as 1946 (Figure 8). Successful valve tubes for rectification did not become commercially available until 1926. Snooks system included a milliampere meter. Grigg states that even the earlier models were capable of producing 100 kilovolts peak at 100 milliamperes, more than the existing x-ray tubes could carry. In 1916,

Snook made available a thirty-button autotransformer in the main line circuit for selecting kilovolts-peak, a crucial factor in control. All present generators incorporate this device. During the first year, 1896, many developments occurred that are still incorporated into modern systems. Cathodes were constructed in cup-shape to provide focussing of electrons. The importance of a small area emitting x rays was recognized at an early stage (Figure 9). in the early stages also, tubes were constructed with the anode aligned with the axis of the tube with but its surface set at an angle, much like modern tubes. The x rays were then produced by electrons hitting the metal anode rather than the glass wail of the tube. We now know that the emission of x rays is more efficient the higher the atomic number of the target material, so that this design change represented a significant advance, aIlowing for shorten exposure times. The early tubes, even so, presented problems associated with anode heating during prolonged exposures. Figure 10 is a diagram of a modern x-ray tube, circa 1903. The importance of diaphragms to eliminate as much as possible of the off-focus radiation was also appreciated. An elegant applicatlon is shown in William Rollins Internal Diaphnagm Tube (Figure 1 1), which was illustrated in an article published in 1899. Tube shielding

Figure 8 Snooks rectifying switch This shows the complete circuit, except for the filament voltage supply. The autotransfonmer, the step-up (high-voltage) transformer and the cross-arm switching apparatus driven by a synchronous motor are shown.

SNooKs Snook

RECTIFYING

SWITCH.

The Hospital

insert in

shows Philadelphia)

the
.

first

(at

Jefferson

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Feldman

Technical

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(1896-1920)

was used in some Installations, but not all. Figune 12, dated 1899, shows fluoroscopy being performed with a tube covered with a hand rubber shield. One might wonder how effective this was. incidentally, the generator was a motor-driven static machine. The failure to shield tubes surely was responsible for many of the radiation Injuries that occurred in the early days. Filtration of the useful beam was frequently used and was believed to improve the quality of the Images. We now know that the value of filtration is mainly to differentially attenuate the low-energy photons which would

not contribute significantly to the image, but which would result in unnecessary radiation dose to the superficial tissues. This may not have been well-understood in the early years. The apparatus used was not shockproof, quite the contrary. Electrocution was considered a real hazard, and some deaths were, in fact, recorded. The first shockproof unit is beIleved to have been Waites oil-Immersed, radiation-proof mobile unit, which dates from 1919. This was not yet an application of shockproof cables.

I1

tel

to

lrnctit:al

X.IC;iv

Work

md

Allici

Arts

orol

iro

lOL.;7.
ROENT(iETl
LIDNT

ST.

LOUIS.

JULY.
flection step pearance shown
in

1899.
from toward of Fig. the The of this the central the 3 by wid, diaphragm. light ladling l, ttcr tsil
it. n

% (1

NOTES.

rcsultc when

fl
the dark forc.s in ring as evertl ircic is c:t
tfit is wi

In

the

accompanying of internal xli.

Fig. diaphragm

42

5%

shown

form tioned
.0

tube

ring men#{149} come phragm. im but shadow beyond

is

Product

through

ojtning

in Note

work the best portance ehan1the

For definition
amount
,\\

most

medical

is of less of light,

Focus
was

TUBE.

originally

Claimed designed

by, and ascribed by Sir Herbert

1936).

to, many it Jackson (1863SCALC

Figure 9 Sketch of a focus tube dates from early 1896.

This tube design probably

I:i,;. tl,er.. are

42.

--Ri,i iii

i.E\

l.IilIT

Norrs..-INrruvAI. and by all

li.srHkM;sI external waves the central diaphragm: which so that small.

ANODE ELVI-THE

Tier. prarti. are used in the utilized

RUsh.
C

strioLtures

like valualil. diapliiagrn

tl,&

teith

the
the

Figure1 1 Rollins Internal Diaphragm Tube In modern tubes the limitation of off-focus radiation is accompIished by collimation external to the tube.

hones biiiing thu aiiil prove wc in cover

wher,: it is the internal Ii glass the diapliragni, section the P screen prcveiit

By cornwith the in Fig. ouch 34 imby maand to.

WC

through ant area

opening the

in
I

shown Fig.
42.

nal diaphragm.
is always
NOTS

deiintion,

and of diffused

if, in addition, non.radisble light

to lC photographed

a perforated

In Note xx the anode rush was ii tioned and its effecta on the target t11
*IinNotexxi Hersiatfigureof

terial

to

__
\jj

\\

Figure 10 A Modern

x-ray tube ( 1903 on earlier)

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Technical

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F#{149}idman

Now, let us return to technical developments in visualizing and recording the image. Roentgen had, as was stated earlier, used a screen coated with barium platinocyanide for the visualization of objects placed in the x-ray beam. This could be called fluonoscopy, i.e., visualization of the shadows in realtime, while the x-ray beam was on. Roentgen had also recorded images by direct exposure of photographic plates. Thomas Edison, starting work almost immediately upon learning of Roentgens discovery, set out to find the best luminescent screen material. It appears that the material he preferred, natural calcium tungstate, was used by Professor Nicholas Pupin to make what is generally accepted to be the first radiograph using an intensifying screen, on February 2, 1896. Edison, however, saw the future in fluoroscopy, rather than in radiognaphy, and he constructed a device he initially called the Vitascope, and subse-

quently called a fluoroscope. Figure 12 shows Edison looking at the image of the hand of his unfortunate assistant, Clarence M. Daily. (He is believed to be the first person to die of x ray induced injuries. He died in 1904). The x-ray tube is inside the wooden box on which the hand is resting. Among others who built similar devices, and which, in fact, antedated Edisons 5Vitascope, were Salvioni in Penugia (February 5, 1896) and Magi at Princeton University (also February 5, 1896). Their devices both used barium platinocyanide. Aside from the use of this type of device in medical diagnosis (Figure 12), many radiologists used it to test the hardness of the x-ray tube by placing one of their hands between the tube and the fluoroscope. This resulted in many tragic instances of radiation injury. Figure 14 is a photograph of a radiologist testing the hardness of a tube; it was taken in 1896.

Figure 12 Fluoroscopy ( 1899) with a hand-held fluoroscope (frequently called a cryptoscope in those days). Note that there is some sort of shield around the x-ray tube. The motor and belt indicate that this is a static generator.

Figure13 Edison looking into his fluoroscope subject.

DaIly is the

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Technical

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(1896-1 920)

.O

#{149}

*1

Figure 14 The classical stance ofthe pioneer testing the hardness of the tube (1896)
t

Barium piatinocyanide screens were, in many respects, ideal, but they had a serious stability problem, principally because of the loss of water of crystallization. No totally satisfactory solution to this was ever developed. A stable substitute composed of Willemite (zinc orthosilicate) was developed, however. The screen was stable and gave a bright image, but the image was grainy and the screen exhibited phosphorescence. The resulting image lag was a considerable impediment in fluoroscopy when the fluoroscope was moved from one position to another. These screens, nevertheless, enjoyed a certain degree of popularity. The first real improvement in fluoroscopy, however, reached the market in June, 1914, when the Patterson Fluoroscopic screen composed of cadmium tungstate was announced. In the production of radiographs, the need to prevent motion unshanpness was painfully apparent, and whatever could reduce exposure times was welcomed. The intensifying screen was obviously at least a partial solution. In the early days of the use of intensifying screens, there were serious problems of filmscreen contact. in 1916, CV. Patterson (of the Patterson Fluoroscopic Screen) joined F. W. Reuter to form a partnership, the Patterson Screen Company. In that year, they announced the Patterson Standard Intensifying

Screen. This was somewhat slower than existing screens, but it was a fine grain screen of excellent uniformity. The next step was to sandwich the film between two screens. Though film was then a single emulsion type, speed was increased. In 1918 Kodak announced a film with emulsion on both sides, and, in the meantime, Patterson had developed a combination: the front screen was a Special intensifying screen, and the back screen, the Patterson Standard. Coating screens to make it possible to clean them was a formidable problem, but Patterson announced this significant achievement in 1921 Further developments occurred after 1920, with Eastman Kodak entering the field; with Patterson offering Hi Speed and Pan Speed screens; and with Dupont acquiring the Patterson Screen Company in 1943. There have been further developments by these and other manufacturers, culminating in the development of rare-earth screens, which are the present standard. Early radiography was done mainly with glass plates. Before 1880, It was difficult to obtam dry plates, wet plates were the preponderant recording medium for photography. Dry glass plates came just in time for the beginning of radiology. In the early years, most plates used for radiography were the same as those used for pictorial and portrait photogna.

Volume

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Technical

history

of radiology

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Feldman

phy. It was realized that plates of higher sensitivity could be produced, and within about five years of Roentgens discovery, plates with a higher concentration of silver bromide per unit area, and thus with a higher sensitivity, were being manufactured. The calcium tungstate intensifying screens introduced in the second decade emitted blue light, which was ideal for the blue-sensitive emulsions that were being used. Development of the plates (or films) was usually done in trays so that visual control was possible. This control was used to compensate for the uncertainties of radiation exposures from gas tubes. Often, nadiographs were used as negatives to make prints on photographic paper. This afforded a further opportunity for manipulation of the image. The move away from glass plates was almost forced by the difficulty of obtaining glass from Europe, especially Belgium, during World Wan I. As was mentioned earlier, double emulsion film became available in 1918, and this, together with the double-screen cassettes, made for a great improvement in receptor speed. The availability of the Coolidge tube made a great impact on processing of films and plates, because the exposures were now controlled and reproducible. This meant that standardized development, including standardized times, was possible. Also, multiple films suspended vertically in a deep tank could be developed simultaneously, because obsenvation during development was no longer necessary. W. D. Coolidge described his tube in the December, 1913, Physical Review, and an abstract, with considerable detail, appeared in The American Journal of Roentgenology for January, 1914 (6). Figure 15 shows his diagram of the tube, and Figure 16 shows the electrical connections. The tube was highly evacuated (about 0.001 micron). The source of electrons was the heated filament within the cathode structure. The temperature of the filament was adjusted by varying the current passing through it. The applied kilvoltage, from anode to cathode, had negligible influence on the amount of current flowing from cathode to anode, provided that the voltage was more than a few kilovolts (emission-limited current). High vacuum and meticulous out-gassing of

all the interior parts of the device were absolutely crucial for the successful operation of the Coolidge tube. In the following article in the same journal, Cole gave a preliminary report on the applications of the Coolidge tube (7,), but the tube was not readily available for the first few years because of World War I. With the introduction of the Coolidge tube into radiological practice, it at last became possible to control radiation exposures accurately and consistently. Further developments were yet to come, but this represented a major technical revolution in radiology. A good discussion of anti-scatter grids is found in Brecher and Brecher (2 pp. 205-210). They point out that the blurring of the image caused by radiation scattered from the irradiated subject was understood as early as March, 1896, and in the early part of 1903 Dr. Otto Pasche in Berne, Switzerland, suggested and had constructed an ingenious system using synchronized traveling-slit apertures, one between the tube and the patient and one between the patient and the x-ray plate. This did not become the usual apparatus in practice, but Bucky conceived his grid designs in 1913 and applied for patents for both a stationary grid and a moving grid. After a series of problems and developments, with the impontant involvement of Dr. Eugene W. Caldweil and Dr. Hollis E. Potter, General Electric marketed the Potter-Bucky grid in 1921, and its use has been widespread ever since. The therapeutic use of x rays started at a very early stage after Roentgens discovery. Grubbe may have been the first to have treated a malignant lesion (2 ch 8). Grubbes claim was that he treated a patient for carcinoma of the breast on January 29, 1896. He said that he gave this patient 18 treatments. It is worth noting that Grubbe reported that he used sheet lead to protect the healthy parts adjacent to the diseased area In the early years the applicability of x rays for the treatment of cancer was limited by the low kilovoltage available and, hence by the low penetrance of the beams. Brachytherapy using radium and radon was more important than external beam therapy until higher energy external beams became available approximately in 1921.
.

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Figure 15 A sketch of Coolidges

tube (1914).

Figure 16 A diagram of the electric connections to the Coolidge tube The wires at the top of the diagram, of course, connect to the secondary of the high-voltage transformer.

The hazards of x rays were recognized almost immediately after Roentgens announcement. The tragic case of Daily has been mentioned. Grubbe may have been the first person to receive a recognizable injury. He died of metastatic cancer in 1960. Finally, by way of summary, Figures 17-27 have been chosen to illustrate some of the developments and to provide some feeling for first 25 years of radiology. One must be tre-

mendously impressed with the ingenuity of the pioneers and the variety and quality of the work they were able to produce under what we would consider very difficult conditions. I wish to express my deep appreciation to Dr. Nancy Knight, curator of history at The American College of Radiology, for hen assistance and guidance.

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in Chicago

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Figure 18 Edward Jenman is turning the static machine while an unidentified friend has his hand in the beam (February 8, 1896)

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Figure 22 Radiation injury to the skin of a Spanish-Amencan Wan soldien as a nesult of an x-nay examination (1898)

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Figure 24 The x-ray laboratory of Wolfram C. Fuchs in Chicago ( 1900) It was reported (2, p. 64) that Fuchs had performed more than 1400 x-ray examinations by the end of 1896.

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Figure 26 A modern x-ray room circa 191 9 The location is not stated. Note that there are no shockproof cables. The x-ray tube appears to be mounted within a lead glass bowl, and a collimating arrangement is apparent.

Figure 27 Fluonoscopy (posed, obviously) in 191 9 Note that the equipment is not shock proof.

References
I
,

Grlgg

ERN. The trail of the invisible

light. SprIngfield,

Ill.:
& Wilof ra.

5. Glasser

0. Dr. W. C. Roentgen.

2nd ed. Springfield.

Ill:

Charles C. Thomas, 1965.

2. Brecher P. Brecher E. The rays. Baltimore: Williams kins, 1969. 3. The American College of Radiology. The science
4.

diology. 1933. Corn JJ. ed. Imaging the American future.

Charles C. Thomas. 1958. 6. CoolIdge WD. A powerful roentgen ray tube with a pure electron discharge. AJP 1914; 1: I 15-124. 7. Cole LG. A preliminary report on the diagnostic and therapeutic application of the Coolidge tube. AJI?
1914; 1:125-131.

tomorrow: Cambridge,

History, technology Mass. : MIT Press.

and

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