Surgery Meets the New Rays
Surgeons were among the first to see the value of the new rays. The reason was practical. Many of the hardest problems in surgery in the 1890s came from not knowing what was where inside a patient. A surgeon might know that a bullet or a needle was somewhere in a limb but have to explore the wound to find it, and every incision risked infection. The earlier decades had brought anesthesia and the beginnings of antiseptic surgery, which made operations possible and safer, but they did not tell a surgeon where to cut. The X-ray did.
Within weeks of the news from Germany in January 1896, doctors in several countries were using the rays to locate foreign bodies. One often-cited case in Britain involved a needle in a hand. Other reports described bullets located in limbs. These first uses were so clearly helpful that skeptics were quickly answered. A surgeon who could see a bullet on a plate before operating had a direct advantage over one who could not.
How Localization Worked
Finding an object on a flat image is not the same as knowing its depth. Early radiographers developed several methods to work this out. A common approach was to take two images from different angles, so that the position of an object shifted in a predictable way between them. Marking the skin with a metal marker, or using a pair of images viewed together as a stereoscopic pair, helped the surgeon judge depth. Specialized devices for this purpose appeared in the following years, and radiographers wrote textbooks about how to do it.
These methods were fairly demanding, and results depended on the skill of the operator and the quality of the equipment. They were not perfect, but they gave surgeons a map where before they had none.
Fractures and Orthopedic Work
Radiography changed the day-to-day work of setting bones. Before the X-ray, a doctor set a fracture by touch and by the look of the limb. With an image, the alignment of the broken ends could be seen, and a second image afterward showed whether the setting had worked. This gradually affected the way fractures were handled, how long patients were immobilized, and when an operation was considered necessary. Orthopedic surgery was among the specialties most changed.
Later, fluoroscopy allowed a surgeon to watch a fracture being reduced, that is, put back into position, on a screen. This approach became more common in the twentieth century as equipment improved, though it also raised exposure questions for the surgeon, a matter of growing concern as radiation dangers became better known.
The X-Ray Goes to War
Military medicine was an early and eager user of radiography. Armies had always had to deal with wounds, and bullets and shell fragments were a major problem. Reports from the late 1890s suggest that X-ray apparatus was used by several armies in that decade, with accounts commonly mentioning conflicts such as the Greco-Turkish War of 1897, the Sudan campaign of 1898 and the Spanish-American War of 1898. The Boer War, which began in 1899, is often cited as a conflict where the technique was used on a larger scale by the British forces. The details of equipment and numbers in these early campaigns are not always well recorded, and sources differ.
The equipment of the time was awkward for the field. Tubes were fragile, power sources were heavy, and the apparatus needed careful handling. Even so, military doctors found that being able to see where a bullet had lodged justified the trouble.
World War I
The First World War, 1914 to 1918, brought radiography into front-line medicine on a much larger scale. The most famous example is the work of Marie Curie. Already a Nobel laureate for her work on radioactivity, she helped to organize mobile radiological units in France, fitted into vehicles that carried an X-ray apparatus and a generator to field hospitals. The vehicles became known as “petites Curies,” or little Curies. She also helped to train women to operate the equipment, and her daughter Irene took part in this work. Sources commonly say that about twenty vehicles were equipped, together with a larger number of fixed installations, but the figures vary and should be treated as approximate.
The war also pushed improvements in the technique itself. Doctors needed to find shrapnel quickly and accurately, and to follow the healing of fractures in large numbers of wounded soldiers. The Coolidge tube, introduced shortly before the war, was more reliable than the older gas tubes, which helped. In many countries the war created a generation of trained radiographers and radiologists, and a public that had come to see the X-ray as an ordinary part of hospital care.
What Changed in Practice
Looking across surgery and war, a few effects stand out.
- Decisions before cutting. Doctors could plan an operation using an image of the problem instead of exploring blindly.
- Records. An image could be kept, compared with a later one and shown to colleagues.
- Fracture care. Alignment and healing could be checked rather than guessed.
- Staffing. Radiographers, who were often technicians and sometimes former photographers or electricians, became a standard part of hospital staff.
The use of imaging in surgery has continued to develop. Operations today may be planned with medical imaging of various kinds, including computed tomography, and some are guided by live images. The origin of that approach lies in the earliest uses of the rays in the 1890s.
A Note on Risk
The surgeons and radiographers of this period did not yet understand the dangers of repeated exposure, and many worked with little or no protection. The history of those injuries, and of the safety measures that followed, is a separate subject, but it is important to remember that the early success of radiography was achieved at a cost to some of those who practiced it.