'X-rays don't tell lies': the Medical Research Council and the measurement of respiratory disability, 1936-1945

During the first half of the twentieth century, the mining industry in Britain was subject to recurrent disputes about the risk to miners' lungs from coal dust, moderated by governmental, industrial, medical and mining bodies. In this environment, precise measurements offered a way to present uncontested objective knowledge. By accessing primary source material from the National Archives, the South Wales Miners Library and the University of Bristol's Special Collections, I demonstrate the importance that the British Medical Research Council (MRC) attached to standardized instrumental measures as proof of objectivity, and explore the conflict between objective and subjective measures of health. Examination of the MRC's use of spirometry in their investigation of pneumoconiosis (miner's lung) from 1936 to 1945 will shed light on this conflict and illuminate the politics inherent in attempts to quantify disability and categorize standards of health.

[Early attitudes to X-rays in Buenos Aires, 1896-1897: medicine, esotericism and popular fantasies]

The goal of this article is to document early attitudes to X-rays in scientific culture in the city of Buenos Aires. Using various types of periodical sources, the text explores the different reactions to the novelty among different actors in the literary world. Newspapers and weekly magazines for the general public quickly broadcast the discovery, stressing its marvelous or prodigious nature. Meanwhile, physicians in the city took contrasting positions, ranging from mistrust to enthusiasm. Lastly, spiritualists in the city wrote numerous texts about the innovation, and reinterpreted it in accordance with their strategies for self-legitimation.

Synchrotron radiation biomedical imaging and radiotherapy: from the UK to the Antipodes

Although the general public might think of 'X-rays' as they are applied to imaging (radiography) and for the treatment of disease (radiotherapy), the use of synchrotron radiation (SR) X-ray beams in these areas of science was a minor activity 50 years ago. The largest gains in science from SR were seen to be in those areas where signals were weakest in laboratory instruments, such as X-ray diffraction and spectroscopy. As the qualities of SR X-rays were explored and more areas of science adopted SR-based methods, this situation changed. About 30 years ago, the clinical advantages of using SR X-ray beams for radiography, radiotherapy and clinical diagnostics started to be investigated. In the UK, a multi-disciplinary group, consisting of clinicians, medical physicists and other scientists working mainly with the Synchrotron Radiation Source (SRS) in Cheshire, started to investigate techniques for diagnosis and potentially a cure for certain cancers. This preliminary work influenced the design of new facilities being constructed around the world, in particular the Imaging and Medical Beam Line on the Australian Synchrotron in Melbourne. Two authors moved from the UK to Australia to participate in this exciting venture. The following is a personal view of some of the highlights of the early-year SRS work, following through to the current activities on the new facility in Australia. This article is part of the theme issue 'Fifty years of synchrotron science: achievements and opportunities'.

Alfred Caleb Taylor (1860-1927): X-ray pioneer and martyr

Alfred Caleb Taylor was the first radiographer at the Peterborough Infirmary and Dispensary from 1896 to 1923. He constructed the first X-ray apparatus and oversaw the development of the X-ray service in Peterborough. He contracted a chronic radiation dermatitis from exposure to X-rays which was a source of considerable suffering for him. When he died in 1927, X-ray dermatitis was considered to have contributed to his death, and he was recognised as an X-ray martyr and a victim of science. In spite of his achievements and his ill-health from working with X-rays, his name is not included on the Martyrs Memorial in Hamburg.

[Exploring the dark continent: medical image and brain]

INTRODUCTION

Until the late 19th century, direct observation of the central nervous system was practically impossible. The discovery of X-rays in 1895 and their subsequent application in the field of medicine brought about a shift of paradigm that completely revolutionised the way in which neurology was practised. The possibility of viewing the inside of the brain had a pronounced impact on clinical practice, and enriched the diagnosis and treatment of brain pathologies in a manner that was unimaginable up until then.

DEVELOPMENT

The aim of this study is to describe the birth and development of medical imaging of the brain, from the discovery of X-rays and the early days of radiography to the appearance of computerised tomography and magnetic resonance in the 60s, both of which are techniques that were to change the world of diagnostic imaging forever. This brief overview of the history of radiology also includes the origins of angiography and other techniques that are no longer in use, but which were ground-breaking innovations in their time, such as ventriculography or pneumoencephalography.

CONCLUSIONS

The procedures and techniques described in this article made it possible to view the inside of the brain, thereby facilitating the diagnosis and treatment of a number of neurological processes.

Vesalius, Röntgen and the origins of Modern Anatomy

The discovery of X-rays in 1895 by Wilhelm Conrad Röntgen transformed our understanding of both the physical world and our understanding of ourselves. Traditional anatomy as shown by Andreas Vesalius was learnt from dissection of the supine deceased body. Radiology showed anatomy in the living in a manner previously not possible, and has transformed our anatomical understanding, particularly of human growth and variation.

EARLY CLINICAL USE OF THE X-RAY

Western medicine has long been dominated by a faith in the value of science and a belief in the power of technology. I study the history of how technology came to be seen as useful by focusing on one of the most dramatic new tools ever discovered: the X-ray machine. I use a statistically valid sampling of case records from 1900-1925 at the Pennsylvania Hospital to ask why and when physicians at these hospitals came to see X-rays as useful for patient care. Soon after the X-ray's 1895 invention there was seemingly worldwide agreement that it could be used to diagnose common conditions such as fractures and foreign bodies. However, it was only several decades later, after the underlying structure of the hospital changed due to importation of technologies from business, that X-ray images became seen as part of routine patient care.

The Hangover: The Early and Lasting Effects of the Controversial Incorporation of X-Ray Technology into Chiropractic

Chiropractic first adopted the X-ray in 1910 for the purpose of demonstrating tiny misalignments of spinal bones, theorised to cause all disease, which they called chiropractic subluxations. This paper explores the apparent contradiction and resultant controversy of a system of natural healing adopting a medical technology. It centres on the actions of B.J. Palmer, the first chiropractor to use X-rays. It also clarifies details of Palmer's decision to incorporate the technology and interprets the change in the sociological context of boundary work. The continuing use of the subluxation paradigm for radiography by chiropractors has had a lingering effect on the profession, a metaphorical hangover of vitalism that is not consistent with modern healthcare practice. As a result of this conflict, arguments within the profession on the use of X-rays contribute to the continuing schism between evidence-based and subluxation-based chiropractors.

[Clarifying the case of two people with the same name of Manoel de Abreu]

A curious episode in the history of Brazilian medicine is retold here, involving two physicians with the same name, between 1936 and 1937. The most important legacy left by Manoel Dias de Abreu was a method of radiography to diagnose tuberculosis - mass miniature radiography (abreugraphy). Manoel de Abreu Campanario wrote A medicina no interior (Medicine from the interior). The similarities between the two names created such confusion that some people believed that Campanario was a pseudonym. This case of mistaken identity led Manoel Dias de Abreu to send a consultation-statement to the Brazilian Society for Medicine and Surgery, which immediately created a commission to examine the case. The letter of clarification sent by Campanario resolved the issue.

DR AVRAM JOZEF VINAVER (1862-1915) - PIONEER OF RADIOLOGY IN SERBIA

INTRODUCTION

Dr Abraham Joseph Vinaver (1862-1915), a Jew from Poland, was a pioneer of radiology in Serbia. He graduated from the Faculty of Medicine in Warsaw (1887), but lived and worked in abac (the Kingdom of Serbia) since 1890. Dr Abraham Joseph Vinarev - Career Development. He procured the first X-ray machine and developed radiological service in Sabac five years after the discovery of X-rays. These were the beginnings of radiology in Serbia. He introduced the application of artesian wells. Dr Abraham Joseph Vinarev - a Participant at the First Congress of Serbian Physicians and Naturalists, Belgrade 1904. "The diagnostic importance of X-rays in lung disease, especially in initial tuberculosis" and "Five Years of Treatment by X-Ray Machines" were the first works in the field of radiology in Serbia by this author. Dr Abraham Joseph Vinaver - Reserve Medical Officer in the Serbian Army. During the Balkan Wars, he was a volunteer with the rank of major engaged in military corps and he participated in the First World War as well. He died of malaria in 1915 in Gevgelija. "Dr Avram Vinaver"- Stanislav Vinarev. His dedication to work during the typhus epidemics was put into verses of a poem by his son Stanislav Vinarev.

CONCLUSION

Dr Avram Vinaver Joseph was a noble man with a great heart, who selflessly sacrificed himself for the Serbian people and Serbia. He gave his contribution to the development of health services in Serbia, both in peacetime and wartime conditions. Dr Abraham Joseph Vinaver laid the foundations for today's radiology in Serbia.

[History of the development of radiodiagnosis at the Russian Research Center of Roentgenology and Radiology: on the occasion of the 90th anniversary of its foundation]

The paper describes the history of the Russian Research Center of Roentgenology and Radiology set up 90 years ago, the main advances of the researchers of the Institute in roentgenology and radiodiagnosis in historical perspective--from the last century up to the present day. It gives a brief list of the most important procedures and publications on radiodiagnosis, which have been developed and published by the Institute's researchers.

[The Roentgen's discovery -first press releases, research articles and textbooks in Kraków]

The author presents Kraków's publications from the pioneering years of radiology. She also emphasises the great role of the publications in the development of this field in Kraków's medical environment

The early clinical x-ray in the United States: patient experiences and public perceptions

The first x-ray machines were large, loud, sparking, smelly, and ostentatious devices, prone to mishap and injury even when fully under the control of the physicians who, in droves, invested money and prestige in them. Their bizarre and sometimes overwhelming presentation in the clinic reinforced the contemporary public understanding of x-rays as fantastically potent yet ambiguously helpful. As one of the icons of the new scientific medicine, x-rays bore much of the public's expectations for a technological panacea, a belief that was reinforced by the spectacle of their generation and their undeniable effect on the body. A quarter century later, refinement of the technology had made irradiation safer and more effective, but also made the operation of the machines themselves almost undetectable. This "domestication" of x-ray machines underscored their failure as a modern-day heroic medicine, while reinforcing an emergent understanding of radiation as a subtle, cumulative, and insidious threat.

[The development of radiation technologies since Maria Skłodowska-Curie]

The article was written on the occasion of the 100. anniversary of the Nobel Prize in Chemistry awarded to Maria Skłodowska-Curie. The United Nations General Assembly honoured this event by announcing the year 2011 the International Year of Chemistry. Maria Skłodowska-Curie was i.a. the initiator of radiation chemistry, a branch of science analyzing the chemical effects that matter shows when exposed to ionizing radiation. The development of this branch resulted in radiation technologies' applications in many fields of industry, medicine, agriculture, protection of the environment, space research and science. Our point of departure was the article Sur l'etude des courbes de probabilité relatives a l'action des rayons X sur les bacilles that Maria Skłodowska-Curie published in 1929 in the Bulletin of the Académie des sciences. In this study, she presented--for the first time ever--the curves of the so called radiation inactivation, i.e. the relationship between the bacteria life expectancy and the dose of radiation absorbed by it. From the today's point of view, it can be stated that the researcher laid the foundations of the methods of radiation sterilization and material processing by means of radiation. In this context, we recall the history of the first accelerator installation devised and built in 1968 at the Institute of Nuclear Chemistry and Technology in Warsaw. Basing on experiences with the linear electron accelerator, the LAE 13/9 was completed in 1992 as the so far only Polish industrial installation for radiation sterilization of medical products and transplants as well as for food irradiation.

Communication of benefits and risks of medical radiation: a historical perspective

X-rays were discovered by Wilhelm Röntgen in 1895. Within one year, benefits of x-rays, such as visualization of fractures, and detriments, such as x-ray dermatitis, were recognized. Nobel Laureates Pierre and Marie Sklodowska Curie discovered the radioactive element radium in 1898, and a year later the application of radiation to cure cancer was reported. A significant price was paid for this: Marie Curie died of aplastic anemia related to her radiation exposure, and her daughter Irene Joliot Curie, Nobelist for radiochemical research, died of radiation-induced leukemia. Internationally developed radiation protection recommendations were formalized starting in the late 1920s. The increasing use of ionizing radiation in medical diagnosis and radiation therapy has brought significant societal benefits. Known risks of therapeutic radiation include coronary artery disease and secondary malignancy. However, recently concerns have been raised of possible very small but incremental increases in malignancies due to diagnostic medical radiation. Patients are largely unaware of, and referring physicians and even radiologists often underestimate, the carcinogenic effects of radiation. There is a need to determine the appropriateness of imaging tests that use ionizing radiation prior to performance; optimize imaging protocols to reduce unnecessary radiation; include patients in the decision process and encourage and enable them to track their radiation exposure; and promote education about medical radiation to patients, referring physicians, radiologists, and members of the public. The basic radiation protection principles of justification, optimization, and application of dose limits still pertain.

[Ziedses des Plantes: inventor of planigraphy and subtraction]

Bernard George Ziedses des Plantes (1902-1993) trained in Utrecht, the Netherlands, as specialist in nervous diseases, but his lifelong passion was to improve X-ray imaging of living tissues. In the 1930s he not only built the first machine for planigraphy, in which the X-ray tube and the film moved together around the plane of interest, but he also designed the subtraction method to improve images after injection of contrast agents. Eventually a full-time radiologist, he also developed the 'somersault' technique of ventriculography and pioneered isotope scintigraphy.

Suffering and death among early American Roentgenologists: the power of remotely anatomizing the living body in fin de siècle America

This manuscript has two aims. First, I extend the historiography on early American roentgenology that demonstrates that dozens of early adopters knowingly suffered intense pain, mutilation, and death for the sake of the X-ray. The objective is to pinpoint as precisely as possible when and to what extent the roentgenologists knew of the life-threatening risks of X-ray exposure. Second, I articulate a partial explanation for their behavior that is rooted in the social power of remotely anatomizing the living body in fin de siècle American scientific and medical culture.

[The history of radioactivity and its applications in hygiene and therapy]

Since Antiquity, the observation of matter and its composition has been fascinating for the human mind. It represented the core of philosophical studies since the atomistic theory by Leucippus and Democritus, as well as of the opposed theory of elements by Empedocles, Plato and Aristoteles. Research on the atom, on its spontaneous or artificial disgregation, on the practical application of radioactive substances has strongly influenced daily life and the development of knowledge. Products containing radioactive substances have been used, often without regulation or control, in many scientific fields, as well as in medicine and cosmetics.

Beyond a shadow of a doubt? Experts, lay knowledge, and the role of radiography in the diagnosis of silicosis in Britain, c. 1919-1945

The history of silicosis provides an important chapter in the history of occupational and environmental health. Recent historical scholarship has drawn attention to the importance of patient attitudes, popular protests, and compensation claims in the formation of a "lay epidemiology" of such a disease, frequently challenging the scientific orthodoxies devised by large corporations and medical specialists. Surprisingly little research has been undertaken on the United Kingdom, which provided much of the early expertise and medical research in respiratory diseases among industrial workers. This article examines the introduction of a particular technique, x-radiography, and its use by radiologists and others in debates on the causes and consequences of silica inhalation by the laboring population in Britain during the early decades of the twentieth century. In contrast to some recent interpretations, and also to the narrative of progress that practitioner historians have developed since the 1940s, this article suggests that the use of this technology was contested for much of this period and the interpretation of X-rays remained disputed and uncertain into the 1950s. The article also questions recent accounts of lay epidemiology as an adequate model for understanding the progress of such innovations in medical history.

Making medicine a business in Japan: Shimadzu Co. and the diffusion of radiology (1900-1960)

This contribution focuses on the role of the firm Shimadzu in the marketing of X-ray machines in Japan during the first part of the 20th century, viewed from a business history perspective. It attempts to further understanding of the process of technology diffusion in medicine. In a global market controlled by American and German multinational enterprises, Japan appears to have been a particular country, where a domestic independent firm, Shimadzu, succeeded in establishing itself as a competitive company. This success is the result of a strategy based on both the internalisation of technological capabilities (recruitment of university graduate engineers, subcontracting of research and development activities) and an original communication policy towards the medical world. Finally, the specific structure of the Japanese medical market, composed of numerous and largely privatised small healthcare centres, facilitated the rapid diffusion of X-ray machines, a new technology which conferred a comparative advantage on its holders.

2008 - a year of three anniversaries: 125th anniversary of the Club for Natural Sciences in Fiume (Rijeka), 160th anniversary of the birth and 80th anniversary of the death of Professor Peter Salcher

The Natural Science Club was founded in Fiume/Rijeka (Naturwissentschaflichen Club in Fiume/Club di scienze naturali in Fiume) on November 28th 1883. The foundation charter stipulated no restriction on language use, and lectures could be held in any language. Right from the start, the Club had active women members, and one of them, Rosa Fatour, the headmistress of the municipal school, held a lecture entitled "Development of anthropology" as early as in 1889. The Club started to publish a bilingual bulletin in German and Italian in 1896 (Mittheilungen des Naturwissenshaftlichen Clubs in Fiume/Bolletino del Club di scienze naturali in Fiume), bringing not only reports on lectures held in the Club, but also important scientific and professional papers. In 1896, several sections were founded within the Club, as follows: 1. The Committee for Röntgen, whose aim was to purchase the Röntgen apparatus. This task was completed in 1897. The apparatus was ceded to the municipal hospital in 1899, and the Committee was disbanded. 2. The Photography Section, lead initially by A. Riegler. The section organized several photo exhibitions in which women often took part.3. The Prehistoric Research Section was founded subsequent to the discovery of the remains of an old fortification in the town. This section collaborated closely with the municipal museum. Since founding and until 1902, Prof Peter Salcher held important positions in the Club; he founded the Röntgen Committee and the Photography Section; he himself gave 31 lectures and was editor of the German part of the Bulletin.

[Control of health risks in radiodiagnosis: a historic approach]

This paper presents the history of the discovery of ionizing radiation, as well as its biological effects and the resulting need to control subsequent health risks. It describes the historic evolution of risk control in radiodiagnosis in Brazil, demonstrating that it may be associated not only to the dose received, but also to errors in diagnosis and to costs to the health system. It is stressed that sanitary regulations have a broad remit of social co-responsibility to involve all the players with a view to safeguarding health.