X-Rays Personal Recollections

by Captain T. W. Baranard. O.B.E.

(Reprint from BIR Silver Jubilee Souvenir)

Before referring to my Service in Madras, it may be of interest to recall some of the events between 1908, the year I began X-Ray work in London, and 1920 when I took up my post in Madras.

In1908 X-Rays had been used for Medical purposes only a grew years and the apparatus to produce them was very crude compared with that now available. It then consisted of induction coils with various types of interrupters and many gadgets and devises by which it was hoped to overcome leakage of high tension and inverse currents, the X-Ray Tube had to be kept cool by various means. There was but little protection against Radiation and Electrical dangers and the risks " X-Ray Operators" (as the stagg was named in those days) were called upon to incur were many

I joined the staff of "The London Hospital" in that year and at a time when my Senor Colleagues included some who had taken up X-Ray work soon after Roentgen made his famous discovery in 1895. There was no Ipation X-Ray Department even at this important Teaching Hospital and only as small department in the Out-Patient Section. In-Patients who could not be moved to the O.P. Department, which was a considerable distance away and reached by an underground corridor, were radiographed in their beds by means of a protable trolley unit on which there was no protective shield around the X-Ray Tube.

Of the seven men then serving at "The London", E.H. Harnack had been very badly damaged by X-Rays; he had lost one hand and part of the forearm and, also fingers from the other hand which later was amputated. He had therefore, more or less retired from active work, but was employed in showing numerous parties of visitors over the Hospital. Ernest Wilson also had bad X-Ray injuries and could only attend both hands, was, with a youth -Percy Cooper, -on duty in the newly opened skin X-Ray Therapy Department in the O.P. working for Dr. Sequeira who was in charge of this and the Finsen Light Department. H.J. Suggars,. C. Copeland, F.Lovelock and myself covered diagnositc Radiology and also some types of treatment. Six of the seven are dead-Harnack,Wilson, Blackall and Suggars, from X-Ray Injuries, Lovelock from partly X-Rays; Copeland, only slightly damage, died from a heart attack, Cooper gave up X-Ray work after some years service and emigrated to Australia - he receied slight X-Ray injuries but it is not known whether he is still alive. Although I used a 'naked' X-Ray Tube with no protective shield, I escaped serious injury apart from damaged finger nails, as I took precautions ignored by my Seniors, the most importantbeing to keep a safe distance from the X-Ray Tube when it was in action; I attribute the fact thatt I am alive today being due to my use of a length of insulated flex by means of which I swithced the Tube mounted on my Ward apparatus "on and off" from a distance of about 10 feet!

Besides my colleagues at the London Hospital - I met many other early pioneers in the X-Ray World and some of these became intimate friends who took a paternal interest in me - then a rather raw young man just beginning to learn something of the hazardous profession they themselves had adopted, with but little protection. I was associated with some of the workers, who included three of those I have named who invented one of the early protective measures against X-Ray dangers - the lead glass bowl - in which was placed the X-Ray Tube of those days - this type of protection being in use until the advent of the self protected tube. Alas, the invention, although means of protection to those who followed, was of no avail for most of the inventors, as they had already contracted X-Ray injuries from the effects of which they died.

Those early years were vere interesting. The X-Ray exposures required to produce Radiographs were long compared with the flashes of today, although advances had been made since still earlier days when it was necessary to give 15 minutes exposure to produce a veru indifferent radiograph of an ankle - I had to give only 45 to 60 seconds - but with todays powerful apparatus, a fraction of a second is sufficient. In 1909 I had to give a 2 minutes exposure to obtain a radiograph of a patient'2 supine - when we could "nurse" the X-Ray Tube to work for this long period without breaking down: more often we had to rest the tube halfway, having warned the patient not to move during the five or six minutes required for such an examination. In those days we used a device called a Bauer Qualimeter to indicate the penetrating power of the Radiation produced in the X-Raytube. This meter was wired into the high tension circuit and I remember it very well, for on one occasion the needle on the scale became fixed and I carelessly tapped it with my pencil to make it move but it was I who moved, for the lead in my pencil connected me to the high rension circuit and I was flung across the room by the electric shock, being picked up in a very dazed condition but otherwise unhurt.

The X-Ray Tunes used in early days consisted of 6 and 8-inch Gunderlach gas tubes which were difficult to "season" for various types of "soft or hard" X-Rays; it was, therefore, necessary to keep in use a battery of tubes, each having been worked up to the penetrating value required for different examinations. - Therese tubes could be purchased for 150 to 250 Rupees - todays tubes cost anything from 5,000 for diagnostic Radiology to possibly 15,000 Rupees for use with the Super Voltage X-Ray Treatment Units. A complete apparatus in those days could be bought for about 2,000 Rupees, - todays price for a good type of diagnostic X-Ray Unit is about a lakh, while Linear Accelerators used for Treatment may cost over five lakhs of Rupees.

Interesting radiographs I made in London around 1909 included one of a man who had stolen five sovereigns and swallowed these in the hope of making a better use of them at a later stage!! He was unaware of the powers controlled by the X-Ray Department and was very astonsished when the police brought him to the hospital where I " X-Rayed" him and produced a picture in which the five sovereigns were plainly visible in his stomach.

Other interesting Radiographs I made in those days were of the injured firemen and policemen and the associates of "Peter the Painter" involved in the Sidney Street affair and the murders and burglary in Houndsditch, London, leading up to that exciting episode when Winston Churchill, then Home Secretary, ordered out guardsmen from the Tower of London, to help the police to arrest the desperate Anarchist Aliens who having barricaded themselves on the top floor of a house in Sidney Street in the East End kept everyone at bay by using a regular arsenal of firearms, I still retain a mental picture of Mr. Churchill, standing in Sidney Street watching the soldiers who, lying flat on the roads, were firing at the windows of the house from which their volleys were answered by indiscriminate shooting. The house eventually caught fire and was burnt out, the criminals being found dead, although it was suspected that at least two Associates escaped abroad.

Before the first World War, I had command of the 9th London Cadet Battalion, with the rank of Major, and when war broke out I offered myself for service, but owing to the importance of the X-Ray work then being carried out at the London Hospital where several hundred beds had been placed at the disposal of the War Office, my offer was not accepted. However, demands for X-Ray Specialists for active service became urgent and in 1916 I was commissioned by the Medical Department of the War Office for X-Ray Service in India and Mesopotainia and reached Bombay in August of that year, not to leave there until I took up my appointment in Madras in 1920 ! ! On arrival in Bombay I was sent to Cumbala War Hospital and having reported to the Colonel in charge was informed where the X-Ray Department was situated and then requested to let him know when I could begin to accept patients for examination. Arriving at the department where I expected to find the apparatus in order and a staff awaiting me, I was much disappointed to find no staff and only empty rooms except for a dozen packing cases of equipment. The rooms were spacious but not even wired for power and the main switch boards were at least 100 yards distant. I pass over the trials and tribulations of the following month during which I struggled, with the help of a few Indian servants and some assistance from a friendly Indian Electrician, at last succeeding in installing an apparatus which, having been used at Gallipoli and then hurriedly packed when our men had to be evacuated, had also suffered damage during the rough voyage over the Indian Ocean during particularly bad Monsoon Seas!

Eventually the day dawned when I felt I might try out the apparatus. I switched in and there was a terrific explosion—the top of a Gas Chamber in a Mercury Interrupter being blown to pieces, this being caused by an infiltration of air into the Chamber! Another week elapsed during which I had to stand over workmen in the bazaar, explaining and showing them how to make a new top and to fit this with the required electrical wiring! Again I was ready to try out the equipment, but this time I could not persuade any one to remain in the room as it was fully expected there would be another explosion, but when the owners of various heads pushed around door frames and over windows cells found the “mad sahib” still safe they came in and one servant at length and consented to sit at the couch so that I could take a trial radiograph of his hand. He sat there smiling amiably and feeling very important until I switched on the electric current and then things began to happen! It was still very damp in Bombay and as in those days the high tension leads from the induction coil to the X ray tube where only thin were thin brass spiral wire with no insulation, there were sparks every where and angry snaps the current preferring every path except the difficult one of overcoming the resistance of the X ray tube. My “Patient” , although rather alarmed, stood this for some time, but when a great spark flashed from the bare wiring to the tube holder near his head he just fled from the room and once again I was alone. Eventually heads again advanced cautiously through windows and door ways, but by this time the X ray tube had become “soft” enough to allow the current to pass and it began to glow with that beautiful apple green fluoresence not seen in modern X ray tubes. I managed to obtain a good radiograph but it was not there for any length of time as the great heat melted the film. This was averted in other and later radiographs by packing much ice below and around the processing dishes. Remembering all this, in the many departments I planed for south India in after years, I equipped all dark rooms with Frigidaire plant which kept the solutions down to 60* to 65*.

After a few months at Cumbala Hill, I was transferred to the permanent and chief military hospital, at Colaba on Bock Bay, where my difficulties were still greater than in the city, for the X ray department there was built on a jetty on the beach, and as the waves dashed against the walls when the tide was in, the apparatus became very damp. In this department, I worked with captain Shorten I.M.S and we tried every method of drying out our plant, including wiping it over with methylated spirit but found our supplies of this were inadequate as the Indian orderlies used to “Sample” the spirit!! The leakage of current damaged several X ray tubes so we began to discuss electrical methods of over coming our difficulties and after some hazardous experiments, found that if we earthed the negative side of the tube and coil, practically all our troubles were over. There was no electrical danger on this side of the circuit and to “Show off” we occasionally held that side of the tube with our bare hands while high tension current of 80000 volts was passing through it - we feeling no shock. This research was published in the “Journal of the Roentgen society” in 1917 and aroused world wide interest. Later captain Shorten left for east Africa – I stayed on at Bombay continuing to use the new method of wiring. In 1919, I again got into touch with captain Shorten who was still in Africa and we published too more papers in the journal on “Further experience with X ray tubes run on the earthed system”, I having by then made over 10000 radiographs and given several thousand treatments under those condition, without damaged to the apparatus. I like to think that our research and experiments in that little department in Bombay, during the First World War were probably the fore runners of those which eventually produce the modern high voltage apparatus now in use in which one end of the tube is “ Earthed” I was rather amused some 15 years later when Metro-Vickers published in the “British journal of radiology” a paper describing their continuously evacuated X ray tubes and calling attention to the earthing of the tube as some thing new. I wrote to the journal referring to our original articles and some interesting correspondence followed. Writing of alleged new methods and apparatus, I am reminded of another successful experiment, this time in London in 1910 when, I also like to think, I anticipated by 20 years or more the advent of the double focus and rotating anode tube, but this is too technical to refer to in detail in this paper.

I left Bombay in January 1920, having first been appointed by Government to a civilian post in Madras, whereas “ Radiologist to the Government of Madras”, I was instructed to organize a radiological service for the presidency; before taking up my appointment, I went to England on leave and during the next 4 months visited many new X ray departments and also conferred with several eminent men, who, like myself, desired to set up a professional standard for radiographers – the out come of these talks being the formation “ Society of radiographers” which now has a membership of several thousands.

Madras always had a good reputation for its Medical gacilities and its high standard ofg Medical Education. Radiology, however, had until 1920 been rather neglected as was the case in other parts of the world. When I took up my post in Madras, there were only two civilian Government X ray Departments working – those at the General Hospital and at Tanjore. There were I think two private Radiology Institutes – one of these being that of my old friend Dr. Rama Rao. The coil unit at the General Hospital was activated from the mains but the apparatus at Tanjore worked off a battery of about 60 accumulators producing 110 volts. These were recharged by means of an ancient dynamo and an ingeniously arranged equipment, the primary motive power being supplied by a buffalo trotting around at one end of a long axle, the other end of which was attached to a series of wheels which when turned produced enough current to recharge the cells.

It must have been somewhere around 1900 that Madras secured its first X ray out fit and curing the following 20 years the department was housed in two small rooms on the ground floor of the General Hospital. The department since 1909 has been under the charge of Assistant Surgeon Rao Sahib M. Govindarajalu Naidu. These rooms were quite unfit for the work the department had to undertake and when my negotiations for an outside building fell through, the Government readily gave approval to a proposal, made by the Superintendent and the Medical Staff of the Hospital, that an annexe originally designed for operation theatres should be adapted for the X ray Institute, this to be used until a new and permanent building could be erected.

By March 1922 the adaptation had been completed and, also, tby that time two other new X ray Departments had been opened – one at Ootacamund, the other at Madura, all the equipment and apparatus for the latter having been provided by local Millowners at a cost of about 16,00 Rupees. This Department was placed under the charge of assistant surgeon R.A.D Graham, M.B., ch.b, who was transferred from the general Hospital X ray Institute.

The new Institute was opened on March 17, 1922 by the Governor of Madras and in the foreword of the programme issued on that occasion, Colonel T.N. Symoms, the superintendent of the Hospital, made an appeal for Rs 20,000 to defray the cost of a 200,000 volt X ray unit for the treatment of Cancer. This was eventually supplied by the Government in 1924 and was housed in an annexe specially designed and built for it – the first double coil 200,000 volt unit to be installed in the East. The New Institute became very popular and the number of patients dealt with increased each year, additional staff being employed to cope with the extra duties. Much interesting work was done and during these years several episodes occurred which may be thought worth recording- I have referred to a thief in London who stole five sovereigns and swallowed these in order to recover them in due course – he being astonished when the X rays revealed the coins lying in his stomach! An Indian thief equally surprised was one who seeing a small girl standing on the temple steps dressed for festival snatched from her neck a long gold chain and then fled with the Temple crowd in chase – when caught he pretended he too was chasing the thief and abused the police who, on arresting him, found no trace of the chain- however, one of the policemen had been with a party which visited the General Hospital X ray Department a week or so before suspecting that the thief had swallowed the jewellery brought him to the Department where we were able to show the chain lying in his stomach. A somewhat similar affair occurred a few years later, when a criminal band suspected of stealing a large quantity of jewels were round up but none was found secreted in small cavities inside the cheeks of the women of the band; the gold mounts having long before been melted down. On another occasion in 1921, a man arrived in the old department and enquired whether I could test diamonds by X rays and produced from a pocket inside his vest the largest stone I have ever seen – its diameter was 3 ¼ inches and was about ½ inch thick at the centre – tapering off by step cutting on both sides to a thin edge; I have before me life size photograph of jewel! It appeared that it was the property of an Indian Prince in the North and about 500 years before had been used as an ornament for the forehead of the Temple Elephant when he carried the Prince from Palace to Temple. The senior ranee was jealous that this stone could not be used by her and in a fit of temper, while it was being carried to the Treasury seized the stone and threw it into the palace fire where, before it could be recovered by servants, it became whit hot. In order to cool it the stone was placed in chatty of ice- water when the sudden change in temperature caused the many striations which spoiled the jewel. There came troublous times to the Indian State and the Prince decided to secrete the stone in the Temple Well – where it reminded hidden for 500 years, the secret of the hiding place being passed from father to son until at the end of the first world war it was recovered and sent to Bombay for sale at {60000. An offer of { 10000 was made on condition that a certificate was produced stating that the stone was a true diamond, this I was able to give, but by the time the stone was returned to Bombay, the price fell to { 8000 and somewhere around this sum it was sold to be cut into a large number of small stones.

My other experiment with precious stones was made about 1937 when I thought it might be possible to improve the colour of some stones by bombarding them with the Gamma Rays Radium. I therefore persuaded my jeweler friend Vumidi to loan me two water coloured large Sapphires of equal size and weight. One of these I packed in several hundred milligrams Radium Vumidi and I signed the sealed package which was placed in the Radium Safe; the control Sappphire we also sealed and signed and my friend took charge of it. 24 hours later we opened the packages but instead of the bombarded stone having become a cornflower blue Sapphire, which I had hoped for, this stone had changed to a brilliant golden colour and it appeared to be a topez! Vumidi would not permit me to experiment with more of his stock!

While in the temporary Institute, we saw a remarkable display by a fakir who, before a very large audience of Medical Students at General Hospital, swallowed the following items without any apparent ill effects. He consumed broken glass, small stones and earth, live scorpion, a live snake, tin tacks by the handful, Mercury and Nitric acid. Before taking the acid he very carefully smeared his tongue, lip and mouth with chalk and as during the performance he drank huge quantities of water which he conveyed from a bucket by means of half a cocoanut shell cup ! There was no doubt about the tin tacks and mercury, however, for at the request of the Students I X rayed the man and resulting film showed his stomach fully outlined with the small nails and the mercury, the latter having reached the appendix which was plainly visible.

On another occasion, a lady passenger on a ship in the harbour on coming ashore slipped on the gangway and sprained her ankle – she was brought to the Institute for X ray examination and as the ankle was painful, I did not remove her shoe but made the radiograph with it on the foot ; on developing the film, I found that she was a potential smuggler, as the heel of the shoe had been hollowed out and then filled up jewels !!

A number of small items of research was undertaken at New Institute and two important schemes – (1) a series of 500 Radiographic examinations of Epiphysis as an aid to determining the age of a patient – after publishing this we had periodically to examine a number of young criminals! (2) the other scheme also involv3d a very large number of X ray examinations on Endemic Flourine Poisoning.

On the opening of the New Institute in 1934 this was equipped with the latest types of apparatus, including the first 400,000 Volt X ray Unit installed in the East, the Institute being acclaimed by the Medical & lay Press in United Kingdom and the U.S.A as providing one of the best Radiological Service in the World . The equipment had been kept up to date by adding new units such as Convergent Beam, Pendulam and another type of moving beam Therapy apparatus – long before important centers in England received such units. While planning and building the Institute and during the years which have elapsed since 1934 new Radiological Departments have been opened in Districts Headquarters Hospitals and other Centers, the staffs for these having in most cases been trained at the B.I.R. where the candidates sat for the examinations for the Diploma in Medical Radiology (D.M.R) and non medically qualified students for the Radiographer Diploma (C.R.A). I had the honour of being appointed the first President of the Board of Examiners for these Diplomas. The staff of the Teaching Institute had, of course, greatly increased since 1920 when only 4 persons were employed – there must now be over 80 there – I think on the staff in 1940!

I trust that these “recollections” will have proved interesting to the reader and I conclude by conveying to the staff of the Institute my very best wishes for their happiness, long life and prosperity, adding, of course, my congratulations on the occasion of the celebration of the Silver Jubliee year of the Barnard Institute of Radiology.

Interesting note:

In 1921, 24 radiographs from the department in Madras were accepted for the Roentgen Society Exhibition in London during June. There of these were chosen to be shown a second time in the scientific section of the exhibition held by the Royal Photographic Society of Great Britain in London during September and October.