The Roentgen Treatment of Acute Peritonitis and Other Infections with Mobile X-Ray Apparatus

Abstract

IN 1928, under pressure of necessity, a case of gas gangrene was treated with the mobile x-ray unit, and recovered. The mobile unit was the ordinary unit designed for mobile diagnostic work in general hospitals and rated below 90 kilo-volts. In the first report (1) on the treatment of gas gangrene with the mobile unit, two cases out of eight died. Both of those dying had trunk involvement. In the six who recovered, the infection was entirely, or to a great extent, limited to the extremities. From the outcome of these cases it was thought that probably the mobile unit did not have sufficient kilovoltage to obtain the necessary depth dose to effect a cure in the trunk cases. This led to a recommendation for the use of higher voltages in treating deep-seated or trunk infections. Since the maximum kilovoltage obtainable from the mobile unit had been used in treating the two cases which died, it was apparent that in the future cases with trunk involvement must be moved to the x-ray department if they were to be treated successfully, or some apparatus producing a higher kilovoltage must be designed to enable the radiologist to treat at the bedside. Since no bedside apparatus was available, we started to move these patients to the x-ray department. This was done, on a few occasions, and, as these patients recovered promptly, we felt we were well rewarded for our efforts. In fact, we were so impressed with the results that we decided to treat other infections in the trunk. Peritonitis, following acute appendicitis and other intra-abdominal infections, is relatively common and was selected for a trial. The immediate difficulty encountered was that of obtaining the permission of the clinician to move the patient with peritonitis to the x-ray department, and we fully agreed with the clinician that the dangers involved in moving the patient seemed out of proportion to the chances of improving his condition. The whole thing then resolved itself into providing some means of treating the patient with peritonitis without disturbing him in any way, and, as no equipment was commercially available for this purpose, we felt that it was our duty to devise some means of providing x-ray treatment at the bedside, for those who were too sick to be moved. In a short tour of the local x-ray dealers' basements, we were able to select from the stock of obsolete and discarded x-ray equipment, a suitable transformer which was mounted upon a wooden base carrying a tube stand. We found two such units, and built two mobile units; they have served our purpose very well. They are not, we hope, the last word in this type of equipment, as we appreciate some deficiencies in this assembly, but we look for a real piece of apparatus to be developed in the near future for this type of work, as we are certain that the results will warrant its production.2