What happened 114 years ago

2. What happened 114 years ago Dr.P.V.Ramachandran MD FICR, Professor of Radiology , AIMS, Cochin, INDIA

6. Working with a cathode-ray tube in his laboratory, Roentgen observed a fluorescent glow of crystals. When air in the tube was evacuated, and a high voltage was applied, the tube produced a fluorescent glow. The tube that Roentgen was working with consisted of a glass envelope (bulb) with positive and negative electrodes encapsulated in it. Roentgen shielded the tube with heavy black paper, and discovered a green coloured fluorescent light generated by a Barium Platinocyanide screen located a few feet away from the tube.

7. X…… Rays • Roentgen concluded that a new type of ray was being emitted from the tube. • This ray was capable of passing through the heavy paper covering and exciting the phosphorescent materials in the room. • Roentgen also found that the new ray could pass through most of the substances

8. Did not think…but investigated • It is interesting that the first use of X-rays were for an industrial (not medical) application, as Roentgen produced a radiograph of a set of weights in a box to show his colleagues. • And of course , the historic first ever medical radiograph followed within next 6 weeks( 22 Dec 1895)

9. Within a month after the announcement of the discovery, several medical radiographs had been made in Europe and the United States In June 1896, only 6 months after Roentgen’s discovery, X-rays were being used by battlefield physicians to locate bullets in wounded soldiers

10. Hand of Von Kolleiker, President of Wurzburg Physical and Medical Society on 13th Jan 96 This early radiograph was a 15 minute exposure of the hand of Roentgen's wife –22 Dec ‘95

11. After 7 weeks of hard work W.C. Roentgen wrote a short manuscript entitled "On a New Kind of Rays - First Communication" and handed it to the secretary of the Würzburg Physical & Medical Society. Because the society did not meet during the Christmas holidays, Roentgen asked that the manuscript be published prior to its oral presentation, which was scheduled for January 23rd, 1896. The secretary agreed and the manuscript was published in the "Sitzungsberichte der Physikalisch-Medizinischen Gesellschaft in Würzburg" (S. 132-141, Band 137, 1895)

12. H.D. Ruhmkorff (1803-1877) who originally built musical instruments, became famous for the invention of electromagnetic devices such as the induction coil J. W. Hittorf (1824-1914), Professor of Physics at the University of Münster, studied cathode rays and developed a tube with a vacuum more complete than had hitherto been available. Sir William Crookes (1832-1919) built variety of vacuum tubes designed for research into radiant matter. He was of such renown that even in his lifetime "Crookes tube" was used to refer to any kind of vacuum tube Lastly, Roentgen refers to P. Lenard (1862-1947), who was awarded the Nobel Prize in Physics in 1905 ( 4 years after Roentegn) for his ingenious work on cathode rays. In 1892 he has built a special tube

13. The text reads (note the corrections!):- • Ueber eine neue Art von Strahlen • von W.C. Röntgen(Vorläufige Mittheilung) • Lässt man durch eine Hittorf'sche Vacuumröhre, • oder einen genügend evacuierten Lenard'schen, Crooke'schen oder ähnlichen Apparat die Entladungen eines grösseren Ruhmkorff's gehen, und bedeckt die Röhre mit einem ziemlich eng anliegendem Mantel aus dünnen schwarzem Carton, so sieht man in dem vollständig verdunkelten Zimmer einen in die Nähe des Apparates gebrachten, mit Bariumplatincyanür angestrichenen Papierschirm bei jeder Entladung hell aufleuchten, flueresciren, gleichgültig ob die an gestrichene oder die andere Seite des Schirmes dem Entladungs apparat zugewendet ist. Die Fluerescenz ist noch in 2 m Entfernung vom Apparat bemerkbar. • Man überzeugt sich leicht, dass die Ursache der Fluerescenz vom Innern der Entladungsapparatur und von Keiner anderen Stelle der Leitung ausgeht.

14. Concerning a New Kind of Rays by W.C. Röntgen (Preliminary Communication) 1. Upon passing the discharge of a large Ruhmkorff coil through a Hittorf tube or a sufficiently evacuated Lennard, Crookes or similar apparatus, the tube being equipped with a properly tight fitting cover made of thin black card, then in a completely darkened room one sees with every discharge, brightly emitted light, a fluorescing…………………. Fluorescence is observable up to 2m away from the apparatus. It is easily shown that the cause of the fluorescence originates from inside the discharge apparatus and from no other part of the conductors.

15. It is not known which of these various tubes W.C. Roentgen actually used; in his original communication he merely mentioned the three different types in a general way Lenard, however, considered himself to be "the mother of X-rays" while Roentgen was "the midwife who happened to deliver the child". Certainly, both were nominated for the first Nobel Prize in Physics in 1901; and the committee recommended that the prize should be divided equally between Roentgen and Lenard . But the Royal Academy of Science decided to award the prize to Roentgen. In 1896, however, the two scientists were jointly awarded the Rumford Medal of the Royal Society of London. Neither actually travelled to London to receive his prize, and as a result, the two men did not meet on this occasion, nor, indeed, on any other.

16. Prof. Lecher , a physicist from Prague borrowed the manuscript for a single day for his father who was the editor of the Vienna newspaper "Die Presse“ and it was he who wrote the first article on the discovery, which appeared in the Sunday, 5th Jan. 1896, edn. of the newspaper. Owing to haste in the preparation of the article the name of Roentgen was misspelt as "Routgen". By the following evening, 6th Jan .1896, the news had been spread around the world by cable from London.

17. "The noise of war's alarm should not distract attention from the marvellous triumph of Science which is reported from Vienna. It is announced that Professor Routgenof Würzburg has discovered a light which, for the purpose of photography, will penetrate wood, flesh and most other organic substances. The Professor has succeeded in photographing metal weights which were in a closed wooden case, also a man's hand, which shows only the bones, the flesh being invisible".

18. The London Standard printed the report on January 7th, 1896 adding the following remarks: "The Presse assures its readers that there is no joke or humbug in the matter. It is a serious discovery by a serious German Professor". While the first reports in New York were published on January 8th, 1896, the first report by the local newspaper, "Würzburger Generalzeiger", did not appear until January 9th, l896 !

19. Thus, within ten days of the submission of the manuscript to a publisher the news had spread to the entire world , even before Roentgen had presented his findings to the scientific society . An English translation of Roentgen,s communication appeared in “ Nature” ( London ) and two weeks later, in Science (USA).On January 13th, 1896, Roentgen presented his work to Emperor Wilhelm II in Berlin and, on January 23rd, 1896, he eventually gave his oral presentation to the Würzburg Physical Medical Society.

21. Shortly after the discovery of X-rays in 1895, an imaginative English businessman started selling x-ray proof undergarments to women who thought that they would be stared at by men wearing x-ray glasses. The whole world became obsessed by these new rays. Some feared them and spoke of similar rays that might bring death and destruction to whole cities and armies by remote control. Others complained of the banishment of all privacy, for here was an agency that could see right through your clothes! A bill was actually introduced into the New Jersey State Legislature forbidding the use of X-rays in opera glasses on the grounds that public modesty would be outraged, as if X-rays could be incorporated in opera glasses! A London firm actually advertised X-ray-proof underwear!

22. Roentgen did not relish the sudden publicity he gained after the discovery of "a new kind of rays“ which were named "Roentgen rays" following his oral presentation at Wurzburg. He was awarded numerous honorary memberships, medals and other decorations but virtually never accepted these accolades in person. He did travel to Stockholm, however, to accept the first Nobel Prize in Physics in 1901, but did not give an official speech even on that occasion. He was honoured by the Prince Regent of Bavaria with the Royal Order of Merit of the Bavarian Crown which carried with it personal nobility. Roentgen accepted the decoration but refused the status of nobility, a gesture which was most uncommon in those days. He turned down several chances to make profit from his discovery.

23. Mr. Levy, a representative of a well known German company, was sent to Roentgen to negotiate a contract for the industrial exploitation of his current and future discoveries. Mr. Levy recalled Roentgen's answer: "He declared, however, that according to the good tradition of German University professors he was of the opinion that his discovery and inventions belonged to humanity and that they should not in any way be hampered by patents, licences, contracts or be controlled by one group."

24. Born on March 27, 1845 at Lennep, in the lower Rhine Provine of Germany.The only child of a cloth manufacturer and merchant. His mother was Charlotte Constanze Frowein of Amsterdam,a member of an old Lennep family settled in Amsterdam.When he was three years old, his family moved to Apeldoorn in The Netherlands, where he went to the Institute of Martinus Herman van Doorn, a boarding school.

25. In 1862 he entered a technical school at Utrecht, where he was unfairly expelled, accused of having produced a caricature of one of the teachers. (“Consilium abeundi”) He then entered the University of Utrecht in 1865 to study physics. Not having attained the credentials required for a regular student, and hearing that he could enter the Polytechnic at Zurich by passing an “ Entrance exam”, he tried it, got through and began studies there as a student of mechanical engineering.

26. In 1869 he graduated Ph.D. at the University of Zurich, was appointed assistant to Kundt and went with him to Würzburg . Würzburg University, however, hindered Roentgen's academic career. Acting under Bavarian law, it barred his promotion because of his lack of a school leaving certificate ! In 1874 he qualified as Lecturer at Strasbourg University and in 1875 he was appointed Professor in the Academy of Agriculture at Hohenheim in Wurtemberg. In 1876 he returned to Strasbourg as Prof. of Physics. In 1879 He accepted the invitation to the Chair of Physics in the University of Giessen.

27. In 1888, however, Roentgen received an offer which he could not refuse: The same University of Würzburg, which had previously obstructed his academic career now offered him the position of full professor and director of its highly esteemed and well equipped Physics Institute. He accepted the appointment and moved back to Würzburg. In 1894, he received the ultimate academic accolade in his election as Rector. In 1900 he accepted the request from Bavarian Govt. to chair the department. of Physics, University of Munich, where he remained for the rest of his life,

28. Röntgen's first work was published in 1870, dealing with the specific heats of gases.His other areas of interest and work were Thermal conductivity of crystals ; Electrical and other characteristics of quartz; Refractive indices of various fluids; Modification of the planes of polarised light by electromagnetic influences; Variations in the functions of the temperature; Compressibility of water and other fluids ; Phenomena accompanying the spreading of oil drops on water.

29. Contemporary philosopher Münsterberg of Harvard University who on January 15th, 1896 wrote in a report to Science: "Suppose chance helped. There were many galvanic effects in the world before Galvani saw by chance the contraction of a frog's leg on an iron gate. The world is full of such chances and the Galvanis and Roentgens are few."

30. Röntgen retained the characteristics of a strikingly modest and reticent man. Throughout his life he retained his love of nature and outdoor occupations. Many vacations were spent at his summer home at Weilheim at foot of the Bavarian Alps. He went on many mountain expeditions .He was a great mountaineer Amiable and courteous by nature, he was always understanding the views and difficulties of others. He was always shy of having an assistant, and preferred to work alone.Much of his apparatus was built by himself with great ingenuity.

31. Röntgen married Anna Bertha Ludwig of Zürich whom he had met in the café run by her father. She was a niece of the poet Otto Ludwig. They married in 1872 in Apeldoorn, The Netherlands. They had no children, but in 1887 adopted Josephine Bertha Ludwig then 6 year old daughter of Mrs. Röntgen's only brother. Anna died on 31st October 1919. ( For years, she had required five or more daily injections of morphine which he administered personally. ("I want to help and console my poor wife in her dark hours"). Röntgen resigned his position at the university and in the inflation that followed the war, he almost lived in poverty. Loneliness weighed heavily on him . He wrote ("I try to live as I imagine my wife would find satisfactory"). Four years later, Röntgen died at Munich on 10 Febr. 1923 from large bowel cancer

33. Wilhelm Conrad Roentgen ( 1845- 1923), the discoverer of X-rays in 1895, In the pleasant wooded cemetery in GiessenInitially his remains were in another cemetery. Later his ashes were transferred to Giessen where his wife and parents were cremated

34. Major inventions of 1895 Signals by Radio, Marconi (Italy) Wireless High Frequency Telegraph, Marconi (Italy) Diesel Engine, Diesel (Germany) Safety Razor, King C. Gillette (USA) Rayon (Acetate), Cross (England) Photoelectric Cell, Elster (Germany) X-Ray, Roentgen (Germany)

35. Discoveries in the Field of X-rays • 1901-W. C. Röntgen, in physics, for the discovery of X-rays. • 1914-M. von Laue, in physics, for the discovery of X-rays by crystals. • 1915-W. H. Bragg and W. L. Bragg, in physics, for the determination of • crystal structures using X-rays. • 1917 C. G. Barkla, in physics, for the discovery of the characteristic • X-ray radiation of the elements. • 1924 M. Siegbahn, in physics, for discoveries in the field of X-ray spectroscopy • 1927 A. H. Compton, in physics, for revealing the particle nature of X-rays in scattering experiments on electrons • 1936 P. Debye, in chemistry, for determining molecular structures by X-ray diffraction in gases. • 1962 M. F. Perutz and J. C. Kendrew, in chemistry, for determining the structure of hemoglobin and myoglobin. • 1979 A. M. Cormack and G. N. Hounsfield, in medicine, for the development of computerized tomography

36. Key Advances in Radiology • 1896 - Henri Becquerel discovers radioactivity and nuclear medicine is born.1901 – Roentgen receives the Nobel in Physics for the discovery of x-rays.1905 - The first English book on Chest Radiography is published.1910 - Köhler publishes the first edition of his classic book on normal variants,1913 –Coolidge hot cathode tube simplifies the work of technicians 1918 – Eastman introduces film, replacing glass photographic plates.1920 - Society of Radiographers forms.1930s – Doctors are appointed with specific interests in diagnosis or therapy.

38. How fast is Aquillion One ? • Whole brain : 350 mSec • One heart beat Coronary angio ! • Whole Liver : 350 mSec • Arterial phase ~ 8 sec • Portal phase ~ 10 sec • Faster than blood flow in many parts of the body

39. Government budget Is there more money allocated for this ? Or Is this at the expense of other facilities ? Cost Individual patient Same questions Since patient is not capable of analysing the technology, it is the role of government to evaluate technology and make recommendations based on efficacy and make the medical system follow those recommendations

40. Efficacy of technology • Technical Capacity • Replicability • Reliability • Diagnostic accuracy • Sens, Spec, PPV, NPV • Diagnostic Impact • Does result affect subsequent testing ? • Therapeutic impact • Does the test change treatment ? • Patient outcome

41. Efficacy: Performance of test under ideal conditions Effectiveness: Performance in real life `average` condition

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45. “I have seen further by standing on the shoulders of giants” Isaac Newton