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Remarks on X-Ray Treatment of Superficial Infections
NOTES, CASES, INSTRUMENTS X-RAYS INEFFECTIVE AGAINST HERPES VIRUS* THEODORE L. TERRY,
M.D.
REMARKS ON X-RAY TREAT MENT OF SUPERFICIAL INFECTIONS F. B. STEPHENSON,
BOSTON
The methods of treating corneal her pes at present available have been so ineffective that it seemed worth while to investigate any other possible means of combating the infection. It oc curred to us that x-rays might have germicidal effect on the virus con cerned. So far as we can ascertain this possibility has never hitherto been in vestigated. The following experiments seem to be conclusive. Experiments: The source of the virus was a herpetic vesicle less than twenty-four hours old. A small amount of serum from the vesicle was transferred to one-third c. c. of sterile saline solution. This suspension in an open glass container was exposed to x-rays (six inch gap, five ma., fourteen inch distance, two mm. aluminum filter, fifteen minutes). With a knife needle the right cornea of a normal rabbit was immediately inoculated with the sus pension in the usual way. In fortyeight hours the cornea showed a typi cal picture of experimental herpes. On the third day the left cornea of the same animal was inoculated with a suspension of scrapings from the in fected right cornea. The left eye was then exposed to x-rays in the same dosage. In forty-eight hours the left cornea showed a typical picture of ex perimental herpes. The rabbit was then killed and the clinical diagnosis was confirmed by histological examina tion of the eyes. Conclusion: Exposure of the eye to a dosage of x-rays as great as can be used safely is insufficient to have any germicidal effect on the virus of herpes. 243 Charles street. * From the Pathological Laboratory, Massachusetts Eye and Ear Infirmary. 554
M.D.*
DENVER
Experimental work done long since has demonstrated that sufficient x-ray dosage to kill bacteria in living tissue is destructive to the tissue itself, and roentgenologists do not now undertake treatment of inflammatory conditions with the purpose of directly killing the infecting organism. There is, however, a rational use of the x-ray as a therapeutic agent in the more superficial acute inflammatory conditions of bacterial origin. It re lieves pain and causes a subsidence of the inflammation. Some obscure bio physical action seems to promote tissue resistance, whatever that may be; whether by affecting blood circulation or lymph flow, by mobilizing blood cells, or by changing cell structure or nutrition. It is not impossible that the x-ray may modify the growth and mul tiplication or activity of the organism, though not killing it. Such treatment is empirical, but clinical observation of good results in boils, carbuncles, and other more superficial skin lesions has been many times confirmed and is de pendable. The dosage should be stimu lative, not destructive. In herpes zoster of the common type, I have seen good results follow treat ment over the involved spinal nerve roots with the more penetrating rays. The effect noted was early relief of pain and shortening of the course of the affection. Treating only the local skin lesions in one case of shingles caused a resolution of the lesions but did not relieve the pain. It would be rational to treat herpes of the cornea with mild stimulative in terval doses of x-ray, but never with * Roentgenologist.
NOTES, CASES AND INSTRUMENTS
any one dosage approaching the nearerythema dose mentioned by Dr. Terry. This would be justified for the local effect, whether or not more deeply seated nerve involvement is present in this type of herpes. My plan of treatment would com prise the following factors of dosage and intervals of application: electrical potential 66 kilovolts current 5 milliamperes target-cornea distance 8 inches filtration none time IS seconds Repeat dosage every other day for RULE FOR MEASURING ACCOM MODATION, NEAR POINT OF CONVERGENCE, AND INTERPUPILLARY DISTANCE C A P T A I N FREDERIC H A M I L T O N THORNE, M.C. BROOKS F I E L D , TEXAS
The rule described herein was de vised for the purpose of supplying
S55
five to ten doses, being guided as to number by response of the pathological condition. The retinal structures would not be injured under such a regime. A suit able cone should be used for limiting the area of exposure, but exact limita tion to the lesion is not necessary nor is it desirable. The entire cornea could be included if, rarely, the lesions were multiple. Lid retractors should be in place, if needed, to expose the lesion directly to the rays and thus avoid nitration by the lid tissues. 452 Metropolitan building. making original and annual eye ex aminations of the flying person nel, Army Air Corps, it is required that accommodation be measured and recorded in diopters and that the near point of convergence and the inter pupillary distance be measured in millimeters. The Prince rule, which is made of wood, is generally used for this pur
Fig. 1. Rule for measuring accommodation, near point of convergence, and interpupillary distance.
an efficient and rapid instrument for measuring the accommodation, the near point of convergence (PcB) and the interpupillary distance ( P d ) . In
pose. This rule is equipped with a metal slide supporting the test card, but in wet weather the wood becomes swollen, causing the slide to pinch and
M.D.
REMARKS ON X-RAY TREAT MENT OF SUPERFICIAL INFECTIONS F. B. STEPHENSON,
BOSTON
The methods of treating corneal her pes at present available have been so ineffective that it seemed worth while to investigate any other possible means of combating the infection. It oc curred to us that x-rays might have germicidal effect on the virus con cerned. So far as we can ascertain this possibility has never hitherto been in vestigated. The following experiments seem to be conclusive. Experiments: The source of the virus was a herpetic vesicle less than twenty-four hours old. A small amount of serum from the vesicle was transferred to one-third c. c. of sterile saline solution. This suspension in an open glass container was exposed to x-rays (six inch gap, five ma., fourteen inch distance, two mm. aluminum filter, fifteen minutes). With a knife needle the right cornea of a normal rabbit was immediately inoculated with the sus pension in the usual way. In fortyeight hours the cornea showed a typi cal picture of experimental herpes. On the third day the left cornea of the same animal was inoculated with a suspension of scrapings from the in fected right cornea. The left eye was then exposed to x-rays in the same dosage. In forty-eight hours the left cornea showed a typical picture of ex perimental herpes. The rabbit was then killed and the clinical diagnosis was confirmed by histological examina tion of the eyes. Conclusion: Exposure of the eye to a dosage of x-rays as great as can be used safely is insufficient to have any germicidal effect on the virus of herpes. 243 Charles street. * From the Pathological Laboratory, Massachusetts Eye and Ear Infirmary. 554
M.D.*
DENVER
Experimental work done long since has demonstrated that sufficient x-ray dosage to kill bacteria in living tissue is destructive to the tissue itself, and roentgenologists do not now undertake treatment of inflammatory conditions with the purpose of directly killing the infecting organism. There is, however, a rational use of the x-ray as a therapeutic agent in the more superficial acute inflammatory conditions of bacterial origin. It re lieves pain and causes a subsidence of the inflammation. Some obscure bio physical action seems to promote tissue resistance, whatever that may be; whether by affecting blood circulation or lymph flow, by mobilizing blood cells, or by changing cell structure or nutrition. It is not impossible that the x-ray may modify the growth and mul tiplication or activity of the organism, though not killing it. Such treatment is empirical, but clinical observation of good results in boils, carbuncles, and other more superficial skin lesions has been many times confirmed and is de pendable. The dosage should be stimu lative, not destructive. In herpes zoster of the common type, I have seen good results follow treat ment over the involved spinal nerve roots with the more penetrating rays. The effect noted was early relief of pain and shortening of the course of the affection. Treating only the local skin lesions in one case of shingles caused a resolution of the lesions but did not relieve the pain. It would be rational to treat herpes of the cornea with mild stimulative in terval doses of x-ray, but never with * Roentgenologist.
NOTES, CASES AND INSTRUMENTS
any one dosage approaching the nearerythema dose mentioned by Dr. Terry. This would be justified for the local effect, whether or not more deeply seated nerve involvement is present in this type of herpes. My plan of treatment would com prise the following factors of dosage and intervals of application: electrical potential 66 kilovolts current 5 milliamperes target-cornea distance 8 inches filtration none time IS seconds Repeat dosage every other day for RULE FOR MEASURING ACCOM MODATION, NEAR POINT OF CONVERGENCE, AND INTERPUPILLARY DISTANCE C A P T A I N FREDERIC H A M I L T O N THORNE, M.C. BROOKS F I E L D , TEXAS
The rule described herein was de vised for the purpose of supplying
S55
five to ten doses, being guided as to number by response of the pathological condition. The retinal structures would not be injured under such a regime. A suit able cone should be used for limiting the area of exposure, but exact limita tion to the lesion is not necessary nor is it desirable. The entire cornea could be included if, rarely, the lesions were multiple. Lid retractors should be in place, if needed, to expose the lesion directly to the rays and thus avoid nitration by the lid tissues. 452 Metropolitan building. making original and annual eye ex aminations of the flying person nel, Army Air Corps, it is required that accommodation be measured and recorded in diopters and that the near point of convergence and the inter pupillary distance be measured in millimeters. The Prince rule, which is made of wood, is generally used for this pur
Fig. 1. Rule for measuring accommodation, near point of convergence, and interpupillary distance.
an efficient and rapid instrument for measuring the accommodation, the near point of convergence (PcB) and the interpupillary distance ( P d ) . In
pose. This rule is equipped with a metal slide supporting the test card, but in wet weather the wood becomes swollen, causing the slide to pinch and