569 Other Provisioizs. Amongst the other provisions of the Bill of general interest to practitioners may be noted- the fact that all persons on ceasing to be employed are to remain fully insured for all benefits over an average period of one year and nine months (this period commencing, where the unemploy- ment is due to sickness, after the sickness terminates) ; a clause which prevents bodies of persons from contracting out of the medical benefit provisions of the Acts by taking advantage of a provision- intended for individuals making their " own arrangements "-to secure, in effect, the recog- nition of medical institutions which would otherwise be outside the Act; a more careful regulation of the right of societies to subscribe to a " charitable institution " and a definition of such an institution which makes it clear that it must have a real and substantial charitable element and not be merely a body financed by approved societies and designed to give treatment beyond the control of the Minister of Health ; and a minor provision by which medical benefit includes, in addition to provision of medicines, such chemical reagents as may be prescribed ; this will, for example, give the department the opportunity of regularising the use of Fehling’s solution (which has been held to be not a " medi- cine ") in connexion with the administration of insulin. MODERN RADIOLOGICAL EQUIPMENT. THE NEW DEPARTMENT AT EDINBURGH. THE new Radiological Department at the Royal Infirmary, Edinburgh, is an outstanding sign of the important position which radiology has reached at the present day. In the past, the visitor to an unknown hospital, desirous of finding the X ray department, had only to descend to the cellars, in the darkest and most noisome corner of which the depart- ment would certainly be found. The idea that any place is good enough for the radiologist is slowly passing away, and in the future the X ray department of an up-to-date hospital will be planned and built ’’, from the very beginning with a view to fitness for its special work, as in the case of the Edinburgh department. General Arrangement. The building, which was opened on Oct. 9th, 1926, by the Duke of York, is 170 feet long, with an average width of 60 feet. It consists of a basement and two floors, with a flat roof. It is built along the eastern side of the curved passage between the surgical and medical blocks, known to all Edinburgh medicals as the " duodenum." The building is of steel-framed construction with reinforced concrete floors and roof, and with walls of Craigmillar stone. It is consequently fire- and sound-proof. One of the most important factors in the design of rooms in which X radiations of high penetration are to be generated is the provision of adequate protection of the operators and the prevention of the escape of radiations which might in time affect workers in adjacent rooms. In the past this second end has been achieved by lining the walls and doors with heavy sheet lead, but in a building of such size as this the cost would have been prohibitive. It was therefore decided to incor- porate the protection in the building material used for the construction of the walls. Concrete slabs of the following composition were used : rough sand, 1 part ; engine ashes, 2 parts ; Portland cement, 1 part barium sulphate, 3 parts. The slabs were tongued and grooved, and when built the walls were coated on each side with a layer of barium plaster ! inch thick. The walls and ceilings were also coated with this plaster. All screening, radiographic, and treatment rooms were thus protected. The National Physical Laboratory reported that the finished walls gave protection equivalent to 5 mm. thickness of metallic lead, when a peak voltage of 100 k.v. was applied to the tube. The doors are protected with 6 lb. lead on both sides. The radiographic.and screen- ing rooms are provided with protected cubicles. built with the same barium slabs, in which all controls are placed. The meters and patient are observed through windows glazed with two thicknesses of " Super Protex " lead glass, giving protection equal to 5 mm. of lead. Further points of the greatest importance in the design of a radiological department are the avoidance of the noise ofrotating machinery and of corona high- tension discharges, with the consequent pollution of the air of the rooms by ozone and oxides of nitrogen. In the Edinburgh department all rotating machinery has been placed in the basement, in one large machine room with thick rubber flooring. The Electrical Installation. Direct current at 460 volts, from the town mains, is brought into this room, and used to drive a motor generator of 42 k.w. capacity, which supplies alternating current at 200 v. 50 cycles to the whole department. There is also a 3 k.w. rotary convertor for use with an emergency set. A third 1 k.w. motor generator supplies D.C. at 80 volts for electrical treatment. The switch gear for both D.C. and A.C. sides of the main generator‘is grouped in the centre of the room, the wiring at the back being completely caged in. To avoid inconstancy of radiographic results, due to voltage changes resulting either from changes of load in the department or from line fluctuations in the town supply, a Tirrill automatic voltage regulator is used to control the output of the 42 k.w. motor generator. In practice this instrument is very satisfactory, the 200 volt A.C. supply being always perfectly steady. Three oil-immersed 10 k.v.a. high-tension transformers are installed in the machine room, each being directly under an X ray room on the floor above. The high-tension current is led up to the room above by aluminium tubing passing through glass insulators in the machine room ceiling. Each transformer is capable of an output of 100 m.a. at 150,000 volts (peak), and is controlled from a trolley table in the cubicle in the room above. Each transformer, with its mechanical rectifier and coolidge trans- former is enclosed in a metal cage, on the door of which is a red danger sign, which lights up automatically when the main switch in the corresponding room above is closed, thus warning anyone below that the transformer is about to be energised. These transformer units feed the two screening rooms and the main’radiographic room. Next to the machine room is a mechanics’ workshop, well equipped with electrically driven machine tools. There is also a very large fireproof room for filing films returned from the wards. As a result of the grouping of the machinery in the basement there is no perceptible noise or vibration in the X ray rooms. When a screen room is in use, the only sound is a faint hum from the corresponding rectifier below. As all the high-tension wiring is carried out with smooth tubing, sharp bends being avoided, there is no corona in any of the rooms. Ventilation is carried out by a system of air extrac- tion ducts at ceiling level, three high-speed electric extraction fans, for the different sections of the building, being installed in one roof tower, while fresh air inlets are provided at ground level. Practi- cally all the rooms have wash-hand basins with hot and cold water, and all are floored with polished oak. In the corridors the floors and wall dado are of white terrazzo, with light blue decoration. Radiographic Roor2s. An automatic push-button control passenger lift connects the basement with the floors above. On the first floor is the office at which patients are received, two radiographic rooms, dark rooms, direc- tor’s room and secretary’s room, deep and superficial therapy rooms. There are also a lecture or demon- stration room and various staff rooms. The main radiographic room, fed from one of the transformer sets in the basement, contains a Bucky couch, ordinary couch for radiography, and a screening couch for localisation work. As all the controls, including an electro-magnetic remote control for the Bucky
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569
Other Provisioizs.
Amongst the other provisions of the Bill of generalinterest to practitioners may be noted-
the fact that all persons on ceasing to be employedare to remain fully insured for all benefits overan average period of one year and nine months(this period commencing, where the unemploy-ment is due to sickness, after the sicknessterminates) ;a clause which prevents bodies of persons fromcontracting out of the medical benefit provisionsof the Acts by taking advantage of a provision-intended for individuals making their " ownarrangements "-to secure, in effect, the recog-nition of medical institutions which wouldotherwise be outside the Act;a more careful regulation of the right of societiesto subscribe to a " charitable institution " and adefinition of such an institution which makes itclear that it must have a real and substantialcharitable element and not be merely a bodyfinanced by approved societies and designed togive treatment beyond the control of the Ministerof Health ; anda minor provision by which medical benefitincludes, in addition to provision of medicines,such chemical reagents as may be prescribed ;this will, for example, give the department theopportunity of regularising the use of Fehling’ssolution (which has been held to be not a " medi-cine ") in connexion with the administration ofinsulin.
MODERN RADIOLOGICAL EQUIPMENT.THE NEW DEPARTMENT AT EDINBURGH.
THE new Radiological Department at the RoyalInfirmary, Edinburgh, is an outstanding sign of theimportant position which radiology has reached atthe present day. In the past, the visitor to anunknown hospital, desirous of finding the X raydepartment, had only to descend to the cellars, in thedarkest and most noisome corner of which the depart-ment would certainly be found. The idea that anyplace is good enough for the radiologist is slowlypassing away, and in the future the X ray departmentof an up-to-date hospital will be planned and built ’’,from the very beginning with a view to fitness forits special work, as in the case of the Edinburghdepartment.
General Arrangement.The building, which was opened on Oct. 9th,
1926, by the Duke of York, is 170 feet long, with anaverage width of 60 feet. It consists of a basementand two floors, with a flat roof. It is built along theeastern side of the curved passage between thesurgical and medical blocks, known to all Edinburghmedicals as the " duodenum." The building is ofsteel-framed construction with reinforced concretefloors and roof, and with walls of Craigmillar stone.It is consequently fire- and sound-proof. One of themost important factors in the design of rooms in whichX radiations of high penetration are to be generatedis the provision of adequate protection of the operatorsand the prevention of the escape of radiations whichmight in time affect workers in adjacent rooms. Inthe past this second end has been achieved by liningthe walls and doors with heavy sheet lead, but in abuilding of such size as this the cost would havebeen prohibitive. It was therefore decided to incor-porate the protection in the building material usedfor the construction of the walls. Concrete slabs ofthe following composition were used : rough sand,1 part ; engine ashes, 2 parts ; Portland cement,1 part barium sulphate, 3 parts. The slabs weretongued and grooved, and when built the walls werecoated on each side with a layer of barium plaster! inch thick. The walls and ceilings were also coatedwith this plaster. All screening, radiographic, andtreatment rooms were thus protected. The National
Physical Laboratory reported that the finished wallsgave protection equivalent to 5 mm. thickness ofmetallic lead, when a peak voltage of 100 k.v. wasapplied to the tube. The doors are protected with6 lb. lead on both sides. The radiographic.and screen-ing rooms are provided with protected cubicles.built with the same barium slabs, in which all controlsare placed. The meters and patient are observedthrough windows glazed with two thicknesses of"
Super Protex " lead glass, giving protection equalto 5 mm. of lead.
Further points of the greatest importance in thedesign of a radiological department are the avoidanceof the noise ofrotating machinery and of corona high-tension discharges, with the consequent pollution ofthe air of the rooms by ozone and oxides of nitrogen.In the Edinburgh department all rotating machineryhas been placed in the basement, in one large machineroom with thick rubber flooring.
The Electrical Installation.Direct current at 460 volts, from the town mains, is
brought into this room, and used to drive a motor generatorof 42 k.w. capacity, which supplies alternating current at200 v. 50 cycles to the whole department. There is alsoa 3 k.w. rotary convertor for use with an emergency set.A third 1 k.w. motor generator supplies D.C. at 80 voltsfor electrical treatment. The switch gear for both D.C.and A.C. sides of the main generator‘is grouped in the centreof the room, the wiring at the back being completely cagedin. To avoid inconstancy of radiographic results, due tovoltage changes resulting either from changes of load inthe department or from line fluctuations in the town supply,a Tirrill automatic voltage regulator is used to control theoutput of the 42 k.w. motor generator. In practice thisinstrument is very satisfactory, the 200 volt A.C. supplybeing always perfectly steady. Three oil-immersed 10 k.v.a.high-tension transformers are installed in the machine room,each being directly under an X ray room on the floor above.The high-tension current is led up to the room above byaluminium tubing passing through glass insulators in themachine room ceiling. Each transformer is capable of anoutput of 100 m.a. at 150,000 volts (peak), and is controlledfrom a trolley table in the cubicle in the room above. Eachtransformer, with its mechanical rectifier and coolidge trans-former is enclosed in a metal cage, on the door of which is ared danger sign, which lights up automatically when themain switch in the corresponding room above is closed, thuswarning anyone below that the transformer is about to beenergised.These transformer units feed the two screening
rooms and the main’radiographic room. Next to themachine room is a mechanics’ workshop, well equippedwith electrically driven machine tools. There is alsoa very large fireproof room for filing films returnedfrom the wards.As a result of the grouping of the machinery in
the basement there is no perceptible noise or vibrationin the X ray rooms. When a screen room is in use,the only sound is a faint hum from the correspondingrectifier below. As all the high-tension wiring iscarried out with smooth tubing, sharp bends beingavoided, there is no corona in any of the rooms.Ventilation is carried out by a system of air extrac-tion ducts at ceiling level, three high-speed electricextraction fans, for the different sections of thebuilding, being installed in one roof tower, whilefresh air inlets are provided at ground level. Practi-cally all the rooms have wash-hand basins with hotand cold water, and all are floored with polished oak.In the corridors the floors and wall dado are of whiteterrazzo, with light blue decoration.
Radiographic Roor2s.An automatic push-button control passenger lift
connects the basement with the floors above. Onthe first floor is the office at which patients are
received, two radiographic rooms, dark rooms, direc-tor’s room and secretary’s room, deep and superficialtherapy rooms. There are also a lecture or demon-stration room and various staff rooms. The main
radiographic room, fed from one of the transformersets in the basement, contains a Bucky couch, ordinarycouch for radiography, and a screening couch forlocalisation work. As all the controls, including anelectro-magnetic remote control for the Bucky
570
diaphragm, are in the completely protected cubicle,the operator in this room is never exposed to X raysat all, as the tube can only be switched on from insidethe cubicle. In the partition wall between the radio-graphic room and the dark room are two hatcheswith double lead doors. Through one of these freshcassettes are obtained, while the exposed ones arepassed in through the other. The two screening roomsare similar to each other, one being mainly intendedfor gastro-intestinal work, and the other for chestcases. Both have three section screening stands.
These consist of a large framework fixed to the floorand carrving the tube box. This, though very heavilyprotected with lead, can be moved with great ease in bothhorizontal and vertical planes. The section on which thepatient stands, and the third one carrying the operator’sseat, both run on rails allowing the patient to be movedaway from the tube for tele-radiography. In front of theoperator’s seat is a counter-weighted, lead-protected, woodenscreen with side wings, which normally rises and overlapsthe lead glass protection of the fluorescent screen. It canbe depressed temporarily to allow of palpation. Thisarrangement makes the wearing of a lead-rubber apronquite unnecessary. Each room also has a screening couch,with the fullest protection. One screening room has aSelecteur Béc1ère apparatus for rapid serial radiographyof the duodenum, while the other has an apparatus withslot diaphragm and moving film for recording the move-ments of the heart. Both rooms are rapidly darkened bylowering a steel roller blind by means of gearing, but whennot in use they can be thoroughly aired and exposed todaylight. Both have all controls inside the cubicle. Allthe high-tension wiring is carried out with aluminiumtubing, supported by insulators fixed to the ceiling. Con-nexion to the various units is made by means of overheadH.T. switches, which instantly change over both H.T. andfilament currents, without disconnecting any wires byhand. Both wiring and switches are entirely corona-less.Where the H.T. feeders enter the room through the floor,they are enclosed in a metal cage, to a height of 8 ft.The large lecture room is equipped with viewing
boxes, two stereoscopes, and a projection lantern.
Treatment Rooms.Both deep and superficial therapy rooms open into
a large operators’ room, in which the workers areentirely protected from radiation by the barium wallsand lead doors. The respective switchboards are atthe side of lead glass windows through which thepatients are watched.
In both rooms the high tension generators are the Gaiffe-Pilon constant current apparatus, which employs high-tension transformers, charging up large condensers throughrectifying valves of the hot cathode type. The steady" overflow " from the charged condensers constitutes thehigh-tension supply to the X ray tubes. An oscillographicrecord of the current curve of this type of high-tensiongenerator results in an almost straight line, which indicatesthat the voltage generated is almost constant, there beingonly a slight ripple. This means that the X ray beamemitted by the -tube is practically homogeneous as regardswave-length. Moreover, the life of the tubes is prolongedas their anticathodea are not subjected to the rapid heatingand cooling which occurs when a tube is energised by ordinaryrectified A.C., and which causes a breaking up of thetungsten at the focal point. The high-voltage generator,which is placed in a safety cage inside the deep therapy room,is capable of an output of 10 m.a. at 250,000 volts. Thehot cathode X ray tubes are immersed, for insulation andcooling, in oil which is contained in a metal tank. The oilis cooled by a radiator immersed in it through which coldwater circulates. The tank is entirely surrounded by6 mm. of lead, with the exception of the small aperturethrough which the X rays are emitted.
Patients may be treated singly, or two can beirradiated simultaneously, in which case the twotubes are used in parallel from the one generator. Inthis case both tubes have the same applied potential,but the milliamperage through them is under inde-pendent control. A similar, but smaller, constantcurrent generator with an output of 10 m.a. at125,000 volts, supplies the superficial therapy room.A striking feature of both these high-tension generatorsis their silence and absolute steadiness when in
operation. Once the kilovolt and milliampere metershave been set to the desired reading, they remainthere without any fluctuation throughout any lengthof treatment. Notable characteristics of both therapy
rooms are their great height, absence of corona, andexcellent ventilation, all factors of the greatest import-ance if sickness after treatment is to be avoided. Acomplete X ray unit, with transformer and combinedcouch and screening stand, is provided in the emer-gency room. This transformer can be supplied eitherfrom the main motor generator or from a 3 k.w.rotary converter which, though situated in the base-ment, is controlled from the emergency room itself.This allows of the use of the equipment when themain generator is not running. Dental radiographyis also done in this room. The Victor dental set isused, with a dental chair with full movements.The dark rooms are also on this floor, and consist
of the radiographic dark room, a second one forprint and slide-making, and a large drying room.
Massage and Electrotherapeutic Department.The first floor is occupied by the electrotherapeutie
department.One large room is equipped as a gymnasium for remedial
exercises. Adjoining the gymnasium are the two largemale and female massage rooms. Massage couches are,
placed round the walls of the rooms, and above each couchis a wall type treatment board, fed from the 80 volt motorgenerator in the basement, from which both faradic andgalvanic currents can be obtained. At intervals aroundeach room are patresses with four non-interchangeableplug sockets, to each of which is led a different supply -,230 volts D.C. from the town mains ; 200 volts 50 cyclesfrom the motor generator ; 80 volts D.C. from the smallmotor generator; and 4 volts D.C. from accumulators.Each room also contains a Schnee bath.
There are, in addition, several small treatment rooms.Three diathermy machines are provided, and a high-frequencyapparatus. Three rooms are used for ultra-violet lighttherapy. Of these, two have carbon arcs, of which there aretwo in each room. The arcs take 30 amperes, and each pairis used in series on 230 volts D.C. The third room has twoatmospheric mercury-vapour lamps. A hot and cold showerbath is provided for patients.The radium department, also on this floor, has a
waiting room, and a treatment room. A special safe,with very heavy lead protection, is used for the storageof the radium. The treatment room is provided withwash-basin, electric steriliser, &c.
There is also a photographic studio, for clinicalphotography, with a dark room next door.
The building was designed and its constructionsupervised from the beginning by Dr. J. M. WoodburnMorison, medical officer in charge of the department,and Mr. T. W. Turnbull, A.M.I.Struct.E., Master ofWorks, Royal Infirmary, Edinburgh. All the electricwiring and plumbing was carried out by the per-manent staff of the infirmary. The entire X ray andelectrotherapeutic equipment was supplied andinstalled by Messrs. Watson and Sons (Electro-Medical), Ltd. The approximate cost of the buildingand its equipment was .652,000.
MEDICINE AND THE LAW
Death after Vaccination.ON Jan. 24th an inquest was held at Warrington
touching the death of J. H. Chetter, a fitter’s laboureremployed by Joseph Crosfield and Sons, Ltd., soapand chemical manufacturers. A few weeks earlierthere had been a local outbreak of small-pox. Two-cases having occurred at the company’s works, themanagement invited all employees to be vaccinated.While vaccination was optional, workmen who refusedto be vaccinated were informed that they would be-suspended from work for an indefinite period. The-deceased man, though reluctant to be vaccinated,agreed to take this precaution rather than be suspendedfrom his work. He was vaccinated on the 5th withfour injections in his left arm. He continued at workuntil the llth when, owing to the swollen conditionof his arm and the pain he was suffering, he was senthome during the morning. On the 13th he visitedhis panel doctor and obtained a sick note. Threedays later he visited the doctor again and was ordered
