A case of X-ray dermatitis

Excerpt from a case report written by Dr P. Clennell Fenwick (Christchurch Hospital) and published in NZMJ 1911 May;10(38):14–19.

The points of interest in this case may be briefly summarised:—

1. The extent of the wound.—The original wound required a dressing 11 inches square. At present date, 17 months after the injury, it measures 3½ by 2 inches. The point of greatest injury is that part of the skin which was directly opposite the anti-kathode, the rays here being of maximum intensity. This area has always been the deepest part of the ulcer, and will be the last to heal.
2. The intractable nature of the wound.—Time after time the ulcer appeared to be on the point of healing, and as often it "broke back" and returned to its original character. Hall Edwards mentions a case in which, after two exposures of 30 minutes each for renal skiagraphy, a patient developed an ulcer which has remained unhealed for eight years.
3. Nervous phenomena.—On several occasions I noted that the least exposure to air or touching the surface of the wound produced contractions of the recti abdominis muscles, of such violence that the patient was bent double. I have never before seen such violent muscular spasms. The general nervous system was undoubtedly affected. On more than one occasion the patient was delirious.
4. Treatment.—My treatment was strictly limited to the use of the high frequency effleuve. The first application of 15 minutes’ duration caused relief from pain, and patient slept well for the first time for months. After a very few applications, he gave up the use of cocaine, although he had been re-dressing the wound with this as often as 11 times a day and several times each night. After he had left me the pain returned, so that he had recourse to the cocaine once more, but while he was under treatment with the effleuve he always did without this drug. The second action which I can claim for the effleuve was that of increasing the blood supply to the diseased area. The margins of the wound became more congested, and red granulation points appeared all over the surface of the ulcer. It was by the junction of these granulations that the bridges of tissue were formed, and these have increased in size and gradually filled the cavity of the wound.

Without trespassing longer on your time, I would suggest that the publication of this case, which is only one among several that I have seen in New Zealand, should act as a caution to medical men who require a skiagraph of a patient. We can hardly avoid moral responsibility in the event of an accident to a patient unless we have previously warned a patient that a danger of dermatitis does exist, and unless we have taken precautions that no undue exposure to the rays shall be given.

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