Mihran Kassabian

Kassabian was born in Kayseri in the Cappadocia region of Asia Minor.[3] He had three brothers, all of whom became jewelers in Smyrna.[2] Kassabian attended the American Missionary Institute in Kayseri. He went to London to study theology and medicine with the initial goal of becoming a missionary.[3] In London, he also developed a personal interest in photography, but he became much more interested in medicine than he did in theology. He moved to the United States and entered the Medico-Chirurgical College of Philadelphia.[4]

By the time of the Spanish–American War, Kassabian was a naturalized U.S. citizen, and though he had nearly completed medical school, he took a hiatus from school in April 1898 to serve in the war. It was during the war that Kassabian first gained experience with the use of X-rays, which had been discovered only a short time earlier by Wilhelm Röntgen. Kassabian returned to Philadelphia when the war ended a few months later, graduating from medical school in December 1898.[4]

After graduating from medical school, Kassabian worked as an instructor at the Medico-Chirurgical College. The first clinical X-ray had been taken in 1896, and within a couple of years, radiology equipment began to appear in hospitals in the United States and Europe.[5] The problem was that, around the turn of the century, medical schools thought of the practitioners of skiagraphy (an early term for radiography) more as photographers than as medical professionals. In order to establish a legitimate medical school department that could devote attention to X-ray applications, Kassabian's work for the college included skiagraphy and the more established field of electrotherapeutics.[4] He set up his X-ray facilities in the college's old operating theater.[5]

In his first two years of X-ray work, Kassabian imaged more than 3,000 patients, and he produced about 800 static X-ray images.[5] In 1902, he resigned from the college and took over as director of the Roentgen Ray Laboratory at Philadelphia General Hospital.[6][7] Under Kassabian's predecessor, George E. Pfahler, the two-year-old X-ray laboratory at Philadelphia General had recently made the second-ever X-ray diagnosis of a brain tumor.[8]

Kassabian invented a positioning device for chest X-rays that showed the body's rotundity; previously, X-ray images had rendered the ribs as flat. Kassabian wrote a textbook, Electro-therapeutics and Roentgen Rays, which was widely employed in American medical schools.[9] He studied the feasibility of imaging infants' hearts with X-rays and a contrast agent, bismuth subnitrate. He reported on this work in 1907, but due to the difficulty of controlling contrast agents and the problems caused by the rapid beating of the infant heart, his procedure did not become a standard medical practice.[10]

As an expert witness in court, Kassabian worked to establish the value of X-rays in the American legal system.[3] He was chair of the medicolegal committee of the ARRS, and he believed that X-rays could elucidate medical findings for judges and juries. He hoped that the incidence of frivolous lawsuits could be decreased if X-rays were used to objectively characterize the nature of a potential plaintiff's injuries.[11]

Kassabian served as a delegate of the American Medical Association at international conferences, and he was a vice president of the American Roentgen Ray Society (ARRS).[3] Outside of medicine, Kassabian served on the search committee that appointed the first pastor of the Armenian Martyrs' Congregational Church.[12]

Kassabian's hands in 1909

Much of the early work of radiologists involved fluoroscopy, which allowed a body part to be examined through continuous X-ray exposure. Such work required Kassabian to be exposed to radiation for the duration of each patient's X-ray exam. While none of his patients were known to be injured by such exams, Kassabian received thousands of times more radiation than an individual patient.[13]

Kassabian's first published paper, "X-ray as an irritant" (1900), drew on two years of experience with radiography exams at the college as well as his experience in the Spanish-American War. In that paper, he mentioned some radiation-related tissue injuries to his hands.[4] The doctor had first noted reddened areas of skin on his hands earlier that year. Initially, he thought that the issue was related to the use of metol in X-ray film development, but the problem persisted even after he began to handle metol with rubber gloves.[4]

In 1902, Kassabian sustained a serious radiation burn to his hand. Six years later, necrosis had set in and two of the fingers on his left hand were amputated.[14] Kassabian kept a journal and took photographs of his hands as his tissue injuries progressed.[15] Kassabian was diagnosed with skin cancer, which was thought to be related to radiation exposure, in 1909.[14] He continued to work with vigor during his illness; he did not want his patients to know that he had been made ill by radiation exposure.[14] The cancer spread up Kassabian's arm.[13] His physicians, who included Philadelphia surgeon William Williams Keen, performed surgery.[9]

Even as the effects of radiation overexposure were becoming more apparent in Kassabian and other X-ray pioneers in the first few years of the 20th century, the field was slow to act to prevent those problems. Lead shields were available, but there were no standardized X-ray safety guidelines and most radiologists (including Kassabian) did not practice shielding; they felt that lead aprons were either impractical, unnecessary, or potentially distressing to patients. Kassabian even argued against the use of the word burns to describe radiation injuries, believing that such wording might alarm the public and stall the progress that was being made in radiology.[16]

In the spring of 1910, Kassabian had another cancer-related surgery, this time to remove muscle from his chest. On July 12, 1910, The New York Times reported that he was seriously ill. He had come to Jefferson Hospital about ten days earlier to have a dressing changed on his chest. During that visit, Kassabian collapsed and had to be admitted to a hospital room. Unnamed physicians at the hospital told the Times that Kassabian would not recover.[17] He died on July 14.[13]

Kassabian had married Virginia Giragosian of Constantinople about 18 months before his death.[2] Shortly before Kassabian died, the J. B. Lippincott Company announced that it would publish a second edition of his textbook.[13]

• Photograph of Kassabian imaging a patient, published in The Boston Globe, November 6, 1995. Via Newspapers.com.