152356
LIBRARY OF THE
LEGE OF PHYSICIANS
OF PHILADELPHIA
L— —
D)0(c
Vol. 9. No. I
X
July, 1901.
THE AMERICAN
X-RAY JOURNAL.
D)0(c
Cross
DR. HEBER ROBARTS,
EDITOR,
Chemical Building, ST/ OHUS, U.S. A.
ADVERTISEMENTS.
▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼
the Oncomc of Jige i
!
J The value of a stimulant in the enfeebled digestion of the aged has X
X been recognized from the earliest time. * X For those who decline to accept the aid of wine and who need some- X
X thing of a stimulant character to rouse the flagging powers of digestion, X
♦ ♦
I "Yellows' Syrup of lwpophospffltes" i
t Offers Special Advantages. |
♦ ♦
♦ In all conditions commonly seen in persons of Advancing Life, a tonic ♦
♦ like Fellows' Syrup is clearly indicated. ♦
X Dr. Milner F other gill 'wrote: "It (Fellows' Hypophosphites) is a good X
X all-round tonic, specially indicated where there is NERVOUS X
' ~ — i
♦
5
♦ ♦
EXHAUSTION.'
Medical letters may be addressed to
MR. FELLOW'S, 26 Christopher St., New York.
♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦<
. • ; •• ••
TIIK AKTrKAMttJA.TnijRMtcfAL COMPANY *-* JLOJ>tS - U. S. A.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X-RAY PUBLISHING COMPANY.
HEBER ROBARTS, M. D., M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE. United States, Canada and Mexico $3.00 | Foreign Countries $4.00
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 301 Chemical Bldg., St. Louis.
All business matter should be addressed to The American X-Ray Journal Publishing Co., same address.
All contributors of original articles and other matter relative to X-Radiance, of interest to the medical profession, are solicited from all parts of the world. Contributors will be furnished a liberal number oi extra copies of the Journal containing their articles.
Translation of articles written in Gsrman, French and Spanish is made by Frank Ring, M. D., 611 Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. b. ST. LOUIS, JULY, 1901. NO. 1.
CONTENTS VOL. 8, NO. 6.
CONTENTS VOL. 9, NO. 1
Skiagraphy in Oral and Dental Surgery. Shield for Prevention of X-Ray Burns. Improved X-Ray Tubes. Inaccuracies of the X-Ray So-called. The X-Ray in Quackery. Mississippi Valley Medical Association Seek and Ye Shall Find. Trigonometry in X-Ray Work. Forgeries in Art Proved by X-Rays. Bullet in Hip Joint. Becquerel Rays.
Committee on Scientific Research, R. S. Roentgen Society. [U. S.
Roentgen Society of the United States. Detecting and Excluding Renal and
Urethral Calculi. Good X-Ray Pictures. X Ray as an Analgesic.
Roentgen Society of the United States.
Skiagraph in Oral and Dental Surgery.
A Study of Static Electrical Apparatus- Articles 3, 4 and 5.
X-Rays in the Bladder.
Fissures and Fractures.
Rodent Ulcers.
Insects and the X-Rays.
New Process of Pelvimetry and Long Distance Radiography.
Roentgen Society of the United States.
Exact Localization.
X-Ray Therapeutics.
Roentgen Society.
First Becquerel Burn.
Investigation of X-Ray Problems.
A New Hospital.
Epithelioma.
X-Ray Burns in Paris.
Rudolf Virchow Fund.
SEP 29t9ft$essor Roentgen.
152356
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
VOL. 9. ST. LOUIS, JULY, 1901. NO. 1.
Roentgen Society of the United States.
Every member of the medical profes- sion having pride in himself and the advancement of diagnostic medicine should join the Roentgen Society. This is the only body in all this land that has taken the initiative. The society has like all other undertakings come up from necessity; to congeal into a com- mon whole the vast resources of the Roentgen discovery for the profession at large.
If you identify yourself by member- ship you are one of the great fraternity. You are then an integral part, limb and soul in sympathy with its work. If you are outside it is quite natural to become a critic and feel chilly towards the very means you need to employ. Inside we criticise for mutual advantage and weigh the logic of our course in the scales of justice. No one can safely deny the importance of this subject if he is a practitioner of medicine any more than he can lay aside the scalpel if he is a surgeon. See the vastness of the sub- ject. Has any discovery in any age ap- proached its revolutionizing tendency? The ease and certainty of diagnosis has advanced more in the past five years than any previous century. It is not every one that can avail themselves of these advantages in practice, but every doctor can avail himself of the knowl- edge of these facts. The Roentgen Society is making the effort, it is accom-
plishing what it intended to do from the first — unite the best element, the thinkers and unprejudiced minds of our profes- sion into the necessity of the best uses of the x-rays. So much has been writ- ten, of spurious import, upon this subject by well meaning men, yet ignorant of the facts, that society work is the only mill through which we can hope to shift the chaff. It is impossible to be educated through journal reading alone. Editors are not responsible for the points of the contributors and the writers differ in their judgment according to their indi- vidual happenings. The reader is at sea, he has neither anchor nor keel and therefore is led whither he goes. It is difficult to dislodge false teaching and therefore the prime virtue of true learn- ing. If you know the truth — the laws that govern a principle then discussion upon any of its attributes is intelligi- ble. If the writer assumes false premises it is at once detected and the mass is un- worthy of our time. It is for these and other reasons every fervent medical man should be with this society. Crystalize energy on permanency and on truth and thereby conserve forces for the just upbuilding of each and all. If you are with the society you get the truth, and truth is powerful and must prevail. One mind can not cull from the world of rot only that which is good for him. If you are with the society the strength of all is united in one. Seize now on to that which is known to be good so that we may, as professional men, be conscious of nearing the goal we seek.
93°
THE AMERICAN X-RAY JOURNAL.
Skiagraph in Oral and Dental Surgery.
BY WESTON A. PRICE, D.D.S., M. E.
elivered with Stereoptican Views before the Roentgen Society of the United States, Grand Central Palace, New York City, December 13, 1900. Continued from page 915.
Sometimes these abscesses produce very extensive destruction of tissue, as for example in this case (Fig. 8) where the lighter area shows the extent of the abscess in the bone around the lateral incisor. There is no necessity for ex- traction in these cases. Of course, the abscess must have drainage and have the irritant removed and then the treat- ment is very simple. This case had been drained through the root canal which, as you see, left the abscess more than half full of pus all the time. The most dependent point is that marked X. The abscess was perforated at this point and thoroughly sterilized and stimulated and the root filled at once. The cure was rapid and perfect.
The location of the irritant producing these abscesses is often very hard to locate, as in this case (Fig. 9) where the light area shows the extent of the ab- sorption of the bone caused by an abscess from diseased root. The abscess had its fistula beside the second bicuspid and was treated accordingly. The dentist in charge extracted the first bicuspid because it was tender to concussion, but finding it all right replaced it. This radiograph shows the trouble to come from absorption of the apex of the lateral and the case was treated accord- ingly by amputating the apex of the lateral root with excellent results. Of course, drainage was secured at the lowest point of the abscess. Nature soon fills in these large abscess cavities with new bone when the irritant is removed as you will see by a radio- graph of this same case three months later.
The next (Fig. 11) shows a lower jaw more than half cut off by an abscess.
(Fig. 12) shows absorption of the apex of the central incisor, causing a chronic abscess about it which had resisted treat- ment. Now that the cause is known the treatment is simple.
The next (Fig. 13 ) is very remarka- ble, since it is a case of an abscess with a fistula externally upon the face, and while the abscess is quite large as you see, its cause is not apparent. It is prob- ably a so-called pericemental abscess. The fistula leaves it at its superior point marked X. while its most dependent point is much lower marked A. A per- foration or artificial fistula will be es- tablished at this point A, when the patient gets ready, unless it heals by absorption. The flow of pus has ceased since the last skiagraph was taken.
I have spoken of the operation of root amputation without extraction where irritant is a diseased apex of an otherwise good root. This operation is not difficult and is almost always at- tended with a perfect cure. This slide, (Fig. 14) shows a typical case. This tooth has been abscessed for 13 years and resisted treatment. The skiagraph shows the trouble to come from an im- perfectly filled tooth. The apex was amputated at a point where the root- filling stopped, as seen by this same and the result was a perfect cure. Fig. 15 shows another case before and after root amputation The bone fills in around these amputated roots, making them very firm and serviceable. 2238 Euclid ave., Cleveland, O.
(See illustrations on next page.)
TO BE CONTINUED.
Roentgen Exhibition in Hamburg will take place during the meeting of the German "Naturforscher und Aerzte" from September 22 to 29.
Fatigued muscles give much denser shadows than when viewed or radio- graphed in rest.
THE AMERICAN X-RAY JOURNAL. 931
™ 14. FIG. 15.
THE AMERICAN X-RAY JOURNAL.
933
A Study of Static Electrical Apparatus.
BY JOHN TOWNSEND PITKIN, M. D. ARTICLE NO. 3.
The bete noir of the operator of a Holtz static machine, is the frequent loss of charge during the warmer months of the year, when the atmosphere con- tains a high degree of fractional satura- tion of moisture, which renders the air more conductive of the high tension electrical currents.
This variety of static machine has no power to bring itself into primary ac- tion. It, therefore, requires charging, priming or exciting by some secondary apparatus. Usually a small Toepler or Wimshurst static machine is employed for the purpose. (An entirely new and original method of overcoming loss of charge, invented by the writer, will be demonstrated to the members of The Roentgen Ray Society when they meet in Buffalo next September.)
Some makers inclose the charger in the same case with the Holtz machine, placing it at one end thereof, where, by the employment of switches or other devices, it may be connected to the machine proper, and thus operated until all portions of the apparatus are brought into full functional activity.
The objections to this arrangement are manifold. Inclosing the machine and its charger, as above described, requires that the case shall be unduly large, hence it takes up too much space in a crowded office. Unsightly, because the essential portion of the apparatus is in a symmetrical position. To adjust a brush or other portion of the charger, the entire machine must be opened and ex- posed to the damp air of the apartment. The operator cannot predetermine which side of the machine will be of a desired polarity. To dry the case by chemical or electrical means will require more time than would be consumed in drying
a charger inclosed in its individual case.
Inaccessibility precludes the employ- ment of a Ruhmkorff coil or other high potential transformer to excite the charger when that instrument, for un- known reasons, refuses to functionate. To excite a Holtz machine into primary action, proceed as follows: Test the charger to determine whether it is in working order. Operate the machine until all of its members are brought into full electrical activity. Connect the prime conductors of the charger to the corresponding structure of the machine, which is to be excited, using short pieces of wire or metallic chains for the pur- pose. Have the discharging rods of both machines wide open. Bring the two instruments into mechanical activity. Allow the charger considerable speed, while the Holtz machine is run slowly. Nearly close the discharging rods of the latter instrument until feeble sparks commence to pass between the terminals, then very slowly open the rods in such a manner as to maintain them at the maxi- mum sparking distance. The first feeble sparks are derived from the charger, while another portion of its current is passing through the inside of the Holtz machine to awaken its dormant struct- ures. When the discharge suddenly becomes louder, longer, fatter and brighter, the charger may be discon- nected, for the Holtz machine can then be operated independently. The polar- ity of the Holtz machine will correspond to that of the instrument with which it is excited, hence by observing the dis- charge at the collecting combs of the charger in a darkened apartment and making connections accordingly, a de- sired polarity may be obtained.
To insure electrical activity of the charger, it should be inclosed in a suit- able case and kept dry by chemical ab- sorbents or a small electrical heater. Perhaps the best electrical heater for a small machine is an eight or 16 candle-
934
THE AMERICAN X-RAY JOURNAL.
power incandescent lamp, firmly secured by a lamp socket to the bottom of the inside of the case; the terminals of the lamp may be connected to binding posts, which pass through the woodwork and serve for attachment of lead wires from the commercial electrical service.
A charger which refuses to operate may be coerced into action by connect- ing its field brushes to the secondary of a small Ruhmkorff sparking coil, the primary of which is excited by the direct commercial current passed through a bank of lamps placed in simple series.
When a Holtz machine has many plates and the inside of the case is damp, it requires for its excitation an apparatus which generates a current of consider- able volume. Under these circum- stances, either the exciter itself must be a large machine or a small machine operated at high speed, may discharge its current through a pair of Leyden jars, the condensers acting as static trans- former?. To rid the inside of the case of a Holtz machine of moisture, two methods may be adopted, i. e., chemical absorption and electrical heating. The base of the machine can be provided with drying chambers communicating with the inside of the case by trap-doors placed in its floor. Other small doors should open outwards to allow the oper- ator to replenish the chemicals and ad- just or repair the heating coils without opening the instrument proper and ex- posing it to the moist atmosphere of the apartment. In one of the chambers are placed large, shallow, flat trays con- taining commercial calcium chloride, which, by absorbing moisture, turns from a white, dry, lumpy material into a soft, sticky mass, or may even become deliquescent.
During the summer months, the chlor- ide should be freed from water by heat- ing it in flat, iron trays, preferably upon a gas range, every third or fourth day until it becomes anhydrous. Buffalo, N. v.
Fruita, Colorado, June 29, 1901. Dr. Heber Robarts.
Dear Sir: My design patent on sta- tionary plate was officially allowed on the 20th inst., and patent will be issued on July 9.
I enclose drawing of same. It is made in two parts and is separable along lines BB. The line B and B instead of being carried round in a semi-circle is carried out and makes projection at A which serves as a base of support and
the plate is steadied as usual at top B. Hole C is for hub of revolving plates. It has all the appearances and advantages of a circular plate and can be easily re- moved, as well as being cheaper than regular plate and not the danger of breaking. I have the plates on my 4-20 inch rubber plate machine, which runs from 1,000 to 2,000 per minute and it is doing work equal to the larger machines also on one machine with 8-27 inch re- volving plates and results are equal to the best for that size.
Will try and have some photos of the machine before long with description.
Yours truly,
J. M. G. Beard.
Pus is less translucent to the rays than serous fluids.
THE AMERICAN X-RAY JOURNAL.
935
A Study of Static Electrical Apparatus.
BY JOHN TOWN SEND PITKIN, M. D.
ARTICLE NO. 4.
The Charge and the Charger Continued.
A well-constructed Holtz machine can be operated during all portions of the year without a dryer to absorb or heater to expel the moisture, providing a charger of adequate generating capacity is employed to bring it into primary ac- tion its plates will yield their full quota of current, but the damp air will dissi- pate a portion of the energy, and in con- sequence of the low point of magnetic saturation of the atmosphere the con-
the charger, and making connections accordingly, a desired polarity may be given to the instrument that is to be excited.
When, as is usually the case, the mechanical propulsion of the static machine is effected by an electro-motor actuated by a direct commercial current, a rheostat for starting box and speed regulator is placed in a simple series.
The rheostat is essentially composed of resisting iron wire coils, varying lengths of which, by a selecting device, may be interposed in the circuit, causing a portion of the electrical energy to be dissipated in the form of heat. Other coils of similar composition are placed in a special chamber in the base of the
A sixteen revolving plj denser action of the machine and its electrical output will be minimized. If, on the other hand, the case is thoroughly dried, a few turns of a small charger will suffice for its excitation and the electrical output will be at a maximum.
A small charger may be used to bring a larger exciter into action whenever the latter is required, but fails to operate. The polarity of the Holtz machine will correspond to that of the instrument from which it obtains its charge. Hence, by observing in the darkened apartment the nature of the discharge on the collecting combs of
e, Holtz static machine, static machine, where they are employed for drying purposes. Would it not be advisable from an economical standpoint to combine the two devices, using the heat of the rheostat to dry the interior of the apparatus? This may be accom- plished in the following manner: Draw in your mind's eye two pictures of the face of a clock, one on the base and rear side of the static machine over the dry- ing apartment, the other on the inside of the chamber against the front board, the two imaginary clock dials facing in the same direction and in perfect aline- ment.
936
THE AMERICAN X-RAY JOURNAL.
Procure one bound of iron stove-pipe wire. Divide the wire into 12 pieces of equal length. Wind each of the wires over a large lead pencil, thus mak- ing as many coils. String the coils across the drying chamber, attaching their free ends to screw eyes, firmly se- cured in the woodwork at points corre- sponding to the numbers in the imaginary clock dial. Connect the alternating screw eyes at the front end of the cham- ber to their next neighbor, i. e., number one to number two, three to four, five to six, etc., not number two to three, or four to five, etc., by short pieces of wire. The twelve screw eyes at the rear end of the case must pass through the wood- work, each one terminating on the out- side in a small metallic button.
The chamber should be lined through- out with asbestos and all connections of wires made perfect to avoid the danger of setting fire to the apparatus. Pivot from the center of the circular row of buttons, on the rear of the machine, a small metallic arm long enough to over- lap the buttons, its outer end movable, provided with an insulated knob for a handle.
Through an intervening binding-post attach one of the lead wires from the electrical main to the fixed end of the arm. The other lead is to be made fast through another post to but'on number one. When the movable end of the se- lecting arm rests upon button number twelve, all of the resistance is in the cir- cuit. The resistance can be decreased by gradual gradations by moving the arm towards the smaller numbers. Thus reduced, the machine will gain in speed and vice versa.
All of the electrical energy not em- ployed to operate the motor will be con- verted into heat, which, no longer wasted, will be utilized to dry the in- terior of the apparatus.
In bringing the static machine into primary action, a very low rate of speed
is desired; at the same time the load for the motor is very slight, hence all of the resistance may be placed in series and all the coils of the rheostat used for heating purposes. The object in having so many coils in the rheostat is to attain any desired rate of speed for the revolv- tng discs or armature of our lightning generator. Buffalo, N. Y.
X-Rays in the Bladder.
This case has been recently reported to us: A man forty years of age had suffered five years with a disease of the bladder. Some of the eminent surgeons of the east had treated him and for the past four months had been in the great Jefferson Hospital of Philadelphia. Tu- berculous trouble of the prostate was one of the many diagnosis made and for which he was treated. Strange but true, neuresthenia was another diagno- sis. Finally a good doctor "fell upon himself" and employed the x-rays. A stone was located. Operation revealed an encysted calculus of the phosphatic variety the size of a hen's egg weighing four ounces. This case may be one, and we hope it will escape the search- ing lash of the law. We will defend to the uttermost our lame profession, but with neglect similar to this case what can we expect? Sooner or later when the x-ray is available the people will de- mand its use or punish us for neglect of duty. The x-ray is one of the imple- ments of the physician's armory and the law presumes negligence on our part, should we fail to use all the available means for making diagnosis.
Fissures and Fractures.
Dr. Beck teaches the advisability of beginning motion after 10 days, in fis- sure as well as in fracture of the radial head if the skiagraphic observation shows no tendency to displacement.
THE AMERICAN X-RAY JOURNAL.
937
A Study of Static Electrical Apparatus.
BY JOHN TOWNSEND PITKIN, M. D. ARTICLE NO 5.
The Neutralizing Circuit.
Forty-five degrees of a circle formed by the revolving plate of the static ma- chine, computed in the direction that they turn from the two sets of collecting combs which gather the current from the prime conductors, extending a va- reliable distance towards the axle, in the alternating interspaces of the revolving plates, firmly attached to metallic sup- ports are placed secondary sets of rods and combs. These rods and combs, a superior and inferior set, are of similar construction, perfect in alinement with each other and the fellows of the oppo- site side, their function is to relieve the revolving discs of the electro-magnetic energy not employed for useful pur- poses, i. e., maintain the excitation of the field plates and sustain the external circuit. This residue they take up and discharge into a metallic structure, by which the superior and inferior set of rods communicate, named from the function that it performs, the neutralizing rod. When a static machine is brought into primary action, this circuit offers little resistance to the electrical flow, hence it is the first to be excited. It facilitates excitation.
Once the machine is in action, as al- ready intimated, it constantly relieves the revolving discs of all surplus charge, thus they assist in keeping the two sides of the machine of opposite polarity. If resistance in the form of spark gaps, or a Crooke's tube is placed in the external circuit the amount of current in that circuit will be somewhat reduced while that of the neutralizing circuit will be proprotionately augmented.
As the potential of the neutralizing comb-holders d ffers from the comb-
holders of the prime conductor circuit of the same side, they must not be with- in sparking distance of each other. Owing to the tendency of other struct- ures to discharge onto the neutralizing rod it should be placed at the extreme rear of the case and inclosed through- out in half inch hard rubber tubing. The four sets of collecting rods and combs might be made adjustable, like the discharging rods, so that they could be slid in and out according to require- ments. In when the Crooke's tube is of low vacuum, the inside of the case dry and the machine ran at low speed. Out when the tube is hard, the case damp or the apparatus operated with considera- ble speed.
With adjustable rods and combs we would be able to obtain the maximum external, and the minimum internal cur- rent, and dispense with noisy, wasteful interruptions in the form of spark gaps, which in turn cause diffusion of the x-radiance and a blurring of the pictures. Spark-gaps are wasteful because the structures which are insulators for a steady flow become conductors when it is intermitted. The interrupted cur- rent is adisperser of the electro-magnet- ic energy.
The metallic supporters of the collect- ing rods require perfect insulation, con- tact with the wood-work of the case is inadmissable. Buffalo, N. Y.
Rodent Ulcers.
It is certainly impracticable to treat rodent ulcers with the knife either be- cause of scar tissue resulting or the al- most certainty of return of the disease. With the x-rays all these cases recover. Scar tissue does not form or disappear after raying.
The best picture of the heart is taken with the plate to the chest and the anode two inches to the left of the sixth dorsal vertebra 16 inches from the plate.
938
THE AMERICAN X-RAY JOURNAL.
Insects and the X-Rays.
A box was made half of wood, and half of sheet lead. In the wooden half a number of larvae of flies, bees, beetles and other insects was placed and the box was then put in the field of the x-rays.
The insect colony at once became greatly excited and after crawling to and fro, finally emigrated, to a worm, to the leaden half of the box, where the rays could not penetrate.
The experiment was repeated many times and always with the same result.
A similar experiment was tried with the blind larvae of a certain species of beetle. A number of them was placed in an open cigar box, which also con- tained a metal box with an opening. No sooner were the rays turned on than the insects showed signs of distress. Their uneasiness increased and in a lit- tle while they all sought refuge in the metal box.
As the larvae in the second experi- ment were entirely sightless, their per- ception of the rays must take place through the nerves of the skin.
Toledo, Ohio, June 22, 1901. Dr. Heher Rorarts, St. Louis, Mo.
Dear Sir: — I have a Queen 15 inch x- ray outfit which 1 wish to sell. This is one of their latest coils (built last Novem- ber). The only reason I have for sell- ing it is that I am going abroad for six months and wish to have a 25 inch spe- cial coil built for some experiments which I wish to carry out. Outfit consists of a 15 inch coil, 7 cells D. 7 chloride accu- mulator, 2 queen tubes, 2 General Elec- tric Company tubes, large Queen tube stand, 7x8 fluoroscope and x-ray cabi- net mounted on castors. This is 24^ inches square, holds battery and has drawer 8 inches deep large enough to hold 4 tubes, wires, etc. (Cabinet of quarter sawed oak and a handsome piece of furniture). This outfit cost
$400 and I will sell it complete for $300. If party does not want whole outfit will sell coil, battery and cabinet for $240. (list being $320.) I do not care to sell coil without battery but will sell battery separately, as I do not care to have same taken care of while I am away. This outfit is just like new and I will ship to any one you know to be responsible and if they do not find it to be as represented they need not take it. This is not a second-hand outfit to be sold at half price, but anyone wishing a first-class outfit of this kind can secure this and save some money.
Yours truly,
H. W. Dachtler.
Dr. Jose Gallegos of Retalhulen, Guatemala, C. A., has constructed a static machine which he claims to be many times greater in current power with same number of plates and diame- ter, than any static machine heretofore made. The secret of greater length of spark and fatness is due to his method of sector construction. The shape of sec- tors does not differ from those ordinarily made but he reverses the foldings of pa- per many times and between the layers of each is placed a layer of tin foil. It is thus the sectors are built up possibly one-eighth of an inch deep or more and the number of sheets of tin foil thus in- terposed seems to be the exciting cen- ters of greater output of current.
The intestines should be emptied be- fore radiographing for stone in the kidneys, gall stone, abdominal anurism, intestinal concretions, dilatation of the stomach, abscess, and for other search- ings in the abdomen and pelvis. It is often with diagnosis that life depends. Twenty-four hours should be consumed in cleansing the bowels.
A heart after pericarditis is large and the entire muscle cast a denser shadow than a heart healthy.
THE AMERICAN X-RAY JOURNAL.
939
New Process of Pelvimetry and Long Distance Radiography.
This is the title of an article in Scien- tific American Supplement, May n ult. The principle of the article is to show how we can sensibly cause parallel radia- tions imitating our own vision. The bulbs employed are bi-anodic and are placed at considerable distance from the object. A table is given by Dr. Var- nier of a dry pelvis, showing the differ- ence between the dimensions of the pelvis itself and the radiograph. The figures are estimated on shadows 80 to 90 feet distance, but it is alleged that in actual practice 16 feet would answer. If we had a tube that would give good views of an adult pelvis 16 feet away with 10 minutes exposure we would cer- tainly be approaching superior radi- ance— the goal we seek, the entire scheme is a conception and only worthy of mention.
Roentgen Society of the United States.
ANNOUNCEMENT OF COMMITTEE ON ARRANGEMENTS.
The Committee on Arrangements for the next meeting of the Roentgen Socie- ty of America have secured, through the courtesy of the Dean and Faculty of the University of Buffalo, the use of as much of its building as we may require. The location is central, the room ample and on the ground floor. The date of the meetings will be Sept. 10 and 11 at the University of Buffalo, Buffalo, N. Y.
The following rules and regulations in regard to exhibits have been adopted by the committee: Applications for space should be sent as early as possi- ble to R. C. Adams, Secretary, drawer No. 963, Buffalo, N. Y., with particu- lars as to character of exhibit and space needed.
Exhibits may be consigned to Louis
Staffeldt, care University of Buffalo, and all express and freight charges must be pre-paid. Owners of goods sent by freight who wish them transferred to place of meeting on arrival, must notify the secretary and send him the pre-paid bills of lading. The cartage will be at expense of owners.
Exhibits are wholly at risk of owrners, and should be unpacked and installed by them not later than Sept. 7.
Alternating current 104 volts, single phase, 60 cycles, and direct current no volts, will be available, also dark room for photographic purposes. All exhibits must be removed by Sept. 13.
Edgar B. Stevens, Chairman. Roger Cook Adams, Sec, Drawer 693. Dr. James W. Putnam, Dr. Elmer E. Starr, Dr. Rennick R. Ross,
Committee.
X-Ray Burn in Paris.
Dr. Bronardel and M. Ogier were employed as expert witnesses in a case of suit brought for alleged x-ray burns. The doctors testified that no one knows the conditions which give rise to burns in some people, and not in others, and that, consequently, the radiographer was not responsible. The court, how- ever, gave the full amount of the dam- ages claimed 5,000 francs. It said: "We find that the radiographer had acted im- prudently, more like a workman than a medical man, and that his apparatus was defective." The case was a woman whom the radiographer had treated for sciatica, exposing the parts in three sit- tings in three weeks 40, 45 and 75 min- utes each.
If there is no food in the stomach and the intestines are thoroughly cleansed they are at rest. It is then that the best pictures are had of the organs of the abdomen and pelvis.
Bismuth in solution or dry in capsuls can be traced along the alimentary track.
94o THE AMERICAN
Exact Localization.
Dr. Clarence A. Greenleaf, of Phila- delphia, has recently reported through the Philadelphia Medical Journal some obscure cases under the old method of diagnosis. In cerebral localization, the doctor writes: "We do not get the exact location nor does this method of diagnosis give data from which we can absolutely determine the necessity for an operation. It gives no evidence of size or the nature of the foreign matter." He relates a very interesting case re- ported to him by Dr. E. M. Moore, Jr., which, for its completeness and interest- ing character, is worthy of reproduction. But we must protest against the state- ment of inexact location. Nothing is easier than locating anything in the head that can be seen with the fluoroscope with mathematical accuracy. As to the size being distorted — well, this is not a bugbear, either. When the location is established it is no trick to determine the size. Our previous knowledge of shadows instinctively acquaint us with these facts:
"The patient, a male, 37 years of age, shot himself in the head with a 22 cali- ber bulldog revolver, in 1889. He fired three shots, holding the revolver at the right side of his head behind the ear. The patient states that he held the re- volver in the same position while firing the first two shots, but that when he fired the third he moved his head for- ward. He immediately became uncon- scious and was removed to St. Mary's Hospital and placed under the care of Dr. K. M. Moore, Jr. Examination at this time revealed one wound upon the right side of the head and a second one over the occipital protuberance. The first one penetrated the skull, while the second was a simple scalp wound. He remained unconscious for three weeks. He remained in the hospital for three months, although the external wounds
X-RAY JOURNAL.
were healed at the end of three weeks. At the time of his discharge from the hospital the patient had no symptoms except a paretic condition of the right leg and a left heminopia. In April of this year the patient consulted Dr. Moore again, hoping that something nrght be done to relieve him of his continued disability. A physical exami- nation made at this time showed the fol- lowing conditions: A depression upon the right side of the head about the size of a ten-cent piece 6.5 cm. posterior to the upper margin of the right ear and a linear scar about 1.5 cm. long just above the occipital protuberance. Neurologi- cal examination shows the gait of the right leg to be paretic, of the left leg normal. Station is good with eyes closed. There is no voluntary motion of the toes of the right foot. Flexion of foot, extension of leg and flexion of thigh are weakened. The muscles of the foot react to strong faradism. The grasp of the right hand is 50 pounds, of the left 48 pounds. The difference in the circumference between the right and left thigh is seven-eighths of an inch, while the circumference of the right and left calf are equal. The right kneejerk is exaggerated, while the plantar reflex is normal, but produces no movement of the toes. There is a slight ankle-clonus upon the right side. There is no dis- turbance of the sense of touch; the sense of taste is diminished, principally upon the right side of the tongue, which is protruded slightly to the right, al- though movement to both sides is pos- sible. The sense of small is somewhat diminished in both nostrils; the hearing is good in both ears. There is no dis- turbance of the sense of pain. Aphasia, word-blindness and word-deafness are absent and the memory and general in- telligence are good. Ophthalmological examination reveals a lateral heminopia of the left side. Ophthalmoscopic ex- amination is negative.
THE AMERICAN X-RAY JOURNAL.
94 1
"X-ray Examination — A lateral view shows a distinct shadow denoting the presence of a bullet in the brain. This shadow is 4. 5 cm. from the upper surface of the skull and is 6 cm. from its pos- terior wall. There is also a fainter, ir- regular shadow which probably indicates an organized blood-clot, about 2.5 cm. in diameter, situated 0.5 cm. posterior to the bullet. A distorted shadow is seen in the lower posterior part of the head.
"This case presents a few points of special interest: 1. The question of the brain areas involved in the injury as shown by the symptoms and the result of the. neurological and opthalmological examinations. 2. The value of the x-ray in determining not only the presence of the foreign bodies, but also their loca- tion. 3. The value of the x-ray in de- termining the feasibility or advisability of operative interference. In this case it is apparent that an operation for the removal of the foreign bodies is out of the question. It is a remarkable fact that during all these years the symptoms have remained practically stationary, and this fact is also an argument against operative interference, even if it were possible, as the result would be ex- tremely doubtful. Another question to be considered is whether one or two bullets entered the brain, and whether, if one only entered, it divided as it passed through the bones, as in a case reported by Tuffier (La Presse Medi- cate, December 20, 1899). The patient states that he fired two shots, with his head and the revolver in the same rela- tive positions. There was only one wound of entrance and this would seem to confirm the above statement. The radiographs, also, show one complete circular shadow and another flattened or crescent-shaped in an entirely different plane, from which we may conclude that there are two distinct bullets."
X-Ray Therapeutics.
Margaret M. Sharpe, L. R. C. P., re- cently read an article on the above sub- ject before the Roentgen Society, Lon- don, full report of which is given in the "Archives" for May. Miss Sharpe re- tracts from her original belief that der- matitis is the result of the x-rays. She now inclines to the belief that this is due to violet rays such as we get from the sun or from arc lamps which are still richer in the production of violet rays. She found burns to be much more frequent when the tubes were new and soft and where the pencil of violet streamed across from one pole to the other. It is either these rays or the electric current that does the damage. She has noticed irrita- tion in the skin to be greatest under the edges of metal masks where the electric current seems to accumulate. In a case of a woman with an exuberant growth at the end of the nose she used the electric high frequency spark upon one side and the x-rays upon the other. It was noticeable that the side treated with the spark the shrinkage was more rapid than where the raying was done. Miss Sharpe contends that injury to the tis- sues by raying is not only no help in the treatment of diseases and hair removal, but actually a hindrance. The only case in which she failed to permanently re- move the hairs was the one in which dermatitis resulted. The use of the mask and impervious screens are not necessary except to protect the eyebrows and lashes. The electric discharge from the tube claimed by many, both home and abroad, she formerly treated with scorn but is now inclined to accept.
The paper elicits inquiry in the scien- tific aspect of the subject. Discussion on the paper was followed by Mr. Mau- sell — Moullin, Mr. Wilson Noble, Dr. Batten, Mr. Starten, Dr. Mills, Dr. Chisholm Williams, Dr. Sequeira, Mr. Payne and others.
942
THE AMERICAN X-RAY JOURNAL.
Roentgen Society.
The following notice, made by Pro- fessor Monell, Chairman of Committee on Standards, appeals to all persons whomsoever that have any knowledge on this subject; and commends itself espe- cially to medical men having interest in the attainment of more knowledge. Write to Dr. Monell and give expression on one or more of these subjects.
COMMITTEE ON STANDARDS. Dear Sir:
To promote uniformity in results and to secure accuracy and give legal value to the evidence of x-rays, it is necessary to standardize methods of doing the work. To this common benefit all x-ray experts are asked to contribute for the general good of the cause. You are therefore in- vited to write me your best suggestions on such of the following points as you can offer advice upon: A standard uniform nomenclature for the prin- cipal terms required. A standard form of record-blank for briefly filing reports aud indicating all essential details of the exposure. Standard of efficiency for tubes. Qualities which a standard x-ray photographic
plate should possess. Qualities which a standard x-ray fluoroscope
screen should possess. Standard handle for all x-ray tubes so they will
fit a standard tube-holder. Standard tube-holder to fit uniform standard tube-handle — adjustable, rigid, holding tube without vibration — and convenient for gen- eral use.
Standard position of tube for correct shadow.
Standard distance of anode from plate for stand- ard x-ray exposures.
Standard exposure times for chief parts of the body with a standard radiance.
Standard measure of different degrees of x-radiance.
Standard "skiameter."
Standard x-ray examination table, adjustable for all parts of the body.
Standard method of posturing each part of the body for a standard picture.
Standard means of fixing parts immovably dur- ing a standard exposure.
Standard complete definition of what a "stand- ard exposure" should be. (Of medico-legal value. )
Standard land-marks to be pictured in the nega- tive as inherent proof that a standard exposure *vas made — (a medico-legal necessity).
Standard method of localization for both "skia- graphy" and "fluoroscopy," which shall be the most practical, quick and uncomplicated.
Standard technique for picturing correct relation of bones and joints.
Standard technique for picturing details of any kind sought.
Standard technique for picturing contrast for
diagnosis of soft parts. Standard technique for picturing the different
calculi, vesical, renal and gall-stones. Standard technique for x-ray dental diagnosis. Standard technique for x-ray eye work. Standard technique for x-ray heart and lung
diagnosis.
Standard treatment of plates to develop uniform results.
A standard leaflet of brief directions which the physician who does not do his own developing can send with his plates to any fair photogra- pher as a ready guide to proper treatment of an x-ray negative to secure the picture. Standard technique for therapeutic administration of x-rays with proper precautions. You are invited to supply any omitted detail which you believe should be standardized. Will be pleased also to have you select one or more features of the above list in which you have had special experience and make a careful report upon what you regard as the proper standard to officially adopt. A reply is desired in about two weeks. In offering suggestions about standard working methods, postures, special devices, appa- ratus, etc., it is desirable that you send explana- tory camera-photographs illustrating the details for comparison. Thanking you for your profes- sional co-operation in behalf of the committee, I remain, Fraternally yours,
S. H. Monell, M. D., CJiairman of Committee on Standards . 47 West Twenty-seventh street, New York City.
First Becquerel Burn.
Mr. Henri Becquerel started on a journey with a price of radium in his pocket. The radiation which bears his name attacked the skin through the card- board in which the metal was placed and the cloth. It was about two weeks after that the burn marks appeared. These burns were also found to heal obstin- ately like x-ray dermatitis.
A heart beating rapidly will give a better picture that the same heart beat- ing slowly.
THE AMERICAN X-RAY JOURNAL.
943
Investigation of X-Ray Problems. tion and the intensity of the Roentgen
Lisbon, June 26, 1901. Dr. Heber Robarts:
Might I beg you kindly to put before the American Congress of Radiology (The Roentgen Society of the United States), the undermentioned list of problems, whose study is at present interesting me, but which I should also like to submit to the inspection and in- vestigation of the renowned radiologists of your country.
Some of these problems have already been propounded and have undergone a certain amount of investigation, but, as yet, are not thoroughly solved:
1st. How, in a Crooke's tube at a cer- tain degree of gaseous rarefaction to measure the influence exerts upon the quality of the x-rays (penetration and in- tensity*) conforming to a previously fixed standard by the following circumstances:
(a) The distance separating the kathode from the antikathode.
(&) The size of the kathode and antikathode.
(V) Their shape.
(J) The length of the spark measur- ing the discharge within the tube.
(/) The thickness of this spark.
(/) The number of interruptions in the primary circuit (or inductor;, or the number of electric discharges within the tube at one and the same time.
(g) The relation between the length (or duration) of the closing (making) and that of the opening of the primary circuit.
(h) The total capacity of the tube in cubic centimetres in relation to the dis- tance of the electrodes in line of cen- timetres.
2d. How, in a Crooke's tube, to esti- mate the effect produced by the degree of gaseous rarefaction upon the pehetra-
*Measured by their effect upon th^ fluorescent screen, platino cyanide of bp.ryum or upon sen sitized photographic surfaces.
rays t
3d. How, in a Crooke's tube, no matter the degree of rarefaction therein attained, to reduce to a single point the focus of emission of the x-rays placed at the antikathode, in order to attain the best definition?
4th. How to reduce the number of electric discharges within the Crooke's tube to the minimum necessary to give the steadiness and brilliancy in the skia- scopic screen?
In any case enough time must be given to the closed period of the primary cir- cuit for the thorough magnetic saturation of the core, or in other words, to satur- ate the electric capacity of the coil.
5th. How to construct a durable coil and one which would give the greatest produce, i. e. , with a weak primary cur- rent to give a long and a thick spark?
6th. How to establish the standard of the strength of the penetration of the x-rays and its dependence on the quali- ties of the electrical discharge which produces them?
7th. How to establish the standard of intensity of the x-rays?
8th. How to determine the influence of the time exposure on the intensity of the skiogrammes in relation to the in- tensity of the utilized rays?
9th. How to create methods which allow of the regulation of the penetra- tion of the x-rays without considerable interfering with their intensity?
10th. How to create methods allow- ing of regulation of intensity independ- ent of their penetration?
nth. How to determine the absorb- ing power of the bodies for the x-rays, according to the qualities (penetration and intensity) of these rays? . .With the best compliments, r ; * ' Your faithful
0 » » ' • a 9
,%« ! . VlRGILIO MACHADO.
Subscribe for Th,e» American X-Ray Tournal— $3.00 a year.
944
THE AMERICAN X-RAY JOURNAL.
A New Hospital.
We are glad to be able to present the following to the many readers of The American X-Ray Journal. Dr. Lan- phear very early recognized the diagnos- tic value of the x-rays and has persist- ently, with the greatest profit, used the x-ra} s in his practice. His letter speaks for itself:
July ii, 1901.
Dear Doctor:
Having bought a home in Temple Place, I have fitted up my former residence and offices, at 3727 Finney avenue, as temporary quarters for the Woman's Hospital of the Stare of Missouri. I am, therefore, now in position to take care of those unfortunate, respectable women and girls who have not the money to pay the high prices of the other hospitals and sanatoria of the city, who yet require surgical treatment. There are also rooms for a limited number of patients who can afford to pay higher rates for care and special nursing.
The hospital will be in charge of Miss C. E. Jackson, a graduate of one of the best training schools in this country and formerly head nurse of the Woman's Hospital at Sixteenth and Pine streets.
Hoping for at least a word of encouragement for the institution, I am,
Sincerely yours,
Emory Lanphear.
A Laboratory for Poison.
It's a wonderful laboratory, this hu- man body. But it can't prevent the formation of deadly poisons within its very being.
Indeed, the alimentary tract may be regarded as one great laboratory for the manufacture of dangerous substances. "Biliousness" is a forcible illustration of the formation and absorption of poisons, due largely to an excessive proteid diet. The nervous symptoms of the dyspeptic are often but the phys- iological demonstrations of putrefactive alkaloids. Appreciating the importance of the command, "Keep the :ho>.VQfcs open," the physician will .f? nd . in ' *; » Laxa- tive Antikamnia and (Quinine Tablets" -a; convenient and reliable! aid to nature in;
her efforts to remove poisonous sub- stances from the body. Attention is particularly called to the thera- peutics of this tablet. One of its in- gredients acts especially by increasing intestinal secretion, another by increas- ing the flow of bile, another by stimu- lating peristaltic action, and still another by its special power to unload the colon.
Epithelioma.
Johnson & Merrill has recently re- ported several cases of epithelioma apparently cured by means of the x-rays. Pain in all the cases was re- lieved at the beginning of the treatment, the discharge diminished and offensive discharge ceased.
Professor Roentgen.
On the recommendation of the Na- tional Academy of Science the Bernard Medal was awarded to Professor Wil- helm Conrad Roentgen at the "Com- mencement" of Columbia University.
Purchasing Goods.
Prospective purchasers of the x-ray machines should consult the advertising pages of the The American X-Ray Jour- nal. The best manufacturing houses naturally seek the purest means to pre- sent their goods.
Phosphatic concretions are more trans- lucent than urates and oxalates.
Iodoform injected into cavities shows remarkably distinct on plate and screen.
The differential diagnosis between congenital luxation and coxa vara is pre- sented in an interesting manner by the x-rays.
, : *rA muscular person accustomed to labor.and free from fat will give detail in radiography not possible to obtain in a iat subject.
ADVERTISEMENTS.
Ill
Summer Diarrhoea.
In the large class of summer diarrhoeas of children and adults, with griping in the bowels and flatulence, the use of Listerine, in doses varying from ten drops to a teaspoonful (with or without water), has a most salutary and pleasing effect.
It can be administered at short inter- vals after eating as soon as regurgita- tion, distension or acidity occurs. Its action in arresting excessive fermenta- tion is prompt, besides it exercises a decided sedative influence on the mucous membranes of the stomach.
The thymol, menthol and boracic acid which, with the quota of alcohol neces- sary to their proper admixture, form the principal elements of Listerine, lend to
this compound a special value in this class of cases. — New York Medical Journal.
Every Man Should Travel
As extensively as his circumstances will permit, The educational advantages secured by visiting the different parts of the United States, are likely to be of the greatest service to any phy- sician. A doctor with a comprehensive knowl- edge of the affairs of the country at large has an immense advantage over his less fortunate fellow practitioners.
Not every one has the means to travel for travel's sake alone, but any bright young man of fair address and average ability has within him- self a means to not only secure the educational benefits of a trip about the country, but to make such an excursion profitable as well, through the sale of medical publications.
For further particulars, address
F. A. Davis Company,
Medical Publishers, Philadelphia, Pa.
The Kinraide High-Frequency Coil.
The best ^BBhga^M Q
apparatus for use with the direct or alternating cut1 rent.
••••••••••••
SEND FOR DESCRIPTIVE CIRCULAR.
ED. B. Meyrowitz,
Maker of Ophthalmological Apparatus, Complete Standard Electro-Therapeutic Equipments,
X-Ray Apparatus and High Grade Eye, Ear, Nose and Throat Instruments. 104 East Twenty-third Street, ) 604 Nicollet Avenue, Minneapolis.
125 West Forty-second Street, [-NEW YORK, 360 St. Peter Street, St. Paul.
650 Madison Avenue, ) 3 rue Scribe, Paris, France.
The National College of Electro-Therapeutics
The oldest College in the United States devoted exclusively to Electro-Therapeutics. Ten instructors. A thorough practical COURSE of INSTRUCTION by MAIL to those who can not come here. Diplomas granted when competent. Degree conferred. Write for 6th Annual Announcement, and free sample copy of "The Electro-Therapeutist." Address
Nos. 2, 10 Collins Block, Lima, 0. H. L. BENNETT, M , D., M. E., Secretary.
IV
ADVERTISEMENTS.
Our Offer Upset one of our Competitors Completely.
They say no one can afford to ^ive you a dollar for fifty cents. They also say when you are offered a Static Machine for $150, it should set you to thinking. We think the same thing. The physicians have certainly been gulled for years by paying double what they should. Get a special report on us from any commercial agency, or have your bank get it, and you will find we are able to carry out any contract we make. No machine is superior to ours. No concern in the United States turns out the amount and variety of goods that we do.
Send for our Bargain Bulletin of 4,000 Articles sold DIRECT to Physicians at Wholesale Prices.
We have no agencies.
Frank S. Betz & Co.,
37, 39, 41 Randolph Street,
CHICAGO, ILL.
ST. LOUIS
X-Ray Laboratory.
Approved by the leading Surgeons and Physicians in St. Louis.
Laboratory Open 8 a.m. till 9 p.m.
MAIN 2954 A.
M. E. PARBERRY, Manager, 300 Chemical Building,
Eighth and Olive Streets, St. Louis, iMo.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY" THE AMERICAN X-RAY PUBLISHING COMPANY.
HEBER ROBARTS, M. D., M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE. United States, Canada and Mexico $3.00 | Foreign Countries $4.00
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 301 Chemical Bldg., St. Louis.
All business matter should be addressed to The American X-Ray Journal Publishing Co., same address.
All contributors of original articles and other matter relative to X-Radiance, of interest to the medical profession, are solicited from all parts of the world. Contributors will be furnished a liberal number of extra copies of the Journal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611 Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. 9. ST. LOUIS, AUGUST, 1901. NO. 2.
CONTENTS VOL. 9, NO. 1. H. Westbury.
Roentgen Society of the United States.
Skiagraph in Oral and Dental Surgery.
A Study of Static Electrical Apparatus- Articles 3, 4 and 5.
X-Rays in the Bladder.
Fissures and Fractures.
Rodent Ulcers.
Insects and the X-Rays.
New Process of Pelvimetry and Long Distance Radiography.
Roentgen Society of the United States.
Exact Localization.
X-Ray Therapeutics.
Roentgen Society.
First Becquerel Burn.
Investigation of X-Ray Problems.
A New Hospital.
Epithelioma.
X-Ray Burns in Paris.
Professor Roentgen.
CONTENTS OF VOL. 9, NO. 2. Dr. A. C Bernays.
Skiagraph in Oral and Dental Surgery. Constitution Roentgen Society. How to Find Fissure of Rolando. Radiographs — anatomical. Subsequent Outcome of Fractures. The Ostrich Man and the X-Rays. Roentgen Society. Investigation of X-Ray Problems. Roentgen Society of the United States. Book Reviews.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X Ray Work and Allied Arts and Sciences.
VOL. 9. ST. LOUIS, AUGUST, 1901. NO.
Skiagraph in Oral and Dental Surgery.
BY WESTON A. PRICE, D D. S , M . E.
Delivered with Stereoptican Views before the Roentgen Society of the Uni:ed States, Grand Central Palace, New York City, December 13, 1900. Continued from page 930.
This skiagraph (Fig. 16) shows a case of root amputation (which was made for a lady about sixty years old) more than three years after the operation and shows the bone filled in around stub perfectly.
I question if any operation upon the human body requires more mechanical skill than the perfect filling of some root canals, because they are often so small and crooked. Sometimes they can be drilled out larger, but this opera- tion is attended with great danger of going through the sides of the root as this case shows (Fig. 17).
Sometimes it happens that an instru- ment breaks and in trying to get it out it is forced through the end as shown in this case (Fig. 19) where you will ob- serve it has caused absorption of the apex of the root. Notice the imperfect root filling in the other bicuspid.
One of the most difficult operations is to make an artificial fistula to drain a small blind abscess at the apex of a root. The skiagraph is of great assistance, not only in locating the abscess, but also in showing whether you have struck it. This is shown by placing a lead wire in the fistula and skiagraphing. In this
2.
slide (Fig. 20) the lead wire in the pic- ture marked 367 shows that the first at- tempt failed. The other shows that a second attempt was successful.
In orthodontia, which is the correct- ing of the positions of the teeth or cor- recting of the features by changing the positions of the teeth, the Roentgen Rays are of great value to determine the positions of the roots. For example, it is desirable to move all the upper anterior teeth and the bone around them forward to correct a depression of the upper lip. The difficulty is to carry the roots en masse and not to simply push the crowns apart. This case (Fig. 21*) shows the position of the roots at start- ing, and the view to the right shows the roots successfully carried apart without tipping the teeth.
You doubtless all know of the difficul- ties and complications attending the erupting of the third molars or wisdom teeth so called. This skiagraph (Fig. 22*) shows the position of a typical em- pacted one, which was entirely hidden in the flesh and bone, not having erupted yet and producing very serious trouble. You will see the mechanical difficulty of contracting it, since it is engaged or locked against the second molar. The dentist sending the case after seeing the skiagraph operated by extracting the second molar first and then the third and then replacing the second molar after removing its pulp and filling its roots. Result excellent.
The next (Fig. 23*) shows a case with an external fistula on the ramis of the
948
THE AMERICAN X-RAY JOURNAL.
jaw, diagnosed by different surgeons as coming from an empacted third molar and was operated on accordingly for its removal, but unsuccessfully. The skia- graph was then secured, which shows not only that the third molar has never formed but an abscess at the root of the second molar, which has a putrescent pulp and which proves to be the cause of the whole trouble.
There is no difficulty whatever in locating unerupted teeth by means of rays. For example, this patient, a lady over thirty, presented without either permanent cuspids, and the bonyprocess was receded, making it seem quite prob- able that they had never formed, but they are both clearly shown in (Fig. 24*), just beneath the surface, and will be speedily regulated to their proper positions.
(Fig. 25) is a similar case. Patient, age 17, and shows the case before and after regulating.
(Fig. 26) shows a delayed bicuspid. The distal root of the deciduous molar has not been absorbed.
I Fig. 27*) shows a bicuspid erupting towards the roof of the mouth.
(Fig. 28*) shows that but one bicuspid has formed where two should, and it is very badly malposed, having developed back against the molar and locked against it. The treatment was, after waiting three months and skiagraphing and find- ing nature was making no improvement, to extract the temporary molar and with a regulating appliance separate the molar and the cuspid, the latter having pre- maturely erupted. The next slide (Fig. 29), shows how much it has rotated and corrected its position in 60 days.
(Fig. 30) shows the teeth of a baby at 14 months, before any of the temporary t< eth had erupted, and the same at 28 months. It not only shows the tempor- ary set but also the centrals forming of the permanent set. The point of great interest is, that though this boy's father
has not his permanent laterals, we know he will have them, for they are already forming.
Very unfortunately these lantern slides do not show the excellent detail of either the negatives or prints made from them. To illustrate this I have brought a variety of mounted prints that you may compare them. You may have observed how much more faithfully the teeth are por- trayed in these than in skiagraphs taken of the whole head, in which case they are duplicated and blurred by the shadows of the teeth of both sides or the arch falling together. The detail necessary to bring out an abscess, for example, could not be secured in that way. Owing to the limited time, I can not go into the technique of making skiagraphs of these dental conditions of the teeth and adjacent parts, and the best I can do under the circumstances is to refer those desiring this information to my communication before the Third In- ternational Dental College held in Paris,. 1900, or to a book on "The Application of Electricity in Dentistry," by the speaker, which is nearly ready for the publishers. I will be glad to answer any questions any one may desire to ask.
* Electros delayed. 2238 Euclid ave., Cleveland, O.
Leonard calls attention to the fact that many permanent injuries supposed to have been the result of traumatism or sprain are now known to have been fractures. All such accidents in diag- nosis can now be avoided.
An oblique fracture might be in per- fect apposition and the raying done at right angle to the brake which would hardly distinguish the injury. Shifting the position 90 degrees would show the fragments.
A case of carcinoma of the breast, too far advanced for surgical interference, which yielded to the x-rays, was recently reported by Andrew Clark, of London.
THE AMERICAN X-RA Y JOURNAL.
95i
Constitution, Roentgen Society.
At the annual meeting of the Roent- gen Society in New York City, Dec. 14, 1900, a committee was voted to be ap- pointed by the President, to revise the Constitution. Herewith is the result of their careful deliberation. The report will be acted upon at the regular meet- ing in Buffalo, Sept. 10 and n.
CONSTITUTION. ARTICLE I.
Name. — This Society shall be known as the American Roentgen Society.
ARTICLE II.
Object. — The object of the Society shall be the study and practical application of the Roentgen Ravs. x •
ARTICLE III.
Sec. 1. — Its members shall consist of active, corresponding and honorary. They shall be per- sons interested in the object of the Society, and commended by at least two members in writing, approved by the Executive Committee, who must have proof of their good ethical standing and elected by ballot.
Sec. 2. — Active members shall be residents of the United States or Canada, shall sign the Con- stitution and pay annual dues of five dollars ($5).
Sec. 3. — No member shall vote or hold office who is in arrears for annual dues. Any member in arrears for more than two years and duly no- tified by trie Treasurer, shall forfeit his mem- bership.
Sec. 4. — Corresponding members shall be res- idents of foreign countries.
Sec. 5. — Honorary members shall be persons who have distinguished themselves in Roentgen Ray research or practical work.
Sec. 6. — Corresponding and honorary members shall have all the privileges of active members, exceptiog voting and holding office.
ARTICLE IV.
Officers. — The officers shall be a President, First and Second Vice-Presidents, Secretary. Treasurer and Executive Committee of three. The officers shall be elected annually by ballot. ARTICLE V.
Duties of Officers;
Sec. 1— The President shall perform all the duties pertaining to that office. He shall deliver an address at the opening of the annual meeting.
Sec. 2. — In the absence of the President one of the Vice-Presidents shall preside.
Sec. 3. — The Secretary shall keep or cause to
be kept a correct record of all the transactions of the Society in a permanent form. He shall send due notice of all meetings to each member, shall notify all members of committees of their ap- pointment and of the duties assigned to them. He shall conduct the correspondence and perform all the duties usually pertaining to that office.
Sec 4. — The Treasurer shall receive and be accountable for all money that shall come into his hands by virtue of his office. He shall give good and sufficient bonds to the Executive Com- mittee for the safe keeping and disposal of his trust, and shall make a full report to the Society annually- He shall pay out money only on the written approval of the President and the Chair- man of the Executive Committee.
Sec. 5. — An Executive Committee of three members shall be elected as follows: One for three years, one for two years and one for one year, and thereafter, one annually, to serve for three years. They shall hold the bond of the Treasurer and audit his accounts annually, ar- range for annual meetings and have general su- pervision of the affairs of the Society not other- wise provided for.
ARTICLE VI.
Meetings. — The annual meetings shall be held on the Wednesday following the second Tuesday of December of each year.
ARTICLE VII.
Committees.
Sec. 1. — A Committee on Publication, consist- ing of five members, of which the President and Secretary shall be members, s-hall be appointed annually by the President.
Sec 2. — ( Special Committees V ARTICLE VIII. Amendments. — This Constitution may be amended by a three-fourth? vote of all the mem- bers present at an annual meeting, providing that the proposed amendment has been read be- fore the Society at least one day previously and the hour for action by the Society has been set by the Society as a special order of business, and announced in the open meetings for at least one day previous to the time of action. Committee on Constitution:
Weston A. Price. Dwight M. Clapp. A. Clifford Mercer.
Ammetropic eyes ill defines images at their marginal outlines and the x-rays imprint pictures at the margin with less contrast than photographs.
A womb menstruating is less trans- lucent to the x-rays than when quiescent.
952
THE AMERICAN X-RAY JOURNAL.
How to Find Fissure of Rolando.
J. RUDIS-JICINSKY, A. M., M D. , M. E.
In cases of head injuries, whether we have to operate or trephine, we always have to find first the fissure of Rolando, and then may proceed. As far as yet we have assumed, as shown by Thane, that the fissure of Rolando runs downward and forward at an angle of 67 degrees with the middle line. But we know also that the angle varies with shape of the head, that is to say with the cranial index, the lower the angle, the lower is the index; the greater the cranial index, the greater the angle. Horsley assumes a standard for the cranial index of 75, as estab- lished by Broca; for the fissure of Ro- lando of 69, instead of 67, and for every two integers of variation in the cranial index he assumes one degree of vari- ation in the angle of the Rolandic fis- sure. This variation we have nearly in every case, but the variation would not be so great if we could study the ana- tomical relations, having the sutures and the Meningeal grooves as a guide. This, having in mind, I have made few experiments lately, to show that by proper technique we are able to skia- graph the cranium more successfully, and see all the sutures and Meningeal grooves, especially on that side of the head which rests against the photo- graphic plate. Now, if we can see these grooves and sutures in every case different, varying with the shape of the head, we can make up the angle of the fissure of Rolando much more easier, remembering the relation it has to the sutures and Meningeal arteries. The measurements were guesswork any- way, but to study each given case ana- tomically, and according to the relations of positive landmarks we can not only guess, but we may find what we are after and see.
In such cases the application of the x-rays has its value. If we wish, the negative will give us the internal struct- ures of the bones of the cranium wTith wonderful depth and perspective, will show us plainly all the sutures and grooves of the Meningeal arteries, and we may have a picture of the substance, not only the shadow, of which still so many surgeons are afraid. To get such a picture well defined and sharp we have to use tungstate of calcium screen over the photographic plate, the tung- state being right against the film of the dry plate. The plate has to rest on some metallic support, as stanniol, etc. This way we wTill get shadows which are both shadow and substance, which, if we understand them and intelligently interpret them, will always bring us to the correct and most natural landmarks for the fissure of Rolando, and many times to proper diagnosis, especially in cases of bloodclots, etc. If you use fissure meter or any other device the skiagraph will give you a permanent record, and shows not only the instru- ment in place with the angle found- metallic instrument — but gives you the opportunity to study the possibility of deviation. If the cranial index is 77. instead of 75, the angle for the fissure would be 70 instead of 69, as we expect, but the sutures and the grooves of the Meningeal arteries might tell us an alto- gether different story, and will warn us in time, without any marks with the blue pencil, etc , on the shaved head that we have to trephine at some other point, at altogether different angle. The metallic cyrtometers, being pro- vided with means for rotating the arm representing the fissure of Rolando may give proximate position of the fis- sure, but the natural landmarks given above may help us in some cases little better.
The difference, if we use the tungstate of calcium screen over our dry plate,
THE AMERICA X X-RA Y JOURXAL. 953
THE AMERICAN X-RAY JOURNAL.
955
SHOULDER, showing three axillary arteries. A very rare specimen.
[Property of X-Ray Laboratory, Chemical Building, 8th & Olive Sts.]
KIDNEY. One of Dr. Kassabian's radiographs.
THE AMERICAN X-RAY JOURNAL.
957
resting on some metallic support in- stead of wood, is marvelous, and the re- sults obtained are really beautiful. This way we do increase the sensitive- ness of our plates, and, accumulating more rays over the same, reduce the time of exposure. This method is diffi- cult to manipulate perhaps in the begin- ning, but later on gives more oppor- tunity to study, and we may attain results and unexpected success. The screen must be in good order, and in immediate contact with the sensitive film, so that the x-rajs had to pass through the subject, and then the screen before reaching the sensitive surface of the dry plate. I have only one screen, about 8xio inches and use the same in all cases of bone injuries, bone diseases, foreign bodies imbedded deep in soft tissues, fractures, dislocations, skiagraphy of the head, hip, joint, etc. I will not deny that I have spoiled or fogged numberless plates before suc- ceeding in this or other experiments since my pioneer work in 1896, but the results obtained are really gratifying, and most practical. Cedar Rapids. Ia.
Never be content with a radiograph of a suspected fracture from one posi- tion. Make the second exposure at 90 degrees or at right angles to the first.
When the object sought can be seen with the fluoroscope the fluorometer is the most accurate and convenient in- strument for correct localization.
In Austria, by a decree, an official license is required before one can pub- licly operate an x-ray machine, and none but physicians are licensed.
Idiosyncrasy is a factor and the re- action varies in intensity in the treat- ment of lupus vulgaris and rodent ulcer.
It is possible not to get a picture of a fracture in one position that would be clear in another.
Subsequent Outcome of Fractures.
Benjamin Duke in the British Medi- cal Journal reports a case of oblique fracture of the tibia and fibula, in which at the time of the accident and during the subsequent treatment of the case up to the 80th day only a fracture of the fibula was suspected. A radio- graph at this time showed the frag- ments of the tibia to be separated to a considerable degree. The leg seems to have all the function of one that had never been injured, and comment is made that the "case illustrates the fact that x-ray pictures are no indication as to the subsequent outcome of cases of fractures." We here protest against such rank teaching as this quotation im- plies. To the contrary, it is just this indication exactly that illustrates to an intelligent surgeon the subsequent out- come of cases of fractures. Upon the teaching of such stuff a separation of the lower end of the radius might be looked upon as of light consequence. What about the "subsequent outcome?" How about a fracture with the lower end of the humerus? Does it appear to any surgeon that separation of frag- ments here will result well for the patient?
Surgeons have always known the points mentioned in the quotation. It is not so much for the cases that will have good function, though there may be separation of fragments, that the x-rays are brought into requisition, but for those cases that will not have good function unless the bones are put in apposition that the x-rays are so im- portant in the subsequent outcome of cases of fractures. A surgeon is sup- posed to know something of the an- atomy of the living subject and the function of muscles and bones. The quotation cited is at least a travesty upon his profession.
958 THE AMERICAN
The Ostrich Man and the X- Rays.
The title of this brief article is not quite correct, for we are more con- cerned in the defense of the radiographer than we are in the freak. The Strand Magazine for May on page 470, has a picture of the man who alleges to eat glass, nails, saws and knife blades, and also these words : "But several mem- bers of the profession were skeptical. Doubts on this point were soon allayed, however, by Dr. Mihram K. Kassabian, who requisitioned the x ray apparatus to photograph the stomach of the human ostrich. Harrison has good cause to recollect this part of the pro- ceedings, since he was so burned by the application of the rays that he was incapacitated for 19 months, and has since experienced a certain weakness "
Dr. Kassabian feels much agrieved that a high grade publication would permit such a statement, reflecting as it does, upon his professional acumen and using his name wrongfully to adver- tise the freak and add to that sort of yellow journalism.
It seems ' that Mr. Harrison, the numan ostrich so-called, exhibited him- self before the medical students of the Chirurgical Medical College, Philadel- phia, April 9, 1900. He requested that a radiograph be made of his stomach to prove the existence of what he had alleged to have eaten. The clothing was removed and he was placed prone over a 14 by 17 plate. The tube was 36 inches from the body and glowed three minutes. The plate showed on development the presence of foreign bodies. At this time he told Dr. Kas- sabian that some doctor in New York City had attempted to radiograph his stomach but failed and had burned him. Dr. Kassabian could not find any trace of in j nry . About eight months after this he returned to the college, Nov. 27,
X-RAY JOURNAL.
and gave a demonstration by eating nails and tacks. No exposure was made for radiographic purposes at this time, but for about half of one minute the fluoroscope was used. Of course, from the dates it is impossible that the man could have been incapacitated for 19 months, for it had been but 13 months since the first exposure and but about seven months since the last. It is also absolutely physically impossible that injury could have resulted within the distance and in the time he was under the tube at either exposure. No skin was ever known to have been in the least influenced to the knowledge of the person under such conditions.
That Dr. Kassabian could have erred in this would be quite beyond conjecture. He is one of the most careful workers with the x-rays in this or any other country. He is a student, having mastered the grammar of several languages, he took up the study of medi- cine, and on the advent of the x-rays began its use for purely diagnostic pur- poses. No more cautious operator could be found and his statements are weighed with the latitude of a physicist. We take pleasure in presenting the mat- ter briefly as it has come to us.
American Electro-Therapeutic and X-Ray Era, is out with its second num- ber. This issue is an improvement over the first, although the first was a very creditable "starter." The journal is eleven by eight inches, a most attractive size, and will in the future, no doubt, serve for full size radiographs. The matter of the journal is well selected and contains much valuable information. Electro-Therapeutics is so closely woven into the practice of x-ray workers, that we teel certain they will kindly accept the combined art and science in one pub- lication. We, therefore, hope and pre- dict a brilliant future for the American Electro- Therapeutic and X Ray Era.
THE AMERICAN X-RAY JOURNAL.
959
Roentgen Society.
The following notice, made by Pro- fessor Monell, Chairman of Committee on Standards, appeals to all persons whomsoever that have any knowledge on this subject; and commends itself espe- cially to medical men having interest in the attainment of more knowledge. Write to Dr. Monell and give expression on one or more of these subjects.
COMMITTEE ON STANDARDS. Dear Sir:
To promote uniformity in results and to secure accuracy and give legal value to the evidence of x-rays, it is necessary to standardize methods of doing the work. To this common benefit all x-ray experts are asked to contribute for the general good of the cause. You are therefore in- vited to write me your best suggestions on such of the following points as you can offer advice upon: A standard uniform nomenclature for the prin- cipal terms required. A standard form of record-blank for briefly filing reports aud indicating all essential details of the exposure. Standard of efficiency for tubes. Qualities which a standard x-ray photographic
plate should possess. Qualities which a standard x-ray fluoroscope
screen should possess. Standard handle for all x-ray tubes so they will
fit a standard tube-holder. Standard tube-holder to fit uniform standard tube-handle — adjustable, rigid, holding tube without vibration — and convenient for gen- eral use.
Standard position of tube for correct shadow.
Standard distance of anode from plate for stand- ard x-ray exposures.
Standard exposure times for chief parts of the body with a standard radiance.
Standard measure of different degrees of x-radiance.
Standard "skiameter."
Standard x-ray examination table, adjustable for all parts of the body.
Standard method of posturing each part of the body for a standard picture.
Standard means of fixing parts immovably dur- ing a standard exposure.
Standard complete definition of what a "stand- ard exposure" should be. (Of medico-legal value . )
Standard land-marks to be pictured in the nega- tive as inherent proof that a standard exposure was made — (a medico-legal necessity).
Standard method of localization for both "skia- graphy" and "fluoroscopy," which shall be the most practical, quick and uncomplicated.
Standard technique for picturing correct relation of bones and joints.
Standard technique for picturing details of any kind sought.
Standard technique for picturing contrast for
diagnosis of soft parts. Standard technique for picturing the different
calculi, vesical, renal and gall-stones. Standard technique for x-ray dental diagnosis. Standard technique for x-ray eye work. Standard technique for x-ray heart and lung
diagnosis.
Standard treatment of plates to develop uniform results.
A standard leaflet of brief . directions which the physician who does not do his own developing can send with his plates to any fair photogra- pher as a ready guide to proper treatment of an x-ray negative to secure the picture. Standard technique for therapeutic administration of x-rays with proper precautions. You are invited to supply any omitted detail which you believe should be standardized. Will be pleased also to have you select one or more features of the above list in which you have had special experience and make a careful report upon what you regard as the proper standard to officially adopt. A reply is desired in about two weeks. In offering suggestions about standard working methods, postures, special devices, appa- ratus, etc., it is desirable that you send explana- tory camera-photographs illustrating the details for comparison. Thanking you for your profes- sional co-operation in behalf of the committee, I remain, Fraternally yours,
S. H. Monell, M. D., Chairman of Committee on Standards 47 West Twenty-seventh street, New York City.
If you want a fine coil made especially for high grade x-ray work, write to H. W. Dachtler, 1959 Superior St., Toledo, Ohio. His outfit is complete and he offers it very cheap because he is going abroad.
The oval light appearance in the right flank of a radiograph is -due to gas in the cecum.
The Medico-Legal Journal of New York City contains many valuable arti- cles in its June issue, but we are sorry to see some comment on the medico- legal aspect of the x-rays.
96o THE AMERICAN
Investigation of X-Ray Prob- lems^
LISBON, Portugal, June 26, 1901. Dr. Hbber Rob arts:
Might I beg you kindly to put before the American Congress of Radiology (The Roentgen Society of the United States), the undermentioned list of problems, whose study is at present interesting me, but which I should also like to submit to the inspection and in- vestigation of the renowned radiologists o\ your country.
Some of these problems have already been propounded-and have undergone a certain amount of investigation, but, as yet, are not thoroughly solved:
1 st. How, in a Crooke's tube at a cer- tain degree of gaseous rarefaction to measure the influence exerts upon the quality of the x-rays (penetration and in- tensity*) conforming to a previously fixed standard by the following circumstances:
(a) The distance separating the kathode from the antikathode.
The size of the kathode and antikathode.
(V) Their shape.
(,!) The length of the spark measur- ing the discharge within the tube.
(e) The thickness of this spark.
(/) The number of interruptions in the primary circuit (or inductor;, or the number of electric discharges within the tube at one and the same time.
(g) The relation between the length 1 or duration) of the closing (making) and that of the opening of the primary circuit.
i ' 1 The total capacity of the tube in cubic centimetres in relation to the dis- tance of the electrodes in line of cen- timetres.
2d. How, in a Crooke's tube, to esti- mate the effect produced by the degree of gaseous rarefaction upon the penetra-
*Measured by their effect upon the fluorescent screen, platino cyanide of baryium or upon sen- sitized photographic surfaces.
X-RA Y JOURNAL.
tion and the intensity of the Roentgen
rays?
3d. How, in a Crooke's tube, no matter the degree of rarefaction therein attained, to reduce to a single point the focus of emission of the x-rays placed at the antikathode, in order to attain the best definition?
4th. How to reduce the number of electric discharges within the Crooke's tube to the minimum necessary to give the steadiness and brilliancy7 in the skia- scopic screen?
In any case enough time must be given to the closed period of the primary cir- cuit for the thorough magnetic saturation of the core, or in other words, to satur- ate the electric capacity of the coil.
5th. How to construct a durable coil and one which would give the greatest produce, i. e. , with a weak primary cur- rent to give a long and a thick spark?
6th. How to establish the standard of the strength of the penetration of the x-rays and its dependence on the quali- ties of the electrical discharge which produces them?
7th. How to establish the standard of intensity of the x-rays?
8th. How to determine the influence of the time exposure on the intensity of the skiogrammes in relation to the in- tensity of the utilized rays?
9th. How to create methods which allow of the regulation of the penetra- tion of the x-rays without considerable interfering with their intensity?
10th. How to create methods allow- ing of regulation of intensity independ- ent of their penetration?
nth. How to determine the absorb- ing power of the bodies for the x-rays, according to the qualities (penetration and intensity) of these rays?
With the best compliments, Your faithful
Virgilio Machado.
Subscribe for The American X-Rav Journal — $3.00 a year.
THE AMERICAN X-RAY JOURNAL.
961
Roentgen Society of the United States.
ANNOUNCEMENT OF COMMITTEE ON ARRANGEMENTS.
The Committee on Arrangements for the next meeting of the Roentgen Socie- ty of America have secured, through the courtesy of the Dean and Faculty of the University of Buffalo, the use of as much of its building as we may require. The location is central, the room ample and on the ground floor. The date of the meetings will be Sept. 10 and 11 at the University of Buffalo, Buffalo, N. Y.
The following rules and regulations in regard to exhibits have been adopted by the committee: Applications for space should be sent as early as possi- ble to R. C. Adams, Secretary, drawer No. 963, Buffalo, N. Y., with particu- lars as to character of exhibit and space needed.
Exhibits may be consigned to Louis Staffeldt, care University of Buffalo, and all express and freight charges must be pre-paid. Owners of goods sent by freight who wish them transferred to place of meeting on arrival, must notify the secretary and send him the pre-paid bills of lading. The cartage will be at expense of owners.
Exhibits are wholly at risk of owners, and should be unpacked and installed by them not later than Sept. 7.
Alternating current 104 volts, single phase, 60 cycles, and direct current no volts, will be available, also dark room for photographic purposes. All exhibits must be removed by Sept. 13.
Edgar B. Stevens, Chairman. Roger Cook Adams, Sec, Drawer 693. Dr. James W. Putn am, Dr. Elmer E. Starr, Dr. Rennick R. Ross,
Committee.
Pus casts a deeper shadow than brain substance and bones denser than pus, yet, paradoxical as this may seem, we can obtain good radiographs of pus in the brain.
Book Reviews.
System of Physiologic Therapeutics . — By Solo- mon Salis Cohen, A.M., M.D., Professor of Medicine and Therapeutics in the Philadelphia Polyclinic; Lecturer on Clinical Medicine at Jef- ferson Medical College; formerly Lecturer on Therapeutics at Dartmouth Medical College; Physician to the Philadelphia and Rush Hospi- tals, etc. ; Fellow of the College of Physicians of Philadelphia; Member of the Association of American Physicians; former President of the Philadelphia County Medical Society, etc.
This is a practical exposition of the methods, other than drug-giving, useful in the treatment of the sick. Published by P. Plakiston s Son & Co., 1012 Walnut St., Philadelphia, Pa. Price, eleven volumes, S22 net.
Volume I is written by George W. Jacoby, M. D., Consulting Neurologist to the German Hos- pital, New York City; to the Infirmary for Women and Children, and to the Craig Colony for Epileptics, etc. Electrotherapy is the subject of this book, divided into Part I, Electrophys- ics and Part II, Apparatus Required for the Di- agnostic Uses of Electricity. The first part ex- haustively treats of the fundamental conceptions and the realm of electric uses. The second part takes up the uses of the various currents from the sources of their output to their physiologic appli- cation. The study of this volume is a systematic teaching of electricity in a phase never before offered. Methods are conceptions new in ar- rangements, new in manner of expression, and are on a higher plane of classical literature.
Vol. II, Electrotherapy {continued) is also writ- ten by Dr. Jacoby. This book is divided into Diagnosis, Therapeutics, including special articles, by Dr. J. C. Da Costa, Dr. William Scheppen- grell, Dr. F. H. Martin, Dr. Edward Jackson and A. H. Ohmann-Dumesnil. The volumes are richly illustrated, the first containing 163 and the second volume has 80. This latter volume con- tains an addenda upon electrolysis, cataphoresis and x-ray therapy. The Parts into which the entire book is divided: III, Electrophysiology and Electropathology; IV, Electrotherapeutics and Electroprognosis; V, Electrotherapeutics. The chapters are numerous with voluminous headings,
These books deserve close study and invite the investigation of every medical man who values education as an essential to honest practice.
Dental Electricity.— By Levitt E. Custer, B. S.. D. D. S. Lecturer upon Dental Electricity in Ohio College of Dental Surgery; member of Na- tional Dental Association; member Ohio State Dental Society ; member of New York Institute of Stomatology: Honorary member of Kansas State
g62
THE AMERICAN X-RA Y JOURNAL.
Dental Society; Corresponding member of Illi- nois State Dental Society; member of Roentgen Society of the United States, etc. U. B. Pub- lishing House, Dayton, Ohio. More than 50 il- lustrations, 500 pages, cloth. Price, net $4.
This is the first systematic treatise upon the subject of Dental Electricity that we have had the pleasure of reading. Like all works upon medical electricity, the task explaining the mean- ing of electrical modes is here undertaken. To the credit of the author he has performed this work well. The modes of electrical application in dentistry is the full purpose of the book; and so far as one can judge, it seems as if a new vista had been opened up to the profession. The style of the writer is simple and plain, so that his mean- ing is readily understood. The chapter devoted to the x-rays is very good. More is said on the subject of apparatus than is necessary, for there are now so many makes of excellent type all can not be given proper attention. After all, the reader is not able to judge from the description the one he wants. The principles after all, is what he needs.
The book is full of rare and valuable matter. No dentist can consider himself informed that does not possess a knowledge of the facts related in this book. If he does not read the book we do not know where he can easily get the facts. As a physician I find many valuable suggestions.
How to Examine for Life Insurance. — By Frank Ring, M. D., medical examiner for John Han- cock Mutual Life Insurance Company of Boston; Prudential Life Insurance Company, of Newark, N. J.; Security Trust & Life Insurance Compa- ny of New York. i2mo handsomely bound in silk cloth, over 100 pages, Si. 00 net. Charles D. Wilcox, Publisher, 2313 Washington Ave., St. Louis, Mo. The signs of the times are well ex- emplified in this book. The rapid strides made toward improved methods for diagnosing in the past few years makes it incumbent upon the life insurance examiner to know something more than is found in the text-books and in college teach- ings. Life insurance companies require of their examiners that they shall be inquisitorial and categorical without betrayal and without giving offense. To propound questions is an art and it is an equal art to weigh their meaning. This as- pect of the subject Mr. Ring has briefly covered with a comprehension that can nowhere else be found. The book is a ready reference upon clin- ical signs and physical diagnosis valuable to all practictioners whether in or out of the insurance examining service. It is a guide in urinary anal- ysis, valuable to all. The author touches upon the uses of the x-rays as a means to assist in ar- riving at conclusions. In this particular de partment much more should have been said. The doctor is a member of the Roentgen Society
The Kinraide High-Frequency Coil.
The best apparatus for use with the direct or alternating caiicut.
••••••••••••
SEND FOR
DESCRIPTIVE
CIRCULAR.
Maker of Opht halmological Apparatus, Complete Standard Electro-Therapeutic Equipments.
X-Ray Apparatus and High Grade Eye, Ear, Nose and Throat Instruments. 104 Hast Twenty-third Street, \ 604 Nicollet Avenue, Minneapolis.
125 West Forty-second Street, -NEW YOKK, 360 St. Peter Street, St. Paul.
650 Madison Avenue, ) 3 rue Scribe, Paris, France.
ADVERTISEMENTS.
Ill
of the United States and employs the Roentgen rays as suggested on page 105 in his Examiner for Life Insurance.
Etidorhpa. — By John Uri Lloyd, author of Stringtown on the Pike. Dodd, Mead & Com- pany, Publishers, New York City. Richly illus- trated by J. August Knapp. Cloth, postpaid, ii.50.
The reader of Etidorhpa is improved in mental vision and in the certitudes that are so myste-
rious to the untutored who do not read or study or take interest in the realm of ecstatic wonders. The uses of thought and vision so beautifully brought out in this book can not be denied. The clearness of insight in things strange and appa-. rently beyond our grasp, are here clearly traced in a way that the key can be used to broaden our vision. The story is fascinating. It is of high culture and appeals to the cleaner sympathies of man and lives in the truth of science in all its imaginaries. Everybody should read Etidorhpa.
Doctor:
We are successfully treating that class of pa- tients known as Drug Habitues, Inebriates, etc. If you have among your patrons those who are using either Opium, Morphine, Laudanum. Codein, Chloral or other pain-alleviating or sleep producing drugs or alco- holic stimulants to ex- cess, and you are not prepared to successfully treat or manage such cases, we would be pleased to have you send them to us. We immedi- ately destroy the demand, the desire and the necessity for these baneful drugs and alcoholic stimulants. The treatment is antidotal, eliminative and supportive. There is no delirium or painful gradual reduction. All patients remain at Sanatorium at least one week without drugs or alcoholics of every description, and are eating and sleeping well, and regain self -confidence before leaving for home. Treatment con- ducted within ethical lines. Insane not admitted. We have cured cases in nearly- every city and state in the union, and can furnish you medical references in or near your locality. We also take pleasure in referring you to leading members of the Memphis Medical Profession. Sanatorium large, light and well ventilated. Situated on beautiful lawn. Electric lights and city sewerage. Massage, electric and vapor baths. First class cuisine. All correspondence regarded as strictly professional and
confidential. Address: old Homestead Sanatorium, Memphis, Tenn.
WEBSTER'S INTERNATIONAL DICTIONARY
WEBSTER'S INTERNATIONAL DICTIONARY
NEW EDITION
OtZ AAA New Words, ^3,UUU Phrases, Etc.
Prepared under the direct supervision of W. T. HARRIS, Ph.D., LL.D., United States Commissioner of Education, assisted by a large corps of competent specialists and editors.
New Plates Throughout. Rich Bindings. 2364 Pages. 5000 Illustrations.
Better than Ever for Home, School, and Office.
Also Webster's Collegiate Dictionary
" First class in quality, second class in size.
'itha valuable Scottish Glossary, etc. Nicholas Murray Butler.
J$N Specimen pages, etc., of both books sent on application.
G, &, C. MER>RIAM CO., Publishers, Springfield, Mass., S. A.
The National College of Electro-Therapeutics
The oldest College in the United States devoted exclusively to Electro-Therapeutics. Ten instructors. A thorough practical COURSE of INSTRUCTION by MAIL to those who can not come here. Diplomas granted when competent. Degree conferred. Write for 6th Annual Announcement, and free sample copy of "The Electro-Therapeutist." Address
Nos. 2, 10 Collins Block, Lima, O. H. L. BENNETT, M, D., M. E., Secretary.
IV
ADVERTISEMENTS.
Our Offer Upset one of our Competitors Completely.
They say no one can afford to f?ive you a dollar for fifty cents. They also say when you are offered a Static Machine for $150, it should set you to thinking. We think the same thing. The physicians have certainly been gulled for years by paying double what they should. Get a special report on us from any commercial agency, or have your bank get it, and you will find we are able to carry out any contract we make. No machine is superior to ours. No concern in the United States turns out the amount and variety of goods that we do.
Send for our Bargain Bulletin of 4,000 Articles sold DIRECT to Physicians at Wholesale Prices,
We have no agencies.
Frank S. Betz & Co., 37•3,i„4,,cS0,'ff.s,^ee,•
ST. LOUIS
X-Ray Laboratory.
Approved by the leading Surgeons and Physicians in St. Louis.
Laboratory Open 8 a.m. till 9 p.m.
A The automobile is brought into requisition, so that we can do x-ray ^r^jw work in any house or place in the city. Current is adapt-
jfej^l able to storage batteries, so that we can go anywhere
jfm JHV in the country to do x-ray work.
•SP** MAIN 2954 A. M. E. PARBERRY, Manager, 300 Chemical Building,
Eighth and Olive Streets, St. Louis, Mo.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY" THE AMERICAN X-RAY PUBLISHING COMPANY.
HEBER ROBARTS, M. D., M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE. United States, Canada and Mexico S3.00 | Foreign Countries ■ $4.00
Single Copies . 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 331 Chemical Bldg., St. Louis.
All business matter should be addressed to The American X-Ray Journal Publishing Co., same address.
All contributors of original articles and other matter relative to X-Radiance, of interest to the medical profession, are solicited from all parts of the world. Contributors will be furnished a liberal number of extra copies of the Journ al containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611 Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. 9. ST. LOUIS, SEPTEMBER, 1901. NO. 3.
CONTENTS OF VOL. 9, NO. 2 Dr. A. C Bernays.
Skiagraph in Oral and Dental Surgery. Constitution Roentgen Society. How to Find Fissure of Rolando. Radiographs — anatomical. Subsequent Outcome of Fractures. The Ostrich Man and the X-Rays. Roentgen Society. Investigation of X-Ray Problems. Roentgen Society of the United States. Book Reviews.
CONTENTS OF VOL 9, NO 3
Second President Roentgen Ray Society
of America. First President Roentgen Ray Society
of America. Illustrations. Static Electricity. Editorials. Radiographs.
Priority, Radio-Therapeutics. Becquerel Rays.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
VOL. 9. ST. LOUIS* SEPTEMBER, 1901. NO. 8.
The Roentgen Ray Society of America.
It will be noticed that the name of the Roentgen Society of the United States is changed so as to read The Roentgen Ray Society of America. This was made necessary to comply with the Constitution, which admits active members from the continent and especially from Canada, where the so- ciety has a healthy contingency.
This society was organized in Febru- ary, 1900, in Dr. Robarts' office, St. Louis, in response to 100 invitations sent out to physicians by Dr. J. Rudis- Jicinsky, of Cedar Rapids, la. A presi- dent and secretary were chosen for the temporary organization and a regular meeting fixed for December 13 and 14, in New York City, in the Grand Central Palace. Announcement was made
through The American X-Ray Journal and the medical and electrical press everywhere. Voluntary, papers were sent to the secretary and a most excel- lent program prepared. "Manufacturers of x-ray apparatus and accessories ap- plied for space and occupied one of the beautiful rooms shown in the cut here- with. The local arrangements were perfected by a committee of which Dr. S. H. Monell, of New York City, was chairman.
At the time this society was launched there seemed to have come over the x- ray world a settling down to quietude and actual work, since but little was then being said or printed on the sub- ject. Many thought the x-ray followers were getting what Napoleon called "real punishment" — a let-alone policy. Subsequent events, however, have prov- en that the x-ray influence of that time was in a state of incubation. Many pro- fessional men had likened the advent of the Roentgen Society, as also they had The American X-Ray Journal, to a dis- sertation upon the Will-o'-the-wisp. When once said it was all said. Ig- nis fatuus has mysterious wonders wreathed about its graveyard light, but to repeat the story was punching Judy in the face. The x-rays had crowned the period with astonishment and brought light where no vision hoped to dwell, but the story once told, relief and relaxation wrould follow with dreamy re- pose. Time has again shown that the complainer and wrecker fall together,
964
THE AMERICAN X-RAY JOURNAL.
while the enthusiast and builder go on forever. The New York City meeting was a surprise. It was largely attended with 150 x-ray workers. The papers and proceedings were printed in The American X-Ray Journal, extracts from which have been made in American and European journals.
The officers elected at that regular meeting were: President, Dr. Heber Robarts, St. Louis, Mo. ; Secretary, Dr. J. Rudis-jicinsky, Cedar Rapids, la.; Treasurer, Dr. E. A. Florentine, Sag- inaw, Mich. The president appointed on special committees: Standards, Dr. S. H. Mcnell, New York City, chairman; Research, Dr. J. B. Murphy, Chicago, charman; Ways and Means, Dr. J. Rudis-J icinsky, Cedar Rapids, la., chairman; Medico-Legal, Dr. Mihran K. Kassabian, Philadelphia, chairman. Time and place of next meeting was left with the president, who selected Buffalo, and September 10-11 the time. Edgar 15. Stevens, E.E., of Buffalo, was made chairman of the Committee of Arrange- ments, who expended every energy to to furnish the necessities that made the buffalo meeting so agreeable. Although Mr. Stevens had only recently returned from Europe, the perfect plans effected showed the deep interest he had in the society. The amphitheater and recep- tion rooms of the Buffalo University were given over to us. Notices sent out brought voluntary papers to the secre- tary in abundance. A program was ar- ranged 15 days prior to the meeting, as follows:
PROGRAM.
Tuesday, September 10, 2 p. m.
The Diagnostic value of the Roentgen Rays with -|. rial rcfri-cncf tu their application in Sledico- U'Kal cases,
In: Mihkw K KA88ABL4N, Philadelphia, Pa.
An Examining Frame and "One Minute" Locai- izer, u it h demonstrations,
l»n. s. ||. Mom 1.1 , New York City. HOW the indue ion static Machine can be excited without a separate charter.
Di{. John T Pitkin, Buffalo, N. Y. The X-Ray in country practice,
.i< BEPH C. Clark, Olean, N. Y. \vh;ir the K-Rajra rtiaw In Actinomycosis,
DR. (. K. I < '-in in., Cedar Rapids, la.
X-Rav work in Great Britain, results of a trip,
Dr. G. P. Girdwood, Montreal, Canada. Yoluntary Papers, practical demonstrations and inspection of the Exhibits.
Tuesday, September 10, 8 p.m.
President's Address,
Dr. Heber Robarts, St. Louis, Mo. The discovery of the Bacilli in Cancer, Prof. Max S ueller, of Berlin, German University.— Elec- trotherapy, the safest cure of Lupus Vulgaris— The most recent inventions and improvement in Tubes, Coils, Static Machines, etc. (illustra ed) Julius Silversmith, Chicago, 111. Researches in the direction of obtaining Shadow- graphs of the Muscles and ligaments of the body, H. Westbury, Harrison, N. J. Brief remarks on the therapeutic value of the X-Ray and suggestion on a universal co-operation, Dr. Constaxtix V. S. Boettger, Ottawa, Canada. "Some Medico-legal X-Rays," illustrated,
Dr. F. v\ esley Sells, Murray, Iowa. Investigation of X-Ray problems,
Yirgilio Machado, Lisbon, Portugal Skiagraphy of the concretions in urine, especially cystine ,
M. U. Dr. R. Jedlicka, Chirurgical Clinic, Prague,
Bohemia.
Wednesday, September 11, 10 a. m.
Why some mistakes are made in Radiography,
Dr. J. N. Scott, Kansas City, Mo. Description of a simple and efficient form of Elec- trolytic Interruptor,
Dr. Elmer G. Starr, Buffalo, N. Y. The treatment of Cutaneous Cancer by the X-Rays,
Dr. G. E. Pfahler, Philadelphia, Pa. Use of the X-Ray as a Therapeutic Agent. Illus- trated. Demonstration,
Dr. H. P. Pratt, Chicago, 111. Some Light R^ys in Tuberculosis,
Dr. J. Mouxt Bleyer, New York City. X-Ray, an absolute necessity in Dental Surgery, Dr. Fraxk Austix Roy, New York City.
Wednesday, September 11, 2 p. m.
The X-Ray Tube,
Dr. Emil H. Grubbe, Chicago, 111. Development in Crooke's Tube* in 1901,
H. Westbury, Harrison, N. J.
X-Ray Machinery,
W. C Fuchs, Chicago, 111. The Relative Efficiency of X-Ray Generators,
Dr. AY. A. Price, Cleveland, O. Position in Skiagraphy,
M. E. Parberry, St. Louis, Mo. Turck's Gyromele and the X-Rays in diagnosis of the diseases of the Stomach. Demonstration. Illustrated.
Dr. J. Rudis-Jicixsky, Cedar Rapids, la. Yoluntary Papers, practical demonstrations and inspection of the Exhibit.
Committee on Arrangements in Buffalo have plans for entertaining members.
This was strictly adhered to, with
slight exceptions. The matter these
papers contain is most valuable, and,
with some extractions, will be printed
in The American X-Ray Journal fast
as possible. No one can hope to be
acquainted with the recent evolutions of
this science and art unless they read
and study these papers. Much is lost
in not being present at the meeting.
1 he writings were illustrated in many
instances and elicited inquiry and an-
THE AMERICAN X-RAY JOURNAL.
965
swers that writing alone fails to express. Those who attended this meeting were many times repaid for their time and expense. The therapeutics of the x-rays was gone into very fully. The facts brought out must attract wide in- terest. Methods of using the x-rays for curing malignant disease differed only in technic, but in every instance reports of cures were effected or improvement fol- lowed.
This Buffalo meeting was another sur- prise. The meeting was more largely attended than the most sanguine had hoped. One hundred and five new names were registered and money paid for membership. These, of course, went before the censors. Dr. Roswell Park, one of our older members and one of President McKinley's surgeons, ad- dressed the meeting. Owing to re- porters bombarding members and glean- ing from dropped words here and there at the interum of sessions, and publish- ing the same as official, Dr. Heber Rob- arts introduced the following resolution, which was unanimously adopted:
Resolved: That this society assembled express its deepest sense of sorrow for the recent afflic- tion inflicted upon William McKinley, our Presi- dent of the United States; that our society has profound confidence in the wisdom and ability of the great surgeons in charge, and condemn any and all unkindly remarks that have, unfortu- nately, been publicly or privately expressed con- cerning the uses of the Roentgen rays, relying, as we do, on mitigating circumstances, known to the surgeons only.
Resolved: That a copy of this resolution be stricken off and sent to Dr. Roswell Park, a member of the society.
The new officers elected for the ensu- ing year are: — President, Dr. G. P. Girdwood, Montreal, Que.: Secretary, Dr. James Bell Bullitt, Louisville, Ky. ; Treasurer, Dr. E. A. Florentine, Sagi- naw, Mich. An Executive Committee, having quite plenary scope, was organ- ized, with Dr. Weston A. Price, of Cleveland, Ohio, as chairman, and Dr. Marsh, of Troy, N. Y„ and Dr. John-
son, of Rochester, N. Y., associates. The closing scenes of the Roentgen So- ciety was a veritable panegyric of men- tal rejoicing.
Can anybody refrain from applauding, yea, more, to sound and herald the merits of this body? To whom is it due? More advance has been made in diagnostic medicine through the x-rays than any previous hundred years. The Roentgen ray has done more to remove the fright of cancer, the dread of lupus and the shame of eczema than the influ- ence of all previous knowledge. Truly, more is in store: excepting the extinct scourges of medieval times, raying is destined to wipe out a wider range of disease by invading the body. Its ac- tion is already proven benignly in phthisis, tuberculous joints, kidney diseases — in fact, all affections where bacteria is causative.
The Roentgen Ray Society of America is expected to spread these truths through the medium of its members. But let us continuously look for light — more light, remembering again that it is the builder that constructs — not the wrecker. Our mission is onward, while the destroyers sleep by the wayside. We follow beacon lights in science and forget maledictions. We are reaching out, not blindly into the siftings, but in- to clearer domains, where the flight of man aspires. We reach for the stars, and our ambition is not fulfilled. The most distant twinklings allure us, and, solving the wonders there, we plunge into the abyss beyond, seeking the un- known. If we are a fraternity, then in union there is strength. Each member is strengthened by the strength of the whole. Then we can better seek the realm of diagnostic medicine — the phy- sicians' goal. So we are seeking the waywardness of man's anatomy, not so much his mentality. We are looking for the cause of man's suffering, quite content with the remedies at hand. We
966
THE AMERICAN X-RAY JOURNAL.
These cuts show the rooms in which the Roentgen Society of the United States met in first annual meeting. Grand Central Palace, New York City, December 13 and 14, 1900. One room was well filled with exhibits and the other seated for 230 members and spectators.
THE AMERICAN X-RAY JOURNAL.
967
are already proud of our achievements, of its revolutionizing influences, of the conquering x-rays. Conscious, how- ever, of this reward, we behold a new vista and turn from the proud sense of victories won to the labors that await us. Like receding from the small end of the funnel, the working plane ex- pands. We take up the taper of accu- mulated past and with the searching li°ht seek untrodden paths. Then, ap- proaching the consummation of our am- bition, we can proclaim--
With visions clearer than e'en tears could make The eyes, whose limit was the violet rays, We now may see, and things that lie beyond — Life's mysteries long screened are ours today.
The following is a running clipping from an editorial in the great New York Medical Record. It was written at the time Dr. Shrady, the venerable and ac- complished editor, believed the lamented President would recover. He writes:
"The only trouble now from the latter view centers in the present uncertainty as to the location of the bullet. Although believed to be lodged in the muscles of the back somewhere in the lower dorsal or upper lumbar region, there has been no means as yet of proving such a point. Of course, even- hope now rests in the probability of the missile becoming safe- ly encysted and consequently harmless. It is somewhat difficult to understand why, up to flu's writing, the x-ray, so easily ami effectually applied, has not been brought into service. It would hardly be so much a matter of gratifying curiosity — as re- marked by one of the eminent surgeons in the case — as of being absolutely sure of the terminal track of the missile. It is to be hoped that the bullet course be- hind and beyond the stomach is in a safely closed and aseptic condition. This would seemingly be the only absolute guarantee against any future trouble from secondary suppurating processes. "
The italics are our own. Another ref-
erence to these lines might benefit sur- geons. Is it possible that the last sen- tence was a prophesy? May it be pos- sible for secondary suppurating process- es to have occurred about the bullet, the removal of which at the time of in- jury would have prevented.
In a recent monogram or reprint, if we remember correctly, Dr. Beck has some radiographs made from clinical cases exemplifying "Possible Error in Skiagraphy." Four pictures are shown, three of which are radiographs taken at different angles and one of which fails utterly to show a fracture, while the other two show plainly that it is oblique. In the December, 1899, issue of The American X-Ray Journal, pages 671 to 674, we argued this point editorially quite fully and diagramatically showed exactly what would •occur under certain conditions. Means were pointed out to avoid all possible error. The caption of this article is "Photographs and Radiographs, Proof of Accuracy Essen- tial to Admission as Evidence." We are glad to see that Dr. Beck has had an opportunity to prove this in practice. In this particular case irradiation proved a fracture, without which it would have been accepted as a bruise. Accuracy in diagnosis — positive knowledge, not col- lateral and circumstantial — is what every doctor needs.
We hope that discussion of the uses of the x-rays in the lamented President's case will not occur. No good can come out of such disputes. As the only x ray journal in this country we feel it is our duty to mention this since also we are the most deeply interested.
Localization methods were numerous at the Roentgen Society meeting. How- ever, nothing has yet taken the place of the fluorometer for simplicity and ac- curacy.
968
THE AMERICAN X-RAY JOURNAL.
STATIC ELECTRICITY.
What It Really Is-A Plain Statement Divested of Technical Terms and Misleading Matter.
BY HENRY K. WAITE, M. I). The claims made bv some recent writers on static electricity in regard to their alleged wonderful discoveries are misleading and unauthentic. The dis- covery of static electricity was made
Inventor of the First Electric Machine, 1671. over three centuries ago by Otto Guer- icke, a Burgomaster in Magdensburg, Holland, who invented and manufac-
» ELI.CTK % \ I.
First Electric Machine, L671 A. I), ttired the first static machine in 1671. He discovered the principles of attrac- tion and repulsion, also conduction and a spark, his machine being a sulphur ball revolving in trunions. In invent- ing this machine Guericke discovered all
of the currents which have been called by many names since.
The next inventor was Newton, who substituted a glass ball in place of the sulphur one. Later Hawksby discov- ered the electric glow or electric light and he brought it prominently before the public. Subsequently there were a series of balls used together, and in 1731 Gray made extensive experiments in producing electricity by rubbing a glass rod, and charging bodies sus- pended by silk ropes.
From that time on various styles were introduced one of which had a glass cylinder, another a glass plate
First Electro-Therapeut in tne U. S. 1740.
and these were used until Holtz made his celebrated induction or influence machine in 1856. This remains today the most powerful machine for gener- ating static electricity.
The old writers call attention particu- larly to their methods of treatment; they will be found to mention a spark treatment, Leyden jar shock, and a brush discharge from points, either metal or wood. Attention is especially called 10 the method of treating with Leyden jars or a Leyden jar modifica- tion mentioned by these old writers, which is called the Lane Electrometer, but which has been claimed by one of
THE AMERICAN X-RAY JOURNAL.
969
our recent writers as his induced current and as having been discovered by him in 1881. These methods were fully de- scribed by Cavello, Franklin, Watson, Priestly, Cuthburtson, and by Adams over a hundred years ago.
When the history of the subject is looked into are not the statements of a very prolific writer of the present time, who claims to be the discoverer of induced and wave currents of statical electricity, ridiculously wide of the truth? Subjoined is a quotation from one of the old writers referred to who had this to say over two centuries ago and I quote the following from
ADAMS' ESSAY ON ELECTRICITY, I 792.
By the Electric Friction. — "Cover the part to be rubbed with woolen cloth or flannel. The patient may be seated in an insulated chair, and rubbed with the ball of a director that is in contact with the conductor; or one may be connected with the conductor, and rubbed with a brass ball which communicates with the ground. The friction thus produced is evidently more penetrating, more active and more powerful than that which is communicated with the flesh brush; and there is, I apprehend, very little fear of being thought too sanguine, if I assert, that this, when used but for a few minutes, will be found more effica- cious than the other, after several hours' application. Electricity applies here with peculiar propriety to spasm, pleu- risy, and some stages of the palsy, and in every case answers the end of blister- ing where discharge is not wanted, being the most safe and powerful stimulent we know."
By causing a current of the electric fluid to pass from one part of the body, and tints confining and concentrating its operation without communicating the shock. — "Place the patient in an in- sulated chair, and touch one part of the body with a director, joined to a positive conductor: then with a brass ball com-
municating with the ground, touch another part, and when the machine is in action the fluid will pass through the required part, from the conductor to the ball; the force of the stream will be different according to the strength of the machine, etc. Or connect one director with the cushion and the other with the positive conductor, and apply these to the part through which the fluid is to pass, and when the machine is in action the electricity will pass from one ball to the other. It is not necessary to in- sulate the patient in this case."
By the Shock. — "Which may be given to an}7 part of the human body, by introducing that part of the body into the circuit which is made between the outside and inside of the bottle. This is conveniently effected, by connecting one director by a piece of wire with the electrometer, and the other with the outside of the bottle; then hold the directors by their glass handles, and apply the balls of them to the extremity of the parts through which the shocks are to be passed. The force of the shock, as we have already observed, is augmented or diminished by increasing or lessening the distance between the two balls, which must be regulated by the operator to the strength and sensi- bility of the patient. When the little bottle with the glass tube is used as a common bottle, both wires are to be left there, and the shock is communi- cated by two directors, one connected with the bottom, the other with the top by means of the electrometer. The operator will often find himself em- barrassed in giving small shocks, the fluid passing from the conductor to the ball of the electrometer, instead of go- ing through the circuit he desires; when this happens, which may be known by the chattering noise of the spark in passing to the electrometer, the re- sistance formed to the discharge is so great, that the fluid can not force its
THE AMERICAN X-RAY JOURNAL.
way through the circuit; to remedy this, and lessen the resistance, pass two metallic pins through the clothing, so that they may be in contact with the skin, which will lessen the resistance, and conduct the fluid." This is the in- duced current claimed as a recent discovery.
By a sensation between a shock and the spark, which does not communicate that disagreeable feeling attending the common shock — '-This is effected by taking out the long wire from the small medical bottle, and leaving the shorter one which is connected w'.th the tube in its place, the directors to be connected and used as before. In lessening this vibra- tory shock the electrometer may be drawn to a much greater distance; for the rapidity with which the charge of the bottle sends forward the charge of the tube, is sufficient to overcome the resistance of a large body of air. The effect of this species of shock, if it may be called one, is to produce a great vibration in the muscular fibres, without inducing that pungent sensation which the shock effects. It is therefore appli- cable to some stages of palsy and rheu- matism: it may also serve as an artifi- cial means of exercise." This is the -wave current claimed as a new discovery.
/> ! the Bottle Director. — "Insulate the patient, and place the ball in contact with him, by which means this director is charged. Now if the wire is conveyed from the bottom of this to the top of another director, the bottle director will be discharged whenever the ball is brought in contact with the patient, so that by bringing it down with rapidity any number of small shocks may be pro- cured in a minute. Or connect the in- sulated patient with the top or inside of a large charged jar, and then this apparatus used in the foregoing manner will discharge from the jar, at each spark, its own contents, and by repeti- tion discharge the whole jar; thus a number of shocks may be given without
continually turning the machine, or em- ploying an assistant."
By passing the whole fluid contained in the Lexden Phial through a diseased part without giving a shock. — "Connect a director by means of a wire, with the ball of a Leyden jar; charge the jar either completely or partially, and then apply the ball or point of the conductor to the part intended to be electrified, and the fluid which was condensed in the phial will be thrown on the part in a dense flow stream, attended with a pungent sensation, which produces a considerable degree of warmth. If a wire that communicates with the ground is placed opposite to the end of the director, the passage of the fluid will be rendered more rapid, and the sensation stronger. Or insulate the patient, con- nect him with the top of the jar, charge this, and then apply a metal wire or piece of wood to the part through which you mean to make the fluid pass. It is obvious, that in this case the circuit between the inside and outside of the jar is not completed, therefore the shock will not be felt. The condensed fluid passes in a dense flow stream through the required part, while the outside ac- quires a sufficient quantity from sub- stances near it to restore the equil- ibrium."
We shall now analyze the static cur- rent and see what it really is. There are only three conditions or rather three states of static electricity: The first one a condition of strain (this is when the apparatus is charging), the second induction, the third a spark. We first fill up something, it may be a Leyden jar, or an insulated patient, and when voltage is of sufficient force to overcome the resistance of the dielectric air, which is between the pole pieces, the spark jumps and it is discharged: and this goes on repeatedly and with a rapidity which depends upon the gener- ating power of the apparatus.
THE AMERICAN X-RAY JOURNAL.
971
We insulate a patient on a platform which has glass legs; then connect the positive prime conductor of the machine to the insulated platform on which the patient is placed, dropping the other chain on the floor or grounding it to a water pipe, it matters little which. We start the machine in operation, the patient becomes the extended prime conductor and practically that patient becomes the inner coating of the Leyden jar, the glass legs take the place of the glass jar, and a chain dropping from a negative prime conductor to the floor makes the floor the outer coating of the Leyden jar. The sliding pole pieces may now be separated to any desired distance according to the case about to be treated. The operator should always remember that the nearer the balls of the sliding pole pieces approximate the more rapid will be the discharge, there being less resistance to overcome in the shortened air space. As soon as suffi- cient voltage accumulates to overcome the air space a spark jumps, and with such great rapidity, that it seems almost a continuous spark producing an oscilla- tory condition in the entire body. It is practically a strain and a release; a push and a pull; filling up and empty- ing; as, taking a glass of water and pouring it from one glass to the other; charge and discharge.
It may be that only the patient's feet are on the electrode; or his joints may be wrapped in any suitable conductor such as lead, tin, tinsel, or moistened cloth, the whole body is under the in- fluence of the current. Now separate the poles widely and the patient is in a condition of positive strain, which is called static insulation. If we approch the patient on the insulated platform with an electrode held in one hand, we form a spark gap between the electrode and the patient. If we use a pointed electrode we have what is termed a brush discharge; if it is a ball electrode
we have a disruptive discharge called the static spark. This may be of greater or less intensity according to the size and material of the ball and the distance from the patient. If the connecting chain is dropped on the floor the current will be mild; if connected directly to the machine it will be very strong; if held in the hand of the operator, so that his body becomes part of the circuit you have a very mild method of application, which allows you to treat the case from any side. This form of treatment is very pleasant to the patient and the one that should be used when beginning static treatment.
By this explanation it will be seen that to have a current there must be a spark gap, which, in this case is air. There is no action excepting that of strain until the spark passes. You must have a spark or else you have nothing but insulation, and this spark depends upon the kind of electrode you use, as to whether severity or mildness of treat- ment is desired. If you have a con- ductor in contact with the patient, and a spark gap between the patient and the machine you have a mild effect which does not irritate the skin.
Whether the spark gap is in one place or another the result is the same; it is the make and break of the strain. This was described by Mouduyt in 1784.
I have found that the static machine should be run at a speed varying from fifty to six hundred and fifty revolutions in therapeutics and for x-rays.
The test of a static machine is the length of its spark, the radius, one-half of the diameter of the revolving plates being the theoretical limit that a static machine should give under its best con- ditions. A few words in reference to leakage of a static machine: A static machine that does not leak will not give a current of any quantity.
Static electricity, so called, or static
974
THE AMERICAN X-RAY JOURNAL.
Priority, Radio-Therapeutics.
At the Roentgen Ray Society meeting in Buffalo an attempt was made to start a discussion on priority of the therapeutic uses of the x-rays, Dr. Pratt, of Chicago, read a paper in which he alleges to have used the rays as early as April 1 3, 1896, for the cure of lupus. This certainly was the first effort to so apply the new radia- tion. In July, 1898, Dr. Hahn, of Ham- burg, used it successfully in eczema. Freund and Schiff, of Vienna, used it in lupus in 1S97. Dr. Kummell, of Ham- burg, used it in lupus and in 1899, same year, published an article upon the sub- ject in the Annals of Electro-Biology. Professor Rieder, of Munich, published his researches on bactericidal properties of the x-rays in 1898 in Medicinische Wochenschrift. He proved its curative properties in lupus, eczema, favus, sy- cosis and psoriasis. Freund, Hahn and Holland June 15, 1900, published the treatment of 13 cases of lupus in Gesell- schaft der Aertze in Mien. Miss Sharp read her experience at the Roentgen Society of London, which was published in Vol. V, Nos. 2 and 4 of the Archives of the Roentgen Rays.
Becquerel Rays.
The preparations styled radio-active barium and radio-active bismuth refer to polonium and radium, respectively, compounds discovered by Madame Curie. By elimination and selection she isolated these from uranium and thorium ores, particularly the Bohe- mian pitch-blende. It requires several hundred pounds of this to obtain a few grains of the highest efficiency of radio- activity. When put in a small glass tube and covered, one end, with paraf- fined paper, they would emit invisible rays, behaving like the x-rays. Four inches from a plate, after 30 minutes' exposure, the shadow of the hand was observable, but nor the bones. How- ever, a piece of metal could be seen
through the hand. The screen fluoresces with Becquerel rays but too feeble for practical irradiations. F. Giesel, of Brunswick, has recently obtained in very small quantities slightly superior radio-activity.
One feature of the x-rays was well shown at the Buffalo meeting of the Roentgen Society in that we are in a condition of evolution. The science is not fixed, but with all its marvelous strides already made useful to man, it is fast growing. Apparatus exhibited at the New York meeting show at the Buf- falo meeting great changes. This is especially the case in simplicity of work- ing parts ana the controlling machinery.
The October issue of The American X-Ray Journal will contain some illus- trations of the therapeutics of the x-ra)s especially as it pertains to malignant growths. Clear description, of the meth- od of using the x-rays in these cases will be given. The importance of this mat- ter is so great the editor will answer per- sonal inquiry assisting others in raying.
There are now several women mem- bers of the Roentgen Society of America.
Antikamnia and Heroin Tablets.
This is a new combination tablet containing five grains of antikamnia and one-twelfth grain of heroin hydrochloride (muriate) and the medi- cal profession is so well acquainted with the two drugs composing it that it is needless to go into their respective histories. These tablets, aside from their use as a respiratory stimulent, sedative, analgesic and expectorant have been found an excellent remedy for the relief of pain and also a valuable anti-spasmodic in whooping cough. They are an efficient analgesic in the neuralgias, especially in sciatica, trigeminal and intercostal neuralgia. In the treatment of the morphine habit they are said to be of highest value. They constitute the safest and most efficient remedy in the treatment of cough, dyspnoea, phthsis, bronchial and laryngeal affections, emphysema and pneumonia. They have also been employed with very great success in hay fever, coryza, etc.
Administered for the severe pains of rheuma- tism, gout and lumbago, as well as for the light-
ADVERTISEMENTS.
Ill
ning pains of locomotor ataxia, there is no quick- er and more lasting remedy.
To adults they should be administered in one tablet doses, repeated every two, three or four hours, as indications warrant. Children accord- ing to age. A method which is preferred by many practitioners, particularly in respiratory ailments, is to direct patients to allow the tablet to slowly dissolve on the tongue, swallowing the saliva as the solution of the tablet progresses.
Book Review.
Webster's International Dictionary, of the English Language with a Supplement of 95,000 words and phrases by W. T. Harris, Ph. D., LL. D., Editor in Chief, Springfield, Mass. Published by G. & C. Merriam Company, 1900.
This is certainly the most nearly perfect lexicon of the English language. The book now com- prises more than 2,200 pages. In addition to the usual lexicographic contents, there are nearly 400 pages devoted to a Dictionary of Noted Names in Fiction; A Pronouncing Gazetteer; A Pronounc- ing Biographical Dictionary; Pronunciation of Scripture Proper Names, of Greek and Latin Proper Names; A Vocabulary of Common Eng- lish Christian Names; Quotations, Words, Phrases, Proverbs and Colloquial Expressions; Signs used in Writing and Printing; Selection of Pictorial Illustrations embodying the flora, fauna,
science and art; Guide to Pronunciation; List of Words Spelled in Two or More Ways; List of Amended Spellings, and Abbreviations, together with other information.
This dictionary is an improvement upon all former editions. The newer words and phrases brought about by the recent intermingling of dis- similar races, due to war and unprecedented commercial energy throughout the world, is here- in found. Nowhere else can these be found. The definitions of words are ample, clear and concise. Every person who regards knowledge must appreciate the superiority of the Inter- national Dictionary.
The cheaper books styled Webster's Dictionary are makeshifts and must disappoint and chagrin the buyer, for the definitions are often defective, many words absent and type and binding cheap. It is more difficult to purge the mind of false teaching than to learn correctly. Webster's International Dictionary will not burden the mind with unloading.
Mr. Puffer, manager of the Rochester Fluo- rometer Co., has reduced the price of the fluo- rometer from S100 to $50, which includes their fine operating table. They have also an im- proved apparatus, with which the fluorometer can be used with any table or on the floor, and is now sold at a very reasonable price.
The Kinraide High-Frequency Coil.
The best apparatus for use with the direct or alternating current*
••••••••••••
SEND FOR
DESCRIPTIVE
CIRCULAR.
EX B. Meyrowitz,
Maker of Ophthalmological Apparatus, Complete Standard Electro-Therapeutic Equipments.
X-Ray Apparatus and High Grade Eye, Ear, Nose and Throat Instruments. 104 East Twenty-third Street, )
West Forty-second Street, [ NEW YORK,
125
650 Madison Avenue,
604 Nicollet Avenue, Minneapolis. 360 St. Peter Street, St. Paul. 3 rue Scribe, Paris, France.
LI GE OF PHYSICIAN!
THE
IV
ADVERTISEMENTS.
The St. Louis
X-Ray Laboratory
Is owned and managed by
MR. M. E. PARBERRY, m. e.
Member of the Roentgen Society of the United States.
THE appointments of this Laboratory are as nearly complete as pro- fessional skill can accomplish. The static machine is of the highest grade and type and the coils are of the most recent designs. There are indications for the use of two designs of coils depending upon penetration and shadowing, which in each case must be selected. Likewise the static machine comes in requisition for another class.
One coil is equipped with an independent multiple vibrator, an interlock- ing switch, a fuse block, series and parallel spark gaps; and it may run on the 1 10 volt direct current circuit, no volt alternating current circuit, seven cells of storage battery, 14, 40, 70 volts, either its own or mechanical break, the electrolytic break or any outside break of the mechanical or mercurial type. The automobile service is a convenience to physicians where it is found im- practicable to move the patient from home or from hospital.
The experimental stage of the x-rays has passed and physicians now ask for clearer definition and proof of the accuracy of the picture shown. These two requisites are here accomplished. The aim is to reach as near scientific perfection as can be done and to offer to the medical profession a correct sys- tem indisputable in many cases and in others corroborative evidence. We have done work for more than 200 physicians, but desire to enlist the patron- age of all doctors both in and out of the city. No delay will occur when called to outside towns.
Our work includes pictures of the hip joint, stone in the kidneys, gall stones, tumors, abscesses and other work that formerly proved so difficult or
impossible.
We cordially solicit personal inspection of our work by physicians and surgeons.
M. E. PARBERRY, Manager.
Chemical Building.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X-RAY PUBLISHING COMPANY.
HEBER ROBARTS, M. D., M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE. United States, Canada and Mexico $3.00 | Foreign Countries $4.00
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 301 Chemical Bldg., St. Louis.
All business matter should be addressed to The American X-Ray Journal Publishing Co., same address.
All contributors of original articles and other matter relative to X-Radiance, of interest to the medical profession, are solicited from all parts of the world. Contributors will be furnished a liberal number of extra copies of the Journal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611 Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. 9. ST. LOUIS, OCTOBER, 1901.
NO.
CONTENTS OF VOL 9, NO. 3
CONTENTS OF VOL. 9, NO. 4.
Dr, G. P. Girdwood, Second President Roentgen Ray Society of America.
Dr- Heber Robarts, First President Roentgen Ray Society of America.
Illustrations.
Static Electricity.
Editorials.
Radiographs.
Priority, Radio-Therapeutics. Becquerel Rays.
President's Case, Diagramatical.
J. Rudis-Jicinsky, M. D., Retiring Sec- retary Roentgen Society of America. A Letter.
Recovered Case of Lupus.
Diagnosis of Renal Calculi.
Roentgen Rays in Military Surgery.
Becquerel Ray Burning.
Reasons Not Facts Altogether.
The Treatment of Cutaneous Cance
With the X-Rays. The Treatment of Congenital Club
Foot. Inconsistencies. Book Reviews.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
VOL. 9. ST. LOUIS, OCTOBER, 1901. NO. 4.
A Letter.
We are in receipt of a letter from Dr. Carl Beck, of New York City, dated September 23, 1901, in which he writes:
"'Dear Friend Dr. Robarts:
' 'I received the Journal this morning and hasten to congratulate you on the successful meeting at Buffalo. It is especially gratifying to me to see that you have elected a splendid set of officers and whatever I can do to encourage others to enter the society, shall be done. The only feature I do not like at all is that you did not accept the presidency again. The best men of the society have not done one-tenth as much as you did to build the society up under the most difficult circumstances. If I would have been able to follow my intention to be present I would have given expression to these feelings of mine. But I still had to be in the White Moun- tains at the time and had to take care of my burned hands. I experimented with new tubes of great power and am quite sure that it was my own fault that I was injured."
Constant readers of The American X Ray Journal will recall the studious effort of the editor to suppress all flattery of himself or personal mention where it could be avoided. But there is a far- reaching motive in this reference that will be understood by many now and by all a little later. Of course, all publish- ers and editors have received praise- worthy notes and compensating ones containing the venom of the culprit. WTith us it matters personally but little, for praise and calumny strike us about alike. Mr. Lincoln said that "When you come to rub up against men you find them about alike. " If there is any break in this rule it is in consanguinity.
Dr. Beck writes from the heart, be lieves what he says and writes what he thinks. He is an enthusiast and a build- er. He has written inductively upon the x-rays and done more to spread its correct teachings than any doctor at home or abroad. His book upon "Fractures" is classic and is the first effort of the kind by any surgeon. A doctor can not hope to be familiar with the modern practice of setting fractures without this book for reference. He has written scores of articles on surgical procedure with the x-rays as the surgical impliment for ac- curate diagnosis. It is no flattery to him in particular, but to the great domain of the sciences, to say that he has done more to arrive at a correct method of surgical diagnosis than any living man. Of course, from the first issue he has al- ways been a close reader of The American X-Ray Journal. The many egregious errors and recoiling mistakes made by men that have grown strong in other de- partments is due to lack of proper read- ing and the pratice of its precepts. Dr. Beck has evaded these mistakes. His counsel at the meetings of the Roentgen Ray Society will be most valuable.
The newly elected president of the society is one of its most enthusiastic workers. Dr. Girdwood cut short his European trip to be present at the Buffalo meeting. When asked to give ex- pression concerning the treatment of Mr. McKinley, by newspaper reporters, he instantly replied: "See the doctors in the case. I am not in the gossip
976
THE AMERICAN X-RAY JOURNAL.
business." His discussion of papers al- ways drew closest attention. He is scholary, dignified, and kind and was the best material for president. He need not, and it is now not necessary to write etters every day in the year, neither will ie need to question himself: "Am I a missionary or a financier?"
Going back to Dr. Beck's letter, he adds: — "I trust you will appreciate the spirit of admiration for the great strides of the profession in this country, in which to participate, I believe, is one of the greatest privileges of mankind. In a decade men will wonder why the x-rays had to beg for admission into the hearts of the profession — what fools those mor- tals be! And among the best your name will shine in the foreground then."
In The American X-Ray Journal for September, page 967, we referred to Dr. Beck's reprint, "Possible Error in Skiagraphy" and called his attention to an editorial on pages 671-674, the title of which is"Photographs and Radiographs, Proof of Accuracy Essential to Admis- sion as Evidence." The doctor reminds us that two months previous to this edi- torial he had advanced the same points before the German Medical Society of New York City, October 2, 1899, a rec- ord of which is made in New Yorker Medicinische Wochenschrift. We dia- gramatically showed methods for correct- ing distortions and reasons inaccuracies accompanied x-ray operators. Subse- luently a Western New York doctor claimed priority, but he has shown noth- ing in evidence.
In this connection it is interesting to note that Dr. Kean, who was formerly frowning on the x-rays, is now one of its most enthusiastic supporters. So it is .^een again that the devotee has encour- agement. As we have before said: "The complainer and wrecker fall together while the enthusiast and builder go on forever."
Recovered Case of Lupus.
The electro herewith shows a condi- tion of a patient after being cured of Lupus by the x-rays. The young lady gave a history of malignancy in mother and grandmother. The disease had been of 18 months' origin and spread rapidly over nose, inner canthus of both eyes and considerably over both cheeks. She had been treated with "paste," which denuded the parts and left scar tissue and prominent blood vessels. The disease rapidly recurred and at the
time she went under x-ray treatment could not sleep on account of pain. She was greatly emaciated.
A large German tube with a large static machine was employed, and 49 ex- posures were made. The tube was made to show articulations of the joints of the hand four feet away. Exposures were made daily of 12 minutes' duration, 10 inches from the face, the healthy tissue being protected with ^-inch surgeon's felt and a lead-zinc screen. Pain en- tirely ceased on the 10th day and never returned. The entire wound healed on the 40th treatment. The prominent blood vessels and scar tissue had greatly diminished on the 49th exposure, when the patient left for her home, 300 miles away. One year after, she wrote: "I am entirely well. The veins and scars
THE AMERICAN X-RAY JOURNAL.
977
are gone and no one can tell that I ever had a disease. My health was never better than now." In treating this case no local nor constitutional medication was used. The picture was taken at the time she wrote the above lines. No picture was made when treatment be- gan. Dr. Wm. Mayfield, of this city, sent the patient to the St. Louis X-Ray Laboratory for treatment.
Diagnosis of Renal Calculi.
A paper upon this subject was read by Dr. F. D. Carpenter, before the San Francisco Medical Society and is print- ed in full in the September issue of American Journal of Surgery and Gynecol- ogy. It is worth reading. Dr. Carpen- ter has not had much experience with the x-rays in these cases and frankly says so, but concludes his paper: "The abdomen is the most difficult portion of the body to x-ray, yet I believe that sooner or later this will be one of the established means of confirming the di- agnosis." It is possibly not strange, that all writers referring to the rays, whose work with it has been limited, in- variably speak hopefully of its future. If all readers would rightfully under- stand that the author of an article only expresses his personal judgment, then less confusion and false opinions would gain ground. Dr. Carpenter writes: "I believe sooner or later this will be one of the established means of confirming the diagnosis." It is a fact if this had been written early in 1896 it would have been timely and optimistic. But it was read before the society in April, 1901. four years at least, after the facts "I be- lieve," were established beyond contro- versy throughout the civilized world. Nobody acquainted with the facts has, for several years, questioned that the x-rays has "established means of con- firming the diagnosis" of stone in the kidneys.
Roentgen Rays in Military Surgery.
This is the title to a paper read by Dr. J. Hall Edwards, of Birmingham, England, before the British Medical Association, August 1, 1901. Dr. Ed- wards has been in South Africa as Sur- geon Radiographer to the Imperial Yeo- manry Hospital, throughout the entire Kingdom, and wherever the x-rays are used, Dr. Edwards' name is classic. He has done more to harmonize the sur- gical classes with uses of the x-rays than any other one surgeon in England. It is interesting to note that, though so much was written concerning his ingen- ious bicycle for charging the accumula- tors he pronounces it a complete failure. He says: "The Kaffirs took great in- terest in the proceedings, so I let them have a turn, but they soon gave in and lost all further interest in the object which had so bewildered them. I have no hesitation in saying that the bicycle arrangement is a failure, and that the machine I had so carefully designed is a monument of misplaced confidence."
He applauds the electrolytic inter- rupter above all other designs. The doctor, in one sentence, says a good deal, which must be very offensive to the American writers on the "in- accuracies" of the x-rays. It is this: "Professor Roentgen's discovery has placed in the hands of military surgeons an 'accurate' method of diagnosing oi inestimable value."
Among the interesting cases cited the one of Mr. A. D. Fripp is exceptional. A Mauser bullet was located in the spi- nal column; a laminectomy was per- formed and a bullet removed with the greatest possible success. On admission the patient was paralyzed in both legs and had lost control over bladder and rectum. The removal of bullet allevi- ated the symptoms. "I am pleased to say," Dr. Edwards writes, "that at the
978
THE AMERICAN X-RAY JOURNAL.
present time the patient can move about with the aid of sticks and has a fair chance of complete recovery." This case had been brought to the hospital from Mafeking after the relief, where the x-rays had been used for the purpose of locating the bullet with complete failure. Localizing instruments were used in all cases. This is most important. Strange, an ex-president of our American Medical Association was not able to use accurate localizers. A case is in point. We quote from the words of Dr. Edwards: "In no case was a bullet missed after a localization had been made; although in one case I think tt would have occurred had I not been present at the time of the operation. In this case a man was brought in with a suppurating wound over the patella of the knee, and a his- tory of having been operated upon for the purpose of finding a bullet, the pres- ence of which had been demonstrated by the x-rays. Several weeks were al- lowed to elapse before anything could be done. When the wound was quite healed a localization was made, and as it was thought advisable to remove the bullet, an operation was arranged for. The surgeon cut down under the local- izing marks until the surface of the fe- mur was reached, and no signs of the bullet being visible, he arrived at the conclusion that some mistake had been made in the localization. A careful in- spection of the bone led to the discovery of a minute crack immediately under my marks, and upon my advice the sur- geon removed a small piece of bone with a chisel, when the nose of the bul- let at once became visible and the mis- sile was removed. Had I not been pres- ent at this operation, the search might have been once more abandoned and the case might have been handed down to posterity as a glaring example of the uselessness of the x-rays. The failure to find the bullet on the first occasion was undoubtedly due to a want of knowl-
edge of, and sufficient confidence in the possibility of the x-rays."
I desire to quote again from Dr. Ed- • wards. This case has points of interest that may help some surgeons where they are pinched for adequate reasons for not removing a bullet at the time of the op- eration. I have been exactly in this sit- uation:
' 'Another exceedingly interesting case, and one which points to a moral, was one which came under the care of my friend, Mr. H. A. Ballance, of Norwich; and it is with his kind permission that I mention it here. It occurred in the case of a man who had an entrance wound three-quarters of an inch in length, sit- uated half an inch to the right of the middle line of the back, on a level with the sixth Dorsal Spine. There was a tender spot in front, about the middle of the second right Costal Cartilage. An ex- amination with the fluorescent screen showed the presence of a shrapnel bullet. This was localized with some difficulty, owing to the movements of the chest wall, at a depth of one-and-a-quarter inches. As the man was exceedingly well nourished, and was very muscular into the bargain, a discussion took place as to the whereabouts of the missile. A re-examination with the fluorescent screen showed that the bullet moved very slightly during the acts of inspira- tion and respiration, and that the move- ments coincided with those of the chest wall and not with those of the lung. It was thought, and in all probability the bullet had just penetrated the lung, and that an inflammatory area had been set up, causing adhesions. At the opera- tion, Mr. Ballance resected portions of two ribs, when, after a slight dissection, the presence of the bullet could be de- tected with the finger. During the ex- amination, however, the lung suddenly collapsed, carrying the bullet with it. On inserting the finger into the chest, the bullet could be distinctly felt on the
THE AMERICAN X-RAY JOURNAL.
979
surface of the lung; but could not, for obvious reasons, be removed. The wound was stitched up, and dressed, and the patient sent back to his bed. In ten days' time it was found that the lung had again assumed its normal con- dition, and it was decided to once more operate. The wound was ; reopened, and the bullet was removed without the slightest difficulty — new adhesions hold- ing the lung in position. In this inter- esting case, I very much doubt if the use of Wheatstone's Stereoscope would have helped us very much, as the bullet, although embedded in the lung, was sit- uated at such a short distance from the ribs, that even under these cond: tions its exact locale would have been to a great extent a matter of specula- tion."
Prior to the commencement of the war, Dr. Edwards writes: "Few members of the Royal Army Medical Corps had received any training in this most im- portant branch of military medical work; and most of those who had undergone a course, freely admitted that it was inad- equate to give them a complete knowl- edge of the subject."
Becquerel Ray Burning.
The American X-Rav Journal has previously alluded to the burn Becquer- el accidentally received from radium. The Electrical World and Engineer, N. Y. , Sept. 14, observes on this sub- ject: "In addition to the ordinary sun- burning which is prevalent in the north- ern hemisphere about this time of year, and is sought by giddy girls or callow boys, we have arc light burns, x-ray burns and Becquerel ray burns. It seems likely that the action in each of these cases is similar, but a careful compara- tive investigation into the differences of action would probably be both useful and interesting. While the sun burns at a distance of ninety-odd millions of
miles, the arc light and Crooke's tube act at a few centimeters, and radium at a few millimeters."
Reasons Not Facts Alto- gether.
At the Roentgen Ray Society at Buf- falo, a manufacturer of x-ray machines and a member of the society, complained that The American X-Ray Journal published a radiograph of the arteries of the pelvis and failed to give ways for making such an x-ray picture. He con- tended that nothing should go into The Journal without an adequate explana- tion. The point is well taken. In this particular instance of the hip we pre- judged possibly too much, for it seemed at the time that everybody would know it was an injected subject. Occasion- ally light shadows of normal arteries are shown, but no one has thus far been able to control radiance to the degree of repeating the picture in the manner and certainty of showing bones. Some newspaper articles have appeared ex- ploiting such a discovery, but the truth is not apparent. A case in point in the Sept. 21 number of the Philadelphia Medical Journal, ''On the treatment of Women's Diseases by Electricity," ex- tracted from a paper read before the Society of Gynecologists, St. Peters- burg, by Dr. A. N. Alexandroff. The extraction relates 14 cases of oophoritis, 6 cured; 10 of salpingitis and 3 were cured; 12 cases of parametritis and 11 cured; 5 cases of perisalpingitis and 4 cured, and several other diseases men- tioned, but not a word on nature of the current or method of application. Of course, such tables are practically worth- less without the details for imitation and judgment. Distance lends some credit to the report, for wise men are far and divine. The same sort of a report from a home doctor would hardly find room in an American journal.
THE AMERICAN X-RAY JOURNAL.
The Treatment of Cutaneous Cancer with the X-Rays.
Read before the Roentgen Society oi America, Uni- versity Building, Buffalo, N. Y., Sept. 10, 11, 1^01, BY GEORGE E. PFAHLER, M.D., Assistant Chief Resident Physician and Skia- grapher to the Philadelphia Hospital.
The following cases came under my ob- servation in the Phialdelphia Hospital, and the results obtained from the use of the x-rays have been sufficiently encour- aging to justify me in placing them on record. I take this method of doing it, trusting that the society will be inter- ested.
Case No. i was a white woman, age 70, admitted to the hospital July 5, 1900, for senile dementia. Her family history was negative. Twelve years ago a small sore developed upon the nose beneath the bridge of the spectacles. A crust soon covered it, but as fast as it formed it was removed, each time leaving the ulcer a little larger. The ulcer had increased in size more rapidly during the past year. This was specially noticeable during her stay in the hospital. Her mental condi- tion improved and she was transferred from the detention ward to the skin ward. The growth upon her nose was diagnosed as cancer by the visiting surgeons and dermatologists, and was considered in- operable. After consultation with Dr. Stellwagon, tne dermatologist on duty, we decided to expose the growth to the x-rays.
At this time the ulcer involved the en- tire base of the nose, was 3.5 c. m. in diameter, and extended into the inner canthus of each eye, as is shown in the photograph.
Treatment was begun Febuary 12, 1 901. A leaden mask was made to cover the entire face except that portion which was involved by the cancer. Kxposures were made on alternate days, for ten minutes each day, at a distance of about 25 c. m. from the tube, and with a current strength of ten amperes. A soft light was
used from a tube with a vacuum corre- sponding to a parallel sparkgap of about 4 c. m.
The first effect produced was a drying of the secretions, which was noticed after two days. Then a crust formed, and the edges assumed a healthy appearance. After two weeks the ulcer began to heal from the edges toward the centre, and in three weeks was 1 c. m. less in diameter. In three months the ulcer was reduced to .5 c. m. in diameter and was replaced by healthy scar tissue, excepting the right inner canthus which was much improved, but not yet healed. I regret that a pho- tograph was not made at this time. She then had an outbreak of insanity, and treatment had to be suspended. This condition of affairs has been recurring since, and her general health has failed,, so that at the present time the ulcer has again reached its original size.
Case No. 2. W. S., male, age 57,.
white, was brought to the hospital October 29, 1900, suffering from gen- eral paresis. One sister died of car- cinoma and one of phthisis. Otherwise the family history was negative.
Four years ago a small warty growth developed at the inner canthus of the left eye. This increased progressively in size and soon ulcerated. A diagnosis of epithelioma was made and treatment begun March 8, 1901. At this time, as his photograph will show, the cancer had
THE AMERICAN X-RAY JOURNAL.
981
involved the inner canthus of the left eye and both lids, to the extent of two-thirds of the palpebral fissure. It extended downward to one half the extent of the nose. One of the left submaxillary glands was involved. The same tech- nique was used in the treatment of this case as in the former one.
After the first two exposures a diminu- tion in secretion was noted, and after one month the lower portion of the growth had been replaced by apparently healthy skin. There was a gradual im- provement, despite the fact that the patient's general condition was growing progressively worse. On account of the difficulty in handling him, the intervals had to be increased, but by July 11, the open surface was reduced to .5 c. m., and this was granulating. The epithelioma had been replaced by what appeared to be healthy skin, except the margin of the open surface, which was thickened. The indurated submaxillary gland had dis- appeared. I expected him to be well of the cancer in a week or two, when he died of one of the episodes of general paresis on July 17. The accompanying photograph will show the condition at this time.
I would like to add that in this case it was impossible to shield the eye com- pletely, but no bad results followed, not even a conjunctivitis. This patient had in all 34 exposures.
Case No. 3. D. H., male, age 70, white, one of our workmen. One sister died with a growth about the knee which had existed five years. Otherwise the family history was negative.
Four years ago a small papule appeared upon the right lower eyelid. This never disappeared, but as fast as a crust would form it would be torn off, each time leav- ing the growth a little larger. During the past year it has increased more rap- idly in size. A diagnosis of epithelioma was made by one of our surgeons, a dermatologist, and an opthmologist,
and treatment was begun April 26, 1901.
At this time an elevated growth with an ulcerating surface occupied one-half
of the central portion of the lower eye- lid. In this case the same technique was used as before, except that I allowed the interval to be governed by the effect pro- duced, and varied from one to nine days. In each instance I allowed the inflam- matory reaction to disappear before re- newing the exposure. It was completely healed in two months, after nineteen ex- posures, and has remained healthy dur- ing the past two and one-half months. The epithelioma has been replaced by healthy skin, and a scar not more than 1 mm in width, which is freely movable. This covers a groove which indicates the site of previous destruction of the deeper tissues. The result obtained in this case is shown by the photograph taken two months after beginning treatment.
I have treated three other cases all of which show improvement, but are not yet well.
I regret that owing to the fact that the sections made from the cases reported above were poorly preserved, the pathol- ogist was unable to make a satisfactory examination. The cases were shown, however, to the Dermatological Society of Philadelphia, on May 21, when no question was raised as to the diagnosis. Dr. Kascher, one of the resident physi- cians, very kindly made the photograph for me.
I am not the first to use this method of
9^2
THE AMERICAN X-RAY JOURNAL.
treatment, but began independently, be- fore I had read the only report already made.
The literature on the subject is very meager, and consists of a few isolated preliminary reports from men who have begun the treatment at about the same time, and apparently worked independ- ently.
The first report that I find on record is that by Johnson and Merrill, of Wash-
ington D. C, published in the Phil- adelphia Medical Journal, December 8, 1900. They began treatment September 6, 1S99, upon a man who had a re- current epithelioma of the left cheek. Exposures were made every other day until fifteen were given.
The first result of the treatment was a diminution in the secretion and a firmer crust. Six months later a healthy scar had replaced the ulcer. Their sec- ond case was an epithelial cancer of the nose, the diagnosis being confirmed by microscopical examinations. Treatment was begun February 17, 1900. Ex- posures were made on alternate days of ten minutes each. Treatment had to be interrupted twice on account of der- matitis, but in six weeks nearly the en- tire growth had been replaced by healthy tissue. Since this report has been pub- lished I learn that they have treated an epithelioma of the lower lip, a recurrent carcinoma of the breast in which they noticed lessening in pain and slight diminution of the size of the tumor, also two cancerous growths on the nose, with success.
In The British Medical Journal, February 9, 1901, we find a preliminary report of twelve cases of rodent ulcer treated by Dr. James H. Sequira, of London. A patient was sent to him for the Finsen Treatment, but not being able to stand the pressure of the appa- ratus, treatment was begun by the x- rays, August 9, 1900.
The ulcer had been in progress eight years, had been operated on four times, and four years ago had been deemed unfit for further operation. The ulcer extended from the posterior surface of the auricle to within a short distance of the external occipital protuberance. At the junction of the scalp with the pos- terior aspect of the ear, the ulceration was very deep, and the ear itself was invaded, so that there appeared to be every probability of these parts sepa- rating should the disease extend further. Microscopical examination proved it to be rodent ulcer. At the end of one week the discharge was less, and the ulcer cleaner and somewhat shallower. At the end of thirteen weeks the ulcer was practically healed.
His second case was a rodent ulcer
involving the inner canthus of the right eye, and part of the nose and cheek. This was completely healed in about two months, and at the time of the report, two months later, the scar was perfectly sound. Of the twelve cases treated by Sequira, eight were still under treat- ment, and four under observation, the ulcer having been entirely healed. The treatment consisted of daily exposures of ten minutes each, with the tube at a
THE AMERICAN X-RAY JOURNAL.
983
distance of 15 cm. from the ulcer, with a 10-inch coil, and a current of 3-4 am- peres.
Dr. Stenbeck, of Stockholm (1) re- ports a case upon which he began treat- ment September 15, 1900. His case re- quired thirty-five daily sittings, of ten minutes each, at a distance of 10 c. m. The scar was still healthy one month after treatment.
In the Boston Medical and Surgical Journal of January 17, 1901, Dr. Wil- liams expresses himself favorable to this form of treatment of cancer, and reports improvement in cases under his care.
Dr. Andrew Clark reports in the British Medical Journal of June 9, 1901, a re- markable improvement in a case of chronic carcinoma of the breast. The induration as gradually fading, and the auxiliary glands decreasing in size, the pain diminishing, and the general condi- tion of the patient improving. Expos- ures were made five days in the week, and- continued from ten to fifteen min- utes. In all the cases treated the pain has been diminished or relieved, the growth diminished or removed, and the general condition of the patient im- proved. In no case now on record did any serious x-ray burn result. No other treatment was used in any of these cases.
The medical profession today recog- nizes that cancer can be cured when localized in a region favorable for opera- tion. Many patients, however, even in favorable cases, on account of fear of the knife, or painful caustics, postpone oper- ation until glandular involvement has taken place and all hope for cure is lost. Having now at hand an agent that is not painful, but soothing and yet effectual, we have removed the most cause for delay, and can recommend its use in all such, and in all inoperable cases. Let us then add our little mite toward bring- ing this common, insidious, and most loathsome disease under control.
Philadelphia, Pa.
The Treatment of Congen- ital Club Foot.
Dr. James K. Young, Professor of Orthopedic Surgery, Philadelphia Poly- clinic, in the International Medical Mag- azine for September, writes:
"(5) Astragalectomy. The removal of the astraglus is the best operation where it is necessary to correct very se- vere cases, but it should not be under- taken if the patient is under seven years of age, unless the bone is very greatly deformed. If the patient is treated from birth as recommended, and if multiple tenotomy with manual correction is per- formed early, it will seldom be neces- sary to resort to astragalectomy, unless the astraglus is very greatly deformed. Skiagraphs are of great value in deter- mining whether the astraglus will fit in between the two malleoli. If this bone is so much deformed that it can not be replaced after the soft tissues have been divided, it will be necessary to remove it, and this may now be frequently de- rermined before the operation is begun by means of x-ray photograph)'. After the astragalus has been removed it is al- ways necessary to cut the tendo achil- les."
Every doctor and every scholar taking pride in knowledge of the Roentgen Rays reads The American* X-Ray Jour- nal. It is for this reason Elihu Thom- son, Wm. Meadowcraft, Nikola Tesla, Carl Beck, J. B. Murphy, Roswell Park and the class that make history read The Journal.
Dr. Cummings, in Practice and Review for July, voices the teachings of The American X-Ray Journal long ago ex- pressed, that error in determining urin- ary calculi is due to "faulty technique and inability to correctly interpret the skiagraph and not to the method it- self."
9*4
THE AMERICAN X-RAY JOURNAL.
Inconsistencies.
It is most gratifying to note that the firm stand taken by The American X Ray Journal many months ago against the inconsistencies of writers upon the "Inaccuracies of theX-Rays," has silenced all such pretenders. Writers are now appearing in the assumed garb of originality, disclaiming the possibility of inaccuracies of the x-rays. Continue to write, brothers; it is possible every- body has not read The American X-Ray Journal.
Dr. George G. Hopkins, in the Phil- adelphia Medical Journal, is writing a most interesting series of articles en- titled, ''Light and Radiance in the Treat- ment of Disease." There is one para- graph we wish to refer to: "The x-rays has been and is being tried; but as it has so much bony substance to pass through before reaching the diseased
structure within the chest, there is great danger of doing damage to the superim- posed tissue of the chest, if sufficiently hard tubes are used to penetrate the diseased lung." The records do not show damage done to the chest when sufficiently hard tubes are used to pen- etrate diseased lungs. The rays do not kill the germ in the manner of germi- cides. There is a reaction established by the rays, which empowers nature to do the work of establishing health when there was disease. The vis medicatrix nature is the power brought out and enthroned. The phagocytes are here in evidence.
Book Review.
A Treatise on the Acute Infections Exanthemata, including Variola, Rubiola, Scarlatina, Rubella, Varicella and Vaccinia, with Especial Reference to Diagnosis and Treatment, by William Thomas Corlett, M. D., L. R. C. P., London. Professor of Dermatology and Syphilology in Western Re- serve University; Physician for Diseases of the
. W, ft - ■
METHOD OF < I TTINC OFF UNNECESSARY RAYS WHILE TREATING CANCER, st. Louis X-Ray Laboratory.
THE AMERICAN X-RAY JOURNAL.
985
Skin to Lakeside Hospital; Consulting Derma- talogist to charity Hospital, St. Alexis Hospital, and the City Hospital, Cleveland; Member of the American Dermatological Association, and the Dermatological Society of great Britain and Ire- land-. Illustrated by 12 Colored Plates, 28 Half tone Plates from life, and two Engravings, Phil- adelphia. F. A. Davis Company, Publisher, 1901.
For the young practitioner of medicine and for the older, whose experience has been interrupted from constant clinical experience with the infec- tious exanthemata, this book is especially needed. At the outset there is a brief history of the orig- inal source of these diseases, covering nearly 30 pages. It is a most interesting account, dating from the earliest period in all nations of the earth.
Definitions, Varieties, Symptomatology, Etiol- ogy, Diagnosis. Prognosis and Treatment are each subdivided into distinct head-lines giving a variety of catch-attention that betrays an essential
feature, The subjects are illustrated with col- ored and half tone plates in constant evidence of description. The book is richly printed and substantially bound, covering about 400 pages. Infectious diseases are lessening in the civilized races, and the type is somewhat modified, prob- ably due to sanitation, disinfection and isolation, making diagnosis the more difficult. The writer only recently saw a case that had been diagnosed smallpox, and was confirmed by two older prac- titioners. The patient was quarantined and his residence displayed a red flag. The patient de- fied the authorities and his doctors and sought additional advice. The case was a simple form of impetigo. A perusal of this book would have negatived variola at the beginning.
An International System of Electro-Therapeutics , by numerous associated authors. Edited by Ho- ratio R. Bigelow, M. D. Second Edition edited by G. Belton Massey, M. D., Ex- President and Fellow of the American Electro-Therapeutic As-
The Kinraide High-Frequency Coil
The best apparatus for use with the direct or alternating current,
••••••••••••
SEND FOR
DESCRIPTIVE
CIRCULAR.
EX
Maker of Ophthalmological Apparatus, Complete Standard Electro-Therapeutic Equipments,
X-Ray Apparatus and High Grade Eye, Ear, Nose and Throat Instruments. 104 East Twenty-third Street, ) 604 Nicollet Avenue, Minneapolis.
125 West Forty-second Street, -NEW YORK, 360 St. Peter Street, St. Paul.
650 Madison Avenue, ) 3 rue Scribe, Paris, France.
X-RAY TUBES.
Perfect Glass, Reinforced Seals. They Can Always be Repaired.
X-Ray Tubes re-exhausted and repaired. Also Atomizers, Nebulizers for heavy fluids, and Inhalers Glass apparatus of all kinds. Correspondence Solicited.
STUNTZ & ARMSTRONG, - - Owensboro, Ky.
986
THE AMERICAN X-RAY JOURNAL.
sociation; Member of the American Medical As- sociation; Author of Conservative Gynecology and Electro-Therapeutics, etc. Thoroughly illus- trated. F. A. Davis Company, Publishers, Phil- adelphia.
This book is somewhat voluminous, covering about 1200 pages. It is full of good matter. Ver- bosity has no place in the book. Every sentence seems to have been framed to express a thought pertaining to the direct purpose of the subject. There are seven grand divisions, which includes the entire matter, denominated sections. Each of these sections are subdivided, and an author chosen exclusively for that subject. The care- fully prepared composition betrays direction of thought, of experienced and capable teachers. Section A, is the "Introductory," and it is a beautifully written historic sketch of electricity. Section B, Electro-Physics and Electro-Physiol- ogy, is subdivided into nine parts, each of which is written by different authors. This subject covers 328 pages. Section C, Gynecology and Obstetrics has ten subdivisions with a different writer for each. Section D, Diseases of the Nervous System. Section E, Disorders of the Abdominal and Thoracic Viscera. Section F, Diseases of Childhood. Section G, Electro-Sur- gery. Those writing upon this subject are, Drs. L. A. W. Alleman, Charles E. de M. Lajous, I). D. Stewart, Robert Newman, J. Inglis Par-
sons, G. Belton Masey, John Byrne, Henrietta P. Johnson, Plym. S. Hayes. The book is made up by many of the best practitioners and writers in America. The student and doctor will make no mistake in using this book as his guide in practice.
Flugel-Schmidt-Tanger. A Dictionary of the English and German Language for Home and School. In two parts. With Special Reference to Dr. Felix Flugel Universal English-German and German-English Dictionary Edited by Pro- fessor Im Schmidt, Ph., D. and G. Tanger, Ph. D. Fifth Edition. Lencke & Buechner, 812 Broadway, New York City. Price for two Vol. $5.50.
These two fine, large volumes, containing more than 1,000 pages, is probably the best English- German and German-English lexicon now in print. For the purpose for which this dictionary is compiled it meets the ready wants of students and scholars. The print is large, clear and new and the definitions embrace besides their fullest clearness, the synonymous words and terms. Each of these books follow this style, making the vol- umes compare favorably with our great Interna- tional Dictionary of the English language. Eng- lish scholars using German and Germans using the English, especially all persons in the profes- sions must use, if they would seek the purest lan- guage-Flugel, Schmidt-Tanger Dictionary.
You Turn the Button and the Motor Does the Rest.
Explains the simplicity of our
Self- Exciting Holtz Static Machine.
It is the Only Self- Exciting Holtz Induction Machine made.
It is the only Holtz Machine which does not require an auxiliary charger
to excite it.
Self-Exciting, Simplicity, Durability, Compactness and Beauty
ARE ALL QUALITIES OF
Detainer's Self-Exciting Holtz Static Machine,
Manufactured only by
Detwiller Manufacturing Co., #aJ£2£at Buffalo, N.Y.
PRICES ON APPLICATION.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X-RAY PUBLISHING COMPANY.
HEBER ROBARTS, M. D., M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE. United States, Canada and Mexico ..$3.00 | Foreign Countries $4.00
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 301 Chemical Bldg., St. Louis.
All business matter should be addressed to The American X-Ray Journal Publishing Co., same address.
All contributors of original articles and other matter relative to X-Radiance, of interest to the medical profession, are solicited from all parts of the world. Contributors will be furnished a liberal number of extra copies of the Journal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611 Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. 9. ST. LOUIS, NOVEMBER, 1901. NO. 5.
CONTENTS OF VOL. 9, NO. 4.
J. Rudis-Jicinsky, M. D., Retiring Sec- retary Roentgen Society of America. A Letter.
Recovered Case of Lupus.
Diagnosis of Renal Calculi.
Roentgen Rays in Military Surgery.
Becquerel Ray Burning.
Reasons Not Facts Altogether.
The Treatment of Cutaneous Cance
With the X-Rays. The Treatment of Congenital Club
Foot. Inconsistencies. Book Reviews.
CONTENTS VOL. 9, NO. 5.
Visual Localization with Fluorometer. Cancer.
Prospect of Cure in Cancer. Diagnosis of Cancer of the Stomach. Treatment of Inoperable Cancer. Turck's Gyromele. X-Ra}' Tubes.
Some Problems of Radiology.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X Ray Work and Allied Arts and Sciences.
VOL. 9. ST. LOUIS, NOVEMBER, 1901. NO. 5.
Cancer.
So much is being written of late upon the care of cancer, that it is interesting to note what Dr. N. Senn, of Chicago, has recently said upon the origin and source of this disease. It is of special interest now because of the claims made by x-ray operators that malignant dis- eases are cured by the Roentgen ray, provided the disease is an open one and accessible.
Dr. Senn says — ( American Surgery and Gynecology')'. "Carcinoma is due to a typical proliferation of the epithelial cells from the matrix of embryonic cells of congenital or post-natal origin. The law of legitimate succession of cells holds true in the origin and growth of tumors, both benign and malignant, as well as in the production of normal and inflammatory tissue. Being primarily epithelial, carcinoma in the mesoblastic tissue is impossible except by displaced inclusions of epithelial tissue. The his- tology and histogenesis of carcinoma are against the parasitic origin of the disorder. The stroma of carcinoma consists of pre-existing connective tissue fibers and their descendants. Carcino- matous cells usually multiply by irregu- lar atypical karyokinesis, and this path- ologic segmentation is an important in- dication of malignancy and of consider- able diagnostic value. The progressive extension of tumors to adjacent tissues and organs, regardless of their structure, is strong proof of carcinomatous charac-
ter. Regional metastasis takes place exclusively through the lymphatic chan- nels and the pre-existing lymphatic structures take no active part in the ori- gin and growth of secondary tumors. The general dissemination of carcinoma usually takes place by direct implication of veins in the primary or secondary tu- mors. The carcinomatous cells reach the venous circulation through the for- mation of an intra-venous tumor throm- bosis or carcinomatous endophlebitis or through perforation of the vein walls by carcinomatous cells. Retrograde intra- venous extension is due to the transpor- tation of minute emboli of carcinoma cells against the current surrounded by a mantle of blood corpuscles which move step by step on the intima. Re- trograde extension through lymphatics may take place in the same manner, but is more frequently the result of carcino- matous endolymphangitis. The in- crease of carcinoma is more apparent than real and heredity is a generally recognized predisposing cause. As a rule it occurs in elderly persons, but oc- casionally is met with in individuals un- der 25, and then is specially malignant. It seldom follows a single injury, but generally follows repeated or prolonged irritation. Among the predisposing causes must be numerated racial, climat- ic, and topographical influences. Chronic inflammatory products, cica- trices, and benign epithelial tumors are favorable local conditions. The positive results of implantation and inoculation
988
THE AMERICAN X-RAY JOURNAL.
experiments have thus far failed in es- tablishing the parasitic theory and a careful study of the experimental re- searches and the bacteriologic and histo- logic investigations do not warrant us
Cancer of the Breast, after Primary Operation. Case of Dr. I. N. Scott, Kansas City, Mo.
at present in claiming a parasitic origin for carcinoma. The experience of cen- turies with medication has demonstrated that thus far carcinoma is not materially bettered in this way. Direct medica- tion of carcinomatous tissue by paren- chymatous injections has no influence, while the injection of sclerogenic sub- stances into the surrounding connective tissue appears to restrain the local ex- tension by impairing the blood supply. Local applications of any kind for ulcer- ative carcinoma can be only palliative at best. The actual cautery and chem- ical caustics have only a limited field of usefulness in open inoperable carcinoma and should never be used in treatment of closed carcinoma in place of the knife. The serum treatment has yielded only negative results. The early and radical operative treatment offers the only prospect for permanently eliminat- ing the disease, which can be deter- mined only after a lapse of 10 years or more after operation. Radical opera- tion should never be attempted unless local conditions and the general health are such as to warrant it. Admitting carcinoma to be the product of erratic,
planless cell growth, not governed, by the influence of the regular normal tis- sue change, it appears logical to make experiments and observations to find the remedy which will destroy the tumor by causing early and steady degeneration of its parenchyma, or which possesses the property of converting embryonic into mature epithelial cells, thus con- verting a carcinoma into a benign epithe- lioma. "
Dr. G. 'Wiley Broome, in the St, Louis Medical Review, holds to the view that carcinoma- is a parasitic disease. He, however, acknowledges that labora- tory researches are not yet conclusive. He says: "The distinctive character of malignant tumors in the rapidity of their development, the extension of metas- tasis, which so strongly resemble those of diseases known to be due to bacteria, the cachexia out of proportion to the extent of the local disease, and suggest- ing the formation of a toxic substance, the fact that a spontaneous cure never takes place, the disease moving onward relentlessly to the fatal issue, and final-
Cured by X-Rays after 100 Treatments. Case of Dr. I. N. Scott, Kansas City, Mo.
ly the liability of recurrence even after operation, are so many clinical evidences pointing to a parasitic origin. La- boratory researches are not yet conclu-
THE AMERICAN X-RAY JOURNAL.
989
sive, but point to this origin. Plimmer examined microscopically 1,298 cases of carcinoma, in 1,130 of which he found parasitic organisms, while ninety of the entire number were unfit for examina- tion. He states positively that those bodies are constantly present in cancer and constantly absent in other diseases or degenerative conditions. The au- thor believes the outlook to be very hopeful as regards the discovery of the cause and the cure of cancer."
In a paper read before the American Dermatological Association, May, 1901, Dr. William Allen Pussey, of Chicago, says: "As Oudin, Berthelemy and Da- rier have shown, the effect of the x-rays upon the epithelial structures of the skin is to increase the vitality of the least differentiated skin elements, while the differentiated elements — hair, nails and glands — undergo retrogressive changes and atrophy."
Dr. Senn holds that carcinoma is due to atypical proliferation of the epithelial cells, from the matrix of embryonic cells of congenital or post-natal origin. Now, if it is true, as Dr. Pussey says, that the effect of the x-rays upon the epithelial structures of the skin is to in- crease the vitality of the least differen- tiated skin elements, is not this a safe explanation for the curative effect of the x-rays in cancer? It is certain that the rays have but little bactericidal effect in the rays themselves, but it is equally certain that they have a peculiar stimu- lating effect, favorable to healthy resto- ration.
Prospect of Cure in Cancer.
Horace Manders thinks that the great point in the treatment of cancer is to fix one's attention on the natural forces in- herent within the body. We have in electricity, for instance, an agent capa- ble of directly and profoundly affecting the molecular changes that go on with- in cells, increasing metabolism and re-
sistance to adverse influences. In can- cer we may not have to deal with an in- vading microbe, yet it is evident that some malign source is at work, whose influence the natural defensive powers of the body have become unable to re- sist, and it is only reasonable to infer from analogy that if these inherent pow- ers could be revitalized to the extent that generally obtains in the equilibrium of health, as has been done in tuberculo- sis, then there is a definite prospect of a cure for that even more intractable dis- ease— cancer. If these inherent powers did not exist, we should all fall victims, as it is unreasonable to suppose that we are not constantly exposed to the source of cancer, just as we are to that of tu- berculosis, of which we are now well aware. It is quite possible that the ul- tra-violet rays of the spectrum have a distinct value in this condition. Yeast treatment is unreliable. The author closes with the statement that in cur- rents of high potential and exceeding frequency we have a means, hitherto un- known, of stimulating the vital energy of cells and of enabling them to utilize, by taking into their protoplasm auxilia- ry remedies; and that sometimes one and sometimes another, when used in conjunction with these currents, will be found to be the particular one needed.
Diagnosis of Cancer of the Stomach.
J. C. Hemmeter says that the nature and concept of an early diagnosis of can- cer of the stomach are intimately asso- ciated with a knowledge of the duration of the disease, which can be approxi- mately ascertained by three methods: (1) By observing the rate of growth in cancers that are open to direct inspec- tion, e. g. those of the uterus, mammae, rectum, etc; ; (2) by noting the size and rate of growth after the first beginning of subjective and objective complaints
99o
THE AMERICAN X-RAY JOURNAL.
in tumors capable of palpation; and (3) by noting the rate of growth in visible or palpable metastasis. Cancer of the stomach often occurs in relatively young patients. There is nothing characteris- tic in the early dyspeptic symptoms, i I a matemesis occurs in 50 per cent of cases, and constipation in 75 per cent. Hydrochloric acid disappears from the gastric juice, absorption is lessened, lactic acid is generally absent (but this is a later symptom ), the peptic and ren- net ferments are decreased pari passu with the HC1. In the examination of the stomach contents only two structur- al elements have a possible diagnostic value, viz., fragments of the neoplasm and the Oppler-Boas bacilli. The urine contains albumin in about 40 per cent of cases, while indican occurs in excess in about 90 per cent. Demonstration of a tumor is the infallible sign, but it often comes very late in the course of the disease. The author would recom- mend exploratory laparotomy in all cases of gastric disease associated with rap- id emaciation, absence of HC1, reduc- tion of proteid digestion under 30 per cent, and the presence of lactic acid, shown by Uffelman's test, or of numer- ous long base ball-bat shaped Oppler- Boas bacilli. He thinks little can be hoped for from operation in the case of cancer of the stomach, and looks for- ward to the possible discovery of a cure through the methods of research now being pursued.
Treatment of Inoperable Cancer.
The conclusions arrived at by Alfred Cooper, F. K. C. S., and expressed in The Lancet^ October 12, with regard to the remedies recommended in the treat- ment of inoperable cancer are as follows: I 1 1 That in cases of inoperable sarcoma, more especially the spindle-cell variety, the patient should have the option of Coley's fluid given to him, since a cer-
tain number of cases have been cured; (2) That in cases of inoperable cancer of the breast, in women of about forty years of age, in whom the menopause has not occurred, the operation of oophorectomy should be proposed, and this treatment may be combined with thyroid feeding; (3) That in cases of in- operable rodent ulcer, and the superfi- cial malignant ulceration in other parts, the Roetgen rays give a good hope of improvement; (4) That in cases where these other methods are declined, or are inapplicable, the internal adminis- tration of celandine is worthy of trial, and when the case appears quite hope- less, morphine should be pushed with- out hesitation; (5) Finally, Mr. Cooper would suggest that, before trying any of these remedies, the risk should be fully pointed out to the patient that the faint hope, that most of them afford, should not be magnified, and that the discom- fort of treatment should be fully dis- cussed; in fact, the surgeon should not do more than offer the treatment, and leave the patient to accept or refuse it.
Buffalo, N. Y., Oct. 29, 1901. Heber Robarts, M. D.
Dear Doctor: — The Pan-American Exposition now about to close, although in many ways replete in electrical mani- festations was nevertheless woefully short on x-ray apparatus and radio- graphy.
Inasmuch as St. Louis is the home of our X-Ray Journal and its enthusiastic promoter, I most respectfully suggest that in your World's Exposition, a suit- able building be set apart under your management for the proper display of the wonderful achievements in this most progressive and humanitarian of modern sciences. Yours most sincerely,
John T. Pitkin.
True to the newspaper announce- ment, Dr. Wriggle has an x-ray society. The doctor is elected president.
THE AMERICAN X-RAY JOURNAL.
99i
Turck's Gyromele,
And the X-Rays in the Diagnosis of Dis- eases of the Stomach.
BY J. RUDIS-JICINSKY, A. M.,M. D., M. E., Read by title before the Roentgen Society of Ameri- ca, University Building, Buffalo, N. Y., Sept. 10, 1901.
The frequent opportunities I have had since the valuable discovery of the x- ray in correct and absolutely reliable diagnosis seemed to impress me, as well as others, of the practicability and use- fulness of these mysterious rays, rather than the records of a lot of theoretical uncertainties. We may now reproduce renal, biliary, vesical and other calculi on the photographic plate, diagnose posi- tively the beginning of tuberculosis pul- monalis, other diseases of the lungs, aneurisms, arterio sclerosis, intestinal obstructions, diseases of the bones, make out the tumors in the brain, diag- nose and see the adjustment of the frag- ments in fractures, reduce disloca- tions properly, observe the growth of the bones, movementsof the joints in normal state or altered by trauma, find foreign bodies without the dreadful probe and do such and other delicate work in ra- diology that seems to give a wonderful range of usefulness to the x-rays not only in surgery, but medicine also.
I do not say that the x-rays are the only means of diagnosis, I do not state and would not like to state that they are the only reliable way to make a diagno- sis, but I would positively and most em- phatically pronounce the application of the x-rays in popular hands or suffi- ciently skilled and experienced surgeons and x-ray workers, as the best, rapid and practical method by means of which in combination with all other methods a correct diagnosis, based on the history of certain cases, their symptoms as ob- served and exact clinical behavior may be made, when all other methods alone have failed. And that means very much.
Just to show how much it means, for
instance, in the diagnosis of certain con- ditions of the stomach, allow me to de- monstrate to you Turck's gyromele which in combination with fluoroscopic examination or a proper skiagraph, may reveal to us the real condition of the diseased stomach.*
It is not necessary to fill up the stom- ach with albumen or subnitrate of bis- muth to make out the exact outline of the stomach, to see the greater curvature or observe the lesser curvature, the fun- dus, and the pylorus with the help of our x-ray, and we need no more to do the same in trying to diagnose a dilata- tion of the stomach or any obstruction existing at the pylorus. If we introduce Turck's gyromele or the revolving sound — a flexible wire cable — with a sponge attached to the cable and ob- serve the same with the fluoroscope un- der the x-ray, we can easily follow the cable along the oesophagus, examine its condition and go down to the stomach and along the walls of the same. The gyromele will give us the character of the stomach walls, show any thickening, the distensibility of the stomach, the flexibility of the same and beside this, proofs of the physical condition will help us to diagnose atrophy better than any test meal can, with the help of the sponge on the end of the cable. To make out any obstruction or the extent of a tumor or carcinoma we need only to introduce the gyromele and see with the fluoroscope how far the cable goes, where about it struck and may some- times get some blood stains on the end of the cable or plenty of the stomach contents, which easily can be examined HCL The main part that the whole procedure of this new method of com- bined diagnosis does not take more than fifteen minutes, counting the introduc-
*The use of the x-rays for translumination of the body with gyromele in site was demonstrated by Fentor B. Turck, M. D., in the spring of 1896, and diagnosis made. See the skiagraph, journal A. M. A., May 4, 1901.
99 2
THE AMERICAN X-RAY JOURNAL.
tion of the gyromele, fluoroscopic ex- oesophagal tube and then refilling the amination and making a skiagraph, if stomach with fluid. By noting the low- necessary. It is a rapid work, positive er limit of percussion dullness then pro-
and correct.
duced, the lower border of the stomach
a
Penzoldt's modification of Piorr'a was determined. This diagnosis might
method of determining gastric dilatation be accurate in some cases, but not a
was, for instance, to withdraw the con- positive one in every case. In dilatation
tents of the stomach by means of the with obstruction this method could not
THE AMERICAN X-RAY JOURNAL. 993
be used as readily but the gyromele with tient, no danger of displacement, any
a smaller cable may diagnose the ob- marked feeling of distress and the whole
struction first and be pushed slowly opportunity of positive diagnosis, when
along the walls of the dilated stomach, all other methods failed. In making the
by the assistant, and we may follow the skiagraph of the stomach containing the
cable from outside through the abdomi- gyromele cable it is always well to have
nal walls, see how it goes and where. not only all the methods of diagnosis in
There is absolutely no danger to the pa- mind, but the picture to be made must
994
THE AMERICAN X-RAY JOURNAL.
have some stamp of truth on its surface. For this reason I always cover the umbil- icus with some metallic button which will appear on the photo to give us a guide for measurements and proper estimation of the dilatation, etc.
A. M. The patient, a laboring man, aged 45 years. More or less promi- nent symptoms of indigestion about a
pected and there is no obstruction at the pyloric end of the stomach. The ease with which the whole viscus can be pushed by the use of different cables of different flexibility, indicates the pres- ence of gastroptosis and the thick walls at some places giving slight shadow show hypertrophy. As you see the di- agnosis by means of the gyromele cable
year ago. Pain constant at the "pit of the stomach," increased by taking food, especially of an irritating character. Tenderness at one or more points, ex- tending from the front to the back. Vomiting is almost constant as pain, coming on soon after eating, but some- times an hour or more later. Rejected matter undigested or partly digested food or acrid mucus, no blood. Gas- tralgia frequent. The general condition of the patient not significant, the nutri- tion is but little deranged. The bowels are constipated, the stools hard and dry. Offensive regurgitation. The patient being excessive beer drinker, drank twenty or more glasses of beer habitual- ly, every day. On inspection no tumor in the pyloric region, on percussion tympanic note extending below the um- bilicus, but how far, it could not be made out positively. On ascultation a rumbling sound, but not always and not distinct when the body was shaken. Diagnosis: Gastric dilatation. If from the result of pyloric stenosis could not be made out. Turck's gyromele ap- plied and skiagraph made. The gyro- mele shows plainly under the X-Kay that the dilitation is greater than ex-
combined with palpitation and the appli- cation of the x-ray in this case was made certain and easy. "'The treatment itself was ordered accordingly.
Cedar Rapids, Iowa.
The genial and able editor the Ameri- can Electro- Therapeutic and X Ray Era, checks the claim of The American X-Ray Journal as the only x-ray journal in this country. Editorially we have al- ways refrained from self praise or boast- ing and have even left out this same character of matter written by others un- less there was associated with it an edu- cational point. But to the present date this is the only publication exclusively devoted to x-ray work. The American Electro-Therapeutic and X-Ray Era just- ly combines electro-therapeutics with x-ray matter and one or two other pub- lications in the East have added x-rays. Of the personality of the others we know not, but our personal knowledge of Mr. R. Friedlander is most favorable. He is not alone a genial and courteous gen- tleman but a good writer and earnestly engaged in x-ray work. He will succeed with his journal because integrity and worth will win.
THE AMERICAN X-RAY JOURNAL.
995
X-Ray Tubes. .
BY EMIL H. GRUBBE, B. S., M. D., Professor oi Electro-Physics, Radiography and X- ray Diagnosis, Illinois School oi Electro-The- rapeutics. Lecturer on Electro-Therapeu- tics Hah. Medical College and Hospital. Chief Radiographer Illinois X-Ray and Electro-Therapeutic Labora- tory. Member oi Roentgen So- ciety of United States, also Electro-Medical Society oi Chicago, etc.
Read before the Roentgen Society of America, Uni- versity Building, Buffalo, X. Y., Sept. 10, 15*01.
The constant investigations of the past year with the Roentgen phenome- na have developed immense improve- ments in x-ray apparatus. But great as has been our progress as regards ap- paratus and methods, comparatively slow progress seems to have been made in developing that most important part of an x-ray outfit, the Crooke's vacu- um tube.
I wish, in this paper, to give a short review of the principles applied in the construction of tubes and incidently to throw out a few ideas as pertains the methods involved and the kind of tube necessary in order that we may get good, powerful x-rays. This standard, I believe, as far as we now know, is the only one which gives us any conception of the variability of x-rays.
From the great variety of tubes now upon the market we must consider that many attempts have been made to im- prove the Crooke's tube. At present the so-called standard tubes are made upon a general plan which consists of a vacuum bulb of thin glass, having two tapering ends, from one of which enters a highly polished concave aluminum disk, called the cathode, and from the other projects, almost to the centre of the tube, and usually from three to four inches from the aluminum disk, a thin sheet of platinum x-rays are sent out of the tube.
In order that I may not be misunder- stood later on, I wish now to make a
general statement including my opinion of x-ray excitation and partially its ori- gin.
The x-ray is the result, primarily, of electrified particles of gaseous matter propelled or pushed by high voltage from the cathode disk of a vacuum tube, directly opposite this manifestation has been called the cathode ray. When cathode rays are stopped in their terrific speed through the bulb of a tube, by the interposition of a very dense body, as for instance platinum, a trans- formation' occurs, resulting in a peculiar manifestation which we recognize as x-rays. The x-rays then are the re- sult of the reflection or convergence of electrified discharges from the concave aluminum disk to the platinum sheet which is placed in a direct path. Now, when the currents discharged into a vacuum tube are heavy or long con- tinued the platinum sheet becomes red or even white hot, indicating the trans- formation of tnese cathodic electric waves into heat waves. We know that in the ordinary x-ray tube the vacuum is never a constant, but always varies and that this variability increases as we use the tube. The cathode rays de- pend for their generation upon a certain degree of vacuum, and if this vacuum is constantly varying, of course the cath- ode rays vary in quantity and quality and consequently the resulting x-rays vary accordingly.
It behooves us then in order that we may have a constant x-ray value, to provide tubes which will keep, as near as possible, a stationary vacuum and in addition will at all times be under per- fect control of the operator. The all desirable qualities which a tube should have, depend largely upon the purpose or use to which we expect to make the tube. I believe it is impossible to con- struct a tube which will be ideal for all varieties of exciters and also for all va- rieties of uses, viz.: Radiographic,
g96 THE AMERICAN
Fluoroscopic and Radio-Therapeutic.
Today the best type of tube for ra- diographic work is, no doubt, the so called "focus tube." A focus tube has its internal electrodes so shaped and placed that the cathode rays emanating from the negative concave disk will be collected and concentrated upon the positive platinum sheet at a very small area or spot.
When a tube is of such vacuum that it just begins to permit the production of x-rays we say we have a low vacu- um or a soft tube. By -the aid of a fluo- roscope we can always determine rela- tively the vacuum of a tube. In gener- al, we may say, that if the hand is placed before the fluoroscope five inches from the tube and the bone outlines are not clearly distinguishable we have a low vacuum tube. If now the vacuum is raised we shall have more and clearer bone outlines and finally in using a high vacuum tube the x-rays pass through the bones so that they appear only faint in outline.
Under ordinary conditions of low or medium vacuum we can usually make out two separate and distinct hemis- pheres in the tube bulb, one dark, emit- ting no fluorescent light and one lumi- nous, emitting a greenish light, but when we excite a very high vacuum tube using a very high voltage current not only does the platinum disk and the luminous hemisphere give off x-rays but, in fact, the whole tube gives off appreciable rays.
Before making a radiograph a fluo- roscopic view should always be made to determine the vacuum of the tube. I believe at present we know of no other method which may be used as a stand- ard. Of course, even as simple as it may seem, it nevertheless is an exceed- ingly variable standard and therefore a great amount of experience is necessary to apply it. The method is this: We must bring our vacuum to such a de-
X-RAY JOURNAL.
gree that we can generate x-rays pow- erful enough to penetrate the tissue which we wish to radiograph. If we do not penetrate the tissue we certainly can not determine its internal make-up. It is impossible to show the structure of a bone unless you can apply rays pow- erful enough to penetrate the bone. In this connection I might say that if this method is applied before the plate is ex- posed it will be found to materially shorten the time of exposure and above all, the proportion of undqr-exposed and under-developed negatives; in short, useless plates, will decrease as we be- come more and more familiar and adept in the use of the fluoroscopic method. I may also add that the tube must not be too high, as then we lose all detail of structure. The nearer a body is brought to a screen, and the farther away from the tube, the more normal the fluoroscopic outline. For instance, to get sharp bone outlines of the chest in fluoroscopic work the vacuum must not be too high and the fluoroscope must be in direct contact with the body, chest or back.
In order to get a normal shadow of the heart it is necessary to place the body a short distance away from the tube (ten to fifteen inches) as otherwise the shadow may be magnified and at the same time will not show clear in out- line. Here the tube vacuum should be just high enough to give a black outline to the heart, anything higher will blur the shadow and make it irregu- lar.
It is a well known fact that a tube which may atone time be considered of low or medium vacuum will gradually become raised to a higher and higher vacuum. As it is ordinarily used, this is sometimes detrimental. It is also a well known fact that as the vacuum constant- ly becomes higher the voltage necessary to push the current through at first, be- comes ultimately inadequate because of
THE AMERICAN X-RAY JOURNAL.
997
the inability of the apparatus to furnish same.
The first drawback is overcome, if deemed necessary, as for instance, in radio-therapeutic work, by the use of a tube which has a valuable vacuum at- tachment. The second drawback, that of low voltage current, is overcome by the use of more powerful apparatus, which develops enormous voltage and is therefore able to overcome the high resistance of the tube due to its high vacuum. In this connection it maybe mentioned that it seems out of order to label a tube for a certain voltage, as for instance-40 cm. to 50 cm. spark length, when the vacuum, which determines the ability of the tube to stand certain vol- tage goes up and down. In other words, varies constantly as the tube is used.
Scientific research of any kind can be of really little importance if it does not lead to practical results. The endeavor to improve the x-ray tube has been general, but I believe some very impor- tant mechanical and electrical facts have been omitted in the construction of this instrument. First, I find the greatest difficulty of getting a tube which has its external electrodes far enough apart to prevent sparking or short circuiting on the outside.
We know the greatest estimation in x-ray work is maximum radiance. Up to the present time we have not been able to secure radiance approaching the maximum, because of the inefficiency of the Crooke's tubes. Personally. I find, in order that we may use high voltage currents (an absolute necessity to the derivation of maximum or penetrating radiance), that the internal parts of the tube including the vacuum are not so much at fault as the external parts. We must separate the external electrodes much farther than we have been doing.
The more we study the x-ray the more we find it necessary to have spe- cial apparatus to meet certain condi-
tions. For instance, it has been found desirable for radio-therapeutic work to operate a coil, which, by the use of from 3 to 5 amperes of current in the pri- mary, generates a low voltage and high amperage current from the secondary — a short but thick spark. On the other hand, to make radiographs we need a current of high voltage as well as high amperage. In making this statement I am aware that I am discussing only one- half of the question, as the tube vacuum at which it is worked is, of course, a very important consideration also.
Greatest difficulty is experienced in getting tubes which can dissipate more than a certain limited amount of energy in a certain period of time without dan- ger of breaking or burning out. First, then, in order to get a tube high in vacuum, it is necessary to place the ex- ternal electrodes far enough apart so that high voltage currents can be util- ized without danger of breaking the tube or of the spark passing or jumping around the outside of the bulb. Next, we need tubes so constructed that the anode will readily radiate the heat which is developed whenever large vol- ume currents are used. Since the ideal has not yet been reached as regards the above two factors, I believe it is in or- der to mention a few ideas and give a few designs on this subject. In the fol- lowing considerations I need not men- tion specifically the kind of exciting ap- paratus to which these tubes are espe- cially suited, suffice it to say that the tubes for use on the static machine need not be made with as much metal or heat absorbing materials as is necessary when a coil is the exciting agent.
We will now consider tubes from the fluoroscopic standpoint, ignoring as far as possible, the use of the tube from the radiographic or radio-therapeutic standpoint. Good fluoroscopic views are only obtainable from the very high- est vacuum tubes, and indeed in general
THE AMERICAN X-RAY JOURNAL.
it may be said, that for fluoroscopic work a much higher vacuum, relatively is needed than for radiography. Steadiness of the illumination or fluo- rescence is a most desirable function in connection with penetration. The for- mer is brought about by using rapid in- terruptions, if an induction coil is used (1600 to 2500 per minute), the latter is developed by the use of a high vacuum and also very high voltage and is inde- pendent of the quantity of current. Be- cause of these conditions we are able to get better fluoroscopic views from a large rapidly speeding static machine that we can possibly obtain from a coil. Fluorescence is steady and voltage is very high.
Since glass is an obstructor to x-rays it is necessary that the bulb through which the rays pass be exceedingly thin and not only thin, but uniformly thin. In the average tube sold today the bulb part of the tube is so thick that I doubt if we get more than 50 per cent of the actual x-ray value for use on the outside. Another valuable factor to be observed in choosing a good tube for fluoroscopic work is that of a large-sized tube. A large tube will stand both higher voltage and amperage for a giv- en vacuum. Also the larger volume of gaseous space tends to keep such a tube more stable as regards its vacuum and therefore it may be used for a much longer period of time (time being some- times a very necessary consideration in matters pertaining to diagnosis), without any appreciable change in the vacuum. Finally we can say that the larger the bulb the longer the life of the tube.
From our study of the cathode rays in their relation to x-rays we must come to the conclusion that, generally speak- ing, the more cathode rays we have in a tube, the more x-rays are generated.
I wish to refer to diagram No. 1 which illustrates a special tube which I shall call the "Fluoroscopic tube," be-
cause it is designed specially to show to the best advantage all the factors promi- nent in an ideal fluoroscopic tube, as far as I am able to judge. I recommend a very large bulb, 10 to 14 inches in di- ameter ( if it is possible for high vacu- um bulbs of that size composed of glass
inch in thickness to stand up against atmospheric pressure ), because of rea- sons previously mentioned. The large size of the bulb allows of placing larger electrodes in the tube and therefore we naturally get more x-rays than is pos- sible from a smaller tube having small electrodes.
In an excited Crooke's tube the whole luminous hemisphere gives off x-rays. For fluoroscopic use a tube should not focus the cathode rays at a point upon the platinum sheet and the anode is best placed so that it strikes the cathode rays before they come to a focus. In this manner the anode becomes uniformly red hot and we get a large quantity of illumination upon the screen, i. e., x- rays spread over a large area. This is especially appreciated when we wish to use a large screen in examining the chest or abdominal cavities. This spreading of the cathode stream may be brought about by placing the anode at the angle of 45 degrees to the path of the cathode rays and within the focal point of these rays. Now, by moving the cathode end of the tube away from the active hemisphere, and placing the aluminum disk within the bulb, we pre- sent a glass surface of even thickness and since the aluminum disk is insig- nificant as an absorber of x-rays it, of course, need hardly be considered from the standpoint of resistance. In the usual tube the cathode disk is placed so near the glass that in conjunction with the great heat generated upon its sur- face a deposit of metalic aluminum soon occurs upon the glass surface in the neighborhood of the cathode disk. Placing the cathode disk within the bulb
THE AMERICAN X-RAY JOURNAL.
999
also does away with the stray x-rays resulting when the cathode stream strikes the sides of the tube immediate- ly surrounding the disk, usually recog- nized by the formation of a light green ring on the glass surface just above the aluminum disk.
The presence of the metallic ball, pre- ferably made of aluminum, at the cath- ode electrode on the outside of the tube is for the purpose of farther intensi- fying the volume of current. In this position its action is that of a condenser. The value of this attachment becomes obvious, because in using very high vacuum tubes we have learned that heaping up current at the cathode gives us more efficient x-rays ( internal re- sisance being thereby lessened); ulti- mately this is also a means to steady the fluorescence. This condenser is made globular and is to be kept highly polish- ed, in order that the current radiation may be insignificant. Condensers of other shape have been found to be im- practical because of the extensive radia- tion usually present during high resist- ance.
Further consideration of this tube must be left to an examination of the diagram which, I believe, is self-explan- atory.
Next let us consider a tube especially designed for radiographic work. I re- fer you to diagram No. 2.
This tube, as is indicated, is especial- ly constructed for radiographic work; that is, it is able to stand up against both high voltage and high amperage currents.
To be able to use currents of large volume as derived when the various types of electrolytic or mercury inter- rupters are in circuit, is has been found best to cool the heated platinum disk by having a continuous flow of water near the anode to absorb the heat generated. By this method we may pass powerful currents through the tube for a few min-
utes without noticing any material de- terioration of the vacuum. According to the diagram we do away with the con- tinuous water stream, and substitute a very large steel jacket extending almost the full length of the anodal electrode in the bulb of the tube, and in addition to this we fill this metal jacket with a large quantity of heat absorbing oil, ( even water may be used ). This does away with water bags or bottles and rubber tubing for conveying the water to the tube, a very inconvenient arrange- ment.
Since it is a well known fact that if we wish to attain the best definition on a plate exposed to the x-rays we must bring the cathode stream to a very fine focus at the anode and the smaller the focal area the better the definition. The platinum anode in this tube has a small but very heavy projection upon which the cathode rays are brought to a focus. This tends to confine the heating to a small area and also sends away x-rays sooner than an}- other part of the disk. In order to still farther favor the focus- ing of the cathode rays the anode should be placed at angle of from 60 - 65 de- grees to the cathode stream. This ar- rangement gives sharp or clean and con- trast)* picture and the exposure can be made very short. We get not only a shadow picture of the gross outlines of parts exposed, especially bones, but also an idea of the inner structure. This we call definition and it depends primarily upon our ability to place the cathode rays at a small area upon the platinum disk.
The bulb of a radiographic tube need not be as large as for a tube used if fluo- roscopic work. Indeed, in order to pre- vent blurring of the picture we wish to avoid all radiation except that originat- ing at the focal point upon the anode. A small tube gives off few stray rays, there is very little spreading, and conse- quently such a tube is desirable for pro-
IOCO
THE AMERICAN X-RAY JOURNAL.
ducing pelvic and chest pictures. It is well established that the more we in- crease the amperage of the current ap- plied to a Crooke's tube, provided the voltage is high enough to overcome the resistance, the more x-rays we get. No doubt the degree of fluorescence deter- mines largely the photographic power of the tube, but if it is possible to measure, the quantity of current passing through the tube at any period of time we are al- ways in position to know accurately the radiographic effect of a tube. It may be stated that the higher our amperage for a given vacuum the more rapid our ability to make radiographs. It is the large quantity current which causes chemical changes upon the photograph- ic plate.
A properly constructed x-ray tube to give clear definition and prevent diffu- sion to any great extent, must have its cathode disk so placed and shaped (very concave) that cathode rays coming from this disk do not strike anything before reaching the anode. This cathode disk, in order that it may stand the large quantity of heat developed upon its sur- face, should also be large in area, as shown in the diagram, so that heat radia- tion may be good. Finally, in order that we may use high voltage currents and thereby get penetrating x-rays, all the electrode containing parts of the tube are placed far apart; about twice the distance which is observed in the common tube.
In conclusion let me say that no apolo- gies are offered for anything presented in this paper, because I believe it is only through digestion of speculative ideas that we can hope to proceed in our in- vestigations of so powerful a force as the way has proven itself to be. ' US rhamplain Bid* Chicago, 111.
XWhen this paragraph is marked with a re>l a/d blue cross it shows our friends thatNfheir time has expired, and we shall be/n\appy to receive a re- newal of their /subscription soon.
Some Problems of Radiology.
BY VIRGILIO MACHADO.
The Rhumkorf coils have lately been subject to numerous improvements such
as:
a — To divide the secondary circuit in- to segments or partial coils, being cap- able of spreading singly or in twos, threes, etc.
b — The use of a thick wire in the sec- ondary circuit to diminish its resistance, while thus augmenting the amperage of the current circulating therein.
c — The use of an adjustable condenser so as to be able to regulate the capacity, in relation to the intensity of the prima- ry current.
d — The use of interrupters which give the maximum length to the time the cir- cuit is closed, in relation to the time it is open.
c — The use of a special inductor, with- out a condenser when employing the Wehnelt interrupter.
/ — The method of fabrication that guarantees to keep the coils in a good state of preservation, without becoming treated while operating, etc.
In spite of all these improvements, the coils perhaps may be able to pro- duce even greater results.
Before giving any problems on this subject, I take the liberty to propose the following considerations: At pres- ent it is generally admitted that the in- tensity of the x-rays, estimated by the intensity of the fluroscopic light, or by the effect produced upon the photo- graphic plate, depends chiefly upon the volume of the originating discharge.
This volume is roughly estimated by the depth of the spark. If two dis- charges, a and b are compared whose sparks are of the same length, but of different depth, it will be found that the deeper spark, a will produce the more intense x-rays.
The potential of the discharge judged
THE AMERICAN X-RAY JOURNAL.
IOOI
by the length of the spark, seems prin- cipally to influence the penetrating force of the x-rays.
If two electric discharges a and b are compared, whose sparks are of equal depth, but of different length, then the longer one a will give the more penetrat- ing x-rays.
It is very probable that the potential of the electric discharge does not ex- clusively influence the penetration of the x-rays, but also exerts its power, though in a minor degree, upon the in- tensity of these rays.
It is also likely that the volume of the discharge does not exclusively influence the intensity of the x-rays, but also slightly the penetration of the same rays.
To establish a basis for the construc- tion of coils, complying with all the re- quirements of the radiologists, would demand deep study. Among others, the following problems suggest them- selves, which have already undergone
partial investigation at the hands of some illustrious radiologists.
ist. To determine the mechanic value m which corresponds to the discharge of the secondary current according to the dimensions (length and depth) of the spark, created by the said discharge.
2d. To calculate the relation between this mechanic value m and the penetra- tion of the x-rays produced by the dis- charge to which this value corresponds.
3d. And further to find the analogy between the mechanic value m and the intensity of the x-rays obtained by this value.
4th. In a given coil to determine what relation there exists between the volume of the discharge from the opening in the secondary, and the intensity of the primary current.
5. To determine the relation between the volume of the discharge and the vol- tage of the current, which flows in the primary circuit.
6. To determine the relation between
The Kinraide High-Frequency Coil.
The best apparatus for use with the direct or alternating current.
SEND FOR
DESCRIPTIVE
CIRCULAR.
EX B. Meyrowitz,
Maker of Ophthalmological Apparatus. Complete Standard Electro-Therapeutic Equipments.
X-Ray Apparatus and High Grade Eye, Ear, Nose and Throat Instruments. 104 East Twenty-third Street, ) 604 Nicollet Avenue, Minneapolis.
125 West Forty-second Street. -NEW YORK, 360 St. Peter Street, St. Paul.
650 Madison Avenue, J > 3 rue Scribe, Paris, France.
1002
THE AMERICAiV X-RAY JOURNAL.
the same volume and the electric ca- pacity of the primary, including the con- denser.
7, 8 and 9. To solve questions similar to those marked 4, 5 and 6, except that instead of relating to the volume of the electric discharges, refer to their poten- tial, estimated by the length of the spark.
10. To vertify the influence of the length of time, the current circulates in the primary upon each of the various elements of the phenomena, that this current produces at the time of opening.
To facilitate the solving of the above mentioned problem, it would be well to study the following works:
Ueber die vorgange im Inductionsap- parat. B. Walter in Annalen der Physik und Chemie, Neue Folge Bd. 62-1897, und Bd. 66-1898.
R. Colley-Wiedemann Annalen, 44,
1891.
Seiter-Tbid, 61, 1897. Warburg-Tbid, 59, 1896 F. Braun-Tbid, 60, 1897. Feddersen Poggendorf Ann. 116,
1862.
B. C. Heinke Electrotechn, Leitschr,
18, 1897.
Lisbon, Portugal, Oct. 10, 1901.
"The Physicians' Visiting List"
is just out. It is just the thing for doctors. These pocket records are beautifully bound and on the fly leaves is found emergency information. The fact that the little book is always in the pocket for recording cases, visits and consulta- tions, makes it a most valuable reference in case of emergency, when time is all important or when it is not convenient to refer to the library. P. Blakiston & Co., Publishers, 1012 Walnut Street, Philadelphia, will give any information desired.
X-RAY MACHINES For Any Circuit.
Direct or Alternating. Battery or Lighting. • We have a new line of PORTABLE MACHINES
Very compact and very powerful, with improved spark gaps, inde- pendent interrupt- er, etc.
Then there is the
Cunningham Mercury Jet Interrupter,
Giving interrup- tions variable at will, from 10 to 10,000 per minute, and breaking current up to 30 amperes.
Will young X-Ray Machine— Latest Model— 8" to 18". quarters for Tubes, Fluoroscopes, Tube Stands, Radiographs, Tables, Etc., Etc.
Elmer G. Willyoung, 11 Frankfort St., New York.
TUBES,
Perfect Glass, Reinforced Seals. They Can Always be Repaired.
X-Ray Tubes re-exhausted and repaired. Also Atomizers, Nebulizers for heavy fluids, and Inhalers Gla.-s apparatus of all kinds. Correspondence Solicited.
Hrad
3TUNTZ & ARMSTRONG,
Owensboro, Ky,
1/
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X-RAY PUBLISHING COMPANY.
HEBER ROBARTS, M. D . . M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE.
United States, Canada and Mexico $3.00 | Foreign Countries $4.00
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 301 Chemical Bldg., St. Louis All business matter should be addressed to The American X-Ray Journal Publishing Co., same address All contributors oi original articles and other matter relative to X-Radiance, of interest to the medical
profession, are solicited from all parts oi the world. Contributors will be furnished a liberal number of
extra copies oi the Journal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611
Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. 9. ST. LOUIS, DECEMBER, 1901. NO. 6>
CONTEXTS VOL. 9, XO. 5. COXTENTS OF VOL. 9, NO. 6.
Iodoform in Knee Jcint.
Researches in the Direction of Obtaining Radiographs and Fluoroscopic Ex- aminations of the Muscles and Liga- ments.
The Development of the Crooke's Tube for the Past Twelve Months.
How the Induction Static Machine Can Be Excited without Separate Charger.
X-Ray an Absolute Necessity in Dental Surgery.
Hysteresis.
X-Ray in Country Practice. Verdict— X- Ray Burn. Fracture Upper Third of Thigl X-Rays from Static Machir rapeutic Purposes.
Visual Localization with Fluorometer. Cancer.
Prospect of Cure in Cancer. Diagnosis of Cancer of the Stomach. Treatment of Inoperable Cancer. Turck's Gyromele. X-Ray Tubes.
Some Problems of Radiology.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
VOL. 9. ST. LOUIS, DECEMBER, 1901. MO. 6.
Researches in the Direction of Obtaining Radiographs and Fluoroscopic Exam- inations of the M uscles and Ligaments.
Read before the Roentgen Society of America, Uni- versity Building, Buffalo, N. Y., Nov. 10, 1901, BY H. WESTBURY.
I trust that the title of this little paper will not lead the members to ex- pect that any definite results have yet been obtained in this direction, but I think some brief explanation of what has already been done, with a note of the difficulties to be still overcome, may be interesting and may also incite some of our friends present to investigate this important branch of x-ray research.
There are three directions in which it may prove possible to obtain a definite shadow of the interior of the body i. e., the softer tissues outside the bones, viz., the photographic plate, the fluoroscopic screen and the x-ray tube.
i. — Regarding the photographic plate itself I have not made any attempt to investigate or alter the effect of the x- ray shadow as thrown upon the plate during exposure, as I recognize that while it may be quite in the bounds of possibility to obtain some coating apart from the usual gelatine emulsion which will produce startling results, this branch of research is being ably taken up by many well known photographers for color photography and other purposes. In fact, the question of obtaining various
emulsions giving different results to the uniform black and white has so far proved a very disinteresting one. The old-fashioned collodion plate I may re- mark in passing, shows no difference to the gelatine. A suggestion has been made to me to try the old Daguerrotype process, but so far I have not done so. If any one present has, I would like to learn the results.
2. — Regarding the second direction — the fluoroscopic screen — I have endeav- ored to vary the results in two ways; first by interposition between the tube and the ordinary platine cyanide of barium screen and second by changing the com- position of the screen itself. The ques- tion of interposition has, of course, been entered upon in conjunction with the tube more or less, bearing in mind that the object in view was to break up the light rays, if light rays they are, into their various co-ordinates. I need not go into, in this paper, the various ex- periments made with metallic sub- stances, which have already been fully treated in the various papers published on the different capacity of substances to the x-rays and with which all of you must be more or less familiar. Briefly, none of the ordinary metallic materials or screens make any difference to the light rays. Some of the following ex- periments, however, are interesting, not so much from their results as their possi- bilities:— A screen coated with thorium and interposed between the tube and a barium screen seems to act as an in-
IOO^
THE AMERICAN X-RAY JOURNAL.
tensifyer, bringing the bones up in sharp outline and in isolated instances showing traces of the arteries, etc. A screen coated with zirconium has much the same effect, but not to such a marked de- gree. I have tried a number of other incandescent salts in the same way and have obtained the same results in many cases. Some of them when mixed with the platino cyanide of barium in making an ordinary screen show traces of the ligaments and muscles, but not clearly, and 1 firmly believe that it is in this di- rection of changing the screen itself that ultimate success lies. Nitrate of uran- ium has some very peculiar properties when subjected to the x-ray light, either alone or with other salts. Alone it is about equal to tungstate of cal- cium if prepared and flowed in the usual manner, but if used in lump form so that the rays strike larger crystals of it, traces of refraction may be seen, al- though I have not yet been able to prove this scientifically. Some other curious results are obtained with some of the quartz mineral blocks, especially such as show prismatic refraction. Feldopar, as you are doubtless aware, fluoresces con- siderable to the rays and even in the lump form a piece of ordinary note paper or cardboard is lit up when placed behind the crystal and the x-ray pro- duced in front. All my researches in this direction seem to prove that the x- rays are really some form of light rays low in the spectrum, but of course, I am still unable to understand why, if this is really the case, an aluminum or other metallic screen grounded at one end prevents burning, which I have incon- testably proved it does. This fact seems to adduce Mr. Tesla's theory of parti- cles of matter, but on the other hand possibly this is explained by the counter theory that the injurious particles caus- ing the burning emanate from the elec- tric current and it is quite possible to obtain a spark from the grounded screen.
Colored gelatine layers have all been tried and do not seem to affect the rays at all except in density and as you are aware the ordinary lens has no effect. The rays penetrate a diamond as easily as paper, hence the fact that a true diamond can always be told from a false one with a medium or low tube. A very high tube is apt to go through even car- bon or paste imitations. Sulphide of zinc and calcium are pratically non- fluorescing to the rays, even if mixed with other fluorescing salts and yet they are decidedly useful for intensifying screens and just as effective as tungstate of calcium, which fact is certainly curi- ous. I can safely say that the ordinary methods of producing color photography as at present known have not the slight- est effect on radiography, only the same black and white bone shadows be- ing obtained.
3. — The x-ray tube is, of course, only susceptible to different results by practically following out the same in- terposition theory as stated above. I have varied the glass used in the tube in many ways with practically little suc- cess; the only thing that altered the rays at all was a certain kind of ruby colored glass a mixture of actinic and nonactinic qualities which, you will remember, I showed at the last meeting. It had a bull's eye in the center made out of or- dinary Crooke's tube glass and showed two different densities on the ordinary screen, but only very faint traces of the tissues could be discerned. Numerous varieties of coatings on the glass of the tube have been tried and when coated with certain incandescent salts, about the same results are obtained, as stated above, with a screen in interposition. You are probably aware that it is a very simple thing to change the rays pro- ceeding from a tube, as far as the pene- tratric powers are concerned, either by using different glass or by surrounding the tube with partly opaque substances,
THE AMERICAN X-RAY JOURNAL.
1005
but this simply changes the working amount of rays produced and does not tend to help us in obtaining anything else but the bones, etc. I have care- fully followed up so far as possible the isolated cases known to most of us, where a plate has been exposed in the usual manner and much to the operator's surprise, some portion of arteries or tissues have been obtained after devel- opment, but in each case I have been unable to find any such extraordinary conditions as to enable one to repeat the effects obtained at will. A recent plate even showed the hair lying close to the arm very plainly, but in another plate exposed identically the same, no such traces are visible. Again I have a plate showing the ligaments and ten- dons of the wrist very plainly — exposure one minute. Carbutt plate, medium the same conditions and even with the same wrist do not show these points. Are there, therefore, some peculiar con- ditions in the air, only rarely present, altering the molecules of the rays suffi- ciently to change their penetrative quali- ties, or what is the explanation? Of course, body conditions would make a great difference, as many of us have come across persons, whom it was al- most impossible to penetrate, owing to the density of their flesh. I know of one such case at present that takes a tube which will easily penetrate an or- dinary wall, before any shadow of the bones can be taken. This, however, can not very well explain the fact of the same person giving a different result, when exposed within five minutes of the first exposure.
I have it on good authority that Mine Curie has obtained some interesting re- sults in this line with radium as an in- terposed substance; in fact, it is claimed that thelungs, heart, kidneys, etc. , can be examined very plainly through the fluor- oscope with this ally. As I have not yet had the opportunity to try this, of course,
I can not say whether it is any help in the direction we desire. I have been promised some radium and hoped to have been able to show it at this meet- ing, but unfortunately, I have not yet received it, but shall certainly try it in this way as soon as it reaches me.
If there are any of our members who have made any researches in this di- rection I would very much like to hear from them, as the whole line of research is extremely fascinating and important to us all, and there are so many rare salts and minerals and combinations of such that it is impossible for any one per- son to try them all in any way, but in closing I would like to say that I firmly believe that this can and will be done and before very long. The benefit to the surgeon and doctor will be, I think, even more important than the ability to see the bones; at any rate, it will be one step nearer to the much desired power of seeing all that may occur in that com- plicated machine, our body.
THE DEVELOPMENT OF THE CROOKE's TUBE FOR THE PAST TWELVE MONTHS.
While no very great or startling de- velopments have been made in the Crooke's tube during the past twelve months, yet a number of minor improve- ments have been designed, making the Crooke's tube at the present day consid- erably in advance of that of a year ago. It should be remembered by all operators that the manufacturers are constantly experimenting in little matters of detail with the aim of bringing the tube nearer and nearer to perfection and while these little technical improvements would be passed by without notice by the operator, they all tend to improve the efficiency and penetrative power of the rays.
It may be interesting to members pres- ent to recapitulate for a few moments the steady progression, which has been made in the manufacture of Crooke's
ioo6
THE AMERICAN X-RAY JOURNAL.
tubes. Up to the present time all prac- tical tubes for the production of x-rays have been made in a glass chamber whether of spherical, cylindrical or other shape bulb, into which are sealed by means of platinum wires, two or more electrodes usually made of aluminum which serve to carry the electrical cur- rent into the bulb.
The earliest forms of x-ray tubes were made with two electrodes set into the bulb at almost a right angle to each other, each terminating in a circular disc, of aluminum or other metal, one of such discs being made larger than the other. In use the negative terminal of the ex- citing apparatus was attached to the larger disc and the positive terminal to the smaller disc, thus making the larger disc the cathode and the smaller disc the anode. When the bulb was thus operated the cathode rays would produce x-rays at the point of contact of the elec- trical discharge in the tube, causing the x-rays to be thrown against the glass at a point opposite the cathode. Such tubes were elementary and so on gave way to an improved type.
The next form of tube seems to have been one in which the two electrodes were opposite each other with both cathode and anode inclined at an angle giving better results both for clearness and definition. Such a form of tube was employed by Mr. Edison in May, 1896, the National Electrical Exposition in New York City when many thousands of persons saw for the first time the x-ray phenomena. A number of experiment- ors had, however, found that some method of focusing the rays was absolute- ly necessary to obtain shape, and outline and tubes were finally designed with a piece of thin platinum at the end of one of the electrodes, leaving the cup-shaped aluminum at the end of the other, but made more or less concave so that the cathode rays were impinged upon the surface of the platinum electrode. The
value of this detail has recently been rec- ognized from the fact that all the present types of tubes are made on practically this principle with, of course, various improvements that have suggested them- selves from time to time.
The size of the glass bulb is now made either four or five inches in diameter by nearly all the manufacturers, as this seems to be the most suitable for x-ray work. There does not seem to be much advantage gained by using larger sizes, although a few operators using very heavy coils or static machines use eight or ten-inch bulbs with good results, but as a general thing, extending the length of the terminals of the tube will prevent every chance of any sparks jumping across the outside of the tube.
Among the later improvements may be included the reinforcing of the anode with copper or nickle, designed to meet the demand for a tube, which would stand up against the heavy currents now used. Such currents will burn a hole through an ordinary anode in a very short time and if allowed to run, will melt it all up. Thick pieces of metal either platinum, comium or iridium or alloys of these metals have been used for some years, but the chief trouble with a solid anode is that the metal gives off so much gas that it is very difficult to obtain a steady vacuum in such tubes, added to which the cost is prohibitive However, the reinforcement of the anode is very satisfactory and until some better method of diffusing the heat is devised, it is probably the best type of tube for use with very heavy currents.
A recent improvement has been made on this reinforced type, consisting of a percentage of platinum being alloyed in the face of the nickle backing instead of being laid over in sheet form on it. This enables the operator to use a much heavier current than before, as this anode has the merit of being practically the same as a soild one. It also heats very
THE AMERICAN X-RAY JOURNAL.
1007
slowly and the platinum, of course, does not buckle up as the previous type will do if a white heat is obtained. Until recently a copper backing was used in tubes made abroad, but they have now discontinued this for nickle, probably owing to the fact that copper gives off gas very badly and also tends to discolor the bulb. Yet another form of anode we have noticed consists of nickle al- loyed with iridium which gives fair re- sults, but is more difficult to exhaust to a high vacuum than the alloyed platinum and nickle.
Some little improvements have been made within the past year in tubes with an adjustment for cooling off the target by means of water, but at the present time owing to their lack of uniformity and their expensive cost (from $40.00 to $60.00 each), they can not be recom- mended to the general user. Some fur- ther developments, however, on this line may produce a tube, which will prove satisfactory, as occasionally a magnifi- cent tube may be seen with this device, but unfortunately, apart from the primal high price, they can not be repaired for anything, like a moderate figure.
Probably most of the experimenting on Crooke's tubes this yean has been with the adjuster. Several new salts or amalgamation of salts have been tried with good results and it is now possible to obtain tubes in which either hydrogen or oxygen can be liberated in addition to the old-fashioned watery vapor obtained from potash alone. So far we have not discovered any salt suitable for liberating nitrogen, but as a matter of scientific curiosity, trust to do so very shortly.
The use of the adjuster tube is grad- ually growing in favor both in this coun- try and abroad and there is no doubt that if the operator can be assured that he may keep his vacuum perfectly steady with the adjuster, then tubes not fitted with such a device would rapidly become obsolete. Last year, you will remember,
that the device for lowering the vacuum was more or less in an elementary con- dition. The methods of sparking in common use were more or less likely to puncture the tube, owing to a spark penetrating the glass and the noise caused by the continual passing of the spark in the air was apt to be very irri- tating to the operator and I may add, terrifying to the average patient. A new device has been designed this year, which obviates this difficulty and by means of which the vacuum in a tube can be lowered or again raised at will. We are now, therefore, able to obtain body pictures in less time than formerly, owing to the fact that initially high vacuum tubes can be used with impu- nity. As the operators present are well aware, it is very easy with any appara- tus to manipulate a low vacuum tube, with which the bones of the hand, arm or leg can be seen very plainly and with good definition, but immediately the operator endeavors to look through the body nothing is obtained. This, of course, is owing to the fact that such a tube has not sufficient penetrative power. If a high vacuum tube is placed on the apparatus and sufficient current forced through it to excite it, it will penetrate the heavy parts of the body without definition and all that can be seen is a fussy outline of the bones, the penetra- tion being much too great. The prob- lem, therefore, is to take such a high vacuum tube and increase the definition without lowering the penetration too much and so far this has only been done by means of chemical adjusters.
The user of a modern adjuster tube is especially cautioned in operating the adjuster to first simply allow a single spark to pass through the salt, as in most cases this is amply sufficient to re- duce the vacuum of the tube at once. Failing this, he should still proceed with caution, disconnecting the adjuster wire frequently and allowing the current to
ioo8
THE AMERICAN X-RAY JOURNAL.
pass directly through the tube until he has the required vacuum. Many tubes are often reduced so low by a liberal use of the adjuster that failing sufficient current to heat up the anode and so ab- sorb the gas, they have to be returned to the manufacturer for re-exhaustion.
The operator using an ordinary non- adjustable tube can, of course, tempora- rily lower the vacuum when it becomes too high by warming the body of the tube carefully, but great care has to be taken not to crack the bulb. Probably the safest way is to lay the tube on or near a radiator until it is gently warmed through. Such a tube can sometimes be reduced in vacuum by reversing the po- larities for 20 or 30 minutes, taking care not to bombard the aluminum cathode long enough to melt it down. If the operator has a fairly powerful current, patient manipulation of the terminals of his machine in conjunction with spark gaps will sometimes lower a tube suffi- ciently to enable it to be used, although it must be remembered that a non-ad- justable tube will finally reach a point where the vacuum will not come down and it will have to be re-exhausted.
On the other hand, sometimes a tube will be too low in vacuum. In this case, if it is filled with a purplish gas it can usually be understood that there is a very fine leak or puncture somewhere and that it will have to be re-exhausted. If, however, the color of the gas is blue or grey then the operator can usually run the vacuum up with a little patience. If his exciting apparatus is powerful enough, the anode should be heated red hot and then allowed to cool off, then heated again and cooled off repeating at intervals of several days and the vacuum will probably improve until x-rays are obtained. On a static machine the use of one or both spark gaps will generally raise a tube sufficiently for use or if not a careful use of the Leyden jars or con- denser. This also applies to a coil, but
not to such a degree as to the static ma- chine.
In closing I may say that while the Crooke's tube is still far from perfection, yet the last year has seen a number of minor improvements in construction and detail, improvements in most cases so small as to escape the notice of the average operator, but all tending to in- crease the efficiency and life of the tube. Speaking egotistically, I do not think that we have any reason to be ashamed of the development of Crooke's tubes made in this country and trust before long to see the product of American manufacturers in this line taking the same place as every other scientific manu- facture— the top of the tree. Harrison, New Jersey.
Dr. Niles R. Finsen in Meddelelser fra Finsen s Lys. Institut, gives a sum- mary of his treatment of all skin diseases by use of the Finsen light. At the close of the year 1899 he had under treatment 121 cases of lupus. While during the previous years the lupus patients were treated exclusively by light, there were during 1898 and 1899 some cases which also had other treatment as preparatory for and auxiliary to the light cure.
Whilst under treatment with the rays nearly all the patients wore a protective bandage.
Some of the patients had an experi- mental treatment with Roentgen rays.
The report fails to give number of so-called permanent cures and also fails to mention result of treatment with the x-rays. Subsequent evidence, however, javors the Roentgen light to all other modes of treatment.
At the Academy of Medicine of Cin- cinnati, Dr. E. H. Shield stated that he had seen several cases of chronic rheu- matism entirely relieved of pain by sub- jecting them to the x-rays. He also spoke of pigmented naevus of the foot improving under the rays.
THE AMERICAN X-RAY JOURNAL.
1009
How the Induction Static Machine Can Be Excited Without a Separate Charger.
Read Before the Roentgen Society of America, Uni- versity Building, Buffalo, N. Y., Sept.'ll, 1901,, BY JOHN TOWNSEND PITKIN, M. D.
Around the poles of a loadstone, an ordinary horseshoe magnet, or an elec- tro magnet, there exists what is techni- cally known as a field of force, the pres- ence of which can be made manifest by its action on particles of iron or the electrification of a conductor brought within its confines.
When the permanent or electro— mag- net is circular in form, or the magnetic circuit is closed by a suitable piece of iron called a keeper or armature, the magnetic lines of force will find a path of less resistance in the iron, than in an areal pathway, and the magnetic field of force will not be apparent.
Permeating the insulation and sur- rounding medium of an electrified wire, there also exists a magnetic field of force, shown by the electrification of neighbor- ing conductors, the attraction of iron fillings or the diverging of a compass needle brought within its influence.
Various appellations have been given by recent writers and teachers of electro- magnetism, to the magnetic zone of in- fluence. They are, 1, magnetic field, 2, induction action, which is subdivided into mutual and self-induction; 3, mag- netic lines or tubes of force. The older writers spoke of it as an action at a distance or action by influence.
When a metallic object or conductor becomes the seat of a high tension electrical charge, it is customary to speak of its field, as made up of electro-static lines of force, or of electrical waves. The word magnetism for unknown reasons is not employed.
Having an inspiration in accord with
the spirit of the times the writer has boldly ventured to draw the line of de- marcation between the force called mag- netism on the one hand, and electricity on the other, more sharply than it has ever been drawn before for the following reasons:
Inasmuch as the circular magnet is considered a unit complete within itself, so the horseshoe magnet and its keeper should be similarly considered. If the keeper is removed, its place will be taken by the air, or any other dielectric which comes within the magnetic path- way, does not the dielectric become an essential portion of the magnetic integer?
If so it follows that when the iron core of an electro-magnet is removed its place will be taken by the atmosphere, the air becoming a portion of the elec- tro-magnet.
It also follows that an electrified wire is surrounded by an elongated magnet, consisting of the excited, investing tunics and the atmosphere, irrespective of the E. M. F. of the current, it does not matter whether the current is of low or high potential, the force which per- meates the dielectric without breaking it down should always be called magnetism. Insulators are magnetic substances.
The Hertz waves employed in wire- less telegraphy are not electrical, but magnetic in character. Magnetism is in all probability one of the interplanetary forces the essential constituent of the solar rays.
Consider, if you will, the position taken in this paper tenable and how the study of static electrical apparatus is thereby simplified and elucidated.
The glass, mica or hard rubber plates, revolving and stationary, are magnets, which, by their mutual reaction upon each other and the surrounding atmos- phere, form magnetic circuits. Metallic objects placed in these circuits become electrified. The static machine is there-
IOIO
THE AMERICAN X-RAY JOURNAL.
fore a high potential dynamo, a gener- ator of the lightning current.
If the current from such a generator is conducted to the arms of a second static machine, the revolving plates or armature of the second instrument will move in the opposite direction and light running machinery attached to the pul- ley on its axle can be operated. Under these circumstances the static machine is an electro-motor.
As already intimated the electro-mag- nets constituting the fields of a dynamo, a motor or a dynamotor find their ana- logue in the stationary or field plates of the static machine, the tinfoil or gilded paper taking the place of the wire wound upon the bobbin, and the sheet of glass or other material is the counterpart of the iron core.
In the construction of the Toepler static machine the stationary or field plates are usually circular in form, com- posed of two thin discs of glass cemented to each other.
Inclosed between these two sheets of glass are two large kidney shaped pieces of paper, similar to each other in their dimensions and symmetrical in their po- sition which is equidistant from an im- aginary line drawn vertically through the center of the field plates.
Superimposed on either side of each kidney shaped piece of paper at their center, is a narrow strip of tinfoil. The strips of tinfoil face outwards so that they may be seen through the glass plates, each strip is metallically con- nected to a fine wire brush which plays against the outer surface of the neighbor- ing revolving disc where, by the friction between brush and disc, a condition of electro-magnetic excitation is estab- lished.
After excitation, the brushes and their supporters act as conductors of electric- ity, from the revolving to the stationary plates, and thus maintain the electro- magnetic activity of the latter structures.
It will be our effort to demonstrate that after primary excitation is obtained a collecting comb can perform the func- tion of conductor equally as well as the brush and the apparatus can thus be re- lieved of the objectional friction action.
In other words, to show that brushes are only necessary on a Toepler or other variety of static machine to bring it into primary action.
As the result of considerable study and experimental work prosecuted with a view of incorporating in a single static machine all of the good features of its predecessors, to eliminate as far as pos- sible their objectional ones and, at the same time, add such improvements as might prove of benefit, the writer deter- mined to incorporate within a single case upon a common axle a single sec- tioned, variously modified, Toepler in- strument with a Holtz machine of many sections, both portions to have revolving plates of the same dimensions.
As constructed the Toepler section develops the initial charge which excites all portions of the apparatus. After full electrical activity is obtained, by a special device, operated from the outside of the case, the brushes are thrown out of ac- tion and their places taken by small col- lecting combs, then the entire machine can be operated as a purely induction apparatus.
This device consists of a hard rubber knob or handle the base of which passes through the woodwork at the rear of the case. On the inside of the machine the base of the handle is fastened by a hinge joint to a long piece of hard rubber tubing in such a manner that the turn- ing of the knob will impart to the tub- ing a to and fro motion. The tubing is placed diagonally across the machine behind the posterior wheel, just under the axle, nearly at right angle to the neutralizing rod. It is supported at either extremity by a short arm, which extends to a small metallic hub attached
THE AMERICAN X-RAY JOURNAL.
i o I I
to the projecting edge of the stationary plates. From the same hub there pro- jects at other angles a brush and a comb holder. So that the to and fro motion of the rod imparted tnrough the knob on the outside of the case will throw one of these structures into and the other out of action.
Owing to the resistance in the form of air gaps interposed between the col- lecting combs of the field plates and the revolving discs the Toepler machine thus constructed, can not reverse its polarity while in operation.
If the brushes are removed and are not replaced by collecting combs, the Toepler section appears to work back- wards because it consumes some of the energy generated by the other portions of the apparatus.
The Toepler section also differs from the conventional form of that machine in that the exciting energy for both sta- tionary plates is obtained from the ex- ternal or posterion revolving disc. Not any energy is taken from the internal or anterior disc, consequently, that struct- ure is not provided as is usually the case with sectors.
When all the portions of the appa- ratus are electrically active the Toepler section generates a quantity of electricity which compares favorably with the amount generated by any single section of the Holtz.
The kidney shaped paper fields of the Toepler are turned from their usual sym- metrical position and are brought as nearly as possible into this alinement with the saddle shaped paper fields of the Holtz.
This combination of old and new principles has been operated most suc- cessfully in the hands of several local experts. It is now presented from the home of my alma mater for your in- spection, commendation or criticism. Buffalo N. Y.
X-Ray an Absolute Necessity in Dental Surgery.
BY DR. FRANK AUSTIN ROY.
Mr. President and Gentlemen of the Roentgen So- ciety of America.
We make a very strong statement whan we claim that anything is an ab- solute necessity, but the electrics have become such to modern life, to twentieth century existence.
Some places exist without the tele- phone, telegraph, etc., but not for long in this century. They are asleep or dy- ing because lacking the necessities of twentieth century life.
So the surgeon who goes on guessing with or without good judgment and ex- perience, probing and prodding and cut- ting for mere diagnosis, while his con- freres use the x-ray and know what to do without preliminary exploratory operat- ing. The surgeon who fails to use this necessity will drop out of the race this century.
This positive diagnosis has become a necessity also to dental surgery. Deal- ing with the structures that affect the appearance of the face as well as having their more utilitarian value at the gate- way of the digestive tract, any extra or uncertain cutting here does far more harm because disfigurement is added to loss of use and impairment of the nutri- tive functions so necessary to life. So I may say positively that in this twentieth century the x-ray is an absolute neces- sity to dental surgery. Without the x-ray such surgery is of the past.
Dr. Price and others of this society have done an immense amount of x-ray work for dental surgery. Your wonder- ful pictures have corrected diagnosis and shown how useful the x-ray is to us.
I belong to that class of dentists who believe we must go beyond the merely mechanical in dentistry and meet all the surgical requirements that are in any
I 01 2
THE AMERICAN X-RAY JOURNAL.
w*y connected with the teeth, yet not caring to do any surgery not so con- nected.
There are very many troubles of the teeth and adjoining parts that require more than mere mechanical treatment. True surgical work is necessary. To diagnose the location and extent of the trouble is always difficult, but with the x-ray it becomes positive.
Very few dentists have neither the time or inclination to take up for themselves the study of the x-ray and the necessary photography. I believe we can much better afford to pay an expert than spend time becoming only mediocre x-ray oper- ators, especially as good dental x-ray work is very difficult to attain.
Dentists can find good men within reach in any section of the country. I do not think any one thing could do more to extend and popularize the use of the x-ray. You who do this kind of work should advertise yourselves among the dentists for the good of the cause, even if you are too busy yourselves.
Being difficult work, you must get a good fee to pay you for the extra trouble that comes up in many cases.
It may take some time for the dentist to learn to read the negatives aright, but if he really knows the pathological con- ditions liable to be met in dental surgery, then, with the assistance of a slight knowledge of photography, he will get positive results and be willing to pay well for good x-ray work.
I have had very fine work done for my patients, giving me positive diagnosis, and reassuring the patients as to pro- posed operations.
There is no need of citing cases. You have had a great many fine negatives of such cases exhibited before this society.
W hy should a New York surgeon ad- vise drilling into the jaw to see if there be a nonerupted tooth, when a New Or- leans dentist had located the tooth with the x-ray?
Why should a patient go on suffering pain for years with an apparently healthy tooth and wish it extracted, when the x-ray picture showed conclusively a slight blind abscess easily cured by a simple operation.
Why should we go on probing and prodding and cutting blindly when a per- fect diagnosis can be made with the help of your services with the x-ray? New York City.
Hysteresis.
It has been noticed by operators of x-ray coil machines that when the inter- ruptions are very rapid there are less x-rays than when the interruptions are slower. We have been asked to ex- plain this. In the journal of Physical Therapeutics for Oct. 15. Ch. Colombo and Thouvenet have written these words: '•The more frequent the interruptions the shorter becomes the time during which the case is excited, for here the phenomena of hysteresis comes into play ; that is to say, a delay of magnetization and of demagnetization. The magnet- ization does not arise immediately on the passage of the current, and does not cease immediately. The current stops in the same way as a mill-wheel: does not begin to move immediately the water falls on it, nor does it stop immediately the water ceases to flow, on account of the phenomena of inertia. Hysteresis represents magnetic inertia. Now as the phenomena of hysteresis have come into play, it may be said that the greater the speed the less the magnetization and consequently the less the secondary dis- charge. Hence high frequencies can not be obtained by the interrupter, which in reality possesses an action much more limited than might be thought and which, to work well, ought to work the more slowly the greater the size of the coil."
Subscribe for The American X-Rav Journal — $3.00 a year.
THE AMERICAN X-RAY JOURNAL.
101 3
X-Ray in Country Practice.
Read before the Roentgen Society oi America, Uni- versity Building, Buffalo, N. Y., Sept. 11, 1901, BY DR. JOSEPH C. CLARKE.
The x-ray in the practice of medicine and surgery in the country has become a decided necessity as an adjunct to sur- gical skill and medical diagnosis and the object of this paper is to show the sim- plicity of its use in many emergencies that arise.
The country physician may be a little backward upon the theory of the x-ray light, the cause of the x-ray burn and many other mooted points, but if he is going to do x-ray work he must have a good apparatus which every morning must be put in working order, ready for the emergency that may come upon him like a bolt of lightning out of a clear sky. My usual course during the muggy weather is to put a Mason fruit jar, filled with cracked ice in the static machine and if it is very damp and humid, light my gas stove for about half an hour, raising the temperature of the room to about 90 degrees. This, with the help of a charger, will insure a good current every day of the 365. After four years of experience with actual cases, I am more than ever a firm friend of the soft tube and have yet to have a burn occur in my practice.
The patient appears with a needle in the hand or an elbow that is injured and a radiograph is desired. My photo- grapher furnishes me with the size plate needed and after an exposure of from 2 to 30 minutes, depending upon the thick- ness of the part, the plate is returned to the gallery and developed under my di- rection. My experience with ordinary plates has been so satisfactory that I shall continue to use them until I find something better.
If an operation is decided upon, the plate is brought back and used for refer- ence during the operation and the
prints from the plate are made later.
Now all this is very simple, but to read an abnormal condition correctly, one must know the normal and I have on hand radiographs of nearly all the joints taken to locate foreign bodies, and by comparison am able to make a sure diagnosis.
Since the meeting in New York last December, where my treatment of Lupus was the only case reported in this coun- try, I have treated three cases of Lupus successfully and present a photo of one of them. There have been no relapses in these cases.
I believe the Roentgen ray will cure rapidly and quickly the superficial varie- ties of Lupus and will control and assist caustics in the cure of the deeper varie- ties that are characterized by relapses and the formation of tubercles. I be- lieve it will relieve the pain and often cause marked lessening of discharge in epithelial cancer, but do not believe it will cure them, nor do I believe it will cure pulmonary tuberculosis and I would suggest this society make a definite statement upon these subjects, because the quacks all over the country are vic- timizing many, who if they were warned, would then have no one to blame but themselves.
The use of the Roentgen ray, in my opinion, will for some time to come be an emergency one, and the surgeon whose office is equipped with apparatus and familiarity due to daily use will always be prepared for any emergency that may •arise, and also can dip into the many new avenues of use that are constantly opening. I believe a clear cut state- ment as to just what can be done by the x-ray as an aid to diagnosis by any good common-sense physician will do more to advance the use of the x-ray than columns upon the cause of x-ray burn and other theories.
The following emergency case came into my office last Friday: A child 16
ici4
THE AMERICAN X-RAY JOURNAL.
months old, with a history of having commenced to choke the Wednesday evening preceding. Temp. 193, pulse 160, respiration 60, croupy and signs of decided obstruction in the larnyx. An x-ray examination showed a foreign sub- stance in the larnyx. Tracheotomy was performed and the foreign substance lo- cated in the aesophagus and all efforts to reach it and remove it through the mouth failing, the subtance was pushed into the stomach with a bougie. The child, upon Saturday, passed a copper rivet ^ of an inch long with a head }i of an inch in diameter and is making a rapid recovery.
In conclusion, I would say, have a good apparatus that is always ready and then with care and ordinary skill suc- cessful results will follow your efforts.
Olean. X. Y.
Verdict— X-Ray Burn.
Otis Clapp & Son of Providence, R. I., have written us that a verdict has just been rendered against them for the sum of $6,750 on account of an x-ray burn inflicted with a static machine.
Dr. Augustus C. Bernays has recently been elected president of the Academy of Medicine. This is the most enlight- ened, classical and high grade medical body west of the Allegheny's. Lr. Dam- pheare was the retiring president. Both of these surgeons use the x-rays.
Dr. John B. Deaver, of Philadelphia, in the St. Louis Clinique, says that the x-ray is used in making differential diag- nosis between renal colic and appendi- citis.
0
IK A 1 I I HI IIM'KK THIRD OF THIGH.
Note nature's effort to repair, by the abundance of callus thrown about the frag- ments, notwithstanding the bones are almost at right angles. Property Ol 8t. Louis X-Ray Laboratory, Chemical Building, Eighth and Olive Streets.
THE AMERICAN X-RAY JOURNAL.
1015
X-Rays from Static Machines for Therapeutic Purposes.
The following letter from Dr. Pusey, of Chicago, will explain itself. The inquiry is a quotation from his reprint on the x-rays in the treatment of skin diseases. Dr. Pusey's opinion is not shared by all x-ray operators:
Nov. 7, 1901. Dr. Heber Robarts, St. Louis, Mo.
Dear Doctor: — I have your favor of October 30 asking me why "the work should not be under- taken with static machines or with the ordinary apparatus used for diagnostic purposes." The answer to this is suggested in the previous sen- tence of the same paragraph of my article, viz. : "It is necessary that all of the factors involved in producing the light be definite and that there be repeated exposures to a weak light, the effects of which may be controlled, rather than the use of a strong light for a few exposures." As I said in that paragraph I use the technique suggested by Schiff and Freund, described in my previous article, in which the light is produced by standard current of 12 volts and \ amperes and a coil of 30 c. m. spark length. I believe it is only by main-
taining your factors definite and using a weak light that you can pursue the method with safety in all cases. The light produced with a static machine is in quantities which are greater than is safe to use repeatedly for long exposures and there is no way of accurately determining the factors in the production of light. Of course, the often made statement that burns do not occur with static machines is readily refutable. The ordinary apparatus used for diagnostic purposes requires a larger primary current than I believe is safe and the ordinary apparatus also is not equipped with means of measuring the primary current. For these reasons I believe it should not be used for the sort of work which I had under consider- ation. Of course, in desperate conditions like inoperable carcinomas one might be justified in running the risk of injury by the use of uncertain and large quantities of light, but I take up in my article rather more extensively than the malig- nant diseases minor affections of the skin which are treated with the x-rays, as acne, hypertrich- osis, and the treatment of such cases should be undertaken only with apparatus where the chances of any damage are reduced to a minimum. I was afraid in writing my article, when considering its use in such conditions as acne, sycosis, ring- worm, etc., that some men who are unfamiliar with the subject might be led on to use it in these
The Kinraide High-Frequeiicy Coil.
The best apparatus for use with the direct or alternating current,
SEND FOR
DESCRIPTIVE
CIRCULAR.
EX B. Meyrowitz,
Maker of Ophthalmological Apparatus, Complete Standard Electro-Therapeutic Equipments,
X-Ray Apparatus and High Grade Eye, Ear, Nose and Throat Instruments. 104 East Twenty-third Street, ) 604 Nicollet Avenue, Minneapolis.
125 West Forty-second Street, [-NEW YORK, 36a St. Peter Street, St. Paml.
650 Madison Avenue, ) 3 rue Scribe, Paris, France.
ioi6
THE AMERICAN X-RAY JOURNAL.
comparatively trivial affections without due care and with the production of unexpected disastrous results, I felt, therefore, that at least one short paragraph of caution should be given. Thanking you for your kind letter, I am,
Yours truly, W. A. Pusev.
The Electrical Review, of London, gave a brief summary of the meeting of the Roentgen Ray Society of America. The expression was kind and timely, and is appreciated by members who read this great weekly.
Otis Clapp & Son of Providence, R. I., will pay cash for Vol. 6 of The American X-Ray Journal. Any one desiring to dispose of this Vol. please write to them.
D'Arsonval currents are not high fre- quencies, but are condenser discharges with not too high speed interruptions. They are oscillation discharges.
Instruction
IN-
X-RAY WORK
Is now offered to Physicians at the
St. Louis X-Ray Laboratory.
The Static Machine and a variety of coils are used in giving instructions. The commercial current, storage bat- tery, Wehnelt interrupter, methods for correcting apparent distortions of the rays are taught, together with the gen- eral detail of x-ray work and develop- ing of plates.
300 Chemical B'ldg, 8th and Olive Sts. Write or call for particulars.
X-RAY MACHINES For Any Circuit.
r Alternating. Battery or Lighting.
new line of PORTABLE MACHINES
Very compact and very powerful, with improved spark gaps, inde- pendent interrupt- er, etc.
Then there is the
Cunningham Mercury Jet Interrupter,
^ Giving interrup- I tions variable at will, from 10 to |1 10,000 per minute, J and breaking current up to :*" |MP^" amperes. Willyoung X-Ray Machine— Latest Model— 8" to 18". Headquarters for Tubes, Fluoroscopes, Tube Stands, Radiographs, Tables, Etc., Etc.
Elmer G. Willyoung, 11 Frankfort St., New York. X-RAY TUBKS.
Perfect Glass, Reinforced Seals. They Can Always be Repaired.
X-Uay Tubes re-exhausted and repaired. Also Atomizers, Nebulizers for heavy fluids, and Inhalers
(ilass apparatus Ol all kinds. Correspondence Solicited.
STUNTZ & ARMSTRONG,
Owensboro, Ky.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Praciical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X-RAY PUBLISHING COMPANY
HEBER ROBARTS, M. D., M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE.
United States, Canada and Mexico $3.00 | Foreign Countries $4.00
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Heber Robarts, Editor, Suite 301 Chemical Bldg., St. Louis All business matter should be addressed to The American X-Ray Journal Publishing Co., same address All contributors of original articles and other matter relative to X-Radiance, of interest to the medical
profession, are solicited from all parts of the world. Contributors will be furnished a liberal number oi
extra copies of the Journal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611
Chemical Building, St. Louis.
Entered at the Postofflce at St. Louis, Mo., as Second-Class Matter.
VOL. 10. ST. LOUIS, APRIL, 1902. NO. 1>
CONTENTS OF VOL. 9, NO. 6
Iodoform in Knee Joint.
Researches in the Direction of Obtaining Radiographs and Fluoroscopic Ex- aminations of the Muscles and Liga- ments.
The Development of the Crooke's Tube for the Past Twelve Months.
How the Induction Static Machine Can Be Excited without Separate Charger.
X-Ray an Absolute Necessity in Dental Surgery.
Hysteresis.
X-Ray in Country Practice. Verdict — X-Ray Burn. Fracture Upper Third of Thigh. X-Rays from Static Machines for The rapeutic Purposes.
CONTENTS VOL. 10, NO. 1.
The Practical X-Ray Diagnosis. A B C of X-Ray.
The Value of the X-Ray as a Thera- peutic Agent. Tube and Exposure.
Roentgen Rays in Medicine and Surgery Radiant Ore in United States. Letter from D. W. Spence. Letter from H. A. Dow. Letter from J. Hall Edwards. Protection for X-Ray Workers' Hands. Multiple Use of Static Machine While Running.
The Practical X-Ray Diag- nosis.
Prepared by J. Rudis-Jicinsky. A. M . M. D . M. E.. Cedar Rapids, la. Revised by M. U. Dr. Joseph Hofiman, Vienna, Austria.
A series of A. B. C. teaching for workers in x-ray diagnosis and therapeutics, to be concluded in 20 articles. Fully illustrated.
PREFACE.
In presenting these series of articles to the student of the new branch of diagnosis, I wish to express my obliga- tions to the many of my collaborators and authors, whose various works I have freely consulted, asking from the reader kind consideration of my effort to de- scribe fully and practically the progress of the x-ray since its discovery, the phases of which have changed, especial- ly in diagnosis, and are still changing.
What are the x-rays?
We do not know just what the x-rays are, nor why they are produced under the conditions existing in a vacuum tube. But we do know that by follow- ing certain processes and making certain chemical combinations we can make as much x-rays and in such proportions as we want or need for penetration of cer- tain objects. It is difficult to predict to what final uses the simple fact discov- ered by Prof. Roentgen, that different substances are more or less opaque to the x-rays, in proportion to their density, may be put, and what the near future will bring us in regard to the proper diagnosis in Surgery and Medicine.
l.
There are enormous possibilities lying dormant.
Emile Gautier says: "Suppose that we are looking at a photograph repre- senting the skeleton of a pocketbook. There are the metallic parts, the frame, the leather lightly discernable, while in- side are the key and a piece of money.
"Let us now see how the photograph- er produces this queer picture.
"First, he goes into his dark cabinet. He has no electrical apparatus or any other apparatus for that matter.
"He places the pocketbook on a sen- sitive plate. At the end of two or three hours he takes his plate, develops it, and we have the photograph of the pock- etbook. All this has been done without sun or electricity.
"What kind of a miracle is this?
"It is simple. The photographer has left in the proximity of the plate a tube, containing a few centigrams of chloride of barium. This story reads like a fairy tale, yet it is only one chapter of the history of science.
"In 1S96, M. Henri Becquerel made the discovery that the compounds of a metal called uranium, emitted peculiar rays, and the emission was spontaneous and constant. That is, he discovered that this matter has in itself its own light and t-h^t this light was eternal. This fact reversed all known principles of chemis- try. These rays were given the name of Becquerel rays, and the substances emit- ting them were called radioactive.
"It was in studying the properties of
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X Ray Work and Allied Arts and Sciences.
OL. 10. ST. LOUIS. APRIL. 1902. NO-
ioi8
THE AMERICAN X-RAY JOURNAL.
the radioactive rays that the investiga- tors ascertained in an ore, the ore of ox- ide of uranium, the existence of three substances. These substances were po- lonium, which was found by M. and Mme. Currie; the radium, which was also discovered by them; and the actin- ium, which was discovered by M. De- bierne.
"These ores of uranium were secured at the state works at Jachymov, in Bo- hemia. Several thousand kilograms, besides tedious, expensive and hard la- bor, were required to obtain a few deci- grams of the substances, which are now astonishing the scientific world. They partake at the same time of the proper- ties of the cathodic and x-rays.
"These substances spontaneously gen- erate electricity. In a laboratory of physics they upset all the apparatus. If the operator is saturated with their mys- terious energies, he can not approach an electrical appliance without upsetting it. At a distance they produce a chemical reaction. One of the most wonderful results in connection with this is photo- graphs as mentioned above. They are spontaneously luminous without under- going any transformation to a percep- tible degree.
"The price of these substances, owing to the difficulty of their production, practically annihilates their industrial value. But it is reasonable to suppose, that later on they will be produced as cheaply as aluminum, formerly so ex- pensive and obtained so easily at small cost.
"We can already perceive the appli- cations that will be made of these sub- stances. It will be possible to treat wounds by the radioactive action of ra- dium. The volts of radium may be used one day to cure neuralgia through slow emission of electricity.
"Anyone carrying in his pocket a few grains of the substances would be able to p produce, and with what ease, all
kinds of skiagraphs. With a sensitive plate he would be at liberty to read through solid bodies, as it has been demonstrated that the rays can pene- trate through several centimeters of metal."
PART I. LESSON I.
Introduction — Apparatus for the production and application of Roentgen or X-Rays.
Roentgen ray or x-ray diagnosis are the terms used to designate the methods which are employed for detecting of normal or abnormal conditions, disease or injury in some part or any organ of the human body; to observe during life the anatomical changes which can be recognized with the help of the x-ray only, or with the employment of the x-rays in connection with other methods of eliciting the signs of disease, or trauma. The proper significance of this method is shown, not by theory, but through clinical behavior and observa- tion confirmed by the x-ray examination in all those cases where skiagraphy is possible. Inspection, Palpitation, Mensuration, Percussion and Aus- cultation, Blood count, Microscopi- cal, Chemical and all modern methods of diagnosis are sometimes only subsidi- ary to these important findings of the x-rays. But for a complete and accu- rate exploration >ou must always em- ploy all the different methods and mod- ern means of diagnosis, to do your duty toward the patient and the profession at large.
The question of the value of the x rays in diagnosis of certain lesions seems to be settled; it is beyond the experimental stage and has come to stay. I desire to take this opportunity to urge the more general use of x-ray examinations by our profession and to repeat the warn- ing again and again, that this branch should and must remain in our hands only, because there is a necessity of a great deal of refinement in operating the
THE AMERICAN X-RAY JOURNAL.
1019
x-ray, and its pictures, experience in ex- amining, ability to read correctly the varying shadows, as well as a good deal of knowledge in anatomy, pathology, and physic. There are so many new "things", proprietary and otherwise, added to the list of the surgeon of today, that the individual can scarcely keep posted on all of them, but he will with great avidity appropriate those facts which can be instantly transformed into working force, and will always appreci- ate the demand for the practical, the utilizable, especially in the case of early and proper diagnosis.
Pushing aside the theoretical discus- sion and gain, from which is conspicu- ously apparent, it is well to review the results of actual , the good work only. For good x-ray work, the first requisite is an exciting apparatus, and it makes no differ e nee if it is a coil or a static machine of good make. We are after the proper source of electricity, and nothing more. The knowledge of our apparatus, proper technique in each in- dividual case, the knowledge of our Crookes' tube, the management of the same, the knowledge of the power of our x-ray produced, the distance of the tube from our object, the distance of the anode plate from the photographic plate specially prepared for the x-ray manipulations, the dura'ion of exposure, the relative position of the tube to the object and the angle at which the picture or skiagraph is taken, are the first main rules in the photography of the invisible.
We have to know the capacity of our apparatus or the length of the spark, which may be produced. If a static machine is employed in our x-ray work, mark the number and diameter of re- volving plates and their speed. If a coil is used, look always after current em- ployed, remembering the amperage of the current passing to the tube. The best tube is the one which is known to you, and used every day, the one in
which you know the distance between the anodal plate and the cathodal cup, the one in which you know and have learned to observe the quality of the vacuum backed up by a certain length of spark gap before radiance appears, and know all other points of individual- ity of the tube. Beside that, note the character of the photographic plate, when skiagraph should be made, the number of coatings of film, sensitiveness, the age of the plate and what support and the number of intensifying screens shall be used, if used at all. Also note the particulars of development, the de- veloper used and all steps concerning printing, paper, etc. If we wish to make correct diagnosis in suitable cases for skiagraphy, and produce an accurate picture of the status presens, we must never be satisfied with one picture or skiagraph of the injured part or the dis- eased part examined, but make it also our duty to compare the picture of the diseased part with the normal one. We have to work as rapidly as possible, make short exposures and protect our patients. We always have to keep the obliqueness of the x-ray in mind, make skiagraph as near life size as possible, to get sharply defined outlines, remem- bering that we are dealing with shadows only, and use proper means of proof for measurements and exactness of our picture.
We will now briefly describe the dif- ferent apparatus which may be employed as aids in x-ray diagnosis, and give some rules to guide us in their use.
APPARATUS REQUIRED.
The apparatus required for the pro- duction and application of the Roent- gen or the x-ray, consists of following parts and accessories:
1. Source of electric current.
2. The Crooke s tube or the vacuum tube.
3. Induction coil or static machine with her
own current, with or without Tesla s trans- former.
4. Fluoroscope, fluorescent screen, skiameter.
I 020
THE AMERICA X X-RA Y JOURNAL.
5. Interrupter, with speed indicator and spark
tester. 6 X-ray tube stand. - Moveable bar with wire-holder. S. Connecting wires. 9. The casket.
10. Special dry plates or films.
11. Intensifying screens.
12. The copying frame.
13. The operating table. (Measuring stand for
fluorometer).
14. Leaden box with diaphgrams for preclud-
ing the diffused rays.
The electric current may be generated by primary or plunge batteries, storage batteries or accumulator batteries, static machines, or the charging may be done by means of an electric light installa- tion, thermo-piles, and constant, direct or alternating current.
To enable the observer to see the x-ray, it is necessary to employ a screen of tungstate of calcium or barium-pla- tino-cyanide, which is mounted in a frame that can be stood on a table in the dark room or in the shape of a hand flu- oroscope, which is a hood fitting closely to the face and excludes the outside light.
A B C of X-Rays.
We have arranged for a series of ar- ticles covering the entire teachings of the uses of the x-rays. This will include the physics of the apparatus, but more particularly the A B C or primary in- struction in diagnosing and the therapy of radiant matter. The lessons will probably be divided into 20 sections, some of which will be liberally illus- trated. No one interested in the x-rays and its teachings can afford to miss these lessons. They are unexcelled and absolutely new.
The Illinois School of Electro-Thera- peutics, of Chicago, is doing good and faithful work and deserves the highest commendation.
Subscribe for Thk American X-Ray J <>i knai -53.00 a year.
The Value of the X-Ray as a Therapeutic Agent.
Read before the Roentgen Society of America, at University Building, Buffalo, N. Y., on September 11, 1901, BY PROF. H. P. PRATT, M. D., of Chicago
In the x-ray we have an agent whose therapeutic value has been underes- timated in certain cases and overesti- mated in others. This is probably due to the lack of sufficient knowledge on the subject, especially as to the nature and character of this force and its meth- od of application. We must not be car- ried away with the idea that it is a cure- all; if so, we will certainly be disap- pointed. But with a thorough knowl- edge of the nature and effects of this force, we may reasonably expect good results. It has its field of work. A full knowledge of this field can not be ac- quired in a day, but only by months of hard labor. Every day's work brings to us added knowledge. The limit of its healing powers time alone will decide.
This force has been applied with good results in the following cutaneous and other diseases: Hypertrichosis, sycosis, favus, rosacea, eczema, psoriasis, lupus vulgaris and erythematosus: also in tuberculosis of the bones, joints and softer tissues. In epitheleoma, car- cinoma, sarcoma and osteosarcoma, improvement, and in some instances, cures have been reported. Most of the above diseases have been reported cured or much improved in the for eign medical journals, by such men as Schiff and Fruend, of Vienna; Kemmell and Hahn, of Hamburg; Steinbeck, Seyneira and many others.
Admitting that the x-ray is of some the- rapeutic value, as we must in the face of the above authorities, let us refer to his- tory and note the progress made along this line and the obstacles we have had to contend with. We have in this coun- try quite a number of investigators and original experimentors, who are working
THE AMERICA X X-RA Y JOURXAL.
IQ2I
along the same lines as our foreign friends. Such men as Jones, of San Francisco; Knox, of Cincinnati; John- son and Merrill; and in our own city (Chicago i such men as Burdick, Black- marr and Pusey. Our worthy presi- dent, also our secretary, our treasurer and other members of this society are working alongthis line; and, in fact, each city can make claim to individual work- ers as well. The first investigators found it a difficult task to overcome the vari- ous obstacles that lay in their path; the lack of a suitable apparatus, such as coils, tubes, etc., and especially the prejudices of the profession. With time came a better apparatus, and the x-ray burn, which being indisputable proof of the power of the x-ray to do something, called the attention of the profession to its therapeutic value.
The first published account that I saw of the x-ray burn came from Berlin by cable, to the Xcw York Journal, July 23, 1896, as follows: "Dr. Markuse, whose interior has been photographed thirty times within the last twenty days by the Roentgen process, has lost all of his hair as a result, and his face has assumed a brownish color. The skin has peeled off his breast where the instrument had touched it, and on his back, what was first a sore, finally developed into a bleeding wound, surrounded by burnt looking cuticle. The victim is exhaust- ed." My attention was first called to the x-ray burn in April, 1896, when Prof. YYightman and myself inoculated Guinea pigs with the bacilli of tuber- culosis and exposed them to the x-ray, which tookthe hair off from the pigs in patches, leaving a sore. This state of affairs began to check pro- gress for a while, preventing further in- vestigation. Scientists were endeavor- ing to determine the cause of these in- jurious effects. It, however, took fur- ther experiments out of hands of the tyro and brought about a more careful
and systematic method of investigation. More than one man has sacrificed his life in the development of the x-ray. To my knowledge there has been five or six deaths.
I will now give a brief review of my own work in this field. On the morning of the seventh day of February, 1896, I saw the first account of Prof. Roentgen's work. Having been a student and teach- er of physics and interested in college work, I had in my experimental labora- tory a Ruhmkorff coil, Crookes and Geissler tubes, which had been in my possession for a period of over 20 years, used for experimental work, and I was somewhat familiar with the cathode ray and the changes in vacuum tubes. I had observed similar phenomena, so I was in a position to formulate a theory imme- diately, which was published in all the daily papers and in the electrical and medical journals. I then followed up a series of experiments to test the correct- ness of my theory. In the first part of April, 1896, with the kind assistance of Prof. Hugo Wightman, I succeeded in destroying the bacilli of eight different diseases, in culture tubes, as follows:
The bacilli of Cholera,
" Diphtheria,
" Influenza,
" Glanders,
" Pneumonia,
" Typhoid,
" " " Tuberculosis,
" " " Anthrax.
An account of this was published in the Chicago Times-Herald^ on April 13, 1896, and republished in other dailies, and in electrical, scientific and medical periodicals. Immediately after destroy- ing the above cultures, thereby demon- strating the therapeutic value of the ray, I commenced to use it as a therapeutic agent, and on April 13, 1896. the date of the above announcement, I placed my first cancer patient under treatment. A report of this appeared in the Chicago Timcs-Hcrald of April 14, 1896. The
1022
THE AMERICAN X-RAY JOURNAL.
most notable effects observed at that time were the relief of pain and the checking of the hemorrhages. This was a case of cancer of the stomach. On the iSth day of April, 1896, assisted by Prof. Wightman, I inoculated Guinea pigs with the bacilli of tuberculosis and ex- posed them to the x-ray with the following result: — Those exposed to the x-ray increased in weight and thrived; the others died. On the sides of the pigs nearest the tubes, as I said before, all the hair came out, leaving a running sore. This experi- ment was repeated several months after- ward.
Cable to the New York Journal: "Lyons, June 25, 1896. — Prof. Lortet, who has experimented on Guinea pigs, says investigation proves that Roentgen rays prevent the development of the ba- cilli of tuberculosis."
On July 9, 1897, I exposed to the x-ray, rabbits which had been inoculat- ed with rabies by Dr. Lagorio, of Chi- cago. Results unsatisfactory.
On April 17, 1896, I treated my first patient suffering from pulmonary tuber- culosis. This patient improved under treatment. I, however, lost track of this case and have been unable to ob- tain a report before this meeting. On April 19, 1896, I placed my second case of pulmonary tuberculosis under treat- ment. The patient died several weeks afterward. He was too far gone and he only continued his treatment about a week and then left the city. This case was placed under treatment in the inter- est of the New York Journal, and re- ports can be seen in that paper at the time.
( )n May 20, 1 896, the third patient suf- feiing from pulmonary tuberculosis, was placed under treatment. This patient was referred to me for treatment by Dr. Fran- ces Dickinson and Dr. Effie Lobdell, of Harvey Medical College. The patient was examined by Dr. Wm. Harsha, Dr.
Geo. F. Hawley, Dr. J. C. Spray, Dr. M. F. Sterling, Dr. J. E. Gilman and others, of Chicago.
The following record of this case was kept by Dr. M. F. Sterling:
Case: Andrew Gorgan was born near Naples, Italy, in 1875 His parents were vineyardists; both are living and healthy. He has a brother of 17, who is a strong and healthy boy. In 1886, the family emigrated to America and set- tled in Ohio. Near their home was a large creek of very cold water, and An- drew often stole away to bathe there with the other boys, remaining in wet clothes often for hours. He caught cold after cold, and at last a nagging cough set in, of which he could not get rid. Suddenly hemorrhage set in, and for the first time, his parents took alarm. Physi- cians were summoned, but he never got anything more than temporary relief. Hemorrhages again and again recurred, growth ceased at this point, appetite be- came irregular and capricious, sleep restless and unrefreshing, there was con- stant fever and drenching night sweats. The parents now determined to move to Chicago, desiring to consult a wider range of medical skill than the Ohio town afforded. They arrived in the au- tumn of 1895. He at once began attend- ance at the clinics of the medical colleg- es in rotation; as he found no improve- ment in one he tried another. At last his case was pronounced hopeless by several specialists, and his father was directed to use anything to make him comfortable. Treatment was considered useless, and so he was given up to die. Early in 1896, the x-ray was a topic of anxious investigation to us, as to wheth- er it had therapeutic value or not, until we placed tube culture of the bacillus tu- berculosis under the ray and found that no further propagation occurred afterex- posure of two hours. This test was made time after time with different cul- tures, always with the same results.
THE AMERICAN X-RAY JOURNAL.
1023
This discovery was given to the world, and was received with much adverse criticism, and even ridicule, by all class- es of the profession. To the initiated, the thoughtful and those who really de- sired to see the demonstration of the truth, every facility was given to verify the statements made. After all doubt was removed as to the cultures, the con- servative criticism was advanced that, although tube cultures were unable to stand the x-ray, it might not be the same with bacilli in the human lung tissue in the living organism. It was thus that this unquestioned case was submitted for experiment. Before placing him un- der the ray, his height was 4 feet 11^ inches, weight 74 pounds. The right lung from apex to mammary region was said to be one big abscess, discharging pus in quantity. Appetite was gone, digestion impaired, sleep restless and unrefreshing until nearly morning, fever constant, rising to 104 degrees. Hem- orrhages recurred every four or six weeks, amount varying from a few mouthfuls to a breakfast cup full at each discharge. Of the leading specialists who passed upon him, the most hopeful placed his longest possible limit of life at about five weeks.
His x-ray treatment began May 20, 1896, at 1:15 p. m., and continued for two hours at each seance. Before treat- ment his temperature, pulse and respira- tion were taken; temperature 103.5 de- grees, pulse 100, respiration 34. At the beginning of the second hour, tempera- ture 102 degrees, pulse 120, respira- tion 28. At the end of the second hour, temperature 101.75 degrees; pulse 120; respiration 22. Half an hour after the treatment ended, temperature 101 de- grees, pulse 100, respiration 20. At the end of the first hour of treatment Andrew was sleeping soundly.
May 23, temperature 99.5 degrees, pulse 112, respiration 36. Second hour, temperature 100.20 degrees, pulse 112,
respiration 30. Third hour, temperature 99 8 degrees, pulse 98, respiration 35. The patient reports night sweats much lessened, no return of hemorrhage, which was threatening at last treatment. Feels stronger and appetite is improved.
May 26, 1:30 p. m. ; temperature 99 .3 degrees, pulse no, respiration 28. Sec- ond hour, temperature 100 degrees, pulse 120, respiration 27. Third hour, temperature 100 degrees, pulse 120, res- piration 30.
May 28, 1:30 p. m.; temperature 98 2 degrees, pulse 90, respiration 18. Sec- ond hour, temperature 98 5 degrees, pulse 96, respiration 18 Third hour; temperature 100 degrees, pulse 96, res- piration 18
Cough much lessened in frequency; yesterday only two paroxysms during the day. Bowels regular, appetite vora- cious, sleep restful and dreamless; awoke only twice to cough and immediately slept again. Sweating much less, but still overnormal in amount.
June 9, 1:30 p. m. ; yesterday felt so well that he attended an Italian wedding in his church. Attended the supper at night, overate and was taken to the drug store to be treated for colic.
Has gained one pound in body weight. Reports almost no cough during the day, but several times during the night. Is in fine spirits; begins" to walk about freely. Urine excessive in quantity, has been so since the first.
First hour, temperature 98.5 degrees, pulse 100, respiration 20. Second hour, temperature 98.5 degrees, pulse 100, res- piration 28. Third hour, temperature 98.5 degrees, pulse 86, respiration 18.
The variation in pulse, respiration and temperature, is dependent upon the distance of the tube from the chest wall and the strength of the current. The closer the tube the stronger the force, and hence, the more powerful the electro-therapeutic action. A rise, there- fore, of pulse and respiration always oc-
1024
THE AMERICAN X-RAY JOURNAL.
curs under treatment, but this declines abruptly about an hour later.
June 13. He has gained another pound in body weight. Microscopic ex- amination of the sputa shows marked decrease in the number of bacilli. Urin- alysis showed that although the urine was in excess, the proportion of the sol- ids was unchanged. He, today, walked two miles without fatigue. Appetite still in excess, digestion good; present weight 78 pounds.
June 30. Yesterday he attended an Italian picnic in Lincoln Park; sat on the wet grass for several hours, caught cold and all his symptoms showed acute nephritis.
Now says he had acute inflammation of the kidney four years ago, and for a time this was a very bad complication.
Angust 6, 11:45 a. m. Temperature 99 degrees, pulse 92, respiration 14. Second hour, temperature 99.5 degrees, pulse 84, respiration 16. Third hour, temperature 100 degrees, pulse 92, res- piration 18.
Says he feels good, appetite and di- gestion very good. Cough almost gone, except in the morning a little. Urine shows specific gravity 1014, reaction neutral. Sediment normal, no sugar, no blood, no albumen.
September 3, 1:30 p.m. Yesterday, wrestled to try his strength, then ran to a street corner and jumped on a street car in motion and got a sudden wrench; began to cough and brought up a small quantity of blood. Greatly frightened, but today no rise of temperature, pulse, or respiration. On examination found the blood came from the back of the throat. Complains of the throat be- ing sore on swallowing; says he has eaten two pecks of peaches and one large watermelon without asssistance in two days. Complains of pain over the kidneys recurring at intervals. Small calculi voided with much pain. Microscopic examination of sputa shows
only very few bacilli, in all not more than four in six slides.
June 23, 1897. Andrew Gorgan is in fair health. No fever or night sweats. Good appetite, sound sleep, and can walk for miles without great fatigue. From the day he took his first treatment he has never had the slightest hemor- rhage from the lung; can take a deep breath without coughing. He is now simply weak and requires country air and a change from his very unsanitary surroundings.
This patient was in comparatively good health until his death, which took place July 9, 1900. Four months before his death he was at my office feeling bet- ter than he ever had. A few weeks later he took a severe cold and had an attack of pneumonia, which he partially recov- ered from. He finally died after an op- eration had been performed upon his foot or leg, I don't remember which, which resulted, as I understand, in blood poisoning. He had suffered for three or four years previously with stones in the kidneys, and we were in hopes that he would be able to be operated on for them. This case was reported by Dr. Finley Ellingwood, in the Chicago Medical Times, July, 1896, and by Dr. J. E. Gilman, before the Clinical Society, of June, 1897, and published in their official organ, The Clinic, July 15, 1897. From June 1, 1896, to March 1, 1901, I have treated for J. E. Gilman, over 50 patients, suffering from tubercu- losis, cancerous, asthmatic, rheumatic, syphilitic and skin diseases, with the x-ray. I refer you to him for data of cases.
On June 8, 1896, Dr. John B. Murphy, of Chicago, referred to me for treatment a patient, suffering from lupus-vulgarus. The treatment continued for about three months, at which time the patient was discharged cured. The patient came to my office a year afterward feeling in the best of health. There was no re-
THE AMERICAN X-RAY JOURNAL.
1025
currence up to that time. She, howev- ever, left the city and I have been un- able to obtain a final report in time for this paper.
On Oct. 21, 1896, Dr. Finley Elling- wood referred to me a patient, suffering from tuberculosis of the kidney. She was discharged cured by the doctor in about four months. The patient is still alive, and as Dr. Ellingwood informed me a few days ago, is enjoying the best of health.
For the results of the other patients treated by me for the various physicians, I will refer you to them for full data.
The pioneer worker's path is not strewn with roses. No sooner had we announced the destruction of the bacilli on April 13, 1896, and before the ink was dry, a cable from London to the New York Journal, dated April 14, 1896, stated that Dr. T. Glover Lyon had just tried similar experiments with negative results, and that the statements made by us, that we had accomplished it, were false.
On April 15, 1896, a cablegram came to the New York Journal, from Prof. Roentgen, which is as follows:
"Your dispatch tells me diphtheria was slain outright in the Chicago exper- iments, while no final and positive ver- dict is as yet given as to the effect on the bacilli of cholera, pneumonia, typhoid, and other plague germs tested. This is astonishing and partly disappoints my anticipation. I consider diphtheria and cholera the most deadly of plagues and believe positively that the bacilli of the other scourges would be the least diffi- cult to kill. But I am confident that eventually the x-ray will prove an effect- ual cure for all such diseases.
''I will rejoice when it will be in the power of every competent physician to kill those bacilli. Then once having located them, the modus of annihilation will be mere technicality.
"If Profs. Pratt and Wightman have
successfully completed their experi- ments, their names should go down to posterity as benefactors of the race, since humanity is immeasurably benefited by their work."
"What are your plans for the future?" was the next question.
"You know," he said, "that my orig- inal invention was accidental, but I am now going home full of new ideas to fin- ish every detail.
"It is possible that I will hit upon the same modus of Profs. Pratt and Wightman.
"I am fully prepared and will have much better equipments to continue any investigations, and I will do so on my own lines, looking neither to the right nor to the left.
"All professional men are heartily welcome to my conclusions, though in their struggle to obtain the best possi- ble results, each must go his way."
In answer to the question whether he had any conception of Prof. Pratt's methods, Prof. Roentgen said:
"I would rather not guess at Prof. Pratt's methods, but I am eagerly ex- pecting further particulars, though as far as my own studies are concerned, I do not believe that they will be abrogated or adversely influenced by them. Amer- icans sometimes accomplish great things in a hurry. We prefer to work more slowly and with greater deliberation. In conclusion let me repeat that I antic- ipate the usefulness of the x-ray in the cure of all manner of diseases from the start."
In the above dispatch, Dr. Roentgen also complimented me, thinking I was his old friend, Prof. Pratt, of Johns Hopkins University. After he discov- ered his error, he kept quiet for a short time until he had tried experiments on the bacilli of diseases. Then he made the statement that the x-ray was not a therapeutic agent, as it had no effect upon the tissues of the human body.
IO20
THE AMERICAN X-RAY JOURNAL.
Just about this time Prof. Minck, of Munich University, succeeded in par- tially destroying the bacilli of typhoid fever.
On April 1 6, 1896, the following cable was received from Vienna: "The asser- tions made by Chicago professors, to the effect that they have established proof that Roentgen rays will kill bacteria of cholera and other diseases is regarded here as worthless, and the alleged dis- covery is absolutely false. Doctors of Vienna and Munich have proved to the contrary.
On April 27, 1896, Prof. Wm Schroe- der, head of the electrical department of the University of Missouri, and Prof. Hickman, the bacteriologist, destroyed the bacilli of diphtheria in culture tubes. On August 1, 1896, they inoculated Guinea pigs with bacilli of diphtheria.
Several theories have been advanced to explain the nature and character of the x-ray. The two principal ones of today are the English and the German. The former is that of irregular transverse vibrations in the ether, the latter longi- tudinal waves of Hertz. Neither of these two theories seem to be quite satis- factory.
It appears to me that if we consider the x-ray as an electric current of very high potential, which makes its circuit from the inner surface of the tube out- ward, perpendicularly to the surface, then radiates in straight lines until the potential falls, when the rays return to complete their circuit by the terminals, we have a simple and practically useful explanation of all the phenomena.
After it was discovered that the x-ray possessed the power of blistering and burning the skin, the papers were filled with various warnings. My business, as well as that of others in this line, drop- ped off. No one wanted an x-ray pic- ture taken, much less treatment.
The following theory, suggested by me, was published in the Times-Herald,
April 13, 1896, the date of the original announcement, explaining the reason for the destruction of the bacilli:
"The magnetic force from the x-ray passes directly into the affected tissues. Electrolysis results, the chemical de- composition liberates oxygen, which unites with the free oxygen of the body and makes ozone. Ozone will kill ev- ery bacterium the human body possesses. The present state of the experiment proves outright murder in some instan- ces and inability to work in others.
"The effect in either case, is eventu- ally the same to the patient. The tis- sues in the latter instance gain new strength and drive out bacilli."
Eight months after this there was pub- lished in the daily papers, dated Dec. 6-7, 1896, the following article, defend- ing the x-ray as a healing medium. I quote this in full, as it shows the same line of thought suggested in my original announcement, and also helps you to appreciate my position in the matter.
"Recently much has been published about the injurious effects of the x-ray upon the human body, such as its pro- ducing abscesses, burning and blistering of the skin, shedding the hair and finger nails, etc. For the last eight months I have had patients under the x-ray in my laboratory from 9 a. m. to 6 p. m., du- ration of treatment varying from a half hour to four hours at each sitting, and not once with any bad result in any case.
"After the Crookes tube is excited by the coil, the magnetic lines of force are projected down, in the same manner as they pass off from a magnet, and trav- ersing the intervening space, pass through the body down to the floor, and back to the coil and tube again, com- pleting the circuit.
"The x-ray is electrostatic in charac- ter and of a very high potential. With every discharge from the Crookes tube oxygen is liberated in the body as well as in the surrounding atmosphere which,
THE AMERICAN X-RAY JOURNAL.
1027
combining with the nascent oxygen, forms ozone.
"It is due to the electrolysis produced in the body that we are able to destroy the bacilli in contagious diseases; ozone being the most powerful germicide known.
"Ihe ozone generated between the tube and the body does not produce the burning, etc., noted; it is the increased current which, passing through the body, produces electrolysis, the skin being of a higher resistance than the rest of the tissues.
"This same condition of burning takes place under the galvanic and static cur- rents if excessive use be made of them. Except for potential alone, the two forces are identical.
"In some of the Eastern states crim- inals are electrocuted. Here electroly- sis is carried to extreme, destroying the whole body; but the product of partial destruction exhibits abscesses, etc.
"In the disastrous treatments given and reported, the unskilled operators used a current in the apparatns of too high tension, and instead of hastening normal physiological change, carried their treatment to a point of electrocu- tion. Strychnine is a good drug when used by a skillful physician, but a dan- ger when in the hands of a tyro.
"It must not be forgotten that electric phenomena are very powerful, and not every man who can buy a machine is capable of applying it. The electrical machine must be as skillfully adjusted to each individual as the microscope to a specimen submitted to it. It is a treat- ment full of danger if ignorantly or rash- ly handled, but beyond price in value to the skilled and careful electro-thera- peutist."
We will now take up the subject of x-ray tubes.
The hard and soft tubes are the same as high and low vacuum tubes. The x-rays are produced by the bombard-
ment of the molecules of residual gas against the inner surface of the tube. The number of molecules of residual gas in the tube determines the degree of vacuum, as to whether it is a hard or soft tube.
The x-ray tube when excited, acts in a similar manner to a condenser or Leyden jar. It discharges in one direc- tion, the outer surface of the tube be- comes electro-positive, while the inner surface is electro-negative.
The tubes, as a rule, are excited from the terminals of the Ruhmkorff coil or the static machine. The current is es- tablished through the molecules of the residual gas in the tube, thereby con- necting the cathode with the anode. Each oscillation in this circuit causes the molecules of residual gas to bombard the inner surface of the tube, which point of impact is the source of the x-ray.
When the tube is excited, some of the molecules of the residual gas are thrown from the cathode, striking the platinum disk or anode, which serves as a target, causing the molecules to rebound and strike the inner surface of the tube. This point of impact on the inner surface of the tube, as I said before, is the source of the x-ray. Every molecule of gas striking the inner surface of the tube, causes one or more lines of magnetic force to be thrown out at right angles to the surface of the tube. The distance to which the lines of force are projected or, in other words, the limit of the pen- etrating power of the ray, depends en- tirely on the potential of the tube, and this in turn depends on the force of the impact of the individual molecules of residual gas. The higher the vacuum, the less the number of molecules of residual gas in the tube, the greater the free path, the higher the potential, the greater the penetrating power. The lower the vacuum the greater the num- ber of molecules, the less the free path,
I02S
THE AMERICAN X-RAY JOURNAL.
the lower the potential, the less the pen- etrating power.
All substances through which the x-ray passes, form part of the x-ray circuit.
The x-ray circuit is the same as any other electrical circuit. It has its re- turn forming an endless chain of mole- cules arranged in series. The higher the potential the greater the number of molecules added to the chain, the longer the chain; and vice versa.
The circuit is formed first from the point of impact on the inner surface of the tube, being directed outward until the potential drops, then returning to the tube through the terminals.
The x-ray is electro static in charac- ter, an accumulation of lines of mag- netic force of high potential and short wave lengths in a circuit. They decom- pose every substance capable of being decomposed in their path and render every substance over which they travel a conductor of electricity.
The light which is emitted from the tubes is the result of the decomposition of the molecules in the atmosphere around and inside of the tube This light is not the x-ray current. The x-ray force is purely electrical and is invisible.
The softer the tube (limited) the great- er are the number of the lines of force thrown out and the stronger the x-ray current, which increases decomposition; but the penetrative power is decreased.
The harder the tube the less the num- ber of lines of force thrown out, and consequently the weaker the x-ray cur- rent and the less the decomposition, but the greater the penetrating power.
F'or good therapeutic effects, use a soft tube, increase or decrease the pri- mary current to suit the case, but be careful to avoid x-ray burns. The or- dinary hard tube will not burn during any reasonable time of exposure.
It has been my aim to establish the proposition that this new force is simply
an agent or element for producing elec- trolysis and to give a more comprehen- sive idea of this force, I may restate my hypothesis based on "electrolysis," which is the "disassociation of the ele- ments of a compound by the aid of elec- trical energy." When a direct current is applied to the body, be it the gal- vanic, the static or x-ray current, for the x-ray current is as much a current as the others, electrolysis ensues, produc- ing a continual dissociation and asso- ciation of the elements of the body as long as the current is applied.
The stronger the current the greater is the number of ions evolved, and vice versa. Ions are the products of electro- lysis. Those evolved at the anode or positive pole, or on the surface of the body nearest the tube, are termed anions, and those evolved at the cathode or neg- ative pole, on the opposite side of the body, away from the tube, are termed kations.
There are two distinct forms of reac- tion produced, found in the polar and interpolar regions. The polar region is the region of the body that comes in contact with the poles or electrodes, or the surfaces of the body; the interpolar region, the region between the poles, or within the surfaces of the bod}7.
When the direct or x-ray current is ap- plied to the body, immediately electro- lysis takes place, driving all the electro- positive elements or ions along the lines of force away from the positive pole or anode, or surface of the body nearest the x-ray tube, to the cathode which is on the opposite side of the body, and all of the electro-negative elements or ions away from the negative pole or cathode, or opposite side of the body, to the anode in the direction of the tube. In other words, all of the electro-positive ele- ments are repelled from the anode or surface of the body nearest the tube, but attracted to the cathode on the op- posite side of the body away from the
THE AMERICAN X-RAY JOURNAL.
1029
tube; and all the electro-negative ele- ments are repelled from the cathode, or the surface of the body on the opposite side away from the tube, but attracted to the anode or surface of the body near- est the tube.
The sodium chlorid, formula Na CI, and water, H2 O, the chlorin and the oxygen being electro-negative, are re- pelled from the negative side, but at- tracted to the positive. The hydrogen atoms of the solution being electro-pos- itive are repelled from the positive side, but attracted to the negative side of the body. The accumulation of the ions at the negative pole, side, or cathode, called kations,have an alkaline reaction, while anions are of acid reaction. The two poles or surfaces are sometimes known as the alkali and acid poles and if the current is sufficiently strong to produce vesication (which is the x-ray burn) the effect of the local cautery at the negative is similar to that of an al- kali (caustic potash), and the one at the anode similar to that of an acid (hy- drochloric acid).
When an electrical current is applied to the human body it renders every por- tion of the body over which the lines of force pass (in the interpolar regions) aseptic. The current is antiseptic by virtue of the generation of ozone in the body, due to electrolysis. Ozone is one of the most powerful germicides known, and the integrity of the whole body is due to its presence. (Ozone is of neu- tral reaction). A sufficient amount of ozone in the human system will destroy all pathogenic microbes. In the polar regions we have two forms of action, which are purely local, having a varied effect upon the pathogenic microbes. We find forms of microbes that will thrive in an acid medium, but will be destroyed in an alkaline medium, and vice versa. Any form of microbes that can be destroyed by aid of an acid, can be destroyed with the positive pole of a
galvanic battery; and those that are de- stroyed by an alkali will succumb to the negative pole. Remember that the acid radicals accumulate at the positive side (anode), and the alkaline radicals at the negative side (cathode).
The physiological effects of the anode and cathode on the tissues of the body are diametrically opposite. For instance, the ions found at the anode have an acid reaction, those of the cathode are alka- line. At the anode the circulation is diminished, at the cathode it is in- creased. At the anode the tissues are dehydrated, at the cathode they are hy- drated. At the poles albumen is coagu- lated, at the cathode slightly, at the anode to an extreme degree. In the anode we have an acid cautery, in the cathode an alkaline one. The acids ac- cumulated at the anode will destroy a large number of varieties of pathogenic microbes, while the alkalies accumulat- ed at the cathode will destroy the rest. Andrew Gorgan was treated with the x-rays current for about six months, after which he remained in fairly good health, with temperature, pulse, and res- piration normal until about four months before his death, which was due to py- aemia, not tuberculosis. Just before his death I was notified of his condition and requested his family in event of his demise to notify me immediately, so we could hold a post mortem, to determine if possible, the effect of the x-ray on the lung tissue. As this was one of the first patients treated with the x-ray, an au- topsy would have been of great interest and benefit to science. Owing to ex- tremely rapid decomposition they were forced to bury him immediately, thereby preventing a post mortem.
Taking into consideration that one lung was entirely gone before treatment began and the other one was seriously impaired, to stop the progress of the dis- ease and to heal up the lungs at that late date, was little short of a miracle,
1030
THE AMERICAN X-RAY JOURNAL.
we had succeeded in keeping him alive for over four years and he enjoyed reas- onable health.
The therapeutic properties of the x-ray may be summed up as follows:
The force from the x-ray tube is elec- trostatic in character and of very high potential, it acts on matter in the same manner as any electro-motive force; that is to say, it produces a dissociation of molecules along its lines of force, which is electrolysis, it may be used for cata- phoresis.
The x-ray is a germicide through the liberation of the ions (which is electro- lysis) along its lines of force; collecting in the polar region at the anode, anions (of acid reaction); at the cathode, kations (of alkaline reaction); in the interpolar region, ozone (of neutral reaction).
The x-ray, through the liberation of the ions, hastens physiological changes, or metabolism, causing a temporary rise in temperature and an increased elimin- ation of waste products by the lungs, skin and kidneys, at the same time in- creasing the activity of the phagocytes.
The softer the x-ray tube (limited) the stronger the current, and consequently, the greater the electrolytic effect on the tissue.
In treating cancerous, tuberculous and other infectious diseases, more at- tention should be paid to the degree of vacuum in the tube, than to the appa- ratus used in exciting the tube. The de- gree of vacuum and the amount of cur- rent necessary can only be determined by actual experience coupled with a thorough knowledge of ejectro-physics and physiology.
For superficial and deep cancer, use a low tube and vary the current accord- ing to the depth of the lesion.
With reasonable care and proper in- sulation the x-ray burn can be avoided. The lower the tube the greater is the danger of producing a burn, owing to the increased number of lines of force
thrown off from the tube. The area of the x-ray burn is limited, and it is not dangerous except with excessive use.
All of the x-ray burns produced, so far as I am able to learn, are due to the lack of proper antiseptic measures.
The microbes and impurities in the atmosphere are driven into the body, where, after a period of incubation, they set up a form of septicemia.
The x-ray tubes for therapeutic work, should be much larger than any of the tubes on the market. The average size should be from 18 to 20 cm. in diam- eter, or as large as the tube can be made and properly exhausted. The larger the tube the greater the number of lines of force thrown off, the stronger the cur- rent and the greater the electrolytic ef- fect on the tissues.
Owing to the rapid discharge from the x-ray tubes, the eyeball is placed on a strain, especially if the fluoroscope is being used in making examinations, particles which are freed from the screen during decomposition and are driven along in the direction of the x-ray force, striking the eye, setting up an acute con- junctivitis, which seems to be one of the detrimental troubles that x-ray opera- tors have to contend with. It becomes necessary to use a mild lotion in the eyes almost daily to allay or prevent this conjunctivitis. The remedy used must be simple and of such a nature as not to injure the eye in the least.
The preparation that I have used for the last five years, and the only one that has, so far, proved satisfactory in my case, is a prescription written by one of our local celebrities. I have forgotten the formula, but it is marketed under the name of "Murine."
One of the strongest proofs that the x-ray circuit is an electrical circuit, is that a picture can be taken of an object on the back of a photographic plate, away from the tube, showing a return of the lines of force.
THE AMERICAN X-RAY JOURNAL.
1031
As a preventative of x-ray burns, a screen must be used; a sheet of steel or of lead, arranged with a window cut into it about 14 inches square. On the side of the window nearest the tube, a celluloid screen of % of an inch in thickness is placed. This is to prevent the microbes and particles of dust being driven into the body, and at the same time allows the x-ray to pass through without much interference, as it offers but a slight re- sistance to the ray. Back of the cel- luloid screen, away from the tube, I have shutters made of steel with open- ings in their centers, varying from one inch to 12 inches in diameter. These shutters are interchangeable. I use an- other screen made of lead-foil, which is arranged in close contact with the body, with holes cut into it the size and shape of the part that is being exposed to the ray. The patient is placed four to five inches from the tube. The celluloid, steel and lead plates are between the pa- tient and the tube. Then the tube is crowded by increasing and decreasing the current, as required for the part of the body being submitted to the treat- ment. A low vacuum tube or soft tube, as it is sometimes called, should be used in treating all cases.
In treating lupus, increase the current until, as shown by the fluoroscope, a faint outline of the bones of the hand is seen.
In treating deep or internal cancer or tuberculosis, increase the current until the bones of the whole skeleton are vis- ible. The length of time of exposure depends entirely upon the susceptibility of the patient to electrical influence.
At the last meeting of the Chicago Electro-Medical Society the Research Committee made a preliminary report on Priority in X-Ray Therapeutics, showing that the first successful attempt to destroy bacteria by means of x-rays was made by Drs. Pratt and Wightman,
of Chicago, in April, 1896. Dr. Pratt also preceded by a few days Drs. Lortet and Genoud in the successful treatment of Guinea pigs after inoculation with the bacilli of tuberculosis, and was the first to apply the new radiations to the treat- ment of both cancer and tuberculosis in the human subject.
The final report of the committee, giv- ing a summary of the work done in x-ray therapeutics during the year 1896, will be presented at the next meeting of the society. T. P. Hall,
March 7, 1902. Secretary.
The Chicago Medical Times, July, 1896, gives an account of Dr. Pratt's experi- ments with tuberculosis patients. — Ed.
Tube and Exposure.
Dr. J. P. Hetherington, of Logans- port, Ind., in writing to us, concludes his letter:
"It seems to me such a mistake for writers to state they have taken a radio- graph in so many minutes. In nearly all illustrations, the only record of de- tails given, is 'exposure (so many) min- utes.' Such a record is no assistance or information for any one. We might as well prescribe a certain dose of medicine for all — babies or adults — without refer- ence to conditions or desired results. The only way a radiograph can be use- ful to others — aside from a mere illus- tration— is to give all important details; and I believe you would add to science and the interest of your readers if you would require: Static machine or coil; make or form of tube; tube hard, me- dium or soft; make or brand of plate; length of exposure, and developer. I keep such a record of every plate I make and it is a wonderful assistance to look over the plates and observe where the results come from. It goes without say- ing that each tube is always worked with a strength of current that will develop its best radiance. I do not believe we will approach a standard any other way.
1032
THE AMERICAN X-RAY JOURNAL.
The length of exposure depends upon conditions which, if not given, ren- ders the illustration scientifically use- less. I do not believe my German 30-centimeter tube of low vacuum would make a radiograph in 5 hours that my high vacuum Wehnelt will make in 5 minutes or less on my 18 inch coil.
"How interesting and instructive it would be if each of us would take our favorite 'crack' tube to the next meeting of the Roentgen Society in Chicago, for comparison. Less than ten days after Dr. Price exhibited his voltohm and de- fended its merits in Buffalo, I could not find a voltohm for sale anywhere. "Yours sincerely,
J. P. Hetherington."
Roentgen Rays in Medicine and Surgery.
This book disappoints the x-ray worker. It is a nicely bound work, but the lasting impression it fur- nishes is its advertising a particular make of a machine. The book has the strong ear marks of Mr. Rollins, whose technical versatility has been much read and much admired. We regret exceed- ingly the book leans so much upon one side — forgetting the real essentials. Mr. Hinze is an admirable young man and a hard worker. He deserves encourage- ment. In fact, all parties concerned in the making of the book, deserve the best. This is about the sense of the de- scription of the book that comes to us. One writer says: "I have seen Dr. Williams' book. It is a good, illus- trated work, but not for the practitioner. The latest technique is forgotten alto- gether. There is nothing there about the method of skiagraphing the internal structures of bones; nothing about the beautiful skiagraphing of the chest by Dr. Donath, or internal organs on the under-exposed plate with the intensify- ing screen and the lead box and nothing about the latest method of localization
with fluroscope, made stereoscopic or flu- orometric conveniences. None of these are found, though known more than two years to the members of the Roentgen Society of America."
Radiant Ore in United States.
The following letter will explain itself and is a valuable contribution to the literature of the subject. Ed.
Telluride, Col., Dec. 1, 1901. Dr. Heber Robarts,
St Louis, Mo.
Dear Sir: — I received a few days ago, the Nov. number of The X-Ray Jour- nal, with a red cross in one corner, and so I hasten to send you the necessary $3 for another year's subscription.
While I am not at present engaged in radiography nor electrical work, yet I never miss reading every line of your valuable Journal, expecting to take up the work again before many months.
I send you in this letter a rather poor print from a negative made with a piece of uranium ore, which is found plenti- fully a few miles from here. This min- eral is "Carnotite," or a uranyl-vana- date; U2 O3, V2 O3, and is a sandstone impregnated with the oxides. The min- eral also contains radium, polonium and zirconium.
Under separate cover I will send you a small sample of this mineral and also a piece of "Rocoelite," a sandstone con- taining V2 O3, (about 3 per cent).
These two minerals are both impreg- nations of the same sandstone forma- tion, sometimes as separate layers and often intermixed.
The gircon crystals are easily collected in the residue after treating with hydro- fluric acid.
Hoping these will be of some interest to you, I remain Yours respectfully,
Orr Adams.
Subscribe for The American X-Ray Journal — $3.00 a year.
THE AMERICAN X-RAY JOURNAL.
1033
College Station, Tex., Dec. 30, 1901. Dr. Heber Robarts,
St. Louis, Mo.
Dear Sir. — Please send The American X-Ray Journal for two years, begin- ning with the number for January, 1902, to the Department of Physics, A. & M., College Station, Texas.
Please send me back numbers (one each) of Vol. 1, No. 1; Vol. 1, No. 4; Vol. 2, No. 2; Vol. 3, No. 2; Vol. 4, No. 3; Vol. 4, No. 5; Vol. 5, No. 2; Vol. 7, No. 4. If there are any of these which you can't supply, please include them in the ad below.
Please insert the following ad. in the next two numbers:
"Wanted. — Back numbers of The American X-Ray Journal, Vol. 1, No. 3; Vol. 5, No. 5; Vol. 6, Nos. 1-3-4-5-6; Vol. 7, No. 6. Send postal to D. W. Spence, Prof. Physics, A. & M. College of Texas, College Station, Texas."
Please send me duplicate bills for all of above made out against Dept. of Physics, A. & M. College of Texas, and oblige, Yours Truly,
D. W. Spence.
[We regret our inability to supply the missing numbers of the American X-Ray Journal Prof. Spence needs for the Li- brary of the State University. Readers who can spare such numbers or have duplicates will kindly write to the Pro- fessor. Ed ]
Battle Creek, Mich., July 21, 1901. Dr. Heber Robarts, St. Louis, Mo.
Dear Doctor: — I have been a reader of the X-Ray Journal since Vol 1 and No. 1, and a worker in x-ray work for the Battle Creek Sanitarium, since its first advent in '96, and am interested in all that pertains to it. On page 934, July number, you show a plate for a static machine made in two pieces. I wish to say that in one of my visits to Dr. Younghusband (now deceased), of Detroit, Mich., he showed me one of his
machines that he had made with plates the same as the illustration in your X- Ray Journal, produced by Dr. J. M. G. Beard, only his plate did not narrow up at the bottom, but was made with a straight base. When I first saw it, it was in the year 1894, but on my next visit to the doctor, he had disposed of the machine and I gathered the idea that the divided plate impaired the out- put of the machine. I write this for your benefit and others you may desire to call the attention to.
Fraternally, H. A. Dow.
Perry, Iowa, December 10, 1901. Editor X-Ray Journal:
A new motor desired to run a Static or x-ray apparatus. Will some genius invent a contrivance for driving a static machine, that you can wind up like a clock or a peanut roaster and run long enough to give a good static seance of half an hour's duration. Bring out an inventor. How many feet of wire rope and what weight would it require to a shaft and gearing, to run a static machine for thirty minutes, 250 revolu- tions per minute?
Up here, and in many places, there is no electric service or water pres- sure; hence an electric or water motor are out of the question, and a noisy gas- oline engine is too high priced.
Please reply in next issue.
When your usually well behaved sta- tic machine goes on a strike and changes polarity while in motion, either when giving an insulation or while doing the invisible, it is owing to its warning you to cleanse the glass disks with a clean, dry, woolen cloth, scour the brass- work combs and brush-rods, axle but- tons, etc., with strong aqua ammonia and whiting. This will remove grease and gum coating that comes from using calcium chloride (fused), sulphuric acid, etc. Also removes the corrosion from ozone, and your machine will work as
i°34
THE AMERICAN X-RAY JOURNAL.
good as a new one and spark equal to a buxom widow in the dark and pick up its charge as expeditiously as the lady would a kiss. Electrically thine,
Dr. Johnson.
ioi Newhall Street. Birmingham, England, August 12, 1901. Heber Robarts, Esq. M. D.
Dear Sir: — I have long intended to write to you but since my return from South Africa, I have had so much to do that my time has been fully occupied. I am now engaged in writing a book on the x-rays, and should very much like to have a complete set of your journals from the first. Can you let me have them? I have only seen my last article since my return, and am very pleased with the way in which it was produced. I am herewith sending you a copy of a paper I read a few days since; it has not yet been published in England. You can do what you like with it. I have any amount of material for papers, but I am afraid that I shall have little time at present to send you anything. I, however, shall not forget you when the time comes. Hoping that you are well, with kind regards. Yours truly,
J. Hall Edwards.
Protection for X-Ray Workers' Hands.
ByG. E. Pfahler, M. D., Assistant Chief Resident Physician and Skiagrapher to the Philadelphia Hospital.
Nearly every one who makes frequent fluorosco- pic examinations or demonstrations with x-rays, suffers more or less from a dermatitis of the hands. This effect varies from a mere hyperaemia or pigmentation to fissures and ulcerations, followed by contractures. Some men are compelled to abandon the work entirely, while others continue to make themselves martyrs to the medical pro- fession. This part of our work is not taken into consideration in the compensation for our labors. Therefore it behooves us to take every possible precaution for its prevention, and especially those of us who engage in general medical or surgical work, as it unfits us for our regular duties.
For this purpose I have had constructed a pair of mittens covered upon the backs with lead-foil. The mittens were made of chamois skin, though almost any substance will do. They should be
made to fit loosely. For the lead-foil I used heavy tea-foil or lead. Adhesive plaster was placed over the top of the lead and the edges sewed to the mittens to hold it in place. All the ordinary manipulations neccessary can be made with these mittens.
The irritations of the developing solutions may be prevented by the use of rubber gloves. Since I have taken these precautions my hands are im- proving and I trust that this suggestion may be of value to others.
Multiple Use of Static Ma- chine While Running.
Dr. W. B. Clark, of New Albany, Ind., has recently written to us of the use he makes of the static machine. In order that time and expense may be saved, he runs an insulated wire to ad- jacent rooms from his machine and op- erates Crooke's tubes and treats patients at other points all at the same time. He does not claim originality — save for himself — has not heard of others using the machine in this way.
Have TTo-UL Got It©
Not $300, not S200, not $150 for an 8-plate, but
$125.00 CASH,
for a High Grade Perfection
16 -PLATE 5 S*T MACHINE.
Western Surgical Instrument House,
647-653 W. 59th St., Chicago, III.
THE AMERICAN
X-Ray Journal
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X-RAY PUBLISHING COMPANY CHARLES P. RENNER, M. D.. M. E., Editor.
SUBSCRIPTION RATE%-IN ADVANCE.
United states, Canada and Mexico $3.00 | Foreign Countries $4.ot>
Single Copies 25 | Single Copies 35
Editorial matter should be addressed to Dr. Charles P. Renner, Editor, Suite 301 Chemical P.ldg.. St. Louis.
All business matter should he addressed to the American X-Ray Journal Publishing Co.. same address.
All contributors of original articles and other matter relative to X- Radiance, of interest to the medical profes- sion, are solicited from all parts of the world. Contributors will be furnished a liberal number of extra copies of the Joi rnal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ping, M. D., fill Chemical Building, st. Louis, Mo.
Entered at the Postdffice at st. Louis, Mo., as Second -Class Matter.
VOL. 10. ST. LOUIS, MAY, 1902. No. 2.
CONTENTS VOL. 10, NO. 1.
The Practical X-Ray Diagnosis. A B C of X-Ray.
The value of the X-Ray as a Therapeu- tic Agent. Tube and Exposure.
Roentgen Rays in Medicine and Surgery^ Radiant Ore in the United States. Letter from D. W. Spence. Letter from H. A. Dow. Letter from J. Hall Edwards. Protection for X-Ray Workers' Han< s. Multiple use of Static Machine while Running.
CONTENTS VOL. 10, NO. 2. .
Practical X-Ray Diagnosis.
Dr. Monell's Latest Book.
Priority in X-Ray Therapeutics.
Pus Foci in Bone.
The New Static Machine for 1902.
X-Ray Burns.
How Errors Are Made in Radiography. Injurious Forces From X-Ray Tubes.
ULB» u:r w yin COLLEGE CF MY5ICIAJ
OFPHILADHLFWA
THE AMERICAN X-RAY JOURNAL.
The eleetrograph herewith shows the con- dition of a patient eighteen months after the disease began. A full conception of the depth can not be had from the picture because at the time the picture was taken the ulcerous excavation was packed with gauze. The flesh had sloughed from the side and back and to within three inches of the spine. The axilla wTas undermined al- most to the glenoid cavity. The breast that had not fallen off was hard and insensative. It was crusty and had the appearance of dry gangrene. Ulcerous nodules abound over
and tube was used exposing the affected parts, ten minutes each, thirty minutes in all, the first sitting. The tube was a Ger- man make adjusted to give visual radiation of the carpus two feet, the patient one foot from the tube. The patient immediately improved physically. With a few excep- tions the treatments were daily till the twentieth exposure when she wTas suddenly attacked with hypostatic pneumonia and died on the twenty-ninth day afterthe first treatment. The wound had wholly ceased to slough, odor had long since ceased, pain
the chest and back while the base of the vast area that had sloughed away was pale and smooth. The patient was carried to Dr. Robarts' office almost moribund. She was too weak to talk. Her pulse was too Frequent and weak and irregular to count. Of course the case had been abandoned as inoperable. An optomistic uncle insisted that she be treated so long as she lived. No surgery had ever been done. Great masses of dead flesh were adherent to the edges of the ulcer. The discharge was profuse and the odor most foul. The coil
was gone, the wound was healing at many places about the edges: at one place it had filled in nearl3T one inch. Her sleep, strength, appetite and appearance had greatly improved.
The picture was taken two weeks before death and is reproduced to show how a body can compensate and live with so ex- tensive decaying tissue; and also to show that notwithstanding the nearness to death the x-rays gave demonstrated hope when all other procedures known to man had failed.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
VOL. 10. ST. LOUIS, MAY. 1902. No. .
The Practical X-Ray Diag- nosis.
Prepared by J. Rndis-Jicinsky, A. M.. M. I).. M. E., Cedar Rapids, la. Revised by M. U. Dr. Joseph Hoffman. Vienna, Austria. A series of A. P». C. teaching for workers in x-ray diagnosis and therapeutics, to be concluded in '20 articles. Fully illustrated.
Description of Parts. Source of Electric Current.
LESSON II.
We know that an electric current is a source of energy — that is to say, it is capable of doing work. This is clear from its power of evolving heat, one form of energy. But the electrical en- ergy may be transformed directly into mechanical work, and from there, ac- cording to the principle of conservation of energy, when we keep up a constant supply of the same, into the unknown ray so convenient in our diagnosis. The simplest way of considering the different sources of electricity will be to divide the first into two main divisions, accord, ing to the kind of energy which is employed to maintain the current. These two kinds of energy are : 1. Mechanical Work ; '2. Energy of Chemical Action.
Electrical Measurement.
The successful operator in radiology requires to know not only whether a current will be produced under certain circumstances, so that he may be able to determine the conditions most favorable
to its production, but he has to remem- ber also, the electric quantity conveyed in one second by his current of unit strength. These units are based on the centimetre as measure of length, the gramme as a measure of mass, and the second as a measure of time. The prac- tical unit of electric current is defined as one-tenth of the centimetre, gramme second unit of the current, and is called an Ampere after the great French elec- trician of that name. The unit of electro- motive force is called a Volt, after Volta, and is taken to be a hundred million C. G. vS. units. The unit of resistance, which is called the Ohm. is then defined as the resistance of a conductor through which an electro-motive force of one Volt will produce a current of one Am- pere. The unit of power employed is defined electrically as the power de- veloped in a circuit traversed by a cur- rent of one Ampere with a potential difference at its terminals of one Volt. This unit is called Watt.
As has been previously stated, various methods of generating the electric cur- rent for the production of the x-rays may be employed, namely : Primary Batteries, Plunge Batteries, or Accumu- lator Batteries. Static Machines, or the charging may be done by means of an Electric light Installation, Thermo-pils and Constant, Direct or Alternating Current, each working equally satisfac- torily, but requiring more or less different accessory apparatus to add to their gen- eral efficiency. The least expensive form in end for the general practitioner.
1036
THE AMERICAN X-RAY JOURNAL.
1 think, is to employ a good Static Ma- chine, which may be used for both purposes, the Electro-Therapeutics and Radiology, or if we use the induction coil, the Primary Batteries, and any good set of cells giving the voltage re- quired to operate the coil, will answer. Either, if properly constructed and in the hands of a competent manipulator, will do the x-ray work.
The average voltage required by 8 to 10-inch coil is about 10.(5 volts, repre- sented by twelve cells of Edison Laland Battery Type S. With these cells, the outfit consists simply of the vacuum tube, coil, fluoroscope or screen, and batteries, the electro-motive force of the cells making it safe to use the vibrator of the coil without injury to the same,
while the single condenser in the base oi the coil lias sufficient micro-farad capacity l<> give a good fluorescence. Better and more- steady discharge is ob- ' lined by the employment of an addi- tional adjustable multiple condenser of at
leasl 2.5 micro-farads. For a coil giving L2-inch spark we have to have twelve Edi -oil Laland cells. Where there is no
other source of electricity at disposal, recourse to such a battery can be taken. It has, however, the inconvenience of requiring frequent replenishing of the cells.
If no lighting circuit is to hand, accumulators or storage cells are recom- mended as being a useful and sure source of current. For the same results as above we use six storage cells, giving twelve volts. The difference between the two types of batteries is that the storage cells can be kept operative by being recharged at stated periods at any electric light station, while in the pri- mary cells, the entire elements are con- sumed and have to be replaced. In making these statements, high speed in- terruptions are contemplated, and we employ a make and break wheel op- erated by a motor, which takes the place of the vibrator on the coil. Two addi- tional storage cells are required to oper- ate the motor.
If a lighting circuit is at disposal, which supplies continuous current, it will be very convenient to utilize this source of electricity for working the induction coil, or with the help of motor and a good rheostat a Static machine may be manipulated with good results. When making use of the constant incan- descent current, it is only necessary to employ a shunt board to reduce the cur- rent to the required voltage, This will operate the coil in the same manner as the batteries, but the source of current being inexhaustible, it is, of course, preferable. At the same time a pro-
THE AMERICAN X-RAY JOURNAL.
1037
portionately better result is again ob- tained by the make and break wheel or interrupter, the motor of which can also be operated by the current. In this case the necessary resistances for regula- ting the strength of current must be interposed in the circuit. The current of the apparatus should be directly branched off from the main circuit and be provided with needful safety-fuses. The resistances are arranged so that a fixed resistance remains constantly inter- posed, and second resistance is adjustable for regulating the tension at pleasure. Now for instance, if we use the one
in a disk, and the discharge from the two terminals is vastly different from the discharge of the Rumkorff coil or Tesla's transformer. Such apparatus is not only portable, but can be attached to any lamp socket, either in the physi- cian's office, the ward of a hospital, or carried in a buggy, and attached to the alternating current socket in the pa- tients' room, but if necessary, a storage battery may be employed. The alterna- ting current can also be used in con- nection with a Static machine and a motor, but in such cases the direct cur- rent ^ives more satisfaction.
hundred ten V. current from street cir- cuit, the control of the voltage may be done by the interposed ten or more thirty-two candle power incandescent lamps, placed in series, reinforced by a sliding Rheostat. This gives ample power, and prevents a side variation.
If our lighting circuit supplies an alternating current, the use of a new coil consisting of two separate seconda- ries with their primaries connected in series, is recommended. Each such sec- ondary must have a high and low poten- tial terminal, due to position and method of winding. The secondary is wound
Static Machine.
LESSON III. Although the discovery of static elec- tricitv was made by Guericke in 1671, and the treatment with static electricity recorded in 1750 and brought to America in 1752 by Franklin, more than two cen- turies ago, yet, it appears to have shared the common fate of most discoveries made before their time, and to have in main been forgotten. It has always been considered natural that electricity has some influence in some diseased con- dition, but a complete cure of some
L038
THE AMERICAN X-RAY JOURNAL.
cases by static electricity has generally been looked upon as an absurdity. Vet, the adage, natura noil agit saltatim, has its application even here. For it is the scientist rather than Nature, who has drawn hard and fast lines everywhere — who marks out abrupt boundaries where she herself shades off with gradations. The static electricity has weathered many storms of adverse criticism, but with the remarkable discovery of Prof. Wm. Conrad Roentgen, it was found, that unlike other apparatus for x-ray generation which possess but single utility, the main representative of static electricity, the influence machine, is a commodity of the utmost therapeutic
glass disks arranged with rubbers, collec- tors and inducing strips ; they may be strictly frictional or"influence"machines. The charges produced reside only on the surfaces of the bodies charged, and two mutual and equal phases of ex- citement are developed, the positive and negative charges with affinity for each other, neutralizing both. If the charge is great enough, the positive and nega- tive surfaces need not be in actual con- tact, and we get a good spark for our x-ray work. It is necessary to find out first which is the positive and the nega- tive prime conductor on our machine. The conductors are then connected with small condensers, known as " Leyden
value. A Static Machine may be util- ized as an instrument that combines treatment with diagnosis, capable of accomplishing good work in the x-ray field, and exercising a power to produce a thoroughly efficient form of medica- tion in Electrology and Radiology both. The Static Machine is a very simple, safe and most convenient method of pro- ducing x-rays, especially in the office of the busy practitioner, and being inde- pendent of an electric circuit from the street, and generating its own electric source, it can be operated very easily in any locality, and is always ready for in- stant use.
In the Static Machines, powerful charges are produced by the revolution of
Jars," the size of these jars to be selected in accordance with the degree of vacuum of our Crooks tube. The connecting wires resting on some wooden support, stand, have to be covered with rubber tub- ing and go to the cathode and anode of our Crooks tube, having for the success- ful excitation of the same as a key, the spark-gap between the discharging rods of the machine, when starting. The length of spark depends altogether upon the size of our tk Leyden Jars," the vac- uum in the Crooks tube or the interrup- ter used on the discharging rods. Experience will teach us to regulate the length of a spark necessary for good ( ffects. The jars may he omitted on account of a possible explosion, but
THE AMERICAN X-RAY JOURNAL.
1039
their action as condensers, if carefully manipulated, increase our volume of electricity, and give us more steady radi- ance. In my laboratory I have used, with comparatively good results, to bring my ten-plate Static Machine in proper motion, the direct current with one-fourth h. p. motor and rheostat with eight buttons.
The glass plates must always be turned to the left, looking at the machine from the front, and the revolutions may vary from 300 to 350 and more in x-ray work. To charge the machine we have to place the discharge rods about half an inch apart. The small arm on the front right-hand end of the case, if there is separate charger, should be turned down and the small chain attached to this arm should be hooked over the left-hand pole-pieee, so as to connect the small plates with the large plates ; then start the small plates or Wimhurst machine, by turning the small handle to the right, making several revolutions, until the maximum spark is obtained; then stop the Wimhurst and immediately start the large plates by turning the driving wheel with or without the motor, to the left. The chain is then unhooked and the arm turned up. This explains one method of charging, but every make of machine has its own special device to do the same thing. Separate the discharge rods about an inch, and when machine is in action it will be seen that the cur- rent given off the positive pole is whiter in appearance, and has longer, straight
handle to the spark produced. The dis- charge rods should be separated the full distance between the pole-pieces if nec- essary. The smallest jars will give the finest current ; the medium jars have to touch the bottom of the same, and the connections must be properly made. Ordinarily, the machine should be let alone and the case never opened, except when necessary to adjust a plate or comb,
or to oil the shaft of the Wimshurst. When difficulty may be experienced in charging the machine, we may use, in humid weather, Calcium Chloride — about ten pounds, distributed in dishes in the four corners of the case — but never allow the Calcium to become fluid, and be careful not to use Chloride of Lime. The case must always be tightly sealed. If a motor is to be used for power, move the pulley nearer to the
L040
THE AMERICAN X-RAY JOURNAL.
end of the shaft, so that the belt will clear t he case, and run the belt direct to the motor, which is usually placed on the floor or a shelf made for the pur- pose. A good Static machine of mod- ern construction, if properly groomed and kept in order, will excite a tube equal to t lie requirements of general practitioners, and its usefulness, thera- peutically, adds additional value. We have found that 10 10 plates will gener- ate a sufficiency for all therapeutic and
tions which the term implies. By re- peating experiments, research, facts, experiences, better apparatus and better technique, we are now able to photo- graph not only the shadow of the bones, but the substance of the same, and do work that is much more successful.
There has been much written about the fallacies of the x-ray, tending to push aside this new method of diagnosis. But how about microscope, ophthalmo- scope, or any other delicate instrument?
x-ray purposes.
In the laboratory of the expert x-ray worker, we will find the coil,
■ I just as well as the Static
■ I machine. but at the p resen 1 time, there are but three forms of appa- ratus from which to choose viz : t he Rum- korff or simple form of inducl ion coil, the Tesla
or high induction coil, and portable; and i he Stai ic machine.
Vet") early in the history of the x-ray n was found thai we have to deal only with the shadows, wilh all the iimita-
You have to look until you see some- thing; and in fact, to the unpracticed eye, the microscope or opthalmoscope is
much more liable to lead one astray than the vers simple application of the x-ray. To practice medicine, we have to study;
THE AMERICAN X-RAY JOURNAL.
1041
to manage an individual case of typhoid, we have to read ; to operate in a difficult case, we have to look up our authorities, etc., and to manage the new means of diagnosis, the x-ray, we have to study just as well.
It is very simple, indeed, to get hold of the handle or switch and produce the x-ray with the help of the coil or the vStatic machine, but it is really very difficult to manage the same and to know what to do in some cases, when the fundamental laws and principles of Electrology and Radiology are not understood. And let us state right here, that such and similar nonchalance was the main cause of misrepresentations and many mistakes in the beginning of x-ray phenomena, attributed falsely to the x-ray. instead of the operator himself.
A BOOK.
At last a book has been made for the benefit of x-ray workers. The title of the book is "A Pictorial System of Instruction." The vol- ume is clcissed into six grand divi- sions : X-Rav Diagnosis, X-Ray Therapy. These two make up Pour-fifths of the entire book of over 1,000 pages. The remainder is devoted to Photo-Therapy, Hot- Air Therapy, Vibration Therapy and High Frequency Electric Cur- rents. The book abounds with illus- trations with explanatory foot-notes and referred to in the text for the purpose of quickening under- standing and amplifying intellectual greed. There are no apparatus advertised in this precious book. This is left to the makers of ma- chines, from whom doctors can get
catalogues for the simple asking. This work is wholly new and has no parallel, even in part, in any book previously written. It is a concise, plain series of instructions to the worker of an x-ray machine. The doctor may read and at once imitate the practice of this great master, so simple are its teachings. The wide therapeutical aspect of radiation has sealed the importance of the x-rays in the mind of every true thinker of pathology. This Pictorial System of Instruction lifts the cloud of doubt, and to the prac- titioner everywhere draws aside the veil of hindrance to easy uses of the x-rays in diagnosis and to practice. This is Dr. Monell's best work. We will review the book in a subsequent issue of the Ameri- can X-Ray Journal.
H. R.
Readers of the American X-Rav Jour- nal are acquainted with correct methods of x-ray therapy.
The American X-Ray Journal is an index medicus of all that goes on in the x-ray world.
If you want the truth about the uses of the x-ray, purged of verbosity and specu- lation, read regularly the American X-Rav Journal. Where else can you get it?
We are pleased to note that Dr. H. H. Fabrique, Chief Surgeon of St. Francis Hospital, Wichita, Kansas, called upon Dr. Robarts during past week for instruc- tion in the therapy of the x-rays. Dr. J. M. Haney of Centralia, 111. and Dr. Albert H. Dollear of Jacksonville, 111. were also here in the same capacity. It is a good sign when physicians seek the best means for information.
L042
THE AMERICAN X-RAY JOURNAL.
Priority in X-Ray Therapeutics.
A Summary of the Work Done in L896.
( Report of the Research Committee of the Chicago Electro- Medical Society). A dopted Ma rch 25, 1902.
The first published suggestion for the therapeutic use of the x-ray appears to have been made by Dr. T. Glover Lyon in a letter to the London I^ancet, Feb- ruary 1, 1890, page 326. This was fol- lowed by a second letter dated February 17. 1896 giving an account of his expo- sure of the bacilli of tuberculosis and diphtheria, in cultures, to the x-rays for twelve hours, with results entirely nega- tive.
In the Munchener Medicinische Woch- enschrift for February 4, 1896, pages 101, L02, Dr. Franz Mink gave an account of two exposures of bacteria cultures to the x-rays, for about half an hour each, with negative results. In the March number of the same journal, page 202, Dr. Mink reported a second exposure of a culture of the typhus bacilli in agar, for fifteen hours, with negative results.
On February 17, 1896, Professors Schuster and Delepine of Owens Col- lege (British Medical Journal, February 29, 1896) exposed to the X-Rays three sets of culture tubes containing cholera vibrio, bacillus coli communis, and bacil- lus typhosus, for IT), 80 and 60 minutes respectively. Two days later a similar Bel was exposed to the rays for two hours. The results were negative in hot li eases.
On April 5, 1896, Drs. II. Preston Pratl and Hugo Wightman of Chicago exposed to the x-rays lor one, two and
three hours respectively, three sets of culture tubes of the following bacilli : cholera, diptheria, influenza, glanders, pneumonia, typhoid, tuberculosis and anthrax. Several of the cultures were killed by one hour's exposure ; and all by three hour's exposure. — {Chicago Times- Herald, April 13, 17, 18 ; Chicago Tribune, April 14, 1896.) April 13, 1896, Dr. Pratt treated two patients who had cancer of the stomach, who were immediately benefited by the ex- posures of one hour each. — {Chicago Tri- bune, April 14.) Guinea pigs were in- oculated, April 18, with tubercular bacilli. — (limes-Herald, April 19,) and exposed to the x-rays for one hour daily. Those thus treated lived, though with x-ray burns ; the controls all died of tuberculosis.
Dr. Pratt by request of the New York Journal, began the treatment of a case of pulmonary and laryngial tuberculosis by the x-rays, April 19, 1896. After one week, during which improvement was very marked, the patient left the city, and later died. — New York Journal, April 19, et seq.)
On April 23, 1896, Drs. Lortet and Genoud inoculated eight Guinea pigs with tubercular bacilli, and exposed three of them to the x-rays one hour daily. These three remained well; the rest developed suppurating abcesses. — {Medical Week, Paris, Vol. IV, 1896, pp. 326-27.)
Professors Schroder and Hickman of Missouri, April 27, succeeded in destroy- ing the bacilli of diphtheria by the \-rays.) — Chicago Tribune, April 28, 1896, page 4.)
Two pronounced cases of pulmonary tuberculosis successfully treated by Dr. II. P. Pratt were reported by Dr. Fin- ley Ellingwood in the Chicago Medical limes, Vol. XXIX, No. 7, July, 1896, and Sept. 1896. Treatment of the first was begun April 17 and continued for
THE AMERICAN X-RAY JOURNAL.
1043
six weeks, with marked improvement. Treatment of the second began May 20, and in September, 1896, he was to all appearances completely cured. (See also The Clinic, July 15, 1897.)
Dr. Stone of Fort Leavenworth, in a letter to the Association of American Physicians, April 30, 1896, stated that the x-rays in his experiments appeared to have no destructive effect upon bac- teria.
Dr. F. Berton {Medical Week, Vol. IV, 1896, p. 351) exposed broth cult- ures of bacillus diphtheria to the x-rays for sixteen, thirty-two and sixty-four hours, without effect.
Dr. Despeignes (mentioned in Medical Record, August 29, 1896, page 307) used the x-rays for a case of carcinoma of the stomach. The patient improved under the treatment, but died later.
During the latter half of 1896, Drs. Pratt and Stirling {Chicago Medical Times, December, 1896, page 456) treated a number of disorders success- fully with the x-rays; among which were lupus (in June), sciatica (in July), emotional melancholia (in September), dorsal pain, articular rheumatism, and tuberculosis of the kidney.
Dr. J. Tarkhanoff, in Gazetta Bolkina,
1896, No. 33, (Presse Medicate, Febru- ary 24, 1897) reports the recovery of frogs poisoned by strychnine, when ex- posed to the x-rays. Those not exposed [died.
Drs. Rendu and du Castel {Progres Medical, January 30, 1897, page 71; and La Semaine Medicalc, 1897, page 20) gave a pneumonia patient relief in three applications of the x-rays.
Dr. Freund {La Semaine Medicate,
1897, page 24) reported the cure of a large, pigmented, hairy nevus by x-rays. ? Dr. E- Aussat (Journal de clinique et de therapeutiqne infantile, February 11, 1897 ; and Lancet, March 6, 1897, page 630) found no effect of the x-rays upon
tubercular bacilli in cultures ; but treated a child of seven years, by the rays for pulmonary and abdominal tuberculosis, with marked improvement.
Dr. Voigt, Hamburg, in November, 1896, treated a case of pharyngial carci- noma.— (Mentioned by Dr. Gocht in Gebiete der Roentgenstrahlen, Vol. 1, page 14.
Dr. Schiff at Versammlung Deutscher Naturforscher und Artze in Braunch- weig, September 22, 1897, gave a report of his work in the treatment of lupus, extending over about one }Tear. — (Fort- schritte suf dem Gebiete der Roentgens- trahlen, Vol. 1, 1897-8, page 89.)
The Roentgen Societv of America will meet sometime in December in annual session, unless changed by the managing board. Chicago will probably be the place of meeting.
The Roentgen Societv of London have changed the rules that similar agents to the x-ra}rs may be discussed at their meetings. They have two classes or char- acter of meetings. One class admits the laity. These meetings are more for exhibi- tion purposes and probably convivial. The other class admits members only or pro- fessional persons. In these meetings di- agnosis and treatment are discussed. Their meetings are monthly. Election of members and officers occurs once a year if the new ruling prevails.
The two great meetings of the Roentgen Society of America, the one in Decem- ber, 1900, in the Grand Central Palace, New York City, and the other in September, 1901, in the University of Buffalo, Buffalo, N. Y., will go down in the history of medi- cine as the most valuable meetings for the diffusion of x-ray information ever held. As time goes on and the importance of this subject grows, every member of the Society that attended these meetings will be honored for having embraced that op- portune.
Dr. J. F. Rinehartof Oakland, California, has recently reported satisfactory treat- ment of Epithelial Skin-Cancers and Sy- cosis Non- Parasitica with the x-ray.
104-4-
THE AMERICAN X-RAY JOURNAL.
The New Machine for 1902.
By joiix Tow n-send Pi tkin, M. D.
Since the discovery of the x-rays by Professor Roentgen, each successive year has been productive of new and better apparatus for their generation.
Static machines having but eight revolving wheels have been replaced by others having ten, twelve, sixteen, eighteen or twenty-four revolving discs.
With each increase in the number of plates, other improvements being com- mensurate, a given tube and speed and absence of spark gaps has placed pro- portionately more x-ray light at our disposal.
Instead of an eighth of a horse power electro-motor as the source of propulsion of the apparatus, we now require one- half of a horse power for its actuation. This means that w7e have nearly one- half of a horse power of x-radiance.
Other evidences of the increase in the power of the modern apparatus are the thickness (not the length) of the spark, brightness of the flash, the heavy report or detonation and greater therapeutic action.
Owing to a better selection of insula- tors and conductors and the relative positions which they bear to each other, the Static machine recently installed for the year L902, with twenty-four ("24) revolving cycles, occupies no more floor space than was required for any of its less efficient predecessors.
As air space is a fairly good insulator for high tension electrical currents, small machines have been cheaply built by inclosing them in large cases, placing the conductors entering into the con- struction of the case beyond sparking distance.
By employing heavy plate glass for Strength and insulation with only
enough wood work to hold it and afford support for the axl the space inside of the machine utilized for the generation of ek The cycles of the new mac' twenty-nine inches in diamet- have found larger plates less c because their "moment of ine greater — harder to maintain in 1 hence, their speed is often limit vibratory or rocking motion, warp in the plates throws them out of alignment, it is harder them properly adjusted and to rubbing. At an average spee voltage is excessive.
The stationary plates consist o pieces of glass, a superior and an set. Each field plate is double, tin-foil inductor inclosed betwee: The pieces of tin-foil are saddle with one serrated margin. Eac' tor presents forty-two square ir surface for electrification.
The advantage of the dout the single fields are manifolc have greater exciting power auc ity or retentivity of the same, i: more action in the revolving dis rarely loose their charge or sps the neutralizing system.
Glass is a better inducing i than the air.
The field plates project bey. revolving discs at either end of 1 chine eight inches.
The axle is incased through' cept in the bearings, in a heav rubber sleeve ; it is supported a end by an upright (not nor: piece of wood, which extends fi top to the bottom of the case.
Over the sleeve of the axle sol rubber discs are placed ; they S the revolving plates from each ot from the field plates, and hold mer firmly in situ.
pp, i oU-S- 1 otro
THE AMERICA X X-RAY JOURNAL.
cases in the report. There are two points of interest in this report — First: the pictures show that the operator was master of his work. Dr. Wio-ht is a surgeon. The x-rays brought to light what no other method of diagnosis could have done, and he operated from the facts thereby acquired, with the \ best results obtainable. One case of ankylosis of the elbow is espec- ially interesting. It was an old tuberculous joint in which the ex- ternal condyle was a mass of dead bone and pus surrounded with a thin shell of bone. The x-ray pic- ture gave all the detailed informa- tion, and the surgeon performed a linear osteotomy. Repair was com-
L051
plete with motion through an arc of 65 degrees. Most of the cases men- tioned in the paper involved the joints. The second point of inter- est is. that after all, the paper was not read — only by title. We are not aware of just the reason, but we feel quite certain that if Dr. Wight should present another pa- per on some surgical procedure, in which the x-rays figured in the case, he would be asked to read it. The past twelve months has added immensely to the surgical interest of the x-rays. Societies that ignore the tenets of our pro- fession must lose the respect of modern practitioners.
H. R.
TiiiaUreene&Go.
42, 44. 46 Wabash Ave.
OHIO AGO, U.S.A.
Manufacturers. Importers, and Dealers in
ALL FORMS OF
Electrical Apparatus
Known to Medical Sceince.
A Product of Our Own Foctory.
Our Wall Cabinet
Maybe furnished for cells 110-220 or 500 volt direct com. currents
Special points of merit are: High Tension Coil.
Shunt Graphite, Rheostat.
Standard "Dead Beat." Mil-am-meter.
Automatic Rheotome.
We will be pleased to forward prices on application.
105-2
THE AMERICAN X-RAY JOURNAL.
X-Ray Divergence Chart.
SUPPLEMENT TO
A System of Instruction in X-Ray Methods and Medical Uses of Light, Hot-Air, Vibration and High-Frequency Currents.
By S. H. MONELL, M. D.
This chart shows at a glance the follow- ing points of essential interest to the X-Ray operator: —
1. A Plane Diagram of X-light radia- tions from the anode focus-point.
2. The rate of departure of X-Rays from a parallel path at different distances from the tube.
3. The proportionate loss of right-angle shadows at different distances horizontal to the perpendicular axis.
4. The area of non-distorted field of ob- servation at any distance from the tube.
5. The area within which a body of any thickness will shadow a right-angled rela- tion of the parts at a given distance from the tube.
6. The distance from the tube at which a part and the photographic plate must be exposed to secure essential correctness and non-distortion for a diagnostic field of any given size.
7. The general area of approximate non- distortion on the plate.
8. The obliquity of shadows at all dis- tances outside of the central field of exact perpendicularity of radiation.
The Scale of the Chart reads down from the focus -point of the tube to an imaginary plate twenty inches distant. For greater distances, extend the indicated lines below the Chart, and apply the same rule of in- terpretation. For full explanatory descrip- tion see Chapter XVIII.
I n entering new fields it is 1 always well to be
'Introduced right"
> J
V our printea matter is your 1 introduction to new trade.
M eat work makes a good im= [ill pression and if you have the goods, the first impression can be made lasting.
T be neatest work in town is 1 done by
MOCKLER PRINTING COMPANY,
N. E. CORNER 4th A PlNE.
THE AMERICAN
X-Ray Journal
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
PUBLISHED MONTHLY BY THE AMERICAN X BAY PUBLISHING COMPANY CHARLES P. RENNER, M. D.. M. E., Editor.
SUBSCRIPTION RATES— IN ADVANCE.
United states. Canada and Mexico $3.00 | Foreign Countries $4.00
single Copies 25 | Single Copies H5
Editorial nutter should 1k> addressed to Dr. Charles P. Renner, Editor, Suite KOI Chemical Bldg.. St. Louis.
All business matter should be addressed to the American X-Ray Journal Publishing Co.. same address.
All contributors of original articles and other matter relative to X-Radianee. of interest to the medical profes- sion, are solicited from all parts of the world. Contributors will be furnished a liberal number of extra copies of he Journal containing their articles.
Translation of articles written in German, French and Spanish is made by Frank Ring, M. D., 611 Chemical Building, St. Louis, Mo.
Entered at the Postoftice at St. Louis. Mo., as |
Second-Class Matter. |
||
VOL. 10. |
ST. LOUIS. JUNE, |
1902. |
No. S. |
CONTEXTS VOL. 10, NO. 2. CONTENTS VOL. 10, NO. 3.
Practical X-Ray Diagnosis.
Dr. MoneU's Latest Book.
Priority in X-Ray Therapeutics.
Pus Foci in Bone.
The New Static Machine for 1002.
X-Ray Burns.
How Errors Are Made in Radiograph} Injurious Forces From X-Ray Tubes.
The Practical X-Ray Diagnosis. Observations on Broken Necks. A Xew Application of the X-Ray. X-Ray Xarrative.
Xotes on X- Light and Radio- Active
Substances in Therapeutics. Radiotherapy of the Prostate. Origin of Cancer.
History of a Case of Unrecognized Frac- ture of the Radius. X-Ray Prophecy.
Treatment of Ephithetical Skin-Cancers and Sycosis Xon-Parsitica with the X-Ray.
X-Ray Narrative.
Radium.
Surgical Operations in the Old. Roentgen Society of America.
THE AMERICAN X-RAY JOURNAL.
This radiograph is a section of one described in this number of the Journal, under the caption, "History of a Case of Unrecognized Fracture of the Radius," b) Dr. Paul I\ Fletcher. The arm, forearm and hand were taken in one plate, but the section that revealed injury was all that we had electrotyped. 1 Ik- offending Spicula of bone is clearly seen. The radiograph was made in the x-ray laboratory of Dr. Robarts.
THE AMERICAN
X-RAY JOURNAL.
Devoted to Practical X-Ray Work and Allied Arts and Sciences.
VOL. 10. ST. LOUIS, JUNE, 1902. No. S.
The Practical X-Ray Diag- nosis.
Prepared by J. Rudis-Jicinsky, A. M., M. D>, M. E. Cedar Rapids, la. Revised by M. I'. Dr. Joseph Hoffman, Vienna Austria. A series of A B C teaching for workers in x-ray diagnosis and therapeutics, to be concluded in 20 articles. Fully illustrated.
Crookk's Tubes.
LKSSON IV.
The Crookes' tubes or the Vacuum tubes which are used to generate the x- rays, are so named after Sir William Crookes, F. R. S., who constructed them for his famous experiments in radiant matter. In these tubes the air has been exhausted to such a degree that the re- maining particles have a vastly greater freedom of movement than when under usual atmospheric pressure.
Under these circumstances, on leading a powerful electric force into the tube by means of its sealed-in electrodes, these air particles are thrust to and fro be- tween the electrodes and the glass op- posite, just as an electric machine causes pith balls to dance, and by their incess- ant bombardment cause heat to appear in both metal and glass. The tube is the most essential part of an x-ray out- fit, and must be of good efficiency. The efficiency of the tube greatly depends focus tubes, containing a platinum re- upon the spark length, the volume of
the same and the proper technique. But the most important discovery, how to keep the character of the light more constant and complete, has to be made yet. If we work in the beginning with diminished tension and gradually increasing the same by means of the current regulator of our apparatus, the life of the tube will be considerably prolonged.
The interior action of an x-ray tube may be regulated. What the x-rays are themselves we are not vet able to say. What changes occur in the tube from the standpoint of a physicist we do not know positively ; some say it is the disassocia- tion of vapor molecules of water, others think that there is some breaking up of hydrogen atoms, and finally, the theory of corpuscles was given for the whole phenomena in the tube during the ray- ing. We, however, do know how to get and reproduce some certain results of x-ray work ; results giving us different degrees of x-rays with different de- grees of shadows in our pictures. The rays we observe with the fluoroscope, the penetration and the shadows may be differentiated with a skiameter and to become a master observer of these rays, should be our aim.
These tubes are made in various shapes. Globular, Pear-shaped and Cylindrical, so-called on account of the peculiar constructions of the electrodes. The best tubes yet made are the so-called
1054
THE AMERICAN X-RAY JOURNAL.
Hector (Monell's etc.), as shown in Fig. 2, with or without the regulating device for increasing or decreasing the vacuum in the tube, or they may be reinforced
Fig. 2.
on platinum plate with platinum (Green and Bauer). The concave electrode is al- ways used as the cathode. The cathode rays, proceeding from it, focus on the platinum sheet, which forms the anode with or without a disk reflector, rotary target, cooled target (Rollins), or con linuous metallic conductor with or with- out the cup (See : Amer. X-Ray Journal, July, 1899), sending off from the SpOl on which they focus a powerful shaft of x-rays. As this spot is quite small, skiagraphs, or radiograph; mad- with this or similar tubes arc al- ways well defined, and may now be made especially with tin- help of intensifying screens in a much shorter time than would have been considered possible at
an earlier period of the photography of the invisible. Fig. 3 represents Thomp- son's double focus tube, having two ca- thode electrodes, the rays from which are projected simultaneously against the Y-shaped anode placed between them. ( Not showm. )
Leonard's double focus tube is constructed in such a way that a proper localization without any other device is not only possible, but sure and simple. (See : Amer. X-Ray Journal, Nov. 1899.) There are tubes in the market supplied with additional chamber containing vol- atile salts or wires, the heating of which reduces the vacuum of the tube, and thus a more uniform vacuum can be ob- tained or the vacuum itself may be regu- lated . Muller's Universal Roentgen Tube
G
K
etc.) Muller's Universal Roentgen Tube with auxiliary tube for regulating the vacuum to either a high or low degree is the latest. The advantages of this regulating modus operandi comprise the following :
1. That the use of a flame is entirely abrogated and,
2. That the regulating device can be Used in the simplest and most effective
THE AMERICAN X-RAY JOURNAL.
1055
manner as an automatic regulator while the application is proceeding, and
3. That by reason of the addition of the auxiliary tube it recommends itself specially for long exposures as well as for exact impressions.
4. Most important of all advantages is the fact that the regulating elements contained in the auxiliary tube are so plentifully present that the longevity of the tube is thereby secured and with careful use should last for a long time.
Fig. 5 represents the tube, which was devised by Edison. Two slanting disks mutually converge the cathodic stream to the area of the glass bulb, at certain angle. With such a tube the over-heat- ing is impossible. (Not shown.)
If we use the high potential and high frequency current another ingenious tube devised by Tesla may be employed. Fig. 6 shows the tube, which needs only
i ^SP-
Fig. 6.
one terminal, but can not be used with- out the powerful Tesla coil.
There is another tube for stereoptic vision designed by Caldwell. By using two sources of x-rays in the same tube each eye views independently the shad- ow, with the result that the picture stands out distinctly. It is thought that the fluoroscopic examination of frac- tures especially may be made much more successfully, permitting immediate examination by this method with a fluor- oscope having a special rotating shutter.
Reduction of Vacuum.
When the vacuum has become too high in consequence of much use, cer- tain focus tubes had to be heated with a spirit lamp around the cathode or aluminium electrode until they again emit x-rays. This must not be done
while the current is passing through the tube, the operator may receive shocks from the apparatus, or the lamp could explode. If the degree of exhaustion of vacuum in the common focus tube or the New Improved German tube is too high, sparks will often play around the tube ; to avoid this we use a round me- tallic disk at the anode (See Fig. 7), and
4-
Fig. 7. Disk at anode, not shown.
get a steady light, that, by proper ad- justment, may be increased to a brilliant glow, thus affording of any degree of penetration.
A very simple way to get a vacuum suited to our apparatus is by a hand regulator or a temporary regulator may be made by twisting a bit of wire on a stick. This way we may always cause several sparks to pass into the chemical bulb, place the regulator or short cir- cuiting rod in contact with the platinum loop at the anode and cause the spark to pass to the cathode end of the tube. A very few sparks, sometimes one or two, should lower the vacuum sufficient- ly for the time, being.
In discussing the problem of the proper manipulation of the vacuum of a tube to get good results and good
L056
THE AMERICAN X-RAY JOURNAL.
effects, we have to consider also the raising of the vacuum electrically in case of necessity. As stated already, the vacuum of a tube is constantly chang- ing and the quantity differs occasionally and can never be relied upon to remain the same in every exposure. Our ex- perience of observation with the help of the fluoroscope, therefore, is a better guide in each given case than all the theoretical advices given, lengths of ex- posures, etc. Sometimes few beautiful flashes of the x-ray, as seen on the screen of our rluoroscope, give us photo- graphically better results than prolonged exposures made according to some giv- en pattern. It is only necessary to be- come familiar with the stage of vacuum in our tube adopted for certain work, and to know how to produce it. We can expel gas from anode of our tube by introducing a variable capacity discharge in the anode end of the tube, and in this way or by simple burning, lower the vacuum, and by capacity discharge in cathode end and no discharge in anode, may raise the vacuum. So that by regu- lation of those two capacities, we can have the vacuum at a certain degree, and by varying the intensity of the current we can vary the quantity and the degree of our rays. The rluoroscope must al- ways be our guide and if there is any blue color streaming along the inner walls of the tube, we know that we have only very w eak rays, and it may require a longer stream of our current to pro- duce the well-known green color of the x-ray proper. The x-rays have to have the necessary penetrating power, which easily may be made out on rluor- oscopic examination, and the differentia- tion will follow, especially if we have a good apparatus possessing regulating mechanism of special construction. To raise the vacuum electrically, there- tore, we have to simply, send a moderate
current through the tube continuously, the operator watching its behavior care- fully for a little time, and as the fluor- oscope indicates the different qualities of the rays, the observation may successful- ly be applied. (Rollins.)
We all know that the particles of gas in a Crookes' tube, and also those oc- cluded in the terminals, become electri- callv charged and carry their charge from one terminal to the other when the tube is in action. The stream goes from the cathode to the anode. This movement of particles causes repulsion of unlike sign attraction, so that the par- ticle being repelled from the cathode and attracted to the anode, strikes the latter with great force of the bombardment. This breaking up of the particles pro- duces the x-ray; therefore, the more particles we have in action, the greater will be the quantity of rays. To have great contrast in our photographic work on our plates, we must have a good source of electricity, and a certain inten- sity of bombardment to each particle in our Cookes? tube ; and to make short exposures, we must have a great quan- tity of rays, which we collect with the help of the calcium-tungstate screen, face down upon the film side of the sen- sitive plate. The vacuum of Crookes' tube is constanly changing quantity and should not be relied on to remain con- stant ; it differs in different tubes and sometimes in one and the same tube. We therefore have always to watch our tube. To know our tube, the resistance of the same, and the proper technique is the whole secret of good results in radiology. The discovery of Roentgen, which makes possible and easy an abso- lutely correct diagnosis where previous ly uncertainty and error outweighed definite knowledge, through this results in experimentation and researches seems to be still more important.
THE AMERICAN X-RAY JOURNAL.
1057
LESSON V.
Induction Coils.
The induction coils used with x-ray apparatus are built on one and the same principle. The most practical point so far substantiated in the coil is that al- most instanteous skiagraphs can be ob- tained with not less than a 12-inch spark- gap. Larger coils than this are not re- quired for general use. The commonly
known Ruhmkorff Coil is used mostly, being named after Ruhmkorff, of Paris, who, although not the inventor of same, made many instruments of the kind, and contrived various improvements. There is no question about it that one of the most important factors in the produc- tion of the x-ray is a perfect working- induction coil, as upon its action depends the satisfactory fluorescence of the vacuum tube. In the laboratory of an expert the coils are used, being very much more powerful, and as it is claimed giving effects which cannot be produced with a static machine. The coils are not affected by atmospheric changes and are in some instances portable. In my ex- perience the coils gave us good results in skiagraphy, especially when the induc- ing currents were short, sharp, snappy and vigorous in connection with a good interrupter, but we like the work of a static machine just as well. In regard to the portability the coil certainly plays the main part and then is by far the most satisfactory to handle.
The induction coil consists of primary and a secondary winding of many miles
of wires and a case, which contains con- densor or not. The primary coil and the condensor are provided with terminals for the connections. The primary coil is composed of a bundle of thin iron wires, around which a copper wire is wound. In coils giving 10 to 40-inch spark or over, the primary winding is entirely covered with an ebonite insula- tor, the inner coil is movable, so that it can easily be drawn out. This arrange- ment adds considerable to their effi- ciency and offers great security during transport. In introducing a quickly-in- terrupted current into the primary wire, currents of very high tension generated in the secondary wire and sparks of con - siderable length and volume are pro- duced. The efficiency of an induction coil is greatly dependent upon the in- terrupter. (See the illustration in May issue of this Journal.)
When the coil is put in operation, a current regulator is interposed between the source of electricity, and the coil, in order to introduce into the latter the amount of current necessary for working tube. The speed of the interrupter must be also regulated until the most power- ful results are obtained. A good coil has to maintain the full length of sparks even when the interrupter is working with great rapidity ,and what is just as important, the spark has to be produced with every interruption. This is a very important point, as good results can only be obtained by interruptions of high speed. Remember that the value of an induction coil depends not only on the length of spark, but it is also neces- sary for the spark to be powerful and complete with every interruption, even when the interrupter is running at its greatest speed. Experience has shown a rapidity of 1,000 to 1,500 interruptions per minute to be the most useful both for skiagraphy and screen work. When
1058
THE AMERICAN X-RAY JOURNAL.
operating with higher speed, the tube will not always glow at every interrup- tion and may act irregularly, not steady. The alternating current was not so ef- fective as direct current when derived from the dynamo machine for our coil, and when batteries are used the main in- convenience in alternating the direction of the primary current is the use of a double break-wheel. Direct current in the primary circuit with proper interrup- tion is the thing we are after The kind of regulator, interrupter or vibrator or a break-wheel may be safely left with the manufacturer, who knows exactly what his coil properly needs.
When the apparatus is connected as per diagram (See : Amer. X-Ray Jour- nal, Nov., 1899, page 663), it is ready for use and needs only the closing of the switch and possible slight adjustment of the contact screwrs to start the vibrator, interrupter, etc. When this is accom- plished, the tube should become fluor- escent. That is, if the tube has been so connected that the negative — or cathode current passes through the. aluminum plate, which is in the tube, disk or any other device, the light which appears will be of a pale green color, and al- most completely fill the space between the electrodes, while the x-ray may be instantly seen with the rluoroscope. If, however, the anode positive current passes into the tube through the alum- inum electrode, the green light will be diffused part behind the platinum elec- trode and part of the lower edge of the bulge, while no light can be made out on the screen of the rluoroscope. In such a case, the wires which are connected to the- tube should be reversed.
The Kinraide Induction coil was al- ready mentioned; it consists of two sep- arate secondaries with their primaries connected in scries Fig. i). The weak- feature of the common Ruhmkorff coil
is the heat developed in primary, but in this coil insulation can not be melted and no delicate part of the apparatus will suffer by the heat generated. The Kin-
Fig. 9.
raide coil is portable, safe in operation, simple in construction, durable and may be operated with comparatively small amount of the current, giving strong x- ray light and great volume. The dif- ficulty attending prolonged exposure does not exist, the skiagraphs will be very tine and finished negatives give full detail, and are as usually better than the positives.
There is another good coil to be men- tioned and designated by Rollins. The vacuum in the tube with this apparatus may be regulated by moving rubber handles in front of the coil in and out. The contrast of light with tubes of dif- ferent resistance may be observed very easily and with a Electrolytic-Interrup- ter the apparatus may be run for many hours daily. The coil may be operated from the direct or alternating current of 1 10 volts.
In case of any strikingly new develop- ment, the apparatus as first used is al- ways a modified form of that already existing, but this gradually is abandoned and new types arise, which give more satisfaction or better results. » The proof of this simple fact is also the Fessenden machine, which does not require delicate usage ; is very simple, compact and port- able. To start the machine all that is necessary, is to turn the switch and press
THE AMERICAN X-RAY JOURNAL.
1059
down the knob. There is no condenser, rheostat or other complicated apparatus, because all the adjustments are made by moving spark-gap handles. It is impos- sible for this coil to break down, be- cause the insulation is different, even if deluged with water or acid. In such case you need only to remove the faulty section, and replace it with a new one. instead of requiring practically the re- building of the entire coil, as in the old method of construction. The volume of the spark in this coil is great and the enersrv of the secondary circuit mav run up to 300 watts.
Observations on Broken Necks.
Dr. Reginald H. Say re of New York presented a number of photographs from cases of fracture of the cervical vertebrae. In making the diagnosis the position of the head was of extreme importance: if the fracture involved the three upper vertebrae, the head would almost invari- ably be twisted to one side after the manner of torticollis, there was often also an abnormal straightness of the back of the neck. Dr. Say re said experience had taught him that support of the cer- vical vertebrae was necessary for a much longer time than was generally supposed. Skiagraphs of these cases were often mis- leading, in very many cases an excellent mode of treatment was to envelope the body and head of the patient in plaster- of-Paris, so as to combine a helmet with a jacket.
These brief remarks on broken necks have one point of interest. "Skiagraphs of these cases are often misleading." All skiagraphs are misleading in the hands of the ignorant. Of course I mean the ignorant operator. This is like the old "inaccuracies of the x-rays" that haunted so many until the Ameri-
can X-Ray Journal pointed out the sources of the inaccuracies. If in the instance of the subject the operator would use some device to correct the distortion his picture would have a known value. If he has knowledge of normal anatomy then his picture would show to him the condition exactly as it is and the abnormal state be properlv i interpreted.
A New Application of the X-Ray.
According to the Journal de Medicine a man placed under arrest for illegal practice of medicine, claiming to be a graduate of an American college, pre- sented a diploma which excited suspi- cion. The Roentgen rays revealed the outlines of a named erased to; make room for that of the man who was thus con- victed.
The above is taken from an exchange and as there are no comments we are urged again to give our disapproval of the publication of any matter that gives evidence of falsity or smacks of quack- ery in x-rays. It is more difficult to unlearn than to learn correctly. False im- pressions only weaken the great impor- tance of raying. Some months ago the American X-Ray Journal published quite fully the advantages the x-ray gave to those who were trying to identify the original signature upon paintings. It was valueless in every case except where the signature wras made in gold. Modern ink with a fair amount of erasure will not be seen either on plate or screen.
The Royal College of Physicians and the Royal College of Surgeons together have sanctioned a plan for the systematic in- vestigation of cancer. It is prepared to raise 5500,000 for the purpose.
1000
THE AMERICAN X-RAY JOURNAL.
,,/) X-Ray Narrative.
A Series of Articles by Dr. F. S. O Hara.
••It is remarkable what a part this machine can play in the destinies of mankind " said the gray-haired doctor as he leaned back in his chair and contem- plated the trim outline of his static ma- chine.
I surveyed the speaker with a quick and penetrative glance. It was late when I arrived in his office, but he had consulted with me regarding my ailment, advised me kindly what plan of treat- ment to follow, and now that our busi- ness had been finished we had turned to the discussion of the wonderful Roentgen Ray.
My analysis of Doctor Barsto was highly unsatisfactory. He was an enig- ma. That powerful build, agile move- ment, and immediate deduction from a line of reasoning, that he exhibited re- garding my case, seemed more that of an expert detective than of a physician. And true it was that he had at one time been a great detective, but I am ahead of my story.
•kTo what particular destiny of man do you allude doctor?" I queried.
•Many, my dear sir, many and varied are the things in life intimately associated with the vital essence of life, electricity." What is it? You cannot see it, in its □ascent state you cannot feel it, neither can you smell it nor yet can you taste it ; yet it is that inexplicable something that rules this planet of ours, and if I am right in my theory it is that which holds the world of planets in position, and keeps chaos from supplanting cosmos. I call to mind a circumstance that if you have tlu- time I shall take pleasure in re- lating to you, and which will show you One of the manifold uses to which a static machine can be put."
Assuring him that my time was in no
wise so valuable as was his, I settled my- self to hear the tale he was about to relate.
"It was soon after the discovery of the ray was made by Prof. Roentgen, that I purchased a machine for experimental purposes, little thinking it to be of great value to me. I had learned the use of the various portions of the appa- ratus, and had succeeded in acquiring a lovely dermatitis during the course of my experiments, when I was consulted by a friend of mine, regarding a legal matter that engrossed his attention.
You are probably unaware that I was. many years ago, a dabbler in the science of criminology to the extent that I perhaps merited the title of detective. I would not mention this but for the fact that it has a bearing upon the case in discussion.
One evening, after I had my machine about three months, an old human blood hound friend of mine called to see me to ask some advice regarding a certain case that was puzzling him not a little.
The story, briefly told, was that Mrs.
A had reported to the police the loss
of a diamond necklace worth $15,000.00. A servant of the household was sus- pected, a search warrant issued, and even the most minute investigation failed to reveal even a trace of the missing gems. The servant was incarcerated, upon sus- picion, and whilst in prison had commit- ted suicide by dashing his head against the jail wall.
There had been found a communica- tion, an ante-mortem statement left by the man, that he could stand all else but disgrace, and in his last hour of life he vehemently asserted his innocenee in writing. The associates of this man had been watched, and still no trace of the missing property discovered. It was a perplexing case, and the reputation of my friend, the detective, depended upon the solution.
THE AMERICA X X-RA Y JOURNAL. 1061
I queried him regarding the possi- bility of any other of the servants being at fault. Xo. They had also been un- der surveillance.
Could the woman have robbed her- self, as is sometimes conveniently done when one is short of funds? Xo. That would leastways lead to a pawn shop, and all the loan offices had been investi- gated. The fact of the business, was that those stones had disappeared so completely that they had not left even a ring of blue smoke, and the question that confronted us, was, where, and how?
I was nonplussed. I went indus- triously into the family history, the hus- band was wealthy, there was no appar- ent reasons why either he or his wife should act in a suspicious manner.
Upon my suggestion each and every member of the household was shadowed for several weeks and nothing suspi- cious developed. It is without a doubt, that the solution of the mysterv would never have occurred but for one little circumstance which I will now relate.
It was perhaps a month later that a Veterinary Surgeon, who was a good friend of mine called at my office, bear- ing in his arms a small dog. He begged pardon for his presumptiousness, but explained that he thought that he could presume upon our friendship, to such an extent, that I would make an examina- tion of the canine, by aid of the Roentgen ray, and see if I could give him an idea of the cause of intestinal obstrucrion that existed in the dog. I told him that while I did not profess to skill in his line of business, I saw no reason why the ray should not be of benefit to beast as well as to mankind, and after connecting up the tube, I started the motor, turned out the lights in the room, and in a few moments the apple green color of the tube, told me that everv- thing was in readiness for the test.
He held the dog within the focus of the rays, and I applied the fluoroscope to my eyes. A confused mass appeared in the interior of the animal, and upon changing the position of the dog, I saw the outline of a chain, possibly contain- ing stones, mounted in metal of some kind.
The mind acts quickly in such cases. I hurried to the telephone and called up the police station. My friend Mr. Olden happened to be in, and I re- quested him to call at my office at once.
Whilst waiting for Olden I subjected the animal to a more accurate localiza- tion of the mass within its bowels. It is impossible to accurately localize an object seen, unless the distortion of the rays is corrected by means of the fluoro- meter. By correcting the rays from four distinct places, the accurate locali- zation is unquestionable.
I was not certain that the mass was within the stomach of the canine, so I requested Dr. Albert to hold the ani- mal quiet, whilst I applied the fluoro- meter, and adjusted the sights. Having set the tiny metal wings front and back it was plain to be seen that the foreign body was correctly located from front to back, and by changing the position of my tube without changing the position of the subject and repeating the pro- cedure, with the rays penetrating from the side, I laid my second two points of correction, and I knew that a knife thrust in a direct line from point to point of correction must surely pass through the foreign body.
I queried the veterinarian as to whom the animal belonged. "To Mrs. A.," was the response, and I knew by intui- tion that the missing string of diamonds were brought to light by means of the wonderful Roentgen ray. It is to be remembered that diamonds are transpar- ent to x-rays, and are not any more shadowed than that much charcoal, or
L062
THE AMERICAN X-RAY JOURNAL.
bits of wood. The gold mounting and chain, however, being wholly capable of absorbing rays, the mass was seen in black relief, in contrast to the translu- cent flesh.
Olden arrived, breathless, in a short time, and he in turn viewed the pheno- menon.
Operation upon the canine was out of the question, and at the suggestion of Doctor Albert, a lethal dose of morphia was administered to the animal. In ten minutes the gems were in our hands. In the interim we had explained the case to the Doctor, and he coincided with our views, that the wisest course to pur- sue, was strict silence regarding the place in which we found the diamonds.
Next morning, Mrs. A. was made happy by the restoration of her diamond necklace, which she still wears, not knowing that they reposed for some time in the intestinal canal of her favor- ite poodle.
Olden received a handsome reward, which he concientiously divided with Doctor Albert, and I had the satisfaction of knowing from practical experience, one more use of the Roentgen ray."
Having finished his story, Doctor Uarsto lighted his cigar, leaned far back in his chair, and blew rings of smoke towards the ceiling.
I thanked him for his entertaining narrative, and prepared to leave. "Come again," said lie, "and I will tell you of some other cases, criminal and other- wise, in which my machine has figured.
Springfield, iu..
Ry reading the American X-Ray Jour- nal you acquaint yourself with the correct methods of x-ray therapy.
A a recent meeting of the Harvard Medi- cal Society of New York City, Dr. W. J. Morten read a paper on the treatment of malignant growths by the x-rays, with a provisional report on casts under treat- ment.
Notes on X-Light and Radio-Active Substances in Therapeutics.
William Rollin has made experiments with radio-active substances in the hope of finding a substitute for x-light. He found that some of the radiations retained their activity after passing through ani- mal tissues as thick as the body of a guinea-pig. He is anxious to have radi- um tried on lupus, superficial cancer, and diseases of the skin in which x-light has been found useful. Radio-active substances can be used in sealed capsules held against the body by adhesive plas- ter, or they can be made to cover large areas by mixing them with rubber or cel- luloid to form moisture-proof plasters. These plasters may be still further pro- tected by being coated on the side nearest the body by aluminum foil, and on the opposite sides by lead foil. They could be kept in stock by the yard by drug- gists and given to patients by prescrip- tion with proper directions as to the length of application. They could be worn at night. They could be used by the poor at much less expense than sit- tings for the use of x-light from a vacuum tube.
We are glad to print this little refer- ence abstracted from the New York Medi- cal Record because it really does have some significance. Becquerell carried a piece of radio-active substance in his pocket for several days and found a dermatitis developing at the point the substance was nearest the skin.
It is more difficult to unlearn false teach- ings than to acquire original truth. Begin right and read the American X-RavJotr-
NAI,.
How can one hope to be informed unless lie reads and thinks. Every reader of the American X Ray Journal is informed.
THE AMERICA X X-RAY JOURNAL.
1063
Radiotherapy of the Prostate.
By Dr. Heber Robarts.
I desire to call the readers attention to a method that is wholly new in liter- ature— a mode of treatment for the restoration of diseased and hypertro- phied prostates.
It is not known that the method to be mentioned has ever been used by others. I was persuaded to use the x-rays for the relief of pain in a patient that had long been a sufferer with a tender and hypertrophied prostate. The relief af- orded encouraged me to use radiations in other similar cases. The first iutimatiou however that this form of light would render relief came through a case of Dr. Logan's. The patient was being treated for extravasation in the corpora cavernosa and corpus spongiosum ren- dering the entire organ useless except as a channel for carrying away the con- tents of the bladder. At every effort to erection, deep, not painful dorsal incurv- ature attended. As an organ of pleasure it was an abomination. Time and alter- ative medication and local application gave no relief. There was no history to account for the trouble. The injury was of six months standing and futile efforts for relief urged the doctor to advise about the x-rays. The patient had suffered for some years periodically with prostatic disease. Since the later trouble, however, he had directed all his attention to the virile organ. I was consulted and by agreement we ex- posed the patient daily for the relief of the extravasation. About six ex- posures were made when the patient spoke of the relief the rays afforded the prostate. It must not be under- stood that the prostate resumed its normal size under this treatment. But after the treatment was discontinued
the bulk of the unnatural prostate seemed to continuously lessen.
The method I have pursued for the treatment of these cases is to place the patient upon a chair having a wooden seat with a plane even surface through- out. In the middle of the seat there is an opening about one inch across, slightly greater laterally. Over the en- tire seat is fitted a sheet of lead with a fenestral equal to the size just men- tioned. Surrounding the chair a cur- tain of lead is permitted to drop to near the floor. Eight inches beneath the seat the tube is suspended having its support in insulated thimbles resting in the curtains. The anode is directed towards the opening. The coil or static machine may be used as in all other therapy of the x-rays. The patient is seated with the perineum over the cen- tre of the opening the widest portion being lateral to the patient. The bulb of the urethra should not be within the range of the radiation. About one inch from the junction of the scrotum with the perineum is the situation of the bulb. At this point the anterior edge of the opening in the seat should be placed. The patient sitting firmly upon the open- ing the perineum drops into it slightly, and if the body is somewhat inclined for- ward the prostate is immediately over the anode. The energy of the tube should be sufficient to give radiance through the prostate. If the carpus can be seen at a distance of four feet from the tube, radi- ation will be sufficient. This can be test- ed before the patient takes his seat. The current should pass through the tube without any apparent difficulty and there- fore such a tube is a soft one. This is a relative term however. The source of electrical energy whether from coil or from plates very much determines the nature of the tubes capacity. When familiar with the apparatus and tube, without fluoroscopic test we can fairly accurately
L064
THE AMERICAN X-RAY JOURNAL.
judge of what the tube is doing in any particular case. With the coil having a rheostat with fifteen to twenty buttons the condition of the tube is determined quite accurately. The same can be done with a rheostat controlling the static machine and with the interrupters, fairly well regulate the tube. With the coil the degree of light can be regulated with almost the precision of a wick in an oil lamp. The position of the patient is im- portant but it is not neccesary to use any protecting batting between the sheet of lead and the skin. This was a former notion, and may have been a good thing when there was a great deal of wasted energy about the tube.
The third pafient I treated was 70 years of age. The third lobe of the pro- state was the only portion of the gland affected, so far as diagnosis could be made. On account of difficult micturat- tion he consulted me. The prostatic urethra was considerably lengthened. It was with considerable difficulty that a metal catheter could be introduced. He suffered with some pain and perineal un- easiness. I placed the patient in the radio-postatic position and gave him daily treatments of 15 minutes each for 20 days. The soreness and perineal un- easiness was not noticeable after the first treatment. Micturation became less troublesome after each treatment, and after the twentieth he was apparently well.
The next case I had was 55 years of age. The prostate gland was hyper- trophied and would probably weigh 15 drachms or more. There was no trouble in urinating but if the bowels were at all constipated he suffered in the perineal region. He was not impotent but had precipitate semen. An anxious counte- nance foretold that he was worried. The radio-postatic position was directed and raying done for IS minutes alternating days till In treatments were given. The
patient apparently recovered. In all cases treated marked relief followed. It is too soon to know with what perma- nency these treatments will relieve the patient for this common and distressing affection. Roentgen-theapy is several years old already. I have been doing this work since its inception, and find sug- gestions every day for improving tech- nique in x-ray work.
In tumors, especially of cancerous type the rays act with wonderful results. Tumors judged to be cancerous imbedded beneath the tissues yield to radiations. The prostate gland differs from cancerous structure. Hypertrophy is due to in creased natural fibrous and muscular tis- sue of the organ together with the gland- ular structure. However the rays are not confined to one line of influence. It must be remembered that the most potent action for good is its revitalizing action, as is known to occur on scar tissue. Its antiphlogistic action is seen when psoriasis spots fade away. The two actions here mentioned might be enough to account for its benign influence on hypertrophied prostates. But we must know that the rays have bactericidal action and also an inflammatory action. May at least the first of these not be wrell influenced towards good in hyper- trophy of the prostate. The analgesic action is the fifth well defined action of the x-rays on human tissue. This last action accounts for the immediate relief experienced by those suffering with painful prostates. As to just how nature act to remove hypertrophied con- ditions is conjectural and speculative. At present we are content with the known remedy.
In my teachings I find it is better for the doctor to know better how to relieve suffering than to understand the physics of his machine.
There has been probably no time in the history of civilized races when the
THE AMERICAN X-RAY JOURNAL.
1065
prostate gland was not known to a very large number of persons. It has been written that an organ is only known by its owner when diseased. In health we have no thought of the presence of an organ. When perversion of normal functions ensues, we are reminded of Something going wrong. Our mode of living and the ever tendencies of man to excess in natural and unnatural ways, invited particularly in crowded districts where show and venery is encouraged, it can only be expected, and is perfectly natural, when we consider nervous and emotional dependencies, that the prostate should be hypertrophied or otherwise diseased. Following the laws that maintain other organs, exercise in mod- eration maintains normalcy : excessive use leads on to changed conditions.
The prostate gland is a venereal organ. The plexus of veins about the base of the gland receive the dorsal vein of the penis; the arteries are from the internal pudic, and they go on to form the capil- laries of the trabeculae. The nerves are from the prostatic plexus, and besides supplying the prostate they are dis- tributed to the vesiculae seminalis, and the erectile structure of the organ. The common seminal ducts perforate the prostate and terminate in the prostatic urethra where the twelve ejaculatorv ducts of the prostate open. The secre- tion of the gland makes up by far the greater portion of the ejaculatorv mass at the time of the orgasm. The secre- tion of the prostate like the testis, con- tinues while the receptacles and ducts are empty. Disease of the prostate ma- terially affects this.
The precision of the normal functions of this gland acting in harmonv with the promptings of other venereal organs, as- sures to the owner immunity from knowledge of tts presence. Hut this organ is subjected to many artificial and unnatural abuses. Its lower bourder is
within one and a half to two inches from the anus, and in a normal condition weighs but four drachms, but in disease may enlarge to a weight of ninety drachms. In most instances it com- pletely surrounds the urethra at the neck of the bladder. The three divisions of the gland, which are almost always present, lie between the urethra and the rectum. Xo tissue of any moment pro- tects the prostate from the urethra and bowel. The recto-vesical pouch is four inches above the anus, and unless the gland is greatly enlarged it is in no way concerned with this fold of peritoneum. In all conditions of a distended rectum the prostate is pressed and encroached upon. The folds of mucous membrane in the rectum are subjected to thickning and ulceration. Such disturbance alters the physiological function of the prostate. Piles, strictures of the bowel and fistulae are likewise contributory causes. Fis- sure of the anus and diseased or irritable rectal pouches are disturbing elements. Constipation with impacted feces en- courage the formation of a reservoir of the rectum and therefore pressure is made upon the gland. These are a few of the diseases of the rectum that materially have some bearing on the etiology of dis- eased prostates, and which were practi- cally unknown to the primeval races. Yerv few of us reach fifty years of age without some acquaintance with the rec turn introduced to our senses by some form of disease.
The urethra is an organ of much unnat- ural interference. Stricture of the urethra narrows the channel and burdens the bladder in greater contraction to expel its contents. This strain has its effect upon the neck of the bladder, distending it and encroaching upon the prostate. Every effort at micturating has its ma- lign influence here. Gonorrhea is a potent factor, especially when the pros- tatic urethra is involved. Repeated uses
1666
THE AMERICAN X-RAY JOURNAL.
of the sound disturbs the prostate. Venery, greatly over-indulged in, is the great parent of pathological prostates. It is in the prostatic urethra that we find the primary cause of many cases of impo- tency. The nerves that come down and preside over the ducts of the seminal receptacles and prostate are ever prone to abuse. A diseased prostate, by mechanical interference against the nerves of this region may keep up a con- stant irritation. Due to this, an in- creased flow of blood is encouraged, and congestion ensuing to all the adjacent organs, the prostate is in turn the greatest sufferer.
Strictures of the urethra and other dis- eases of the urinary tract, together with the affections of the rectum, should be cleared away with the least possible dis- turbance. I mean by disturbance, that the knife should be used with the great- est possible caution in the cure of these troubles. Relief should be prompt as possible, but the knife is not the only recource. Now, after all else is satisfac- torily done, the prostate deserves the undivided attention. But most often when these contributing troubles are all cleared up, there yet remains a troubled prostate. The patient complains of throbbing, especially at night, heat, pul- sating, weight, muscular movements, nervous uneasiness, fullness, fatigue, a mental unrest. There may be an over- stimulation of the procreative organs, or a diminution, or even a complete aboli- tion of the sexual desires. The desires may remain and the power for erection be gone. There may be feeble erections and precipitate semen. All of these may be the direct result of an over-distended pmtate. What shall we do with this hypertrophy? It has been the study of tin- ages. Old age does not necessarily mean an enlarged gland. Persons con- tinent through the earlier periods of life,
and those having escaped the popular
diseases, go into the eighties without any hypertrophy whatever. Much has been said upon this subject of natural hyper- trophy in old age. But I am sure that obedience to natural laws leads man up- and onward without calling for remission in any particular, of any organ. So nat- ural are the dispensations that the ideal is sometimes seen. The body as a whole moves in unison with its parts. It is physiological for an organ to slowly sur- render, if done, in harmony with the ebb and flow of Nature's laws. Its lapsing functions should cause no physical jar nor mental disquiatude.
Treatment of hypertrophy of the pros- tate gland is far from being satisfactorily done. Medicine has utterly failed, whether used internally, locally or hyperdermatically. Electricity has al- ways offered the greatest hope. Surgery with the knife alone, is not a success. Six modes of operation are practiced with the electric current: First: The galvano-cautery sound, wdiich is intro- duced to the prostatic uretha must cau- terize the tissue in situ, and by one or two successive breaks, and in twTo or more places. The tissues are seared, but the patient scarcely, if at all, feels pain So little local disturbance is elicited that there is no after effect appreciable. The treatment must be repeated a few times after a few weeks of intervening rest. Second: Bottini's rapid method at one seance. In this operation the cautery is thrust through the offending portion of the prostate and direct into the blad- der. Third: Combination of suprapubic cystotomy and galvano-cautery has reached its perfection in the surgical skill of Belfield and Hunter- McGuire. The operation simply consist- in remov- ing the gland in situ by galvano-cautery through the superpubic opening. Fourth : Electrolysis with weak currents. Fifth: Electrolysis by strong currents, by which 15 milla, and sometimes 70m., may be
THE AMERICA iV X-RAY JOURNAL.
1067
used. Encouraging reports are reported by Massey. The active pole, which is the negative one , is placed over the pros- tate in the uretha, while the indifferent pole is placed in the perineum. This treatment is done twice a week, while daily application of the negative pole to the prostate through the rectum is done with the positive pole over the abdomen The treatment is complicated by using the faradic current immediately follow- ing the galvanic application through the uretha. Zinc or tin electrodes are used. Sixth : Galvano-puncture consists in plunging a platinum needle into the body of the prostate, the positive elec- trode placed over the abdomen to com- plete the circuit. 301 Chemical Building.
Origin of Cancer.
This was the subject of a communication sent to the Chelsea Clinical Society. March 25, by Dr. J. G. Adami of Montreal. We desire to record the points herein made, because they are in accord with the best informed persons upon this subject. It is especially useful to readers of the American X-Ray Journal, for the}- are doing work with the x-ra3Ts for the cure of cancer.
He said: "From a study of the syney- tionia malignum, it might be legitimately deduced that there existed one form of tumor of highly malignant tj-pe, in which the infiltrating cells were not those of the organism itself, but were derived from another organism. The infiltrative and invasive properties of these cells were not a new aquirement, but were an exaltation of properties normally possessed by them, or, more exactly, under normal conditions it was observed that there was an inter- action of two forces— one the invasive properties of these cells, and the other the protective properties of the surrounding maternal tissues, by which interaction the extent of invasion of the cells was strictly limited to the placental side. Dr. Adami's view was that the development of the syn- cytioma malignum must therefore be at-
tributed to either an increase in the inva- sive properties of the syncytial cells or to a lessened resistance on the part of the maternal tissues, or a combination of the two. It was concluded, therefore, that if microparasites played any part in the pro- duction of the tumor that it must be either by exalting the infiltrative powers of the one, or by lowering the resistant powers of the other. Dr. Adami pointed out that proof positive of the existence of such specific microparasites was still wanting, and in its absence he found it difficult to conceive how specific microparasites could bring about those results.
The prevalent conception of cancer para- sites, as existing within the cancer cells, involved the idea of malignant growths being the product of parasites acting with- in parasites, because, as shown by the study of syncytioma malignum, the tumor cells themselves were essentially parasitic in the organism.
In short, according to Dr. Adami, if the present popular idea was traced to its legi- timate conclusion, the most that could be said for it was as the association of para- sitic ideas might already have occurred to some, that the theory was in harmony with the great generalization of the poet who wrote that
Greal lira - have little fleas upon their backs to bite them- And little fleas have lesser fleas, and so on ad infinitum.
Dr. Adami wished to know if that gener- alization was also to be applied to explain the action of pathogenic bacteria. In the long-continued action of microparasites he was willing to recognize a process which might, like other modes of stimula- tion, initiate aberrant and neoplastic cell growth, but be5rond that point he con- tended that they seemed to be asked to contemplate a most extraordinary condi- tion of affairs.
The parasitic theory of the origin of can- cer presents to many earnest and keen investigators so large a number of diffi- culties that, before being accepted as the true cause, a quantity of unsolved points must be made clear.
The progress towards this end has, of late, been by no means rapid.
The increase, however, in the facilities for cancer research in various countries of the world gives rise to the hope that the final unraveling of its mysteries may not be far distant.
1 068
THE AMERICAN X-RAY JOURNAL.
History of a Case of Unrec- ognized Fracture of the Radius.
R\ Paul F. Fletcher, late A. A. Surgeon U. S. Army.
On March 12th of the present year, a young lady consulted me regarding pecu- liar, fugitive pains of the left arm and forearm. On questioning, the following history was elicited: Ten years ago, while riding on a sled, she was thrown to the ground, and in attempting to protect her body, injured her left wrist. The family physician was immediately summoned, and after an examination, declared the in- jury a sprain. He applied a dressing, placed the member in a sling and at the end of three weeks discharged the patient.
Soon after the removal of the dressing, the young woman experienced ill-defined, fugitive, yet persistent pain in the radial side of the fore-arm and hand, also at the posterior aspect of the humerus near the musculo-spiral groove.
The physician who had attended her be- fore was again called, and after an exami- nation, pronounced the condition one of partial paralysis, due to some affection of the radial nerve. At this time the patient observed great difficulty in manipulating the hand, and frequently dropped articles after grasping them.
The surgeon in attendance applied a plaster cast which was maintained for a long period— just how long I do not know— and during the time it remained in posi- tion, no pain was suffered. On the removal of the cast, pain and discomfort returned, and another surgeon was consulted. He advanced a diagnosis of synovitis of the wrist point, and placed a cast on the pain- ful forearm and hand. The same relief of pain was noted, and when the cast was re- moved, it returned with the same degree of intensity.
At this time some one recommended that she consult the osteopathists at Kirksville. This was done, and a diagno- sis of curvature of the spine in the region of the seventh cervical vertebra, was made. Osteopathic measures were followed for a short time, and then becoming discouraged, the patient abandoned this treatment and
consulted me. I was as unsuccessful in reaching a diagnosis as my colleagues, but favored a diagnosis of synovitis. A cast was again applied, temporarily, and the patient advised to submit herself to the x-ray. This was consented to, a radio- graph made, and lo! a fractnre site with a resultant spur of bone was discovered at the external and posterior aspect of the radius, five centimeters from the apex of the styloid process.
Operation was counseled and yielded to. Patient was taken to a hospital, and an in- cision made near the posterior surface of the radius, and the tissues separated down to the periosteum. On reaching the deeper tendons, that of the extensor carpi radialis longior was found adherent to the osseous spur. This spur was devoid of periosteum, or osteoncus, which had penetrated the tendon sheath and substance. The inflam- matory deposit was extensive and had resulted in adhesion over a considerable area. These were broken up, the radialis longior tendon released and the spur chis- eled from its bed, flush with the normal line of the shaft. The periosteum was then drawn over the denuded area and sewn with fine cat-gut, and the muscular structures permitted to resume their nor- mal positions.
The integument was sutured with silk- worm gut and a skin suture of fine car- bolized cat- gut introduced. Union by first intention was secured.
The patient left the hospital in eight days. All pain, which before the operation was constant and occasionally of great paroxyismal intensity, has disappeared.
In performing this operation, I avoided disturbing muscular structures where pos- sible, without exposing a much more extensive area of bone surface and inter- fering with the attachments of the Pronator Quadratus. I could not trace the fracture line to discover the course of the line of union. Superficially it appeared to be a Colles' fracture, yet, from the absence of much deformity, I am inclined to believe the injury to have been a greenstick fract- ure. (Radiograph of case on 2d page.)
st. Louis, Mo
"A Pictorial System of Instruction," the new and most invaluable work of Monell's, contains no part of the matter of his former works. All x-ray workers should have it.
THE AMERICAN X-RAY JOURNAL.
1069
X-Ray Prophecy.
Sometimes when you become familiar with a subject that is quite unknown to the many, it is easy to make a good guess that seems prophetic to others if it comes true. Readers of The American X-Ray Journal will remember four years ago we predicted that no work on surgery would sell that ignored the x-rays. The predic- tion was treated with silent contempt. What about the works that have appeared? We predicted that successful operators and skin specialists would be compelled to use the rays or go out of business. They laughed at the suggestion. How is it? It is like a stampede now. They are all fall- ing over each other to get there. Five years ago there were but three houses in America that made static machines, al- though electro-therapeutics was largely taught in special schools. Now, there are more than 25 manufacturing houses, some of whom like Van Houten & Ten Broeck, Waite & Bartlett Manufacturing Co., Mcintosh Battery and Optical Co., R. W. Wagner Manufacturing Co. , Electro-Thera- peutic Manufacturing Company, and others that can not keep up with the demand for x-ray machines.
We made investigations of 120 medical colleges on this continent, and not one of these, two years ago taught x-ray ther- apy. We predict now, that within four years, not an accredited medical school in America will be without a professor of radio-therapy. Don't forget this.
Treatment of Epithetical Skin-Can- cers and Sycosis Non-Parsi- tica with the X-Ray.
J. F. Rinehart speaks of the advan- tages of the treatment of these cases by the x-ray. It gives no pain, there is but little scar tissue left after the sore has healed, and there is the possibility of a more thorough eradication of the disease, as the effect of the rays is to destroy all the cancer cells within the area exposed. He reports a number of cases which illustrate the success of this
treatment. It is best not to be in too great a hurry to obtain the reaction lest too much inflamation be caused. There is a great difference in skins as to their ability to withstand the x-ray. It is best to begin with a five-minute expo- sure at six or eight inches and try that for a day or two, and if no reaction is obtained, increase the time of exposure till the desired effect is produced.
This abstracted matter briefly points out a procedure that is quite correct and is imitated by all good operators. In diseases that are amenable to ordinary medication they differ in different subjects and require different modes of procedure to effect a cure. In x-ray therapy this must be observed.
We are glad of the interest the better medical journals are now taking in x-ray literature.
The American X-Ray Journal two years ago predicted that every wri- ter of a work on surgery that failed to give ample space to the importance of the x-ray, would have practically no sale. It has proven so.
Dr. Charles Warren Allen reports 13 cases of cancer under his care, and all of these are improving. One of his patients was a physician suffering with cancer of the rectum.
Carl Beck in his paper, entitled "Differ- entiation between Inflammatory Processes and Neoplasms of the Bones by the Roent- gen Rays," says that many limbs have been sacrificed by unnecessary amputation, and many lives lost by deferred amputa- tion, on account of errors in differentiating the various inflammatory processes from the growths of the bones and joints.
The x-rays have opened entirely new fields in this sphere, and in many cases the Roentgen rays give positive informa- tion.
Owners of x-ray machines, who desire to be up-to-date in x-ray work should read the American X-Ray Journal. Have you subscribed ? Why not ?
1070
THE AMERICAN X-RAY JOURNAL.
X-Ray Divergence Chart.
SUPPLEMENT To
A System of Instruction in X-Ray Methods and Medical Uses of Light, Hot-Air, Vibration and High Frequency Currents. By S. H. MONELL, M. D. Students of X-Ray work should study this chart reproduced on the front cover of this Journal.
This chart shows at a glance the follow- ing points of essential interest to the X-Ray operator: —
1. A Plane Diagram of X-light radia- tions from the a?iode focus-point.
2. The rate of departure of X-Rays from a parallel path at different distances from the tube.
3. The proportionate loss of right-angle shadows at different distances horizontal to the perpendicular axis.
X-Ray Narrative.
The series of articles under this head- ing are being written by Dr. Fred S. O'Hara of Springfield. 111. The articles are written for the benefit of physicians operating x-ray machines. On account of inability of physicians to receive the proper instruction in this branch of the science and art, or in other words, the diagnostic and therapeutical uses of the x-rays, these articles are written. They are interesting to all readers, but doubly so to those wishing clearer understand- ing of radiotherapy and correct methods of irradiation. They are alluring to a tired doctor whose services in the general field of practice have worn off the nural sheath. In these articles we find the awakening of green spots in the mental domain. The plan is to take up tired na- ture, and while repasting on vivid ideas, con sume modes and methods of doing ac- curate x-ray work. Like Oliver Wendell Holmes. William A. Hammond and Wier Mitchell, so Fred S. O'Hara in- clines to the literary entertaining in teaching. He is a young man with a rare talent. Those who follow him will weigh more in the scale of knowledge.
4. The area of non-distorted field of ob- servation at anj- distance from the tube.
5. The area within which a body of any thickness will shadow a right-angled rela- tion of the parts at a given distance from the tube.
6. The distance from the tube at which a part and the photographic plate must be exposed to secure essential correctness and non-distortion for a diagnostic field of any given size.
7. The general area of approximate non- distortion on the plate.
8. The obliquit5' of shadows at all dis- tances outside of the central field of exact perpendicularity of radiation.
The scale of the Chart reads down from the focus -point of the tube to an imaginary plate twenty inches distant. For greater distances, extend the indicated lines below the Chart, and apply the same rule of in- terpretation. For full explanatory descrip- tion see Chapter XVIII.
Roentgen Society of America.
The regular meeting of the Roentgen Society of America will convene in Chicago, December 10th to 11th. The local Committee are : Dr. Ralph R. Campbell.
414 Marquette Building. Dr. John B. Murphy.
Reliance Building. Dr. Louis E. Schmidt.
424 North State Street. Dr. L. M. Harris. Chicago. Dr. W. L. Baum, 103 State Street. Dr. H. C. Axthoxy.
465 Dearborn Avenue. Dr. W. A. Pussy.
Columbus Medical Bid. , Chicago.
An x-ray apparatus in the hands of one not able to use it properly is a cumbersome and expensive luxur>\ The new work of Monell's "A Pictorial System of In- struction," will teach any ordinary mind practical uses of the machine.
Dr. Reginald reports an old case of Lupus Vulgaries, which was repeatedl}' cut and scraped, with the local application of the usual remedies, had resulted in no improvement, until the x-ray was resorted to.
THE AMERICAN X-RAY JOURNAL,
1071
Radium.
Reference made in the following- obser- vations to diagnostic possibilities of radium in eye disease is not altogether new. It should be noted that in using- radium fluorescing- surfaces are not used But the points made have no advantage over the screen under the x-rays. We examined several hundred cases of blind and partially blind persons in 1896. There is a way to determine the degree of blindness, when due to atrophy of the optic nerve, by the x-rays. These observations of ours were widely published, at the time, all over the world.
Javal makes an interesting communica- tion to the Gazette des Hopitax Civils et Militaires, April 17, 1902, concerning the curious properties of the new metal, radi- um, discovered and studied by Mr. and Mine. Currie. In the dark this metal emits a light which is peculiar in itself, which is not phosphorescence, and which is distinct from Roentgen rays, although bearing a certain analogy to the latter. The rays from this metal traverse opaque bodies and produce physiological effects. Currie thinks that these properties could be utilized to discover if the optic nerve in the blind is absolutely atrophied, and if, accordingly, all hope should be abandoned of the recovery of sight. Javal cites several instances in which certain blind patients could perceive the glinuner of radium. In others, on the contrary, there were no perception of its light. This metal is still extremely rare. It is prepared in the form of the chloride.
Surgical Operation in the Old
is referred to in the Radiance Medical Jour?ial by Dr. J. C. Sexton. The doctor contends that it's disease, not years, that makes people old. In surgical operations shock is not a great factor. The loss of *blood is. It is not necessary to produce deep narcosis in old people for the extreme sensibility of the nervous system incident to the prime of life seems dulled in old age. Old people can endure a great deal - of surgical infliction. The observation is worthy of thoughtful consi-deratior .
At the meridian of life the greatest tendency occurs for the gtowth of canc^r^.^ For women this is the most critical period.
Scarcely is there a hospital that does not have cases under surg-ical care for cancer. But a lessening of this variety of cases is noted day by day. Instead of surgery. the cases are being successfully treated with the x-rays. Surg-ery finds this fruitful field diminishing-. We predict the ultimate restoration of cancerous cases without shock, by the benign system of radio theraphy.
Dr. J. Rudis-Jicinsky reports two cases of Intestinal Obstruction, diagnosed by the x-ray.
We are glad to see some of our medical friends in old St. Louis awakening to the uses of the x-rays. Some of them are being provided with useful apparatus, and we trust they will not stop short of learning how to make the best use of them.
At a recent meeting of the Vienna Soci- ety of Physicians, Dr. Schiff and Dr. Freund presented an interesting paper, on Depilation by High-Tension Electric Cur- rents.
Have Yom Got It '?
Not $300, not $200, not $150 for an 8 -plate, but
$125.00 GASH,
for a High Grade Perfection
16-pliite mm.
Western Surgical Instrument House,
647-653 W. 5t>i» &t„ Chicago, 111,
HI
ADVERTISEMENTS.
C
L
E
N
E
f
I notice in the advertisement of the manufacturers of Mica Plate Machines that they claim that two revolving Mica Plates are equal to ten revolving glass plates in a Static Machine.
I am ready to make the test to prove to the contrary : that two Mica Plates will not give the same amount of current that ten glass plates of equal size will give.
I will meet in competition the manufacturers of the Mica Plate Machine in Chicago, or in New York City, in the presence of a body of Medical and Scientific Electri- cians to decide upon the merits of the machines, and will furthermore prove that a machine with two glass plates, same size as two Mica Plates, will equal and do more and better work, (x-ray or otherwise), under same conditions, than a Mica Plate Machine can do.
This advertised statement has been heretofore unchal- lenged, and I now give them (the manufacturers of the Mica Plate) the opportunity to prove the same and have it settled which is the most efficient in actual practice.
HEINRV E. WAITE, M. D.,
President, WAITE <f BARTLETT MEG. CO.,
10» Bast 33d Street,
NEW YORK CITY.
ADVERTISEMENTS.
)000000000000000000000000000000000000000000(
AN/EMI A
TYPHOID
CONSUMPTION
and all impoverished and depleted conditions yield to the heal- ing and magical influence of
BOVININE
with wonderful rapidity and finality. Measure the increase of red cells and haemoglobin in the blood as you proceed, and g note improving strength and functions of your patient. In o typhoid fever it is quickly absorbed and ass'milated without g the slightest functional labor or irritation. It is a support and rest to the stomach and intestines. A postal brings our scien- tific treatise on "Haematherapy," with details of treatment in all cases, and hundreds of clinical reports.
THE BOVININE CO.,
75 West Houston St., New York.
LEEMING MILES & CO., MONTREAL. . Sole Agents for the Dominion of Canada. 5 >OOOOOOOOOOOOOOOOOOOOOOOOOTOOOOOC>OOOOOOOOOOOOOOOOOOOOOOo8
Every Static Machine
Should be kept dry so that it will work at all times and under ALL conditions.
How Can This Be Done?
U
SE AN ELECTRIC DRYER. Lessen the use of chemicals. They all corrode the apparatus and injure the machine. Electric Dryers are permanent, clean, and the output of the ma- chine is made constant and regular. They are cheap.
Made especially for Static Machines to fit all designs. Work on any incandescent light current. State voltage in all cases when ordering. Address
EMERGENCY X-RAY CO., St. Louis, Mo
THE AMERICAN X-RAY JOURNAL.
Mcintosh Battery and Optical Co.,
<>2 to 98 State Street, - - CHICAGO, ILLINOIS.
ADVERTISEMENTS.
Preparation-Par excellence
fellows' Syrup of fiypopbospbites
CONTAINS
Hypophosphites of Iron, Quinine, Strychnine, Lime, Manganese, Potash.
Each fluid drachm contains Hypophosphite of Strychnine equal to l-64th grain of pure Strychnine.
Offers Special Advantages
in Anaemia, Bronchitis, Phthisis, Influenza, Neurasthenia, and during Convalescence after exhausting diseases.
SPECIAL NOTE*— Fellows' Hypophosphites is Never Sold in Bulk, and is advertised only to the Medical Profession. Physicians are cautioned against worthless substitutes.
Medical Letters may be addressed to K Literature of value upon application. MR. FELLOWS, 26 Christopher St., New York.
ADVERTISEMENTS.
BLOOD INTRODUCTION
In all anaemic, consumptive and dyspeptic pa- tients, where there is a lack of ability to produce good and sufficient blood, why not introduce it ?
BOVININE
is live blood — blood of fullness, energy and integ- rity, arterial blood of the healthy bullock. It is the physician's greatest auxiliary. Prepared by cold process. Antiseptic and sterilized. Try it per rectum when the stomach is unavailable. Try it per sub-cutaneous Injection when collapse calls for instantaneous blood supply. Send for our scientific treatise on topical and internal adminis- tration, and reports of hundreds of clinical cases.
THE BOVININE CO.,
75 West Houston St., New York.
Have YOU Seen
1
.THE
B. U. Cube Regulator?*
For use with any apparatus.
Adjusts the Vacuum to any devised degree and main- tains it at such point permanently.
Eliminates 95 per cent of the danger of puncturing.
Enables one tube to do the work of three.
Heavy Radiography with short exposures.
BARIO VACUUM COMPANY,
106 East 23d Street
NEW YORK CITY.
THE AMERICAN X-RAY JOURNAL.
+
f *
*
* f *
4-
%
f * *
! % %
*
t f + + f f + *
IT HAS NO EQUAL
FOR EITHER
X-Ray or Therapeutic Work.
Mcintosh Improved Construction Sixteen-Plats Static Machine.
Our m Edition Catalogue
WILL BE MAILED FREE TO ANY ADDRESS —
CONSULT US BEFORE PURCHASING
Static Machines, the Kinraide Coil, X-Ray Tubes, BATTERIES AISD ELECTRODES.
Mcintosh Battery and Optical Co.,
39 West Randolph Street,
CHICAGO.
++++++++++++++++++++++++++++++++++++ 4.**+**++**++*+++*+++****+*
This Book is due on the last date stamped below. No further preliminary notice will be sent* Requests for renewals must be made on or before the date of expiration.
DUE
JON 7- 1950
FEB - 8 1983
M2
RETURNED
JU* 1-1950
A fine of t^£nt^fiye centsjwill be charged for each week or fraction of a week the book is retained without the Library's authorization.