Röntgen ray diagnosis and therapy

Front matter

COLUMBIA LIBRARIES OFFSITE

HEALTH SCIENCES STANDARD

HX641 18088 RC78 .B38 Rontgen ray diagnosi

Preface

Literature upon the application of the Rontgen rays has become very extensive. Many contributions have been made during the last few years, and a number of splendid text-books, like those of Morton, Gocht, Midler, Donatb, Williams. Walsh, and Albers- Schoenberg, were written on this fascinating subject. Still none of those standard works, while indispensable for the Rontgen-ray worker, treats the large field from a strictly clinical view-point. To demonstrate how the Rontgen rays can best be utilized in medical and surgical practice has therefore been the author's aim. This desire underlies the continuous allusion to clinical points, and especially the numerous illustrations of therapeutic means. It entailed representation of methods (operative steps, application of splints, etc.), which at first glance may appear foreign to a treatise on the Rontgen rays. But on a closer study it will be evident that these can be understood only on the basis of an exact knowledge of the new science.

While these factors are the predominating feature of the book, the technical points are not neglected. They are of so complicated a nature that they require special study, as do the microscope, the laryngoscope, the ophthalmoscope, asepsis, etc. The employment of the apparatus must be mastered and the complicated rationale of the various changes in the tubes thoroughly understood.

In the General Part the author has tried to furnish a guide for practical work, emphasizing the essential points only. Thus he refrained from discussing the elementary principles of electricity and from describing the large number of apparatus in the market because they are thoroughly advertised and explained by the various firms interested. So much may be said, however, that nearly all of them are useful, as long as they are in good order.

As this book is written for physicians, great stress has been also laid on topographic anatomy. None except the physician is

v vi THE RONTGEN RAYS

deemed as competent in Rontgen science. It is only the knowledge of anatomy and pathology which permits correctly placing the part to he examined and proper interpretation of the result. The many errors which were and are still attributed to the rays are not only due to technical faults, but, in the large majority of cases, to insufficient knowledge of normal anatomy. To recognise the atrophic area in osteosarcoma, or to differentiate a renal calculus from intestinal contents in a mediocre skiagraph, to appreciate a sesamoid or to define the shadow of an aneurysm, requires much scientific knowledge and Rontgen experience.

It must, furthermore, not be forgotten, that valuable as the Rontgen method is, it cannot serve as a substitute, but only as an important adjunct to our well-tested clinical methods.

In the part devoted to Rontgen therapy the author has carefully tried to keep facts and conjectures well asunder, appreciating the limitations of this new field, which is still in a stage of development.

The skiagrams are exact reproductions of photographic prints. The author resisted all temptation of emphasizing their essential points by artistic interference, with the exception of two illustrations in which the important points were lost during the process of reproduction. None of the representations were selected for their pictorial excellence, but to illustrate the points of the text ; therefore the author often had to sacrifice some of his beautiful reproductions for mediocre ones that would better subserve the special purpose.

It affords the author special pleasure to thank Professor Rontgen for the many courtesies of which he has been the recipient at his laboratory. His sincere acknowledgments are also due to Professors von Bergmann, Czerny, Koenig, Pfuhl. Koehler, Hildebrand, Koerte, Hoffa, Lesser, Lassar, Hochheimer, Gocht, Helbig. Surgeon-General Stechow. Dr. Max Levy, and to Messrs. Siemens and Halske, Max Kohl, and the Allgemeine Elektricitaetsgesellschaft. Great credit is due to Dr. J. R. Broome and the publishers, Messrs. Applcton & Co.. for the typographic and pictorial excellence of this book.

Carl Beck.

No. 37 East Thirty-first Street, New York,

Contents

PAGE

Introduction . 1

Section I General (technical) Part

CHAPTER

I. — The Apparatus 7

II. — Rontgen Technique 24

III. — Fluoroscopy 40

IV. — Skiagraphy 45

V.— Examination of the Patient ....... 58

Section II Regionary (clinical) Part

VI.— Head 64

VII.— Neck ?9

VIII.— Chest 86

IX. — Abdomen .111

X. — Pelvis and Lower Extremity 142

XL — Shoulder and Upper Extremity 178

XII. — Malformations 240

XIII. — Diseases of the Bones and Joints 249

XIV. — Neoplasms 284

XV- — The Utilization of the Rontgen Rays in Fractures . . 306 XVI. — The Operative Treatment of "Deformed Fractures as indicated by the Rontgen Pays 310

X VII.— The Medico-legal Aspect of the Rontgen Rays . . . 339

vii viii CONTENTS

Section III Effects Of The Rontgen Rays

PAGE

XVIIL— Rontgen Therapy . 360

XIX. — Special Indications 381

XX. — Becquerel Rays and Radium 431

XXL — Pinsen Method and Ultra-violet Rays 436

Index 455

LIST OF ILLUSTRATIONS GENERAL PART

Chapter I

1. Portable Ron tgen-Ray Apparatus .

2. Field Apparatus ....

3. Field Apparatus ready for Use

4. Walter Commutation Arrangement .

5. Static Machine ....

6. Simple Wehnelt Interrupter

7. Tube provided with Osmo-Regeneration

8. Regulating Tube ....

9. Regulating Tube in Use .

10. Grunmach-Kny Tube provided with Water-Coolinj.

Apparatus

PAGE

8 9 9 11 12 13 18 20 20 21

Chapter II Rontgen Technique, Page 24

12. Osteoscope in Use .......... 26

13. Lateral Dislocation of Elbow and Old Fracture of External Condyle 27

14. Normal Ankle-joint, taken with a Tube of Medium Hardness . . 28

15. Fracture of Lower End of Radius followed by Displacement, taken

with a Soft Tube ......... 29

16. Faint indication of Bullet in the Os Magnum and Evidence of Small

Fragments in the Carpus (Low Vacuum Tube) ... 30

17. Bullet Case, illustrated by Figs. 16 and 18, Lateral Exposure (Low

Vacuum Tube) 31

18. Bullet Case, illustrated by Figs. 16 and 17, showing Bullet Distinct

and Bones Translucent (Tube of Medium Hardness). . . 32

19. Plate Diaphragm 34

20. Tubular Diaphragm 34

21. Simple Form of Lead Diaphragm ....... 34

22. Simple Compression Diaphragm 35

23. Skiagraphing Renal Calculi by using the Compression Diaphragm . 35

24. Examining the Foot by the Compression Diaphragm ... 36 x THE RONTGEN RAYS

FIG. PAOE

25. Author's Movable Diaphragm ....... 36

26. Textural Details shown by the Aid of Author's Diaphragm in Frac-

ture of Radius, associated with Fracture of Styloid Process of Ulna 37

27. Skiagraphing Hand by the Aid of Author's Diaphragm . . .37

28. Skiagraphing Head by the Aid of the Diaphragm .... 38

Chapter III Fluoroscopy, Paoe 40

29. Tracing Apparatus . . . . . . . . . .41

30. Orthodiagraph^ Examination ....... 43

31. Hoffmann's Measuring Stand ........ 44

Chapter IV Skiagraphy, Page 45

32. Apparatus of Hildebrand ........ 51

33. Fracture of Femoral Diaphysis, showing Angular Deformity (Ante-

34. Fracture of Femoral Diaphysis, showing Overlapping of Fragments

35. Fracture of the Middle of the Femur, showing Juxtaposition,

Seven Weeks after the Injury, in a Boy of Seven Years . . 54

36. Localization of Bullet in the Arm by AVire Letters .... 55

Chapter V Examination Of The Patient, Page 58

37. Queen's Examining Table ........ 59

Chapter VI Regionary (clinical) Part, Page 64

38. Infantile Skull (Fracture of Skeleton)

39. Hydromeningocele .........

40. Nasofrontal Hydromeningocele ......

41. Case of Hydromeningocele, illustrated by Figs. 39 and 40, One Year

after Operation ........

42. Bullet in the Skull (Lateral View)

43. Bullet in the Skull (Front View)

44. Fracture of Inferior Maxilla Wired ......

45. Fracture of the Inferior Maxilla Reduced (Note Outlines of the

Upper Trachea and the Epiglottis) . . . .

46. Protruding Filling in Tooth .......

47. Incisor, situated transversely in the Superior Maxilla of a Girl of

Fifteen Years .........

48. Transverse Tooth in the Mandible ......

66 67

69 71

72 73

74 75

LIST OF ILLUSTRATIONS

XI

Chapter VII Neck, Page 79

FIG.

49. ~A Five-cent Piece in the (Esophagus

50. Goitre containing ('idea icons Matter

51. Skiagraph of Calcareous Deposits in Goitre,

52. Tuberculous Glands of Neck

-1 rated by Fit

PAGE 81 si 85

Chapter VIII Chest, Page 86

53. Topographic Relations <>f Intrathoracic Viscera

54. Tuberculous Foci in the Lungs

55. Abscess of Lungs ......

56. Fifth, Sixth, Seventh and Eighth Ribs, Three Weeks after Resection

for Old Pyothorax ........

57. Hypertrophy of Left Ventricle after Rheumatic Endocarditis .

58. Arteriosclerosis .........

59. Osseous Degeneration of the Saphenous Vein ....

60. Myelosarcoma of Thoracic Wall ......

61. Perforating Pyothorax resembling Solid Tumor

62. Oesophageal Stenosis caused by Carcinoma ....

63. Aortic Aneurysm projecting into the Supraclavicular Space

64. Aortic Aneurysm showing Improvement after the Administration

of Iodide of Potassium

65. Enormous Aortic Aneurysm, causing Atrophy of the Clavicles and

the Sternum .....

66. Aortic Aneurysm (see Photograph, Fig. 64)

67. Heart and Aortic Aneurysm

68. Fracture of Scapula and Ribs .

87 90 91

9:5 95

104 105 108 109

Chapter IX Abdomen, Page 111

69. Subphrenic Abscess ......... 112

70. Concretions in the Hepatic Ducts . . . . . . .114

71. Various Types of Biliary Calculi . . . . . . .115

72. Translucency of Gallstones (compare Figs. 71 and 73) . . . 116

73. Biliary Calculi, illustrated by Figs. 71 and 72, irradiated through

the living body . • • • • • • ■ .117

74. Position for Skiagraphing Region of the Gall-Bladder by the Aid of

Author's Diaphragm ........ 118

75. Faceted Biliary Calculi 120

76. Three Biliary Calculi . -121

77. Solitary Biliary Calculus .....-•• 122

78. Biliary Calculus 123

79. Numerous Biliary Calculi in Much Distended Gall-Bladder . . 124

80. Renal Calculus 126

FIG.

81. Resected Halves of Vesical Calculus, illustrated by Figs. 82 and S3

82. Vesical Calculus, (compare Fig. 81) .....

83. Vesical Calculus (compare Figs. 81 and 82) ....

84. Vesical Calculus in a Man of Seventy Years .... 8.5. Spina Bifida

86. Spina Bifida, showing Hiatus

87. Spina Bifida, see Fig. 88

88. Spina Bifida, illustrated by Fig. 87, in Antero-posterior Projection

89. Rhaehitic pelvis . . . .

90. Extrauterine Mole, containing foetus, removed by Laparotomy

91. Embryo of Three Weeks

92. Embryo of Ten Weeks

93. Fcetus of Four Months-Abortus caused by Syphilis .

94. Fcetus of Five Months

Chapter X Pelvis And Lower Extremity, Page 142

95. Congenital Dislocation of Both Hips in a Girl of Two and a Half

96. Congenital Dislocation of Left Hip in a Boy of Four Years, the

Right Hip being Normal . . . .

97. Congenital Dislocation of Hip in a Girl of Seventeen Years, the

Empty Acetabulum showing Well Formed

98. Tuberculous Hip-Joint ........

99. Fracture of Femoral Neck

100. Fracture of Femur, followed by Necrosis ....

101. Sequestra indicated by Skiagraph, Fig. 100, after Removal .

102. Popliteal Aneurysm showing Phlebolith .....

103. Popliteal Aneurysm (compare Skiagraph, Fig. 102)

104. Normal Knee-Joint . . .

105. Patellar Fragments turned after Wiring ....

106. Diastasis of Patellar Fragments, Twenty Years after the Injury

107. Transverse Fracture of the Patella ......

108. Normal Sesamoid of the Semitendinosus Muscle .

109. Osseous Ankylosis of the Knee

110. Oblique Fracture of the Tibia, showing Slight Axial Displacement

111. Fracture of Tibia, showing Anterior Gaping ....

112. Fracture a la Bee de Flute of the Tibia, in a Boy of Nine Years

113. Dressing in Pott's Fracture as indicated by Skiagraphic Anatomy

114. Pott's Fracture

11.5. Fracture of the Internal Malleolus reduced ....

116. Fracture of Both Malleoli, associated with Backward Displacement

of Foot

117. Case Illustrated by Fig. 116 in Oblique Antero-Posterior Projection

118. Fracture of the Calcaneum . . . .

119. Foot showing Os Trigonum Tarsi ....

LIST OF ILLUSTRATIONS

XI 11

FIG. PAGE

120. Fracture of Second and Third Metatarsus, followed by Lateral

Displacement . . . . . . . . . 1 74

121. Fracture of Second Metatarsal J Jone ...... 175

122. Malunion of Fracture of Large Toe, Throe Years after the Injury . 177

Chapter XI

123. Deformed Union in Fracture of the Upper End of the Humerus

(also note the Normal Relations of the Thoracic ( )rgans)

124. Impacted Fracture of the Surgical Neck of the Humerus .

125. Deformed Fracture of Surgical Neck of Humerus .

126. Anterior View of Shoulder (compare Fig. 127)

127. Fracture of the Anatomical Neck of the Humerus, Posterior View

(compare Fig. 12G) ......

128. Fibrous Ankylosis of Shoulder . . .

129. Fracture of the Diaphysis of the Humerus in a Baby, sustained

during Labor — (Rapid Exposure) ....

130. Wiring of Humeral Head to the Acromion for Old Subcoracoid Dis-

131. Subcoracoid Dislocation of Humerus . . . .

132. Greenstick Fracture of Humerus .....

133. Fracture of the Diaphysis of the Humerus, Non-united after Nine

134. Refracture, in Case illustrated by Fig. 133

135. Extreme Displacement causing Diastasis of Fragments and Mus-

cular Intervention .........

136. Well-united Fracture of the External Condyle, associated with

Slight Downward and Inward Displacement, and with Outward Bending of the Ulna (the Relations of the Infantile Cartilages being Normal) .....

137. External Condyle Completely Turned after being Fractured

138. Supracondylar Fracture shortly after Reposition .

139. Supracondylar Fracture displaced Posteriorly (Extension

140. Oblique Supracondylar Fracture, associated with Backward Dis-

placement in a Baby of Six Months ....

141. Supracondylar Fracture

142. Old Fracture of External Condyle

143. Drop-Wrist, due to Paralysis of the Radial Nerve, caused by

ture of the External Condyle (see Fig. 142)

144. Backward Dislocation of Elbow .....

145. Postero-Medial Dislocation of Elbow ....

146. Fracture of Coronoid Process of Ulna associated with Forward

location of Radius . . . . .

147. Fissure of the Head of the Radius .....

148. Fracture of Both Bones of the Forearm

Frac-

Frac-

Dis-

184 185

187 188 189

190 191

195 196 197

199 200

201 202 203

204 206 210 xiv THE RONTGEN" RAYS

149. Fracture in the Middle of the Forearm in a Boy of Three Years . 211

150. Displaced Fracture of Radius and Ulna, producing Synostosis . 212

151. Case illustrated by Fig. 150, after Wiring 213

152. Fracture of Radial Diaphysis . 214

153. Fracture of Radial Diaphysis after Alleged Reduction (compare

154. Fracture of the Ulnar Diaphysis ....... 216

155. Fracture of Radius, Upward Bayonet-shaped Displacement 218

156. Fracture of Lower End of Radius, showing Upward and Inward

Displacement and Outward Bending of Ulna .... 221

157. Oblique Intra-Articular Fracture associated with Spiral-Shaped

Fracture of Lower End of Ulna 222

158. Outward Displacement in Fracture of the Lower End of the Radius

in a Woman of Sixty Years, Four Days after the Injury . . 224

159. Thumb-Splint — Hand slightly Abducted — for Fracture followed

by Displacement . . . . . . . . . 225

160. Upward Displacement in Chondro-Epiphyseal Separation . . 228

161. Fracture of Lower End of Radius associated with Fracture of Ulnar

End, in a Woman of Sixty-eight Years 230

162. Fracture of Lower End of Radius associated with Dislocation of

Ulna 231

163. Case illustrated by Fig. 164 after Operation, the Trimmed Radial

Fragments being in Apposition after Correction of the Ulnar Portion (taken through the Plaster-of-Paris Dressing) . . 232

164. Isolated Fracture of Scaphoid Bone ...... 234

165. Drainage-Tube Splints for Metacarpal Fracture .... 235

166. Fracture of Fourth Metacarpal Bone, causing Sideward Displace-

167. Fracture of the Second Metacarpal Bone ..... 237

168. Fracture in the Middle of the Fiftli Metacarpal Bone, showing En-

sheathing Callus .......... 238

169. Old Displaced Fracture of the Second Metacarpal Bone . . . 239

Chapter XII Malformations, Page 240

170. Syndactylism of Third, Fourth and Fifth Fingers in a Child of

Eight Months .

171. Metatarsal Synostosis in a Baby .....

172. Webbed Fingers and Toes ....

173. Congenital Club-Hand, and Absence of Radius and Ulna

174. Congenital Dislocation of the Wrist ....

175. Supernumerary Toes .......

176. Congenital Absence of Nasal Bones ....

177. Skiagraph of a Case of Rudimentary Ear, illustrated by Fig. 178

178. Rudimentary Ear in a Child of Three Months (compare Fig. 177)

LIST OF ILLUSTRATIONS xv

Chapter XIII Diseases Of The Bones And Joints, Page 2-19

FIG. PAGE

179. Osteomyelitic Focus of Humerus ....... 250

180. Advanced Stage of Osteomyelitis of Tibia ..... 251

181. Extensive Osteomyelitis at the Point of Perforation . . . 252

182. Osteomyelitic Focus in the Tibia (compare Fig. 181) . . 253

183. Sequestrum Exfoliating from the Radius ..... 25 1

184. Osteoperiostitis following Phlegmon of Hand .... 255

185. Synostosis between Radius and Ulna, and Exfoliating Sequestrum 256

186. Sequestrum in the Femur ........ 257

187. Necrotic Radius and Eroded Humerus, Covered by Iodoform

Gauze 258

188. Remnant of Radius, showing Beginning Bone-Proliferation after

Removal of Necrotic Area (compare Fig. 187) . . . 259

189. Traumatic Atrophy of Shoulder-Joint and Humerus, followed by

Relaxation of Ligaments (Subluxation) — Posterior Exposure

(compare Fig. 190) 261

190. Same as Fig. 189 (Anterior Exposure) 262

191. Enlargement of Internal Condyle, causing Valgus Position of Knee,

in Tuberculosis (compare Fig. 192) ...... 264

192. Tuberculous Knee-Joint after Osteotomy (compare Fig. 191) . . 265

193. Tuberculous Knee, showing Erosion of Cartilages .... 266

194. Enlargement of Both Internal Condyles in a Boy of Fourteen Years,

four Months after his Tuberculous Gonitis was cured by the

Injection of Iodoform-Glycerine ...... 267

195. Photograph of Case of Tuberculous Knee illustrated by Fig. 196 . 268

196. Tuberculous Foci in and around the Knee-Joint (see Fig. 195) . . 269

197. Synostosis between Patella and Femur, before Operation . . 270

198. Exophthalmus caused by Tuberculous Destruction of Skull . . 270

199. Skiagraph of Case illustrated by Fig. 198 271

200. Swelling of Hand in Tenontitis and Tenontothecitis Prolifera Cal-

carea (see Fig. 201) 272

201. Tenontitis and Tenotothecitis Prolifera Calcarea (see Fig. 200) . 272

202. Rhachitic Deformity of Lower Extremities ..... 274

203. Rhachitic Tibia 274

204. Arthritis .276

205. Fracture of the Coronoid Process of the Ulna, followed by Arthritis . 277

206. Luetic Destruction of Frontal Bone ...... 278

207. Destruction of Frontal Bone (compare Figs. 206 and 208 . . 278

208. Skiagraph of Necrotic Fragments after Removal (see Figs. 206

209. Case illustrated by Figs. 206, 207 and 208, after Operation . . 279

210. Destruction of Nose and Left Frontal Sinus (compare Fig. 211) . 280

211. Luetic Destruction of Nose (compare Fig. 210) .... 281

212. Luetic Osteoperiostitis of Tibia (compare with Fig. 218, illustrating

Periosteal Sarcoma) ........ 282

213. Syphilitic Dactylitis of the Phalangeal Joint of the Thumb . . 283 xvi THE RONTGEN RAYS

Chapter XIV

NEOPLASMS, PAGE 284 FIG. PAGE

214. Recurrent Periosteal Sarcoma of Humerus (see Fig. 215) . . 284

215. Periosteal Sarcoma of Humerus (see Fig. 214) .... 285

216. Osteosarcoma of Humerus 285

217. Periosteal Sarcoma of the Tibia radiating into the Surrounding

Tissues (compare with Fig. 212, illustrating Lues) . . . 286

218. Osteosarcoma of Right Arm (see Fig. 219) 287

219. Skiagraph of Arm illustrated by Fig. 218 288

220. Myelogenous Osteosarcoma of Lower End of Radius (compare

221. Myelogenous Osteosarcoma of Lower End of Radius (compare

222. Osteosarcoma of Radius

223. Osteosarcoma of Radius

224. Osteosarcoma of Femur

225. Large Lipoma of Thigh .

289 290 290 291 292

226. Sarcoma of Superior Maxilla extending to the Os Frontis . . 293

227. Osteoma of Humerus ......... 294

228. Multiple Exostoses (Humerus, Scapula and Ribs) .... 295

229. Osteoma of Finger (see Fig. 230) 295

230. Chondroma of First Phalanx of Middle Finger (see Fig. 229) . . 296

231. Fibroma of Fourth Finger 296

232. Foot in Acromegaly 297

233. Osseous Cyst of Tibia 300

Chapter XVI

THE OPERATIVE TREATMENT OF DEFORMED FRACTURE AS INDICATED BY THE RONTGEN RAYS, PAGE 310

234. Fracture of Tibia and Fibula, taken through Plaster-of-Paris

Dressing .

235. Fracture of the Surgical Neck of the Humerus — Juxtaposition

236. Fracture of Tibia Wired, and Double Fracture of Fibula in Mai

237. Wire Left in situ after Suturing the Radius — Relations analogous

to Fig. 236

238. Diastasis of Fragments causing Pressure upon the Musculospiral

239. Fracture of Radial Head, showing Considerable Outward Dis

placement (compare Figs. 240 and 241) ....

240. Fractured Radial Head illustrated by Fig. 182 after a Futile Effort

at Reduction (compare Figs. 239 and 241)

311 312

LIST OF ILLUSTRATION'S xvii

FIG. PAGE

241. Radial Head Reduced, taken through the Plaster-of-Paris Dressing

242. Diastasis of Fragments in Fracture at the Ulna (compare Fig. 226), 322

243. Ideal Union after Fracture of the Olecranon, Three Weeks alter the

244. Oblique Fracture of Olecranon Wired ...... 324

245. Fracture of Diaphysis of Humerus associated with Separation of

Fragment 326

24G. Juxtaposition in Fracture of Femur ...... 328

217. Transverse Fracture of Femur Non-united. Angular Deformity

corrected Eleven Weeks after the Injury .... 320

248. Fracture of Lower End of Radius followed by Upward and Side-

ward Displacement ........ 330

249. Wrist after Removal of Displaced Fragment (compare Fig. 248) 331

250. Fracture of Upper End of Ulna associated with Sideward Disloca-

tion of Radius (compare Figs. 251 and 252 ) . . . . 332

251. Elbow after an Effort to reduce the Fragment (compare Figs. 250

252) 333

252. Case illustrated by Fig. 250, after Bloody Reposition (compare I rig.

251) * 334

253. Fragment of Calcaneum adjusted to the Tibia by a Screw after

Pirogoff s Amputation ........ 335

254. Compound Fracture of Ulna ........ 336

255. Multiple Fracture of the Lower End of the Radius .... 336

256. Tibia Fractured by Gun-shot 337

Chapter XVII The Medico-legal Aspects Of The Rontgen Rays, Page 339

257. Needle in the Foot of a Dwarf 342

258. Fracture of Radial Diaphysis, overlooked first by Fluoroscopic

Examination as well as in a Mediocre Skiagraph . . . 348

259. Fracture of Tibia — Lateral Exposure ...... 350

260. Fracture a la Bee de Flute of the Middle of the Tibia — (compare

Fig. 259) Anterior Exposure .353

261. Shattered Elbow . . .355

SECTION III.— EFFECTS OF THE KONTGEN EAYS CHAPTER XVIII

RONTGEN THERAPY, PAGE 360

262. Rontgen Light Burn of the Second Degree ..... 368

263. Rontgen Hand 370

264. Telangiectasis Two Years after Rontgen Light Dermatitis . . 374

B xviii THE KOXTGEN KAYS

Chapter XIX Special Indications, Page 381

fiO- PAGE

265. Sykosis (compare Fig. 248) 382

266. Case of Sykosis illustrated by Fig. 265 after One Exposure . . 383

267. Lupus Simplex (compare Fig. 268) 38S

268. Case of Lupus Simplex illustrated by Fig. 267, Cured by Irradiation 389

269. Lupus Erythematodes (compare Fig. 270) ..... 390

270. Case of Lupus Erythematodes, illustrated by Fig. 269, cured by

271. Carcinomatous Area not affected by the Rays (compare Fig. 272) . 393

272. Carcinomatous Area after Irradiation, showing Colloid Degenera-

273. Epithelioma of Lower Lip and Canthus (compare Fig. 274) . . 397

274. Case of Epithelioma illustrated by Fig. 273, Cured by Irradiation . 398

275. Epithelioma of Lower Lip (compare Fig. 276) ..... 399

276. Carcinomatous Tumor of Inferior Maxilla and Submaxillary

Tissues (compare Fig 275.) 399

277. Carcinomatous Growth in the Inguinal Region Two Years after

Removal of Mamma? 400

278. Carcinoma Mammae after Operation for Ninth Recurrence (compare

279. Case of Carcinoma Mamma? after First Operation (compare Fig. 27S) 402

280. Recurrent Carcinoma Mamma? (compare Fig 281.) . . . 403

281. Case illustrated by Fig. 280, Recovering 403

282. Fibrocarcinoma Mamma? a Year after its Onset .... 404

283. Recurrence of Carcinoma Mamma? ....... 405

284. Infraclavicular Carcinoma in a Woman of Seventy Years . . 406

285. Carcinoma of Skull 407

286. Carcinoma Developing from an Old Sebaceous Cyst . . . 407

287. Epithelioma of Lower Lip 407

288. Carcinoma of Vaginal Introitus in a Woman of Sixty-seven Years . 408

289. Melanosarcoma 408

290. Specimen of Case of Melanosarcoma illustrated by Fig. 289 . . 409

291. Melanosarcoma (compare Figs. 289 and 290) 409

292. Appearance after Seventh Irradiation (compare Figs. 289, 290, and

291) 410

293. Osteosarcoma of Orbit showing Necrotic Rontgen-Ray Burn . . 410

294. Osteosarcoma illustrated by Fig. 293 — One Year later (compare

295. Skiagraph of Case illustrated by Figs. 293 and 294 . . . .412

297. Osteosarcoma of Skull (compare Figs. 299 and 300) . . .414

298. Round Cell Sarcoma 415

299. Case illustrated by Fig. 297 Two Years after Extirpation . . 416

300. Recurrent Sarcoma of Skull treated by Irradiation (compare Figs.

301. Sarcomatous Tissue after Irradiation ...... 418

LIST OF ILLUSTRATIONS xix

vm. PAGE

302. Sarcomatous Tissue after Irradiation (Epithelium wanting) . . i 1 s

303. Sarcomatous Tissue, Deep Stratum, after Irradiation . . . 419

304. Osteosarcoma originating from Superior Maxilla (compare Fig. 305) 420

305. Case of Osteosarcoma of Superior .Maxilla illustrated by Fig. 304,

after Removal . . . . . . . • .420

30G. Osteosarcoma of Superior Maxilla ....... 421

307. Osteosarcoma originating from Inferior Maxilla .... 421

308. Sarcoma originating from the Periosteum of the Sternum and the

309. Fibrosarcoma Mammae in a Woman of Twenty-three Years 421

310. Sarcoma of Groin in a Man of Forty Years ..... 422

311. Periosteal Sarcoma of External Condyle 122

312. Sarcoma of Leg showing Gangrene in its Centre . . . 423

313. Proliferating Sarcoma of Leg ....... 423

314. Periosteal Sarcoma ......... 424

315. Osteosarcoma of Frontal Bone and Orbit ..... 424

316. Tuberculosis of Thumb 428

317. Adenoma of Tongue 42S

318. Malignant Lymphoma 429

319. Noma after Scarlet Fever 430

Chapter XX Becquerel Kays And Radium, Page 431

320. Skiagraph of a key by Bromide of Radium 433

321. Skiagraph of Hand by Bromide of Radium 434

Chapter XXI Finsen Method And Ultra-violet Rays, Page 436

322. Irradiation by Finsen Light 439