Living anatomy and pathology

Front matter

i

Class

Book / H 7 GofiyiightN°_

Preface

The Roentgen ray has been largely used as an aid to diagnosis in both early and later life. Its mechanism has been fully explained in various books, but a systematic exposition of the practical results of the Roentgen method of examination has not yet appeared.

The purpose of this book is to deal as little as possible with the questions of apparatus and technic and to devote the entire space to the actual clinical teaching of the subject.

This teaching is accomplished by means of illustrative plates, by legends corresponding to them, and by a text explanatory of what can really be seen in health and in disease in early life.

The book is devoted to the diagnosis of disease and does not deal to any extent with treatment. It is intended to provide a means by which a fair knowledge of the Roentgen method can be acquired by the student when the personal instruction of a skilled Roentgenologist is not available.

I believe that in teaching Roentgenology it is of the utmost importance to present illustrations of evident conditions and not to mislead the student with vague descriptions. In the plates I have been careful not to allow any retouching whatever, and I have discarded those which would have to be altered in order to show what would be described in the legends. Unless this is done the plates are reduced to diagrams and lose their value for accuracy and for teaching the student to interpret them independently.

The plates are placed opposite to the legends, and the illustrations and details are given to the student as would be done if an vi PREFACE.

expert Roentgenologist were standing beside him describing the plate by means of an illuminator. The different parts of the plate, whether normal or abnormal, are designated by leaders and by letters just as the Roentgenologist would designate them with his pointer.

The two methods are in this way identical, excepting that the questions which the student may ask have to be anticipated in the legends. It is, therefore, important to make the legends cover what a fairly intelligent student can reasonably be expected to ask. It is important to explain in the text whether the different parts of the illustrations are normal or abnormal. This is not only to anticipate possible questions, but in order that the student may learn to distinguish normal conditions, and by studying the reproductions methodically, recognize the normal in his search for the abnormal.

In this sense the recognition of the normal becomes as important as does that of the abnormal, and the student is taught not to overlook anything — not even an artifact.

By this method, if reference is made to previous normal illustrations, the abnormal can readily be compared with the normal conditions of the same part. The knowledge acquired from this book will thus approach very closely to that obtained from the living instructor, and the student's power of original observation will be strengthened and improved.

Believing, as I do, that in the study of diseases a knowledge of normal conditions should first be mastered, I have begun my illustrations by showing a set of normal Roentgenographs covering the different stages of development from a late period of intra-uterine life through childhood.

I have then given the results of my study of the bones of the wrist, so as to exemplify what especial practical use can be made from an exact knowledge of the living anatomy of an especial part.

PREFACE. vii

I have next given examples of what can be seen in diseases of the new-born, such as the various congenital malformations and such abnormal conditions as are present at birth.

By this portrayal of normal living anatomy and the grosser forms of the abnormal conditions the student is prepared to understand the finer pathologic lesions in the living subject.

I have next shown the characteristic living lesions of the diseases of nutrition. I have then divided the book into certain groups which represent living pathologic conditions. Thus, in one division I have described the head and spine. In the next division I have given in detail what can be seen in Roentgenographs of the thorax, describing in succession abnormal conditions of the bronchial nodes, the bronchi, the lungs, the pleura, the pericardium, the heart, and aneurism.

In the next division, the abdomen, I have been able to illustrate the various conditions to only a limited degree, as this part of the infant and child presents great difficulties for the technic of the Roentgen method.

Next I have shown how foreign bodies can be detected in different parts of the trunk and extremities. Finally I have grouped under diseases of the extremities, for obvious technical reasons, a number of conditions of varying etiology.

The material which illustrates the book has in most cases been taken from the Roentgen records of the Children's Hospital, and I wish to express my appreciation of the courtesy of the Managers, who have permitted me to use what has amounted in the past year to over two thousand and three hundred cases.

The plates of the Roentgen illustrations were taken by Dr. Arial W. George, and in their unusual excellence speak for themselves. To Dr. George I can only express my appreciation of his skill and the ever new light which he has thrown upon a somewhat difficult subject by his clear and original interpretation.

viii PREFACE.

To Dr. Percy Brown I owe my thanks for much expert advice on subjects connected with the writing of the book and for the plates illustrating long and short exposures.

To Dr. Walter Curtis Miner I wish to express my appreciation of his work in connection with those illustrations which represent the development of the teeth and their anomalies. What is shown in these dental Roentgenographs will be of great service not only to the oral surgeon but to the orthodontist and to the general practitioner.

Dr. William Palmer Lucas has given much practical aid in many ways connected with the book, and to him are due my thanks.

I offer this work to the Medical Profession in the hope that it may be of assistance in solving many of the more difficult problems which arise in the diagnosis of disease in early life.

THOMAS MORGAN ROTCH.