DOI: 10.1148/rg.236035128
(Radiographics. 2003;23:1457-1459.)
© RSNA, 2003
Scenes from the Past
First Textbook of Pediatric Radiology (1910): A Historical Vignette in the Form of a Book Review1
Alan E. Oestreich, MD
1 From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati OH 45229-3039. Received May 6, 2003; revision requested May 30 and received June 25; accepted June 27. Address correspondence to the author (e-mail: oestreich.ae@cchmc.org).
Index Terms: Radiography, in infants and children • Radiology and radiologists, history
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Introduction
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Before Caffey (1) and before Engel and Schall (2), in 1910, a large illustrated textbook on the topic of pediatric radiology by Professor Thomas Morgan Rotch was published (Fig 1). I comment on the book now to further historical interest in the earlier days of our specialty and my subspecialty.
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Figure 1. Title page of Rotch’s pioneer book. The title on the spine of the book was The Roentgen Ray in Pediatrics. The book, which was copyrighted in 1910, was printed by J. B. Lippincott Company at the Washington Square Press, Philadelphia. Its text pages, including the index, numbered 225, but its contents also included 303 illustrations (generally full-page plates and their legends) and 25 pages of front matter. Rotch dedicated his book to William Osler, MD, then Regius Professor of Medicine at Oxford University, England.
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Review
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Although this pioneering book was of its time, it was also ahead of its time in many of its approaches to pediatric radiology. Rotch, professor of pediatrics at Harvard University Medical School, Boston, Massachusetts, selected the large number of pertinent plates provided by Dr Arial W. George to illustrate the use of medical images (they called them roentgenograms then) in the practice of pediatrics and child health care.
Rotch emphasized a physician’s need to know the normal pattern to be able to recognize the abnormal. The textbook contained a generous selection of plates of normal hands and wrists that were intended to show the gradual maturation of bones during childhood. Rotch anticipated by decades the various methods for bone age determination now in use in pediatric radiologic practice. The book also included a chapter on living normal anatomy, which emphasized the generic parts of bone, including the roentgenographically unseen periosteum, and the patterns of normal bone growth. Newborns and metabolic disease (as then understood) received separate chapters as well, before the areas and systems of the body were covered, followed by chapters on some specific diseases.
Deliberately wishing to illustrate actual disease, Rotch did not retouch any of the images. Artifacts were pointed out and commented upon.
Although he appropriately referred to achondroplasia as a slowing of enchondral ossification, Rotch stated that a majority of babies with that diagnosis die soon after birth. In earlier days, so many other non-achondroplasia diagnoses were lumped with that diagnosis, that such statements were common (and often repeated). We now know that children with achondroplasia almost always survive. Bismuth was already used to illustrate the lumen of the stomach. Very properly, Rotch indicated that the instance of Sever disease of the calcaneus in plate 195 was normal: Later investigators were not so accurate. In a modern fashion, Rotch properly referred to the example of likely Trevor disease in plate 171 as an exostosis. Of further—one hopes only historical—interest were examples of polio. A fairly large number of tuberculosis cases were illustrated.
From the vantage point of today’s knowledge, I take issue with at least two of the author’s diagnoses. Plate 68 (Fig 2) was considered an example of "osteogenesis imperfecta." However, we see not osteoporosis, but rampant rickets with marked secondary hyperparathyroidism, which is the cause of the fractures. Plate 247 (Fig 3) was believed to show "tuberculosis of the carpal bones." The advanced maturation of the carpal bones of the involved hand that are at the same time crowded compared with those of the contralateral hand almost surely represents a case of juvenile rheumatoid arthritis instead. Finally, I reproduce herein a most unusual foreign body case that demonstrates also Rotch’s emphasis on clinical correlation (Fig 4). The child had a 10-year history of cystitis and painful urination. The plate appeared in a short and pertinent chapter on foreign bodies.
Before concluding, I point out the coincidence that Rotch’s textbook of pediatrics itself (3) was copyrighted in 1895, the year of Roentgen’s discovery of the x ray! It was actually printed in 1896, however.
A more contemporary book review published in 1910 (4) is full of praise for Rotch’s text and George’s images, as well as for the gastrointestinal images contributed by Dr Percy Brown. That brief review concludes "This volume should be in the library of every Roentgenologist, as it constitutes a valuable contribution to American Roentgenology."
As Caffey would later do in his textbook (1) that revolutionized the teaching of pediatric radiology and established the standard, Rotch emphasized the normal, the concepts of growth and maturation, changes from metabolic disease, the value of clinical information, and the study of images to prepare for the practice of child health care.
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Acknowledgments
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Reference 2 was kindly presented to me by the late Dr Wilhelm Holthusen. The interest and assistance of Dr John F. O’Connor is much appreciated.
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References
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- Caffey J. Pediatric x-ray diagnosis: a textbook for students and practitioners of pediatrics, surgery and radiology Chicago, Ill: Year Book, 1945.
- Engel S, Schall L. Handbuch der Röntgen-Diagnostik und Therapie im Kindesalter Leipzig, Germany: Thieme Verlag, 1933.
- Rotch TM. Pediatrics: the hygienic and medical treatment of children Philadelphia, Pa: Lippincott, 1895.
- Anonymous. Book review. Am Q Roentgenol 1910; 2:153.
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Introduction
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