Radiology at Children's Hospital in Boston: a history.

Abstract

In 1 895, the year of Roentgen’s discovery, pediatrics was in a primitive state. By the standards of a century later, the list of the most common admitting diagnoses at Children’s Hospital in Boston sounds almost medieval: osteoarthnitis of the hip (i.e., tuberculosis), vertebral osteitis (also tuberculosis), typhoid fever, “croupous pneumonia,” and chorea [1]. However, there were stirrings of progress, which included the use of Roentgen’s new rays. The first “skiagrapher to the Children’s Hospital” was Ernest Amory Codman, a young surgeon still remembered for Codman’s triangle of peniosteal elevation. He began producing roentgenograms on glass plates at Children’s Hospital in the summer of 1899 and had logged 300 cases by February 1901 [2], thus initiating the first pediatric radiology department in America [3]. Unfortunately, the magical properties of the new technique led him to underestimate its hazards, since, as he said, “no burn has been produced by an exposure equal to or less than the equivalent of 5 minutes at 10 inches,” that is, a continuous 5mm exposure 10 in. (25 cm) from an unshielded tube [4]. Codman’s successor was Percy Emerson Brown, appointed radiologist for the years 1903 through 1905 [5, 6]. He made 933 “x-ray negatives,” all on glass plates, during the year 1904-1905 [1]. Most were of the extremities, probably because short exposures are not critical in bone radiology and because radiographs produced by the low-output, low-kilovoltage tubes of the day did not penetrate other body parts well. The department’s first substantial scientific contribution was Dr. Brown’s article with orthopedist Robert Lovett on the radiology of “hip disease” (another euphemism for tuberculosis) [7]. That article had several modern features: it was based on 100 consecutive cases, it was a blind study, the false-positive results were listed, and the sources of diagnostic error were analyzed. Dr. Brown had many technical problems, among them the electricity supply [8]. He reported that