In a recent survey of the literature on fluoroscopy made at the Boston Medical Library, Yale Medical Library, and the New York Academy of Medicine, I was amazed to find that little or no attempt has ever been made to do fluoroscopy by any other method than the dark room. Dr. George C. Johnson (1), of Pittsburgh, in 1905 wrote an article descriptive of a device whereby he allowed a pyramid of rays to emerge from the tube. The fluoroscope consisted of an ordinary fluoroscopic screen set parallel with the line of vision. He made use of a mirror to reflect a shadow on the fluorescent screen, but his device was a hand fluoroscope, and, as such, was necessarily of limited use and fraught with all the dangers of exposure to the direct rays. Lewis Gregory Cole (2), of New York, in 1913 described a table in which he made use of a mirror, a fluorescent screen, and a stationary dark chamber. The table and dark chamber were placed against a lead-lined partition, back of which was placed a cabinet from which the table was operated. In the article descriptive of this table no mention was made of fluoroscopy outside of a dark room or cabinet. In Dr. Cole's device the operator was separated from the patient, which, of course, made it impossible for him to do manual palpation in a gastro-intestinal series, or manual manipulation in case of a fracture. With the Cole table it was necessary to adjust the patient to the screen, rather than the screen to the patient. In other words, Dr. Cole's screen was stationary and could be used only from one fixed point on the table, as the rest of the table was lead-lined beneath. For several months, I have been using in my office (a well lighted room), a daylight fluoroscopic device which has given me considerable satisfaction. I am not separated from the patient, can palpate while observing the shadow or can allow the surgeon to manipulate a fracture while observing the shadow. The fluoroscopic screen can be adjusted to the patient rather than the patient to the screen, as my device is beneath the table and can be moved lengthwise and crosswise with respect to the table. While the series of cases in which I have used this device is a comparatively small one, I feel that it is large enough to justify me in bringing the principle before the roentgenologists. I submit a drawing (Fig. 1) which will clearly bring out the idea, and will describe it in a brief way. Reduced to its simplest terms, this device consists of a freely movable lead-lined dark chamber, having a fluorescent screen placed on lead glass, backed by a colored plain glass of wood, which excludes all light from the chamber, and serves a s a roof for the same. In the bottom of the chamber is placed a mirror which is capable of being tilted to an angle, and this reflects the shadow from the screen. In the side of the cabinet facing the operator is a lead-lined glass window which may be as large as 8 × 10 for observation of the shadow.
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