in an article in the Journal of the American Medical Association, November 5, 1897. Dr. Tracy gives two photographs of the same hand in which any tyro could detect a different anatomical appearance of the bone. Dr. Early, an X-ray photographer in Columbus, Ohio, has exhibited photographs so taken as to show a very marked deformity in a natural limb, and on the other hand what seemed to be a normal limb was shown, when in fact it was considerably deformed. Dr. B. L. Baldwin, of Columbus, relates a case in which a woman had been shot by her husband, the bullet entering the head near the external ear. As the result of an X-ray examination it was very positively stated, by the examiner, that the bullet was outside of the jaw. Dr. Baldwin told him that it could not possibly be there, from the direction of the bullet and the condition of the parts, but the examiner was absolutely certain he had not misinterpreted the negative which he had obtained. An incision was made and the bullet found, but at a finger's length inside the jaw bone, and therefore nowhere near its supposed place of lodgement. Another case of much greater and inexplicable error, that has come under my own observation, occurred during the past year in the practice of Dr. Geo. W. King and Dr. G. H. Barbour, of Helena. The case was that of a man supposed to have a bullet in his leg. A skiagraph taken by C. H. Gaunt, of Helena, showed a bullet to be in the region of the ankle just below the internal malleolus. An incision was made and the flap turned back, but after searching thoroughly down to the os calvis no bullet was found, so a flap was dissected from the region of the external malleolus, which also resulted negatively. Mr. Gaunt suggests the bullet might have been in the flaps, but the doctors say it was impossible. This skiagraph therefore showed a bullet in the region of the internal surface of the ankle while, as a matter of fact, no bullet was present. C. H. Gaunt, of Helena, who has probably had more experience with the X-ray, in every particular, than any other individual in the State of Montana, has demonstrated to me with the fluoroscope, at my office, how utterly distorted and exaggerated, as to size, contour, etc, a normal member can be made to appear simply by placing it to the right or left, below or above the focus, or point of greatest intensity of the ray. I say, so utterly distorted and exaggerated as to seem almost incredible. Since the above demonstrations I have often by experiment upon my own person and that of others, verified the above statement. Last November I corresponded with several of the more prominent surgeons of the United States, concerning the status of the X-ray in legal medicine, and could get no positive reply, as there seems to be a great diversity of opinion among the members of the profession as to the reliability of these pictures. To give you a fair, general idea of the way these pictures are regarded by the best surgical talent of the country, I cannot do better than to quote from a letter I received from Dr. W. H. Whorton, of Philadelphia, who says: "I will try to send you a report of the status of the X-ray pictures in medico-legal cases. There is at present much diversity of opinion as to the admission of such pictures in evidence. The American Surgical Association appointed a committee to investigate this subject, but unfortunately they have not reported up to the present time. From my personal experience and from what I hear from various members of the asosciation, which represents the best surgical talent in the United States, I am inclined to think that the report will be adverse to the admission of skiographs on account of their unreliability." A letter from Dr. J. William White, of Philadelphia, who is chairman of the committee mentioned in Dr. Whorton's letter, elicited the information that the committee up to the present time had only been able to report progress. Now, when we come to consider that cases of malpractice are tried before a lay jury whose anatomical knowledge is practically nil, and prosecuted by attorneys of whom generally speaking but little more can be said, with such a condition of affairs there is no gainsaying that blackmailers, and for that matter individuals who think they have a grievance against a physician, are possessed of an additional weapon in cases of malpractice, that must be met and dealt with to the best possible advantage of the profession. What, then, should be the attitude of the profession and the courts toward X-ray pictures? The skiagrph should be taken by an expert, or at least one who has had the necessary experience in this class of photography, to which must be added a requisite anatomical knowledge of the members or organs to be taken. The physician should accompany his case to the examiner, or if he himself takes the photograph a witness should be present. Before taking the picture both parties should verify with the fluroscope the anatomical position of the part with reference to the plate and tube. It is also necessary for the sake of accuracy that the part be taken in several positions; in other words, there should be several different negatives. If the picture is introduced in evidence, or if it is trying to be excluded, the examiner should be required to demonstrate in detail just how the picture was taken. Finally, it being perfectly practicable, the X-ray apparatus itself should be brought into court and the jury allowed to examine the part with fluoroscope. Judging from the present tendency to give scientific demonstrations of all kinds before juries, the time is not far distant when the fluoroscope will appear in court. It being the best possible form of evidence, the object of the profession should be to bring this about at the earliest moment. For by so doing all the accidental errors, not to mention those brought about by trickery and would be eliminated. In closing, a few words concerning the ethics of these pictures would not be amiss. If ever occasion demands you to take a skiagraph of a case treated by another physician, do not under any consideration allow the patient to get possession of the picture, for should any deformity or abnormality, real or fancied, be present, it might act as an incentive to one so disposed to bring an action against some innocent fellow practitioner. 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The Twentieth Since that ancient eon when the cooling pole first began sloughing its superabundant hordes of anthropoids southward, this human cosmos of ours has undergone great changes in environments, though little in fundamental attributes. At first thought there appears an abysmal distinction between the man-ape, who did his courting by clubbing his bride-to-be and dragging her unconscious to his cave, and on the other hand the cultured youth of today, who woos his lady love with dainty sonnets, sweet-meats and roses-yet after all the primal instinct is in both instances the same. Greed and deceit, injustice and hypocrisy and the love of noisy murder are as rampant at the beginning of the twentieth century of Christianity as in the snarling times of our primeval ancestors. Whatever its blessings to individual lives, Christianity in high places has ever been more name than fact, from the time of its first installation in power by the fratricide Constantine up to his most Christian majesty, Louis the Putrid, and on to William McKinley, who dares to style as "benevolent assimilation" the slaughter without |