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ercise of tact children manifest little fear of the apparatus, as it is almost noiseless.

Even very young subjects are often more tractable than nervous adults. Fluorescopic examination should be as short in duration as possible. A good radiogram, to my mind, is of greater value than the momentary appearance of a shadow cast upon the screen. To secure a radiogram, or even more than one, requires but little more time than a careful fluorescopic examination. Especially is the above true in children. It has been my custom to secure the part to be radiographed to the sensitive plate by a few turns of a roller, or a strip or two of adhesive plaster, thus reducing blurring and double images to the minimum by an easy restraint. The time necessary for exposure in children, to secure good results, is fortunately much less than in adults, the tissues being singularly easy of penetration, and the detail all that could be desired. The certainty of location of foreign bodies in any part of the economy in children is a matter of satisfaction. The assurance that such foreign body will appear upon the plate is looked forward to with a degree of positiveness, which does not obtain in the adult at all times.

The advantages of a routine use of the X-ray, as a necessary part of an office equipment, should appeal to every surgeon. So numerous are the occasions for the use of the apparatus that today we would feel at a loss without it. No surgeon can dispense with this diagnostic aid, and the same necessity in the near future will appeal to the physician. In the diagnosis of intrathoracic diseases it is a fact that, as an adjunct to the methods of physical diagnosis, most positive information is given to those capable of interpreting fluorescopic appearances. A grand field is to be opened up in this direction by those interested particularly in internal medicine. To those whose instincts and work run in the line of general surgery, a brief enumeration of a few instances. of the routine utility of the new agency may not be without interest. It has been my pleasure to locate bullets in the head, thorax and thigh; indeed, in all parts of the economy. The location of the same in the extremities is never difficult to radiograph, clear, distinct pictures being uniformly obtained. The location of foreign bodies in the head, lumbar vertebræ and upper sacral region requires in adults, at times, more than one exposure. In children the purely mechanical difficulty of penetration does

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not apply by reason of diminished distance through the parts and the ease with which the rays pass through histological structures possessing less density. The study of unusual joint lesions, dislocations, fractures and the differential diagnosis of obscurities in the osseous system demand, for intelligent management, X-ray examination. The text-books of surgery and anatomy will necessarily, in part, require to be rewritten, owing to the revelations at variance with past teaching and ideas. The excuse that the conditions in a fracture-dislocation about the elbow cannot be determined, by reason of great swelling of the soft parts, will not, in the future, prevail. An examination with the fluorescope, or the positive evidence of a radiogram, will establish with certainty the conditions present and enable the attendant to make a prognosis as to the future of the joint, thereby protecting in a measure the attendant from the all too frequent damage suits. The detection of gall-stones is a matter of uncertainty and no assurance may be given in any case that their presence will be demonstrated. Urinary calculi lodged in any part of the tract present fewer difficulties. Stone in the bladder in children is usually to be demonstrated. From a large collection of radiograms a few illustrative of X-ray diagnosis in children are exhibited. The half-tones, while of most excellent workmanship, cannot do justice to the original negatives.

No. 1 shows a marble impacted in the lower end of the sophagus. The boy, aged 5, was brought into the office from the street by a passing pedestrian, who found the child gasping for breath, in fact, in a critical condition. A playmate gave the information that his unfortunate companion had had several marbles in his mouth and had been suddenly seized with a choking spell. The marble could be felt through the cervical soft parts. We could not grasp the foreign body with forceps, and in manipulation by external pressure the smooth, round "flint glass" marble passed downwards. The child was immediately relieved, as far as urgent respiration symptoms were concerned, but the pain was intense until it reached the stomach. The fluorescope revealed the marble in situ, and I could not resist securing a radiogram. A five-minute exposure was at once made. A few moments later the marble must have passed into the stomach, as all pain suddenly ceased. The subsequent history of the case

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