Full download Handbook of x-ray imaging: physics and technology 1st edition paolo russo pdf docx
Handbook of X-ray Imaging: Physics and Technology 1st Edition Paolo Russo
Visit to download the full and correct content document: https://textbookfull.com/product/handbook-of-x-ray-imaging-physics-and-technology-1 st-edition-paolo-russo/
More products digital (pdf, epub, mobi) instant download maybe you interests ...
Handbook of X-ray Imaging: Physics and Technology 1st Edition Paolo Russo (Editor)
Series in Medical Physics and Biomedical Engineering
Handbook of X-ray Imaging Physics and Technology
Edited by Paolo Russo
University of Naples “Federico II” Department of Physics “Ettore Pancini” Naples, Italy
Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business
MATLAB® is trademarks of the Math Works, Inc. and are used with permission. The Mathworks does not warrant the accuracy of the text or exercises in this book. This book’s use or discussion of MATLAB ® software or related products does not constitute endorsement or sponsorship by the Math Works of a particular pedagogical approach or particular use of the MATLAB® software.
Chapter 64 is a contribution of the Food and Drug Administration and is thus not subject to copyright.
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
International Standard Book Number-13: 978-1-4987-4152-1 (Hardback)
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com ( http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com
and the CRC Press Web site at http://www.crcpress.com
Section I Basic Physical and Technological Aspects
41.
You Zhang and Jing Wang
Simon Zabler, Michael Böhnel, Nils Reims, Michael Salamon, and Christian Fella
Jochen Hiller, Thomas S. Miller, and Peter Hornberger
Carina Stritt, Mathieu Plamondon, Jürgen Hofmann, and Alexander Flisch
Section IV Phase-Contrast X-ray Imaging and Other Aspects
Daniele Pelliccia, Marcus J. Kitchen, and Kaye S. Morgan
Paul Claude Diemoz, Alberto Bravin, Paola Coan, and Luigi Rigon
51. X-ray
Pekka Suortti, Jani Keyriläinen, and William Thomlinson
54. X-ray Scattering: Analytical Applications and Imaging
Antonio Brunetti and Roberto Cesareo
55. Tissue Substitute Materials for Diagnostic X-ray Imaging .................................................................................................
Srinivasan Vedantham
56. Phantoms for Image Quality and Dose Assessment
Alessandra Tomal and Paulo Roberto Costa
57. Software Phantoms for X-ray Radiography and Tomography............................................................................................
Kristina Bliznakova
58. Radiography and Computed Tomography for Works of Art
Maria Pia Morigi and Franco Casali
59. Computer-Aided Diagnosis for X-ray Imaging
Lia Morra, Silvia Delsanto, and Giulia Grazzini
60. Computer Analysis of Mammograms
Chisako Muramatsu and Hiroshi Fujita
61.
Maria Evelina Fantacci
Maria Evelina Fantacci and Alessandra Retico
63. Display Optimization and Human Factors
Elizabeth A. Krupinski
64. Display for Medical Imaging and DICOM Grayscale Standard Display Function Fundamentals.................................
Wei-Chung Cheng and Aldo Badano
65.
Alisa Walz-Flannigan and Heather Weber
66.
Francis R. Verdun and Nick Ryckx
67 Educational Aspects in Radiography, Physics, and Technology
Stelios Christofides
68. Tables of X-rays Mass Attenuation Coefficients of K and L—Energy, of K, L, and M Fluorescence Yield of Kα /K β, Lα /L β, and L α /L γ Ratios
Roberto Cesareo
Preamble
Contemporary medical physics starts with the discovery of the X-rays and their medical application. Currently, X-ray imaging examinations are more than three-quarters of all medical imaging examinations and deliver the highest patient dose of these. The field of X-ray imaging technology is also very dynamic and new methods/equipment are constantly introduced in the clinical practice. This requires special attention to the subject of X-ray Imaging—from the points of view of supporting research in the field; of safe and effective translation of this research into practice; of educating the staff applying these methods; and of providing them with reliable reference material.
The Handbook of X-ray Imaging: Physics and Technology, edited by Prof. Paolo Russo, is without a doubt the most comprehensive handbook on the subject ever produced. The publication has several specific features that distinguish it from previous publications on X-ray imaging:
• The Handbook presents a very broad overview of the field, combining not only medical X-ray imaging, but also other related applications of X-ray imaging (e.g., industrial)
• The Handbook includes information on the physics of the processes and also on X-ray image engineering— opening its scope to a specific field of medical engineering and industry
• The Handbook includes aspects related to clinical (and other) applications of X-ray imaging—opening its scope to medical and other specialists
• The Handbook gives a brief historical perspective on a number of X-ray imaging areas, and also covers the newest developments in X-ray imaging (e.g., phasecontrast imaging)
• The Handbook not only covers the theoretical aspects, but also many practical aspects of X-ray imaging, such as test objects and quality control procedures
• The Handbook has attracted as authors about 120 specialists from 18 countries, which makes it truly international
The Handbook includes about 1400 pages, organized into four large sections:
• Basic Physical and Technological Aspects (16 chapters)
• X-ray Radiography and Fluoroscopy (15 chapters)
• X-ray Computed Tomography (17 chapters)
• Phase-Contrast X-ray Imaging and Other Aspects (20 chapters)
All chapters of the Handbook are very well illustrated—having in total over 1300 images and diagrams, together with detailed tables with data, and thousands of references.
The scientific quality of the Handbook is underpinned by the team of established professionals who have prepared the chapters of this monumental publication. This text will be undoubtedly an important resource for the medical physics profession and will find its place in most scientific libraries over the world.
The Handbook of X-ray Imaging: Physics and Technology is an unique publication, which gives a detailed overview of a whole branch of the medical physics profession. This huge project will support the education of all medical physics students/trainees and the work of thousands of colleagues worldwide. Books such as this one are an evidence of the fruitful collaboration between the CRC Press (Taylor & Francis) and the IOMP (International Organization for Medical Physics) through the Series in Medical Physics and Biomedical Engineering.
Having myself been a Coordinating Editor of a large reference material, I fully appreciate the hard work of the entire team and especially of the Main Editor Prof. Paolo Russo. On behalf of the IOMP, I want to congratulate all the authors of the Handbook for this enormous achievement.
Prof. Slavik Tabakov, PhD, Dr.h.c., FIPEM, FHEA, FIOMP President IOMP Coordinating Editor of the Encyclopaedia of Medical Physics
Foreword
I have a beautifully polished glass X-ray tube insert, mounted on a hardwood pedestal, sitting on a coffee table in my living room. Most of my nonscientific friends see it and ask, “what’s that?”. I tell them that it’s what I owe my livelihood to; a device that produces X-rays for medical imaging. With its gray-metal anode, shiny cathode housing and precise bearings, it is a small monument to the advancements that medical imaging has experienced over the past century.
To my scientific friends, I can point to this Handbook of X-ray Imaging, edited by my friend and colleague, Prof. Paolo Russo. This tome is not polished on the outside; its beauty is the science described between its covers. This book is a digest of X-ray science that presents a wide-ranging scientific discussion of a particularly valuable region of the electromagnetic spectrum. To the X-ray scientist, this book is both an important scientific reference text and a comprehensive description of X-ray science, addressing mainstream modalities and niche applications. The authors who have contributed to this compilation are world-class authorities on their subject matter, and their collective effort gives this Handbook impressive depth and breadth.
Section I introduces the Basic Physical and Technological Aspects of X-ray interaction and production, and it focuses on the foundation of X-ray physics including X-ray source technology, X-ray interactions, X-ray spectra, and detector technology used for X-ray imaging. This section grounds the reader in the basic science of X-ray physics in an interesting and approachable manner.
Section II discusses X-ray Radiography and Fluoroscopy; at a clinical level these topics are the bread and butter of any X-ray imaging facility, but this section delves deeper than rad/fluoro and includes chapters on X-ray discovery, mammography, dental radiography, industrial radiography, and forensic radiography. It also includes chapters on limited angle tomography—tomosynthesis—as well as radiation dose and its potential risks.
Section III is on X-ray Computed Tomography, and chapters in this section describe important aspects of CT technology such as reconstruction methods, small animal, dual energy, and cone beam imaging applications; CT dosimetry, industrial, antiquity, and metrology applications of CT imaging; high temporal resolution CT, and both kV and MV applications of this technology. Like CT itself, this section represents topics with different angles, all which focus upon the central theme.
Section IV focuses on Phase-Contrast X-ray Imaging and Other Aspects. The phase-contrast chapters cover theory, breast imaging, and tomosynthesis applications of this emerging
technology, as well as different phase extraction methodologies. The other aspects of this section address X-ray scatter, and physical and mathematical phantoms for image quality and dose assessment. Other important chapters in this section discuss computer-aided diagnosis, education, display hardware, optimization, calibration and quality assurance, and radiation protection. This section rounds out this handbook, describing various interpretation strategies for X-ray images using computer and human observers.
Finally, a series of tables provide up-to-date physical data useful to the X-ray scientist.
From a one-dimensional application in documenting attenuation in a Pb-shielded wall to a five-dimensional application depicting a dual-energy CT movie of a beating heart, the X-ray has proven to be a ubiquitous tool for better understanding the physical world, and for providing important medical diagnostic information quickly and in a cost-effective manner. I sometimes wonder about the thousands of stories that my coffee table X-ray tube contributed to before its retirement; how many broken bones, foreign bodies, and pulmonary nodules did the X-rays produced by this very X-ray tube reveal? As readers peruse this outstanding Handbook of X-ray Imaging, they should remember that the science and technology so eloquently described herein have important real-world consequences in improving human health through better diagnoses, analyzing thirteenth century Italian relics, discovering faulty pipeline welds—and a million other important applications. Roentgen would be very impressed.
John M. Boone, PhD, FAAPM, FSBI, FACR, FAIMBE, FSPIE Professor of Radiology and Biomedical Engineering
University of California—Davis/USA Fair Oaks, California
Series Preface
The Series in Medical Physics and Biomedical Engineering describes the applications of physical sciences, engineering, and mathematics in medicine and clinical research.
The series seeks (but is not restricted to) publications in the following topics:
• Artificial organs
• Assistive technology
• Bioinformatics
• Bioinstrumentation
• Biomaterials
• Biomechanics
• Biomedical engineering
• Clinical engineering
• Imaging
• Implants
• Medical computing and mathematics
• Medical/surgical devices
• Patient monitoring
• Physiological measurement
• Prosthetics
• Radiation protection, health physics, and dosimetry
• Regulatory issues
• Rehabilitation engineering
• Sports medicine
• Systems physiology
• Telemedicine
• Tissue engineering
• Treatment
The Series in Medical Physics and Biomedical Engineering is an international series that meets the need for up-to-date texts in this rapidly developing field. Books in the series range in level from introductory graduate textbooks and practical handbooks to more advanced expositions of current research.
The Series in Medical Physics and Biomedical Engineering is the official book series of the International Organization for Medical Physics.
The International Organization for Medical Physics
The International Organization for Medical Physics (IOMP) represents over 18,000 medical physicists worldwide and has a
membership of 80 national and 6 regional organizations, together with a number of corporate members. Individual medical physicists of all national member organisations are also automatically members.
The mission of IOMP is to advance medical physics practice worldwide by disseminating scientific and technical information, fostering the educational and professional development of medical physics and promoting the highest quality medical physics services for patients.
A World Congress on Medical Physics and Biomedical Engineering is held every three years in cooperation with International Federation for Medical and Biological Engineering (IFMBE) and International Union for Physics and Engineering Sciences in Medicine (IUPESM). A regionally based international conference, the International Congress of Medical Physics (ICMP) is held between world congresses. IOMP also sponsors international conferences, workshops and courses.
The IOMP has several programmes to assist medical physicists in developing countries. The joint IOMP Library Programme supports 75 active libraries in 43 developing countries, and the Used Equipment Programme coordinates equipment donations. The Travel Assistance Programme provides a limited number of grants to enable physicists to attend the world congresses.
IOMP co-sponsors the Journal of Applied Clinical Medical Physics. The IOMP publishes, twice a year, an electronic bulletin, Medical Physics World. IOMP also publishes e-Zine, an electronic news letter about six times a year. IOMP has an agreement with Taylor & Francis for the publication of the Medical Physics and Biomedical Engineering series of textbooks. IOMP members receive a discount.
IOMP collaborates with international organizations, such as the World Health Organisations (WHO), the International Atomic Energy Agency (IAEA) and other international professional bodies such as the International Radiation Protection Association (IRPA) and the International Commission on Radiological Protection (ICRP), to promote the development of medical physics and the safe use of radiation and medical devices.
Guidance on education, training and professional development of medical physicists is issued by IOMP, which is collaborating with other professional organizations in development of a professional certification system for medical physicists that can be implemented on a global basis.
The IOMP website (www.iomp.org) contains information on all the activities of the IOMP, policy statements 1 and 2 and the “IOMP: Review and Way Forward” which outlines all the activities of IOMP and plans for the future.
Preface
In October 2014, the Publications Committee of the International Organization for Medical Physics (IOMP) (www.iomp.org) discussed, among other topics for the diffusion of publications, to propose new books and e-books in various fields of medical physics, also with reference to the Series in Medical Physics and Biomedical Engineering of CRC Press, an official book series of IOMP. As a member of this Committee, with reference to my scientific interests in the field, I launched the idea to edit a book related to the physical aspects of diagnostic radiology: these were the origins of the present Handbook of X-ray Imaging: Physics and Technology, which sees the light of day November 7th, the International Day of Medical Physics 2017 (Marie Curie’s birthday) and that of November 8th (when X-rays where first observed by Roentgen in 1895).
The title should declare its vocation: use of X-ray imaging techniques, in the medical and biological fields as well as in other applied fields, for example, industrial testing, requires the understanding of the physical and technological aspects at the basis of techniques and devices. However, given the wide scope of such a field, the related material can be found only in a number of books and textbooks. Hence, I was thinking of a comprehensive Handbook which could represent a condensed reference for classic aspects as well as recently introduced advancements in X-ray imaging: this implied the preparation of a completely new publication in such diverse fields as X-ray radiography and tomography for medical diagnosis and biomedical research, for dentistry imaging, for industrial testing and for veterinary diagnosis, prepared by many contributors. Eventually, this last application field was dropped from the Table of Contents, since I could not recruit contributors.
The Handbook is divided into four sections (Basic Physical and Technological Aspects, X-ray Radiography and Fluoroscopy, X-ray Computed Tomography, Phase-Contrast X-ray Imaging, and other aspects). While in organizing the Handbook structure I tried to cover the most relevant aspects of each topic, some of them remained uncovered in the final version of the manuscript, though initially foreseen: future editions of the Handbook will try to fill the gap of these missing topics.
The Handbook of X-ray Imaging is directed to a vast audience including graduate students in medical physics, PhD students,
medical physics residents, biomedical engineering students, technology students in radiology, students in medical radiology, physicists and engineers in the field of nondestructive industrial testing techniques using X-rays, radiology technicians, scientists interested in understanding and using X-ray imaging techniques.
This Handbook is the result of the dedication and competent authorship of as many as 132 scientists, and of the careful review of a Scientific Board, which includes as many as 39 scientists, during a period as long as three years. I warmly thank all of them. The profound scientific and technical competence of all of them is at the basis of this Handbook, which I hope will be welcome in the field.
I thank my former mentor, Professor Alberto Del Guerra, who introduced me (almost 30 years ago) into the field of digital radiography, a continuous source of scientific interest for me.
I acknowledge the many helpful discussions with my colleague Professor Giovanni Mettivier.
I thank all my graduate and PhD students in medical physics, this Handbook was prepared also for them.
I thank all CRC Press officials who contributed to publishing this volume, first of all, Francesca McGowan: her smiling and gentle attitude and professional advices were always appreciated during the long period of preparation of the Handbook. CRC Press’ Rebecca Davies was an important reference point in the last two years: I thank Rebecca for her professional editorial work and courtesy.
I dedicate this editorial effort to my daughter, Elena: I would have hardly gone to the end of it, without her continuous support and patience and without her editorial assistance (though at 6700 km distance) in keeping records of all material produced, in keeping contacts with all the contributors (via thousands of emails exchanged with authors, editors, and publisher), in solving a large number of editorial issues.
My final thanks go to my wife, Lucia and my son, Gabriele: they understood and supported me once again, for this new effort.
Paolo Russo University of Naples Federico II Naples, Italy
MATLAB® is a registered trademark of The MathWorks, Inc. For product information, please contact:
The MathWorks, Inc.
3 Apple Hill Drive
Natick, MA 01760-2098 USA Tel: 508 647 7000
Fax: 508-647-7001
E-mail: info@mathworks.com Web: www.mathworks.com
Editor
Paolo Russo was born in Naples (Italy) in 1958. In 1981 he graduated in physics at the University of Naples Federico II, where he was a research associate from 1984, an associate professor from 1992, and a full professor of medical physics from 2001. His scientific activity is related to the development of medical imaging systems, for digital radiography, computed tomography, and nuclear medicine. Applications range from autoradiography with microstrip and pixel semiconductor
detectors, to digital mammography with photon-counting detectors, to small animal SPECT and semiconductor compact gamma cameras, to a prototype scanner for cone beam breast computed tomography using attenuation-based and phasecontrast-based methods. From 2008 to 2012 he was the associate editor of Physica Medica (European Journal of Medical Physics) for the field of medical imaging, and since January 2013 he is the editor-in-chief of this journal. He is the vice-chair of Publications Committee of IOMP (International Organization for Medical Physics) and chair of Publications and Communications Committee of EFOMP (European Federation of Organisations in Medical Physics). He serves as reviewer for several journals in medical physics, and for research projects for European Research Foundations. He has coauthored over 140 papers on peer-reviewed journals and scientific book chapters.
Scientific Board
Masami Ando
Predrag R. Bakic
Rolf Behling
Kristina Bliznakova
Hilde Bosmans
Anders Brahme
Franco Casali
Martin Caon
Carlo Cavedon
Kin-Yin Cheung
John Damilakis
Alberto Del Guerra
Kunio Doi
Hiroshi Fujita
Maryellen L. Giger
George C. Kagadis
Willi A. Kalender
Mannudeep K. Kalra
John Kotre
Elizabeth Krupinski
Keith Horner
Kiyonari Inamura
Thomas K. Lewellen
Andrew D. A. Maidment
Giorgio Margaritondo
Kwan-Hoong Ng
Peter B. Noël
Fridtjof Nuesslin
Colin G. Orton
David Paganin
Ishmael Parsai
Ambika Sahai Pradhan
Perry Sprawls Jr
Andrew W. Stevenson
Magdalena Stoeva
Tae Suk Suh
Slavik Tabakov
Virginia Tsapaki
Jeffrey F. Williamson
Contributors
Greeshma Agasthya
Department of Radiology
Duke University Durham, North Carolina
Fauzia Albertin
Ecole Polytechnique Fédérale de Lausanne EPFL
Faculté des sciences de base et Faculté de sciences et techniques de l’ingénieur Vaud, Switzerland
Masami Ando
Research Institute of Science and Engineering
Tokyo University of Science Chiba, Japan
Christos Angelopoulos
Columbia University College of Dental Medicine New York and
Aristotle University
Thessaloniki, Greece
Aldo Badano
Center for Devices and Radiological Health
US Food and Drug Administration
Silver Spring, Maryland
Cristian T. Badea
Center for In vivo Microscopy
Department of Radiology
Duke University Medical Center Durham, North Carolina
Soenke H. Bartling
X-ray and Computed Tomography
Department of Medical Physics in Radiology
German Cancer Research Center (dkfz) Heidelberg, Germany
Rolf Behling
Philips Medical Systems Hamburg, Germany
Kristina Bliznakova
Laboratory of Computer Simulations in Medicine
Technical University of Varna Varna, Bulgaria
Michael Böhnel
Fraunhofer IIS
Development Center X-ray Technology EZRT Fürth, Germany
Douglas Bollinger
Department of Radiation Oncology
Washington University School of Medicine St. Louis, Missouri
Alberto Bravin
Biomedical Beamline ID17
European Synchrotron Radiation Facility Grenoble, France
Antonio Brunetti
Dipartimento di Scienze politiche, scienza della comunicazione ed ingegneria dell’informazione
Università di Sassari Sassari, Italy
Uwe Busch
Deutsches Röntgen-Museum
Remscheid, Germany
Franco Casali
Centro Fermi - Museo Storico della Fisica e Centro Studi e Ricerche “Enrico Fermi” Rome, Italy
Roberto Cesareo
Istituto di Matematica e Fisica
Università di Sassari Sassari, Italy
Sha Chang
Department of Radiation Oncology
The University of North Carolina at Chapel Hill Chapel Hill, North Carolina
Guang-Hong Chen
Department of Medical Physics and Department of Radiology
University of Wisconsin-Madison Madison, Wisconsin
Jian-Hua Chen
Department of Anatomy
University of California
San Francisco, California
Wei-Chung Cheng
Center for Devices and Radiological Health
US Food and Drug Administration Silver Spring, Maryland
Stelios Christofides
Biomedical Research Foundation Nicosia, Cyprus
Paola Coan
Department of Physics and Department of Clinical Radiology
Ludwig-Maximilians-Universität München Munich, Germany
Adriano Contillo
Dipartimento di Fisica e Scienze della Terra Universita degli Studi di Ferrara Ferrara, Italy
Bruno Correa de Azevedo
Department of Surgical/Hospital Dentistry
University of Louisville School of Dentistry Louisville, Kentucky
Paulo Roberto Costa
Institute of Physics
University of São Paulo São Paulo, Brazil
Ian A. Cunningham
Robarts Research Institute and Department of Medical Biophysics
University of Western Ontario London, Canada
David R. Dance
NCCPM
The Royal Surrey County Hospital Guildford, United Kingdom
Silvia Delsanto im3D Torino, Italy
Slobodan Devic
McGill University and Jewish General Hospital Montréal, Québec, Canada
Paul Claude Diemoz
Department of Medical Physics and Biomedical Engineering University College London London, United Kingdom
Robert L. Dixon
Department of Radiology
Wake Forest University School of Medicine Winston-Salem, North Carolina
Axel A. Ekman
Department of Anatomy
University of California San Francisco San Francisco, California
Terenz Escartin
Robarts Research Institute and Department of Medical Biophysics
University of Western Ontario London, Canada
Michela Esposito College of Science University of Lincoln Lincolnshire, United Kingdom
Uwe Ewert
Division of NDT–Radiological Methods
Bundesanstalt für Materialforschung und–prüfung (BAM) Berlin, Germany
Geert Van Eyndhoven University of Antwerp Belgium
Maria Evelina Fantacci
Department of Physics University of Pisa Pisa, Italy
Allan G. Farman
Independent Consultant Maxillofacial Imaging Science Chicago, Illinois and
Federal Institute for Materials Research and Testing (BAM) Berlin, Germany
Christian Fella Fraunhofer IIS NanoCT Systems Würzburg, Germany
Alexander Flisch
Empa Center for X-ray Analytics Dübendorf, Switzerland
Hiroshi Fujita
Department of Electrical, Electronic and Computer Engineering and
Department of Intelligent Image Information
Graduate School of Medicine
Gifu University Gifu, Japan
Gisella Gennaro
Department of Radiology
Veneto Institute of Oncology (IRCCS) Padua, Italy
Leonida A. Gizzi
Istituto Nazionale di Ottica
Consiglio Nazionale delle Ricerche (CNR) Pisa, Italy
Department of Radiology Massachusetts General Hospital Harvard University Boston, Massachusetts
Timur E. Gureyev
ARC Centre of Excellence in Advanced Molecular Imaging School of Physics
The University of Melbourne Parkville, VIC, Australia
Gyorgy Hegyi
McGill University Montreal, Quebec, Canada
Jochen Hiller
Fraunhofer Application Center for Computed Tomography in Metrology CTMT
Deggendorf Institute of Technology DIT Deggendorf, Germany
Jürgen Hofmann
Empa Center for X-ray Analytics Dübendorf, Switzerland
Peter Hornberger
Fraunhofer Application Center for Computed Tomography in Metrology CTMT Deggendorf, Germany
Bernhard Illerhaus
Bundesanstalt für Materialforschung und -prüfung (BAM) Berlin, Germany
Susumu Imashuku Institute for Materials Research Tohoku University Sendai, Japan
Noriah Jamal Malaysian Nuclear Agency Selangor, Malaysia
Jani Keyriläinen
Department of Medical Physics
Turku University Hospital Turku, Finland
Marcus J. Kitchen
School of Physics and Astronomy
Monash University
Melbourne, Victoria, Australia
Elizabeth A. Krupinski
Department of Radiology and Imaging Sciences
Emory University Atlanta, Georgia
Naresh Gandhi Kujala X-ray Photon Diagnostics Group European XFEL Germany
Luca Labate
Istituto Nazionale di Ottica
Consiglio Nazionale delle Ricerche (CNR) Pisa, Italy
Carolyn A. Larabell
Department of Anatomy
University of California San Francisco
San Francisco, California and
Molecular Biophysics and Integrated Bioimaging
Lawrence Berkeley National Laboratory Berkeley, California
Yueh Lee
Department of Physics and Astronomy and Department of Radiology
The University of North Carolina at Chapel Hill Chapel Hill, North Carolina
Mark A. Le Gros
Department of Anatomy
University of California San Francisco San Francisco, California and
Molecular Biophysics and Integrated Bioimaging
Lawrence Berkeley National Laboratory Berkeley, California
Hua Li
Department of Radiation Oncology
Washington University School of Medicine
St. Louis, Missouri
Ke Li
Department of Medical Physics and Department of Radiology
University of Wisconsin-Madison Madison, Wisconsin
William R. B. Lionheart
School of Mathematics
University of Manchester Manchester, United Kingdom
Jianping Lu
Department of Applied Physical Sciences and Department of Physics and Astronomy
The University of North Carolina at Chapel Hill Chapel Hill, North Carolina
James G. Mainprize
Sunnybrook Research Institute Toronto, Ontario, Canada
Giorgio Margaritondo
Ecole Polytechnique Fédérale de Lausanne EPFL
Faculté des sciences de base et Faculté de sciences et techniques de l’ingénieur Vaud, Switzerland
Nicholas W. Marshall
Department of Radiology
UZ Gasthuisberg Leuven, Belgium
Gerry McDermott
Department of Anatomy
University of California San Francisco San Francisco, California
Mark F. McEntee
Faculty of Health Sciences
The University of Sydney New South Wales, Australia
Amit Mehndiratta
Centre for Biomedical Engineering
Indian Institute of Technology Delhi All India Institute of Medical Sciences New Delhi, India
Ralf Hendrik Menk
Elettra - Sincrotrone Trieste Trieste, Italy and
Department of Medical Imaging University of Saskatchewan Saskatoon, Saskatchewan, Canada
Thomas S. Miller
Fraunhofer Application Center for Computed Tomography in Metrology CTMT Deggendorf, Germany
Pascal Monnin
Institute of Radiation Physics (IRA)
Lausanne University Hospital (CHUV) Lausanne, Switzerland
Bruno Morgan University of Leicester Imaging Department University Hospitals of Leicester Leicester Royal Infirmary Leicester, United Kingdom
Kaye S. Morgan
School of Physics and Astronomy Monash University
Melbourne, Victoria, Australia and
Institute of Advanced Study & Chair of Biomedical Physics
Technische Universit ät München München, Germany
Maria Pia Morigi
Department of Physics and Astronomy
University of Bologna Bologna, Italy
Junji Morishita
Department of Health Sciences
Faculty of Medical Sciences Kyushu University Fukuoka, Japan
Lia Morra im3D Torino, Italy
Chisako Muramatsu
Department of Electrical, Electronic and Computer Engineering Gifu University Gifu, Japan
Tomi F. Nano
Robarts Research Institute and Department of Medical Biophysics
University of Western Ontario London, Canada
Yakov I. Nesterets
Manufacturing, Commonwealth Scientific and Industrial Research Organisation Clayton, VIC, Australia
Kwan Hoong Ng
Department of Biomedical Imaging Faculty of Medicine
University of Malaya Kuala Lumpur, Malaysia
Fumio Okuyama
Graduate School of Engineering
Nagoya Institute of Technology
Nagoya, Japan
Daniele Panetta
Institute of Clinical Physiology, IFC-CNR
National Research Council Pisa, Italy
Daniele Pelliccia School of Science
RMIT University and Instruments & Data Tools Pty Ltd Melbourne, Victoria, Australia
Kostas Perisinakis
Department of Medical Physics
University of Crete Medical School Crete, Greece
Mathieu Plamondon
Empa Center for X-ray Analytics Dübendorf, Switzerland
Tia E. Plautz
Department of Anatomy
University of California San Francisco San Francisco, California
Gavin Poludniowski
Medical Radiation Physics and Nuclear Medicine
Karolinska University Hospital Stockholm, Sweden
Nils Reims
Fraunhofer IIS
Development Center X-ray Technology EZRT Fürth, Germany
Alessandra Retico
National Institute for Nuclear Physics (INFN) Pisa Division Pisa, Italy
Luigi Rigon
Department of Physics
University of Trieste and INFN Trieste, Italy
Claire Robinson
Imaging Department University Hospitals of Leicester, Leicester Royal Infirmary Leicester, United Kingdom
Alejandro Rodriguez-Ruiz
Department of Radiology and Nuclear Medicine
Radboud University Medical Center
Nijmegen, the Netherlands
Guy N. Rutty
East Midlands Forensic Pathology Unit
Leicester Royal Infirmary
Leicester, United Kingdom
Nick Ryckx
Institute of Radiation Physics
University Hospital of Lausanne Switzerland
Michael Salamon Fraunhofer IIS
Development Center X-ray Technology EZRT Fürth, Germany
William C. Scarfe
Department of Surgical/Hospital Dentistry
University of Louisville School of Dentistry Louisville, Kentucky
Ralf Kurt Willy Schulze
Section of Oral and Maxillofacial Radiology
Medical Center of the Johannes Gutenberg-University Mainz, Germany
Ioannis Sechopoulos Department of Radiology and Nuclear Medicine
Radboud University Medical Center Nijmegen, T he Netherlands and
Dutch Reference Center for Screening (LRCB)
Nijmegen, T he Netherlands
Jan Sijbers
University of Antwerp Antwerp, Belgium
Andreas Staude
Thermo Fisher Scientific, Materials and Structural Analysis
Zuse Institut Berlin (ZIB) Berlin, Germany
Carina Stritt
Empa Center for X-ray Analytics Dübendorf, Switzerland
Pekka Suortti
Department of Physics University of Helsinki Helsinki, Finland
Angelo Taibi
Dipartimento di Fisica e Scienze della Terra
Universita degli Studi di Ferrara Ferrara, Italy
Nobukazu Tanaka Department of Health Sciences Faculty of Medical Sciences Kyushu University Fukuoka, Japan
Xiangyang Tang Emory University Atlanta, Georgia
Adrian M. K. Thomas School of Allied Health Professions Faculty of Health and Wellbeing Canterbury Christchurch University Kent, United Kingdom
William Thomlinson Department of Physics University of Helsinki Helsinki, Finland
William M. Thompson
Carl Zeiss X-ray Microscopy, Inc. Pleasanton, California
Shiva Toghyani
Department of Surgical/Hospital Dentistry University of Louisville School of Dentistry Louisville, Kentucky
Alessandra Tomal Institute of Physics “Gleb Wataghin” University of Campinas São Paulo, Brazil
Paolo Tomassini
Istituto Nazionale di Ottica Consiglio Nazionale delle Ricerche (CNR) Pisa, Italy
Nada Tomic
McGill University and Jewish General Hospital Montréal, Québec, Canada
Annalisa Trianni
Azienda Sanitaria Universitaria Integrata di Udine (ASUIUD)
Polo Ospedaliero “S. Maria della Misericordia” Udine, Italy
Srinivasan Vedantham Department of Medical Imaging
The University of Arizona Tucson, Arizona
Francis R. Verdun Institute of Radiation Physics University Hospital of Lausanne Switzerland
Alisa Walz-Flannigan Radiology Mayo Clinic Rochester, Minnesota
Jing Wang University of Texas Southwestern Medical Center Dallas, Texas
Heather Weber Healthcare Technology Management Mayo Clinic Rochester, Minnesota
Huiqiao Xie Emory University Atlanta, Georgia
Kai Yang
Department of Radiology Massachusetts General Hospital Boston, Massachusetts
Chai Hong Yeong
Department of Biomedical Imaging Faculty of Medicine University of Malaya Kuala Lumpur, Malaysia
Tetsuya Yuasa Graduate School of Engineering and Science Yamagata University Yamagata, Japan
Simon Zabler Fraunhofer IIS NanoCT Systems Würzburg, Germany
Lei Zhang
Department of Applied Physical Sciences
The University of North Carolina at Chapel Hill Chapel Hill, North Carolina
You Zhang University of Texas Southwestern Medical Center Dallas, Texas
Otto Zhou
Department of Applied Physical Sciences and Department of Physics and Astronomy
The University of North Carolina at Chapel Hill Chapel Hill, North Carolina
Uwe Zscherpel
Division of NDT–Radiological Methods Bundesanstalt für Materialforschung und–prüfung (BAM) Berlin, Germany
Section I
Basic Physical and Technological Aspects
Another random document with no related content on Scribd:
Another patient aged twenty-seven had whooping cough, which lasted six weeks, and was followed by severe pain in the back. For this she consulted various physicians, being treated for Pott's disease and spinal irritation. She, however, continued to grow worse, and every jar and twist gave severe pain. At this time she had lost much flesh, had pain in her back and elsewhere, and was subject to numerous and violent spasms. When first seen by the physician who consulted me she was complaining of pains in her legs, hips, and left shoulder, which she considered rheumatic, and with pain in the abdomen. Examination of the back with the patient on her side showed a slight prominence over the position of the first or second lumbar vertebra. The spot was painful on pressure, and had been so ever since the attack of whooping cough three years before. A tap on the sole of either foot made her complain of severe pain in the back. The same result followed pressure on the head. The patient was unable to stand or walk, but occasionally sat up for a short time, although suffering all the time. There was no muscular rigidity. The limbs and body were quite thin, but, so far as could be detected, she had no loss of motor or sensory power. At times, when the pains were worse, the arms would be flexed involuntarily, and she stated that once the spine was drawn back and a little sideways. The pain in the hips was augmented by pressure. During the application of a plaster bandage she had a sort of fit and fainted, and the application was suspended. She soon recovered consciousness, but refused to allow the completion of the dressing. I diagnosticated the affection as largely hysterical, and a few months later received word that the patient was on her feet and well.
Kemper109 relates the case of a lady who eventually died of sarcoma of the vertebræ, the specimens having been examined by J. H. C. Simes of Philadelphia and myself. She was supposed at first and for some time to be a case of hysteria with spinal irritation. In the case of a distinguished naval officer, who died of malignant vertebral disease after great suffering a short time since, this same mistake was made during the early stages of the disease: his case was pronounced to be one of neurasthenia, hysteria, etc. before its true nature was finally discovered. The absence of muscular rigidity in the
back and extremities is the strongest point against vertebral disease in these cases.
109 Journal of Nervous and Mental Diseases, vol. xii., No. 1, January, 1885.
In hysterical hemianæsthesia, ovarian hyperæsthesia, hysteroepileptic seizures, ischuria, and other well-known hysterical symptoms have usually been observed. The anæsthesia in hysterical cases is most commonly on the left side of the body, but it may happen to be so located in an organic case, so that this point is only one of slight value.
Some older observers, as Briquet, who is quoted and criticised by Charcot, believed that hemianæsthesia from encephalic lesions differed from hysterical hemianæsthesia by the fact that in the former case the skin of the face did not participate in the insensibility, or that when it existed it never occupied the same side as the insensibility of the limbs. Recently-reported cases have disproved the accuracy of this supposed diagnostic mark. In his lectures, delivered ten years ago, Charcot observed that up to that period anæsthesia of general sensibility alone appeared to have been observed as a consecutive on an alteration of the cerebral hemispheres, so that obtunding of the special senses would remain as a distinctive characteristic of hysterical hemianæsthesia. He, however, expected that cases of cerebral organic origin would be reported of complete hemianæsthesia, with derangements of the special senses, such as is presented in hysteria. His anticipations have been fulfilled. In the nervous wards of the Philadelphia Hospital is now a typical case of organic hemianæsthesia in which the special senses are partially involved.
Paralysis and contractures, if present, are apt to be accompanied in cases of organic hemianæsthesia, after time has elapsed, by marked nutritive changes, by wasting of muscle, and even of skin and bone. This is not the case in hysteria.
The subsequent history of these two conditions is different. The hysterical patient will often recover and relapse, or under proper
treatment may entirely recover; while all the treatment that can be given in a case of organic hemianæsthesia will produce no decided improvement, for there is a lesion in the brain which will remain for ever. Hemianopsia, so far as I know, has not been observed in hysterical hemianæsthesia.
In the monograph of Shaffer, with reference to both true and false knee-joint affections certain conclusions are drawn which I will give somewhat condensed:
Chronic synovitis produces very few if any subjective symptoms; hysterical imitation presents a long train of both subjective and objective symptoms and signs, the former in excess. Chronic ostitis may be diagnosticated if muscular spasm cannot be overcome by persistent effort; when the spasm does not vary night nor day; when it is not affected by the ordinary doses of opium or chloral; when reaction of the muscles to the faradic current is much reduced; when a local and uniform rise of temperature over the affected articulation is present; when purely involuntary neural symptoms, such as muscular spasm, pain, and a cry of distress, are present. Hysterical knee-joint is present, according to this author, when the muscular rigidity or contracture is variable, and can be overcome by mildly persistent efforts while the patient's mind is diverted, or which yields to natural sleep, or which wholly disappears under the usual doses of opium or chloral; when the faradic response is normal; when rise of temperature is absent or a reduced temperature is present over the joint; when variable and inconstant, emotional, and semivoluntary manifestations are present.
To recognize the neuromimesis of hip disease Shaffer gives the following points: The limp is variable and suggests fatigue; it is much better after rest; it almost invariably follows the pain. Pain of a hyperæsthetic character is usually the first symptom, and it is found most generally in the immediate region of the joint. “In place of an apprehensive state in response to the tests applied will be found a series of symptoms which are erratic and inconstant. A condition of muscular rigidity often exists, but, unlike a true muscular spasm, it
can in most cases be overcome in the manner before stated. A very perceptible degree of atrophy may exist—such, however, as would arise from inertia only. A normal electrical contractility exists in all the muscles of the thigh.”
In the neuromimesis of chronic spondylitis or hysterical spine the pain is generally superficial, and is almost always located over or near the spinous processes; it is sometimes transient, and frequently changes its location from time to time; a normal degree of mobility of the spinal column under properly directed manipulation is preserved; the nocturnal cry and apprehensive expression of Pott's disease are wanting.
With reference to the hysterical lateral curvature, Shaffer, quoting Paget, says “ether or chloroform will help. You can straighten the mimic contracture when the muscles cannot act; you cannot so straighten a real curvature.”
In the diagnosis of local hysterical affections one point emphasized by Skey is well worthy of consideration; and that is that local forms of hysteria are often not seen because they are not looked for. “If,” says he, “you will so focus your mental vision and endeavor to distinguish the minute texture of your cases, and look into and not at them, you will acknowledge the truth of the description, and you will adopt a sound principle of treatment that meets disease face to face with a direct instead of an oblique force.” According to Paget, the means for diagnosis in these cases to be sought—(1) in what may be regarded as the predisposition, the general condition of the nervous system, on which, as in a predisposing constitution, the nervous mimicry of disease is founded; (2) in the events by which, as by exciting causes, the mimicry may be evoked and localized; (3) in the local symptoms in each case.
Local symptoms as a means of diagnosis can sometimes be made use of in general hysteria. A case may present symptoms of either the gravest form of organic nervous disease or the gravest form of hysteria, and be for a time in doubt, when suddenly some special local manifestation appears which cannot be other than hysterical,
and which clinches the diagnosis. In a case with profound anæsthesia, with paraplegia and marked contractures, with recurring spasms of frightful character, the sudden appearance of aphonia and apsithyria at once cleared all remaining doubt. Herbert Page mentions the case of a man who suffered from marked paraplegia and extreme emotional disturbance after a railway collision, who, nine months after the accident, had an attack of aphonia brought on suddenly by hearing of the death of a friend. He eventually recovered.
To detect hysterical or simulated blindness the methods described by Harlan are those adopted in my own practice. When the blindness is in both eyes, optical tests cannot be applied. Harlan suggests etherization.110 In a case of deception, conscious or unconscious, he says, “as the effect of the anæsthetic passed off the patient would probably recover the power of vision before his consciousness was sufficiently restored to enable him to resume the deception.” Hutchinson cured a case of deaf-dumbness by means of etherization. For simulated monocular blindness Graefe's prism-test may be used: “If a prism held before the eye in which sight is admitted causes double vision, or when its axis is held horizontally a corrective squint, vision with both eyes is rendered certain.” It should be borne in mind that the failure to produce double images is not positive proof of monocular blindness, for it is possible that the person may see with either eye separately, but not enjoy binocular vision, as in a case of squint, however slight. Instead of using a prism while the patient is reading with both eyes at an ordinary distance, say of fourteen or sixteen inches, on some pretext slip a glass of high focus in front of the eye said to be sound. If the reading is continued without change, of course the amaurosis is not real. Other tests have been recommended, but these can usually be made available.
110 Loc. cit.
The diagnosis of hysterical, simulated, or mimetic deafness is more difficult than that of blindness. When the deafness is bilateral, the
difficulty is greater than when unilateral. The method by etherization just referred to might be tried. Politzer in his work on diseases of the ear111 makes the following suggestions: Whether the patient can be wakened out of sleep by a moderately loud call seems to be the surest experiment. But, as in total deafness motor reflexes may be elicited by the concussion of loud sounds, care must be taken not to go too near the person concerned and not to call too loudly. The practical objection to this procedure in civil practice would seem to be that we are not often about when our patients are asleep. In unilateral deafness L. Müller's method is to use two tubes, through which words are spoken in both ears at the same time. When unilateral deafness is really present the patient will only repeat what has been spoken in the healthy ear, while when there is simulation he becomes confused, and will repeat the words spoken into the seemingly deaf ear also. To avoid mistakes in using this method, a low voice must be employed.
111 A Textbook of the Diseases of the Ear and Adjacent Organs, by Adam Politzer, translated and edited by James Patterson Cassells, M.D., M. R. C. S. Eng., Philada., 1883.
Mistakes in diagnosis where hysteria is in question are frequently due to that association with it of serious organic disease of the nervous system of which I have already spoken at length under Complications. This is a fact which has not been overlooked by authors and teachers, but one on which sufficient stress has not yet been laid, and one which is not always kept in mind by the practitioner. Bramwell says: “Cases are every now and again met with in which serious organic disease (myelitis and poliomyelitis, anterior, acute, for example) is said to be hysterical. Mistakes of this description are often due to the fact that serious organic disease is frequently associated with the general symptoms and signs of hysteria; it is, in fact, essential to remember that all cases of paraplegia occurring in hysterical patients are not necessarily functional—i.e. hysterical; the presence of hysteria or a history of hysterical fits is only corroborative evidence, and the (positive) diagnosis of hysterical paraplegia should never be given unless the
observer has, after the most careful examination, failed to detect the signs and symptoms of organic disease.”
PROGNOSIS.—Hysteria may terminate (1) in permanent recovery; (2) in temporary recovery, with a tendency to relapse or to the establishment of hysterical symptoms of a different character; (3) in some other affection, as insanity, phthisis, or possibly sclerosis; (4) in death, but the death in such cases is usually not the direct result of hysteria, but of some accident. Death from intercurrent disorders may take place in hysteria. It is altogether doubtful, however, whether the affection which has been described as acute fatal hysteria should be placed in the hysterical category. In the cases reported the symptom-picture would in almost every instance seem to indicate the probability of the hysteria having been simply a complication of other disorders, such as epilepsy, eclampsia, and acute mania.
As a rule, hysterical patients will not starve themselves. They may refuse to take food in the presence of others, or may say they will not eat at all; but they will in some cases at the same time get food on the sly or hire their nurses or attendants to procure it for them. In treating such cases a little watchfulness will soon enable the physician to determine what is best to be done. By discovering them in the act of taking food future deception can sometimes be prevented. Hysterical patients do sometimes, however, persistently refuse food. These cases may starve to death if let alone; and it is important that the physician should promptly resort to some form of forcible feeding before the nutrition of the patient has reached too low an ebb. I have seen at least two cases of hysteria or hysterical insanity in which patients were practically allowed to starve themselves to death, but an occurrence of this kind is very rare. Feeding by means of a stomach-tube, or, what is still better, by a nasal tube, as is now so frequently practised among the insane, should be employed. Nourishment should be administered systematically in any way possible until the patient is willing to take food in the ordinary way. In purposive cases some methods of
forcible feeding may prove of decided advantage. Its unpleasantness will sometimes cause swallowing power to be regained.
Wunderlich112 has recorded the case of a servant-girl, aged nineteen, who, after a succession of epileptiform fits, fell into a collapse and died in two days. Other cases have been recorded by Meyer. Fagge also speaks of the more chronic forms of hysteria proving fatal by marasmus. He refers to two cases reported by Wilks, both of which were diagnosticated as hysterical, and both of which died. Sir William Gull describes a complaint which he terms anorexia nervosa vel hysterica. It is attended with extreme wasting; pulse, respiration, and temperature are low. The patients were usually between the ages of sixteen and twenty-three: some died; others recovered under full feeding and great care. In many of the reported fatal cases careful inquiry must be made as to this question of hysteria being simply a complication.
112 Quoted in The Principles and Practice of Medicine, by the late Charles Hilton Fagge, M.D., F. R. C. P., etc., vol. i. 1886, p. 736.
Are not hysterical attacks sometimes fatal? With reference to one of my cases this view was urged by the physician in attendance. Gowers113 on this point says: “As a rule to which exceptions are infinitely rare, hysterical attacks, however severe and alarming in aspect, are devoid of danger. The attacks of laryngeal spasm present the greatest apparent risk to life.” He refers to the paroxysms of dyspnœa presented by a hemiplegic girl as really alarming in appearance, even to those familiar with them. He refers also to a case of Raynaud's114 in which the laryngeal and pharyngeal spasm coexisted with trismus, and the patient died in a terrible paroxysm of dyspnœa. The patient presented various other hysterical manifestations, and a precisely similar attack had occurred previously and passed away, but she had in the interval become addicted to the hypodermic injection of morphia, and Raynaud suggested that it might have been the effect of this on the nervecentres that caused the fatal termination. Such cases have been described in France as the hydrophobic form of hysteria.
113 Epilepsy and Other Chronic Convulsive Diseases, by W R. Gowers, M.D., London. 1881.
114 L'Union médical, March 15, 1881.
Patients may die in hysterical as in epileptic attacks from causes not directly connected with the disease. One of these sources of danger mentioned by Gowers is the tendency to fall on the face sometimes met with in the post-epileptic state. He records an example of death from this cause. He also details a case of running hysteria or hystero-epilepsy, in which, after a series of fits lasting about four hours, the child died, possibly from some intercurrent accident.
TREATMENT.—Grasset,115 speaking of the treatment of hysteria, says that means of treating the paroxysm, of removing the anæsthesia, of combating single symptoms, are perhaps to be found in abundance, but the groundwork of the disease, the neurosis or morbid state, is not attacked. Here he indicates a new and fruitful path. In his own summing up, however, he can only say that the hysterical diathesis offers fundamental grounds for the exhibition of arsenic, silver, chloride of gold, and mineral waters!
115 Brain, January, 1884.
No doubt can exist that the prophylactic and hygienic treatment of hysteria is of paramount importance. To education—using the term education in a broad sense—before and above all, the most important place must be given. It is sometimes better to remove children from their home surroundings. Hysterical mothers develop hysterical children through association and imitation. I can scarcely, however, agree with Dujardin-Beaumetz that it is always a good plan to place a girl in a boarding-school far from the city It depends on the school. A well-regulated institution may be a great blessing in this direction; one badly-managed may become a hotbed of hysteria.
Recently I made some investigations into the working of the publicschool system of Philadelphia, particularly with reference to the question of overwork and sanitation.116 I had special opportunities
during the investigations to study the influences of different methods of education, owing to the fact that the public-school system of Philadelphia is just now in a transition period. This system is in a state of hopeful confusion—hopeful, because I believe that out of its present condition will come eventually a great boon to Philadelphia. At one end of the system, in the primary and the secondary schools, a graded method of instruction has been introduced. The grammar and the high schools are working on an ungraded or differently graded method. I found still prevailing, particularly in certain of the grammar schools for girls, although not to the same extent as a few years since, methods of cramming and stuffing calculated above all to produce hysteria and allied disorders in those predisposed to them.
116 The results of these investigations were given in a lecture which was delivered in the Girls' Normal School of Philadelphia before the Teachers' Institute of Philadelphia, Dec. 11, 1885.
Education should be so arranged as to develop the brain by a natural process—not from within outward; not from the centre to the periphery; not from above downward; but as the nervous system itself develops in its evolution from a lower to a higher order of animals, from the simple to the more complex and more elaborate. Any system of education is wrong, and is calculated to weaken and worry an impressionable nervous system, which attempts to overturn or change this order of the progress of a true development of the brain. To develop the nervous system as it should be developed— slowly, naturally, and evenly—it must also be fed, rested, and properly exercised.
In those primary schools in which the graded method was best carried out this process of helping natural development was pursued, and the result was seen in contented faces, healthy bodies, and cheerful workers. In future the result will be found in less chorea, hysteria, and insanity
To prevent the development of hysteria, parents and physicians should direct every effort. The family physician who discovers a child
to be neurotic, and who from his knowledge of parents, ancestors, and collateral relatives knows that a predisposition to hysteria or some other neurosis is likely to be present, should exercise all the moral influence which he possesses to have a healthy, robust training provided. It is not within the scope of an article of this kind to describe in great detail in what such education should consist. Reynolds is correct when he says that “self-control should be developed, the bodily health should be most carefully regarded, and some motive or purpose should be supplied which may give force, persistence, unity, and success to the endeavors of the patient.” In children who have a tendency to the development of hysteria the inclinations should not always or altogether be regarded in choosing a method or pursuing a plan of education. It is not always to what such a child takes that its mind should be constantly directed; but, on the contrary, it is often well to educate it away from its inclination. “The worst thing that can be done is that which makes the patient know and feel that she is thought to be peculiar. Sometimes such treatment is gratifying to her, and she likes it—it is easy and it seems kind to give it—but it is radically wrong.”
In providing for the bodily health of hysterical children it should be seen that exercise should be taken regularly and in the open air, but over-fatigue should be avoided; that ample and pleasant recreation should be provided; that study should be systematic and disciplinary, but at the same time varied and interesting, and subservient to some useful purpose; that the various functions of secretion, excretion, menstruation should be regulated.
The importance of sufficient sleep to children who are predisposed to hysteria or any other form of nervous or mental disorder can scarcely be over-estimated. The following, according to J. Crichton Browne,117 is the average duration of sleep required at different ages: 4 years of age, 12 hours; 7 years of age, 11 hours; 9 years of age, 10½ hours; 14 years of age, 10 hours; 17 years of age, 9½ hours; 21 years of age, 9 hours; 28 years of age, 8 hours. To carefully provide that children shall obtain this amount of sleep will do much to strengthen the nervous system and subdue or eradicate hysterical tendencies.
Gymnastics, horseback riding, walking, swimming, and similar exercises all have their advantages in preventing hysterical tendencies.
117 Education and the Nervous System, reprinted from The Book of Health by permission of Messrs. Cassell & Co., Limited.
Herz118 has some instructive and useful recommendations with reference to the treatment of hysteria in children. It is first and most important to rehabilitate the weakened organism, and especially the central nervous system, by various dietetic, hygienic, and medicinal measures. It is important next to tranquillize physical and mental excitement. This can sometimes be done by disregard of the affection, by neglect, or by removal or threatened removal of the child from its surroundings. Such treatment should of course be employed with great discretion. Anæmia and chlorosis, often present in the youthful victims of hysteria, should be thoroughly treated. Care should be taken to learn whether children of either sex practise masturbation, which, Jacobi and others insist, frequently plays an important part in the production of hysteria. Proper measures should be taken to prevent this practice. The genital organs should receive examination and treatment if this is deemed at all necessary. On the other hand, care should be taken not to direct the attention of children unnecessarily to those organs when they are entirely innocent of such habits. Painting the vagina twice daily with a 10 per cent. solution of hydrochlorate cocaine has been found useful in subduing the hyper-irritation of the sexual organs in girls accustomed to practise masturbation. Herz, with Henoch, prefers the hydrate of chloral to all other medicines, although he regards morphine as almost equally valuable, in the treatment of hysteria in children. Personally, I prefer the bromides to either morphia or chloral. Small doses of iron and arsenic continued systematically for a long period will be found useful. Politzer of Vienna regards the hydrobromate and bihydrobromate of iron as two valuable preparations in the hysteria of children, and exhibits them in doses of four to seven grains three to four times daily.
118 Wien. Med. Wochen., No. 46, Nov. 14, 1885.
Hysteria once developed, it is the moral treatment which often really cures. The basis of this method of cure is to rouse the will. It is essential to establish faith in the mind of the patient. She must be made to feel not only that she can be helped, but that she will be. Every legitimate means also should be taken to impress the patient with the idea that her case is fully understood. If malingering or partial malingering enters into the problem, the patient will then feel that she has been detected, and will conclude that she had better get out of her dilemma as gracefully as possible. Where simulation does not enter faith is an important nerve-stimulant and tonic; it unchains the will.
Many physicians have extraordinary ideas about hysteria, and because of these adopt remarkable and sometimes outrageous methods of treatment. They find a woman with hysterical symptoms, and forthwith conclude she is nothing but a fraud. They are much inclined to assert their opinions, not infrequently to the patient herself, and, if not directly to her, in her hearing to other patients or to friends, relatives, nurses, or physicians. They threaten, denounce, and punish—the latter especially in hospitals. In general practice their course is modified usually by the wholesome restraint which the financial and other extra-hospital relations of patient and physician enforce.
Although hysterical patients often do simulate and are guilty of fraud, it should never be forgotten that some hysterical manifestations may be for the time being beyond the control of patients. Even for some of the frauds which are practised the individuals are scarcely responsible, because of the weakness of their moral nature and their lack of will-power. Moral treatment in the form of reckless harshness becomes immoral treatment. The liability to mistake in diagnosis, and the frequent association of organic disease with hysterical symptoms, should make the physician careful and conservative. It is also of the highest importance often that the doctor should not show his hand. The fact that an occasional cure, which is usually
temporary, is effected by denunciation, and even cruelty, is not a good argument against the stand taken here.
Harsh measures should only be adopted after due consideration and by a well-digested method. A good plan sometimes is, after carefully examining the patient, to place her on some simple, medicinal, and perhaps electrical treatment, taking care quietly to prophesy a speedy cure. If this does not work, in a few days other severe or more positive measures may be used, perhaps blistering or strong electrical currents. Later, but in rare cases only, after giving the patient a chance to arouse herself by letting her know what she may expect, painful electrical currents, the hot iron, the cold bath, or similar measures may be used. Such treatment, however, should never be used as a punishment.
The method of cure by neglect can sometimes be resorted to with advantage. The ever-practical Wilks mentions the case of a schoolteacher with hemianalgesia, hemianæsthesia, and an array of other hysterical symptoms who had gone through all manner of treatment, and at the end of seven months was no better. The doctor simply left her alone. He ordered her no drugs, and regularly passed by her bed. In three weeks he found her sitting up. She talked a little and had some feeling in her right side. She was now encouraged, and made rapid progress to recovery. Neglect had aroused her dormant powers. It must be said that a treatment of this kind can be carried out with far more prospects of success in a general hospital than in a private institution or at the home of a patient. It is a method of treatment which may fail or succeed according to the tact and intelligence of the physician.
I cannot overlook here the consideration of the subject of the socalled faith cure and mind cure. One difference between the faith cure as claimed and practised by its advocates, and by those who uphold it from a scientific standpoint, is simply that the latter do not refer the results obtained to any supernatural or spiritual agency I would not advise the establishment of prayer-meetings for the relief
of hysteria, but would suggest that the power of faith be exercised to its fullest extent in a legitimate way.
A young lady is sick, and for two years is seen by all the leading doctors in London; a clergyman is asked in and prays over her, and she gets up and walks. The doctors all join in and say the case was one of hysteria—that there was nothing the matter with her. Then, says Wilks, “Why was the girl subjected to local treatment and doses of physic for years? Why did not the doctors do what the parson did?”
Tuke119 devotes a chapter to psychotherapeutics, which every physician who is called upon to treat hysteria should read. He attempts to reduce the therapeutic use of mental influence to a practical, working basis. I will formulate from Tuke and my own experience certain propositions as to the employment of psychological measures: (1) It is often important and always justifiable to inspire confidence and hope in hysterical patients by promising cures when it is possible to achieve cures. (2) A physician may sometimes properly avail himself of his influence over the emotions of the patient in the treatment of hysterical patients, but always with great caution and discretion. (3) Every effort should be made to excite hysterical patients to exert the will. (4) In some hysterical cases it is advisable to systematically direct the attention to a particular region of the body, arousing at the same time the expectation of a certain result. (5) Combined mental and physical procedures may sometimes be employed. (6) Hypnotism may be used in a very few cases.
119 Influence of the Mind upon the Body.
The importance of employing mental impression is thoroughly exemplified, if nothing else is accomplished, by a study of such a craze as the so-called mind cure. Not a few people of supposed sense and cultivation have pinned their faith to this latest Boston hobby. A glance at the published writings of the apostles of the mind cure will show at once to the critical mind that all in it of value is dependent upon the effects of mental impression upon certain
peculiar natures, some of them being of a kind which afford us not a few of our cases of hysteria. W. F. Evans has published several works upon the subject. From one of these120 I have sought, but not altogether successfully, to obtain some ideas as to the basis of the mind-cure treatment. It is claimed that the object is to construct a theoretical and practical system of phrenopathy, or mental cure, on the basis of the idealistic philosophy of Berkeley, Fichte, Schelling, and Hegel. The fundamental doctrine of those who believe in the mental cure is, that to think and to exist are one and the same, and that every disease is a translation into a bodily expression of a fixed idea of mind. If by any therapeutic device the morbid idea can be removed, the cure of the malady is assured. When the patient is passive, and consequently impressible, he is made to fix his thoughts with expectant attention upon the effect to be produced. The physician thinks to the same effect, wills it, and believes and imagines that it is being done; the mental action to the patient, sympathizing with that of the physician, is precipitated upon the body, and becomes a silent, transforming, sanitive energy. It must be, says Evans, “a malady more than ordinarily obstinate that is neither relieved nor cured by it.”
120 The Divine Law of Cure
Hysteria cannot be cured by drugs alone, and yet a practitioner of medicine would find it extremely difficult to manage some cases without using drugs. Drugs themselves, used properly, may have a moral or mental as well as a physical influence. Among those which have been most used from before the days of Sydenham to the present time, chiefly for their supposed or real antispasmodic virtues, are galbanum, asafœtida, valerian, castor and musk, opium, and hyoscyamus. The value of asafœtida, valerian, castor, and musk is chiefly of a temporary character. If these drugs are used at all, they should be used in full doses frequently repeated. Sumbul, a drug of the same class comparatively little used, is with me a favorite. It can be used in the form of tincture or fluid extract, from twenty minims to half a drachm of the latter or one to two drachms of the former. It certainly has in many cases a remarkably calmative effect.
Opium and its preparations, so strongly recommended by some, and especially the Germans, should not be used except in rare cases. Occasionally in a case with sleeplessness or great excitement it may be absolutely indispensable to resort to it in combination with some other hypnotic or sedative. The danger, however, in other cases of forming the opium habit should not be overlooked. According to Dujardin-Beaumetz, it is mainly useful in the asthenic forms of hysteria.
Of all drugs, the metallic tonics are to be preferred in the continuous treatment of hysteria. Iron, although not called for in a large percentage of cases, will sometimes prove of great service in the weak and anæmic hysterics. Chalybeates are first among the drugs mentioned by Sydenham. Steel was his favorite. The subcarbonate or reduced iron, or the tincture of the chloride, is to be preferred to the more fanciful and elegant preparations with which the drugmarket is now flooded. Dialyzed iron and the mallate of iron, however, are known to be reliable preparations, and can be resorted to with advantage. They should be given in large doses. Zinc salts, particularly the oxide, phosphide, and valerianate; the nitrate or oxide of silver, the ammonio-sulphate of copper, ferri-ferrocyanide or Prussian blue,—all have a certain amount of real value in giving tone to the nervous system in hysterical cases.
To Niemeyer we owe the use of chloride of sodium and gold in the treatment of hysteria. He refers to the fact that Martini of Biberach regarded this article as an efficient remedy against the various diseases of the womb and ovaries. He believed that the improvement effected upon Martini's patient was probably due to the fact that this, like other metallic remedies, was an active nervine. He prescribed the chloride of gold and sodium in the form of a pill in the dose of one-eighth of a grain. Of these pills he at first ordered one to be taken an hour after dinner, and another an hour after supper. Later, he ordered two to be taken at these hours, and gradually the dose was increased up to eight pills daily. I frequently use this salt after the method of Niemeyer.
The treatment of hysteria which Mitchell has done so much to make popular, that by seclusion, rest, massage, and electricity, is of value in a large number of cases of grave hysteria; but the proper selection of cases for this treatment is all important. Playfair121 says correctly that if this method of treatment is indiscriminately employed, failure and disappointment are certain to result. The most satisfactory results are to be had in the thoroughly broken-down and bed-ridden cases. “The worse the case is,” he says, “the more easy and certain is the cure; and the only disappointments I have had have been in dubious, half-and-half cases.”
121 The Systematic Treatment of Nerve-Prostration and Hysteria, by W S. Playfair, M.D., F. R. C. P., 1883.
Mitchell122 gives a succinct, practical description of the process of massage: “An hour,” he says, “is chosen midway between two meals, and, the patient lying in bed, the manipulator starts at the feet, and gently but firmly pinches up the skin, rolling it lightly between his fingers, and going carefully over the whole foot; then the toes are bent and moved about in every direction; and next, with the thumbs and fingers, the little muscles of the foot are kneaded and pinched more largely, and the interosseous groups worked at with the finger-tips between the bones. At last the whole tissues of the foot are seized with both hands and somewhat firmly rolled about. Next, the ankles are dealt with in the same fashion, all the crevices between the articulating bones being sought out and kneaded, while the joint is put in every possible position. The leg is next treated— first by surface pinching and then by deeper grasping of the areolar tissue, and last by industrious and deeper pinching of the large muscular masses, which for this purpose are put in a position of the utmost relaxation. The grasp of the muscles is momentary, and for the large muscles of the calf and thigh both hands act, the one contracting as the other loosens its grip. In treating the firm muscles in front of the leg the fingers are made to roll the muscles under the cushions of the finger-tips. At brief intervals the manipulator seizes the limb in both hands and lightly runs the grasp upward, so as to favor the flow of venous blood-currents, and then returns to the
kneading of the muscles. The same process is carried on in every part of the body, and especial care is given to the muscles of the loins and spine, while usually the face is not touched. The belly is first treated by pinching the skin, then by deeply grasping and rolling the muscular walls in the hands, and at last the whole belly is kneaded with the heel of the hand in a succession of rapid, deep movements, passing around in the direction of the colon.”
122 “Fat and Blood,” etc.
Massage should often be combined with the Swedish movement cure. In the movement cure one object is to call out the suppressed will of the patient. This is very applicable to cases of hysteria. The cure of cases of this kind is often delayed by using massage alone, which is absolutely passive. These movements are sometimes spoken of as active and passive, or as single and duplicated. Active movements are those more or less under the control of the individual making or taking part in them, and they are performed under the advice or direction, and sometimes with the assistance, of another. They proceed from within; they are willed. Passive movements come from without; they are performed on the patient and independently of her will. She is subjected to pushings and pullings, to flexions and extensions, to swingings and rotations, which she can neither help nor hinder. The same movement may be active or passive according to circumstances. A person's biceps may be exercised through the will, against the will, or with reference to the will.
A single movement is one in which only a single individual is engaged; speaking medically, single movements are those executed by the patient under the direction of the physician or attendant; they are, of course, active. Duplicated active movements require more than one for their performance. In these the element of resistance plays an important part. The operator with carefully-considered exertion performs a movement which the patient is enjoined to resist, or the latter undertakes a certain motion or series of motions which the former, with measured force, resists. Still, tact and experience are here of great value, in order that both direct effort and resistance
should be carefully regulated and properly modified to suit all the requirements of the case. By changing the position of the patient or the manner of operating on her from time to time any muscles or groups of muscles may be brought into play. It is wonderful with what ease even some of the smallest muscles can be exercised by an expert manipulator.
The duplicated active movements are those which should be most frequently performed or attempted in connection with massage in hysterical patients. The very substance of this treatment is to call out that which is wanting in hysteria—will-power It is a coaxing, insinuating treatment, and one which will enable the operator to gain control of the patient in spite of herself. As the patient exerts her power the operator should yield and allow the part to be moved.
Much of the value of massage and Swedish movements, in hysteria as in other disorders, is self-evident. Acceleration of circulation, increase of temperature, direct and reflex stimulation of nervous and muscular action, the promotion of absorption by pressure,—these and other results are readily understood. “The mode in which these gymnastic proceedings exert an influence,” says Erb,123 “consists, no doubt, in occasioning frequently-repeated voluntary excitations of the nerves and muscles, so that the act of conduction to the muscles is gradually rendered more facile, and ultimately the nutrition of the nerves and muscles is augmented.”
123 Ziemssen's Cyclopædia
The objects to be attained by the use of electricity are nearly the same as from massage and duplicated active movements: in the first place, to improve the circulation and the condition of the muscles; and in the second place, to make the patient use the muscles. The faradic battery should be employed in these cases, and the patient should be in a relaxed condition, preferably in bed. A method of electrical treatment introduced some years ago by Beard and Rockwell is known as general faradization. This is sometimes used in the office of the physician. In this method the patient is placed in a chair with his feet on a large plate covered with chamois-skin; the
