Eariy periodical iiterature of dentai radioiogyAletha A. Kowitz, MAVHannelore T. Loevy, CD, MS,

Examination of the early literature of dental radiology reveals that dental scientists of the time were eagerto experiment with the new technology but were unaware of the dangers associated with radiation.(Ouintessence tnt 2001:32:629-632)

Key words: dental radiology, history of dentistry, radiation

I t was late in the afternoon of Friday, November 8,1895, that Wilhelm Konrad Roentgen performed the

critical experiments that resulted in the diseovery ofx-rays. He repeated the experiments several times andreported them in a short manuscript entitled, "On aNew Kind of Rays, a Preliminary Communication." Hesubmitted the manuscript to the secretary of the Wiirz-burg Physical Medical Society with the request that itbe published speedily, although it had not been read atone of the society's meetings (unusual to say the least).It was published as the last 10 pages of the 1895 vol-ume of Annals of the Würzburg Physical MedicalSociety, It has been suggested that this printing actu-ally took place in early 1896; a separate printing, madelate in 1895, comprised preprint copies of the article,which Roentgen sent on January 1, 1896, to a numberof physicists.'

That the discovery by Roentgen was soon reportedin the general medical literature is evidenced by areport by Arthur Schuster that appeared in the BritishMedical Journal in 1896, under the title "On the NewKind of Radiation."^

Roentgen published a second communication onMarch 9, 1896, in which he reported that both posi-tively and negatively electrified bodies were dis-charged by x-rays. His third report, published on May10, 1897, was entitled, "Further Observations on theProperty of the X-ray."' Roentgen did not publish onthe subject again for many years, but many otherresearchers reported on their own research and theo-rized about the work of others.

'Director (Retired], Bureau of Library Services, American Dental Associa-

lion, Chicago, Illinois.

^Professor ot Clinical Pédiatrie Dendstry, College of Dentistry, tJniversity ofIllinois at Chicago, Chicago, minors.

Reprint requests: Dr Hannelore T. Loevy, Professor ct Clinioal PediatncDentistry, Coiiege ot Dentistry. University ol Iiiinois at Chicago, 801 SouthPaulina Street, m/c aso, Chioago, lilinois 60612.

EARLY LITERATURE ONDENTAL APPLICATIONS OF X-RAYS

Members of the dental profession immediately under-stood the significance of the discovery for their field ofstudy and application. On January 14, 1896, only 2weeks after Roentgen's paper was published. OttoWalkhoff of Braunschweig, Germany, with the assis-tance of Fritz Giesel, a chemistry professor, preparedthe first dental roentgenogram ever made by radi-ographing his own teeth,' During his graduate study inBerlin, Louis I. Grossman"" visited Walkhoff in 1928and heard the story directly from Walkhoff himself:"Professor Walkhoff took a sensitized glass platewrapped in a rubber dam, put it in his mouth betweenhis teeth and tongue, so that he could steady the platewith his tongue, and lay on the ñoor for 25 minutes toexpose the plate to the x-rays. The image he obtainedwas of the crowns of his maxillary and mandibularposterior teeth." It was the first bitewing image.

Probably the first oral presentation concerning den-tal radiography was given by M. Jastrowicz at theBerliner Gesellschaft für innere Medizin on January 6,1896. This presentation was published in the Zahn-ärztliches Wochensblatt of February 15, 1896. The sub-ject was the use of radiography in dental diagnosis.'

In England, shortly thereafter (January 1896),Frank Harrison constructed a special vacuum tubethat allowed radiography of tooth roots with 10-minute exposure times.' His report on a study of thepulp chambers of teeth and accompanying radio-graphs were published in the Journal of the BritishDental Association on June 26, 1896.^ In February1896, Wilhelm Koenig of Frankfurt made 14 dentallyuseful radiographs after an exposure time of only 9minutes (Fig 1).

The first dental radiographs in the United Stateswere made in 1896 by William J, Morton. He reported

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Fig 1 Eariy dental radiograptis.

on this activity at a meeting of the New YorkOdontological Society on April 24, 1896. Americandentists read the first professional article on the "X-rayand Its Application to Dentistry" in June the 1898issue of Dental Cosmos. Jn this article, Morton' statedthat radiographs could:

...greatly aid the art of dental surgery. Radio-graphs open out to you a wondrous field forinvestigation and study. Each errant fang isdistinctly placed; teeth before their eruptionstand forth in plain view; an unsuspected exosto-sis is revealed; a pocket of necrosis, of suppura-tion, or oí [tuberculosis] revealed. Extent andarea of metallic filling are sharply delineated.Most interesting is the fact that the pulp cham-ber is beautifully outlined.

In the article, along with the text of the lecture,were a photograph of a man in profile and skiagraphs(as radiographs were cailed in the early days) of thefront of a skull, artificial crowns on a molar, teeth insitu, pulp canals, and a lingual restoration in a lateralincisor. Morton obviously was trying to find any and

all uses for the radiographs that he waf; taking. In thesame volume of Dental Cosmos, a report of theCommittee on Dental Practice of the Dental Societyof the State of New York stated that, "He [Morton]demonstrated, however, that on account of thegreater density of the roots it is possible to penetratethrough the alveolar plates and obtain a perfect pic-ture of the entire tooth from the crown to the end ofthe root."

C. Edmund Kells' discussion of skiagraphs and hisreport to the American Dental Association in whichhe showed skiagraphs taken with 5- to 15-minuteexposure times also appeared in the 1896 volume ofDental Cosmos. However, there is always a delaybetween the time the work is completed and the timeof pubhcation, so this experiment probably was per-formed as early as January or February 1896.

Tbese reports coincide with the work of JuliusAJbrecht of Frankfurt, who, in March 1896, had pro-posed 4 indications for "x-ray photographs." Althoughhe recognized their diagnostic value, Albrecht feh tbatthe use of x-rays would be limited by the major diffi-cuhies involved in making the x-ray photographs,^

As early as July 14, 1896, when F. H. Grubbe, anexperimenter and manufacturer of Geissler andCrookes tubes, noted bis radiation dermatitis, bispbysician stated tbat, "any pbysical agent capable ofdoing so mucb damage to normal or bealthy tissuemight offer possibilities if used in a therapeutic mea-sure...." Thus, within 160 days of Roentgen's discov-ery, the idea of radiotherapy was born in Cbicago.̂

On April 27, 1897, )obn Dennis of Rocbester, NewYork, presented a paper to tbe Seventh District DentalSociety on a system of measurement for x-ray work inwbicb be included a fluorometric radiograph of a skullwith a bullet as a foreign object.

Within 10 years of the discovery of x-rays, an exten-sive health sciences periodical literature developed.This literature was included in the Index-Catalogue ofthe Surgeon-General's Office of the United Statesunder the subject heading, "Roentgen Rays." The firstpossihie date of inclusion was volume 14, series 2,1909, because the previous relevant volume had beenpublished in 1890. The 1909 entry covered a total of35 pages of very fine print and included both periodi-cal articles and books. Because each item was enteredonly once in this reference work, no matter howimportant it might be considered, the sheer volume ofthe entries is an indication of the size of the literature,A total of 23 subbeadings were used, and any one oftbem included a monumental list. The major portionof the literature cited was in German, French, andEnglish. Ahout 100 books were cited, but it was theperiodical literature that was most impressive andimportant.

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EARLY PERIODICALS DEVOTEDTO X-RAY TECHNOLOGY

One of the earliest periodicals devoted completely tox-rays and their technology and use was initially titledArchives of Clinical Skiagraphy and, ultimately, theBritish Journal of Radiology. It started to issue inApril or May 1896 and has remained in print underone title or another to date. By the fourth issue (1897),the title had changed to Archives of Skiagraphy, indi-cating a change in emphasis. When the RoentgenSociety of Great Britain held its first Annual Meetingon June 3, 1897, its proceedings were published in thenow titled Archives of the Roentgen Ray which borethe subtitle in parentbeses. Formerly Archives ofSkiagraphy. The Archives of the Roentgen Rayincluded originai articles by radiologists, physicists,and manufacturers of materials and equipment, as wellas book reviews and summaries of meetings in bothEurope and North America.

The title page of the first volume, which was startedby the editor, Sydney Rowland, a medical student atthe time, carried a descriptive phrase; "A series ofcollotype illustrations with descriptive text, illustratingapplications of the new photography to medicine andsurgery." In the Preface (dated April 2, 1896) Rowlandnoted that radiography is "nothing more than the pho-tographic representation of the shadow cast by opaquebony structure, or by metallic foreign bodies, on sensi-tized plates." In the Introduction he provided adescription of the equipment used, the manner of use,and the original experiment by Roentgen (Fig 2), Itwas Rowland who had coined the term, skiagraphy,which meant "shadow pictures."

After a disagreement over policy with Rowland, theRoentgen Society withdrew its suppotl (although thepublication never bad been the official organ of thesociety) and the Archives started to include materialon electrotherapeutics. In 1904 the title was changedto the Archives of the Roentgen Ray and Allied Phen-omena with the subtitle. An International MonthlyReview of the Practice of Physical Therapeutics. Withthe outbreak of World War I in 1914, tbe title waschanged once again, this time to Archives ofRadiology and Electrotherapy. In the late 1920s thetitle was changed still another time, to the Britishjournal of Radiology.

Copies of early issues are difficult to locate, but arewell worth the time and effort. The first issue appearedin either April or May 1896 (just 4 montbs after theoriginal announcement of x-rays by Roentgen).Althougb major portions of the issues were devoted tomedical conditions and to instruments and equipment,dental conditions were reported and were accompa-nied vnth their attendant x-ray photographs.

Fig 2 Eariy x-ray equipment.

The first 8 volumes of the Archives of Skiagraphycontain as many as 10 articles demonstrating the useof radiographs in dentistry. They were considered fordiagnostic procedures, for location of foreign objects,and for therapy for pathologic conditions. Volume 2,1897, had articles reporting "On the Nature of Roent-gen's Rays," by Silvanus P. Tbompson, and "A Standfor Radiography and Screen Work," illustrated with aline drawing of the stand and screen. Volume 6,1901-1902, included "On Radiography Applied toDental Surgery," by Prosper H. Marsden, radiographerat Liverpool Royal Infirmary. This article was illus-trated with 12 radiographs of the teeth and jaws,demonstrating a supernumerary tooth that was caus-ing a diastema, the diagnosis of the condition of atooth that was to be crowned, an unerupted rightcanine tooth, injury to teeth in a carriage accident,and an unerupted tooth encased in a jaw cyst.

Volume 7, 1902-1903, presented "A Set of ArtificialDentures Lodged in the Pharynx," by A. Eid. Tbe arti-cle bad 2 radiographs showing the position of the den-ture in the pharynx. (The denture was successfullyremoved, and the patient fully recovered,) Anotherárdele in volume 7 was "Epithelioma of Lower Lip" byJ. Hall-Edwards. A description of the treatment of the63-year-old patient was given and healing was reportedto have occurred after a number of x-ray treatments of10-minute durations over a period of 1 month. Thearticie "X-ray Treatment of Epithelioma of the Tongue,"by H. E. Gamlen, reported a 3-month treatmentsequence that included a 5-minute x-ray treatmentevery other day for a leukoplakia fhat covered theentire tongue. Three months later the leukoplakia

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recurred, and another course of x-ray treatment wascompleted. This was followed by a third regimen aftera further 3 months. Ultimately the tongue was removedsurgically, but the patient's survival time was notreported.

By volume 8, 1903-1904, articles on new forms ofx-ray tubes already appeared, accompanied withdetailed line drawings. The field continued to developrapidly both clinically and technologically until thepresent day.

German-language articles concerned with variousaspects of radiology were also frequently published. In1896 and 1897, journals included the following arti-cles: "Practical Uses of X-rays," by Geist-Jacobi, "Studyon the Determination of the Value of Roentgen Raysin Dentistry," by Julius Albrecht, "Further Work onRoentgen Rays," by O. Grunert, and "Findings in aFailing Tooth With the Aid of Roentgen Rays," by R.H. Catching. Another German-language article (by M.Hacker of Vienna) discussed the diagnosis of 2 casesof tooth retention. One wonders however, when read-ing these articles, about how much damage was doneto patients by x-rays with regular exposure times of 6to 30 minutes.

By 1897, the first continental European journalabout radiology, Fortschritte auf dem Gebiete derRoentgenstrahlen, was published In Hamburg. A fewyears later there was sufi'icient material so that othertitles were founded in other countries. These includedthe Journal Beige de Radiologie in Belgium in 1907,Strahlentherapie in Vienna in 1912, Journal deRadiologie et d'Electrologie in Paris in 1914, LaRadiológica in Italy in 1914, and Acta Radiológica inStockholm in 1921.'

EARLY MENTIONS IN THE POPULAR PRESS

The popular press was not slow in picking up theannouncement and significance of x-rays. On January6, 1896, Der Wiener Presse (Vienna) published an arti-cle on x-rays that was reprinted by the New YorkHerald of January 7, 1896.' The Pall Mall Gazette ofLondon included a number of articles on x-rays in1896, but many of these were pessimistic and fearful ofthis new and strange discovery. One of the articlesstated, "The consequence of which appears to be thatyou can see other people's bones with the naked eye,and also see through eight inches of solid wood. On therevolting indecency of this, there is no need to report."'McClure's Magazine of April 1896 published a 14-page,liberally illustrated article on Roentgen and his work.

Nature, dated January 23, 1896, and Science, datedFebruary 14, 1896, included translations of Roentgen'sarticles,' and volume 1 of the Mallinckrodt Classics ofRadiology series was devoted to Wilhelm ConradRoentgen. On a New Kind of Rays, A BibliographicalStudy."' Included were a bibliographic study ofRoentgen's first paper on the subject, a hibUography ofhis works, an English translafion of Roentgen's 3 orig-inal papers, and facsimiles thereof in both Germanand English (Fig 5). This periodical is difficult tolocate except on the rare book market, but historianswill agree that it is worth the effort to find.

CONCLUSION

The eariy literature of radiology is amazing for thespeed with which work was reported in all kinds ofpublications. It is also frightening for the understand-able ignorance of the dangers under which theresearchers worked. Even a superficial reading ofsome of the material provides a greater understandingof the suffering and death that was caused by radiationin the eariy part of the 20th century.

REFERENCES

1. Eisenberg RL. Radiology: An Illustrated History. St Louis;Mosby, 1992.

2. Ec:kert WG, Gardland N. The history of forensic applit:a-tions in radiology. Am J Forensic Med Pathol 1984;5(1):53-56.

3. Rezai RF. Otto Walkhoff-Renalssance man of dentistry.Bull Hist Dent 1986;34:115-12L

4. Grossman LL A brief history of endodontics, J Endod1982;8(special issue):s38.

5. Langland OE, Sippy FH, Langlais RP. Textbook of DentalRadiology, ed 2. Springfield. IL: Thotnas, 1984.

6. Fields RT Jr, Goaz FW. Notes or the history of dental radi-ology. Texas Dent J 1995;112(2);15-22.

7. Morton WJ. The x-ray and its application in dentistry. DentCosmos 1896;38:478-486.

8. Bober-Moken I, Perez RS. Historic insights on dental radio-graphy. Bull Hist Dent 1986:34:13-27

9. Glasser O. Am | Roent and Radium 1931;25:437-453, CitedIn Bober-Moken I, Perez RS. Historic insights on dentalradiography. Bull Hist Dent 1986;34:13-27.

10. Klickstein HS (ed). Wilhelm Conrad Roentgen. On a NewKind of Rays. A Bibliographical Study. Mallinkrodt Classicsof Radiology, vol 1. Philadelphia Mallinkrodt Chemical Co,1966.

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