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CHARLES FREDER ICK BAKER, M. D.
198 Clinton Avenue,
Newark, N.J.
April 27th, 1928.
Messrs. Collins & Corbin,
1 Exchange Place,
Jersey City, N. J.
Gentlemen:-
On April 24th, 1928, at 4.pm. I visited the
Orthopedic Hospital in Orenge with Dr. Rector and examined the
xray films of the following individuals supposed to be suffering
from radium poisoning as a result of pointing brushes on the tongue,
said brushes being used in applying radioactive substances on
watch dials. Previous to examining these films I had had ex-
perience with one case (Miss Eckert who later worked for L. Bam-
berger Co. ) but who it was found worked in the same way pointing
the brushes on her tongue. I was therefore prepared for the de-
tection of the bone changes shown to have existed in these five
cases. In as much as these are among the earliest discovered who
have suffered from this affliction and no great number of cases are
at hand for comparative study, it is not easy without the history
of radium poisoning, to state definitely what the bone changes are
due to excepting that the bone changes do not conform exactly to
those found in any other known disease.
In these lesions we find irregular increase
in bone density going hand in hand with erosion in other portions
of the same or other bones and a collapse of some of the bones
subjected to pressure viz: the vertebrae. The hips which are
subjected to pressure by weight bearing show more or less erosion
of the articular surfaces of the femurs while at the same time
we find irregular white lines in the adjacent portions of the
femur and ischium (a part of the large pelvic bone). It is reason-
able to think that radiumwhichhas become permanently fixed in the
endothelial structures of the bone first produced a mild (but
constant) stimulation which resulted in striations of new bone of
greater density than the normal, and that as time goes on and the
radiation is forever acting the bone undergoes atrophy with ultimate
collapse most notable in those locations on which pressure is born.
LST CASE STUDIED: CATHERINE STRAUB. Showed
partial destruction of the articular surface of the femur in the
right hip joint, the cartilage space being normal. Below the
articular surface above mentioned the bone showed increased den-
sity. There were a few scattered shadows of increased density
in the left ischial tuberosity and the left femur, the latter
occurring in upper shaft and neck. The left ankle films showed
increased density in the lower portion of the tibia and the articular
surface of the astragalus showed beginning erosion.
2ND CASE: MRS. J. LARICE. Throughout the pelvis
bones could be seen striations of increased bond density running
through the ilia and sacrum, these lines showing no regular con-
formation and not simulating any previously known bone disease. The
ilial tuberosities appeared slightly involved. The left hip showed
a slight irregularity in the outline of the head of the femur in-
dicating a beginning erosion.
3RD CASE: Mrs. EDNA HUSSMAN. Plates dated
November 1925 showed a "pathological" fracture of the neck of the
left femur. Films of November 6, 1926, show union. As to this
case I do not have any other knowledge as to the cause of the
fracture than Dr. Humphrey's statement that it was a radium case
and that no trauma was received. As to the bone changes, they were
not typical as in the other cases, there being an absence of erosion
or the striations above described.
4TH CASE: MRS. QUINTO McDONALD. The heads of both
femurs showed areas of diminished density and bone or calcific (lime)
shadows were seen along the necks and heads of both femurs (result
of bone stimulation). In both hips the articular surfaces showed
slight erosion.
5TH CASE. GRACE FRYER. This case showed involve-
ment of spine and left foot. The bodies of the first, second and
third lumbar vertebrae were much diminished in density and although
the cortex was not destroyed erosion not yet having occurred, the
outlines suggested pressure with indentation of the superior and
inferior surfaces.
In the left foot there was a lesion of the
scaphoid bone which was partly destroyed with marked change in its
contour going hand in hand with increased density throughout the
bone. The appearance of this bone is similar to that in which bone
destruction from infection has occurred and when repair has started.
The films of this foot were identical with those of Miss Eckert
whom I xrayed at my office last year for the same disease and in
whom not knowing of her previous exposure to this condition and not
having had other experience I at first made an incorrect diagnosis.
These two cases showed such similar appearances in the same bone S that
if the films were not marked for identification could not be told
apart.
Very truly yours,
C. F. BAKER, M. D.
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"ocrText": "CHARLES FREDER ICK BAKER, M. D.\n198 Clinton Avenue,\nNewark, N.J.\nApril 27th, 1928.\nMessrs. Collins & Corbin,\n1 Exchange Place,\nJersey City, N. J.\nGentlemen:-\nOn April 24th, 1928, at 4.pm. I visited the\nOrthopedic Hospital in Orenge with Dr. Rector and examined the\nxray films of the following individuals supposed to be suffering\nfrom radium poisoning as a result of pointing brushes on the tongue,\nsaid brushes being used in applying radioactive substances on\nwatch dials. Previous to examining these films I had had ex-\nperience with one case (Miss Eckert who later worked for L. Bam-\nberger Co. ) but who it was found worked in the same way pointing\nthe brushes on her tongue. I was therefore prepared for the de-\ntection of the bone changes shown to have existed in these five\ncases. In as much as these are among the earliest discovered who\nhave suffered from this affliction and no great number of cases are\nat hand for comparative study, it is not easy without the history\nof radium poisoning, to state definitely what the bone changes are\ndue to excepting that the bone changes do not conform exactly to\nthose found in any other known disease.\nIn these lesions we find irregular increase\nin bone density going hand in hand with erosion in other portions\nof the same or other bones and a collapse of some of the bones\nsubjected to pressure viz: the vertebrae. The hips which are\nsubjected to pressure by weight bearing show more or less erosion\nof the articular surfaces of the femurs while at the same time\nwe find irregular white lines in the adjacent portions of the\nfemur and ischium (a part of the large pelvic bone). It is reason-\nable to think that radiumwhichhas become permanently fixed in the\nendothelial structures of the bone first produced a mild (but\nconstant) stimulation which resulted in striations of new bone of\ngreater density than the normal, and that as time goes on and the\nradiation is forever acting the bone undergoes atrophy with ultimate\ncollapse most notable in those locations on which pressure is born.\nLST CASE STUDIED: CATHERINE STRAUB. Showed\npartial destruction of the articular surface of the femur in the\nright hip joint, the cartilage space being normal. Below the\narticular surface above mentioned the bone showed increased den-\nsity. There were a few scattered shadows of increased density\nin the left ischial tuberosity and the left femur, the latter\noccurring in upper shaft and neck. The left ankle films showed\nincreased density in the lower portion of the tibia and the articular\nsurface of the astragalus showed beginning erosion.\n2ND CASE: MRS. J. LARICE. Throughout the pelvis\nbones could be seen striations of increased bond density running\nthrough the ilia and sacrum, these lines showing no regular con-\nformation and not simulating any previously known bone disease. The\nilial tuberosities appeared slightly involved. The left hip showed\na slight irregularity in the outline of the head of the femur in-\ndicating a beginning erosion.\n3RD CASE: Mrs. EDNA HUSSMAN. Plates dated\nNovember 1925 showed a \"pathological\" fracture of the neck of the\nleft femur. Films of November 6, 1926, show union. As to this\ncase I do not have any other knowledge as to the cause of the\nfracture than Dr. Humphrey's statement that it was a radium case\nand that no trauma was received. As to the bone changes, they were\nnot typical as in the other cases, there being an absence of erosion\nor the striations above described.\n4TH CASE: MRS. QUINTO McDONALD. The heads of both\nfemurs showed areas of diminished density and bone or calcific (lime)\nshadows were seen along the necks and heads of both femurs (result\nof bone stimulation). In both hips the articular surfaces showed\nslight erosion.\n5TH CASE. GRACE FRYER. This case showed involve-\nment of spine and left foot. The bodies of the first, second and\nthird lumbar vertebrae were much diminished in density and although\nthe cortex was not destroyed erosion not yet having occurred, the\noutlines suggested pressure with indentation of the superior and\ninferior surfaces.\nIn the left foot there was a lesion of the\nscaphoid bone which was partly destroyed with marked change in its\ncontour going hand in hand with increased density throughout the\nbone. The appearance of this bone is similar to that in which bone\ndestruction from infection has occurred and when repair has started.\nThe films of this foot were identical with those of Miss Eckert\nwhom I xrayed at my office last year for the same disease and in\nwhom not knowing of her previous exposure to this condition and not\nhaving had other experience I at first made an incorrect diagnosis.\nThese two cases showed such similar appearances in the same bone S that\nif the films were not marked for identification could not be told\napart.\nVery truly yours,\nC. F. BAKER, M. D."
}