Radiology in ragtime: Seeing beyond the air

Walter Dandy's immense contribution to radiological diagnosis of cerebral disease in the form of intraventricular air is well known. His pivotal role in neuroradiological evaluation from 1918 to the 1970's was not without precedent, but how much the unexpected radiological diagnosis of traumatic pneumoventricle before 1918 influenced radiodiagnostics is the question this paper examines in detail.

A critical review of the first radiographically documented case of pneumoventricle, seen in 1912 by Drs. William H Stewart and William H. Luckett of New York City. Discussion is of the diagnosis and treatment of this condition in a 47-year-old man who was hit by a trolley car, sustaining a fracture of the outer and inner table of the right frontal sinus. Some general literature of this period (including Dandy's) concerning neuroradiological diagnosis is examined to help form a better picture of early 20^th-century knowledge of intraventricular air, both accidental and deliberate.

Reasoned speculation about the diagnosis and treatment of pneumoventricle in 1912 leads to the conclusion that in the early 1910s, neurosurgeons and radiologists would never have been able to see the potential for neurological and neurosurgical diagnoses from radiographs depicting air in the ventricular system. Dandy's air studies of the brain and abdomen are examined in some detail in the first section of the paper, because some unexpected linkages and conflicts in information were found. Similarly, the discussion of the Luckett and Stewart case is well detailed because again, crucial conflicts in information are found that are independent of Dandy.

While of great interest in its own right, the first published case of pneumoventricle diagnosed by skull x-rays is found to have no impact on Dandy's work with pneumoventriculography 5 years later.