History

The Foundation and Early Meetings of the Society for Pediatric Radiology

^{by N. Thorne Griscom, MD}

^{Drs. Neuhauser, Caffey, Holt, Silverman and Taybi at the 1975 meeting in Atlanta Georgia}

John Patrick Caffey was born in 1895, the year of Roentgen's discovery. He was trained in internal medicine at Barnes Hospital in St. Louis and at the University of Michigan and then in pediatrics at Babies Hospital in New York. His academic career in pediatrics was well underway at Babies Hospital when, in 1929, he was abruptly assigned to take charge of radiology as the hospital's first in-house radiologist (the position was actually titled "roentgenologist"). At first he tried to avoid this added duty, but he found he enjoyed it. He began to realize that the field was wide open for a physician of scholarly bent and pediatric background, and he seized his opportunity. He rapidly taught himself the range of normal appearances and the plain-film manifestations of children's diseases. His first radiologic articles dealt with the findings in lead poisoning, rickets, the hemolytic anemias, hemophilia, and syphilis. His meticulous, disciplined approach led, in 1945, to the first edition of Pediatric X-ray Diagnosis, a major step toward establishing pediatric radiology as a discipline within pediatrics (as Dr. Caffey probably expected) and radiology (as it turned out). The second edition of this enormously influential book was published in 1950 and the third edition in 1956. His description of infantile cortical hyperostoses ("Caffey's disease") appeared in 1945, and his observations on the frequent presence of fractures in the long bones of infants suffering from subdural hematomas- that is, battered children-were published in 1946, both in the American Journal of Roentgenology. During the 1950s he produced a whole series of reports defining the normal radiologic appearance of various bones and establishing the normality of several findings that had previously been considered pathologic. 

John Patrick Caffey was born in 1895, the year of Roentgen's discovery. He was trained in internal medicine at Barnes Hospital in St. Louis and at the University of Michigan and then in pediatrics at Babies Hospital in New York. His academic career in pediatrics was well underway at Babies Hospital when, in 1929, he was abruptly assigned to take charge of radiology as the hospital's first in-house radiologist (the position was actually titled "roentgenologist"). At first he tried to avoid this added duty, but he found he enjoyed it. He began to realize that the field was wide open for a physician of scholarly bent and pediatric background, and he seized his opportunity. He rapidly taught himself the range of normal appearances and the plain-film manifestations of children's diseases. His first radiologic articles dealt with the findings in lead poisoning, rickets, the hemolytic anemias, hemophilia, and syphilis. His meticulous, disciplined approach led, in 1945, to the first edition of Pediatric X-ray Diagnosis, a major step toward establishing pediatric radiology as a discipline within pediatrics (as Dr. Caffey probably expected) and radiology (as it turned out). The second edition of this enormously influential book was published in 1950 and the third edition in 1956. His description of infantile cortical hyperostoses ("Caffey's disease") appeared in 1945, and his observations on the frequent presence of fractures in the long bones of infants suffering from subdural hematomas- that is, battered children-were published in 1946, both in the American Journal of Roentgenology. During the 1950s he produced a whole series of reports defining the normal radiologic appearance of various bones and establishing the normality of several findings that had previously been considered pathologic.

Edward Blaine Duncan Neuhauser, born in 1908, had a very different medical background. His first post-internship training was in orthopedics. However, orthopedic routines quickly led to disenchantment; the crowning blow was a family of five children, all of whom needed to have their slightly flat feet checked and their corrective shoes (16 boxes of them, brought in by the chauffeur) re-prescribed. Deeply discouraged and never bound by orthodoxy, Dr. Neuhauser considered a variety of career alternatives, including that of being a professional tugboat captain. Calmer counsel prevailed, however, and he entered radiology residency at the University of Pennsylvania. In 1941, he was appointed roentgenologist at Children's Hospital in Boston and started up the academic ladder at Harvard. He began to produce a blizzard of articles on such topics as cystic fibrosis, vascular rings, gastroesophageal reflux, leukemic infiltration of the kidneys, the pathophysiology of Hirschsprung disease, diastematomyelia, and the effects of radiation therapy on the growing spine. Though his original training had been in orthopedics, only a modest number of his reports were on osseous subjects. Dr. Caffey, on the other hand, though trained in internal medicine and pediatrics, concentrated on the skeletal system in his scientific articles. Dr. Neuhauser established the world's first regular pediatric radiology fellowship in 1949. He was a spectacularly stimulating teacher. With residents, fellows, and visitors crowding behind him, he would interpret the day's films, using the Socratic method of questioning his students until the correct observations were made and the critical deductions drawn. He was a brilliant, intuitive radiologist, a connoisseur of syndromes, a devotee of esoteric information, and a superb publicist for pediatric radiology.

By the late 1950s, these two giants and their colleagues had developed pediatric radiology to the point where the need for a society to focus and improve the radiologic care of children was felt in both pediatric and radiologic circles. One factor suggesting such an organization was a surge in concern about the risks of radiation, fueled by above-ground testing of nuclear weapons in Nevada, the Soviet Union, and elsewhere. The president of the American Academy of Pediatrics approached Dr. Caffey about the formation of a section on radiology, parallel to the academy's surgical section. Close to mandatory retirement at Columbia and not particularly fond of organizational chores, Dr. Caffey referred him to Dr. Frederic Silverman, who had trained with Dr. Caffey and who had become the roentgenologist for Children's Hospital in Cincinnati. Accordingly, early in 1958, Dr. Silverman sent out a letter to 19 (later 26) American and Canadian physicians (some were pediatricians but most were radiologists) practicing pediatric radiology. That letter described three possible roads for a pediatric radiologic organization to follow-affiliation with the American Academy of Pediatrics, affiliation with a radiologic organization, and complete independence-but leaned toward the first course. The response was encouraging, and Dr. Silverman (noting the simultaneous efforts of Dr. Harold Peterson, described next) arranged a luncheon meeting of interested physicians for April 21 during the annual meeting of the American Academy of Pediatrics in New York.

And so it begins.....

Dr. Neuhauser was then chairman of the publication committee of the American Roentgen Ray Society and was about to become its president-elect. At his suggestion, Dr. Harold Peterson, director of instructional courses for the society and chief of radiology at the University of Minnesota, sent out a letter suggesting a one-day get-together-"a 'jam session' for pediatric radiologists"-in Washington, DC, to take place the day before the opening of the society's annual meeting. Though it would have no official connection with the pediatric session, the American Roentgen Ray Society would provide viewboxes, a lantern slide projector, and a blackboard. The meeting would not be publicized to the general membership of the American Roentgen Ray Society.

These two approaches seemed to be on a collision course, and this was the subject of much discussion at Dr. Silverman's April 21 meeting. However, to quote his summary, "it became clear, as the discussion went on, that most of the individuals [there were only nine] at the meeting had a greater affinity for radiology meetings." He cited the scientific and commercial exhibits in support of this but left the issue open for further consideration at the September meeting in Washington, DC. In July, Dr. Peterson circulated an official announcement of that meeting; it would be for "radiologists who are primarily interested in pediatric radiology"; it was not an official function of the American Roentgen Ray Society but was "a result of personal discussions between Dr. Neuhauser and myself"; it would last from 10 AM to 4 PM and would include lunch; there was to be no printed program, but everyone should be prepared to present his or her own cases and discuss others' cases and problems in a very informal way; those present would decide whether they should organize themselves into a society.

This September 29, 1958, meeting in the Shoreham Hotel in Washington, DC, was the first annual meeting of the Society for Pediatric Radiology (SPR). Thirty-three physicians (one from France) signed the attendance sheet, including 11 who later became president of the society. There was one woman in the group. The majority were radiologists, but some had been trained wholly in pediatrics, and the motions passed at the meeting do not include any requirement for formal radiologic training. It was decided (discussion on the point was reportedly not entirely free of acrimony) that the society would meet in conjunction with the American Roentgen Ray Society. Dr. Neuhauser was elected president by acclamation, perhaps because more than half of the charter members had spent some time in Boston under his pedagogical spell. Dr. Silverman was named president-elect, not only because of his outstanding qualifications and his close ties to Dr. Caffey (who was not present), but also because he practiced in Cincinnati, the site of the next meeting of the American Roentgen Ray Society. The scientific part of the meeting consisted mostly of interesting cases shown by lantern slides or by films on viewboxes. Unsigned handwritten notes in the society's archives show that Dr. Neuhauser presented data and films on infantile polycystic kidney disease and its coexistence with pulmonary hypoplasia and cystic disease of the liver (2). Dr. Edward Singleton showed a case of pulmonary microlithiasis in an 11-year-old child. Dr. John Kirkpatrick had brought a cine-roentgenographic strip of poor esophageal peristalsis after repair of esophageal atresia (3). There were several other presentations, the notes on some of which cannot be deciphered. Thus, radiology's first subspecialty organization was born.

During the next year, a rules committee thrashed out many organizational issues. The society should be separate and autonomous. Membership should be confined to individuals with a primary interest in pediatric radiology and should be limited to 100. Part or all of the meeting should be closed to everyone but members and contributing guests. The meeting should ordinarily be held the Monday before the meeting of the American Roentgen Ray Society, which had customarily devoted that day to golf. Members failing to attend five consecutive meetings were to be dropped from the rolls.

The second meeting (in 1959) of the SPR, held in Cincinnati, showed the results of these organizational efforts. The tradition of the evening-before reception was inaugurated at the home of Dr. and Mrs. Silverman; the reception was nearly swamped by gate-crashers from the larger society. The meeting itself was held at Children's Hospital, and lunch was in the hospital cafeteria. There were 16 presentations. About half dealt with plain films; the remainder, with intravenous urography, barium studies, nuclear medicine, dosimetry, and so forth (6). Many were merely case reports. Fourteen of the presentations were supported by an abstract of one to five sentences; each had only a single author. The abstracts were more teasing than informative, few of them really summarizing the material to be presented. One presenter found that he could not attend; Dr. Silverman hoarded the unused 15 minutes until the end of the day and then devoted the time to "Members' Miscellany," a series of even more informal presentations that actually lasted about an hour and a half. The meeting was characterized by spontaneity, freedom of discussion, a high degree of stimulation, and ease of transfer of information. The information transferred, however, would not have met modern standards for scientific rigor. Dr. Caffey was in attendance and, in recognition of his enormous contributions, was elected honorary counsellor.

John Holt of the University of Michigan was president for the third (1960) annual meeting, in Atlantic City. Of the 52 members, more than half were from the northeastern United States, but seven were from Canada and one was from France; most were at the meeting. The American Roentgen Ray Society, of which Dr. Neuhauser was then president, provided the meeting room and the projection equipment. The program, which was circulated ahead of time, consisted of a reception the previous evening, 19 scheduled papers (including one from Germany and one from France), lunch for members, a separate "Ladies' Dutch Treat Luncheon" for wives (there was no note of husbands), and "Members' Miscellany." Once again, plain films dominated the presentations. The only contrast material examinations discussed were barium studies, urograms, and cystograms. There was one nuclear medicine paper but none on any form of cross-sectional imaging. However, nearly every organ system--the major exception was the central nervous system--was represented on the program (6). Discussion was uninhibited, and excitement was great. By the end of the meeting it was clear that, as a vehicle for the promotion of good radiologic care of children, the society would be a success (8).

*Among the sources for this article were the archives and programs of the SPR and interviews of Drs. Frederic Silverman, John Gwinn, John Kirkpatrick, and Bertram Girdany. Additions and corrections by those who were actually present at these events will be welcome.

1. Silverman FN. Presentation of the John Howland Medal and Award of The American Pediatric Society to Dr. John Caffey. J Pediatr1965; 67:1000-1007.
2. Reilly BJ, Neuhauser EB. Renal tubular ectasia in cystic disease of the kidneys and liver. AJR 1960, 84:546-554.
3. Kirkpatrick JA, Cresson SL, Pilling GP IV. The motor activity of the esophagus in association with esophageal atresia and tracheoesophageal fistula. AJR 1961; 86: 884-887.
4. Holt JF, Wright EM. The radiological features of neurofibromatosis. Radiology 1948; 51: 647-664.
5. Keats TE, Anast CS. Circumscribed skeletal rarefactions in osteogenesis imperfecta. AJR 1960, 84:492-498.
6. Griscom NT, Jaramillo D. Trends in papers presented at meetings of the Society for Pediatric Radiology. Pediatr Radiol 1995, 25: 161-164
7. Silverman FN. Dysplasies épiphysaires: entité proteiforme. Ann Radiol (Paris) 1961; 4: 833-867.
8. Griscom NT. Pediatric radiology in the United States and Canada. In: Gagliardi R. ed. A history of the radiological sciences: diagnosis. Reston VA: Radiology Centennial, Inc., 1996:345-368.