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DIAGNOSTIC IMAGING
This new edition is also available as an e-book.
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Companion website
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ANDR E A R O C K A L L
BSc, MBBS, MRCP, FRCR
Professor of Radiology
Imperial College, London, UK
ANDREW HATRICK
MA, MB BChir, MRCP, FRCR
Consultant General and Interventional Radiologist
Frimley Park Hospital NHS Foundation Trust
Frimley, UK
PETER ARMSTRONG
MBBS, FMed Sci, FRCP, FRCR
Formerly Professor of Radiology
Medical College of St Bartholomew’s
and the Royal London Hospitals, London, UK
Formerly Professor and Vice-Chairman
Department of Radiology, University of Virginia
Charlottesville, Virginia, USA
MARTIN WASTIE
MB BChir, FRCP, FRCR
Formerly Professor of Radiology
University of Malaya Medical Centre
Kuala Lumpur, Malaysia
Formerly Consultant Radiologist
University Hospital, Nottingham, UK
SEVENTH EDITION
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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
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Cover image: © Andrea Rockall, Andrew Hatrick, Peter Armstrong, Martin Wastie
Cover design by Jim Smith
1 2013
Contents
v
Preface
Medical imaging is central to many aspects of patient man- only the advantages but also the limitations of modern
agement. Medical students and junior doctors can be for- medical imaging.
given their bewilderment when faced with the daunting We have continued to try to meet the needs of the medical
array of information which goes under the heading student and doctors in training by explaining the tech-
‘Diagnostic imaging’. Plain film examinations remain the niques used in diagnostic imaging and the indications for
most frequently requested imaging investigations that non- their use. We aim to help the reader understand the prin-
radiologists may be called on to interpret and we continue ciples of interpretation of imaging investigations. New for
to give them due emphasis. However, the use of cross- this edition is the availability of online material, including
sectional imaging techniques continues to increase and, in multiple choice questions for each chapter, allowing readers
some situations, has taken over from the plain film. The to test their knowledge.
growing use of ultrasound, computed tomography (CT), It is beyond the scope of a small book such as this one to
magnetic resonance imaging (MRI), radionuclide imaging, describe fully the pathology responsible for the various
including positron emission tomography (PET), and inter- imaging appearances and the role of imaging in clinical
ventional radiology is reflected in the new edition. management. Consequently, we encourage our readers to
With the widespread availability of most of the various study this book in association with the study of these other
imaging techniques, there are often several ways of inves- subjects.
tigating the same condition. We have avoided being too
prescriptive as practice varies depending on the available Andrea Rockall
equipment as well as the preferences of the clinicians and Andrew Hatrick
radiologists. It is important, however, to appreciate not Peter Armstrong
Martin Wastie
vii
Acknowledgements
It would not have been possible to prepare this edition The following kindly provided illustrations for this and
without the help of the many radiologists who have given previous editions: Lorenzo Biassoni, Nishat Bharwani, John
ideas, valuable comments and inspiration. We would like Bowe, Paul Clark, Siew Chen Chua, Peter Jackson, Jill
to thank particularly the staff of the Radiology Departments Jacobs, Ranjit Kaur, Priya Narayanan, Steven Oscroft, Niall
at St Bartholomew’s Hospital, London, Frimley Park Power, Shaun Preston, Ian Rothwell, Peter Twining,
NHS Trust, University Hospital, Nottingham, University of Caroline Westerhout and Bob Wilcox.
Malaya Medical Centre, Kuala Lumpur and County We would like to thank Julie Jessop for her superb sec-
Hospital, Lincoln for this and past edition illustrations. Our retarial help and we would like to express our gratitude to
special thanks go to those radiologists who gave us their the staff of Wiley-Blackwell.
expert assistance, including Dr Rob Barker, Dr Francesca
Pugliese, Dr Sarah Vinnicombe, Dr Muaaze Ahmad, Dr
Polly Richards and Dr Kasthoori Jayarani.
viii
List of Abbreviations
ix
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x
The Anytime, Anywhere Textbook xi
Companion website
www.wileydiagnosticimaging.com
The website includes:
• Interactive multiple choice questions for each chapter
• Figures from the book in PowerPoint format
1
Technical Considerations
Diagnostic Imaging, Seventh Edition. Andrea Rockall, Andrew Hatrick, Peter Armstrong, and Martin Wastie.
© 2013 A. Rockall, A. Hatrick, P. Armstrong, M. Wastie. Published 2013 by John Wiley & Sons, Ltd.
1
2 Chapter 1
tissues. Traditionally, images were produced using a silver- other planes are sometimes practicable, axial sections are
based photographic emulsion but now they are recorded by far the most frequent. The operator selects the level and
digitally and viewed on computer screens in most centres. thickness to be imaged: the usual thickness is between 1.25
Projections are usually described by the path of the x-ray and 2 mm (often viewed by aggregating adjacent sections
beam. Thus, the term PA (posteroanterior) view designates so they become 5 mm thick). The patient is moved past an
that the beam passes from the back to the front, the stand- array of detectors within the machine. In effect, the data at
ard projection for a routine chest film. An AP (anteroposte- multiple adjacent levels are collected continuously, during
rior) view is taken from the front. The term ‘frontal’ refers which time the x-ray beam traces a spiral path to create a
to either PA or AP projection. The image on an x-ray film ‘volume of data’ within the computer memory. Multidetector
is two-dimensional. All the structures along the path of the (multislice) CT acquires multiple slices (64, 128, 256 or 320
beam are projected on to the same portion of the film. depending on the machine) during one rotation of the x-ray
Therefore, it is often necessary to take at least two views to tube. Multidetector CT enables the examination to be per-
gain information about the third dimension. These two formed in a few seconds, thereby enabling hundreds of thin
views are usually at right angles to one another, e.g. the PA sections to be obtained in one breath-hold. A relatively new
and lateral chest film. Sometimes two views at right angles development is dual source (or dual energy) CT. This tech-
are not appropriate and oblique views are substituted. nique allows a virtual non-contrast CT image to be derived
Portable x-ray machines can be used to take films of from CT acquired with intravenous iodinated contrast
patients on the ward or in the operating theatre. Such medium (see later in chapter) allowing a reduction in radia-
machines have limitations on the exposures they can tion dose in certain CT protocols.
achieve. This usually means longer exposure times and The data obtained from the multislice CT exposures are
poorer quality films. The positioning and radiation protec- reconstructed into an image by computer manipulation.
tion of patients in bed is often inferior to that which can be The computer calculates the attenuation (absorption) value
achieved within the x-ray department. Consequently, port- of each picture element (pixel). Each pixel is 0.25–0.6 mm
able films should only be requested when the patient in diameter, depending on the resolution of the machine,
cannot be moved safely to the x-ray department. with a height corresponding to the chosen section thick-
ness. The resulting images are displayed on a monitor and
can be stored electronically. The attenuation values are
expressed on an arbitrary scale (Hounsfield units) with
Computed tomography
water density being zero, air density being minus 1000
Computed tomography (CT) also relies on x-rays transmit- units and bone density being plus 1000 units (Fig. 1.2). The
ted through the body. It differs from conventional radiog- range and level of densities to be displayed can be selected
raphy in that a more sensitive x-ray detection system is by controls on the computer. The range of densities visual-
used, the images consist of sections (slices) through the ized on a particular image is known as the window width
body, and the data are manipulated by a computer. The and the mean level as the window level or window centre. CT
x-ray tube and detectors rotate around the patient (Fig. 1.1). is usually performed in the axial plane, but because attenu-
The outstanding feature of CT is that very small differences ation values for every pixel are present in the computer
in x-ray absorption values can be visualized. Compared memory it is possible to reconstruct excellent images in
with conventional radiography, the range of densities other planes, e.g. coronal (Fig. 1.3), sagittal or oblique, and
recorded is increased approximately ten-fold. Not only can even three-dimensional (3D) images (Fig. 1.4).
fat be distinguished from other soft tissues, but also grada- The human eye can only appreciate a limited number of
tions of density within soft tissues can be recognized, e.g. shades of grey. With a wide window all the structures are
brain substance from cerebrospinal fluid, or tumour from visible, but fine details of density difference cannot be
surrounding normal tissues. appreciated. With a narrow window width, variations of
The patient lies with the body part to be examined within just a few Hounsfield units can be seen, but much of the
the gantry housing the x-ray tube and detectors. Although image is either totally black or totally white and in these
Technical Considerations 3
X-ray tube
Scan
areas no useful information is provided. The effects of implants, dental fillings or surgical clips. Both types give
varying window width and level are illustrated in Figs 1.5 rise to radiating linear streaks. The major problem is the
and 2.6. resulting degradation of the image.
+1000 Bone
+100
Liver–approx +80
Muscle–approx +55
Kidneys–approx +40
0 Water (cysts)
Fat
–100
–1000 Air
(a)
Fig. 1.4 Shaded surface 3D CT reconstruction. The images can be
viewed in any desired projection and give a better appreciation of
the pelvis. Two fractures are demonstrated in the left innominate
bone (arrows), which were hard to diagnose on plain film.
Ultrasound
In diagnostic ultrasound examinations, very high fre-
quency sound is directed into the body from a transducer
placed in contact with the skin. In order to make good
acoustic contact, the skin is smeared with a jelly-like sub-
stance. As the sound travels through the body, it is reflected
by the tissue interfaces to produce echoes which are picked
up by the same transducer and converted into an electrical
signal. (b)
As air, bone and other heavily calcified materials absorb
nearly all the ultrasound beam, ultrasound plays little Fig. 1.5 Effect of varying window width on CT. In (a) and (b) the
part in the diagnosis of lung or bone disease. The informa- level has been kept constant at 65 Hounsfield units (HU). The
window width in (a) is 500 HU whereas in (b) it is only 150 HU.
tion from abdominal examinations may be significantly
Note that in the narrow window image (b), the metastases are
impaired by gas in the bowel, which interferes with the better seen, but that structures other than the liver are better
transmission of sound. seen in (a).
Fluid is a good conductor of sound, and ultrasound is,
therefore, a particularly good imaging modality for diag-
nosing cysts, examining fluid-filled structures such as the
bladder and biliary system, and demonstrating the fetus in structures produce echoes from their walls but no echoes
its amniotic sac. Ultrasound can also be used to demon- from the fluid contained within them. Also, more echoes
strate solid structures that have a different acoustic imped- than usual are received from the tissues behind the cyst, an
ance to adjacent normal tissues, e.g. metastases. effect known as acoustic enhancement. Conversely, with a
Ultrasound is often used to determine whether a struc- calcified structure, e.g. a gall stone (Fig. 1.7), there is a great
ture is solid or cystic (Fig. 1.6). Cysts or other fluid-filled reduction in the sound that will pass through, so a band of
6 Chapter 1
reduced echoes, referred to as an acoustic shadow, is seen Fig. 1.7 Ultrasound scan of gall bladder showing a large stone in
behind the stone. the neck of the gall bladder (downward pointing arrow). Note
Ultrasound is produced by causing a special crystal to the acoustic shadow behind the stone (horizontal double-headed
oscillate at a predetermined frequency. Very short pulses arrow).
of sound lasting about a millionth of a second are transmit-
ted approximately 500 times each second. The crystal not
only transmits the pulses of sound but also ‘listens’ to the number of slices must be created by moving or angling the
returning echoes, which are electronically amplified to be transducer.
recorded as signals on a television monitor. Photographic Unlike other imaging modalities, there are no fixed pro-
or video reproductions of the image can provide a perma- jections and the production of the images and their subse-
nent record. quent interpretation depend very much on the observations
The time taken for each echo to return to the transducer of the operator during the examination. Ultrasound images
is proportional to the distance travelled. Knowledge of the are capable of providing highly detailed information, e.g.
depth of the interface responsible for the echoes allows an very small lesions can be demonstrated (Fig. 1.8).
image to be produced. Also, by knowing the velocity of Small ultrasound probes, which may be placed very
sound in tissues, it is possible to measure the distance close to the region of interest, produce highly detailed
between interfaces. This is of great practical importance in images but with a limited range of a few centimetres. Exam
obstetrics, for example, where the measurement of fetal ples are rectal probes for examining the prostate and trans-
anatomy has become the standard method of estimating vaginal probes for the examination of the pelvic structures.
fetal age. Tiny ultrasound probes may be incorporated in the end of
During the scan, the ultrasound beam is electronically an endoscope. Lesions of the oesophagus, heart and aorta
swept through the patient’s body and a section of the inter- may be demonstrated with an endoscope placed in the
nal anatomy is instantaneously displayed. The resulting oesophagus, and lesions of the pancreas may be detected
image is a slice, so in order to obtain a 3D assessment a with an endoscope passed into the stomach and duode-
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mummified as in the Eastern prairies, are readily reduced to
skeletons.
The station-house in the Reese-River Valley had lately been
evacuated by its proprietors and burnt down by the Indians: a new
building of adobe was already assuming a comfortable shape. The
food around it being poor and thin, our cattle were driven to the
mountains. At night, probably by contrast with the torrid sun, the
frost appeared colder than ever: we provided against it, however, by
burrowing into the haystack, and, despite the jackal-like cry of the
coyote and the near tramping of the old white mare, we slept like
tops.
To Smith’s Creek. 14th October.
Before 8 A.M. we were under way, bound for Smith’s Creek. Our
path stretched over the remainder of Reese’s River Valley, an
expanse of white sage and large rabbit-bush which affords fuel even
when green. After a long and peculiarly rough divide, we sighted the
place of our destination. It lay beyond a broad plain or valley, like a
huge white “splotch” in the centre, set in dirty brown vegetation,
backed by bare and rugged hills, which are snow-topped only on the
north; presently we reached the “splotch,” which changed its aspect
from that of a muddy pool to a yellow floor of earth so hard that the
wheels scarcely made a dent, except where a later inundation had
caused the mud to cake, flake, and curl—smooth as ice without
being slippery. Beyond that point, guided by streams meandering
through willow-thickets, we entered a kanyon—all are now wearying
of the name—and presently sighted the station deep in a hollow. It
had a good stone corral and the usual haystack, which fires on the
hill-tops seemed to menace. Among the station-folks we found two
New Yorkers, a Belfast man, and a tawny Mexican named Anton,
who had passed his life riding the San Bernardino road. The house
was unusually neat, and displayed even signs of decoration in the
adornment of the bunks with osier-work taken from the neighboring
creek. We are now in the lands of the Pa Yuta, and rarely fail to
meet a party on the road: they at once propose “shwop,” and readily
exchange pine nuts for “white grub,” i. e., biscuits. I observed,
however, that none of the natives were allowed to enter the station-
house, whereas in other places, especially among the Mormons, the
savages squeezed themselves into the room, took the best seats
near the fire, and never showed a symptom of moving.
To Cold Springs. 15th October.
After a warmer night than usual—thanks to fire and lodging—we
awoke, and found a genial south wind blowing. Our road lay through
the kanyon, whose floor was flush with the plain; the bed of the
mountain stream was the initiative of vile traveling, which, without
our suspecting it, was to last till the end of the journey. The strain
upon the vehicle came near to smashing it, and the prudent
Kennedy, with the view of sparing his best animals, gave us his
worst—two aged brutes, one of which, in consequence of her
squealing habits, had won for herself the title of “ole
“OLE HELLION.”
Hellion.” The divortia aquarum was a fine water-shed
to the westward, and the road was in V shape, whereas before it
had oscillated between U and WW. As we progressed, however, the
valleys became more and more desert, the sage more stunted, and
the hills more brown and barren. After a midday halt, rendered
compulsory by the old white mare, we resumed our way along the
valley southward, over a mixture of pitch-hole and boulder, which
forbids me to forget that day’s journey. At last, after much sticking
and kicking on the part of the cattle, and the mental refreshment of
abundant bad language, self-adhibited by the men, we made Cold-
Springs Station, which, by means of a cut
COLD-SPRINGS STATION.
across the hills, could be brought within
eight miles of Smith’s Creek.
The station was a wretched place, half built and wholly unroofed;
the four boys, an exceedingly rough set, ate standing, and neither
paper nor pencil was known among them. Our animals, however,
found good water in a rivulet from the neighboring hills, and the
promise of a plentiful feed on the morrow, while the humans,
observing that a “beef” had been freshly killed, supped upon an
excellent steak. The warm wind was a pleasant contrast to the usual
frost, but, as it came from the south, all the weather-wise predicted
that rain would result. We slept, however, without such accident,
under the haystack, and heard the loud howling of the wolves, which
are said to be larger on these hills than elsewhere.
To Sand Springs. 16th October.
In the morning the wind had shifted from the south to a more
pluvial quarter, the southeast—in these regions the westerly wind
promises the fairest—and stormy cirri mottled the sky. We had a
long stage of thirty-five miles before us, and required an early start,
yet the lazy b’hoys and the weary cattle saw 10 A.M. before we were
en route. Simpson’s road lay to our south; we could, however, sight,
about two miles distant from the station, the easternmost formation,
which he calls Gibraltar Gate. For the first three miles our way was
exceedingly rough; it gradually improved into a plain cut with
nullahs, and overgrown with a chapparal, which concealed a few
“burrowing hares.” The animals are rare; during the snow they are
said to tread in one another’s trails after Indian fashion, yet the
huntsman easily follows them. After eight miles we passed a spring,
and two miles beyond it came to the Middle Gate, where we halted
from noon till 5 15 P.M. Water was found in the bed of a river which
fills like a mill-dam after rain, and a plentiful supply of bunch-grass,
whose dark seeds it was difficult to husk out of the oat-like capsules.
We spent our halt in practicing what Sorrentines call la caccia degl’
uccelluzzi, and in vain attempts to walk round the uncommonly wary
hawks, crows, and wolves.
Hitching to as the sun neared the western horizon, we passed
through the Gate, narrowly escaping a “spill” down a dwarf
precipice. A plain bounded on our left by cretaceous bluffs, white as
snow, led to the West Gate, two symmetrical projections like those
farther eastward. After that began a long divide broken by frequent
chuck-holes, which, however, had no cunette at the bottom. An
ascent of five miles led to a second broad basin, whose white and
sounding ground, now stony, then sandy, scattered over with carcass
and skeleton, was bounded in front by low dark ranges of hill. Then
crossing a long rocky divide, so winding that the mules’ heads
pointed within a few miles to N., S., E., and W., we descended by
narrow passes into a plain. The eye could not distinguish it from a
lake, so misty and vague were its outlines: other senses corrected
vision, when we sank up to the hub in the loose sand. As we
progressed painfully, broken clay and dwarf vegetation assumed in
the dim shades fantastic and mysterious forms. I thought myself
once more among the ruins of that Arab village concerning which
Lebid sang,
“Ay me! ay me! all lone and drear the dwelling-place, the home—
On Mina, o’er Rijam and Ghool, wild beasts unheeded roam.”
Tired out and cramped with cold, we were torpid with what the
Bedouin calls El Rakl—la Ragle du Désert, when part of the brain
sleeps while the rest is wide awake. At last, about 2 30 A.M.,
thoroughly “knocked up”—a phrase which I should advise the
Englishman to eschew in the society of the fair Columbian—we
sighted a roofless shed, found a haystack, and, reckless of supper or
of stamping horses, fell asleep upon the sand.
To Carson Lake. 17th October.
Sand-Springs Station deserved its name. SAND-SPRINGS STATION
Like the Brazas de San Diego and other
mauvaises terres near the Rio Grande, the land is cumbered here
and there with drifted ridges of the finest sand, sometimes 200 feet
high, and shifting before every gale. Behind the house stood a
mound shaped like the contents of an hour-glass, drifted up by the
stormy S.E. gale in esplanade shape, and falling steep to northward
or against the wind. The water near this vile hole was thick and stale
with sulphury salts: it blistered even the hands. The station-house
was no unfit object in such a scene, roofless and chairless, filthy and
squalid, with a smoky fire in one corner, and a table in the centre of
an impure floor, the walls open to every wind, and the interior full of
dust. Hibernia herself never produced aught more characteristic. Of
the employés, all loitered and sauntered about désœuvrés as cretins,
except one, who lay on the ground crippled and apparently dying by
the fall of a horse upon his breast-bone.
About 11 A.M. we set off to cross the ten miles of valley that
stretched between us and the summit of the western divide still
separating us from Carson Lake. The land was a smooth saleratus
plain, with curious masses of porous red and black basalt protruding
from a ghastly white. The water-shed was apparently to the north,
the benches were distinctly marked, and the bottom looked as if it
were inundated every year. It was smooth except where broken up
by tracks, but all off the road was dangerous ground: in one place
the horses sank to their hocks, and were not extricated without
difficulty. After a hot drive—the glass at 9 A.M. showed 74° F.—we
began to toil up the divide, a sand formation mixed with bits of
granite, red seeds, and dwarf shells, whose lips were for the most
part broken off. Over the fine loose surface was a floating haze of
the smaller particles, like the film that veils the Arabian desert.
Arrived at the summit, we sighted for the first time Carson Lake, or
rather the sink of the Carson River. It derives its name CARSON LAKE.
from the well-known mountaineer whose adventurous
roamings long anticipated scientific exploration. Supplied by the
stream from the eastern flank of the Sierra Nevada, it is just such a
lake as might be formed in any of the basins which we had traversed
—a shallow sheet of water, which, in the cloudy sky and mitigated
glare of the sun, looked pale and muddy. Apparently it was divided
by a long, narrow ruddy line, like ochre-colored sand; a near
approach showed that water on the right was separated from a
saleratus bed on the left by a thick bed of tule rush. Stones imitated
the sweep of the tide, and white particles the color of a wash.
Our conscientious informant at Sand-Springs Station had warned
us that upon the summit of the divide we should find a
perpendicular drop, down which the wagons could be lowered only
by means of lariats affixed to the axle-trees and lashed round strong
“stubbing-posts.” We were not, however, surprised to find a mild
descent of about 30°. From the summit of the divide five miles led
us over a plain too barren for sage, and a stretch of stone and
saleratus to the watery margin, which was troublesome with sloughs
and mud. The cattle relished the water, although tainted by the
rush; we failed, however, to find any of the fresh-water clams,
whose shells were scattered along the shore.
Remounting at 5 15 P.M. we proceeded to finish the ten miles
which still separated us from the station, by a rough and stony road,
perilous to wheel conveyances, which rounded the southern
extremity of the lake. After passing a promontory whose bold
projection had been conspicuous from afar, and threading a steep
kanyon leading toward the lake, we fell into its selvage, which
averaged about one mile in breadth. The small crescent of the moon
soon ceased to befriend us, and we sat in the sadness of the shade,
till presently a light glimmered under Arcturus, the road bent toward
it, and all felt “jolly.” But,
“Heu, heu! nos miseros, quam totus homuncio nil est!”
A long dull hour still lay before us, and we were approaching
civilized lands. “Sink Station” looked well from without; there was a
frame house inside an adobe inclosure, and a pile of wood and a
stout haystack promised fuel and fodder. The inmates, however,
were asleep, and it was ominously long before a door was opened.
At last appeared a surly cripple, who presently disappeared to arm
himself with his revolver. The judge asked civilly for a cup of water;
he was told to fetch it from the lake, which was not more than a
mile off, though, as the road was full of quagmires, it would be hard
to travel at night. Wood the churl would not part with: we offered to
buy it, to borrow it, to replace it in the morning; he told us to go for
it ourselves, and that after about two miles and a half we might
chance to gather some. Certainly our party was a law-abiding and a
self-governing one; never did I see men so tamely bullied; they
threw back the fellow’s sticks, and cold, hungry, and thirsty, simply
began to sulk. An Indian standing by asked $20 to herd the stock for
a single night. At last, George the Cordon Blue took courage; some
went for water, others broke up a wagon-plank, and supper after a
fashion was concocted.
I preferred passing the night on a side of bacon in the wagon to
using the cripple’s haystack, and allowed sleep to steep my senses in
forgetfulness, after deeply regretting that the Mormons do not
extend somewhat farther westward.
To Fort Churchill. 18th October.
The b’hoys and the stock were doomed to remain near the Carson
Lake, where forage was abundant, while we made our way to
Carson Valley—an arrangement not effected without excessive
grumbling. At last the deserted ones were satisfied with the promise
that they should exchange their desert quarters for civilization on
Tuesday, and we were permitted to start. Crossing a long plain
bordering on the Sink, we “snaked up” painfully a high divide which
a little engineering skill would have avoided. From the summit, bleak
with west wind, we could descry, at a distance of fifty miles, a snowy
saddle-back—the Sierra Nevada. When the deep sand had fatigued
our cattle, we halted for an hour to bait in a patch of land rich with
bunch-grass. Descending from the eminence, we saw a gladdening
sight: the Carson River, winding through its avenue of dark cotton-
woods, and afar off the quarters and barracks of Fort Churchill. The
nearer view was a hard-tamped plain, besprinkled
FORT CHURCHILL.
with black and red porous stones and a sparse
vegetation, with the ruddy and yellow autumnal hues; a miserable
range of low, brown, sunburnt rocks and hills, whose ravines were
choked with white sand-drifts, bounded the basin. The farther
distance used it as a foil; the Sierra developed itself into four distinct
magnificent tiers of snow-capped and cloud-veiled mountain, whose
dissolving views faded into thin darkness as the sun disappeared
behind their gigantic heads.
While we admired these beauties night came on; the paths
intersected one another, and, despite the glow and gleam of a camp-
fire in the distance, we lost our way among the tall cotton-woods.
Dispersing in search of information, the marshal accidentally
stumbled upon his predecessor in office, Mr. Smith, who hospitably
insisted upon our becoming his guests. He led us to a farm-house
already half roofed in against the cold, fetched the whisky for which
our souls craved, gave to each a peach that we might be good boys,
and finally set before us a prime beefsteak. Before sleeping we
heard a number of “shooting stories.” Where the corpse is, says the
Persian, there will be the kites. A mining discovery never fails to
attract from afar a flock of legal vultures—attorneys, lawyers, and
judges. As the most valuable claims are mostly parted with by the
ignorant fortunate for a song, it is usual to seek some flaw in the
deed of sale, and a large proportion of the property finds its way
into the pockets of the acute professional, who works on half profits.
Consequently, in these parts there is generally a
FIGHTING LAWYERS.
large amount of unscrupulous talent. One
gentleman judge had knived a waiter and shot a senator; another,
almost as “heavy on the shyoot,” had in a single season killed one
man and wounded another. My informants declared that in and
about Carson a dead man for breakfast was the rule; besides
accidents perpetually occurring to indifferent or to peace-making
parties, they reckoned per annum fifty murders. In a peculiar fit of
liveliness, an intoxicated gentleman will discharge his revolver in a
ballroom, and when a “shyooting” begins in the thin-walled frame
houses, those not concerned avoid bullets and splinters by jumping
into their beds. During my three days’ stay at Carson City I heard of
three murders. A man “heavy on the shoulder,” who can “hit out
straight from the hip,” is a valuable acquisition. The gambler or
professional player, who in the Eastern States is exceptionably
peaceful, because he fears the publicity of a quarrel, here must
distinguish himself as a fighting-man. A curious story was told to
illustrate how the ends of justice might, at a pinch, in the case of a
popular character, be defeated. A man was convicted of killing his
adversary after saying to the by-standers, “Stoop down while I shoot
the son of a dog (female).” Counsel for the people showed malice
prepense; counsel for defense pleaded that his client was rectus in
curia, and manifestly couldn’t mean a man, but a dog. The judge
ratified the verdict of acquittal.
Such was the state of things, realizing the old days of the
Californian gold-diggings, when I visited in 1860 Carson City. Its
misrule, or rather want of rule, has probably long since passed away,
leaving no more traces than a dream. California has been
transformed by her Vigilance Committee, so ignorantly and unjustly
declaimed against in Europe and in the Eastern States of the Union,
from a savage autonomy to one of the most orderly of the American
republics, and San Francisco, her capital, from a den of thieves and
prostitutes, gamblers and miners, the offscourings of nations, to a
social status not inferior to any of the most favored cities.
Hurrah again—in! 19th October.
This day will be the last of my diary. We have now emerged from
the deserts of the Basin State, and are debouching upon lands
where coaches and the electric telegraph ply.
After a cold night at the hospitable Smith’s, and losing the cattle,
we managed to hitch to, and crossed, not without difficulty, the deep
bed of the Carson River, which runs over sands glittering with mica.
A little beyond it we found the station-house, and congratulated
ourselves that we had escaped a twelve hours’ durance vile in its
atmosphere of rum, korn schnapps, stale tobacco, flies, and profane
oaths, not to mention the chance of being “wiped out” in a
“difference” between a soldier and a gambler, or a miner and a rider.
From the station-house we walked, accompanied by a Mr. O.—
who, after being an editor in Texas, had become a mail-rider in Utah
Territory—to the fort. It was, upon the principle of its eastern
neighbors, a well-disposed cantonment, containing quarters for the
officers and barracks for the men. Fort Churchill
FORT CHURCHILL.
had been built during the last few months: it
lodged about two companies of infantry, and required at least 2000
men. Captain F. F. Flint (6th Regiment) was then commanding, and
Lieutenant Colonel Thomas Swords, a deputy quarter-master
general, was on a tour of inspection. We went straight to the
quarter-master’s office, and there found Lieutenant Moore, who
introduced us to all present, and supplied us with the last
newspapers and news. The camp was Teetotalist, and avoided cards
like good Moslems: we were not, however, expected to drink water
except in the form of strong waters, and the desert had disinclined
us to abstain from whisky. Finally, Mr. Byrne, the sutler, put into our
ambulance a substantial lunch, with a bottle of cocktail, and another
of cognac, especially intended to keep the cold out.
The dull morning had threatened snow, and shortly after noon the
west wind brought up cold heavy showers, which continued with
intervals to the end of the stage. Our next station was Miller’s,
distant 15 to 16 miles. The road ran along the valley of Carson River,
whose trees were a repose to our eyes, and we congratulated
ourselves when we looked down the stiff clay banks, 30 feet high,
and wholly unfenced, that our journey was by day. The desert was
now “done.” At every few miles was a drinking “calaboose:”[233]
where sheds were not a kettle hung under a tree, and women
peeped out of the log huts. They were probably not charming, but,
next to a sea voyage, a desert march is the finest cosmetic ever
invented. We looked upon each as if
“Her face was like the Milky Way i’ the sky,
A meeting of gentle lights without a name.”
[233] The Spanish is calabozo, the French calabouse. In the Hispano-
American countries it is used as a “common jail” or a “dog-hole,” and, as
usual, is converted into a verb.
No.
of
Mail. Miles. Start. Arrival. Date.
1. Leave St. Joseph, Missouri, in N.
lat. 39° 40′, and W. long. 94°
50′. Cross Missouri River by
steam ferry. Five miles of bottom
land, bend in river and
settlements. Over rolling prairie
2000 feet above sea level. After
6 miles, Troy, capital of Doniphan
Co., Kansas Territory, about a
dozen shanties. Dine and change
mules at Cold Spring—good 20- A.M. P.M. Aug.
water and grass. 24 9 30 3 7
Road from Fort Leavenworth (N.
lat. 39° 21′ 14″, and W. long. 94°
44′) falls in at Cold Spring, distant
15 miles.
From St. Jo to Cold Spring there
are two routes, one lying north of
the other, the former 20, the latter
24 miles in length.
2. After 10 miles, Valley Home, a
whitewashed shanty. At Small
Branch on Wolf River, 12 miles
from Cold Spring, is a fiumara on
the north of the road, with water,
wood, and grass. Here the road
from Fort Atchinson falls in.
Kennekuk Station, 44 miles from
St. Joseph. Sup and change 22- P.M. P.M. Aug.
mules. 23 4 8 7
3. Two miles beyond Kennekuk is the
first of the three Grasshopper
Creeks, flowing after rain to the
Kansas River. Road rough and
stony; water, wood, and grass.
Four miles beyond the First
Grasshopper is Whitehead, a
young settlement on Big
Grasshopper; water in pools,
wood, and grass. Five and a half
miles beyond is Walnut Creek, in
Kickapoo Co.: pass over corduroy
bridge; roadside dotted with
shanties. Thence to Locknan’s, or P.M. A.M. Aug.
Big Muddy Station. 25 9 1 7, 8
4. Seventeen miles beyond Walnut 18 A.M. A.M. Aug.
Creek, the Third Grasshopper, 3 6 8
also falling into the Kansas River.
Good camping-ground. Ten miles
beyond lies Richland, deserted
site. Thence to Seneca, capital of
Nemehaw Co. A few shanties on
the N. bank of Big Nemehaw
Creek, a tributary of the Missouri
River, which affords water, wood,
and grass.
5. Cross Wildcat Creek and other
nullahs. Seven miles beyond
Seneca lies Ash Point, a few
wooden huts, thence to “Uncle
John’s Grocery,” where liquor and
stores are procurable. Eleven
miles from Big Nemehaw, water,
wood, and grass are found at
certain seasons near the head of
a ravine. Thence to Vermilion
Creek, which heads to the N.E.,
and enters the Big Blue 20 miles
above its mouth. The ford is miry
after rain, and the banks are
thickly wooded. Water is found in
wells 40-43 feet deep. Guittard’s A.M. noon. Aug.
Station. 20 8 12 8
6. Fourteen miles from Guittard’s,
Marysville, capital of Washington
Co., affords supplies and a
blacksmith. Then ford the Big
Blue, tributary to Kansas River,
clear and swift stream. Twelve
miles W. of Marysville is the
frontier line between Kansas and
Nebraska. Thence to Cotton-
wood Creek, fields in hollow near P.M. P.M. Aug.
the stream. 25 1 6 8
7. Store at the crossing very dirty and 26 P.M. P.M. Aug.
disorderly. Good water in spring 6 11 8
400 yards N. of the road; wood
and grass abundant. Seventeen
and a half miles from the Big
Blue is Walnut Creek, where
emigrants encamp. Thence to
West Turkey or Rock Creek in
Nebraska Territory, a branch of
the Big Blue: its approximate
altitude is 1485 feet.
8. After 19 miles of rough road and
musquetoes, cross Little Sandy, 5
miles E. of Big Sandy; water and
trees plentiful. There Big Sandy
deep and heavy bed. Big Sandy P.M. A.M. Aug.
Station. 23 12 4 9
9. Cross hills forming divide of Little
Blue River, ascending valley 60
miles long. Little Blue fine stream
of clear water falling into Kansas
River; every where good supplies
and good camping-ground. Along A.M. A.M. Aug.
the left bank to Kiowa. 19 6 10 9
10. Rough road of spurs and gullies
runs up a valley 2 miles wide.
Well wooded chiefly with cotton-
wood, and grass abundant.
Ranch at Liberty Farm, on the A.M. P.M. Aug.
Little Blue. 25 11 3 9
11. Cross divide between Little Blue
and Platte River; rough road,
musquetoes troublesome.
Approximate altitude of dividing
ridge 2025 feet. Station at Thirty-
two-Mile Creek, a small wooded
and winding stream flowing into P.M. P.M. Aug.
the Little Blue. 24 4 9 9
12. After 27 miles strike the Valley of 34 P.M. A.M. Aug.
the Platte, along the southern 10 30 8 10
bank of the river, over level
ground, good for camping,
fodder abundant. After 7 miles
Fort Kearney in N. lat. 40° 38′
45″, and W. long. 98° 58′ 11″:
approximate altitude 2500 feet
above sea level. Groceries,
cloths, provisions, and supplies
of all kinds are to be procured
from the sutler’s store. Beyond
Kearney a rough and bad road
leads to “Seventeen-Mile
Station”.
13. Along the south bank of the Platte.
Buffalo chips used for fuel. Sign
of buffalo appears. Plum-Creek
Station on a stream where there A.M. P.M. Aug.
is a bad crossing in wet weather. 21 9 30 1 15 10
14. Beyond Plum Creek, Willow-Island
Ranch, where supplies are
procurable. Road along the
Platte, wood scarce, grass
plentiful, buffalo abounds; after
20 miles “Cold-Water Ranch.”
Halt and change at Midway P.M. P.M. Aug.
Station. 25 2 30 8 10
15. Along the Valley of the Platte, road
muddy after rain, fuel scarce,
grass abundant, camp traces
every where. Ranch at Cotton-
wood Station, at this season the P.M. A.M. Aug.
western limit of buffalo. 27 9 1 45 11
16. Up the Valley of the Platte. No 30 A.M. A.M. Aug.
wood; buffalo chips for fuel. 6 15 11 11
Good camping-ground; grass on
small branch of the Platte. To
Junction-House Ranch, and
thence to station at Frémont
Springs.
17. Road passes O’Fallon’s Bluffs. “Half-
way House,” a store and ranch,
distant 120 miles from Fort
Kearney, 400 from St. Joseph, 40
from the Lower Crossing, and 68
from the Upper Crossing of the
South Fork (Platte River). The noon. P.M. Aug.
station is called Alkali Lake. 25 12 5 11
18. Road along river; no timber; grass,
buffalo chips, and musquetoes.
Station at Diamond Springs near P.M. P.M. Aug.
Lower Crossing. 25 6 10 15 11
19. Road along river. Last 4 miles very
heavy sand, avoided by Lower
Crossing. Poor accommodation at
Upper Ford or Crossing on the
eastern bank, where the mail
passes the stream en route to
Great Salt Lake City, and the
road branches to Denver City and P.M. A.M. Aug.
Pike’s Peak. 25 11 3 15 12
20. Ford Platte 600 yards wide, 2·50
feet deep, bed gravelly and solid,
easy ford in dry season. Cross
divide between North and South
Forks, along the bank of Lodge-
Pole Creek. Land arid; wild sage A.M. P.M. Aug.
for fuel. Lodge-Pole Station. 35 6 30 12 45 12
21. Up Lodge-Pole Creek over a spur of 25 P.M. P.M. Aug.
table-land; then, striking over the 3 5 45 12
prairie, finishes the high divide
between the Forks. Approximate
altitude 3500 feet. On the right is
Ash Hollow, where there is plenty
of wood and a small spring. The
station is Mud Springs, a poor
ranch.
22. Route lies over a rolling divide
between the Forks, crossing
Omaha, Lawrence, and other
creeks, where water and grass
are procurable. Cedar is still
found in hill-gullies. About half a
mile north of Chimney Rock is a
ranch where the cattle are A.M. P.M. Aug.
changed. 25 8 12 30 13
23. Road along the south bank of
North Ford of Platte River. Wild
sage the only fuel in the valley:
small spring on top of first hill.
Rugged labyrinth of paths
abreast of Scott’s Bluffs, which
lie 5 miles S. of river, in N. lat.
41° 48′ 26″, and W. long. 103°
45′ 02″. Water found in first
ravine of Scott’s Bluffs 200 yards
below the road, cedars on P.M. P.M. Aug.
heights. To station. 24 1 30 5 30 13
24. Road along the river; crosses Little
Kiowa Creek, a tributary to Horse
Creek, which flows into the
Platte. Ford Horse Creek, a clear
shallow stream with a sandy P.M. P.M. Aug.
bottom. No wood below the hills. 16 6 30 8 30 13
25. Route over sandy, and heavy river 26 A.M. P.M. Aug.
bottom and rolling ground, 6 10 20 14
leaving the Platte on the right:
cotton-wood and willows on the
banks. Ranch at Laramie City
kept by M. Badeau, a Canadian,
who sells spirits, Indian goods,
and outfit.
26. After 9 miles of rough road cross
Laramie Fork and enter Fort
Laramie, N. lat. 42° 12′ 38″, and
W. long. 104° 31′ 26″. Altitude
4519 feet. Military post, with
post-office, sutler’s stores, and
other conveniences. Thence To
Ward’s Station on the Central P.M. P.M. Aug.
Star, small ranch and store. 18 12 15 4 14
27. Rough and bad road. After 14 miles
cross Bitter Cotton-wood Creek;
water rarely flows; after rain 10
feet wide and 6 inches deep;
grass and fuel abundant. Pass
Indian shop and store. At Bitter
Creek branch of Cotton-wood the
road to Salt Lake City forks.
Emigrants follow the Upper or
South road over spurs of the
Black Hills, some way south of
the river, to avoid kanyons and to
find grass. The station is called
Horseshoe Creek. Residence of
road-agent, Mr. Slade, and one of P.M. P.M. Aug.
the worst places on the line. 25 5 9 30 14
28. Road forks; one line follows the 25 A.M. A.M. Aug.
Platte, the other turns to the left, 10 45 2 45 15
over “cut-off;” highly undulating
ridges, crooked and deeply
dented with dry beds of rivers;
land desolate and desert. No
wood nor water till end of stage.
La Bonté River and Station;
unfinished ranch in valley; water
and grass.
29. Road runs 6 miles (wheels often
locked) on rugged red land,
crosses several dry beds of
creeks, and springs with water
after melting of snow and frosts
in dry season, thence into the
Valley of the Platte. After 17
miles it crosses the La Prêle
(Rush River), a stream 16 feet
wide, where water and wood
abound. At Box-Elder Creek
Station good ranch and P.M. P.M. Aug.
comfortable camping-ground. 25 4 9 15
30. Along the Platte River, now shrunk
to 100 yards. After 10 miles, M.
Bissonette; at Deer Creek, a
post-office, blacksmith’s shop,
and store near Indian Agency.
Thence a waste of wild sage to
Little Muddy, a creek with water.
No accommodation nor A.M. noon. Aug.
provisions at station. 20 8 30 12 16
31. After 8 miles cross vile bridge over 18 P.M. P.M. Aug.
Snow Creek. Thence up the river 1 15 4 15 16
valley along the S. bank of the
Platte to the lower ferry. To
Lower Bridge, old station of
troops. To Upper Bridge, where