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Pediatric
Orthopedics and
Sports Medicine

A Handbook for Primary Care

Physicians
Amr Abdelgawad
Osama Naga
Marwa Abdou
Editors
Second Edition

123
Pediatric Orthopedics and Sports Medicine
Amr Abdelgawad • Osama Naga
Marwa Abdou
Editors

Pediatric Orthopedics
and Sports Medicine
A Handbook for Primary Care Physicians

Second Edition
Editors
Amr Abdelgawad Osama Naga
Maimonides Medical Center Children's Pediatric Practice
Brooklyn, NY El Paso, TX
USA USA

Marwa Abdou
Department of Pediatrics
NYC Health + Hospitals/Kings County
Brooklyn, NY
USA

ISBN 978-3-030-48137-7    ISBN 978-3-030-48138-4 (eBook)

https://doi.org/10.1007/978-3-030-48138-4

© Springer Nature Switzerland AG 2021

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita-
tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor-
mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To my parents, my wife, and my children.
–Amr Abdelgawad

To all authors who contributed to this

edition.
–Osama Naga

To my family and to all readers who use this

knowledge to help children all over
the world.
–Marwa Abdou
Preface

It is our honor to present the second edition of Pediatric Orthopedics and Sports
Medicine: A Handbook for Primary Care Physicians to our readers, which is
designed to be a quick and practical resource for pediatricians, family medicine
physicians, residents, nurse practitioners, physician assistants, and medical students
and all other health care providers caring for pediatric population with musculoskel-
etal disorders. This book is a concise, clinically oriented and readily available
resource to study common pediatric musculoskeletal diseases and sports medicine
injuries. The book will help you to decide whether to treat the condition or refer it
to the specialist.
The second edition kept the same interesting and easy-to-follow format that the
first edition had. We tried to stay away from long paragraphs and controversial state-
ments. The information in the book is presented in a simple “bullet” format that
allows the reader to understand the topic easily and with minimal effort. More than
300 figures were included in this handbook.
This edition comes with significant changes from the previous edition. Because
most children participate in sports, we have expanded on this part of the book and
added a new chapter that describes the general aspects of sports participating includ-
ing pre-participation physical assessment. The basics of pediatric musculoskeletal
imaging was a topic that needed more clarification to our readers, so we added a
new chapter for this purpose. Most chapters had revisions to come closer to our goal
of providing concise and “to the target” information to our readers.
We would like to thank all who purchased the first and/or the second edition in
either its paper or digital format. Without the enormous support and useful com-
ments from our readers, we could not have issued this valuable second edition. We
hope that this enhanced second edition will stand to the expectations of our readers
and it will be a great source of knowledge to them.

Brooklyn, NY, USA Amr Abdelgawad, MD, MBA

El Paso, TX, USA Osama Naga, MD
Brooklyn, NY, USA Marwa Abdou, MD

vii
Contents

1 Introduction to Orthopedic Nomenclature����������������������������������������������   1

Amr Abdelgawad and Marwa Abdou
2 Pediatric Musculoskeletal Imaging���������������������������������������������������������� 13
Amr Abdelgawad and Sherif Osman
3 Growth and Development and Their Relation
to Musculoskeletal Conditions������������������������������������������������������������������ 21
Ahmed M. Thabet
4 Metabolic Conditions�������������������������������������������������������������������������������� 31
Osama Naga and Marwa Abdou
5 General Conditions Affecting the Bones�������������������������������������������������� 47
Osama Naga and Marwa Abdou
6 Birth Injuries and Orthopedic Manifestations in Newborns���������������� 61
Marwa Abdou and Amr Abdelgawad
7 The Hip ������������������������������������������������������������������������������������������������������ 69
Amr Abdelgawad and Osama Naga
8 The Knee/Leg �������������������������������������������������������������������������������������������� 93
Amr Abdelgawad and Osama Naga
9 The Foot������������������������������������������������������������������������������������������������������ 119
Amr Abdelgawad and Rami Khalifa
10 Hand and Upper Extremity���������������������������������������������������������������������� 151
Amr Abdelgawad and Miguel Pirela-Cruz
11 Sports Medicine: General Aspects������������������������������������������������������������ 175
Daniel Murphy
12 Sport Injury: Lower Extremity���������������������������������������������������������������� 199
Amr Abdelgawad and Colby M. Genrich
13 Sport Injuries: Upper Extremity�������������������������������������������������������������� 223
Justin M. Wright and Daniel Murphy

ix
x Contents

14 Management of Pediatric Orthopedic Patients

During the Postoperative Period�������������������������������������������������������������� 259
Indu Pathak and Lisa Ayoub-Rodriguez
15 Tumors and Tumor-Like Conditions�������������������������������������������������������� 271
Lisa A. Kafchinski and Amr Abdelgawad
16 Spasticity and Gait������������������������������������������������������������������������������������ 293
Mahmoud A. Mahran, Walid Abdel Ghany,
and Mohamed Abdel Rahman Nada
17 Non-accidental Trauma ���������������������������������������������������������������������������� 313
Amr Abdelgawad and Osama Naga
18 Orthopedic Trauma ���������������������������������������������������������������������������������� 321
Amr Abdelgawad and Enes Kanlic
19 Approach to a Limping Child ������������������������������������������������������������������ 379
Amr Abdelgawad and Osama Naga
20 Casts, Splints, and Braces ������������������������������������������������������������������������ 385
Amr Abdelgawad and Osama Naga
21 Pediatric Spine������������������������������������������������������������������������������������������� 393
Amr Abdelgawad and Ahmed Saleh
22 Neuromuscular Conditions ���������������������������������������������������������������������� 421
Amr Abdelgawad and Marwa Abdou
23 Musculoskeletal Infections������������������������������������������������������������������������ 431
Amr Abdelgawad and Osama Naga

Index�������������������������������������������������������������������������������������������������������������������� 451
Contributors

Amr Abdelgawad, MD, MBA Maimonides Medical Center, Brooklyn, NY, USA
Marwa Abdou, MD Department of Pediatrics, NYC Health + Hospitals/Kings
County, Brooklyn, NY, USA
Lisa Ayoub-Rodriguez, MD, FAAP Department of Pediatrics – Hospitalist
Division, Texas Tech University Health Sciences Center El Paso, Paul L. Foster
School of Medicine, El Paso Children’s Hospital, El Paso, TX, USA
Colby M. Genrich, MD Family and Sports Medicine, Department of Family and
Community Medicine, Texas Tech University, El Paso, TX, USA
Walid Abdel Ghany, MD Neurosurgery Departement, Ain Shams University
Hospitals, Cairo, Egypt
Lisa A. Kafchinski, MD University of Alabama Birmingham, Department of
Orthopaedic Surgery, Birmingham, AL, USA
Enes Kanlic, MD, FAAOS Orthopedic Surgery, Santa Cruz Valley Regional
Hospital, Green Valley, AZ, USA
Rami Khalifa, MD Orthopedic Surgery, Texas Tech University Health Sciences
Center, El Paso, TX, USA
Mahmoud A. Mahran, MD Orthopedic Surgery Department, Ain Shams
University Hospitals, Cairo, Egypt
Daniel Murphy, MD, FAAFP, CAQSM Texas Tech University Health Science
Center El Paso, Paul L. Foster School of Medicine, Department of Family and
Community Medicine, Family Medicine, CAQ-Sports Medicine, El Paso, TX, USA
Texas Tech University Health Science Center El Paso, Paul L. Foster School of
Medicine, Department of Family and Community Medicine, El Paso, TX, USA
Mohamed Abdel Rahman Nada, MD Neurosurgery Departement, Ministry of
Health Hospitals, Cairo, Egypt
Osama Naga, MD Children’s Pediatric Practice, El Paso, TX, USA

xi
xii Contributors

Sherif Osman, MD Department of Radiology, Texas Tech University Health

Sciences Center El Paso, El Paso, TX, USA
Indu Pathak, MD Department of Pediatrics – Hospitalist Division, Texas Tech
University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El
Paso Children’s Hospital, El Paso, TX, USA
Miguel Pirela-Cruz, MD Texas Tech University Health Sciences Center, El
Paso, TX, USA
Ahmed Saleh, MD Maimonides Medical Center, Brooklyn, NY, USA
Ahmed M. Thabet, MD Orthopedics Department, Texas Tech Health Science
Center at El Paso and El Paso Children Hospital, El Paso, TX, USA
Justin M. Wright, MD, FAAFP, CAQSM Texas Tech University Health Science
Center El Paso, Paul L. Foster School of Medicine, Department of Family and
Community Medicine, El Paso, TX, USA
Introduction to Orthopedic
Nomenclature 1
Amr Abdelgawad and Marwa Abdou

Physis (the Growth Plate)

• It is a cartilaginous area that is responsible for the longitudinal growth of

the bone.
• It appears as a radiolucent area in the radiographs.
• It should not be confused with fractures (physis has specific anatomic location
with smooth outline) (Fig. 1.1).

Epiphysis

• It is the proximal or the distal part of the bone (Fig. 1.1).

• The physis separates the epiphysis from the diaphysis.
• Usually articulate with the epiphysis of another bone to form a “joint.”
• Epiphysis develops by “secondary ossification center” (see later).

Apophysis

• Epiphysis which does not articulate with another bone (e.g., iliac crest apophy-
sis, greater trochanter apophysis, calcaneal apophysis, tibial tubercle apophysis)
(Fig. 1.2).
• The apophysis usually has muscles attached to it and exposed to traction from
this muscle (e.g., abdominal muscles and gluteal muscles attached to iliac crest).

A. Abdelgawad (*)
Maimonides Medical Center, Brooklyn, NY, USA
M. Abdou
Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA

© Springer Nature Switzerland AG 2021 1

A. Abdelgawad et al. (eds.), Pediatric Orthopedics and Sports Medicine,
https://doi.org/10.1007/978-3-030-48138-4_1
2 A. Abdelgawad and M. Abdou

Fig. 1.1 Radiograph of

the knee of a 6-year-old
child showing
anteroposterior view of the
knee. Arrows show the
epiphysis, physis,
metaphysis, and diaphysis

Epiphysis

Physis (growth plate)

Metaphysis

Diaphysis

Fig. 1.2 Anatomical

nomenclature: proximal
femoral epiphysis (arrow
head) and greater
trochanter apophysis
(arrow). Proximal femoral
epiphysis articulates with
acetabulum to form the hip
joint while the greater
trochanter does not
articulate with other bone;
it has the attachment of the
hip abductors muscles
1 Introduction to Orthopedic Nomenclature 3

• The apophysis can get irritated “apophysistis” causing pain (e.g., calcaneal apophy-
sitis (Sever’s disease), tibial tubercle apophysitis (Osgood-Schlatter disease)).

Metaphysis

• The part of the diaphysis which is adjacent to the physis (Fig. 1.1).
• The metaphysis is a very active part of the bone with active cell division (cells
added from physis are laid in the metaphysis).
–– Most of the bone tumors arise in the metaphysis (due to the high cellular
activity of this area).
• The metaphysis is formed of less dense bone (cancellous bone).
• The circulation in the metaphysis is sluggish as this is an end-capillary area (the
physis is a relatively avascular structure separating the circulation of the metaph-
ysis from the one in the epiphysis) (Fig. 1.3).

Fig. 1.3 Metaphyseal

circulation. The blood flow
in the metaphysis is slow
as it passes from arterial
system to venous system.
The physis is relatively
avascular structure
separating the flow in the
metaphysis from the
epiphysis
4 A. Abdelgawad and M. Abdou

–– Hematogenous osteomyelitis usually occurs in the metaphysis. The bacteria

from remote sites will migrate in blood and settle in the metaphysis with its
sluggish circulation (see Chap. 23).

Diaphysis (Shaft)

• It is the midsection part of a long bone (Fig. 1.1).

• It is the middle tubular part of the long bone composed of compact bone (cortical
bone) which surrounds a central marrow cavity.
• It develops by “primary ossification center” (see later).

Primary Center of Ossification

• It is the ossification island responsible for changing cartilage tissue to oste-

oid tissue.
• It develops in the diaphysis of all long bones in the intrauterine life.

Secondary Center of Ossification

• It differs from the primary center of ossification in that it develops in the epiphy-
sis after birth at different ages (except distal femur epiphysis which develops in
intrauterine life) (Fig. 1.4).

Periosteum

• It is a membrane that lines the outer surface of all bones, except at the joints
surfaces.
• In children, periosteum is thick and loosely attached to the bone (except at the
physis where it becomes firmly attached to the bone).
• Raising the periosteum away from the bone surface for any reason (e.g., infec-
tions, tumors, trauma) will cause new periosteal bone formation (Fig. 1.5).

Some Anatomical Nomenclature

Proximal:
• The part closer to trunk (axial skeleton) of the body.
Distal:
• The part further away from the trunk (axial skeleton) of the body.
1 Introduction to Orthopedic Nomenclature 5

Fig. 1.4 Radiograph of a

3-day-old boy showing the
shaft of the femur, tibia,
and fibula (primary centers
of ossification developing
intrauterine). The
radiograph also shows the
distal femur ossific center
which is the only
secondary ossific center
present at birth (arrow).
Proximal tibial and fibular
epiphyses cannot be seen
in the radiograph because
they are still cartilaginous

Medial:
• The part close to the Medline.
Lateral:
• The part away from the Medline.

Deformities Definitions

Varus deformity:
• The deformity in which the distal part points medially (Fig. 1.6).
Valgus deformity:
• The deformity in which the distal part points laterally (Fig. 1.6).
6 A. Abdelgawad and M. Abdou

Fig. 1.5 Periosteal new

bone formation in case of
fracture healing. Plain
radiograph of the tibia and
fibula anteroposterior view
showing periosteal new
bone formation (white
arrow) that happened
during fracture healing
(black arrow)

Contracture deformity:
• The joint is contracted in certain position; for example, flexion contracture of the
knee means the knee is always kept in a certain degree of flexion and cannot
reach full extension (Fig. 1.7).

General Orthopedic/Joint Examination

Inspection:
• Swelling
• Deformity
• Scars of previous surgeries
• Atrophy of the muscles
Palpation:
• Anatomical landmark
• Tenderness
• Swelling and effusion
18 A. Abdelgawad and S. Osman

Fig. 2.7 (continued)

2 Pediatric Musculoskeletal Imaging 19

Bone Scan (Bone Scintigraphy)

• Radioactive material is injected in the body and its uptake in bone is measured.
Tm99 is the most commonly used material.
• Triphasic bone scan: the radioactive material is injected and then uptake is mea-
sured in three phases.
• Flow phase:
–– Demonstrates blood flow to the area of interest.
–– 2–5-second images are obtained for 60 seconds after injection.
• Blood pool phase:
–– Measures relative vascularity to the area of interest. In areas of inflammation,
capillaries dilate, causing increased blood flow (first phase) and blood pooling
(second phase).
–– Images obtained 5 minutes after injection.
• Delayed phase:
–– Images obtained 2–4 hours after injection.
–– Urinary excretion of the radioactive material will decrease the amount of the
radioactive material in soft tissue; thus, the bone uptake of the radioactive
material becomes clearer.
–– Measures relative bone turnover associated with the studied pathology.
Pathological increased uptake is typically seen in infections and tumors.
• In pediatric patients: there is normal expected increase uptake at the physes
(Fig. 2.7).
• In children, significant blood supply to the bone comes from periosteal vessels,
and these are disrupted by the subperiosteal abscess (this disruption can give
false negative with cases of osteomyelitis associated with subperiosteal abscess).
• Advantages of bone scan:
–– It can detect abnormal uptake in the whole body (this is of advantage in cases
of suspected multiple sites of pathology (e.g., multi-focal osteomyelitis).
–– Compared to MRI: less expensive and more readily available.

Magnetic Resonance Imaging (MRI)

• MRI does not involve ionizing radiation, so does not impose increased cancer
risk for the children.
• MRI can assess the soft tissues pathologies.
–– Can be used to assess tumors, infections, and soft tissue injuries (e.g., knee
ligaments injuries).
–– Can assess tumor extension in the medullary cavity (Fig. 2.7).
–– If suspecting infection or tumor: MRI should be ordered with and without
contrast.
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 Weighting a Metal Base

Molten Lead as Poured In around Screws Fastened to the Base

Having to weight a shallow metal base to support a 4-ft. brass

tube, I found that the easiest way was to fasten four screws on the
base with nuts, as shown in the illustration, and pour in lead. The
screws were taken out in polishing the base.—James M. Kane,
Doylestown, Pa.

¶In toasting bread over a camp fire, it is best to cover the fire with a
tin pan.
Trunk Bookcase for Convenient Shipment

A Small Library may be Shipped Handily in This Bookcase

 Mechanics, engineers, and other persons are sometimes engaged
in work which keeps them at the same locality only a few months.
Those who desire to carry with them a small library will find the trunk
bookcase, as shown, convenient. It may be shipped as a trunk, and
used as a bookcase in one’s hotel or dwelling. Other articles than
books may be packed in it. The outside dimensions when closed are
31 by 18 by 18 in., providing for three shelves. It may be made of ³⁄₄-
in. pine or whitewood, and stained, or covered with impregnated
canvas. The outer corners are reinforced with metal corner plates,
and suitable hardware is provided.—Lloyd C. Eddy, Jr., Buffalo, N. Y.
 Bottle Carrier Made of Pipe Straps
Two metal pipe straps, fitted around the neck of a bottle and bolted
together, form a convenient method of attaching a carrying handle to
a large bottle. The handle proper is made by fixing a grip in a bail of
wire similar to that on a bucket.
A Developing or Etching-Tray Rocker
 An appliance that saves time for the worker in a photographic dark
room is a tray rocker, made as follows: Fasten a bracket of strap
iron, into which are riveted the pointed ends of two spikes, to the
under side of a board, as shown in the detail sketch. Support this
further with a double angle fastened at the end of the board. Fix a
small can, weighted with lead, on the end of an iron rod, adjusted to
a suitable curve, and fasten the rod to the bracket. The weighted end
should extend under the edge of the table, as shown, and be
balanced so that it will rock the board and tray without tipping the
latter toward the bracket. The nails pivot on metal pieces, to protect
the table top.—L. L. Llewellyn, Piedmont, Calif.
Combination Laundry Tub and Dishwashing Sink

A saving of space and time was effected in a home kitchen by the

use of a sink developed in a large kitchen. Two ordinary laundry tubs
were installed with the faucets raised above the tubs, as shown. A
sink of sheet zinc was fitted in the upper part of one tub; it has
handles, and a strainer set in the bottom. The strainer is closed by a
rubber stopper, and the sink becomes a dishpan. The sink is easily
lifted out for cleaning, or for washing clothes. Another use for the
sink, between meals, is for washing and preparing vegetables and
fruits. The second tub has a wire dish-draining rack, in which the
china is rinsed and sterilized by hot water from the faucet.—Mrs.
Avis Gordon Vestal, Chicago, Ill.
A Leather and Silk Bookmark
 A Jolly Good Book
Wherein To Look
Is Better To Me
Than Gold

An artistic and useful bookmark was made from a silk ribbon

passed through a buckle of leather, tooled with an inscription and a
conventional design. Ribbon of various sizes may be used, and the
leather left plain if desired. The ends of the ribbon are fringed, as
shown. Monograms make interesting and individual decorations for
the leather portion.—Will Chapel, Manchester, Ia.
 Emergency Oarlock of Rope
An oarlock that will give considerable service may be made by
fixing a loop of rope to the gunwale of a boat at the proper position.
This kink is useful in an emergency, such as when an oarlock is
dropped overboard.
 Planing Thin Sticks Held in Flooring Groove
Boys who make thin sticks for arrows, kites, etc., as well as the
mechanic, can make good use of the following suggestion: The
difficulty of handling thin strips while planing them may be overcome
by setting the strip in the groove of a piece of flooring, clamped in a
vise. A peg or nail is driven into the groove and acts as a stop for the
end of the strip.
 A Submarine Camera
by Charles I. Reid

Submarine photography should have great attractions for amateur

photographers who have access to lakes, ponds, and other clear
waters. While more careful work is demanded than in ordinary
photography, the method of obtaining good results is not difficult, and
the necessary equipment may be provided by constructing the
device shown in the illustration. Submarine pictures can be taken in
a considerable depth of water, providing it is reasonably free from
foreign matter. This is a fascinating field of photography, and many
pictures of educational and scientific value remain to be made of
under-water life. The illustration shows the detailed construction of
the camera chamber, and the method of suspending it from a bridge,
or other place convenient to the body of water. Reproduced in the
oval panel is a photograph of fish near baited hooks, on a fishline.
The original was made from a negative exposed by the use of the
camera chamber described.
The problem of making photographic exposures under water
involves the provision of a strong water and pressure-proof container
for the camera, a means for controlling the shutter, and a suitable
opening in the container through which the exposures may be made.
The arrangement described combines these features in a simple
manner, and by the use of materials that can be obtained without
difficulty. It was made for a camera taking 4 by 5-in. pictures, and the
dimensions given are for a container for this size. The dimensions
may be varied to adapt the device to various cameras, within
reasonable limits. A 9-in. steel pipe was used for the chamber, and
its ends were fitted with pipe caps. A heavy piece of plate glass was
fitted into the forward cap, which was cut into the shape of a ring, to
provide the exposure opening. The general arrangement of the
camera in the chamber is shown in the sectional view, Fig. 1, as
seen from the shutter end. The electrical device, by which the shutter
is controlled, is shown in this view, and in Fig. 2 it is shown in detail.
The chamber was made as follows: A section of 9-in. steel pipe
was cut to a length of 11¹⁄₂ in. and threaded on the ends to fit pipe
caps. The forward pipe cap was chucked up in a lathe and the center
portion cut away, to provide an exposure opening and a shoulder at
the rim, on which the plate-glass window rests. A graphite paint was
applied to the rim, then the glass was bedded solidly in it, and a
rubber gasket was fitted to the joint, making it waterproof when the
cap was drawn up tightly. The chamber assembled and in detail is
shown in the illustration.
Holes were bored into the top of the chamber, and eyebolts were
fitted into them. Between the eyebolts a hole was bored and fitted
with a water-tight collar, through which the wires leading to the
shutter-control device pass. The chamber is supported by the wires,
which are fixed to the eyebolts and secured at the base of operations
by the photographer.
A support for the camera was provided by bending a strip of ¹⁄₈ by
1-in. band iron to the shape indicated in Fig. 1, at A, and riveting it to
the bottom of the chamber. Its upper surface is flat and was bored
and threaded to fit the tripod thumbscrew B, on the lower surface of
the camera. The camera is arranged on the support and clamped
into place firmly by the thumb nut, as it might be on a tripod. The
adjustment of the camera in the chamber is done from the rear, and
the space beneath the thumbscrew should be large enough to make
access easy. A camera of the size indicated, when fitted with its lens
centering on the center of the window, will be raised sufficiently for
convenience in clamping it. The threads on the back cap must fit
snugly and no paint must be used on them. Hard oil, or vaseline,
may be applied to insure a water-tight joint that permits easy removal
of the cap.
The making and adjustment of the electrical shutter device
requires care, but its operation is simple. An electromagnet, of the
type used on doorbells, was fixed to the front of the camera, above
the shutter, as shown in Fig. 1, and in detail in Fig. 2. It is actuated
by current from two dry cells. The latter are kept in a convenient
carrier at the base of operations, and are connected to the magnet
by a single strand of double, waterproof wire. This is spread as it
reaches the chamber and fastened to the two eyebolts in the top.
The ends of the wires are conducted through the water-tight center
opening between the eyebolts, and attached to the magnet. The
release lever is fitted to a steel hook, pivoted at its upper end with a
small nail, C, Fig. 2. A rubber band is fixed to the lower edge of the
shutter lever and its other end is attached to the front of the camera.
When the current is permitted to flow into the magnet by pressing a
contact key, in the hand of the operator, the steel hook is drawn from
the release lever, and the rubber band draws the lever down, making
an exposure.
The double-wire cable carries the current as well as holds the
chamber suspended in the water. The wire should be about 25 ft.
long, and, in transporting the outfit, or when only partly used, is
coiled. The chamber should be completed for picture-taking
operations by giving it a coat of dull, black waterproof paint, both
inside and outside. This will prevent rusting and also serves to make
the object inconspicuous when in the water. It is important that the
interior be painted in this manner, because reflections of light within
the chamber may cause difficulty in obtaining satisfactory results.
When the paint is thoroughly dry, the device may be tested for
leakage and assembled ready for a test before making an actual trial
in the water. The camera is fitted into the chamber so that it centers
on the center of the plate-glass window, and is clamped into place. If
the electrical device operates satisfactorily the plate may be inserted,
the plate-holder slide withdrawn, the back cap replaced securely,
and the outfit lowered into the water. It should be watched carefully
until it reaches the proper depth, for, if it is permitted to touch the
bottom, the sediment stirred up must be given time to settle before
an exposure is made. The forward end of the chamber should be
marked on its upper edge with a streak of white paint, to aid in
identifying it at considerable depth in the water. This is important,
since the operator must shift the chamber carefully until the window
faces the objects to be photographed. When the chamber is in
position, the contact key is pressed and the exposure is made.
The time of exposure for under-water photography depends on the
clearness of the water, the depth at which the pictures are to be
taken, and the light conditions on the surface. A bright day is, of
course, desirable for this class of photography. A safe approximation
on a sunny day, in clear water, and with the chamber lowered to a
depth of 20 ft., is ¹⁄₂₅ sec. at the F 8 stop. The fastest plates or films
obtainable should be used for this work, making possible a fairly
rapid shutter speed. This tends to overcome the movement of the
subject and possible movement of the camera.
The camera should be focused while in the chamber in order that
the plate glass may not disturb the focus. The glass usually changes
the focal length of the lens slightly, hence this precaution must be
taken. The camera should be focused in the chamber for a distance
of 10 ft., as this is the average at which under-water photographs will
be taken ordinarily.
When attempting under-water photography in cloudy waters, or at
a considerable depth, the necessary illumination may be provided by
a charge of flash-light powder. For this purpose another submarine
chamber, similar to that used for the camera, should be provided,
with a plate glass, ¹⁄₂ in. thick, and a valve fitted into the top of the
chamber, and opening outward, so that the gas may escape. Fifteen
grains of powder will suffice, and this should be set off by a small
electrical fuse connected to the current supply.
 Fig. 1
Fig. 2
Photographing Subjects under Water Is a
Fascinating Diversion, and Each Exposure
Has an Element of Mystery in the
Uncertainty of the Result. The Photograph
Reproduced in the Oval was Taken with the
Outfit Shown. The Construction of the
Chamber is Shown at the Middle. Fig. 1
Shows a Sectional Interior View, and Fig. 2,
a Detail of the Electrical Shutter Release

Every pond, lake, and river abounds in interesting and instructive

subjects for submarine photography. Along the coast of Florida, and
at many points along the Pacific coast, are waters of such clearness
that pictures may be taken at a depth of nearly a hundred feet,
without the use of artificial illumination. These localities abound in
objects under water of great interest, such as shipwrecks. The
fascinating art of taking pictures under water does not make it
necessary for one to go to these places, for subjects are easily
available. Whenever the submarine chamber is raised from the water
there is an element of mystery involved, regarding what may be
recorded on the plate or film, and this is an attractive feature of the
diversion.