McClure's Magazine, Vol. VI., No. 6, May, 1896
by
Various
Part 4 out of 4
which were inserted into the palm of the hand through two incisions. It
will be noticed that their denser shadow is seen even _through the
bones_ of the hand themselves, for the hand was skiagraphed palm
downward.
Professor von Bergmann of Berlin has uttered, however, a timely warning
upon this very point. In many cases, after bullets or shot have been
embedded in the tissues for any length of time, they become quite
harmless. They are surrounded with a firm capsule of gristly substance
which renders them inert. In 1863, soon after I graduated in medicine, I
remember very well assisting the late Professor S.D. Gross in extracting
a ball from the leg of a soldier who had been wounded at the Borodino,
during Napoleon's campaign in Russia. It lay in the leg entirely
harmless for almost fifty years, and then became a source of irritation,
and was easily found and removed. There are many veterans of the Civil
War now living with bullets embedded in their bodies which are doing no
harm; and there is not a little danger that in the desire to find and
remove them greater harm may be done by an operation than by letting
them alone.
Glass is, fortunately, quite opaque to the Roentgen rays, and it will be
of great service to the patient, if the surgeon shall be able, by
skiagraphing the hand, to determine positively whether any fragment of
glass still remains in a hand from which it is at least presumed all the
fragments have been extracted. Even after the hand has been dressed, it
is possible, through the dressing, to skiagraph it, and determine the
presence or absence of any such fragments of glass.
[Illustration: FIGURE 10.---SKIAGRAPH OF A SECTION OF A HUMAN ARM,
SHOWING TUBERCULOUS DISEASE OF THE ELBOW-JOINT.
("American Journal of the Medical Sciences," March, 1896.)]
Possibly before long we shall be able to determine also the presence or
absence of solid foreign bodies in the larynx or windpipe. Every now and
then, patients, especially children, get into the windpipe jack-stones,
small tin toys, nails, pins, needles, etc., foreign bodies which may
menace life very seriously. To locate them exactly is very difficult.
The X rays may here be a great help. An attempt has been made by Rowland
and Waggett. to skiagraph such foreign bodies, with encouraging results.
Improvements in our methods will, I think, undoubtedly lead to a
favorable use of the method in these instances. Beans, peas, wooden
toys, and similar foreign bodies, being easily permeable to the rays,
will not probably be discovered.
If our methods improve so that we can skiagraph through the entire body,
it will be very possible to determine the presence and location of
foreign bodies in the stomach and intestines. A large number of cases
are on record in which plates with artificial teeth, knives, forks,
coins, and other such bodies have been swallowed; and the surgeon is
often doubtful, especially if they are small, whether they have remained
in the stomach, or have passed into the intestines, or entirely escaped
from the body. In these cases, too, a caution should be uttered as to
the occasional inadvisability of operating, even should they be located,
for if small they will probably escape without doing any harm. But it
may be possible to look at them from day to day and determine whether or
not they are passing safely through the intestinal canal, or have been
arrested, at any point, and, therefore, whether the surgeon should
interfere. The man who had swallowed a fork which remained in his
stomach (_l'homme a la fourchette_, as he was dubbed in Paris) was
a noted patient, and would have proved an excellent subject for a
skiagraph, had the method then existed.
As sunlight is known to be the foe of bacteria, the hope has been
expressed that the new rays might be a means of destroying the microbes
of consumption and other diseases in the living body. Delepine, Park,
and others have investigated this with a good deal of care. A dozen
different varieties of bacteria have been exposed to the Roentgen rays
for over an hour, but cultures made from the tubes after this exposure
have shown not only that they were not destroyed, but possibly they were
more vigorous than before.
The facts above stated seem to warrant the following conclusions as to
the present value of the method:
_First_.--That deformities, injuries, and diseases of bone can be
readily and accurately diagnosticated by the Roentgen rays; but that the
method at present is limited in its use to the thinner parts of the
body, especially to the hands, forearms, and feet.
_Second_.--That foreign bodies which are opaque to the rays, such
as needles, bullets, and glass, can be accurately located and their
removal facilitated by this means; but that a zeal born of a new
knowledge almost romantic in its character, should not lead us to do
harm by attempting the indiscriminate removal of every such foreign
body. _Non nocere_ (to do no harm) is the first lesson a surgeon
learns.
_Third_.--That at present the internal organs are not accessible to
examination by the X rays for two reasons: First, because many of them
are enclosed in more or less complete bony cases, which cut off the
access of the rays; and, second, because even where not so enclosed, the
thickness of the body, even though it consists only of soft parts, is
such that the rays have not sufficient power of penetration to give us
any information.
_Fourth_.--Even if the rays can be made to permeate the thicker
parts of the body, it is doubtful whether tumors, such as cancers,
sarcoma, fatty tumors, etc., which are as permeable to the rays as the
normal soft parts, can be diagnosticated. Bony tumors, however, can be
readily diagnosticated; and possibly fibrous tumors, by reason of their
density, may cast shadows.
_Fifth_.--That stones in the kidney, bladder, and gall bladder
cannot be diagnosticated, either (1) because they are embedded in such
parts of the body as are too thick to be permeable by the rays, or (2)
are surrounded by the bones of the pelvis, or (3) are, in the case of
gall stones, themselves permeable to the Roentgen rays.
_Sixth_.--That with the improvements which will soon be made in our
methods, and with a better knowledge of the nature of the rays, and
greater ability to make them more effective, we shall be able to
overcome many of the obstacles just stated, and that the method will
then probably prove to be much more widely useful than at present.
[Illustration: FIGURE 11.--SKIAGRAPH OF A HUMAN WRIST WHICH HAD BEEN
DISLOCATED.
From a photograph taken by Mr. Herbert B. Shallenberger, Rochester,
Pennsylvania, and reproduced by his permission. This is a particularly
interesting picture, because it not only shows the bones with unusual
clearness, but also shows that the ulna (the small bone of the forearm)
has been broken; a small projection at its lower end, which ought to
appear, being absent from the bone as shown in the picture.]
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