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.]