CHAPTER XIII

A FEW TYPICAL APPLICATIONS OF X-RAYS IN ANATOMY, SURGERY, DIAGNOSIS, ETC.

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200. HOGARTH’S EXPERIMENT. NEEDLE LOCATED BY X-RAYS AND REMOVED. _The Lancet_, Lon., Mar. 28, ’96.—Dr. Hogarth is the medical officer of the general hospital, Nottingham. A young woman was suffering with a pain in her hand near the metacarpal bone of the ring finger. A slight swelling existed. Ten weeks before, a needle had entered the palm while washing the floor. It had entered at the base of the fifth metacarpal bone. Chloroform had been given and an incision made, but no needle found and its presence doubted. A sciagraph was taken and the needle was accurately located and the next day removed.

201. SAVARY’S EXPERIMENT. NEEDLE LOCATED BY SCIASCOPE AND REMOVED. _The Lancet_, Mar. 28, ’96.—Dr. Savary located a needle by a sciascope although efforts by all other methods had failed. A line was drawn between two points intersecting the needle at right angles. About half an inch below the surface of the skin of the wrist the blade of the scalpel impinged upon the needle, which was removed without difficulty.

202. RENTON & SOMERVILLE’S EXPERIMENT. DIAGNOSIS. _The Lancet_, Lon., Apr. 4, ’96.—A writer for the _Lancet_ reported that Drs. Renton and Somerville made a diagnosis with the assistance of the screen. In one, the suspected case of unreduced dislocation of the phalanx, they saw that the parts were in the proper position. He showed to medical men an old fracture of the forearm where the fragments of the bones were distinct as to the shadows.

203. MILLER’S EXPERIMENTS. LOCATION OF BULLETS. _Elect. World_, Mar. 21, ’96.—Bullets were clearly located in the hands of two different men by Prof. Dayton C. Miller, of the Case School of Applied Science. In one, the bullet had been lodged for 14 years and had always been thought to lie between the bones of the forearm, but two sciagraphs from different directions located the ball at the base of the little finger. By means of five sciagraphs from different directions, the ball in the other hand was located at the base of the thumb.

204. INJURIES BY ACCIDENT AND MISCELLANEOUS CASES. _The Integral_, Cleveland, Ohio, ’96.—Many fingers and hands were examined by Prof. Miller that had been injured by planing machines, cog-wheels, base balls, pistols, etc., and in each case the nature of the injuries was determined. Several cases of fractured arms were studied—some through splints and bandages. Some sciagraphs indicated that the ends of the broken bones had not been placed in apposition. Subsequently, an operation was performed to remedy the setting. In one case, he sciagraphed the arm from which a piece of the ulna had been removed five years previously. The necrosis had increased. Two sciagraphs at right angles to each other clearly exhibited the nature of the disease. The permanent set of the toes by wearing pointed shoes was clearly exhibited (p. 30.) The figure on page 147 is the side view of a foot in a laced shoe. The outlines of the bones can be traced, also the eyelets and the pegs in the heel, while the uppers scarcely appear. In Fig. 1 (introduction) is shown a head, only the skull being clearly reproduced. In the negative, the teeth appear and places whence the teeth have been extracted, also the jaw bones, nasal cavities and the ragged junction of the bones and cartilage. The varying thickness is represented in the cut, at the temples and ears. Fig. 2 (introduction) shows that a broken bone was badly set, the ends overlapping each other instead of meeting end to end. A sciagraph of an elbow is shown on p. 161. The flesh is scarcely visible. Fig. 3 (introduction) is a picture which reproduced the mere indication of the spine and ribs. In the original negative the collar bones, pelvis, clavicles, buckle of clothing and location of the heart and stomach were faintly outlined. Fig. 4 (introduction) is a representation of the knee of a boy 15 years old, in knickerbockers, showing the buttons clearly, and dimly a 32 caliber bullet which is imbedded in the end of the femur.

204_a_. NECROSIS. Mortification of the ulna is represented on p. 142. Necrosis of the bone corresponds to gangrene of the soft parts; life is extinct.

205. MORTON’S EXPERIMENT. DIAGNOSIS. _Elect. Eng._, N.Y., June 17, ’96. Lect. before _Odontological So._, N.Y., Apr. 24, ’96; repeated in _Dental Cosmos_, June, ’96.—Dr. William J. Morton, of New York, made several important examinations of the human system by the use of X-rays.

In regard to application in dentistry, he stated:—“Each errant fang is distinctly placed, however deeply imbedded within its alveolar socket; teeth before their eruption stand forth in plain view; an unsuspected exostosis is revealed; a pocket of necrosis, of suppuration, or of tuberculosis is revealed in its exact outlines; the extent and area and location of metallic fillings are sharply delineated, whether above or below the alveolar line. Most interesting is the fact that the pulp-chamber is beautifully outlined, and that erosions and enlargements may be readily detected.”

206. The author saw one of Dr. Morton’s original photographed sciagraphs of the thorax, 15 inches by 11 inches, not at all creditably reproduced at page 161. In the original, to the surgeon’s eye: “The acromion and coracoid processes of the shoulder blade are clearly shown in their relations to the head of the humerus, or arm bone, and also the end of the clavicle, or collar bone, is shown in its relations to the shoulder joint. We have, in short, an inner inspection in a living person of this rather complicated joint, the shoulder, and there can be no doubt that in defined pictures of this nature even very slight deformities and diseases would be detected. It is noticeable that the front portions of the ribs are not shown, only the posterior portions lying nearest to the sensitized plate appear; also the breastbone was sufficiently dense to almost entirely obstruct the X-rays. A collar button at the back of the neck is taken through the backbone. In some of my negatives the dark outline of the heart and liver is shown as well as the outlines of tumors in the brain; but this is evidently for purposes of demonstrating the location of organs, an over-exposure, and does not, therefore, indicate the outlines of the heart.”

The time of exposure was reduced by the use of a fluorescent screen in conjunction with the photographic plate.

207. A woman was troubled with a stiffened wrist. Dr. Morton took a single sciagraph of both wrists side by side as shown at page 174, (the photographic print being presented for this book by E. B. Meyrowitz, 104 East 23d Street, N.Y.) The injured wrist in the picture exhibited the Colles’ Fracture—the ulna and radius bones being telescoped into their fractured ends by a fall upon the sidewalk a year before. By knowing the cause, the manner of cure became evident, and, accordingly, the patient is expected to bend the wrist backward and forward and laterally several times a day.

Dr. Morton, in a lecture before the Medical Society of the County of New York, to be printed in the _Medical Record_, related that another promising field of research and application is in the detection of calcareous infiltrations involving, for instance, the arteries, or occurring in the lungs and other tissues. Calculi in kidneys, in the bladder, in the salivary ducts have already been successfully located. The stages of ossification, and the epiphyseal relations of the osseous structure in children may be pictured as is demonstrated in the picture of the entire skeleton of an infant five months of age. The sciagraph shows plainly that it will be possible to detect spinal diseases, either in children or in adults. (_Not reproduced._)

208. NORTON’S EXPERIMENT. DIAGNOSIS. _Elect. World_, N.Y., May 23, ’96.—In conjunction with Dr. Francis H. Williams, Dr. Norton examined several patients from the city hospital to determine how an X-ray diagnosis would agree with that previously made by the hospital staff. (See also § 142, at end.) The outline of an enlarged liver, 7 inches in diameter, was easily distinguished, the two outlines, one by percussion and one by X-rays, agreeing better in favor of the latter by 1/2 inch. An enlarged spleen was perfectly outlined. The tuberculosis of one lung caused it to be more opaque than the sound lung. It was found necessary to take into account the seams of clothing, buttons, buckles, etc. A bullet was found exactly under the spot which they marked as being over the bullet. A foreign metallic body can be easily detected in the œsophagus, because the latter is quite transparent. They could see the shadows of the cartilaginous rings in the trachea, glottis, and epiglottis. Younger persons, up to 10 years of age, are more transparent than older.

209. LANNELONGUE, BARTHELEMY AND OUDIN’S EXPERIMENTS. OSTEOMYELITIS DISTINGUISHED FROM PERIOSTITIS. _Elec. Rev._, Lon., Feb. 14, ’96.—In a sciagraph of a person diseased with the former, the surface of the bone was proved to be intact, while the internal parts were destroyed. In the latter disease the changes proceed from the surface to the interior.

The art of sciagraphy, more nearly, as every month passes, becomes developed by means of improved apparatus, screens, photographic plates and other elements which at present are only dimly predicted. Nevertheless, how can a better sciagraph of bones, showing their thickness and porosity, be desired than that reproduced on page 177, and taken by Prof. Arthur W. Goodspeed, and representing a club foot of a child? In the race to excel in this new art, no one, to the author’s knowledge, has surpassed Prof. Goodspeed, of the University of Penn., considered jointly from the standpoints of _priority_, _superiority_, _quantity_ and _variety_. Dr. Keen, L.L.D., Professor in the Jefferson Medical College, of Philadelphia, stated (_Inter. Nat. Med. Mag._, June, ’96) that Prof. Goodspeed “has far eclipsed all others in these most beautifully clear sciagraphs.”

210. A book could be filled with the numerous cases of diagnosis by X-rays showing the utility. In closing this chapter, let it suffice to mention some of the sources of literature relating to this subject directly or indirectly: location of shot (by Dr. Ashhurst, Phila.) in lady’s wrist, not located by other means. Dr. Packard’s case of acromegaly; Dr. Muller’s (Germantown) location of needle in boy’s foot; cause of pain not before known; needle subsequently removed; a perfect thorax, or trunk, by Prof. Arthur W. Goodspeed, University of Pennsylvania; Thomas G. Morton’s (M. D. Pres. Acad. Surg., Phila.) application to painful affection of the foot, called metatarsaligia. All of the above noticed in _Inter. Med. Mag._, June, 1896. Case of a burned hand with anchylosis of the fingers, by W. W. Keen, M.D., L.L.D. Bacteria not killed by X-rays. Normal and abnormal phalanx distinguished. Fracture and dislocation sometimes differentiated by X-rays. _Amer. Jour. Med. Sci._, Mar., ’96.