THE RÖNTGEN RAY
One of those extraordinary discoveries which startle the whole world came nearly at the end of the nineteenth century, in the winter of 1895–96. At that time a modest professor in the University of Würzburg announced that he could readily see the skeleton inside the body through the flesh! Naturally, the first announcement was received with almost absolute incredulity; but very soon his discovery was confirmed from all sides, and it has now taken its place among the recognized phenomena of science. By means of certain rays, which, being of unknown nature, were called “X”-rays, after the well-known mathematical X, or unknown quantity, Professor Röntgen has shown us that not only can the bones be seen, but that almost every substance in the body can be seen and reproduced in pictures. The reason for this is because they are all obstacles to the passage of these X-rays and so produce shadows on a sensitized photographic plate. If the exposure is sufficiently prolonged the rays penetrate even through the bones and act upon the photographic plate, so that no shadow remains. If the rays are allowed to penetrate for a shorter time the bones show dense shadows, and one can get a light shadow of the soft parts. If the exposure is still shorter, then we can recognize the dense shadow of the bone, the much less dense shadows of the muscles, and the still lighter shadows of the layer of fat immediately under the skin. The heart can be seen beating, and its shadow is now a well-recognized feature in skiagraphs of the chest. At first it was thought impossible to discover anything inside the bony skull, but there are now on record nearly a score of instances in which bullets have been detected within the skull, and after trephining have been found and removed exactly at the location indicated. It is a very common thing now to locate a piece of steel or other similar foreign bodies within the eyeball by the method of Dr. Sweet, or some similar method, within one or two millimetres (a millimetre is one-twenty-fifth of an inch). It is now well recognized that even stones in the kidney will throw shadows sufficiently strong for them to be recognized, and by noting their level in relation to the vertebræ we can tell precisely in what part of the kidney to make the incision in order to find and remove them. It has happened to myself and many other surgeons in the past to cut down upon a kidney, believing that there was a stone in the kidney, only to find that we had been misled by the apparently clear symptoms of such a foreign body. In future no such mistake should be made by any surgeon within reach of a skilful skiagrapher. Unfortunately, gall stones and numerous other foreign bodies, vegetable substances such as beans, corn, wood, etc., being as transparent to the X-rays as are the soft parts, are not revealed by means of this new method of investigation; but cavities in the lung, abscesses in bone, and similar diseases which produce thinning of the lung, bone, and other such organs, and so lighten instead of deepen the shadows, can now be recognized by means of light spots in the pictures as well as others by means of a shadow.
I spoke a moment ago of the need of a “skilful” skiagrapher, for it must be remembered that there may be the same difference in the personal skill, and, therefore, in the reliability of the results in skiagraphy as there is in photography. A poor photographer will get very different results from a skilful one, even if he uses precisely the same quality of plates and precisely the same camera. Personal skill and experience in the skiagrapher is, therefore, one of the most important elements in success. It must be remembered also that the X-rays in not a few cases may mislead us. I have, personally, fractured a bone on account of deformity, taken an X-ray picture immediately after the operation, the picture showing not the slightest evidence of a fracture, which I absolutely knew existed. Moreover, foreign bodies found on the outside of the person may mislead us, as, for example, the metal part of suspenders, a coin in one’s pocket, and such like. They look in the picture as if they were inside rather than outside the body, and any article the shape or size of which would not reveal its nature might easily be mistaken for a foreign body within the patient. Therefore, in many cases only an expert can determine precisely what the skiagraph means. I especially mention this, because there is a tendency at present to utilize skiagraphs in court in order to convince the jury that such a picture is an evidence of malpractice. Such pictures always need an interpreter in order to judge correctly of their meaning. It is precisely as if the jury were asked to look through a microscope. I have been myself accustomed to use the microscope for thirty years, but there are many instances even yet in which I am obliged to ask a pathologist or bacteriologist what I really am looking at in the microscope. While one may make a mistake of small moment in some cases, yet if a man’s life or liberty or purse is at the mercy of a jury which does not know how to interpret a skiagraph, and, may, therefore, give a verdict which is “precisely wrong,” as Professor Lincoln, my old teacher of Latin, used to call many of our translations, it will be a very serious matter and lead to gross injustice.