McClure's Magazine, Vol. 6, No. 6, May, 1896

by Various

(From the "American Journal of the Medical Sciences," March 1896.)

Mr. Arthur H. Lea has ingeniously suggested that the translucency of the soft parts of the living and of those of the dead body might show a difference, and that, if such were the case, it might be used as a definite test of death. Unfortunately Figure 6, of a dead hand, when contrasted with Figure 11, of a living hand, shows virtually no difference, and the method cannot be used as a positive proof of death.

That we are not able at present to skiagraph the soft parts of the body, does not imply that we shall not be able to do it hereafter; and should this be possible, especially with our increasing ability to penetrate thick masses of tissue, it is evident, without entering into details, that the use of the X rays may be of immense importance in obstetrics.

The bones, however, as is seen in nearly all of the skiagraphs illustrating this paper, cast well-defined shadows. This is at once an advantage and a hindrance. To illustrate the latter first, even one thickness of bone is difficult to penetrate, so that the attempt to skiagraph the opening which had been made in a skull of a living person by a trephine entirely failed, since the bone upon the opposite side of the skull formed so dense an obstacle that not the slightest indication of the trephine opening appeared. To take, therefore, a skiagraph of a brain through two thicknesses of skull, with our present methods, is an impossibility. Even should the difficulty be overcome, it is very doubtful whether there would be any possibility of discovering diseases of the brain, since diseased tissues, such as cancer, sarcoma, etc., are probably as permeable to the X rays as the normal tissues. Thus Reid ("British Medical Journal," February 15, 1896) states that a cancerous liver showed no difference in permeability to the rays through its cancerous and its normal portions.

Foreign bodies, such as bullets, etc., in the brain may be discovered when our processes have become perfected. Figure 7 shows two buck-shot skiagraphed inside of a baby's skull, and therefore through two thicknesses of bone. It must be remembered, however, that not only are the bones of a baby's skull much less thick than those of an adult's skull, but they are much less densely ossified, and so throw far less of a shadow.

The dense shadows cast by bone are, at least at present, an insuperable obstacle to skiagraphing the soft translucent organs of the body which are enclosed within a more or less complete bony case, as the rays will be intercepted by the bones. Efforts, therefore, to skiagraph the heart, the lungs, the liver, and stomach, and all the pelvic organs, probably will be fruitless to a greater or less extent until our methods are improved. While a stone in a bladder outside the body would undoubtedly be perceptible, in the body the bones of the pelvis prevent any successful picture being taken.

("American Journal of the Medical Sciences," March, 1896.)

To turn from the hindrances to the advantages of the application of the method to the bones, one of the most important uses will be in diseases and injuries of bones. In many cases it is very difficult to determine, even under ether, by the most careful manipulations, whether there is a fracture or a dislocation, or both combined. When any time has elapsed after the accident, the great swelling which often quickly follows such injuries still further obscures the diagnosis by manipulation. The X rays, however, are oblivious, or nearly so, of all swelling, and the bones can be skiagraphed in the thinner parts of the body at present, say up to the elbow and the ankle, with very great accuracy. Thus, Figure 8 shows the deformity from an old fracture of the ulna (one of the bones of the forearm) very clearly.

By this means we shall be able to distinguish between fracture and dislocation in obscure cases. Thus Mr. Gray ("British Medical Journal," March 7, 1896), in a case of injury to an elbow, was enabled to diagnosticate and successfully to replace a very rare dislocation, which could not be made out by manipulation, but was clearly shown by the X rays. We may also possibly be able to determine when the bones are properly adjusted after a fracture; and all the better, since the skiagraph can be taken through the dressings, even if wooden splints have been employed. If plaster of Paris is used (and it is often the best "splint") this is impermeable to the rays.