The chief use of the method up to the present time, besides determining the diseases, injuries, and abnormities of bone, has been in determining with absolute accuracy the presence of foreign bodies, especially of needles, bullets, or shot and glass. It is often extremely difficult to decide whether a needle is actually present or not. There may be a little prick of the skin, and no further positive evidence, as the needle is often imperceptible to touch. The patient, when cross-questioned, is frequently doubtful whether the needle has not dropped on the floor; and it might be, in some cases, a serious question whether an exploratory operation to find a possible needle might not do more harm than the needle. Moreover, though certainly present, to locate it exactly is often very difficult; and even after an incision has been made, though it may be embedded in a hand or foot, it is no easy task to find it.
(Skiagraphed by Mr. Sydney Rowland, and published in the "British Medical Journal.")
The new method is a great step in advance in the line of precision of diagnosis, and, therefore, of correct treatment. About half a dozen cases have already been reported in the medical journals in which a needle was suspected to be in the hand or the foot, and, in some instances, had been sought for fruitlessly by a surgeon, in which the use of the X rays demonstrated absolutely, not only its presence, but its exact location, and it has then been an easy matter to extract it. So, too, in an equal number of cases, bullets and shot have been located, even after a prior fruitless search, and have been successfully extracted. Figure 6 is the skiagraph of the hand of a cadaver which shows a needle deeply embedded in the thumb, and also two buck-shot, 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 Röntgen 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.
("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.