THE USE OF THE ROeNTGEN X RAYS IN SURGERY.

BY W.W.  KEEN, M.D., LL.D.

The nineteenth century resembles the sixteenth in many ways.  In or about the sixteenth we have the extensive use of the mariner’s compass and of gunpowder, the discovery of printing, the discovery and exploration of America, and the acquisition of territory in the New World by various European states.  In the nineteenth century we have the exploration of Africa and the acquisition of territory in its interior, in which the various nations of Europe vie with each other again as three centuries before; the discovery of steam, and its ever-growing application to the transportation of goods and passengers on sea and land; of the spectroscope, and through it of many new elements, including helium in the sun, and, later, on the earth; of argon in the earth’s atmosphere; of anaesthetics and of the antiseptic methods in surgery, and, lastly, the enormous recent strides in electrical science.

Not only has electricity been applied to transportation and the development of light and power; but the latest discovery by Professor Roentgen of the X rays seems destined, possibly, not only to revolutionize our ideas of radiation in all its forms on the scientific side, but also on the practical side to be of use in the domain of medicine.  It is, therefore, with great pleasure that I accede to the request of the editor of this Magazine to state briefly what has been achieved in the department of medicine up to the present time.

The method of investigating the body by means of the X rays is very simple, as is shown in Figure 1.  The Crookes tube, actuated from a storage battery or other source of electricity through a Ruhmkorff coil, is placed on one side of the body.  If need be, instead of using the entire tube, the rays from the most effective portion of it only are allowed to impinge upon the part of the body to be investigated, through an opening in a disk of lead interposed between the Crookes tube and the body.  On the other side of the part to be investigated is placed a quick photographic plate shut up in its plate-holder, and is exposed to the rays emanating from the tube for a greater or less length of time.  The parts of the plate not protected by the body are acted upon by the rays, through the lid of the plate-holder (to which the rays are pervious), while the tissues of the body act, feebly or strongly, as the case may be, as obstacles to the rays.  Hence, the part of the plate thus protected is less acted upon than the rest, and a shadow is produced upon the plate.  The soft tissues of the body form but a very slight obstacle to the passage of the rays, and, hence, throw very faint shadows on the plate.  The more dense portions, presenting a greater obstacle to the passage of the rays, throw deeper shadows; hence the bones are seen as dark shadows, the soft parts as lighter ones.  That the flesh or soft parts are not wholly permeable to the rays is well shown in the skiagraph—­i.e., a “shadow picture”—­of a foot. (Figure 2.) Where two toes overlap, it will be observed that there is a deeper shadow, like the section of a biconvex lens.