"Let us shake hands now," he said, smiling, flushed with success, as he looked into the eyes of this very pretty woman.

"I shall take off my glove first—such old friends as we are! It must be a real ceremony."

She laid a soft, white, dimpled hand, covered with glistening rings, in his outstretched palm, and gazed at him with coquettish plaintiveness. "It's so lovely to see you again! Have you forgotten the night you kissed me?"

"I have thought of it daily," he replied, giving her hand a hearty squeeze. They both laughed, and he took a surreptitious peep at her from under his eyelids. Marie Wakeman! Yes, truly, the same, and with the same old tricks. He had been married for nearly fourteen years, his children were half grown, he had long since given up youthful friskiness, but she was "at it" still. Why, she had been older than he when they were boy and girl; she must be for—He gazed at her soft, rounded, olive cheek, and quenched the thought.

"And you are very happy?" she pursued, with tender solicitude. "Nettie makes you a perfect wife, I suppose."

"Perfect," he assented gravely.

"And you haven't missed me at all?"

"Can you ask?" It was the way in which all men spoke to Marie Wakeman, married or single, rich or poor, one with another. He laughed inwardly at his lapse into the expected tone. "I feel that I really breathe for the first time in years, now that I'm with you again. But how is it that you are not married?"

"What, after I had known you?" She gave him a reproachful glance. "And you were so cruel to me—as soon as you had made your little Nettie jealous you cared for me no longer. Look what I've declined to!" She indicated Jim Shore, leaning disconsolately against the cornice, chewing his moustache. "Now don't give him your place unless you really want to; well, if you're tired of me already—thank you ever so much, and I am proud of you to-night, Billy!"

Her lustrous eyes dwelt on him lingeringly as he left her; he smiled back into them. The lines around her mouth were a little hard; she reminded him indefinably of "She;" but she was a handsome woman, and he had enjoyed the encounter. The sight of her brought back so vividly the springtime of life; his hopes, the pangs of love, the joy that was his when Nettie was won; he felt an overpowering throb of tenderness for the wife at home who had been his early dream.

The last speeches were over, but Mr. William Belden's triumph had not ended. As the acknowledged orator of the evening he had an ovation afterward; introductions and unlimited hand-shakings were in order.

He was asked to speak at a select political dinner the next week; to speak for the hospital fund; to speak for the higher education of woman. Led by a passing remark of Henry Belden's to infer that his cousin was a whist player of parts, a prominent social magnate at once invited him to join the party at his house on one of their whist evenings.

"My wife, er—will have great pleasure in calling on Mrs. Belden," said the magnate. "We did not know that we had a good whist player among us. This evening has indeed been a revelation in many ways—in many ways. You would have no objection to taking a prominent part in politics, if you were called upon? A reform mayor is sadly needed in our city—sadly needed. Your connection with Judge Belden would give great weight to any proposition of that kind. But, of course, all this is in the future."

Mr. Belden heard his name whispered in another direction, in connection with the cashiership of the new bank which was to be built. The cashiership and the mayoralty might be nebulous honors, but it was sweet, for once, to be recognized for what he was—man of might; a man of talent, and of honor.

There was a hurried rush for the train at the last on the part of the visitors. Mr. William Belden snatched his mackintosh from the peg whereon it had hung throughout the evening, and went with the crowd, talking and laughing in buoyant exuberance of spirits. The night had cleared, the moon was rising, and poured a flood of light upon the wet streets. It was a different world from the one he had traversed earlier in the evening. He walked home with Miss Wakeman's exaggeratedly tender "Good-by, dear Billy!" ringing in his ears, to provoke irrepressible smiles. The pulse of a free life, where men lived instead of vegetating, was in his veins. His footstep gave forth a ringing sound from the pavement; he felt himself stalwart, alert, his brain rejoicing in its sense of power. It was even with no sense of guilt that he heard the church clocks striking twelve as he reached the house where his wife had been awaiting his return for four hours.

She was sitting up for him, as he knew by the light in the parlor window. He could see her through the half-closed blinds as she sat by the table, a magazine in her lap, her attitude, unknown to herself, betraying a listless depression. After all, is a woman glad to have all her aspirations and desires confined within four walls? She may love her cramped quarters, to be sure, but can she always forget that they are cramped? To what does a wife descend after the bright dreams of her girlhood! Does she really like above all things to be absorbed in the daily consumption of butter, and the children's clothes, or is she absorbed in these things because the man who was to have widened the horizon of her life only limits it by his own decadence?

She rose to meet her husband as she heard his key in the lock. She had exchanged her evening gown for a loose, trailing white wrapper, and her fair hair was arranged for the night in a long braid. Her husband had a smile on his face.

"You look like a girl again," he said brightly, as he stooped and kissed her. "No, don't turn out the light, come in and sit down a while longer, I've ever so much to tell you. You can't guess where I've been this evening."

"At the political meeting," she said promptly.

"How on earth did you know?"

"The doctor came here to see Willy, and he told me he saw you on the way. I'm glad you did go, William; I was worrying because I had sent you out; I did not realize until later what a night it was."

"Well, I am very glad that you did send me," said her husband. He lay back in his chair, flushed and smiling at the recollection. "You ought to have been there, too; you would have liked it. What will you say if I tell you that I made a speech—yes, it is quite true—and was applauded to the echo. This town has just waked up to the fact that I live in it. And Henry said—but there, I'll have to tell you the whole thing, or you can't appreciate it."

His wife leaned on the arm of his chair, watching his animated face fondly, as he recounted the adventures of the night. He pictured the scene vividly, and with a strong sense of humor.

"And you don't say that Marie Wakeman is the same as ever?" she interrupted, with a flash of special interest. "Oh, William!"

"She called me Billy." He laughed anew at the thought. "Upon my word, Nettie, she beats anything I ever saw or heard of."

"Did she remind you of the time you kissed her?"

"Yes!" Their eyes met in amused recognition of the past.

"Is she as handsome as ever?"

"Um—yes—I think so. She isn't as pretty as you are."

"Oh, Will!" She blushed and dimpled.

"I declare, it is true!" He gazed at her with genuine admiration. "What has come over you to-night, Nettie?—you look like a girl again."

"And you were not sorry when you saw her, that—that—"

"Sorry! I have been thinking all the way home how glad I was to have won my sweet wife. But we mustn't stay shut up at home as much as we have; it's not good for either of us. We are to be asked to join the whist club—what do you think of that? You used to be a little card fiend once upon a time, I remember."

She sighed. "It is so long since I have been anywhere! I'm afraid I haven't any clothes, Will. I suppose I might—"

"What, dear?"

"Take the money I had put aside for Mary's next quarter's music lessons; I do really believe a little rest would do her good."

"It would—it would," said Mr. Belden with suspicious eagerness. Mary's after-dinner practising hour had tinged much of his existence with gall. "I insist that Mary shall have a rest. And you shall join the reading society now. Let us consider ourselves a little as well as the children; it's really best for them, too. Haven't we immortal souls as well as they? Can we expect them to seek the honey dew of paradise while they see us contented to feed on the grass of the field?"

"You call yourself an orator!" she scoffed.

He drew her to him by one end of the long braid, and solemnly kissed her. Then he went into the hall and took something from the pocket of his mackintosh which he placed in his wife's hand—a little wooden dish covered with a paper, through which shone a bright yellow substance—the pound of butter, a lump of gleaming fairy gold, the quest of which had changed a poor, commonplace existence into one scintillating with magic possibilities.

Fairy gold, indeed, cannot be coined into marketable eagles. Mr. William Belden might never achieve either the mayoralty or the cashiership, but he had gained that of which money is only a trivial accessory. The recognition of men, the flashing of high thought to high thought, the claim of brotherhood in the work of the world, and the generous social intercourse that warms the earth—all these were to be his. Not even his young ambition had promised a wider field, not the gold of the Indies could buy him more of honor and respect.

At home also the spell worked. He had but to speak the word, to name the thing, and Nettie embodied his thought. He called her young, and happy youth smiled from her clear eyes; beautiful, and a blushing loveliness enveloped her; clever, and her ready mind leaped to match with his in thought and study; dear, and love touched her with its transforming fire and breathed of long-forgotten things.

If men only knew what they could make of the women who love them—but they do not, as the plodding, faded matrons who sit and sew by their household fires testify to us daily.

Happy indeed is he who can create a paradise by naming it!



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.



When we attempt to skiagraph the thicker portions of the body, for example, the shoulder, the thigh, or the trunk, even the parts consisting only of flesh obstruct the rays to such an extent, by reason of their thickness, that the shadows of the still more dense tissues, like the thigh bone, the arm bone, or the bones of the trunk, cannot be distinguished from the shadows of the thicker soft parts. Tesla ("Electrical Review," March 11, 1896) has to some extent overcome these difficulties by his improved apparatus, and has skiagraphed, though rather obscurely, the shoulder and trunk, and Rowland has been able to do the same. Doubtless when we are able to devise apparatus of greater penetration, and to control the effect of the rays, we shall be able to skiagraph clearly even through the entire thickness of the body.

It might be supposed that clothing or surgical dressings would prove an obstacle to this new photography, but all our preconceived notions derived from the ordinary photograph must be thrown aside. The bones of the forearm or the hand can be as readily skiagraphed through a voluminous surgical dressing or through the ordinary clothing, as when the parts are entirely divested of any covering. Even bed-ridden patients can be skiagraphed through the bed-clothes, and, therefore, without danger from exposure.



One of the principal difficulties of the method at present is the time ordinarily required to obtain a good picture. Usually this time may be stated at in the neighborhood of an hour, though many good skiagraphs have been taken in a half hour or twenty minutes. It is stated that Messrs. McLeennan, Wright, and Keele of Toronto have reduced the necessary time to one second, and that Mr. Edison has taken even instantaneous pictures; but I am not aware of the publication of any pictures showing how perfect these results are. Undoubtedly, as a result of the labors of so many scores of physicists and physicians as are now working at the problem, before long we shall be able to skiagraph at least the thinner parts of the body in a very brief interval. The brevity of the exposure will also better the pictures in another way. At present, if the attempt is made to skiagraph the shoulder or parts of the trunk, we have to deal with organs which cannot be kept motionless, since the movements incident to breathing produce a constant to and fro movement of the shoulder, the lungs, the heart, the stomach, the liver, and other organs which, hereafter, may be made accessible to this process. There is no serious discomfort excepting the somewhat irksome necessity of remaining absolutely still.

Another method of seeing the denser tissues of the body is by direct observation. A means of seeing through the thinner parts of the body, such as the fingers or the toes, has been devised simultaneously by Salvioni of Italy, and Professor Magie of Princeton. Their instruments are practically identical, consisting of a hollow cylinder a few inches long, one end of which is applied to the eye, the other end, instead of having a lens, being covered by a piece of paper smeared with a phosphorescent salt, the double cyanide of platinum and barium. When the hand is held before a Crookes tube, and is looked at through the cylinder, we can see the bones of the hand or foot almost as clearly as is shown in Figure 2. It has not yet, I believe, been applied to thicker parts of the body. Figures 3 and 4 show a baby's foot and knee as seen through this tube. The partial development of the bones accounts for the peculiar appearance. There is no bony knee-pan, or patella, at birth, and the bones of the toes consist only of cartilage, which is translucent, and therefore not seen. The name given by Professor Salvioni to this sort of "spy-glass"—if one may apply this term to an instrument which has no glass—is that of "cryptoscope" (seeing that which is hidden). The name suggested by Professor Magie is "skiascope" (seeing a shadow.)

This leads me to say a word in reference to the nomenclature. The very unfortunate name "shadowgraph" has been suggested and largely used in the newspapers, and even in medical journals. It has only the merit of clearness as to its meaning to English-speaking persons. It is, however, an abominable linguistic crime, being an unnatural compound of English and Greek. "Radiograph" and its derivatives are equally objectionable as compounds of Latin and Greek. The Greek word for shadow is "skia," and the proper rendering, therefore, of shadowgraph is "skiagraph," corresponding to photograph.

The first question that meets us in the use of the method in medicine is what normal constituents of the body are permeable or impermeable to the X rays. It may be stated, in a general way, that all of the fleshy parts of the body are partially permeable to the rays in a relatively short time; and if the exposure is long enough, they become entirely permeable, so that no shadow is cast. Even the bones, on prolonged exposure, do not present a sufficient obstacle to the passage of the rays, and the shadow originally cast becomes obliterated. Hence, skiagraphs of the same object exposed to the rays for varying times may be of value in showing the different tissues. The most permeable of the normal tissues are cartilage or gristle, and fat. A kidney (out of the body) is stated by Dr. Reid of Dundee to show the difference between the rind, or secreting portion, which is more transparent, and the central portion, consisting chiefly of conducting tubes, which is less transparent. On the contrary, in the brain the gray cortex, or rind, is less transparent than the white nerve tubules in the centre.

The denser fibrous tissues, such as the ligaments of joints and the tendons or sinews of muscles, cast very perceptible shadows, so that when we come to a thick tendon like the tendo Achillis, the shadow approaches even the density of the shadow cast by bone. I presume that it is for the same reason (the dense fibrous envelope, or sclerotic coat) that the eye-ball is not translucent to the rays, as is seen in Figure 5, of a bullock's eye.



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.



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.

That this method will come into general use, however, is very unlikely, since the expense, the time, and the trouble will be so great that it will be impracticable to use it in every case, especially in hospitals or dispensaries, where crowds of patients have to be attended to in a relatively brief time. In the surgical dispensary alone of the Jefferson Medical College Hospital, about one hundred patients are in attendance between twelve and two o'clock every day, and all the time of a large number of assistants is occupied with dressing the cases. It would be manifestly an utter impossibility to skiagraph the many fractures which are seen there daily, considering that it would take from half an hour to an hour of the time of not less than two or three assistants skilled not only in surgery, but also in electricity, to skiagraph a single fracture. Now and then, in obscure cases, however, the method will be undoubtedly of great service, as in the case above described.



Too hasty conclusions, especially in medico-legal cases, may easily be reached. We do not yet know, by skiagraphs of successful results after fracture, just how such bones look during the process of healing, and, therefore, we cannot yet be sure that the skiagraph of an unsuccessful case is an evidence of unskilfulness on the part of the surgeon.

In diseases of bone, which are obscure, it has already proved of great advantage, as in a case related by Mr. Abrahams ("British Medical Journal," February 22, 1896). A lad of nineteen, who had injured his little finger in catching a cricket ball, had the last joint of the finger bent at a slight angle, and he could neither flex nor extend it. Any attempt to do so caused great pain. The diagnosis was made of a fracture extending into the joint, and that the joint having become ossified, nothing short of amputation would give relief. Mr. Sydney Rowland skiagraphed the hand, and showed that there was only a bridge of bone uniting the last two joints of the finger. An anaesthetic was administered, and with very little force the bridge of bone was snapped, the finger saved, and the normal use of the hand restored.

Deformities of bone can be admirably shown. Thus Figure 9 ("British Medical Journal," February 15, 1896) shows the deformity of the last two toes of the foot, due to the wearing of tight shoes. (Owing to the accidental breaking of the plate, only a part of the foot is shown.) The lady whose foot was thus skiagraphed stated that she had suffered tortures from her boots, so that walking became a penance, and she even wanted the toes amputated. Relief was obtained by wearing broad-toed boots, which gave room for the deformed toes. Another admirable illustration of a similar use of the method is seen in Figure 2, from a case of Professor Mosetig in Vienna. The last joint of the great toe was double the ordinary size, and by touch it was recognized that there were two bones instead of one. The difficulty was to determine which was the normal bone, and which the extra bone that ought to be removed. The moment the skiagraph was taken, it was very clear which bone should be removed. Bony tumors elsewhere can also be diagnosticated and properly treated. Possibly, also, we may be able to determine the presence of dead bone, though I am not aware of any such skiagraphs having been taken.



Diseases and injuries of the joints will be amenable to examination by this method. Figure 10 shows an elbow joint with tuberculous disease. The bones of the arm and forearm are clearly seen, and between them, is a light area due to granulation-tissue, or to fluid, probably of tuberculous nature, which is translucent to the rays. The picture confirms the prior diagnosis of tuberculous disease, and shows that the joint will have to be opened and treated for the disease. Deposits of uric acid in gouty diseases of the joints will undoubtedly be shown by these methods, but this will scarcely be of any help in the treatment. Whether light will be thrown on other diseases of the joints is a problem not yet solved.

Analogous to the bony tissues are the so-called ossified (really, calcified) arteries. In the dead body, arteries filled with substances opaque to the X rays, such as plaster of Paris or cinnabar mixtures, have already been skiagraphed successfully. It is not at all improbable that calcified arteries in the living subject may be equally well shown. So, too, when we are able to skiagraph through thick tissues, we may be able to show such deposits in the internal organs of the body. Stones in various organs, such as the kidney, will be accessible to examination so soon as our methods have improved sufficiently for us to skiagraph through the thicker parts of the trunk. The presence of such stones in the kidney is very often inferential, and it will be a great boon, both to the surgeon and the patient, if we shall be able to demonstrate positively their presence by skiagraphy. For the reason already given (the pelvic bones which surround the bladder), it is doubtful whether we can make use of it in stone in the bladder. Gall stones, being made not of lime and other similar salts, as are stones in the kidney and bladder, but of cholesterine, are, unfortunately, permeable to these rays; and it is, therefore, doubtful whether the X rays will be of any service to us in determining their presence.

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.



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 Roentgen 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.



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.

As sunlight is known to be the foe of bacteria, the hope has been expressed that the new rays might be a means of destroying the microbes of consumption and other diseases in the living body. Delepine, Park, and others have investigated this with a good deal of care. A dozen different varieties of bacteria have been exposed to the Roentgen rays for over an hour, but cultures made from the tubes after this exposure have shown not only that they were not destroyed, but possibly they were more vigorous than before.

The facts above stated seem to warrant the following conclusions as to the present value of the method:

First.—That deformities, injuries, and diseases of bone can be readily and accurately diagnosticated by the Roentgen rays; but that the method at present is limited in its use to the thinner parts of the body, especially to the hands, forearms, and feet.

Second.—That foreign bodies which are opaque to the rays, such as needles, bullets, and glass, can be accurately located and their removal facilitated by this means; but that a zeal born of a new knowledge almost romantic in its character, should not lead us to do harm by attempting the indiscriminate removal of every such foreign body. Non nocere (to do no harm) is the first lesson a surgeon learns.

Third.—That at present the internal organs are not accessible to examination by the X rays for two reasons: First, because many of them are enclosed in more or less complete bony cases, which cut off the access of the rays; and, second, because even where not so enclosed, the thickness of the body, even though it consists only of soft parts, is such that the rays have not sufficient power of penetration to give us any information.

Fourth.—Even if the rays can be made to permeate the thicker parts of the body, it is doubtful whether tumors, such as cancers, sarcoma, fatty tumors, etc., which are as permeable to the rays as the normal soft parts, can be diagnosticated. Bony tumors, however, can be readily diagnosticated; and possibly fibrous tumors, by reason of their density, may cast shadows.

Fifth.—That stones in the kidney, bladder, and gall bladder cannot be diagnosticated, either (1) because they are embedded in such parts of the body as are too thick to be permeable by the rays, or (2) are surrounded by the bones of the pelvis, or (3) are, in the case of gall stones, themselves permeable to the Roentgen rays.

Sixth.—That with the improvements which will soon be made in our methods, and with a better knowledge of the nature of the rays, and greater ability to make them more effective, we shall be able to overcome many of the obstacles just stated, and that the method will then probably prove to be much more widely useful than at present.

THE END