Beview of Rt^vieivs, 1/0/13. 



LEADING ARTICLES. 



707 



THE RONTGEN RAYS IN MEDICINE. 



The earliest uses of the X-rays in 

 medicine were for the location of 

 foreign bodies, such as bullets, frag- 

 ments of rock, splinters of bone, etc., 

 which had been forced into the human 

 body by violence, or such things as 

 coins, buttons, bones, and pins, which 

 had been accidentally swallowed, or had 

 " gone down the wrong way," and be- 

 come lodged in the air-passages, and for 

 the location and the determination of 

 the extent of internal injury due to frac- 

 tured bones. 



During the past few years, however, 

 the field of this wonderful instrument 

 has been vastly widened by improve- 

 ments in technique and by the painstak- 

 ing experiments and careful records 

 made by numerous experts in various 

 parts of the world. 



It is now possible for the skilled 

 Rontgenologist to study the condition 

 and the movements of the hollow organs 

 of the body, such as those constituting 

 the alimentary canal, and even to note 

 delicate tissue changes, such as those in- 

 volved in the lesions occasioned by 

 tuberculosis and cancer. 



A recent number of Die Natiinvissen- 

 schaften (Berlin), contains an article on 

 the subject. The author, Dr. Max Levy- 

 Dorn, I3erlin, begins by calling atten- 

 tion to the fact that observations may 

 be made by means of the fluorescent 

 screen or by photographs. 



The fluorescent screen consists of a 

 substance that glows under the influence 

 of the X-rays. The barium-platinum- 

 cyanide screen, which glows with a 

 green light, has been much used, but is 

 now often replaced by the " astral- 

 screen, or zinc-chloride screen, which 

 gives a white light and which has the 

 advantage of being more stable. 1 he 

 screen shows the observer the organs 

 actually in motion. It does not, how- 

 ever, show the finer details which appcar 

 in a photograph. Obviously, too, the 

 photograph forms an important record. 



Thus, in the adunrably equipped and 

 conducted X-ray department of St. 

 Luke's Hospital in New York (jly, 

 which the writer mentions because oi 

 personal knowledge, there are carefulK' 

 catalogued and indexed series of phot 



o- 



graphs forming invaluable records of 

 individual cases, and affording means 

 of comparison and study to physicians 

 interested in similar cases. 



These photographs are made by in- 

 stantaneous exposure or time-exposure, 

 according to the nature of the subject. 

 " Snap-shots," of course, are better 

 where motions are to be recorded, while 

 more time is advisable where there is a 

 state of rest and where flne details are 

 to be brought out, such as the deteriora- 

 tion of tissue or a delicate hair-like frac- 

 ture of bone. 



Nearly every part of the body can 

 now be photographed in i-ioo of a 

 second. Only in " fleshy " persons is 

 there difficulty in this, especially for the 

 stomach and intestines — however, the 

 motion of these organs is so slow that 

 this difficulty is not important, since 

 i-io — I 3-10 seconds is sufficiently fast. 



The " snap-shots " are particularly im- 

 portant in taking nervous or restless per- 

 sons, or children, in comparing men and 

 animals, or in studying involved motions 

 as of stomach and intestines. Some- 

 times stereoscopic views are desirable. 

 These should be taken raj')idly, and ex- 

 cellent apparatus has been devised which 

 automatically shifts the tubes and 

 change the plates. Of late some cine- 

 matograph records have been made, 

 but these are more im]:)Ortant for scien- 

 tific than for ])ractical purposes. In 

 general, however, time-exposures of i .', 

 seconds to 2 seconds are preferable, as 

 being more certain of success and giv- 

 ing more detail. 



The chief progress in X-ray diagnosis 

 of late years has been with regard to 

 the digestive organs. Since these are 

 hollow they can l)e investigated by 

 X-rays only when filled with some con- 

 trasting substance, generally some 

 o]iaque substance such as bismuth. 



It is primaril)- requisite, of course, 

 that the subslaiue used should be harm- 

 less. For this reason Bisiiiuf/nnii snbiii- 

 tricuni has l>een replaced b\- Bisvuitlimu 

 larboniciiui, because the former some 

 times (though rarel\-\ caused symptoms 

 of ]ioisoning. 



The opaque substance is used ui the 

 form of a fine powder stirred into a 



