THE ROENTGEN RAYS AS A DIAGNOS TIC AGENT.—The Roentgen rays have become, during the past three years, an accepted diagnostic agent in pulmonary diseases. During 1896 and 1S97, Bou chard, of Paris; Stubbert, of Liberty; and Williams, of Boston, published, in the order named, papers showing posi tively that, by means of shadows and lights thrown on the fluoroscopic screen, many diseased conditions could be accu rately diagnosed.
Generally speaking, the Roentgen rays are valuable in corroborating signs dis covered by auscultation and percussion, but, at times, by their aid, we can dis cover incipient lesions or small isolated foci of infection not recognizable by ordinary methods of examination.
In addition, the fluoroscope enables us to recognize more fully and accurately the degree, position, and relation of areas of infiltration and consolidation, and also delineates plainly the limits of these areas.
Method of Exoin things are requisite for the successful use of the fluoroscope: a certain amount of prac tice and a primary knowledge of the fluoroscopic picture of a normal thorax. The thinner the subject. the more im mediate and easy the diagnosis. In all subjects one has, as does the tyro with the ophthalmoscope, to look for nothing until he can see something. The patient is placed standing before or lying above the Crookes tube for examination by the fluoroscope. A better methOd, however, is to seat the patient on a chair without a back, with the Crookes tube held be tween the scapula; and the fluoroscopic screen in front of the chest. A dark cloth now being placed over the tube and the patient's shoulders, concentrates all the light upon his chest, and the whole outline of the thorax appears as a picture upon the screen in front of the patient.
The advantage of this method is that both sides of the chest are exposed simultaneously; the comparisons are, therefore, more accurate.
When the fluoroscope is used it should be applied firmly and evenly to the bared chest, and, the two clavicles having been located, their relative distinctness of out line will generally indicate the side which is involved.
Having examined the apices, the fluoroscope is passed up and down the whole thoracic region in search of other foci of infection.
Normal Chest.—In about 50 per cent. of normal chests the right apex is not quite as clear as that on the left side. The normal lung is more transparent, and the reflex brighter at the end of inspiration. The ribs are more clearly defined during inspiration, and in a healthy chest an evenly clear transmis sion of light is visible between them.
Infiltration.—In cases of slight infil tration there is a haziness or fog between the light and the observer. The clav icle may, in other instances, appear to have a gauzy veil thrown over it. This haziness, as the infiltration advances, be comes a light shadow, the ribs becoming more indistinct, and the borders of the haze or shadow fade away gradually to a normal reflex. On deep inspiration this light shadow becomes slightly more gray in color.
Occasionally a slightly - thickened pleura at the apex may lead one to diag nose infiltration, or, rather, the begin ning of consolidation, as the pleural shadow is darker than a haze. When, however, we remember that a sharply defined pleurisy at the apex generally signifies underlying tubercular infiltra tion, there is but .a slight chance of error in diagnosis.
Consolidation.—When there is marked consolidation, the transmitted light is relatively less, the edges of the clavicle are indistinct, or the bone may be in visible. The limits of the consolidated area are sharply defined, and ordinarily are bordered by an area of haziness. When pathological changes arc present at both apices it is an easy matter, by comparing the two sides, to decide upon which the disease has made more prog ress. Comparative shadows at the apices are generally more clearly defined from behind than in front.