THE TELEPHONE IN SURGERY

Dominion, Volume 8, Issue 2406, 11 March 1915, Page 3

THE TELEPHONE IN SURGERY

LOCATING A BULLET

AN IMPROVEMENT ON THE X-RAYS Search out your enemy and attack him is a military maxim which has uu /''•opted by others and perhaps with benefit to ourselves. Tho maxim is one which has been adopted by military . surgeons in the localisation and extraction of bullets and fragments of shell.. but in this respect the tendency in the present war has been towards restricting both the searching for and nil 6 ?, x ;: r . act !°n. of such foreign bodies. 6 British Medical Journal," in a recent issue, publishes some interesting articles on this subject. Among these is one by Sir James Mackenzie Davids?ll,,on r" Tll ,® Principles and Practice ot tho Localisation of Foreign Bodies by A-Rays. The detection of a bullet or fragment of shell in the body v means of X-rays may be a most simple matter, but the localisation of it— that is to say, its depth from the surface and is relationship to surrounding structures and tissues —is far from simple; 111 .fact, the X-rays, unless properly applied and interpreted, may be altogether misleading and conducive to meddlesome surgery. These articles at the present time are therefore most opportune. ' At the risk of being too elementary, oir James Davidson draws attention to what sometimes appears to be forgotten namely, that space has three dimensions, and that an X-ray picture on the fluorescent screen or an X-ray photograph is merely a shadow or silhoutte. This single shadow-picture indicates little more than that a foreign body is present, and gives no certain knowledge about its relation to surrounding structures. Indeed, if these limitations are not realised, the X-ray method becomes a positive danger to the patient as well as to the surgeon. J.he annoyance and disappointment brought about by failure to tind, even after a prolonged search, the bullet or foreign body whioh was so clearly demoiisfcrated in a single X-ray photograph is a matter of common experience amongst surgeons. The single Xray photograph is misleading; an enormous advantage i 6 gained by stereoscopic X-ray photography, as thereby a realistic view of the true and relative positions of all tlie parts concerned in tho picture i 6 given.

| Deteotion by Sound. Sir James Davidson concludes his ar A , 6 i a description of a method which he has recently adopted with considerable success as an adjunct to the operative measures. It consists in the use of a telephone—preferably one with double receivers—such as is used in wireless telegraphy. One end of the telephone wire is attached 'to a small piece of platinum. This is placed U P') ll any part of the patient's skin which has iirst been moistened in the usual way with salt water. Plaster or a bandage is used for holding the small disc of platinum in position. The other end of the telephone wire B J) 4 k®. ' n . f° r in of a disinfected thread of silver (for preference), because this can readily be attached to any of the surgeon's instruments, such as. a knife, a probe, a needle, or a pair of forceps. 'l'ho only precaution necessary is that the attachment of tho terminating wire to the instrument shall bo firm. If the surgeon then attaches the telephone receiver to his ear, and begins to use his instrument upon the patient's tissues, he may possibly distinguish some slight sound on first making contact, but this is so faint as to bo negligible. What he will hear with .great distinctness is,..however,' the characteristic microphonic rattle the instant his instrument touches any metal embedded in tho patient's tissue.

It is not necessary to have a man from the trenches with shrapnel in his body to demonstrate the value of this adjunct to surgery. A potato of good size may be taken to represent the patient, or that part of the patient in which the metal' foreign body is lodged and a common nail well embedded in the substance of the potato may represent a fragment of shell or shrapnel. The potato is placed upon a piece of patinum foil, moistened in the usual way, on a table; the telephone is then connected up in the manner which has been described, both to the platinum foil ajid also to a knife which is steel throughout. _ The potato is incised with the knife, and the moment the blade touches the nail a grating sound is heard, and is repeated whenever the contact of the knife with the nail is ropeated. More Rapid Recovery, This adjunct to the operative instruments of the burgery, when used carefully and intelligently, is of considerable value, more particularly in conjunction with stereoscopic X-ray photography. _ With the help of the two, the maxim, "Search out your' enemy and go directly to the position which he occupies" can be fully adopted. By this method an operation is not only considerably shortened, but the disturbance of adjacent tissitis and structures in making a • prolonged search is I reduced and a more rapid recovery ensues.

Before leaving the subject, it would be well to draw attention to a popular fallacy that a- foreign body, whether it be shrapnel, bullet, or the smallest gunshot, in the human body should be removed, and if left alone must do harm. Iji fact there seems to be an impression abroad among 6oldiers that their chance-of employment is diminished if they are known to have a bullet embedded somewhere in thei* bodies. The tendency of surgery, both in this war and in the Boer war, has been to abstain as much as possible from those extensive exploratory operations of former days which perhaps left the patient with a far larger and more serious wound than any modern bullet could produce. Experience has shown that the human body has a remarkable tolerance of the foreign bodies with which we are at the present time concerned, so that the sooner the popular fallacy to which we have referred is removed the better.