Medicine: Un-haystacking a Needle

No less a patient than President James A. Garfield was once the subject in a surgical problem still alive this week: how to find the exact location of a foreign body in the human frame by electrical means.

Shot on July 2, 1881, Garfield died 78 days later, because his doctors, headed by his boyhood friend, Dr. D. W. Bliss, could not locate the assassin’s bullet in his abdomen. By using an electromagnet, Telephonist Alexander Graham Bell had figured out the general location of the bullet (see cut), but no operation was performed. A more accurate guess (through deduction) by Anatomist Feneuil Dunkin Weisse was also disregarded, but later proved by autopsy. A wag cracked: “When ignorance is Bliss, ’tis folly to be Weisse.” Two Points. Even though X-ray has long been in use, research on finding foreign bodies still goes on in the attempt to bridge a surgeon’s difficulty in not being able to see what he is after. Even with the best modern methods he sometimes scores a miss.

Fiery Dr. Lewis Gregory Cole, radiologist of White Plains, N.Y., offered a suggestion last week in the American Journal of Surgery: with the help of any horizontal fluoroscope, points can be located on opposite sides of the injured member so that the foreign body is some where on the straight line between them.

If the surgeon cuts along the line between the two marks, Dr. Cole says he cannot miss. Special equipment includes X-ray calipers to check correct positioning of the marks, and duplicate surgical calipers which, when properly set, point directly to the foreign body. Both kinds of calipers are placed with one arm above and the other below the injury; when the operation is done, the surgical calipers duplicate the position of the X-ray calipers.

This equipment was first tried out on wax models of a human thigh. Afterward, when a surgeon used it to find a needle in a fat woman’s shoulder, the tiny object, usually a surgeon’s bugbear, was snagged in 47 seconds. Dr. Cole wishes the Army would give the method a trial, thinks it would be able to detect bullets or shell shards more quickly, cut down probing and cutting.

Two Planes. The Army’s standard equipment is the mobile X-ray unit, of which the Medical Corps has more than 3,000 (cost: $2,380 each). The outfit, consisting of an X-ray machine, a generator, a tent darkroom and a table for patients, is carried in three Army trunks and takes six minutes to assemble in the field. As no calipers are used, an injured man need not be moved while he is on the table. In most cases the X-ray man merely spots the foreign body by fluoroscopy and gives the surgeon a report and an iodine mark on the skin above the foreign body to work from. In complicated cases, a second fluoroscopy can be done from the side, giving the surgeon two planes to work from, I.e., he knows just how deep the bullet is, from two directions.

For air transport, the Army has a more compact unit which can be carried in three small cases and is mercifully speedy in use: determinations usually take about 40 seconds.