Relation of lesions of the small intestine to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole, M.D., Professor of Roentgenology in Cornell University Medical College.

  • Cole, Lewis Gregory, 1874-1954
Date:
1914
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Licence: In copyright

Credit: Relation of lesions of the small intestine to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole, M.D., Professor of Roentgenology in Cornell University Medical College. Source: Wellcome Collection.

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    the right hypochondrium in cases of appendicitis, and in the gastric symptoms manifested by acute intestinal obstruction. Mayo has compared the stomach to a fire-alarm box, and has called attention to the futility of trying to extinguish the fire by squirting water on the alarm box. In a recent article read before the American Roentgen Ray Association,1 Crane quoted Mayo’s simile, and cited instances in which he also had observed gastro-intestinal symptoms with roentgenological evidence of a lesion at some distant point. In this communication I shall try to show that the roentgenologist can detect the first sign of smoke, and after searching farther, can usually find the location of the fire itself. Terminology. Before entering upon any discussion an ex¬ planatory word should be said concerning terminology. While the roentgenological findings of the gastro-intestinal tract differ in every individual, I have come to recognize certain findings as usual and others as unusual. In this communication the term usual will be applied to those findings which are most common, that is to say, normal, so far as I have been able to determine, and the term unusual will be applied to uncommon roentgenographic findings, which are associated with symptoms. Thesis. As a working basis it will be necessary to describe the physiology of the duodenum, jejunum, and ileum as observed roentgenologically, and to compare the unusual findings with the usual findings. It will be seen that certain phenomena in the small intestine are frequently accompanied by peculiar manifestations in the stomach and cap. These gastric manifestations, viz., primary and secondary evidences of spasm and their opposites, atony or lack of peristalsis of the pylorus, pyloric sphincter and cap, must next be described. Upon this foundation we shall build up the super¬ structure which is the main subject of this communication—that ileal stasis, and particularly ileal dilatation, are directly related to and responsible for certain spasms and even organic lesions of the pylorus, pyloric sphincter, and cap. In conclusion, we shall estimate the value of the roentgenological evidence for determining in each individual case whether or not surgical procedure is indicated, or what other method of treatment is advisable. Technique. In order to obtain the findings upon which our observations are based, an extensive routine examination of the entire gastro-intestinal tract is essential. Although the technique employed is being elaborated continually, a brief description of the present method may be of interest. About 11 p.m., or ten hours before the roentgenographic ex¬ amination, the patient takes bismuth or barium suspended in buttermilk, in conjunction with a meal of meat, potatoes, and bread. At 9 o’clock the next morning he presents himself for Boston, October, 1913.