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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    tered. If this is not effective the patient takes a saline cathartic early in the morning, but on no account an enema, as this might be retained and dilute the bismuth clyster, which is used to distend the colon. Examination of Gall-bladder. Before the colon is examined, roentgenograms are made over the gall-bladder region, as biliary calculi can be detected in at least 50 per cent, of the cases when they are present.2 Examination of the Colon. A clyster of bismuth or barium, mucilage of acacia, and hot water (barium sulphate §v, mucilage of acacia gxij, hot water q. s., gxxx) is now administered and retained by the patient while a pair of stereoroentgenograms of the colon are made. It is a wise procedure to make a third plain roent¬ genogram or another pair of stereoroentgenograms, because it is sometimes difficult to differentiate between spasms and organic lesions in a single pair of stereoroentgenograms. The gastro-intestinal tract has now been completely examined by successive series of roentgenograms made immediately after the bismuth meal, and at intervals thereafter of two hours, four hours, six hours, eight hours, ten hours, twelve and fourteen hours, twenty-four hours (if necessary), forty-eight hours, and seventy- two hours, and by one or more pairs of stereoroentgenograms of the colon, made after a bismuth clyster has been administered. Such a series of roentgenograms, viewed upon a light box, where they may be studied individually and collectively, gives a wealth of information. By carefully studying the findings in one region and comparing them with the findings in other portions of the tract it is often possible to unravel the most complicated cases. Value of Complete Gastro-intestinal Examination. A study of about 300 such cases, showing the stomach, small intestine, and colon at various intervals after the ingestion of food, has revealed a great variety of significant findings, a correlation of which leads me to the publication of this preliminary report. Erroneous Methods of Determining Gastro-intestinal Motor Efficiency. Many of the previous roentgenological observations on ileal stasis have been unreliable, because the bis¬ muth has been mixed with or suspended in unsuitable mediums, and because the period required for ileal evacuation has been reckoned from the time when the bismuth was administered, instead of being reckoned from the time when the last trace of it left the stomach. 2 Case, The X-ray Examination of the Liver and Gall-bladder, Arch, of Roent. Ray, September, 1913; Roentgenoscopy of the Liver and Biliary Passages, with Special Reference to Gall-stones, Jour. Amer. Med. Assoc., September 20, 1913. Cole, Roentgenographic Diagnosis of Gall-stones and Cholecystitis, Surg., Gyn., and Obst., February, 1914, vol. xviii, No. 2. Pfahler, Die Roentgenstrahlen als Hilfsmittel bei der Gallensteindiagnose, Fort. a. d. Geb. d. Roent., April, 1911, N.H., xvi, B. 5, pp. 335-337. Gastric and Duodenal Adhesions in the Gall¬ bladder Region and Their Diagnosis by the Roentgen Ray, Jour. Amer. Med. Assoc., June 17, 1911, vol. lvi, No. 24, pp. 1777-1779.