Eleven cases : roentgenographic and operative findings / by A. Judson Quimby, M.D., New York City and William Seaman Bainbridge, A.M., Sc.D., M.D., New York City.

  • Quimby, A. Judson (Adoniram Judson), 1875-
Date:
[1914?]
Catalogue details

Licence: In copyright

Credit: Eleven cases : roentgenographic and operative findings / by A. Judson Quimby, M.D., New York City and William Seaman Bainbridge, A.M., Sc.D., M.D., New York City. Source: Wellcome Collection.

    9/36 (page 7)
    Undoubtedly the most expert work ac¬ complished in this direction is that of Alfred C. Jordan, of London, who has been asso¬ ciated with Sir Arbuthnot Lane in so much of the latter's investigation of the subject of chronic intestinal stasis. Jordan’s success in this line has been attributable in large meas¬ ure to the fact that he has gone over his plates, made before operation, at the oper¬ ating table, comparing step by step his fluor¬ oscopic and radiographic findings with con¬ ditions actually found during operation. By checking up his errors in this way he has been able to better guard against them. He has thus developed the ability to make negative as well as positive diagnoses. Those who, like Jordan, are willing to devote the time and patience required in this checking-up method, will find a certain sense of security in their work that it must be difficult to ac¬ quire by confining one’s effort to the X-ray laboratory. Such work, T fancy, will dispel forever the possibility of our following the will-of-the-wisp which the distinguished pathologist (Adami) has inferentially desig¬ nated an obsession. However, it is not the purpose of this brief communication to discuss the merits or demerits of Lane’s theories concerning chronic intestinal stasis. I think we may dismiss,, for the present, as proved, his con¬ tention that adventitious bands do form about certain portions of the gastrointes¬ tinal tract, that they may cause kinking of the gut at points of fixation, and that the immediate result of this state of affairs is often a slowing of the contents of the great drainage canal,—a condition to which he has applied the term chronic intestinal stasis, with a long chain of symptoms which can be best explained by a toxic condition resulting from an absorption of poisons from the in¬ testinal tract. If there is still a doubt in the minds of those who are studying the matter, I feel sure that the checking-up method of study alluded to, in which surgeon and radi¬ ologist co-operate at the operating table, will go far toward dispelling such doubts. It is necessary, first, however, for both surgeon and radiologist to understand per¬ fectly the mechanics of the great drainage scheme of the body. All this has been so clearly detailed in papers by Lane and his students that I need not take the time here to discuss the matter. One point, however, I wish again to reiterate, namely, that in searching for kinks in the gut it must be borne in mind, by radiologist as well as surgeon, that there is a difference in the re¬ lationships of the intestines when the patient is in the erect and in the prone position upon the back. In the upright posture there is, as all know, a tendency to a greater or less degree of general ptosis of the hollow vis¬ cera, and that it is this falling of the vis¬ cera which causes the strain on the points along the course of the drainage canal at which the lines of stress and strain have crystallized into definite bands. In the prone position, as on the operating table, this ptosis is temporarily overcome, of course, and no kink is visible upon superficial ex¬ amination, no matter how definite it may be when the individual is in the upright position. By lifting up the bowel the kink comes into view. This is just the reason why the radiologist should study his sub¬ jects in both positions, and at the operating table. It is important, as Lane and Jordan have so often repeated, that the alimentary tract be regarded as a whole, that its diseases should not be regarded as “isolated phe¬ nomena,” but that local manifestations along its course and in accessory organs be regarded as expressions of a general dis¬ order. As we all know, Lane maintains that many diseases, such as gastric ulcer, cancer, gall-stones, rheumatoid arthritis, and others, are the remote results of chronic intestinal stasis. This theory forms an im¬ portant part of the “obsession which the great pioneer is supposed by some to harbor. It is not the purpose of this communication to attempt to prove or disprove this theory. There seems, however, to be much food for thought just here, as some of the cases