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Twenty-nine years ago I gave my first opaque enema under fluoroscopic screen control. The publications of Pfahler and a few references from foreign literature constituted the stimulus for the undertaking. Bismuth subnitrate was the opaque salt, suspended in buttermilk. The chief aim of the study was to determine the position of the transverse colon and of the right and left colic flexures. To emphasize the contrast presented by the elaborate roentgen study of the colon as practiced now, with indications for its use covering a very wide range of pathologic possibilities, I was asked to offer a review of the evolution of the technic of x-ray examination of the colon, followed by an evaluation of the different methods.Routine practice in intestinal x-ray examinations includes the opaque meal, with appropriate screen or film observations of the opaque residues as they move along the large bowel (fig. 1), followed by the

My purpose in this communication is to set forth briefly the objectives to be attained by roentgen-ray examination after gastric and duodenal operations, the technic of such examination and some details of the principal findings.One of the most successful of stomach operations is gastro-enterostomy. In the great majority of cases, it gives brilliant results; nevertheless, every physician having occasion to treat or examine a large gastro-intestinal clientele sees a considerable number of gastro-enterostomized persons who complain of more or less serious postoperative disturbance. Naturally, only the dissatisfied patients return to the clinician, and the internist who sees a considerable number of this class is apt to feel an unjustified lack of confidence in the operation. The foregoing is true, more or less, of all the different forms of operation involving an anastomosis between the stomach and the intestine, as well as the various plastic operations for modification of the

In the case of practically every new curative agent, the medical profession sooner or later experiences the unhappy realization that its value has been greatly overrated, and that the first exaggerated evaluation has to suffer extensive revision before the true worth of the method or means is firmly established. Deep radiotherapy has not proved any exception to this generality, and the present is a period more or less critical in its history.Although radium and roentgen rays have shown themselves indispensable means of treating superficial malignancies, their value in deeper seated lesions is still held decidedly in question by important groups of scientific men. It is a misfortune that so many have been willing to write of their results without waiting for the passage of at least a three or five year period, many of the published results thus constituting immature data which are useless as evidence for aiding in

In conversing with a large number of physicians from various parts of the country, one is impressed with the fact that the real purpose and value of Graham's gallbladder test are still unappreciated, even by many who attempt to employ it. The idea seems to have gained strong foothold that the method is simply a functional test in which tetraiodophenolphthalein is orally administered with the hope that some of the dye will enter the gallbladder and thus cause it to show on the roentgenogram. If the gallbladder is thus visualized, well and good; if it is not visualized, it is pathologic. Certain variations of shadow density are recognized, but little importance can be attached to them when the test has been given by the oral method, for under such circumstances it is impossible to determine how much of the dye has been absorbed. Of course, if nonopaque gallstones are recognized,

Rarely does the roentgen-ray examiner stumble onto anything more interesting and startling than the revelation of a calcareous deposit in the pericardium. This relatively rare deposit of lime salts, occurring in a regular or irregular manner on the surface of the heart, sometimes loosely spoken of as "ossification" and "bone" in the pericardium, is more properly designated as pericarditic calcification or pericarditis calculosa. The calcium deposit, composed of the phosphate combined with small amounts of the carbonate and a trace of sodium, usually is confined to the pericardium; but it may extend into the substance of the heart.There have been published several excellent summaries of our knowledge of the pathology and symptomatology of this rare condition, notably those by Diemer,1 Jones,2 Mitchell,3 Klason4 and Mueller.5 The total number of cases found reported in the literature prior to 1922 is ninety. To these I have

Especially within the last three years the interest of the profession in this country has been aroused by claims advanced for the value of the "new deep roentgenotherapy," a method of radiation involving the use of rays of much shorter wave length than have heretofore been available for purposes of treatment. For a decade such physicists as Duane, Dessauer and Coolidge have been seeking means for producing roentgen rays of wave length nearly approximating the shorter gamma rays of radium. Refinements have been reached in the construction of roentgen-ray apparatus, permitting the maintenance of constant very high voltages (from 200,000 to 280,000) delivered at the roentgen-ray tube terminals. Dr. Coolidge has continued the development of his tube until we now have a type of roentgen-ray tube, capable of withstanding more than 200,000 volts at 8 milliamperes in continuous use. The physical and biologic investigations carried on simultaneously in Europe and

Through my institutional connections I have for a number of years enjoyed special advantages for the roentgenologic study of patients after gastric and intestinal operations. My colleagues have extended many much appreciated courtesies in arranging for the postoperative studies on which this paper is based Results both good and bad have been included, the patients studied representing the work of a number of different surgeons, some of the cases coming from the most famous clinics of this country. Many of the patients had no complaint, the postoperative condition being satisfactory, at least subjectively. Others were referred for postoperative convalescence, and the opportunity was improved to make the postoperative roentgenologic observations. In the majority of the cases reported in this paper, the examination was advised in the hope that it would assist in ferreting out the cause of untoward symptoms. I would not insinuate that, because the majority of the cases

A toxemia of alimentary origin has long been considered one of the probable factors in the causation of diabetes. The purpose of this paper is not to affirm or deny the validity of such a claim but to summarize the statistics in seventy-two cases recently examined through the courtesy of my colleagues, Drs. C. C. Hubly and C. S. Staines, of the staff of the Battle Creek Sanitarium.The majority of diabetics give a history of constipation or, what is worse, constipation alternating with diarrhea. Although most authorities urge the necessity of careful attention to intestinal hygiene as a part of the treatment of this malady, the literature contains very few articles dealing specifically with intestinal stasis as a cause of diabetes.Brosch1 reported the necropsy findings in a patient of 60 who had died comatose and uremic with slight jaundice. The urine had shown large quantities of sugar