study of small intestine
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SOME years ago Halsted made the statement that all that is thought new in medicine may not be new but merely rediscovery and elaboration. The major advances in medical knowledge are rarely the work of one individual but the culmination of the work of many, for the investigators have, as a rule, used the framework laid by other workers to erect the superstructure. It too frequently happens, however, that we are unaware of much that has been done in related fields so that the application of the discoveries to our own work is for a time completely overlooked.
The investigations of Beaumont (1), London (2), Cannon (3), Cole (4), Forssell (5), and a host of others are of direct interest to roentgenographic practice, and yet in the main they have aroused comparatively little interest among roentgenologists. In the forty years that the opaque meal has been utilized for gastro-intestinal visualization, there has resulted no general recognition of application to roentgen practice of much of the fundamental work which has been contributed by investigators, for even now there is no standardization of the technic employed in gastro-intestinal investigation. The influence of the consistency of the meal has received scant attention. The even greater effect on the gastro-intestinal tract of the vehicle for the barium has as yet hardly been considered. The divergent practice which results in the use of water, normal saline, buttermilk, malted milk, or whole milk as a vehicle for the barium meal indicates a lack of thoughtful consideration of a very important problem.
If roentgenographic exploration is to keep abreast of the modern advances in the medical sciences it must take cognizance of the results of investigative work which influence roentgenologic practice. This was brought home to us very forcibly a short time ago in regard to the motor meal which is still in use in many departments. In Figure I-A is shown the gastric emptying and the small intestinal pattern in a normal individual two hours after ingestion of a water-barium meal. In Figure 1-B the water-barium was ingested together with five ounces of black coffee and a slice of toast. The time for gastric emptying was three hours and fifteen minutes. The addition of cream to the coffee, two strips of bacon, and a fried egg resulted in a gastric emptying time of over four hours and fifteen minutes, with a marked change in the small intestinal pattern (Fig. 2). Daily, roentgenologists are reporting gastric retention under similar conditions, with the implication that such findings are of special significance.
It is with the hope of interesting our readers in a more rigid standardization of the technic employed in gastro-intestinal examination, that we are presenting seme observations on the gastric emptying time and the small intestinal pattern under a variety of conditions
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