PAPERS ON MEDICINE AND PUBLIC HEALTH 255 



show pus and organism of different type than those pre- 

 dominating in the duodenal content, before and after this 

 portion, the deduction follows that the contents are not 

 only from the gall bladder, but that there are signs of 

 cholecystitis. 



It is true that it is not possible to drain every gall blad- 

 der even after repeated attempts, but when positive find- 

 ings are secured, they are a distinct aid. I have recovered 

 typhoid, para-typhoid A. & B., colon, streptococci, diplo- 

 cocci and pyocyoneus organisms. Many times I have re- 

 covered the same organism on repeated trials upon one in- 

 dividual. 



THE ROENTGENOLOGIC AID 



Attempts directed toward visualization of pathological 

 gall bladders require infinite patience and innumerable 

 films. The technique as developed by Dr. Robert A. 

 Aarens of Michael Reese Hospital, with whom I have co- 

 operated in all my roentgenologic examination, is as fol- 

 lows : The patient lies face downward on the plate and com- 

 pression is used to assist in immobilizing the part. Im- 

 mobility of the diaphram is of the utmost importance as 

 the slightest movement will blot out the shadow of the gall 

 bladder. It is, therefore, very essential that if the patient 

 cannot or does not understand how to hold his breath that 

 he be taught how to do so. 



A duplitized film with a double screen and a radiator 

 type Coolidge tube taking 25 M. A. is used. The penetra- 

 tion is varied for each patient. A series of from four to 

 eight exposures is made with slight differences in the pene- 

 tration of the ray. The first exposure is made with a 

 penetration as soft as it is possible to use to get through 

 the patient. Each successive exposure the penetration is 

 increased by about 34" so that when the series is com- 

 pleted, the plates will vary from an under exposure, to an 

 over exposure with one or two perfect films in the series. 

 The time for each exposure varies from four to eight 

 seconds, depending on the patient's size, the same time 

 being used on all exposures in the same patient. 



