454 



NATURE 



[June 9, 192 1 



interesting facts and reflections, and, unlike 

 English Socialists, the author sees clearly that 

 the unchecked increase of population is the most 

 fatal obstacle to social amelioration. 



W. R. Inge. 



X-rays in Medical Practice. 



General Practice and X-rays. By Alice Y. Knox. 

 With chapters on the production of X-rays and 

 instrumentation by Dr. R. Knox. (The Edin- 

 burgh Medical Series.) Pp. xiv + 214-fxxxii 

 plates. ^London: A. and C. Black, Ltd., 1921.) 

 155. net. 



IN view of the great advance which has 

 occurred in radiography and radiotherapy 

 during the past ten years, the author is justified in 

 her contention that the time has come to present 

 to medical practitioners a general survey of the 

 subject in order to enable them to gain a full 

 appreciation of the value of X-rays in diagnosis 

 and treatment. The author divides medical prac- 

 titioners into three groups : (i) Those who look 

 upon X-rays as something of a scientific play- 

 thing ; (2) those who rely upon radiology to estab- 

 lish a diagnosis instead of making a careful 

 physical examination ; (3) those who recognise in 

 the new science a powerful help in the daily fight 

 against disease, to be applied after a thorough 

 physical examination has been made, when it may 

 be of the greatest use in establishing a diagnosis 

 or in treatment. 



When X-rays were first discovered, certain 

 applications to medical diagnosis were at once 

 obvious. These included the discovery and loca- 

 tion of metallic foreign bodies, and the diagnosis 

 ^f fractures and other injuries of the bones. As 

 a natural corollary came the use of X-rays in 

 the study of disease of the bones and joints. 

 With improvement in the construction of ap- 

 paratus, and with advance in technique, it was 

 found possible to extend the uses of X-rays to 

 the diagnosis of certain internal disorders, such 

 as calculi in the kidneys, and disease of the lungs, 

 heart, and aorta. 



The most noteworthy advance of all dates from 

 the discovery that insoluble opaque salts can be 

 administered to patients in sufficient amount to 

 fill the gullet, the stomach, and the intestines, 

 and so enable these hollow organs to be studied. 

 Not only are their size, shape, and position re- 

 vealed by the opaque meal, but also their con- 

 tractile activities can be studied. In this way many 

 valuable additions have been made to our know- 

 ledge of the physiology and pathology of the 

 organs of digestion. With this far-reaching addi- 

 NO. 2693, VOL. 107] 



tion to the uses of X-rays there remain few organs; 

 or parts of the body which are not accessible to- 

 investigation by them, with good prospect of 

 settling a doubtful diagnosis. If this were all, it 

 would be clear that no medical man could afford to- 

 dispense with the services of radiology in the 

 practice of his profession ; but X-rays have done 

 a great deal more than this. They have revealed 

 the fact — previously suspected by few — that all 

 disorders of the digestive tract are interdependent : 

 that the stomach, for instance, does not become 

 the subject of a gastric ulcer if all other parts of 

 the digestive tract are healthy, and that the ap- 

 pendix does not become diseased so long as it is- 

 in a healthy environment. 



Text-books on medicine arrange all diseases- 

 under the headings of the various organs of the 

 body. Each organ has a chapter to itself, and 

 each disorder of this organ occupies a "water- 

 tight compartment." For teaching purposes this- 

 arrangement, no doubt, has advantages, but it 

 also has the great disadvantage of perpetuating the 

 notion that a chronic disease can arise in an organ 

 of a patient who is otherwise in perfect health. 

 X-ray investigation of the digestive systemr 

 has demonstrated the fallacy of this conception 

 of disease ; it has led to a wide recognition of the 

 importance of "chronic intestinal stasis," a con- 

 dition due to abnormal delay of the intestinal con- 

 tents, setting up bacterial decomposition and lead- 

 ing to contamination of the blood-stream. The 

 result of this " toxaemia " is that every tissue of 

 the body receives vitiated blood and becomes de- 

 preciated, so that it loses some of its power of 

 repelling the invasion of microbes. Many 

 chronic ailments, such as rheumatism, arise in 

 this way and resist all efforts to cure until the 

 contamination of the intestinal contents has been, 

 rectified. The stretching of ligaments, which 

 gives rise to spinal curvature, flat foot, etc., is 

 likewise due to the toxaemia of chronic intestinal 

 stasis. The far-reaching importance of this new 

 conception is clear, for in prescribing remedial 

 exercises to strengthen the muscles of the back, 

 or those of the foot and leg, it is important to 

 attend to the general nutrition of the patient and 

 to the efficient drainage of the intestinal canal, for 

 muscles that are depreciated by contaminated 

 blood cannot respond to attempts to strengthen 

 them by exercises, massage, or electrical treat- 

 ment, although such treatment would certainly 

 strengthen healthy muscles. 



These are only a few instances of the way in 

 which the radiological study of the digestive tract 

 is modifying our entire conception of the causes 

 and treatment of disease. 



