2 2 2 



NA TURE 



[August 19, 1909 



passage along the course of the intestine followed on 

 the fluorescent screen. The air forms a very definite 

 band of relatively high transradiancy. The size, 

 shape, and position of all parts of the large intestine 

 can usually be traced out by this means. The 

 presence of' air has a further advantage in that the 

 solid organs of the abdomen stand out in sharp relief 

 against the light background formed by the air- 

 containing large intestine. Thus the lower edge of 

 the liver is shown up as a well-defined margin ; the 

 upper margin of the liver is always obvious, as its 

 domed surface lies in contact with the diaphragm on 

 the right side, and has the base of the right lung 

 immediately above it. On viewing the patient's back 

 (especiallv if he lie prone on a couch with a loosely 

 filled air-pillow under the abdomen, the X-ray tube 

 being contained in a box under the couch), the 

 shadows of the kidneys are shown one on each side 

 of the vertebral column, and their movements up and 

 down with respiration are easily observed. Should 

 either kidney contain a calculus (stone), this is shown 

 on the fluorescent screen, and it is seen to move with 

 the kidney on respiration. 



In a large proportion of cases in which there are 

 symptoms suggesting the presence of a calculus, the 

 Rontgen-ray examination shows that no calculus is, in 

 fact, present. On the other hand, cases are by no 

 means uncommon in which one or more calculi are 

 found by the Rontgen-ray examination, when the 

 clinical examination had led to an entirely different 

 diagnosis. In these cases the calculi may be removed 

 by the surgeon, and the patient cured. 



There is another, an indirect, method of studying 

 the digestive canal. For this method we are indebted 

 to Prof. Rieder, of Munich, who discovered that large 

 doses of bismuth salts may be given to patients 

 without fear of ill effects. The salt used by Rieder in 

 the first instance was the sub-nitrate. Unfortunately, 

 several cases occurred in America in which the ad- 

 ministration of large doses of sub-nitrate of bismuth 

 was followed by fatal results, and we now know that 

 this result was due to the formation of nitrous acid 

 in the stomach, probably through the action of 

 bacteria. The carbonate of bismuth is now com- 

 monly used, and it is a perfectly inert and harmless 

 substance. Two ounces is the dose usually employed, 

 though three or four ounces may be given at a time. 

 It is important to use a pure preparation, for the 

 presence of arsenic or selenium as an impurity be- 

 comes an important source of danger where large doses 

 are used. 



By placing the patient upright in front of the X-ray 

 tube, and trans-illuminating him in an oblique direc- 

 tion, the course of the food-pipe is revealed, occupv- 

 ing a clear space in front of the vertebral column. If 

 the patient be now given an emulsion containing 

 about two ounces of carbonate of bismuth to drink, 

 the course of this drink from the mouth to the stomach 

 can be observed upon the fluorescent screen, as the 

 bismuth-containing fluid throws a very opaque 

 sliadow. Any obstruction in the food-pipe, or any 

 deviation in its course, at once becomes apparent. 

 The bismuth having passed through the food-pipe, it 

 is now seen in the stomach occupying the most de- 

 pendent part of that organ. The opening in front of 

 the X-ray tube-box is now closed down to a small 

 size, and this part of the stomach is examined in 

 detail. The regular contractions by means of which 

 the contents of the stomach are expelled into the 

 small intestine may now be observed, and anv' ir- 

 regularity in the shape of the stomach or obstruction 

 at its orifice is clearly shown. 



Some hours later the course of the bismuth meal 

 may be clearly traced in its path through the large 

 intestine, and here again the exact size, shape, and 

 NO. 2077, VOL. Si] 



position of all parts of the large intestine is shown 

 in strong relief through the opaque mass of bismuth 

 with which the fscal masses are mixed. These bis- 

 muth meals thus constitute a most valuable diagnostic 

 method, and pathological conditions, the recognition 

 of which is of extreme importance, are frequently 

 shown in a manner more certain than is to be ob- 

 tained by any other means of diagnosis. 



One of the newest books dealing with the Rontgen- 

 ray method of diagnosis as applied to diseases of 

 the chest is that of Dr. Hans Arnsperger.^ Improved 

 apparatus and improved methods have led to so rapid 

 an advance in this branch of study that few physicians 

 have been able to keep pace with it. The literature 

 is already large, and is rapidly extending. Dr. 

 .Arnsperger has given a full review of the literature, 

 and has made a full and laborious exposition of the 

 subject. He has lost no opportunity of discussing the 

 application of the Rontgen-ray method to the elucida- 

 tion of contentious problems in physiology and patho- 

 logy. It is true some of the physiological views ex- 

 pressed by those who have studied the Rontgen-ray 

 appearances do not tally with the results of physio- 

 logical experiment; still, many important practical 

 questions are discussed in a useful manner. 



Dr. Arnsperger is careful to lay emphasis on the 

 importance of using the Rontgen-ray method in con- 

 junction with other clinical methods of diagnosis, for 

 it is rarely safe to rely on a Rontgen-ray examination 

 unassisted by a knowledge of the clinical history of 

 the case. It is true that in a case of phthisis (for 

 instance) the extent and distribution of the disease 

 may be shown with great accuracy on the fluorescent 

 screen or on a photographic plate, but in other cases 

 the Rontgen-ray picture is capable of various interpre- 

 tations, and the most useful information will be de- 

 rived from the Rontgen-ray examination if the clinical 

 aspects of the case are fully known. Dr. Arnsperger 

 points out the advantages of the fluorescent-screen 

 examination as compared with the examination of 

 skiagrams. Screen examinations enable observations 

 to be made of the living processes in the body, the 

 movements of respiration, the beating of the heart, the 

 pulsation in the aorta, the peristaltic contractions of 

 the stomach, and so on. Skiagrams are chiefly useful 

 in enabling permanent records to be obtained of the 

 appearances described. In some cases, however, the 

 skiagram shows more detail than is to be seen on the 

 more coarse-grained fluorescent screen, and this 

 applies particularly to the quiescent parts of tlie body, 

 notably the bones and joints. Dr. Arnsperger's book 

 contains twenty-seven plates, upon which fift\'-two 

 photographs are reproduced by the half-tone process. 

 It is unfortunate that no known process of repro- 

 ducing photographs in print represents successfully all 

 the detail which the original negatives show. 



A. C. J. 



THE CYAKAMWE IXDUSTPV OF FRAKCE.'- 



IN 1895 Frank and Caro laid the foundations of 

 an important industry by discovering' that 

 barium or calcium carbide absorbs nitrogen at a tem- 

 perature of Soo°, and is converted into a cyanamide. 

 They expressed the change by the following equa- 

 tion : — 



Caa+2X, = CaCX„+C. 



The cyanamide thus produced is a useful nitro- 

 genous manure of the same class as ammonium 

 sulphate, but has the further advantage of adding a 

 calcium compound to the soil. 



1 "Die Runlgeniiiuers ichung der Brustorgane und ihre Ergebntsse fi'ir 

 Physiologie und Pathoiogie." Fiy Dr. Hans .\rnsperger. Pp. 263+27 

 plates. (Leipzig; F. C. W, Vogel, 1909.) Price 12 marlis 



'■i A p.iper by M. Pluvinage in the Bulletin de la Sociitc' d'Encouragement 

 pour I'lndustrie Nationale, No. 3, v^l. iii. 



