. Röntgen ray diagnosis and therapy . escreen being held infront of the thoraxand the Rontgen tubebehind him, the upperportion of the diseased side must appear normal—that is, this area a dark one appears which indicates the diaphragm(Fig. 69, d). Below the diaphragm a very dark shadow is foundif fluid is present. This would correspond to the dark area indi-cated by Fig. 69, a. When the patients position is changed the dark area, indica-ting the fluid, also changes. Sometimes there is an accumulationof gas in the subphrenic abscess. Then a light area will be seenabove the dark shad
. Röntgen ray diagnosis and therapy . escreen being held infront of the thoraxand the Rontgen tubebehind him, the upperportion of the diseased side must appear normal—that is, this area a dark one appears which indicates the diaphragm(Fig. 69, d). Below the diaphragm a very dark shadow is foundif fluid is present. This would correspond to the dark area indi-cated by Fig. 69, a. When the patients position is changed the dark area, indica-ting the fluid, also changes. Sometimes there is an accumulationof gas in the subphrenic abscess. Then a light area will be seenabove the dark shadow. As soon as the patient is shaken, thehorizontal line, indicating the border-line between gas and fluid,becomes wavy. In the recumbent position the dark area is shown only, even ifgas be present. (As to further information, see authors mono-graph on Subphrenic Abscess, Medical Record, February 15, 1896.)Total transposition of the viscera was well represented in a casedepicted in the Annals of Surgery, May, 1899. Never before has. Fig. 69.—Subphrenic Abscess. ABDOMEN 113 cholecystectomy for cholelithiasis beeen performed on the left side,as it was in this remarkable instance. The greatest usefulness of the rays in hepatic diseases is, how-ever, displayed in the recognition of cholelithiasis. Cholelithiasis.—Gall-stones have not been skiagraphed untilrecently. It was the privilege of the author to show the first undis-puted skiagraph of gall-stones in the living subject at a meeting ofthe New York County Medical Association in October, 1899. As emphasized above, the diffusion of the rays, especially inthe liver, is the main obstacle. The use of the diaphragm obvi-ates this to a certain extent, but not sufficiently for the pur-pose. The harder the tube, the better the penetration, but thegreater the diffusion of the rays. If there be little diffusion, thebones may be represented well, but the biliary calculi are penetratedby the rays to such an extent that they cast no s
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