CAREFUL analysis of existing contributions often reveals that which we consider original is merely an adaptation, revival, or refinement of previous labors. In fact, completely original departure in our state of organized knowledge is highly improbable. This study of the mucosal folds of the stomach is presented as an adaptation and revival of a known technic. It is a surprising fact, not superficially recognized, that the x-ray examination ofthe stomach still escapes absolute recognition of criteria which should make diagnos is a relatively simple matter, although the stomach was one of the first internal organs to be visualized by artificial ingestion and one which has received a major amount of attention. The recognition of early carcinoma of the stomach has become progressively more difficult and baffling. This is not the result of lack of interest in the stomach, because the literature shows an increasing number of articles directed to it. However, if we are to make an early diagnosis of any lesion of the stomach, particularly carcinoma, it is imperative that minute studies of the mucosal relief should be made. It follows, therefore, that newer methods should be employed in order to emphasize the finer mucosal markings to such a degree that the rugal folds can actually be studied with a magnifying glass to effect macroscopic visibility for evidences of morphologic changes. To this end, as early as the turn of the century, Einhorn employed a blower with bismuth powder to coat the stomach, and Holzknecht and Brauner used gas distention with tartaric acid and natrium bicarbonate. Later, various methods of palpation and allowing the bismuth to settle out of suspension (1) were used to demonstrate the mucosal folds. In 1911 the method of inflating the stomach with air was used (2) in combination with a contrasting emulsion. Akerlund (3) used external pressure over the duodenal bulb, displacing all but a thin layer of the opaque solution. In this way rapid progress was being made in the visualization of the mucosal folds. In 1923 a significant point of departure was established by Forssell (4), who drew attention to the mucosal movements independent of peristalsis. This constituted one of the first deliberate attempts to focus attention on the rugæ per se. This contribution to the anatomy of the mucosal membrane of the stomach by means of anatomical pressure succeeded in demonstrating the coil-like rugal folds on the anterior portion of the stomach and the less frequent longitudinal folds of the posterior wall. The remainder of the mucous membrane on the posterior wall was found to be contracted through the building up of a mammillated surface, the so-called “état mammelonné” (Fig. 1). Forssell's studies indicated that the mucous membrane could produce a folding and contraction independent of the peristaltic waves.
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