Roentgenologic Diagnosis of Neoplastic Diseases of the Stomach

In 1899, only four years after Roentgen's discovery, Francis H. Williams, assisted by Walter B. Cannon, examined, by means of roentgen rays, the stomachs of two children who had been given bismuth meals. The observations, which were described in detail in Williams' book, pertained chiefly to variations in size, form, and position of the stomach during the process of digestion, but in his final comment Williams made a significant prophecy. He predicted that after the various characteristics of the normal stomach had been established, abnormal conditions would be more readily recognized by this method. "The constant presence of a darkened area in the stomach," he said, "may suggest thickening of its walls due to malignant disease." Thus he foresaw clearly that a tumor would protrude into the gastric lumen and produce a defect in the shadowed contour; this was the filling defect which was later to become the basic factor in the diagnosis of all gastric neoplasms. But it was not until long afterward that his prediction was fulfilled, and then the roentgenologic diagnosis of organic diseases of the stomach, including the new growths, was swiftly developed to the point at which the law of diminishing returns bears heavily. Progress is now obliged to take the form of more thorough application of old principles, the evolution of minor improvements in technic, and the development of greater skill in interpretation through experience. By such means, however, the knowledge of benign gastric tumors has been substantially enlarged, and malignant growths are discovered earlier now than formerly. Statistics indicate that benign new growths constitute less than 2 per cent of gastric neoplasms. Most common among the nonmalignant tumors are the mucous polyps, adenomas, papillomas, myomas, fibromas, and hemangiomas; less often encountered are the myxomas, lipomas, osteomas, chondromas, teratomas, and cysts. Despite their varied histologic characteristics, and the