Inflation of the intestine is one of the most important diagnostic procedures. Von Ziemssen,1 who first introduced this method of examination, injected successively into the bowel two solutions, one containing tartaric acid, the other bicarbonate of sodium in water. The carbonic acid gas developing fills the large bowel, which can then be recognized by the tympanitic percussion sound, or, in rare instances, by inspection. Schnetter,1 of New York, suggested filling the bowel with carbonic acid gas by means of a tube attached to an inverted siphon containing soda-water, the valve of which is pressed. Here the carbonic acid gas runs into the bowel without any admixture of water. Rosenbach 2 made use of liquefied carbon dioxide from a sparklet. Instead of the latter Runeberg3 recommended inflation of the intestines by means of air. This is best done by a rectal tube to which a compressible air suction bulb is attached. The advantage this method offers consists in the possibility of regulating the amount of the introduced air. In order to be able to measure the amount of insufflated air, Damsch4 has recommended the employment of a syringe of known capacity.

An ordinary bicycle pump can be used for this purpose, the rectal tube being attached to it.

1 Von Ziemsseu: Deutsches Archiv f. klinische Medicin, 1883, Bd. 33, S. 235.

Inflation of the bowel is of importance in detecting a stenosis of this organ. Under ordinary conditions the injected air evenly distends the entire colon, as can be proven by inspection and percussion. In case there is a stenosis in the large intestine the air will distend principally that portion of the bowel below the stricture, while that above will remain unchanged. It is thus possible to recognize the seat of a constriction. The significance of this diagnostic means, however, is confined merely to strictures of a high degree, while a beginning stenosis of the bowel cannot be thus recognized, as the air will pass through it.

1 Schnetter: Deutsches Archiv f. klinische Medicin, 1884, Bd. 34, S. 638. 2 O. Rosenbach: Berliner klinische Wochenschrift, 1889, No. 28. 3 'Runeberg: Deutsches Archiv f. klinische Medicin, Bd. 34, S. 460. 4 Damsch: Berliner klinische Wochenschrift, 1889, No. 75.

The position of the colon can be ascertained by this procedure. Normally the transverse colon is situated somewhat above the navel, while in cases of enteroptosis it may be found about a hand's width above the symphysis.

Inflation of the colon is also of importance in the differential diagnosis of abdominal tumors. As is well known, tumors of the intestine will become more distinct after inflation of the bowel with air, while tumors of the kidney, of retroperitoneal glands, and of the spine tend to recede. According to Minkowski,1 abdominal tumors after filling the colon with air or water are usually slightly shifted in the direction of the organ to which they belong.

Inflation of the bowel with air impregnated with ether has been suggested by Dr. Sutton2 as a means of recognizing intestinal perforation. For this purpose he makes use of a bottle filled with two drachms of ether. The bottle is provided with a perforated rubber cork to which are attached two rubber tubes provided with stopcocks. One of these is then attached to a bicycle pump and the other to an ordinary rectal tube. The air pumped into the bowel must pass through the bottle containing ether and thus takes up the ether vapors. In case of perforation of the bowel, the ether quickly escapes through the opening into the abdominal cavity and equally distends it; while, if there is no perforation, the bowel, first the large and later the small intestine, becomes filled with air and ether; ultimately the ether reaches the stomach and is usually eructated. The ether can then be recognized by its characteristic odor. It seems that this procedure is especially useful in gunshot wounds of the abdomen.

1 Minkowski: Berliner klinische Wochenschrift. 1888, No. 31.

2 E. M. Sutton: "Diagnosis of Intestinal Perforations by Means of Ether Inflation per Rectum." Journal of the Am. Med. Assn., December 30th, 1899.