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To the Editor:
—The signs described by Dr. Carman in his article on the "Radiologic Signs of Duodenal Ulcer," (The Journal, March 28, 1914, p. 980), constitute merely a symptom-complex. In the author's own words, they are "signs" or symptoms, and not direct evidence of the lesion itself. Radiologic signs and symptom-complexes for duodenal ulcer are as numerous and varied as the observers who describe them. Compare Dr. Carman's "radiologic signs" with the symptom-complexes described by Holzknecht, Strauss and Kreuzfuchs, and if you think that they agree as to the significance of the various phenomena, read Holzknecht's and Haudek's latest article in the Fortschritte auf dem Gebiete der Roentgenstrahlen (xxi, 633).Dr. Carman's three "major signs" are trifling compared with the direct evidence which he relegates to the third place under "minor signs." All of the cases illustrating his article present definite direct evidence of the irregularities characteristic of ulcer
Lewis Gregory Cole. "Radiologic Signs" versus Morphologic Defects. JAMA. 1914;LXII(18):1419–1420. doi:10.1001/jama.1914.02560430049028