BEVIEW — TBOPICAL MEDICINE, ETC. 63 



majority of cases an examination of the faeces should be a matter of routine procedure. Faeces- 

 Judging from the small amount of this class of work which falls to the share of the continued 

 laboratories, these examinations are not frequently made in medical practice in Khartoum. 

 Such work is disagreeable, especially in a hot country, and it has to be quickly conducted to 

 be of value. Still I am very certain that a systematic examination of stools would well 

 repay the time spent upon it, both as an aid to diagnosis and to amplify our knowledge of 

 intestinal parasites and various bowel affections. 



Anyhow, some notes on the examination of faeces, a subject which has shared in the 

 recent and general advance of medical knowledge, cannot fail to be useful. 



Baumstark^ points out that in order to properly test the capabilities of the intestine 

 a special diet must be adhered to and it must fulfil certain requirements. These need 

 not be tabulated here, for it is more to the point to quote from the notes dealing with 

 the macroscopic, microscopic and chemical methods : — 



The Macroscopic is the most important and determines the consistency, colour and smell of the faeces. 

 The motion is thoroughly stirred with a wooden spatula and a quantity of the size of a walnut is put in 

 a grater and ground down with a glass pestle, with a gradual addition of distilled water, to an absolutely fluid 

 mass. When no more solid parts exist pour it on a large black plate. With normal intestinal action nothing 

 but macroscopically recognisable remnants of cellular particles (rusk, gruel, cocoa) of the test diet should be 

 found in the faeces. The following are of importance as pathological food remnants. 



1. The remnants of the connective tissue and tendons from the minced meat which has been consumed ; and 

 these, owing to their light yellow colour, their fibrous form, and their firm consistency, can be recognised and 

 most easily distinguished from mucus. Where any doubt exists, a small filament can be treated with a drop of 

 acetic acid ; in the case of connective tissue the filamentous structure vanishes ; in the case of mucus it only then 

 becomes visible. Quite isolated, small, sinewy filaments are to be found sometimes with quite normal digestions, 

 but when in a great quantity they are always pathological. 



2. Remnants of muscle which look like very small, brown-coloured splinters of wood. They are soft, 

 become smaller when pressed, and disclose under the microscope muscle structure. In many cases connective 

 tissue and remnants of muscle are to be met with in the same stool. 



3. Remnants of potato, sago and similar transparent grain, which are frequently mistaken for mucus but which 

 can be distinguished by their globular form and their hard consistency ; they stand out above the level of the 

 thin, spread out layer of the fieces. Under the microscope the potato cells appear to be either empty or filled 

 with bluish (stained with iodine) coloured grains of starch. 



The Microscopic Examination. — This is chiefly useful for the verification of the results obtained by the 

 macroscopic examination ; for example, in the differential diagnosis of connective tissue and mucus shreds. Three 

 microscopic preparations are made, distilled water being added when the ground-np faeces are too hard. The first 

 is simply a small particle placed on a slide and pressed by the cover glass into a thin layer. The second is rubbed 

 up with a little drop of 30 per cent, acetic acid solution and held over a flame until it begins to boil ; the third is 

 rubbed up with a little drop of a strong solution of iodine in iodide of potassium (iodide 1, iodide of potassium 2, 

 distilled water 50), and covered. 



Under normal intestinal conditions the following should be observed in the preparations. 1. Preparation 

 without addition — muscular fibres (flake-like formations coloured yellow and rounded at the edges with indications 

 here and there of transverse striae), some scattered small and larger yellow lime salts, light and dark yellow flakes 

 consisting of sebates of lime, uncoloured (unstained) soaps, single potato cells empty, sparse remnants of chaff 

 from gruel, and remnants of cocoa where cocoa was given instead of milk. 2. In the second preparation, when it 

 is placed under the niicroscope whilst still hot, the larger lime salts and soap flakes are melted to neutral fat drops 

 which, after they are cold, become solidified into small sebacic acid flakes. 3. In the third preparation, which is 

 brown-coloured from the iodine, the potato cells now violet (but not blue) and sometimes violet-coloured sporules 

 (Clostridium hutyricum) are met with. 



Pathologically the following may be observed in the three preparations. In No. 1 broken pieces of muscle 

 tissue in larger number with more clearly defined transverse striae and sharp edges, neutral fat drops, sebacic acid, 

 and soap needles in such quantity that they form the largest part of the preparation, and an abundant quantity of 

 potato cells with more or less well-preserved grains of starch. In cold acetic acid preparations there are 

 pathologically such a number of sebacic acid flocculi that all of the other component parts are in the minority. 

 In the iodine preparation are bluish-coloured potato cells, as also scattered remnants of grains of starch, blue or 

 violet sporules or bacterial flora, and oat colls which are yellow-coloured from the iodine. 



One need not here detail the rather complicated chemical examination, but proceed to 

 the author's consideration of the presence of mucus in the faeces : — 



In many cases of sluggish motion without there being any symptoms of inflammation, a thin mucous coating 

 of the faeces will be observed which causes the hard scybala to appear as if varnished. Many authorities do not 

 regard this as arising from inflammation, but look upon it as ejected secretion. But where mucous shreds are seen 

 constantly deposited externally on the scybala and also mixed with them during a lengthy period of observation, 

 the existence of an inflammatory alteration of the mucous membrane may be inferred. The smaller the mucous 

 particles are and the more they are mixed with the faeces so much higher is the part of the intestine from which 

 they proceed. Their descent from the small intestine can only be assumed if the faeces are liquid and if the 

 mucous flocculi are quite small and contain half-digested cells — that is to say, kernels of cells in their characteristic 



' Baumstark, E. (June IGth, 1906), "Examination of the Faeces." Lajiccl, p. 1683, Vol. I. 



