64 KEVIEW — TROPICAL MEDICINE, ETC. 



Paeces — arrangement. The larger the number of Riioh cells the higher the degree of inflammation. The Inlirubin colouring 



contiiiuc<l '"fitter in the sublimate test and the presence of l)ilirul)in crystals in the microscopical examination strengthen 

 the assumption of the mucus originating from the small intestine. 



The diagnostic conclusions to be drawn from the foregoing observations are as follows. The presence of 

 connective-tissue remnants in the test-diet stools points with certainty to a disorder of the digestion, as only the 

 gastric juice is able to dissolve raw connective tissue — i.e. from the centre and not from the well-cooked part of 

 the meat. Achylia or hypochylia would usually be accountable for such a condition. Excessive peristalsis 

 perhaps also plays an important part in some of these cases. Again, in excessive acidity associated with insuilicient 

 pepsine secretion (cases which not infrequently occur) the raw tissue meets with unfavourable conditions and 

 appears again in the stools. A very minute examination of the stomach should be carried out in these circum- 

 stances. If muscle remnants are found macroscopically, or even in considerable amount microscopically, 

 disturbance of the digestion in the small intestine may be inferred, for the stomach plays only an unimportant 

 part in the dissolving of meat fibre and the digestion of meat does not take place in the colon. With both 

 connective-tissue and muscle remnants in the stools it may be concluded that both stomach and small intestine 

 arc deranged. 



With regard to the digestion of fat, it is to be observed that slighter variations in the fatty contents of the 

 normal stool have no diagnostic meaning, for every stool contains fat in the normal faeces to the extent of 23 per 

 cent, of the dry substance. A morbid increase of the fatty contents is proved at the macroscopic examination by 

 the clayey quality of the light-coloured, nearly white faeces, by the very sour reaction, by the copious quantity of 

 the faeces, and by their filmy appearance when rubbed up. Microscopical increase of the sebacic acid flocculi in 

 the cold acetic acid preparation and neutral fat drops and salts of lime and soap crystals in a native preparation 

 confirm the diagnosis. If the sublimate test show a complete absence of bile in the stools together with an 

 increase of the fatty contents (in which case icterus also occurs), the cause of the disease is to be sought for in the 

 biliary duct system. If, however, in conjunction with the increase of the fat contents (especially in the form of 

 neutral fat drops in the native preparation) , there are signs of muscle tissue simultaneously with the presence of 

 hydrobilirubin and absence of mucus, then the pancreas is the seat of the disease. 



In rare cases, where biliary deficiencies and pancreatic diseases are excluded, severe forms of intestinal 

 disease, such as tuberculosis, amyloid disease, or tabes mesenterica, may be the cause of the derangement of fat 

 absorption. The digestion of albumin is then likewise disturbed, and, as a rule, prior to the impairment of fat 

 absorption. Moreover, purely functional disturbances of absorption limited to fats are sometimes observed. The 

 simultaneous appearance, however, of mucus and processes of decomposition are decisive as regards an organic 

 disease of the intestinal wall itself. 



A complete absence of red or green colouring in the sublimate test shows absence of bile in the intestine (and 

 icterus exists). If icterus be non-existent, then it a question of a temporary suspension of the secretion of bile. 

 In the case of brown, fresh stools, absence of red colouring or a muddy colour would point to intestinal 

 decomposition. When green colouring (bilirubin) is macroscopically demonstrated or if green colouring of 

 separate particles — for example, of muscle tissue — is seen microscopically, it shows too rapid a passage through 

 the colon ; if the entire stool be coloured green, then most probably the small intestine is also involved. If there 

 be a simultaneous appearance of small mucous flocculi described above, the cause is an inflammation of the mucous 

 membrane of the small Intestine. 



Strasburger'* has a paper on much the same lines. He says that : — 



Mucus can be recognised under the microscope, especially if one adds acetic acid. Mucus when recognised 

 in the motion points to a catarrh in some portion of the intestine, and roughly the catarrh is in the large gut 

 when the mucus is recognised macroscopically and in the small intestine when it is only detected microscopi- 

 cally. One learns more by noticing whether the mucus is intimately mixed with the faecal material, and whether 

 there are many cells associated with it. Blood and pus must be carefully looked for, and one must bear in mind 

 that the red corpuscles may not be sufliciently preserved to be recognised under the microscope when the source 

 is high up in the small intestine. 



Bacteria and animal parasites are considered : — 



Comparatively mild affections due to staphylococci can be readily distinguished by means of the micro- 

 scope from the more dangerous infections due to streptococci. Typhoid, cholera, and dysentery bacilli can 

 only be detected by culture, but tubercle bacilli may be demonstrated with compai-ative ease on cover-glass 

 preparations. The amoebae of dysentery, or certain forms of enteritis, can be seen under the microscope in 

 fresh stools, but one must be careful not to press the cover-glass firmly on to the slide and also to keep the 

 sUde warm if one wishes to recognise their movements. 



The latter injunction is unnecessary during the hot weather in the Sudan. At other 

 times a warm stage or, what is far better, a Nuttall's microscope thermostat will be found 

 necessary. 



Daniels gives- a good account of the examination of faeces. The following may be 

 quoted : — 



Macroscopic examination. The points to observe are — 



1. The presence or absence of blood, mucus, muco-pus or pus, and the arrangement relative to the stool of 

 such a discharge. 



' Strasburger, J. (April, 1904), Berl. Klin. Quoted in Medical Annual, 1906. 

 ' Daniels, C. W., " Laboratory Studies in Tropical Medicine." 2nd Edition, 1907. 



• Article not consulted in the original. 



