176 PHYSIOLOGICAL CHEMISTRY 



pathological processes such as ulcer and cancer, red blood cells, pus, 

 and even the cancer cells themselves may be found. For illustrations 

 of the microscopical constituents of gastric contents, see Fig. 55, 



Procedure. Examine a drop of the original (mixed) stomach contents un- 

 stained under the low and high powers of the microscope. Compare your find- 

 ings with the microscopical views shown in Fig. 55. 



Wolff Technic for the Protein Concentration of the Gastric Contents. 1 

 Owing to the diagnostic importance of the protein concentration of the gastric 

 secretion, a short note of this test is given here. Under normal conditions the 

 protein concentration follows that of acidity rather closely. In certain cases, how- 

 ever, such as carcinoma (Fig. 53), there is an actual increase in the protein concen- 

 tration of the gastric juice out of all proportion to the acidity. The test may be 

 made as follows: The regular Ewald test meal is fed and specimens of the gastric 

 contents are obtained at i5-minute intervals by means of the Rehfuss tube. One 

 c.c. of the filtered juice is then diluted with 9 c.c. of water representing a dilution 

 of i :io; 5 c.c. of this mixture is again added to 5 c.c. of water and a dilution of i :2O 

 obtained; this is again repeated using 5 c.c. of the mixture last obtained and 5 c.c. 

 of distilled water and the dilutions are kept up until a series is obtained representing 

 1:10, 1:20, 1:40, 1:80, 1:160, 1:320, and if necessary 1:640 or more. They are 

 then stratified with approximately i c.c. of Wolff's reagent, 2 care being taken that 

 the liquids do not mix. The tubes should be read immediately against a dark 

 background and the tube giving a protein ring at the greatest dilution of gastric 

 juice recorded. A glance at Fig. 53 will show a pronounced case of gastric carci- 

 noma. With normal acid figures the protein concentration evolves proportionally 

 to the acidity. A case of achylia is shown in Fig. 54. 



Tb'pfer's Method of Gastric Analysis 



This method is much less elaborate than many others but is sufficiently ac- 

 curate for ordinary clinical purposes. The method embraces the volumetric de- 

 termination of (i) total acidity, (2) free acidity (organic and inorganic) , 3 and (3) free 

 hydrochloric acid, and the subsequent calculation of (4) combined acidity and (5) 

 acidity due to organic acids and acid sails, from the data thus obtained. 



Procedure. Feed the Ewald test meal as directed on page 165. At the end of 

 one hour remove the entire stomach contents and analyze as directed below. This 

 method of procedure is less accurate than the Fractional Method (see page 150). 

 Measure the volume of the gastric contents, strain it through cheese cloth and intro- 

 duce 10 c.c. of the strained material into each of three small beakers or porcelain 

 dishes. 4 Label the vessels A, B, and C, respectively, and proceed with the analysis 



1 Wolff: Magen- und Darmkrankh., Berlin, 1912, p. 217; also Berl. klin. Woch. t May 29, 

 1911, and March 18, 1912. 



Rolph: Med. Rec., 1913, p. 848. 



Clarke and Rehfuss: Jour. Am. Med. Ass'n, 64, 1737, 1915. 



2 Phosphotungstic acid 0.3 gm. 



Concentrated hydrochloric acid i . o c.c. 



Alcohol 95 per cent 20 . o c.c. 



Distilled water sufficient to make 200. o c.c. 



8 For a discussion of combined acid see chapter on Gastric Digestion. 

 4 If sufficient gastric juice is not available it may be diluted with water or a smaller 

 amount, e.g.,- 5 c.c., taken for each determination. 



