CHAPTER XXVIII. 

 THE FJECES. 



IT is advisable to examine a stool macroscopically befoie taking up 

 the miscroscopical examination. The mucus shreds or casts of the 

 bowel in mucous colitis or membranous enteritis may give the 

 diagnosis of obscure abdominal pain. Pus in stools may often be noted 

 without the aid of the miscroscope. 



The normal stool is sausage shaped and soft. Neither the special form of scybal- 

 ous masses called sheep pellets nor the pencil-like nor the tape-like excrement prove 

 the existence of stricture of the intestinal lumen although suggestive of such a con- 

 dition. The mucus of bacillary dysentery is opaque and grayish from the great 

 number of pus and phagocytic cells. It is well to remember that Charcot Leyden 

 crystals, which are practically always absent from bacillary dysentery stools, are 

 not infrequent findings in the amoebae containing stools; of course, these crystals 

 appear in other intestinal parasite infections. 



In obstruction of the common bile duct we have acholic, whitish, foul-smelling 

 stools. If the putty color be due to bacterial change exposure to the air will restore 

 the brownish tinge. 



Sprue stools are white-wash to putty colored, pultaceous, and filled with air 

 bubbles. The amount is excessive. 



Fatty stools are best examined microscopically. 



As so many solid masses resemble gall-stones it is well to dissolve the suspected 

 mass in hot alcohol and examine for cholesterin crystals upon evaporation of the 

 alcohol. 



If the faecal examination is to be made for the diagnosis of amoebae, 

 in a case where the characteristic mucus stools are not present, or to 

 verify the existence of flagellates, it is best to give a dose of salts early 

 in the morning and examine the liquid stools which follow such treat- 

 ment. This treatment is satisfactory for examination for intestinal 

 parasites or ova. 



A very practical way of obtaining amoebae is to pass a rectal tube or a piece of 

 drainage tube with fenestrations into the bowel, and amoebae may be found in the 

 mucus filling the perforations in the tube. 



If the purpose of the examination is to determine the digestive power 

 of the alimentary tract for proteids, carbohydrates, or fats, it is best 

 to use a test diet, as that of Schmidt and Strasburger. 



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