CHAPTER XXX. 

 THE STOMACH CONTENTS. 



FROM a microscopical standpoint there is comparatively little that 

 is of value in the examination of the gastric contents; there is nothing 

 very specific about the findings. 



A test meal is not a necessity as in the chemical examination, but 

 either vomitus or material withdrawn with a stomach-tube two or more 

 hours after an ordinary meal suffice. 



The most satisfactory specimen is one taken before the giving of 

 the test meal. 



The washings from the stomach are allowed to stand until the 

 sediment has fallen to the bottom and an examination of this is made. 



The microscopical diagnostic points in connection with distinguishing cancer of 

 the stomach from nonmalignant dilatation are: i. Fragments of cancer tissue. 

 These are very rarely found and are most difficult to diagnose. 2. The presence of 

 flagellates in the early stages of cancer (the so-called anacid stage preceding the 

 development of lactic acid) . As flagellates prefer an alkaline medium, they disappear 

 after the acidity due to lactic acid comes on. 3. The presence of the Boas-Oppler 

 bacillus. There* are probably several organisms so designated. They are lactic acid 

 producers and are characterized by being very large bacilli (7X1/0 an d arranged in 

 long chains which stretch across the field of the microscope. They are Gram posi- 

 tive and do not form spores. They can be cultivated on media rich in blood and 

 are aerobic. They should only be reported when present in great abundance and in 

 long chains. Heinemann thinks it probable that the Boas-Oppler bacillus, Lepto- 

 thrix buccalis, and B. bifidus may be identical with B. bulgaricus (see under Milk). 

 4. The absence of sarcinae and yeasts. The presence of these sarcinae and fungi in 

 vomitus is indicative of a simple dilatation. 



In chronic gastritis the picture of mucus entangling large numbers of epithelial 

 cells is characteristic. 



In examining the sediment from the filter-paper after filtering off the stomach 

 contents always use a dilute Gram solution (about i to 4) for mounting the sediment. 

 Muscle fibers, yeast cells, red blood-cells, and epithelial cells are stained a golden 

 yellow. Starch granules are stained blue while fats are unstained and show as glo- 

 bules of varying sizes. 



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