408 BILE IN FAECES 



In normal cases the only fat elements recognizable are yellow calcium or color- 

 less soaps. In sprue from 25 to 30% of the fat ingested appears in the stool while 

 the stool of pellagra shows only about 5% which is the normal figure. 



As quantity of fat increases (as say 500 to 600 mg.) droplets of neutral fat appear 

 with or without increase in number of soap masses. Also needles and splinters 

 of fatty acid and soaps appear. Much connective-tissue debris shows defect in 

 gastric digestion, as only the stomach digests connective tissue. 



A test for activity of fermentation should be made by using a Schmidt 

 apparatus. 



A distinct evolution of gas in twelve hours shows starch digestion defect. Such 

 faeces are acid. A delayed production of gas (after twenty-four hours) shows albu- 

 min' decomposition. Such faeces show an alkaline reaction. The apparatus is 

 shown in Fig. 7. Into a stocky salt mouth bottle we put approximately 5 grams 

 of faeces which have been rubbed up into an emulsion with water and fill the bottle 

 with water. The remaining portion of the apparatus consists of a test-tube or a 

 graduated cylinder fitted with a doubly perforated rubber stopper. One U-shaped 

 glass tube passing through this stopper connects with a second test-tube. This tube 

 serves as a receptacle for any water which may come over from the water-filled tube 

 or graduated cylinder and has an opening punched out of the bottom of the test- 

 tube. The other opening in the twice perforated cork admits a straight tube which 

 connects with a large rubber stopper which fits into the bottle for the faeces. To 

 prepare, fill the graduated cylinder, then push in the doubly perforated cork which 

 is connected with the side receiving tube and the large rubber cork. This latter is 

 then pushed down to fit tightly into the bottle filled full with the faeces emulsion. 



In addition to the faeces examination we should check the results from the test 

 diet with indican and nitrogen partition determinations of the twenty-four-hour 

 urine specimen the ratio of ammonia nitrogen to total nitrogen indicating the func- 

 tional power of liver and the indican the question of stasis in lower part of small 

 intestine. 





The most satisfactory test for bile in the faeces is to emulsify a small 

 particle of faeces in a saturated aqueous solution of bichloride of mercury, 

 preferably with a wooden toothpick, on a concave glass slide. After 

 one or more hours hydrobilirubin-containing faeces show a salmon pink 

 color and bilirubin ones a green color. One should familiarize himself 

 with these reactions in normal cases. The examination of faeces for 

 bile is less certain than duodenal fluid examination. 



In examining a liquid stool after salts, it is well to color the drop of faeces, which 

 is to be covered with the cover-glass, with a small loopful of %% solution of neutral 

 red. If diluting fluid is used, it should be salt solution, and not water. The neutral 

 red tinges the granules of the endoplasm of amoebae and flagellates a very striking 

 rose pink color, thus differentiating them from vegetable cells or body cells. 



Whether examining the thin faeces or the mucus particle, it is well to reserve 

 report on amoebae or flagellates until motion is observed. Encysted protozoa are 



