410 GALL-STONES 



to twenty-four hours, preferably anaerobically, we get (i) a shreddy 

 disruption of the casein, (2) the smell of rancid butter and (3) fully 80% 

 of the casein is dissolved. Smears show short thick Gram-positive rods 

 with slightly rounded ends. B. subtilis is sometimes found but does 

 not give a rancid odor nor the strong disruption of the clot. 



It was until recently thought that Cammidge's reaction (urine) when associated 

 with azotorrhoea and steatorrhcea made for a diagnosis of chronic pancreatitis. 

 At present very little importance is attached to the Cammidge reaction. 



Loss of weight, anaemia, diarrhoea and pains in the upper abdomen 

 are important indications of pancreatic trouble. As chronic pan- 

 creatitis is often associated with cholelithiasis jaundice is frequently 

 present. Glycosuria is not often present. While functional tests 

 are important they do not make for a sure diagnosis. At present we 

 examine the duodenal fluid for presence of pancreatic ferments. 



Miiller's method for pancreatic functioning determination is to give a calomel 

 purge two hours after a meal. A little of the liquid stool is smeared on the surface 

 of blood-serum and the tube incubated at 6oC. (paraffin oven). If the surface is 

 smooth, no trypsin was present; if dotted with spots of digestion liquefaction, it 

 shows that the pancreatic secretion is present. 



In Schmidt's nucleus test small cubes of beef are hardened in absolute alcohol 

 and then tied up in tiny silk bags. These are recovered from the faeces and sec- 

 tioned. Complete preservation of nuclei indicates a total absence of pancreatic 

 functioning provided the passage of the tissue be not too rapid as by diarrhoea. 



In the microscopic examination, epithelial cells are generally more or less disinte- 

 grated. In the mucus of bacillary dysenteric stools, however, large intact phago- 

 cytic cells are frequent, which may be mistaken for encysted amoebae. 



Triple phosphate crystals are frequently observed in faeces, as may also be crys- 

 tals of various calcium salts. Charcot-Leyden crystals are rather indicative of 

 helminthiases. 



Various flagellates, and in particular Lamblia, may be responsible for diarrhceal 

 conditions which may cause rather serious symptoms. 



Balantidium coli has been reported several times as the cause of dysenteric con- 

 ditions. Coccidiadea are found in the faeces. 



Isospora was not an infrequent finding in the stools of the soldiers at Gallipoli. 



Gall-stones are usually recognized by their facetted appearance. 

 The stool should be examined for two weeks following an attack of hep- 

 atic colic and the faeces should be rubbed up in water and passed through 

 a seive. A concentric arrangement of layers is usually noted on frac- 

 turing a gall-stone. For identification dry and pulverize the stone 

 and treat with alcohol and ether. This dissolves the cholesterin and 

 upon evaporation the rhombic crystals separate out and may be recog- 



