GASTRIC ANALYSIS 149 



gastric digestion and is not limited, as in the old method, to information 

 derived from the analysis of a single sample of stomach contents with- 

 drawn at the end of one hour. That the acid values obtained by the 

 old method may be grossly misinterpreted and lead to an incorrect 

 diagnosis is indicated by the foregoing diagram (Fig. 41) : 



It is set forth in the above diagram that various types of abnormal 

 gastric secretion would be considered normal on the basis of a single 

 examination at the end of one hour whereas the application of the 

 fractional method reveals the abnormality of the secretion and enables 

 a rapid and correct diagnosis. The removal of samples of gastric 

 contents at short intervals, for a period of two hours or more after a 

 test meal, is made possible by the use of a modified stomach tube 1 of 

 small diameter (No. 12 French tubing) and fitted with a metal tip. 



FIG. 42. REHFUSS STOMACH TUBE. 



The tip is slotted with large perforations, the diameter of each being 

 equivalent to the maximum bore of the tubing. Such a tube can be 

 left in the stomach through the entire cycle of gastric digestion without 

 inconvenience to the patient. 2 A cut of the Rehfuss stomach tube 

 (Fig. 42) is shown above. 3 



The idea of making a fractional examination of gastric contents is 

 not new. Most of such attempts have been made, however, by using 

 the old type of stomach tube and removing the entire stomach contents 

 at different intervals on successive days, e.g., after fifteen minutes the 

 first day, thirty minutes the second day, forty-five minutes the third 

 day, etc. Hayem 4 was the first to employ this method and later 



1 Rehfuss: Am. Jour. Med. Sci., June, 1914. 



2 McClendon has recently suggested the introduction of an electrode into the stomach in 

 an attempt to follow the consecutive changes in the hydrogen ion concentration of the 

 stomach contents (see Am. Jour. Physiol., 38, 180, 1915). 



3 This tube is manufactured by Charles Lentz & Sons, Philadelphia. 



4 Hayem: Brouardel & Gilbert's, Traite de Medecine, 4, 236, 1905. 



