l6o PHYSIOLOGICAL CHEMISTRY 



the thumb and forefinger and placed on the tongue. Then with the 

 aid of the forefinger the tip is pushed forward until it reaches the root of 

 the tongue and is engaged in the oropharynx. Then the patient is 

 encouraged to swallow persistently while the tube is slowly fed into the 

 mouth. After slight discomfort in the pharynx and its passage past the 

 level of the cricoid cartilage, practically no discomfort is felt. This 

 method is used when it is essential that the pure gastric secretion or 

 residuum be obtained. Ordinarily, however, it is much easier to swallow 

 the tube by the second method. This method consists in placing 

 the tip in the oropharynx and then giving the patient a measured 

 quantity of water or tea to swallow. The movements induced by the 

 swallowing carry the tube rapidly to the stomach with a minimum of 

 discomfort. When an Ewald meal (see below) is given, part of the tea 

 can be reserved for swallowing the tube. This procedure makes it 

 scarcely more arduous than the swallowing of food. Should the patient, 

 however, be extremely neurotic or the unfortunate possessor of marked 

 pharyngeal hyperesthesia, cocain hydrochloride in 2 per cent aqueous 

 solution can be applied to the throat rendering the passage of the tube 

 practically insensitive. When the tube has entered the stomach, as- 

 piration of the material shows the characteristic gastric contents. 

 Should the tip remain in the esophagus through transient cardiospasm 

 or other cause, aspiration results in the removal of only a very small 

 specimen having all the characteristics of the pharyngeal and esoph- 

 ageal secretions. 



2. Removal of Residuum. If the so-called "empty" stomach is 

 examined in the morning before any food or drink has been taken it 

 will be found to contain considerable material. This is termed res- 

 iduum. Before a test meal is introduced into the stomach, this organ 

 should be emptied. If this is not done we cannot consider the samples 

 withdrawn after the test meal is eaten as representing the secretory 

 activity of the gastric cells under the influence of the stimulation of the 

 test meal. It has been generally recognized, clinically, that a residuum 

 above 20 c.c. is pathological. 1 Such a volume has been considered as 

 indicative of hypersecretion, and this in turn in many cases indicates an 

 organic lesion. The observations indicating that a residuum of over 

 20 c.c. was pathological, were made upon residuums removed by means 

 of the old type of stomach tube which does not completely empty the 

 stomach. 2 When the residuum is completely removed by means of 



^oeper: LeQons de pathologic digestive, 1912, Series 2, pp. 17-19. 



Zweig: Magen- und Darmkrankheiten, p. 459. 



Kemp: Diseases of the Stomach, Intestines and Pancreas, 1912, p. 133. 



Wolff: Taschenbuch der Magen- und Darmkrankheiten, p. 22. 

 - Harmer and Dodd: Loc. cit. 



