GASTRIC ANALYSIS 173 



tains the bile pigment if any is present in the stomach contents. Allow a drop 

 of yellow nitric acid to flow down the side of the tube and note the green color in 

 the acetone. 



This green color is biliverdin which has been produced from the 

 bilirubin by oxidation with nitric acid. If too much acid is added 

 the green color will be oxidized to a purple or red. If the acetone does 

 not rise to the surface promptly the liquid has not been completely 

 saturated with ammonium sulphate. 



If the stomach contents contains large amounts of bile as indicated 

 by a deep green color 4-5 drops of the fluid may be diluted with 10 c.c. 

 water and the above test applied. 



(h) Microscopy of the Gastric Contents. A microscopical exami- 

 nation of the gastric contents is a routine clinical procedure. 



When an Ewald meal is given the starch granules in various stages 

 of digestion are observed together with epithelia from the pharynx, 

 esophagus, and occasionally the stomach. Gastric and salivary 

 mucus are seen and readily recognized by their ropy appearance. 

 Pathologically various bacteria are* seen, sarcinae, Oppler-Boas bacilli, 

 streptococci, leptothrix, etc. Retained food from previous meals is 

 readily recognized by its histological appearance; meat fibers, vegetable 

 cells, and cellulose may all occur in pathological retention. In certain 

 pathological processes such as ulcer and cancer, red blood cells, pus, 

 and even the cancer cells themselves may be found. For illustrations 

 of the microscopical constituents of gastric contents, see Fig. 49. 



Procedure. Examine a drop of the original (mixed) stomach contents un- 

 stained under the low and high powers of the microscope. Compare your find- 

 ings with the microscopical views shown in Fig. 49. 



Wolff Technic for the Protein Concentration of the Gastric Contents. 1 



Owing to the diagnostic importance of the protein concentration of the gastric 

 secretion, a short note of this test is given here. Under normal conditions the 

 protein concentration follows that of acidity rather closely. In certain cases, how- 

 ever, such as carcinoma (Fig. 47), there is an actual increase in the protein concen- 

 tration of the gastric juice out of all proportion to the acidity. The test may be 

 made as follows: The regular Ewald test meal is fed and specimens of the gastric 

 contents are obtained at i5-minute intervals by means of the Rehfuss tube. One 

 c.c. of the filtered juice is then diluted with 9 c.c. of water representing a dilution 

 of 1:10; 5 c.c. of this mixture is again added to 5 c.c. of water and a dilution of 1:20 

 obtained; this is again repeated using 5 c.c. of the mixture last obtained and 5 c.c. 

 of distilled water and the dilutions are kept up until a series is obtained representing 

 i : 10, i : 20. i : 40, i : 80, i : 160, i : 320, and if necessary i : 640 or more. They are 



1 Wolff: Magen- undDarmkrankh., Berlin, 1912, p. 217; also Berl. klin. Woch., May 29, 

 1911, and March 18, 1912. 



Rolph: Med. Rec., 1913, p. 848. 



Clarke and Rehfuss: Jour. Am. Med. Ass'n, 64, 1737, 1915. 



