216 METHODS FOR THE ANALYSIS OF GASTRIC JUICE 



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 the 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, aspiration 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 character- 

 istics of the pharyngeal and esophageal 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 residuum. 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 cannot consider the samples withdrawn after the test meal is eaten 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 patho- 

 logical. Such a volume has been considered as indicative of hyper- 

 secretion, 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. When the residuum is completely removed by 

 means of the Rehfuss tube it has been demonstrated that the 

 normal residuum is practically always over 20 c.c. and that the 

 average is about 50 c.c. for both men and women. The normal 

 residuum has been found to possess all the qualities of a physio- 



