THE GASTRIC CONTENTS AND VOMIT I35 



of this double thread will turn away from one another, so that it 

 looks as if there were true branching at the extremity of the 

 filament. If this turns out to be the case in all specimens, it will 

 be a most important means of identifying the organism.* 



Cultures may readily be obtained on media rather highly 

 acidified with lactic acid, but are not requisite for the identifica- 

 tion of the bacillus. 



In addition to the Boas-Oppler bacillus, the vomit may contain 

 a few yeasts, distinguished by their large size, oval or spherical 

 shape, and by the way in which they reproduce themselves by 

 budding ; there may also be a few bacteria of other sorts. But 

 in many cases the bacilli are present in a state of almost absolute 

 purity, and in large numbers, so that they form tangled masses. 



In nearly all cases in which the bacillus is found the vomit 

 contains no hydrochloric acid, or only a trace. To test for it 

 filter some of the vomit and place a drop or two of the filtrate on 

 a white porcelain tile ; place a drop of a o'5 per cent, alcoholic 

 solution of dimethyl-amido-azo-benzol close to it and let the two 

 gradually mix. If physiologically active HCl is present, even in 

 very small amount, a transient pink colour will be produced.! The 

 commonly recommended phloroglucin and vanillin test does not 

 demonstrate the presence of HCl in combination with proteids, 

 and since this is usually the form in which it occurs in the 

 stomach contents the failure to obtain the phloroglucin and 

 vanillin reaction is not of the slightest importance in diagnosis. 

 The use of the latter test is, I think, one of the chief reasons for 

 the common idea that the absence of HCl is of very little value 

 m the diagnosis of malignant disease. Using the dimethyl-amido- 

 azo-benzol test, I have rarely found it fail, and in the only case I 

 remember in which the acid was found present in considerable 

 amount the growth was found at operation to be spreading out- 

 wards, and hardly to involve the mucous membrane at all. But 

 these tests were mostly made on the fluid obtained after a test 

 meal, and not on vomits. 



Lactic acid usually occurs in the absence of free hydrochloric 

 in cancer of the stomach, but its presence is in itself a fact of 

 little value, since it occurs in other conditions. To test for it in a 



» Note to Third Edition. It is not, though I have since seen it two or three 

 times. 



f Where there is a great excess of proteids this reaction may not succeed, 

 even though physiologically free HCl may be present. But I do not think this 

 occurs with an ordinary test meal. 



