136 CLINICAL BACTERIOLOGY AND H^EMATOLOGY 



vomit it is necessary to extract the acid by thoroughly shaking up 

 some of the fluid with ether, pipetting off the latter, and then 

 allowing it to evaporate. The acid is contained in a state of com- 

 parative purity in the residue, which is then dissolved in water and 

 tested in the following way; Td half a test-tubeful of i in 40 

 carbolic add one or two drops of liq. ferri perchlor. A fine 

 amethyst colour will result, and will be changed to a bright 

 canary-yellow on the addition of the solution of the ethereal 

 extract, if the latter contains lactic acid. It is not sufficient to 

 apply this test to the filtrate of a vomit direct, although this is 

 permissible in the case of the fluid removed from the stomach 

 after a test meal. It is useless to apply it to vomit containing 

 much milk, as this often contains abundant lactic acid. 



The vomit in cases of simple dilatation of the stomach usually 

 contains a variety of bacteria, yeasts, etc., but the most character- 

 istic organisms are the sarcinse, a group of cocci which have 

 very definite microscopical characters. They have the property 

 of dividing by three successive divisions in the three planes of 

 space (at right angles), and the eight resulting cocci do not com- 

 pletely separate from one another. The result is the formation of 

 a group of eight cocci which form one mass, having the shape of 

 a bale of soft material tied round by three tightly drawn cords 

 at right angles to one another. Successive divisions take place 

 para.llel to these, and a very complex colony results. The sarcinae, 

 as a rule, are decidedly larger than ordinary cocci, though not as 

 large as yeasts ; the different cocci of each group usually vary in 

 size amongst themselves, the younger forms being the larger. 

 Most of them stain by Gram, but this test is hardly necessary, 

 as they may be readily recognized in unstained wet prepara- 

 tions. 



They occur in profusion (often mixed with yeasts) in many 

 cases of simple dilatation of the stomach, though not in all. 

 They occur in other conditions, but are very rarely found in cases 

 of carcinoma, and this is the only importance attaching to them. 



In dealing with cases of gastritis (whether acute or chronic) 

 due to infection with a single pathogenic organism the possibility 

 of vaccine treatment should be borne in mind. I obtained 

 excellent results in a case of chronic gastritis due to the pneumo- 

 coccus by means of a vaccine after ordinary medicinal means had 

 failed. Suitable cases are those in which there is in the vomit or 

 est-meal material pus or muco-pus containing the orgr.nism in 



