THE GASTRIC CONTENTS AND VOMIT II5 



THE GASTRIC CONTENTS AND VOMIT 



The bacteriological examination of the stomach contents is not 

 of much importance except in one case — i.e., in the differential 

 diagnosis of carcinoma ventriculi and simple dilatation of the 

 stomach. For this purpose it is usually sufficient to examine the 

 vomit, orj if vomiting does not occur, the gastric contents removed 

 by a stomach-tube. It is quite unnecessary to give a test meal, 

 though this is advisable if a chemical examination is to be made ; 

 this should be done in all doubtful cases, but since the methods 

 requisite are outside the scope of this work, only a couple of 

 simple tests will be given. 



The examination is carried out quite simply by the wet method. 

 Two or three drops of the vomit (avoiding undigested food or 

 mucus, since the latter is likely to be derived from the mouth or 

 pharynx) are placed on a slide, and either examined just as they 

 are, or a drop of watery methylene blue, gentian violet, or other 

 stain, is added and stirred well in, and the mixture covered with a 

 cover-glass. If there is an excess of fluid (so that the cover-glass 

 is floated up), it may be sucked up by means of a piece of blotting- 

 paper ; and if an oil-immersion lens is to be used, it will be 

 advantageous to seal the cover-glass down by means of melted 

 paraffin applied by a hot iron, so as to prevent it from being 

 lifted up by the suction of the oil between the lens and cover- 

 glass. If no positive results are found in the first specimen 

 examined, two or three more should be made, as the characteristic 

 organisms are often not distributed uniformly throughout the 

 vomit. Subsequently it may be necessary to prepare dried films 

 to determine whether the organisms stain by Gram. 



In carcinoma of the stomach the characteristic features are 

 (i) the presence of the Boas-Oppler bacillus, (2) the usual absence 

 of sarcinse, and (3) the absence of hydrochloric and presence of 

 lactic acid. In addition there may be blood, pus, and fragments 

 of tumour ; the latter are very rare and difficult to diagnose with 

 certainty. 



The Boas-Oppler bacillus, or B. geniculatus, is very characteristic 

 of carcinoma of the stomach, though it does not occur in every 

 case. It is very rare in other conditions ; I have seen it once in 

 a case of simple chronic gastritis, but here it was present in 

 numbers which were very scanty as compared with the profusion 



