THE GASTRIC CONTENTS AND VOMIT II7 



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 

 in 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 

 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 ; To 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. 



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 

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

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



