Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger.

  • Billings, Frank, 1854-1932.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    sooner or later. This method has the advantage that the gastric mucous membrane is stimulated in a normal manner, because all necessar}' foods , are contained in the meal. It should, therefore, alwa3's be employed when the simpler Ewald method gives a negative result in regard to hydrochloric acid and pepsin. In such cases we often note that the more intense and prolonged stimulation of Leube's test-meal gives a conspicuously positive result; its disadvantage lies in the fact that, because of the complexity of the components of the meal, complete uniformity of the same in every case can only be obtained with difficulty, and gastric patients in particular are frequently unable to consume it entirely. In office practice it is most unpleasant, but sometimes necessary, to evacuate the stomach a long time after the meal, at a late afternoon hour. Test-meal according to Ewald and Boas.—Early in the morning, or at another time when the stomach is empty, the patient receives one or two rolls of wheat bread (35 to 70 grams) and one or two cups of tea without sugar or milk. Water may be taken instead of tea. After an hour or an hour and a quarter (according to whether the single or double quantity has been taken) the stomach is evacuated. This test-meal has the advantage of great simplicity, and the masses which are evacuated do not have the smeary composition which they have by Leube's method. As the evacuation may occur comparatively soon after the intake of food, the administration of the trial breakfast and the evacuation of the stomach contents may be undertaken during the office hour. [The shredded wheat biscuit makes an excellent test-meal. It is free from yeast and contains the entire food elements of wheat. Two biscuits, thoroughly masticated, and a glass or two of water form an ideal Ewald meal.—Ed.] EXAMINATION OF THE GASTRIC CONTENTS A. MACROSCOPIC AND MICROSCOPIC EXAMINATION The odor of the gastric contents normally and also in most pathologic cases, provided the stomacli is empty before the test-meal is administered, is not distinc- tive. In stagnation of the ingesta (gastrectasis, dyspepsia, gastritis) we find, as an expression of decomposition, the odor of fatty acids, acetic acid or butyric acid (like rancid butter). Blood is occasionally admixed with the stomach contents as a small, bright red streak; it originates from retching, and is therefore of no pathognomonic impor- tance. If, however, the entire contents have a distinct hemorrhagic discoloration, the presence of an ulcer, carcinoma, or stasis in the portal vein system is proven, and all further sounding is to be avoided. Bile, characterized by its yellow or greenish color, is very frequentlj' found in the gastric contents and is of no diagnostic significance. Mucus in small amounts may also be found in the normal gastric contents if the quantity of hydrochloric acid present is slight. Larger amounts, particularly thick coagula, denote gastritis, unless the mucus originates from the respiratory passages. In the case of gastritis, the microscopic examination of the mucus as well as of the