A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
Calculate the number of cubic centimeters of decinormal solution which
would be required for 100 c.c. of stomach fluid. This gives, in
degrees, _all the acidity except the combined hydrochloric acid_. The
combined hydrochloric acid is then found by deducting this amount from
the total acidity, which has been previously determined.
_Example_.--Suppose that 5 c.c. of decinormal solution were required
to produce the purple color in 10 c.c. gastric juice; then
5 X 10 = 50 = _all the acidity except combined hydrochloric acid_.
Suppose, now, that the total acidity has already been found to be 70
degrees; then 70 - 50 = 20 _degrees_ of combined hydrochloric acid;
and 20 X 0.00365 = 0.073 _per cent._
* * * * *
(3) Organic Acids.--There is no simple direct quantitative method.
After the total acidity has been {227} determined, organic acids may
be removed from another portion of the gastric filtrate by shaking
thoroughly with an equal volume of neutral ether, allowing the fluids
to separate, and repeating this process until the gastric fluid has
been extracted with eight or ten times its volume of ether. The total
acidity is then determined, and the difference between the two
determinations indicates the amount of organic acids.
(4) Pepsin.--No direct method is available. The following is
sufficient for clinical purposes:
* * * * *
Hammerschlag's Method.--To the white of an egg add twelve times its
volume of 0.4 per cent. hydrochloric acid (dilute hydrochloric acid,
U.S.P., 4 c.c.; water, 96 c.c.), mix well, and filter. This gives a 1
per cent. egg-albumen solution. Take 10 c.c. of this solution in each
of three tubes or beakers. To _A_ add 5 c.c. gastric juice; to _B_,
5 c.c. water with 0.5 gm. pepsin; to _C_, 5 c.c. water only. Place in
an incubator for an hour and then determine the amount of albumin in
each mixture by Esbach's method. Tube _C_ shows the amount of albumin
in the test-solution. The difference between _C_ and _B_ indicates the
amount of albumin which would be digested by normal gastric juice. The
difference between _C_ and _A_ gives the albumin which is digested by
the fluid under examination. It has been shown that the amounts of
pepsin in two fluids are proportionate to the squares of the products
of digestion. Thus, if the amounts of albumin digested in tubes _A_
and _B_ are to each other as 2 is to 4, the amounts of pepsin are to
each other as 4 is to 16.
Certain sources of error can be eliminated by diluting the gastric
juice several times before testing.
* * * * *
{228} D. MICROSCOPIC EXAMINATION
A drop of unfiltered stomach-contents is placed upon a slide, covered
with a cover-glass, and examined with the two-thirds and one-sixth
objectives.
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