A few large non-motile bacilli are frequently seen; they cannot be called Boas-Oppler bacilli unless they are numerous and show something of the typical arrangement. E. THE GASTRIC CONTENTS IN DISEASE In the diagnosis of stomach disorders the practitioner must be cautioned against relying too much upon examinations of the stomach-contents. A first examination is especially unreliable. Even when repeated examinations are made, the laboratory findings must never be considered apart from the clinical signs. The more characteristic findings in certain disorders are suggested here. 1. Dilatation of the Stomach.--Evidences of retention and fermentation are the chief characteristics of this condition. Hydrochloric acid is commonly diminished. Pepsin may be normal or slightly diminished. Lactic acid may be detected in small amounts, but is usually absent when the stomach has been washed before giving the {231} test-meal. Both motility and absorptive power are deficient. The microscope commonly shows sarcinæ, bacteria, and great numbers of yeast-cells. Remnants of food from previous meals can be detected with the naked eye or microscopically. 2. Gastric Neuroses.--The findings are variable. Successive examinations may show normal, increased, or diminished hydrochloric acid, or even entire absence of the free acid. Pepsin is usually normal. In the neurosis characterized by continuous hypersecretion (gastrosuccorrhea), 40 c.c. or more of gastric juice can be obtained from the fasting stomach. Should the fluid contain food-particles, it is probably the result of retention, not hypersecretion. 3. Chronic Gastritis.--Free hydrochloric acid may be increased in early cases. It is generally diminished in well-marked cases, and is often absent in advanced cases. Lactic acid is often present in traces, rarely in notable amount. Secretion of pepsin and rennin is always diminished in marked cases. Mucus is frequently present, and is very significant of the disease. Motility and absorption are generally deficient. Small fragments of mucous membrane may be found, and when examined by a pathologist, may occasionally establish the diagnosis. 4. Achylia Gastrica (Atrophic Gastritis).--This condition may be a terminal stage of chronic gastritis. It is sometimes associated with the blood-picture of pernicious anemia. It gives a great decrease, and sometimes entire absence of hydrochloric acid and ferments. The total acidity may be as low as 1 or 2 degrees. Small amounts of lactic acid may be present. Absorption and motility are usually not affected. {232} 5. Gastric Carcinoma.--As far as the laboratory examination goes, the cardinal signs of this disease are absence of free hydrochloric acid and presence of lactic acid and of the Boas-Oppler bacillus. These findings are, however, by no means constant.