A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
The best evidence of deficient motor power is the detection of food in
the stomach at a time when it should be empty, _e.g._, before
breakfast in the morning. When more than 60 c.c. of fluid are obtained
with the tube one hour after a Ewald breakfast, deficient motility may
be inferred.
* * * * *
{234} Ewald's salol test is scarcely so reliable as the above. It
depends upon the fact that salol is not absorbed until it reaches the
intestine and is decomposed by the alkaline intestinal juices.
The patient is given 15 grains of salol with a test-breakfast, and the
urine, passed at intervals thereafter, is tested for salicyluric acid.
A few drops of 10 per cent. ferric chlorid solution are added to a
small quantity of the urine. A violet color denotes the presence of
salicyluric acid. It appears normally in sixty to seventy-five minutes
after ingestion of the salol. A longer time indicates impaired motor
power.
* * * * *
3. To Determine Size and Position of Stomach.--After removing the
test-meal, while the tube is still in place, force quick puffs of air
into the stomach by compression of the bulb. The puffs can be clearly
heard with a stethoscope over the region of the stomach, and nowhere
else.
If desired, the patient may be given a dram of sodium bicarbonate in
solution, followed immediately by the same amount of tartaric acid,
also in solution; or he may take the two parts of a seidlitz powder
separately. The carbon dioxid evolved distends the stomach, and its
outline can easily be determined by percussion.
{235}
CHAPTER V
THE FECES
As commonly practised, an examination of the feces is limited to a
search for intestinal parasites or their ova. Much of value can,
however, be learned from other simple examinations, particularly a
careful inspection. Anything approaching a complete analysis is, on
the other hand, a waste of time for the clinician.
The normal stool is a mixture of--(_a_) Water; (_b_) undigested and
indigestible remnants of food, as starch-granules, particles of meat,
plant-cells and fibers, etc.; (_c_) digested foods, carried out before
absorption could take place; (_d_) products of the digestive tract, as
altered bile-pigments, mucus, etc.; (_e_) products of decomposition,
as indol, skatol, fatty acids, and various gases; (_f_) epithelial
cells shed from the wall of the intestinal canal; (_g_) harmless
bacteria, which are always present in enormous numbers.
Pathologically, we may find abnormal amounts of normal constituents,
blood, pathogenic bacteria, animal parasites and their ova, and
biliary and intestinal concretions.
The stool to be examined should be passed into a clean vessel, without
admixture of urine. The offensive odor can be partially overcome with
turpentine or 5 per cent. phenol. When search for _Amoeba coli_ is to
be made, the vessel must be warm, and the stool kept warm until
examined; naturally, no disinfectant can be used.
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