In a paper on dilatation of the stomach and gastroptosis, R. C. Kemp (2), holding that transillumination of the stomach is the ideal method of ascertaining its limits, advocates the introduction of fluorescent media into the stomach before the electric lamp is passed, by which means he has found that the brilliancy of the transillumination is increased over one half. The principal medium is bisulphate of quinine in the strength of 10 grains to 1 pint of water, with, preferably, the addition of 5 minims of dilute phosphoric acid or sulphuric acid. The fluorescence is a pale violet. Increased acidity intensities its action, and fluorescence at once disappears if the solution is rendered alkaline. The other medium is fluorescein, used by ophthalmic surgeons to detect ulcers of the cornea. As is well known, it is resorcin-phthalein anhydride. In an alkaline and alcohol medium it gives a green fluorescence. The hydrochloric acid of the stomach is first neutralised by giving 15 grains of sodium bicarbonate dissolved in 8 ounces of water; or 1 or 2 ounces of lime water may be given instead and then a second draught consisting of 8 ounces of water in which are dissolved 15 grains of sodium bicarbonate, 1 drachm of glycerine, and | grain to ^ grain of fluorescein. By this means he has been able to trans-illuminate the stomachs of persons with thick abdominal walls, otherwise a matter of difficulty.
The removal of a portion of mucous membrane for microscopic examination by means of specially constructed forceps has been suggested and even employed by certain specialists, but it need only be mentioned to be condemned as unnecessary and dangerous.
The exploring syringe may afford useful aid in the diagnosis of sub-diaphragmatic abscess, and in exactly localising its site as a preliminary to incision and drainage.
Gastric lavage may be employed with advantage as a therapeutic measure in a number of conditions, but from a diagnostic point of view it serves a very useful purpose for ascertaining the quality of the gastric secretion after a test meal and the character of the retained stomach contents in chronic dilatation, also in estimating the motor activity of the stomach.
Leube's method for ascertaining the motor activity of the stomach consists in washing1 out the stomach at various times after a good meal-a quarter of a pound of freshly-minced meat with some bread. Within six hours the stomach should be empty, but in dilatation or other conditions in which the motor activity of the wall of the stomach is impaired some food may be found many hours later.
In cases of dilated stomach where the succussion splash is well marked and there is no vomiting it is desirable to syphon off the contents in order to ascertain the presence or absence of free HCl, lactic acid, sarcinae or yeast fungi and other abnormal contents of the stomach. The motor activity of the stomach may be also ascertained by Ewald's test of administering salol, which is not split up in the stomach, but which breaks up on coining into contact with the alkaline pancreatic juice; the salicyluric acid resulting is excreted in the urine where it can be readily detected by the addition of neutral ferric chloride solution, a violet coloration occurring.
Fifteen grains of salol is given along with the food, and under normal conditions salicyluric acid appears in the urine in from 40 to 60 minutes, but in dilatation or other conditions in which the motor activity is impaired the time is considerably delayed.
Several instruments have been invented to test graphically the motor activity of the stomach, which, though valuable for physiological experiments, are not reliable in practice.