(A) Gastric Juice

The microscopical examination of the gastric secretion found when fasting shows normally some epithelial cells, cell nuclei, mucous corpuscles, amorphous material, and some micro-organisms (see Fig. 17). The occurrence of snail-like cells in cases of hypercblorhydria was first described by Ja-worski,' who considered them a great rarity. Boas,2 on the other hand, is of the opinion that they are of frequent occurrence. The latter writer considered them as substances which have developed from the mucus under the influence of the gastric juice. I concur with Boas in his statement that the snails are frequently found, and would like to add that they may also be found in patients not troubled with hyperchlorhydria. I found them once in a patient with normal secretion, and once in some fluid which had been obtained from the oesophagus of a patient troubled with cancer of the cardia. The snails may be separately or in groups (see Fig. 18).

Fig. 17. - A Specimen of Mucus in the Gastric Juice obtained from a Patient In the Fasting Condition, showing mucous corpuscles, amorphous material, and few epithelial cells.

1 Jaworaki: Mttnchener med. Wochenschr., 1887, No. 82. 2J. Boas: "Diagnoetik und Therap. der Mageukrankheiten," Theil i., 3te Auflage, p. 212.

(B) Gastric Contents

The microscopical examination of the gastric contents at the height of digestion (either one to one and a half hours after a test breakfast or three to four hours after a test dinner) will allow us to judge to a certain extent regarding the way the act of digestion has progressed. Normally only a few starchy granules are found, most of which have already lost their characteristic spiral configuration. The muscular fibres have likewise already undergone deep changes and do not show diagonal stripes. Plant cells, fat in fine globules, and different kinds of microorganisms are found in small numbers. The presence of a large amount of unchanged starchy granules is most frequently found in cases of hypercblorhydria, while unchanged muscle fibres, showing the diagonal stripes clearly, are found in cases with a diminished gastric secretion. The different varieties of micro-organisms found in the stomach have been thoroughly studied by De Bary,1 Miller,2 Macfadyen,3 Nencki,4 Abelous,4 Boas,5 and others.

While a few years ago it was believed that no micro-organisms can develop in the stomach containing free hydrochloric acid in its juice, of late it has been proven by several authors that micro-organisms may thrive in the stomach even if it contains too large a quantity of hydrochloric acid - or, in other words, the hydrochloric acid (of the gastric juice) does not always exclude fermentative processes in the stomach. Thus Kaufmann,1 of New York, has described a case in which a condition of hyper-chlorhydria existed and in which the motor function of the stomach was not markedly disturbed, but which notwithstanding microscopically gave all symptoms of fermentative processes. The gastric contents always contained numerous living bacteria of various types. Dr. Kaufmann succeeded in separating the eight following micro-organisms from one specimen of the gastric contents by means of culture: (1) Yellow sarcinae; (2) white yeast; (3) Micrococcus aurantiacus (Cohen); (4) Staphylococcus cereusalbus (Passet); (5) Bacillus subtilis; (6) Bacillus ramosus; (7) a large, thick bacillus; (8) a short bacillus, resembling the Bacillus coli communis.

Fig. 18. - A Specimen of Mucus in the Gastric Juice obtained from a Patient in the Fasting Condition, showing single snail forms and some lying in groups; also amorphous material and few epithelial cells.

Fig. 19. - A Specimen of Gastric Contents in the Fasting Condition from Patient K., with Carcinoma Ventriculi. a and 6, Partly digested muscle fibres; c, starch granules; d, fat globules; e, yeast cells; f. sarcinae.

1 De Bary: Arch. f. exper. Path, und Therap., Bd. 20, p. 243.

2 Miller: "Die Mikro-organismen der Mundhohle," Leipzig, 1892. 3Macfadyen: Journal of Anat. and Physiol., vol. 21, 1887.

4 Macfadyen, Nencki, undSieber: Arch. f. exper. Patholog., Bd. 28.

5 Abelous: These de Montpellier, 1888. 6Boas: Deutsche med. Wochenschr., 1802.

Fig. 20. - A Specimen of Gastric Contents from Patient with Ischochymla, showing sarcinae, yeast cells, fat globules, and fat crystals.

1 J. Kaufmann: Berl. k;in. Woeheuschr., 1895, No. 6.

Boas has observed several cases in which, notwithstanding the presence of hyperchlorhydria, there was a decomposition of the albuminate of the food, resulting in the development of sulphuretted hydrogen. I have lately observed numerous cases of this nature myself.

Fig. 21. - A Specimen of Gastric Contents One Hour after Test Breakfast (Patient with Hyperchlorhydria), showing many unchanged starch granules, yeast cells and a great number of micro-organisms.

In cases with abnormal fermentative processes within the stomach, the same kinds of micro-organisms are usually found as in the normal stomach, only in much larger number (Minkowski).1 Yeast cells and sarcinae occur in large numbers in cases with a distinct motor disturbance of the stomach (especially ischochymia). The sarcinae ventriculi, which were first described by Goodsir2 in 1842, occur in cubes or tetrahedrons (see Figs. 19 and 20), but they have only a pathognomonic significance if they appear in very large numbers.

1 Minkowski: "Mittheilungen aus der rued. Klinik zu Konigs-ber," 1888.

2 Goodsir, cited from Ewald: "Diseases of the Stomach," New York, 1882, p. 188.