A Manual of Clinical Diagnosis

by James Campbell Todd

2. Withdrawal of the Contents.—The Boas stomach-tube, with bulb, is probably the most satisfactory form. It should be of rather large caliber, and have an opening in the tip and one or two in the side near the tip. When not in use, it should be kept in a vessel of borax solution, and should be well washed in hot water both before and after using.

It is important confidently to assure the patient that introduction of the tube cannot possibly harm him; and that, if he can control the spasm of his throat, he will experience very little choking sensation. When patients are very nervous, it is well to spray the throat with cocain solution.

The tube should be dipped in warm water just before using: the use of glycerin or other lubricant is undesirable. With the patient seated upon a chair, his clothing protected by towels or a large apron, and his head tilted forward, the tip of the tube, held as one would a pen, is introduced far back into the pharynx. He is then urged to swallow, and the tube is pushed boldly into the esophagus until the ring upon it reaches the incisor teeth, thus indicating that the tip is in the stomach. If, now, the patient cough or strain as if at stool, the contents of the stomach will usually be forced out through the tube. Should it fail, the fluid can generally be pumped out by alternate compression of the tube and the bulb. If unsuccessful at first, the attempts should be repeated with the tube pushed a little further in, or withdrawn a few inches, since the distance to the stomach is not the same in all cases. The tube may become clogged with pieces of food, in which case it must be withdrawn, cleaned, and reintroduced. If, after all efforts, no fluid is obtained, another test-meal should be given and withdrawn in forty-five minutes.

As the tube is removed, it should be pinched between the fingers so as to save any fluid that may be in it.

The stomach-tube must be used with great care, or not at all, in cases of gastric ulcer, aneurysm, uncompensated heart disease, and marked arteriosclerosis. Except in gastric ulcer, the danger lies in the retching produced, and the tube can safely be used if the patient takes it easily.

B. PHYSICAL EXAMINATION

Under normal conditions, 30 to 50 c.c. of fluid can be obtained one hour after administering Ewald's breakfast. More than 60 c.c. points to motor insufficiency; less than 20 c.c., to too rapid emptying of the stomach, or else to incomplete removal. Upon standing, it separates into two layers, the lower consisting of particles of food, the upper of an almost clear, faintly yellow fluid. The extent to which digestion has taken place can be roughly judged from the appearance of the food-particles.

The reaction is frankly acid in health and in nearly all pathologic conditions. It may be neutral or slightly alkaline in some cases of gastric cancer and marked chronic gastritis, or when contaminated by a considerable amount of saliva.

A small amount of mucus is present normally. Large amounts, when the gastric contents are obtained with the tube and not vomited, point to chronic gastritis. Mucus is recognized from its characteristic slimy appearance when the fluid is poured from one vessel into another.