When are examinations of the gastric contents necessary and when not? On the whole, I would say that they may be omitted whenever we are able to arrive at a positive diagnosis without them, and in all acute conditions, the latter generally tending to amelioration in a short while. They are further not absolutely necessary in chronic conditions which are apparently improving under the established regimen and in the majority of purely nervous affections of the stomach. In cases in which there is suspicion of an ulcer, the tube should be used with utmost care, and, if possible, should be replaced by the stomach bucket. In cases of ulcer with hemorrhage it is best to forego either the tube or the bucket. Cases with symptoms pointing to a certain secretory disorder (as, for instance, hyperchlorhydria, gastro-succorrhoea continua periodica or chronica) may first be treated without a verifying examination of the gastric contents; but if this treatment prove unsuccessful, an examination of the gastric contents should be made.

The large field in which these examinations of the gastric contents are necessary comprises all chronic affections of the stomach, with doubtful diagnosis, that show but slight evidences of improvement. The examination may help us to recognize the following conditions:

1. Chronic gastric catarrh: Acidity diminished, the ferments present, free hydrochloric acid variable; mucus present in a large number of cases.

2. Achylia gastrica: total absence of gastric juice, no hydrochloric acid, no ferments, total acidity very low, almost neutral.

3. Cancer of the stomach: In many instances incipient cancer of the stomach may be recognized by the constant presence of the following symptoms: free hydrochloric acid absent; lactic acid present; acidity not especially low, sometimes increased; mucus; sometimes small amounts of blackish-looking blood, and stagnant food.

4. Hyperchlorhydria: free hydrochloric acid present; acidity between 70 and 140.

5. Gastro-succorrhoea continua chronica: presence of about 60 to 100 c.c. of clear gastric juice in the stomach in the fasting condition.

6. Erosions of the stomach: presence of a few small pieces of the gastric mucosa in the wash-water of the stomach in the fasting condition.

7. Ischochymia: presence of food in the stomach in the fasting condition.

Often the examination of the vomited matter may do away with the need of obtaining the gastric contents by artificial means. It is, however, readily understood that the vomited matter may occasionally fail to furnish exact data in regard to the condition of the gastric secretion, as it is mixed with mucus from the oesophageal walls and the mouth.

While the results of examinations of the stomach contents are useful in aiding to establish the diagnosis in gastric disorders, it is hardly necessary to say that we should not rely upon them alone. We must always combine all the data concerning any given case at hand before arriving at a conclusion. It is only in this way that these examinations will be of great service to us in helping us to establish a more positive diagnosis and in thus facilitating the treatment.