STUDIES THE GASTRIC RESIDUUM

CHESTER C. FOWLER
1917 Journal of the American Medical Association  
Extensive studies of the gastric r e s i d u u mofn o r m a l men have been made by Ha wk and c o l l a b o r a t o r s . 1 These investigations have d e m o n s t r a t e d that the average volume is quite large (in over 100 n o r m a l c a s e s the average was 52.14 c.c.), qui t e c o n t r a r y to the views of Loeper,2 Z w e i g , 3 K e mp , 4 Wo l f f , 5 S t r a u s s , 6 Riegel,6 and Soupalt,6 who assert t hat t he q u a n t i t y of residuum in the normal f a s t i n g s t o m a c h s
more » ... g s t o m a c h s h o u l d not exceed 20 c.c. Rosin and S c h r e i b e r 6 s u g g e s t a maximum limit of 60 c.c. for the volume of the gas t r i c residuum. A variation of f r om 17 to 180 c. c. in the volumes of the various r e s i d u u m s e x a m i n e d by Hawk aaaaunimportance of the a aaaaiS aaaaaaaa diaSnosis-These findings of ky Talbot7 The resi duum is a Physiologically active secretion8 and is p r o b a b l y in part the r esul t of the act i vi t y of the gast r i c galnds8 and i n p a r tt h er e s u l tfluid which p a s s e sb y osmosis8 through the stomach walls into the are both slomach-The^that bile and trypsin one to hT'te frea.uently found in the residuum leads regtii-p-if, «• Ve tllat a Portion of it at least is due to lowed sar?"°f fluid from lhe duodenum-°SwaI" rise to a 1Va and esoP«'agea« secretions may also give elimj.' ? Portion.1" The last factor was greatly by enco '" the Work of Hawk and collaboratorsl as possinagjng tlle suIjJects to reject as much saliva not wil0 , , y expectoration. That the residuum is «•o\vler X due to saliva was clearly demonstrated by B log a Tl ' and Hawk« in the case of SubJect to the n subject, normal in every way, submitted n'°rninp SST^e°f « tu,)e on tlle CIliPty stomach in the lests sh? ,01'ty-nine c.c. of liquid were removed, and later fiW • lnat ".he stomach was empty. Two hours attend,« i Uni 1l g wn,ch time the person in question SNvall0, a ture. was free from psychic stimuli, and 106 b) p°S aliva' 29 c-c-were withdrawn (Case B Gssentinji urtbermore, these two secretions were -~~_j'1y the same in every »articular. Carlson11 has also demonstrated that a fluid is being continuously secreted into the empty stomach. The total and free acidities are subject to almost as wide variations as is the volume. The total acidity, in the cases presented by Hawk, ranged from a minimum of 2.4 c.c. of tenth-normal sodium hydroxid to titrate 100 c.c. of juice (about 0.009 per cent, acidity in terms of hydrochloric acid) to a maximum of 77.6 c.c. (about 0.28 per cent, hydrochloric acid), with a mean average of 29.9 c.c. (about O.li per cent, hydrochloric acid). The free acidity averaged 18.5 c.c. (about 0.07 per cent, hydrochloric acid), with a range from 0 c.c. (0 per cent, hydrochloric acid) to 65.8 c.c. (about 0.24 per cent, hydrochloric acid). These acidities are much smaller than those given by Carlson,12 and obtained from a subject with a gastric fistula. The acidities of the contents of the empty stomach of this subject were 0.23 per cent, hydrochloric acid and 0.18 per cent, hydrochloric acid for total and free, respectively. A definite relation between the pepsin content of the gastric residuum and total acidity has been demonstrated for low acid values, but this relation has been shown to disappear as high acid values are approached (Fowler, Rehfuss and Hawk).1 The same investigators found trypsin to be present in practically every specimen of residuum which was examined for it. Dorner13 showed the presence of trypsin in practically all of the residuums obtained from 154 patients, most of whom bad gastro-intestinal disturbances. The cases reported by Hawk and co-workers1 were nonpathologic. The occurrence of trypsin in the stomach has been more completely studied by Spencer, Meyer, Rehfuss and Hawk." The present investigation was undertaken for the purpose of determining whether or not there existed any pronounced differences between the residuums of normal men, and the residuums of normal women. METHODS The subjects of the experiments described in this paper were young women students in the courses in physiologic chemistry at Iowa State College. They willingly submitted themselves for the experimental work, and were requested to drink no water at any time after their evening meal on the night previous to the experiment. They came for the removal of the residuum at 8 o'clock the following morning, and every residuum was removed as near that time as was compatible with the experiment. Each woman was given a thorough examination, physically and by questioning, to detect any abnormalities if they existed. The residuums were removed by means of a modified stomach tube described by Rehfuss.14 The swallowing of the tube was accomplished without the aid of water. The tube and tip were first coated with a thin film of petrolatum, and then the tip was placed in the lower part of the pharynx, back of the tongue, and swallowed without much difficulty. When the tube had reached the stomach (which was ascertained by measurements), the contents were aspirated from it while the subject was reclining on her back, stomach and on each side and breathing deeply. The liquid was immediately measured, placed in an Erlenmeyer flask, and its characteristics noted. The residuum From t h e L a b o r a t o r yofP h y s i o l o g i c a lC h e m i s t r y ,I o w aS t a t e College. Because of lack of space, this article is abbrevi at ed in The Journal by omi ssi on of a table of tests of the normal gastric resi duum of women. The compl et e article appears in the repri nts, a copy of which will be sent by the authors on request. aa aaaa a aaa aaa aaaaa aaaapaars in the reprints, a copy oawhich aayaaon aaaaaa 1. Rehfuss, M. E.; Bergeim, Olaf, a n dH a w k ,P.B. :G a s t r o -I n t e s t i n a l Studies,
doi:10.1001/jama.1917.04270010167003 fatcat:msanjrzhbvcatn3ej7tm3csn2e