Gastric Secretion in Infants and Children.

A simple, rapid and satisfactory method of investigating the gastric secretion in infants and children is of undoubted value in their clinical investigation. The difficulties experienced by the use of the ordinary methods in children necessitates a new approach. With the usual method of passing a gastric tube followed by a test meal, the psychical and physical disturbances which ensue must have an adverse effect upon the functions in question. The swallowing of considerable amounts of saliva and mucus introduces difficulties. The gastric fluid removed after a test meal consists of an intimate mixture in which there is no pure gastric juice. The juice has undergone considerable change, such as dilution, buffering and partial neutralization. The variations in the type of meal used, both qualitatively and quantitatively, the frequency of vomiting during the test, and the length of time usually required for its completion all tend to lessen the value of the method. Our aim therefore has been to elaborate a technique which eliminates swallowing a meal and at the same time causes no disturbance to the child. In order to dispense with the neutralizing and buffering effects of the milk meal, a dilute aqueous solution of ethyl alcohol has been used, following the suggestion of Chesney'. In all the experiments used for this investigation, the conditions were kept as constant as possible. The collections were made in the morning after a night's fasting, except in the case of infants where there was an interval of about six hours. A special tube was devised, consisting of a smail narrow perforated light metal tip connected to very narrow rubber tubing, the width allowing the tube to be passed easily through the nose of even.the smallest child. The nasal route has several particular advantages, causing much less general disturbance, no vomiting, and no increased salivation, because the soft rubber does not irritate the tongue or pharyngeal wall, and also allows the child to breathe easily and eliminates damage to the tube by the teeth. The metal tip aids in guiding the tube into the cesophagus and provides a means of moving the aspirating end around in the stomach in order to obtain all the fluid therein. The resting juice is completely aspirated with a syringe; 20 to 40 c.cm. of neutral 7 per cent. ethyl alcohol in distilled water at body temperature is introduced slowly into the stomach through the tube. The …