The bacterial flora of gastric lavages from patients undergoing partial gastrectomy.

Several investigations have been made into the bacterial content of the stomach and small intestine in health and disease. Cregan and Hayward (1953) investigated the bacterial content of the healthy human small intestine by aspiration through the gut wall, and, on the few occasions when growth was present, found only transient flora, mainly mouth species. Anderson and Langford (1958) confirmed these findings, and found no resident flora in cases of coeliac disease and fibrocystic disease of the pancreas. Howie, Duncan, and Mackie (1953) cultured stomach washings for C1. welchii after partial gastrectomy in view of the similarity between the clinical symptoms of post-gastrectomy diarrhoea and of the gastro-enteritis caused by foodpoisoning with heat-resistant Cl. welchii, type A (Hobbs, Smith, Oakley, Warrack, and Cruickshank, 1953; Oakley and Warrack, 1953). They found numerous Cl. welchii in stomach washings from 12 of 15 patients examined within a week after partial gastrectomy. In eight of the 15 patients, small amounts of Cl. welchii a toxin were also demonstrated in the same specimens. Duncan, Goudie, Mackie, and Howie (1954) took specimens of jejunal contents by MillerAbbott tube from eight patients with anaemia or failure to gain weight after partial gastrectomy. They could find no evidence of bacterial colonization in the jejunum of such patients. They also found heavy growths of Cl. welchii, type A, in the stools of five patients with post-gastrectomy diarrhoea and in a case of acute obstruction of the small intestine. Diarrhoea caused by Cl. welchii as a result of food poisoning (McNicol and McKillop, 1958) does not come within the scope of this paper. The present experiment was based on a series of 60 partial gastrectomies performed by Mr. T. G. E. Loosemore. Specimens were collected from the indwelling Ryle's tube pre-operatively and for a period of 24 to 30 hours after operation. Of the 60 operations, 51 were performed on waiting-list cases for chronic gastric ulcer and duodenal ulcer, six were emergency operations for perforated ulcers, two were emergency operations for haematemesis and melaena, and one radical partial gastrectomy was performed on a case of suspected gastric ulcer, where a small prepyloric carcinoma was found. All patients were given a prophylactic course of " distavone "* (combined penicillin and dihydrostreptomycin) post-operatively.