(A) Physiological

I have made several tests with the gastrograph on healthy people.

The experiments show that the stomach is not so inactive mechanically as several authors believed, and that it churns the contents almost contin-ously with slight periodical interruptions. The number of motions for three minutes averaged from four to forty-one.

When fasting, the mechanical action of the stomach seems to be much less than after meals.

(B) Pathological

Most patients have been examined with the gastrograph either when fasting or from an hour to an hour and a half after the test breakfast, taking about half a glassful of water when swallowing the ball; many of the patients have been examined under both conditions on different days. Some of them have been subjected to a very great number of tests, in order to ascertain whether there is a certain constancy in the results. The whole number of patients examined was twenty-seven, the number of tests sixty-four.

In perusing the gastrograms obtained from my patients and comparing them with those obtained from healthy people, there are three different classes among them. One corresponds to the normal; the second class is marked with too much mechanical action, the number of dots being greatly increased; the third class shows a remarkable slowness and sluggishness of the mechanical function, the number of dots being reduced to 4, 3, or 0.

Fig. 39-Three Gastograms Obtained tram Patients H. R, Dr, A. R and Edw. C. A.

Hemmeter-Moritz's Method

As the gastrograph does not permit of a distinction between the active and passive motions of the stomach, Dr. J. C. Hemmeter,1 of Baltimore, has recently devised another method for testing the gastric peristalsis. The essential part of the apparatus is a deglutible elastic stomach-shaped bag of very thin rubber and attached to an oesophageal tube. The stomach-shaped pouch has the shape of the stomach only when it is blown up. It does not occupy much space when it is collapsed and can be introduced without difficulty into the stomach of patients. The oesophageal tube maybe very small, not quite half the size of the ordinary tube used in lavage. When the bag has reached the stomach, which can be determined by a mark previously made on the tube, it is filled with air and connected either with a water manometer or tambour on the Ludwig kymograph. The slightest contraction of the involuntary fibres of the gastric muscle layer will compress the very elastic intragastric bag and distend the tambour, to which a glass bulb ink pen is attached, recording the gastric peristalsis as the clockwork moves the paper along.

On the upper margin of the kymographion paper a record pen connected with a chronometer indicates seconds on the record by small dots, so that it is possible to determine the time of occurrence and duration of the gastric peristalsis. As the stomach perceptibly moves with every inspiration and expiration, a pneumograph is tied around the patient's waist recording every respiratory movement on the kymograph. It will be seen on the tracing that many movements of the pen connected with the intragastric bag are passive and caused by the act of respiration, but there are other very high and long excursions of the gastric pen which are independent of the movement of the pneumographic pen, or occur when respiration is suspended for a short while. These are the muscular contractions proper of the stomach. The same method has been independently used and described by Moritz, of Munich.

1 J. C. Hemmeter: New York Medical Journal. June 22d, 1895.

In his paper Hemmeter says: "In making studies on the kymograph on the gastric motility, only such patients are taken as have become accustomed to the stomach tube, as the nausea and vomiting first attending the initial introduction of the tube make an exact record impossible".

This sentence shows that this apparatus cannot be applied without difficulty and for this reason appears unsuitable for practical purposes. Although the gas-trograph does not permit a distinction between the active and passive movements, it affords, nevertheless, an accurate idea as to the mechanical action as such, for the passive movements certainly also participate in this function of the stomach and should not be ignored. In this way I think that the gastrograph method, not being so complicated and being easily performed, presents many advantages over Hemmeter's apparatus.