Achylia Gastrica, Combined With Rumination

August R------, 52 years of age, carpenter, was always well and had not consulted a physician for the last twenty years. Suffered in his boyhood from frequent headaches, cramps in the abdomen, and diarrhoea until his twentieth year. The patient attributes the griping pains in his abdomen at that time to the circumstance of growing up under poor and miserable surroundings; as a rule he had very little to eat; from time to time, however, he worked in the country with the peasants, where he had plenty of good things to eat, and here he used to overload his stomach.

As a boy the patient partook of hardly any meat from his fifth to his fourteenth year of age; his main nourishment consisted of potatoes, flour-soup, bread, and water - soup only now and then; of meats he partook only when occasionally visiting his relatives. He did not like buttermilk or coffee.

As long as the patient can recollect he often brought up the food from the stomach into the mouth about half an hour after the meal, chewing it and swallowing it again. When eating cherries he was in the habit of swallowing the pits also, and afterward, when bringing them up from the stomach into the mouth, he used to spit them out.

This bringing up of the food the patient did mainly when feeling well. He enjoyed chewing the second time as much as when first masticating the food. Often the food would come up in morsels, although the patient had not been thinking of it at all. He hardly ever vomited, except when he got drunk - which happened twice during his life - and when crossing the ocean on a trip to Germany. He eats hastily, and the hard substances he chews well afterwards when they come up from the stomach.

The patient can ruminate any time he chooses, except when the stomach contains but very little or is almost empty. In ruminating he takes care to conceal the act from others; he speaks to no one about it, and even his wife is not aware of his habit.

Present Condition

Strongly built man of short stature, is well nourished, with good panniculus adi-posus; chest organs intact; stomach dilated; the lower margin extending to one finger's width above the navel. He has no complaints whatever, enjoys a good appetite, his bowels are regular, and he feels well in every respect. The only thing which strikes him as being abnormal, and for which he was treated for some time in Germany and afterward came to see me, is his coated tongue.

October 27th

One hour after the test breakfast: Patient spontaneously brings up a small quantity of the contents of his stomach (about 20 c.c). With the tube likewise only a small quantity can be obtained.

The roll particles are not minutely minced and almost unchanged. HC1 = 0; acidity = 2; rennet = 0; pro-peptone = 0; peptone = 0; erythrodextrin = 0.

Meltzer's swallowing sounds: Patient drinks water; at the first swallow a sound is heard immediately at the xyphoid process (Durchspritzgerdusch); at the second swallow (one to two minutes later) a sound is heard about eight seconds afterward (Durchpress-gerdusch); at the third swallow the Durchspritzge-rausch is heard immediately; and ten seconds later the Durchpressgerdusch.

I had the opportunity of examining the patient for three months, and always found the stomach contents in the above-described condition, with the same result of chemical analysis.

The history of this case seems to indicate that the abnormal condition of the stomach developed in his early youth; for only at that time the patient had complaints, whereas later on he had no disease whatever. This would show clearly that achylia gastrica may exist forty years without endangering the vital functions of the organism.

The second group, namely, of those presenting gastric symptoms, comprises the greater number of cases. The symptoms consist of loss of appetite, of a sensation of fulness or pain in the epigastric and gastric regions, and of vomiting. Occasionally only one of these symptoms may be present, while in some cases the symptoms mentioned may appear alternately.

Headaches are frequently met with, and constipation of a mild character is also more or less the rule.

In some instances the symptoms are almost identical with those encountered in hyperchlorhydria:1 pains one to two hours after meals, being relieved by the ingestion of food or drink.

The following may be considered as a typical case of this group:

Mrs. G------, aged about 45, has complained of her stomach for the last twelve years. She is almost always troubled after meals with pains in the gastric and epigastric regions. Appetite poor. Bowels inclined to be constipated. Vomiting appears very seldom. Patient had lost considerably in weight during the first years of her ailment; thereafter her weight remained stationary. In 1891 she visited Carlsbad, but her condition did not improve any.

Present Condition

Patient of small stature and quite thin. Panniculus adiposus somewhat thin. Lips and cheeks of a pale color. Tongue not coated. Chest organs normal. Palpation of the abdomen reveals the absence of any tumor. The epigastric region is sensitive on pressure, but not exactly painful. A splashing sound can be produced to about three fingers' width below the navel. The urine does not contain either sugar or albumin.