October 27th, 1892

Examination of the stomach one hour after Ewald's test breakfast: HC1 = 0; lactic acid = 0; acidity = 6; rennet = 0; biuret reaction = 0; erythrodextrin = 0; sugar + The quantity of the gastric contents is not large, and there is a very small amount of liquid. The bread particles are not minute. No mucus.

1 Max Einborn: "Achylia Gastriea Simulating Hyperchlorhydria." Jacobi Festschrift. New York, 1900.

October 30th

When fasting, stomach empty.

January 8th, 1893

Examination of the stomach one hour after Ewald's test breakfast: HC1 = 0; lactic acid = 0; acidity = 4; rennet = 0; pepsin = 0; biuret reaction = 0; erythrodextrin = 0; sugar + .

During the year 1893 several other examinations of the gastric contents were made, with the same analytical data as just mentioned.

The third group, without gastric symptoms but with intestinal disturbances, forms, according to my experience, at least one-fifth of all the cases of achylia gastrica. In this group there may be either no gastric disturbances whatever or very slight ones (as, for instance, occasionally slight pressure in the gastric region - or belching). The appetite is either normal or somewhat increased. The principal symptom in most of these cases is obstinate diarrhoea, or diarrhoea alternating with periods of constipation. Some of these cases present symptoms similar to those met with in diabetes: constant thirst, frequent micturition, extreme weakness, great loss of flesh; in some, however, these symptoms are less marked, or there may exist merely a feeling of weakness and lack of energy.

The following case is a good representative of this-group.

Solomon S------, 571/2 years of age, always enjoyed good health until August, 1892, when he had a severe attack of dysentery; he was confined to the bed for over three weeks and felt afterward extraordinarily weak. Since that time the patient has had attacks of severe diarrhoea (much mucus, sometimes blood in the passages) every two to three weeks. This diarrhoea used to alternate with constipation. From August to October, 1892, the patient lost forty pounds in weight. From that time on he felt weak and miserable and complained of thirst. This condition has since remained unchanged, and he complains at present principally of extreme weakness, of intense thirst, and of very weakening diarrhoeal attacks.

Present Condition

Color of lips and cheeks very pale, anaemic. Tongue furred with a whitish coat. Chest organs intact. The stomach extends to one finger's width below the navel. A splashing sound can be easily produced in the gastric region. There is nowhere any tumor. There are no sensitive spots discoverable in the abdomen. The knee reflex is present. The urine contains neither sugar nor albumin.

Patient was treated for some time, at first with injections into the bowel (tannic acid 2.0 to a quart of water once daily), thereafter with the administration of peptonate of iron. These means, however, failed to be of any benefit whatever; the tired feeling and weakness persisted, and the frequent attacks of diarrhoea likewise remained unchanged.