Incontinence of the pylorus was first described by L. de Sere 1 and later by Ebstein.2 The pylorus may be incompetent, first, when unyielding neoplasms involve this portion of the stomach; secondly, when the pyloric sphincter is in an atonic condition, i.e., when the pylorus is apparently always open by reason of some nervous derangement. Ebstein diagnoses an incontinence of the pylorus if on inflating the stomach with air the latter rapidly passes into the intestines, so that it becomes impossible to fill the organ with gas. Instead of the stomach, the small intestine then becomes filled with air and gives tympanitic sounds on percussion. Ewald justly doubts the accuracy of this diagnostic means. He has, indeed, never observed this symptom. In all the cases in which he had distended the stomach to its utmost extent with air, he could never demonstrate that the air passed into the intestine. Whenever the tension became too great, the air always escaped upward through the cardia with eructation. My own experience coincides with that of Ewald. Incontinence, or rather relaxation of the pylorus, is a rare condition, and we are able to recognize it, not so much by the fact that food and gas pass from the stomach into the duodenum more rapidly than normally, as by the regurgitation of intestinal contents into the stomach.

The presence of the latter condition is shown by the fact that on washing out the stomach in the fasting condition, more or less large quantities of intestinal juice and especially of bile almost always appear. While the occasional regurgitation of intestinal secretion into the stomach may occur as a consequence of irritation caused by the tube when lavage is applied, still the quantity of the intestinal juice is always small. In incontinence of the pylorus, the quantity of regurgitated intestinal juice and bile is considerable and always present in the fasting condition at each washing of the stomach, and sometimes also if the contents of the organ are withdrawn one hour after the test breakfast or three to four hours after a test dinner. Whether the condition in which the stomach becomes empty more rapidly than normally is to be referred to a relaxation of the pylorus, or to an increased motor function (hyperprochoresis) of the organ, is still undecided. In most instances, however, it seems to me that the latter factor is the more probable. I have observed two cases of relaxation of the pylorus, and both have been treated by intragastric faradization with good results.

Occasionally relaxation of the pylorus is combined with relaxation of the cardia, as the following case well illustrates:

1L. de Sere: "Du Relachement du Pylore." Gaz. des hop., 1864 No. 63.

2Ebstein: Deutsch. Arch. f. klin. Medicin, Bd. 26, p. 295.

Miss Emma M------, 24 years of age, suffering for three years from loss of appetite, eructation, constipation, and poor sleep; there was no vomiting but belching of acid fluid after meals. One of the worst complaints of the patient was of this highly annoying ructus, which never left her, and in consequence of which she was hampered in her occupation and frequently kept away from society.

Present Condition

Tongue thickly coaled; splashing sound from the stomach to a point two fingers' breadth below the navel; the right kidney is clearly palpable and easily moved. Examination of the stomach in the fasting condition by means of a tube shows that there is bile mixed with gastric juice in the stomach; also after the test breakfast the contents of the stomach were usually found mixed with bile, as will be seen from the following memorandum:

One hour after the test breakfast: HC1 +; acidity = 68; admixture of bile.

When fasting, the stomach contains 70 c.c. of an intensely yellow-colored fluid (bile present); HC1 +.

The treatment consisted in direct gastro-faradiza-tion and once in a while washing of the stomach. During the month of April the faradization was applied every other day, and the lavage of the stomach once a week in the fasting condition. The patient felt better after a few days' treatment; the eructation disappeared almost entirely, and she could eat with good appetite, having no distress afterward.

Subsequently the faradization was applied once a week and then discontinued. The patient gained several pounds during the treatment, and has been pretty free from complaints since that time.