Under this heading are grouped those cases in which there is not only an increased motor (mechanical) activity of the stomach, but in which the peristaltic movements are distinctly visible.

In this condition the peristaltic action of the stomach is remarkably active. High waves can be seen moving along the stomach from left to right. The time required for one wave to pass from the extreme left to the pylorus is about one minute. This visible peristaltic action of the stomach is more pronounced when it is filled with food. In some instances the exaggerated peristalsis is felt by the patient as a slightly painful contraction. In other instances it is not perceptible to the patient. Peristaltic restlessness of the stomach is usually found in dilated stomachs with obstruction of the pylorus. Here it signifies the effort which the stomach makes to overcome the undue resistance which the contents find in passing through the stenosed pylorus. In rare instances peristaltic restlessness of the stomach may occur alone without any obstruction of the pylorus, in that case being a pure neurosis. Kussmaul has described two such cases of nervous origin. I have had the opportunity of observing eight cases of peristaltic restlessness of the stomach in stenosis of the pylorus (seven cases of cancer and one case of benignant stenosis) and only one case of nervous origin.

The latter was in a man, forty-two years old, who presented distinct symptoms of neurasthenia and complained of a moving cramplike sensation, which usually appeared soon after meals in the gastric region and lasted for half an hour or longer. On inspecting his abdomen half an hour after a light meal, small "mountainous waves" could be seen moving from left to right over the gastric region. In this case the greater curvature of the stomach extended to one finger's breadth above the navel (gastrodiaphany) and the stomach was usually found empty one and a half hours after a test breakfast.

1Kussmaul: "Die peristaltische Unruhe des Magens." Volkmann's Samml. klin. Vortrage, No. 181, 1880.

The treatment of this affection, if associated with pyloric obstruction, must be directed against the latter primary trouble. In cases of neurotic origin, our therapeutic measures will have to be directed against the nervous system. Massage, hydrotherapy, electricity (percutaneous or intragastric faradization), change of climate and surroundings will frequently prove useful. Larger doses of potassium bromide and codeine, either alone or with belladonna, are often beneficial.