Regurgitation denotes a condition in which either liquids or liquids mixed with solid food particles are ejected in small portions from the stomach into the mouth. These contents are, as a rule, spit out; occasionally, however, they are again swallowed. It is generally believed that a relaxation of the cardia is the cause of the trouble. In most instances regurgitation takes place involuntarily, in some, however, the patient is able to produce it at will. In nervous regurgitation the ejected matter does not show any abnormal condition (and does not smell or taste bad). This is different if regurgitation is the result of an organic affection of the stomach. Regurgitation, as a rule, appears soon after meals, and this process may repeat itself quite a number of times in a short period. In most instances this affection does not lead to any serious conditions. Sometimes, however, if regurgitation is very obstinate and large portions of chyme are constantly ejected, serious complications may result from inanition.

The following case, which I have observed, is interesting with regard to this point.

A boy, 8 years of age, had been suffering, as his mother stated, from obstinate vomiting for about three years. The little patient looked extremely pale and emaciated. He had cold extremities, became dizzy quite frequently, especially on rising, and felt very weak, so that a walk of two blocks tired him out. On further inquiry the mother stated that the boy did not vomit a large quantity at once, but brought up small portions of food from the stomach which he spat out. This occurred fifteen to twenty or even more times after each meal. Physical examination of the chest revealed nothing abnormal. The abdomen was slightly bloated: the splashing sound could be produced in the gastric region, extending to two lingers' width below the navel. On palpation no painful spots could be discovered. The patient took a small meal and was observed half an hour afterward. Regurgitation took place while he was in my office. The ejected chyme revealed on examination the presence of free hydrochloric acid in normal amounts. The case was diagnosed as nervous regurgitation, and the extreme degree of anaemia and malnutrition referred to insufficient nutrition on account of the great amount of chyme which was constantly ejected from the stomach and in this way lost to the organism.

The little patient was given no medicine, but was told never to spit out the food which came up into his mouth, but rather to swallow it. The mother was told to keep constant watch over the boy, in order to have this rule strictly observed. In about three months the patient began to grow stronger and gained in weight, so that after this time he could hardly be considered sick. Moreover, regurgitation now appeared quite seldom and was then repeated only once or twice.

Etiology

Regurgitation may develop either in consequence of great mental worry or nervous strain or as a sequel of an acute gastric catarrh.

The prognosis is almost always good.

Treatment

This consists in the application of the faradic current intraventricularlv and in the adminis-tration of strychnine. In conjunction with these remedies, the patient must be told to suppress regurgitation whenever possible. At first he will often fail to do so, but after a while he will be able to suppress it, and still later the tendency to regurgitation will entirely disappear. In cases in which regurgitation is of frequent occurrence and obstinate, and nutrition begins to be insufficient, it is of the greatest importance to forbid the patient to spit out the ejected food and to tell him to swallow it again. This treatment may occasionally artificially produce the condition which will now be described.