Duration

The duration of raerycisra is very variable; sometimes there is rumination going on uninterruptedly during the whole of life. Often it appears in the form of attacks, periods of rumination alternating with normal periods of varying duration.

Sometimes rumination suddenly ceases at the occurrence of an important change in the life of the mery-cist. Thus a case is on record in which a person ceased to ruminate immediately after marriage. But there is also a report of another case in which rumination made its appearance a day after marriage.

These varying circumstances can only prove how deeply rumination is connected with the nervous functions.

Chemical Analysis Of The Stomach Contents

The investigations upon the chemical condition of the stomach in merycists have been made only within the most recent period.

Johannessen says briefly, in his elaborate paper on rumination, that at the end of rumination the ejected materials showed an acid reaction. Alt,1 in 1888, was the first to make exact examinations of the stomach contents in a ruminant. As soon as the patient suppressed rumination it was found that the stomach contents, obtained three to four hours after a test dinner, contained free hydrochloric acid, were rather hyperacid, and showed very retarded amylolytic qualities. But as soon as the patient had practised his rumination as usual, the stomach contents were less acid and the amylolysis was much better. Alt presumes that the rumination in his patient had the purpose of correcting the fault made by a deficient salivation of the food and the hyperacidity arising from it. "We would seem to have," he says, "in rumination a process for correcting the hyperacidity caused by a deficient salivation and the bad digestion of amylaceous matters." Acting on this theory, Alt treated his patient with alkalies, with the result that the patient was less inclined to ruminate, and further, could suppress the habit much more easily.

1G. Cantarono: Neurolog. Centralbl.. Bd. iv., 1885. 2 BourneviUe et Seglas: "Du Merycisme." Arch, de Neurologie, Paris, 1883.

In favor of Alt's theory would be perhaps the case of rumination reported by W. A. Hubbard.2 A farmer, aged thirty-five, consulted Dr. Hubbard for, as he expressed it, "the restoration of his lost cud." This patient had had the habit of ruminating his food since a period beyond his recollection, and had always enjoyed perfect health; now, for a month the rumination had stopped, and this was immediately followed by dyspeptic symptoms. All medicaments proved to be of no use. Should we look with Alt upon rumination as a means of correction, it would be very easy to understand why the patient had the dyspeptic symptoms at the cessation of the rumination, and his wish and hope that " his habit will return as suddenly as it left him," justifiable.

1 Alt Berl. klin. Wochenschr.. 1888, Nos. 26 and 27

2W. A. Hubbard. Medical Record, July 31st: 1880 p 122.

Soon afterward, however, Boas1 published a case of rumination in which the chemical analysis of the stomach contents showed the acidity to be markedly diminished. The treatment consisted in giving the patient hydrochloric acid, and the result was a diminution of the rumination and an amelioration of the glandular function of the stomach. In this way by Boas' case Alt's theory has been refuted. Shortly afterward Juergensen2 published two cases of rumination, with an absence of the free hydrochloric acid.

In considering the figures of the chemical analysis of the stomach contents of iperycists I have observed, I must say that no relationship whatever can be found between the chemical condition of the stomach contents and rumination. In some of the patients the condition of the stomach was perfectly normal in every respect; the chemical analysis showed the presence of hydrochloric acid in a normal quantity; the power of motion also proved to be adequate; Ewald's salol reaction appeared after one hour: in others the chemical analysis of the stomach contents varied greatly on different days. There was found once normal acidity (50), once rather subacidity (40), and once hyperacidity (100), whereas hydrochloric acid was always present. In some, again, there was hyperchlorhydria, while in others achylia gastrica prevailed-The conjecture of Ewald is therefore confirmed. This author, in his book on the "Diseases of the Stomach," says in reference to rumination: "I would not be astonished, the conditions being the same, if varying degrees of acidity were found in the same patient, because such changeable conditions are in the nature of many neuroses." One of my patients (K------) furnished the best example of such an occurrence, and from this we can infer that no connection exists between rumination and the chemical condition of the stomach.

1Boss: Berl klin Wochenschr., 1888, No 831.

2 Juergensen . Berl klin. Wochenschr., 1888, No. 46.

During the last nine years I have observed twenty-two cases of rumination. One of the first cases, which I described in the Medical Record,l was as follows:

March 20th, 1890: G. P------, physician, aged 27, had febris gastrica in his childhood, and in 1884 typhoid fever. Since his ninth year the patient has been troubled with his stomach; at that time, during a period of six months, he usually vomited after partaking of food, especially of fluid. Sometimes the patient had to vomit at the beginning of the meal, immediately after the soup, but could nevertheless continue to partake of his meal directly afterward. Since then his condition has become ameliorated, and instead of vomiting there appeared rumination.

The rumination in this patient appears spontaneously, about one hour after meals, and continues for about a quarter of an hour. The food comes up in small quantities (in the form of boli). The taste is not sour; in chewing the cud the patient has a pleasant sensation.

1 Max Eiuhorn: "Rumination in Man," Medical Record, l. c.

When he partakes of liquid food only (as, for instance, beer, bouillon, coffee, milk), there is no rumination.

In this patient the rumination appears periodically; thus, for instance, he ruminated three months, and then was free from the trouble for about a year.

Even during the period of rumination the bowels act regularly; the patient, however, often suffers from belching.

He is able to ruminate at will any time there is food in his stomach. The act of rumination proceeds even then without any effort. In order to effect the rumi-nation the patient closes his glottis and exerts slight pressure over the stomach by means of his abdominal muscles; the contents are then ejected in small portions into the mouth. Patient is able to do this in any posture; when he is sitting or standing, however, it is done with more ease than in a recumbent position. In the same way the patient is voluntarily able to belch and to vomit; the latter in such a way that all the stomach contents are ejected at once. The patient is thus enabled to cleanse his stomach easily; he does this by drinking a large quantity of water and ejecting it immediately after. He also has the faculty of stopping the vomiting at any moment he chooses, and in this way he can alternate vomiting with rumination. He has diplopia and is color-blind in one eye.

The father of the patient and several of his brothers and sisters are troubled with the stomach; the main symptom of their ailment is belching; nobody in the family, however, had ruminated. The patient is able to suppress rumination, not feeling any pain in doing so. He does not know what causes the periodical attacks of rumination, although he has noticed that after any excitement he is more liable to have an attack.

The physical examination shows no abnormal conditions whatever. Patient is of medium height, well developed, somewhat stout. Tongue perfectly clean. The stomach does not seem to be dilated. Seven seconds after swallowing water a rattling sound appears on auscultation at the xyphoid process.