Examinations Of The Stomach

1. During the rumination period, September 15th, 1888. One hour after Ewald's test breakfast: HC1 +; acidity = 50; erythrodextrin +; achroodextrin +• On the same day the patient took 1.0 gm. salol in a gelatin capsule; the urine showed the salicyluric acid reaction (it became dark red on addition of a few drops of liquor ferri sesquichloridi) after one hour.

2. During an interval of freedom from rumination, March 25th, 1890. One hour after test breakfast: HC1 +; acidity = 54; erythrodextrin +; achroodextrin +. After this examination the patient had an attack of rumination for three days, then it ceased.

Treatment

Formerly hydrochloric acid, alkalies, narcotics, and bitters were tried empirically now and then, with apparent results for a short time, and sometimes without any influence whatever. Lately the attempt has been made to remedy the error - if any - ascertained after a chemical examination of the stomach contents, and hydrochloric acid or alkalies have accordingly been given, with good results.

Koerner tried giving small pieces of ice immediately after meals, and warmly recommends this method. Washing out of the stomach has been practised by Johannessen, and gavage (feeding through the stomach tube) during fourteen days by Juergensen. but with only temporary relief. All these remedies sometimes effect a temporary amelioration; a permanent cure, however, has never been achieved by therapeutic means. As an exception to this rule we might perhaps consider the moral treatment - i.e., the patient determines not to ruminate and, as soon as a desire to ruminate appears, endeavors to suppress it. Ponsgen1 mentions two cases of merycism perfectly cured by this method.

This moral treatment can of course be applied more easily in cases in which the rumination can be suppressed by the will power of the patient, although even in those in which the rumination is wholly independent of the will it can also be effected.

In treating Dr. G. P., I made use of this method; he was instructed, as soon as he felt any inclination to ruminate, to try with all his power to suppress it. The patient has carried out this rule quite conscientiously, and the merycism has since that time occurred only occasionally. In the treatment of several other cases I have applied the same method with the best result.