Synonyms

Merycism, "chewing the cud." By rumination is designated a condition in which the food returns, without nausea, in small portions, from the stomach through the oesophagus into the mouth, some time after meals; here it is chewed anew and swallowed.

Etiology

If we are not inclined to accept as the cause of rumination an anatomical alteration in the upper digestive tract - a hypothesis not demonstrated or even rendered probable - two explanations still present themselves, namely, heredity and self-acquisition. But as hereditv has been met with in only very few cases of rumination, and thus cannot be taken for the main cause of the affection, it appears of importance to lay most stress on self-acquisition. This may arise, firstly, from imitation; secondly, from necessity and custom (adaptation).

1 The history and literature of this affection can he found in my paper: "Rumination in Man," Medhal Record. May 17th, 1890.

As the best example of imitation Koerner's1 case may be cited, where a ruminating governess imparted her own affection to her two pupils; after the governess had been sent away, the two children quickly got rid of their rumination.

In many cases of rumination the patients first, before the beginning of the trouble, had for some time suffered from dyspeptic symptoms with regurgitations; thereafter they commenced to swallow what came up by regurgitation, and, finally, were aware of ruminating. In these cases the development of rumination from slight pathological conditions, by necessity and custom, can be plainly seen.

Most of the reported cases of rumination (in all the literature, to date, but one hundred and six cases have been described) are of the male sex, and belong chiefly to the professional and more educated classes (physicians, philologists, and lawyers); of the female sex only a few cases are reported as ruminants (in all nine cases, figured from the paper of Johannessen).2

This alone would not prove that rumination, in fact,, appears less frequently in men of the lower class and in the female sex; for very often a man of the work-ing class does not deem his condition as a ruminant to be abnormal, and does not make mention of it to his physician. On the other hand, there are several people (especially among women) who would like to conceal their affection, and therefore do not speak about it. In consequence thereof, the correct relation of rumination, in reference to its distribution among the two sexes and the different social classes, cannot be ascertained from the cases reported in literature.

1 Koerner: Deutsch. Arch. f. klin. Mediein, Bd. xxxiii., p 554 2Johannessen: Zeitschr. f. klin. Medicin, Bd. x., p. 274.

Among the insane and idiots rumination has been found quite frequently. Thus G. Cantarono1 found nine cases of rumination among four hundred male insane; but among three hundred female insane he found no ruminants. Bourneville and Seglas2 likewise lay stress on the frequency of rumination in idiots, and also in epileptics.