Whenever the stomach is filled partly with liquid and partly with gas it is possible to produce a splashing sound by striking the abdominal wall in the gastric region. This sound is distinctly audible at a short distance from the patient. Bouchard 2 made an extensive study of this splashing sound and considered it a sign of great diagnostic value in dilatation of the stomach. Nowadays we do not attach so much importance to the splashing sound per se. Dr. A. Rose3 and myself have recently examined a hundred cases for the existence of this symptom and found it present in many persons not troubled in any way with digestive disturbances. The importance of the splashing sound, in my opinion, is that wherever it is present or can be produced, it allows us to ascertain the position of the stomach. In dilated stomachs this sound can be produced over a very large area of the abdominal wall, extending sometimes far down to the pubes.

Another point of importance seems to me to be the ease with which the splashing sound can be repeatedly produced. In cases of gastric dilatation and when the walls of the stomach are relaxed, even light tapping of the abdomen will always give rise to this sound. In normal conditions a splashing sound can sometimes be produced by striking the abdomen with the hand, but on repeating this procedure at once we will, as a rule, fail to produce it, as the stomach then con-tracts more or less, and it is necessary to wait quite a while until it has become relaxed before this sound can be again evoked.

1 W. Pepper. "The Diagnosis and Treatment of Dilatation of the Stomach/ Medical Record, May 9th, 1896.

2Bouchard: Gaz. hebdomadaire de Medecine et de Chirurgie, 1884.

3 A. Rose: "What is the Significance of the Splashing Sound of the Stomach?" New York Medical Journal, June 15th, 1895.

On examining the patient in the fasting condition the existence of the splashing sound is of value in show-ing that the stomach is not empty and hence abnormal-This, however, is not a reliable sign and I perfectly agree with Debove and Remond1 that sometimes, although rarely, the stomach may be found empty notwithstanding a splashing sound. Moreover, the absence of this phenomenon in the fasting condition does not by any means warrant the conclusion that the organ is empty. In many instances I was able to persuade myself that the stomach contained considerable quantities of food notwithstanding the absence of the splashing sound.

1. Deglutition Sounds

The deglutition sounds were first described by Kronecker and Meltzer.2 When drinking there is at times a sound to be heard simultaneously with the act of deglutition which is termed the first deglutition sound. More frequently a second sound is noted about seven seconds after the act of deglutition. Both sounds can be heard at the ensiform process either by placing the ear at that spot or by means of a stethoscope. As a rule only the second sound is perceptible. If the first sound is present, the second sound may also appear or at times may be absent. The presence of these deglutition sounds permits us in some measure to judge about the permeability of the cardia, and their main diagnostic value consists in demonstrating their absence, for then we are entitled to presume that the ingested liquid has not reached the stomach, but has remained in the oesophagus above the cardia. This is most often the case in strictures of the cardia, although occasionally this condition might be caused by a deficiency in the peristaltic motion of the oesophagus.

1 Debove et Remond: "Traite des maladies de l'estomac," Paris.

2 S. J. Meltzer: "Schluckgerausche im Scrobiculus Cordis und ihre physiologische Bedeutung." Centralbl. f. die medicin. Wis-eensch., 1883, No. 1.