By W. B. Cannon, M.D. Front the Laboratory of Physiology in the Harvard Medical School Extracts from American Journal of Physiology; 1898

Since the stomach gives no obvious external sign of its workings, investigators of gastric movements have hitherto been obliged to confine their studies to pathological subjects or to animals subjected to serious operative interference. Observations made under these necessarily abnormal conditions have yielded a literature which is full of conflicting statements and uncertain results. The only sure conclusion to be drawn from this material is that when the stomach receives food obscure peristaltic contractions are set going, which in some way churn the food to a liquid chyme and force it into the intestines. How imperfectly this describes the real workings of the stomach will appear from the following account of the actions of the organ studied by a new method. The mixing of a small quantity of subnitrate of bismuth with the food allows not only the contractions of the gastric wall, but also the movements of the gastric contents to be seen with the Rontgen rays in the uninjured animal during normal digestion.

An unsuspected nicety of mechanical action and a surprising sensitiveness to nervous conditions have thereby been disclosed.

Introductory Literature

The early writings on the subject of gastric movements are characterised by general inferences from physical laws and from the anatomical structure of the stomach. According to Galen the stomach had four functions: to draw the food from the mouth {facultas attractrix), to retain the food {facultas retentrix) during the process of chemical digestion {facultas alteratrix), and, finally, to pass the changed material onward {facultas expulirix). In later writings the facultas attractrix failed to appear as one of the functions of the stomach. Fallo-pius, in the sixteenth century, changed the notion of the facultas retentrix by suggesting that the pylorus alone performed this office, and that the muscles of the gastric wall could help only by remaining quiet. Thus the facultas alteratrix and the facultas expultrix are left as true gastric functions. It is with the latter activity and its effects that this paper is concerned.

The ideas of the early writers concerning the pylorus and cardia are of interest. The cardia, they were agreed, is closed during normal digestion in order to keep the food from re-entering the oesophagus. The pylorus they looked upon as the ruler of the actions of the stomach. Such names as pylorus (keeper of the gate), janitor justus, and rector, which the first investigators gave to the sphincter, indicate their theories of its functions. The passage of chyme into the duodenum, the keeping of undigested food in the stomach, the act of vomiting, were all dependent, they believed, on the "will" of the pylorus.

No substantial advance was made beyond these hypotheses until the beginning of the eighteenth century, when Wepfer and Schwartz applied the experimental method to the study of the gastric movements and laid the foundation of a more accurate knowledge. Wepfer vivisected wolves, dogs, and cats, and observed constrictions following stimulation of the stomach. He remarked a general contraction of the pyloric part in vomiting and noted peristaltic and antiperistaltic movements passing over the organ. About the middle of the stomach he frequently saw a deep constriction. The investigations of Schwartz are more valuable in that his search was for the normal action of the muscular coats. The movements, as he observed them, were generally only slight. They began either at the pylorus and passed to the left, half-way to the cardia, or started at the fundus and went to the pylorus. The contractions and relaxations, following one another, formed larger or smaller depressions and elevations, i. e. more or less definite waves.

Near the middle of the last century Haller, after confirming the results obtained by Schwartz and Wepfer, summarised his knowledge of the motor functions of the stomach as follows. In general, contraction alternates with relaxation, so that the stomach is, now here, now there, made narrower by longitudinal or transverse depressions; then in these same places relaxation and bulging occur. So long as both apertures are closed the food is driven hither and thither by the shifting movements. It first takes a definite direction when the cardia or the pylorus opens. If the cardia opens, there is an antiperistalsis followed by regurgitation and vomiting. If, on the contrary, the pylorus relaxes, a contraction, starting at the oesophagus, pushes the contents of the stomach into the duodenum. The pylorus allows the passage of fluids, but if it be stimulated by over distention or by hard pieces of food, it closes tightly.

Such was the knowledge of gastric movements in Haller's time. A comparison of his descriptions with those in any standard work on physiology published ten or fifteen years ago will show that, despite very many researches, little advance had been made. Examinations of animals and men with gastric fistulas, studies of the stomach through the atrophied abdominal wall, and vivisection have yielded numerous results; but these have not been harmonious, and have led to much controversy. Prominent in this mass of material as a valuable contribution are Beaumont's careful observations through the gastric fistula of Alexis St. Martin. Beaumont's work has recently been confirmed by Hofmeister and Schiitz, who, with Rossbach, Hirsch, Open-chowski, and others, have presented during the last twelve years much new and interesting information. Since, however, it will conduce to clearness to set forth the results of these investigations in connection with my own work, their consideration will be deferred until later.

It will then appear that these later investigations, like the earlier researches, disagree as to the details of the stomach movements. Such differences in results are the proper outcome of the abnormal conditions under which the studies have been conducted. Obviously, in order to see the natural movements of the stomach, the organ should be observed in its natural state, and not after it has been disturbed by removal from the abdomen, or by the adhesions and losses of substance incident to gastric fistulas.

As a means of watching the gastric motor activities under normal circumstances, Dr. H. P. Bowditch, in the autumn of 1896, suggested the use of the Rontgen rays. The present paper is the result of the work thus far completed. The kind assistance and stimulating counsel of Dr. Bowditch throughout the investigation are gratefully acknowledged.