THE NORMAL GASTRIC SECRETION. 



By martin E. REHFUSS, M.D. 



(Read April 14, 19 16.) 



The human gastric secretion has been the subject of persistent 

 study ever since it was reaHzed that there was apparently secreted a 

 free mineral acid in the stomach. Not only has this fact, the presence 

 of a true acid secretion, given rise to endless discussion, but the 

 mechanism of gastric digestion has been attacked from every angle. 

 The x-ray and especially the fluoroscope has thrown much light on 

 gastric movements but has left us hopelessly in the dark as to the 

 intimate chemistry and the respective physico-chemical changes which 

 occur while the kaleidoscopic changes in form are recorded. It has 

 until very recently been practically impossible to investigate either 

 normal or pathological digestion satisfactorily in man. The funda- 

 mental principles were laid down by the painstaking work on fistulas 

 on animals by the Pavlov school and a host of investigators who 

 recorded many observations in man by means of the old stomach 

 tube. With the exception of a few fistula cases such as the historic 

 instance of Alexis St. Martin and the occasional case of gastric 

 fistula consequent to an acquired stenosis of the esophagus there are 

 no coordinated observations on normal digestion in man. This was 

 owing to the lack of a method by which it was possible to follow 

 every phase of gastric digestion. In spite of the lack of a method, 

 the use of the bulky and wholly undesirable stomach tube was fol- 

 lowed and many observations were made. 



In the fall of 1913, while studying the work of Hayen, I en- 

 deavored to find a tube which could be introduced into the stomach 

 and left in place. The original tube was a modification of the Ein- 

 horn tube, but it was neither sufficiently heavy nor of sufficient 

 calibre for this purpose. I then devised a special tip olivary in type 

 and of such a form as to be easily swallowed and of sufficient weight 

 to seek the bottom of the stomach, or the most dependant portion of 



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