462 REHFUSS— THE NORMAL GASTRIC SECRETION. 



the greater curvature of the stomach by gravity. A number of tips 

 were made, but finally one was found which was the most satis- 

 factory — and it was slotted in such a way that the diameter of the 

 slots represented the maximum bore of the rubber tubing. This in 

 turn was glass molded in order that it gave rise to no irritation 

 while in situ. This tube was swallowed in the natural way : it gives 

 rise to practically no irritation and I was able to satisfy myself by 

 radioscopic examination that it reaches the lower part of the stomach. 

 Another important feature was the fact that this tube could be left 

 in place for hours with practically no discomfort and that it con- 

 stituted practically a " via ouvert " or a direct communication to the 

 stomach at all times so that the progress of digestion could be ac- 

 curately followed and the examination of the material removed faith- 

 fully recorded. For the first time it was possible to follow every 

 step in the chemical evolution of digestion and at the Jefferson 

 Medical College, under the supervision of Dr. Hawk and with the 

 collaboration of Drs. Bergeim, Fowler, Spencer, Clarke and others, 

 we began an extensive survey of normal and pathological digestion. 

 Before discussing the important findings regarding gastric diges- 

 tion, the first salient feature which became apparent was the im- 

 possibility of interpreting the findings of a single examination of the 

 stomach as determined by the old method. In a communication to 

 the Journal of the American Medical Association, Vol. LXIV., pp. 

 567-573 — I made the following statement which has been since con- 

 firmed by other workers (Carroll, Pollock, Talbot) : 



1. It is impossible to interpret the figures obtained by the ex- 

 amination of the test meal removed in one hour time by the usual 

 technic. 



2. The one hour period represents but one phase in the con- 

 stantly changing cycle of gastric digestion. 



3. It is absolutely impossible to judge from the old method what 

 has preceded or what will follow this point. 



We were able to show for instance that normal figures at the one 

 hour point may be preceded or followed by entirely different phe- 

 nomena in the brief course of 10 or 15 minutes and that for an 

 accurate analysis of the phenomena, it is essential that we make an 

 examination at every interval during digestion. This method of 



