REHFUSS— THE NORMAL GASTRIC SECRETION. 465 



Some time ago Dr. Hawk and I published a paper on the direct 

 evidence of the secretion of a gastric juice of constant acid concentra- 

 tion in the human subject. We have been criticized for considering 

 the " digestive " plateau while food w^as in the stomach as evidence 

 of this. On the contrary however — the evidence when there is no 

 food in the stomach namely the " plateau " or " constant acid level " 

 seen in certain cases after water introduction, presumably after all 

 water has left the stomach or when the diluting action of water can 

 be no longer felt and again the " constant acid secretion " — frequently 

 seen after all food has left the stomach are the most powerful argu- 

 ments for the secretion of a constant acid grade. 



Normal Secretory Curve. 



For the investigation of gastric disturbances it becomes absolutely 

 essential that we have a standard, any deviation from which con- 

 stitutes a pathological finding. Such an arbitrary and concrete 

 standard is obviously impossible because in every individual there is 

 a characteristic functional output. It is possible to draw the limits 

 of health for any group of individuals, but practically every group 

 of bodily functions undergoes many variations owing to a multitude 

 of variable factors in the course of the day. Under exact conditions 

 the output is the same, but exact conditions are somewhat difficult to 

 approximate. From a very large series of observations on normal 

 healthy medical students, the following statements seem entirely 

 justifiable : 



(c) Each individual has a characteristic gastric response. 



(b) Under identical conditions, physical and environmental, the 

 type and character of the gastric response to a certain stimulus is 

 essentially the same. 



(c) There are several varieties of normal secretory response, 

 normal in that they are found in individuals absolutely free from 

 gastrointestinal symptoms and to all intents and purposes enjoying 

 perfect health. 



We have tried various meals but for simplicity, availability and 

 short gastric transit we have studied the Ewald meal 35 grams of 

 toast and 240 c.c. of weak tea or water in an attempt to outline the 

 normal gastric response. 



