466 REHFUSS— THE NORMAL GASTRIC SECRETION. 



We found that healthy medical students reacted to the Ewald 

 meal in one of three ways : 



1. The " isosecretory " type shows a steady rise, high point, in 

 terms of tenth-normal sodium hydroxid, 60, usually sustained for 

 from half an hour to an hour, and then a gradual decline with a 

 total disappearance of the food residues in from two to two and one 

 half hours. 



The curve is usually steady and unbroken ; its high point is 

 usually rounded and not abrupt and is to be found in the neighbor- 

 hood of one hour. 



2. The " hypersecretory " type shows a rapid response to stimuli, 

 often a marked change in the acidity even of the five-minute samples, 

 rapid increase in acidity, high point from 70 to 100 or over, either 

 sustained or abrupt, and a slow decline or none at all in the usual 

 time. The food left the stomach in normal time from two to two 

 and one half hours, but even after the passage of all food material 

 there was often encountered an outpouring of pure gastric juice for 

 half an hour, one hour, or even several hours. This finding, which 

 was obtained in many cases, is so pronounced and distinct that we 

 call it a " continued digestive secretion " in contradistinction to 

 " hypersecretion " because it occurs in normal symptomless persons. 

 This type we call the hypersecretory type because of the general 

 tendency of the acidity to assume exaggerated proportions. 



These represent but two of such curves in which the tendencies 

 described were pronounced and the " continued " secretion was quite 

 prominent. Several cases in which the acidity approached that seen 

 in the isosecretory type likewise showed this phenomenon. 



3. The third or " hyposecretory " type is similar to the first but 

 there is usually a slower ascent, slower response to stimuli, and a high 

 point from 40 to 50. Digestion is usually completed in two and one 

 half hours. This is the type least frequently encountered. 



A consideration of the curves from the examination of normal 

 persons indicates that there is no normal curve which will hold for 

 all cases. 



A distinction should be made of terms "secretory" refers to the 

 quantity of secretion, " acidity " to the quality or acid grade of the 

 secretion. " Hypersecretion " means the individual who responds to 



