ACHYLIA GASTRICA. 219 



dred and ten pounds ; last summer she gained two pounds. This 

 weight she keeps at the present time." 



Since Dr. Brigham's death in 1 902, the author has been unable 

 to obtain any further history of this case. 



Achylia Gastrica. The fact that human beings can live 

 and be apparently in perfect health, digesting all classes of food- 

 stuffs, and yet possessing no stomach, as is shown most notably in 

 Dr. Brigham's case, makes it quite easy to believe that a similar 

 normal condition may be maintained when the stomach is present, 

 but a stomach which secretes no gastric juice. Such a condition 

 of permanent absence of the gastric secretion is termed achylia 

 gastrica. This affection has been described also under the names 

 gastritis glandularis atrophicans and progressive atrophy of the 

 stomach. There are some cases in which the achylia is congenital, 

 and others in which it comes on at middle life and in connection 

 with chronic gastric catarrh or some other affection. The admin- 

 istration of test-meals demonstrates the absence of hydrochloric 

 acid, pepsin, and rennin. Persons having achylia gastrica are 

 often apparently in perfect health and eat everything they wish. 



The cases in which the stomach has been totally removed, 

 taken in conjunction with these cases of achylia gastrica, all point 

 to the conclusion that the small intestine is capable of carrying on 

 all the digestive processes without any aid from the stomach. 



Still, it can hardly be supposed that the stomach is entirely a 

 superfluous organ. Hemmeter, in discussing "The Logic of 

 Hydrochloric Acid Therapy," in American Medicine, says : 



"The cases frequently noted in patients without any gastric 

 secretion whatever who succeed in maintaining their nitrogen- 

 equilibrium (and we have seen many such), and the experiment 

 on the dog (Kaiser and Czerny), the weight of which was kept up, 

 although the largest portion of the stomach was removed, and 

 Brigham's and Schlatter's total extirpations of the stomach, con- 

 stitute but a weak argument against the therapy of HC1. For 

 although such patients and animals manage to get along fairly 

 well for a time, it is only under the most careful and scientific 

 supervision that their health is maintained. Permanent and 

 perfect health with total absence of gastric secretion is rarely 

 observed, except in those who are able to rest much and have their 

 food prepared with great care. 



" These facts must not be overlooked in considering the work 

 of von Noorden, which demonstrated that absolute and permanent 

 deficiency of gastric juice may be accompanied by perfect health. 

 This health is perfect under the conditions mentioned, but when 

 such patients are taxed by work or the diet is not the usual one, 

 in my experience suffering invariably becomes manifest. If 

 achylia gastrica could really exist without any subjective or 

 objective disturbances, how is it that so many of these patients 

 consult the stomach specialists and are reported by them in lit- 



