REMOVAL OF THE HUMAN STOMACH. 211 



should be insisted on, and all food-substances should be very finely 

 cut up, so that they cannot plug up the tube, even if not digested. 

 The advantages claimed for this test-meal are that after drawing 

 it, in a large number of instances, the conditions of gastric 

 rnotility and secretion may be recognized before any analysis is 

 made ; then, a disappearance of the entire breakfast-meal points 

 to a normal digestion. "Absence of all proteids beef and egg 

 and presence of considerable carbohydrates rice and bread 

 point to hyperchlorhydria ; and, again, absence of all carbohy- 

 drates and presence of some of the beef and egg point to hyper- 

 chlorhydria, subacidity, anacidity, or achylia. Presence of the 

 entire meal, with perhaps milk uncurdled, means impaired motility, 

 with atrophy of gastric mucosa, absence of acids, enzymes, and 

 pro-enzymes. If the entire meal has disappeared, the status of 

 the gastric secretions may be ascertained from the Ewald test- 

 meal, which is still present." 



In his discussion of the physiology of gastric peristalsis, Hem- 

 meter concludes as follows : " It is necessary to distinguish the 

 movements of the (1) fundus, (2) pre-antral portion, (3) antrum, 

 and (4) pyloric sphincter. (1) The motor apparatus of the stom- 

 ach is represented by its muscular fibers. When these are most 

 developed, the peristalsis is strongest ; when they are least devel- 

 oped, it is weakest. (2) The fundus has a thin muscular devel- 

 opment; hence its peristalsis is insignificant, and consists in 

 squeezing its contents into the tubular pre-antrum or prepyloric 

 portion. (3) Waves of constriction along this pre-antrum force 

 the food forward and backward through this portion until a 

 mightier wave-impulse sweeps it into the muscular ampulla just 

 in front of the pylorus, the autrum pylori. (4) The final ex- 

 pression into the duodenum is executed by the antrum, which may 

 contract as a whole or form into two spherical muscular ventricles 

 by a constriction (rarely). (5) A food circulation, in the sense of 

 Beaumont and Brinton, does not occur." 



Removal of the Human Stomach. The first total re- 

 moval of the human stomach was performed by Dr. Connor, of 

 Cincinnati, Ohio, U. S. A., in 1885, the patient dying very soon 

 after the operation. Langenbuch, Schuchardt, and others have 

 also removed the stomach, and inasmuch as in these cases only a 

 small portion was left, and that a portion which could perform 

 no function, these cases may be regarded, from a physiologic 

 standpoint, as complete removals. In Schuchardt's case, the 

 patient lived two and one-half years, and was apparently in ex- 

 cellent health. 



There are two cases, however, of complete ablation of this 

 organ which are of great interest physiologically, and of which 

 many important details are accessible, and these it is our purpose 

 to describe somewhat minutely. One occurred in Zurich, Switzer- 

 land, and the other in San Francisco, California, U. S. A. 



