522 Trans. Acad. Sci. of St. Louis. 
fluences, during the normal process of digestion in the course 
of which we are justified in assuming that inhibitory and 
augmentatory stimulation constantly alternates between the 
two sphincters. 
The physical examination made with reference to the 
condition, complained of at the time of the patient’s first 
visit, was not expected to throw much light on the normal 
behavior of the stomach. I concluded to abide my time, 
and to relieve, if possible, the temporary disturbance. A 
course of matutinal auto-lavage was instituted, a procedure 
of no difficulty as the tube had to overcome but 
a slight pharyngeal reflex, and descended almost by 
its own weight. I had occasion to take note of the ease 
with which the patient is able to relieve his stomach of its 
contents. The effort of effecting this, never assumes 
the vehemence of a vomiting act. A trial meal was 
administered, and expressed one hour after ingestion. The 
stomach contents showed the presence of traces of free 
hydrochloric acid and of a large amount of lactic acid or 
lactates. This led me to prescribe large and frequent 
doses of the dilute hydrochloric acid. Peptonized milk and 
beef peptones were allowed in small quantities at short 
intervals, until the abatement of the acute symptoms war- 
ranted an increase of the nitrogenous diet. The carbo- 
hydrates were at first excluded and only very cautiously 
introduced into the daily regimen. Acting upon a hint 
from the patient as to his having always been benefited by a 
Jong tramp into the country, I advised him to purchase a bi- 
cycle by the use of which I intended to act more forcibly and 
directly upon the abdominal muscles, for a flabby abdomen is, 
undoubtedly, an important factor in bringing on permanent 
dilatation of an already atonic stomach. The existence of 
some muscular insufficiency was suspected by me from the 
very beginning; that my suspicion was not groundless, was 
fully borne out by my further investigation. On this line of 
treatment, the patient gradually improved, and at present his 
health is restored to its usual equilibrium, which of course 
does not mean that the gastric insufficiency has been removed. 
The treatment did not affect Mr. D—’s ruminating pro- 
