Merycism Regarded in the Light of Atavic Tendency. 523 
pensities in any way; it was not intended to do so, for I 
followed, with regard to this feature of the case, the doctrine 
of letting well enough alone. I, of course, insisted all along, 
on a thorough primary mastication. Whether this will have 
ultimately the beneficial effect of eradicating the ruminating 
habit, remains to be seen; thus far no change is noticeable. 
Having done my duty by my patient, I now called on him 
to do his by me, to which call he most graciously responded. 
On March 24th, I subjected him to another physical examina- 
tion, with the following results: Inspection, palpation and 
percussion revealed nothing of any moment. On auscultation, 
with the stethoscope placed below the xyphoid cartilage, 
Metzer’s ‘* Durchspritzgeraeusch’’ (Ewald’s Ist deglutition 
murmur) was audible once out of four times, the Durch- 
pressgeraeusch ’? (Ewald’s 2nd deglutition murmur) was 
perceptible three times out of four, i. e. when the first could 
not be heard. 
250 cc. of water were poured into the stomach by means of the 
tube ;in the standing posture alineof dull d4cm.over 
the umbilicus. The addition of 500 ce. brought the line of dull- 
nessto within 2.5 cm. of the umbilicus. The patient complained 
of a sensation of fullness, and the stomach was emptied. 
After this, distention with air was attempted. At every stroke 
of the double-bulb apparatus, the air rushed out along the 
sides of the tube, with an explosive sound. This fact and 
the great discomfort complained of by the patient sre, 3% 
me to desist from any further attempt at distention. 
Thus far my examination proved to me three points :— 
1. The absence of any considerable degree of gastrectasis. 
2. The high degree of paresis or insufficiency of the cardiac 
Sphincter. 
3. Some muscular atony of the whole organ. 
To establish the degree of motility of the stomach, Ewald 
and Sievers’ salol test was made use of :— 
March 25th, the salicyluric acid reaction was obtained two 
hours after ingestion. ; 
March 31st, the reaction appeared two hours after inges- 
tion and failed to show twenty-four and thirty-two hours 
after. 
