Modern Medicine Library, No. i. May, 1896. Issued Monthly. 
\ Subscription Price, fi.oo per annum. 
What is the Matter 
WITH THE 
American 
Stomach ? 
By J. H. KELLOGG, M. D. 
Member British Gynecological Society, International Periodical Gynecological 
Congress, Societe d’ Hygiene of France, American Medical Association, 
British and American Associations for the Advancement of Science, 
American Microscopical Society, etc., Superintendent of 
the Medical and Surgical Sanitarium and Hos- 
pital, Battle Creek, Michigan. 
MODERN MEDICINE PUB. CO., Battle Creek, Mich. WHAT IS THE MAHER WITH THE 
AMERICAN STOMACH?’ 
NEW AND EXACT METHODS OF FINDING OUT. 
J. H. KELLOGG, M. D. 
Some years ago a leading English practitioner remarked to 
me in London, “Doctor, I suppose that in America the busi- 
ness of physicians is chiefly confined to the treatment of indi- 
gestion.” I replied that I had heard that Americans enjoyed the 
unenviable reputation of being a nation of dyspeptics ; but yet 
we did sometimes encounter other pathological states than those 
of indigestion. Nevertheless, as the remark of the London phy- 
sician has at intervals occurred to me, I have found myself 
recognizing more and more distinctly the fact that, after all, the 
practice of medicine, outside of surgery and obstetrics, for the 
most part revolves about the stomach. 
Bouchard has shown the important relation of ptomains 
developed in a dilated, or atonic, stomach to chronic rheuma- 
tism, to bronchitis, to anginal cardiac affections, to albuminuria 
and renal diseases, to pulmonary phthisis, to jaundice, and to 
skin diseases. He has also shown the intimate relation which 
exists between putrefactive and fermentative processes taking 
place in any part of the alimentary canal, resulting in the pro- 
duction of ptomains and other toxins, to puerperal fever and 
febricula. 
M. l’Gendre has shown the relation of dilatation of the 
stomach to typhoid fever, to tapeworm, to lumbrici, and other 
intestinal parasites, great and small. 
Vigoroux asserts that the great number of functional nerve 
disorders which are included under the general term “neuras- 
l Presented at the Annual Meeting of the Mississippi Valley Medical Association, held at 
Detroit, Mich., Sept. 4-6, 1895, 2 
thenia ” are all of gastric origin; that neurasthenics without 
exception are suffering from uric acid poisoning. Excess of 
uric acid in the tissues is, according to Bouchard, due to an 
abnormal slowing of the processes of oxidation and disassimila- 
tion, which results from a toxemia arising from the absorption 
of the products of. putrefaction and fermentation in the ali- 
mentary canal. 
Dana asserts that organic changes in the central nervous 
system are doubtless due to the absorption of toxic substances 
produced by microbic processes in the alimentary canal. 
Thus we see that special investigators in the etiology of 
disease are from all quarters pointing toward the stomach as 
the starting-point of the train of morbid processes which give 
rise, in each particular case, to a special group of morbid mani- 
festations. Unreasonable as this may at first seem, a glance 
at a few simple physiological facts may serve to dissipate the 
apparent absurdity. 
The function of a tissue or organ depends upon its structure. 
The structure of every cell and fiber of the body depends upon 
the quality and quantity of the material absorbed from the 
alimentary canal. A deficient supply of food weakens the 
structure, and lessens the energy of every organ. An excess of 
food overwhelms the tissues with imperfectly oxidized and toxic 
substances, whereby their structure is deteriorated, and their 
functions perverted or retarded. Food containing toxic sub- 
stances produces upon the body general or specific toxic effects. 
The same results from the development of toxic substances in 
the alimentary canal from the fermentation or putrefaction of 
food in the stomach and intestines. Pasteur, David, and others 
have shown that the mouth, the stomach, and the intestines are 
continually inhabited by a vast number of microbes capable 
of generating various acids, poisonous ptomains and toxins, 
varying in their physical and physiological properties, and some 
of them capable of producing most powerful poisonous effects. 
These poisons are generally produced in greater or less quan- 
tities ; but thanks to the poison-destroying power of the liver 
and the eliminative function of the kidneys, the amount at any 
time circulating in the tissues of a healthy man is not sufficient 
to produce any more deleterious effect than that gradual dete- 3 
rioration of the organism by which the tissue-modifications 
characteristic of old age are brought about. When, however, 
diseased conditions of the stomach or intestines exist, these 
poisons may be increased to an enormous degree; for example, 
Bouchard has shown that if food is retained in the stomach 
more than five hours, the changes which take place are fermen- 
tative and putrefactive, rather than digestive. This explains 
the relation demonstrated by Bouchard and others between 
dilatation of the stomach and chronic rheumatism and the 
lowered vital resistance which prepares the way for tubercular 
disease of the lungs and other structures. 
A catarrhal condition of the stomach and intestines encour- 
ages general toxemia and the development of an infinite variety 
of pathological conditions, by furnishing, in the masses of the 
mucus retained in patches upon the mucous surface, hiding- 
places for microbes, in which they are protected from the germi- 
cidal action of the digestive fluids. The particular form of 
morbid manifestation which may arise from the poison thus 
engendered depends upon the special properties of the poisons 
which may happen to be formed in the greatest abundance, and 
upon the susceptibility of the individual tissues. Modifications 
of conditions may render poisons which at one time are compar- 
atively inert, at another time highly toxic; for example, Klebs 
has shown that the highly toxic poison of cholera nostras is 
derived from guanidin, a comparatively slightly toxic sub- 
stance always present in the tissues ; and Griffith has shown that 
the toxins of scarlet fever and diphtheria which are found in the 
urine of patients suffering from these diseases are derived from 
creatin, a poison always present in the flesh of animals, but pos- 
sessed of comparatively small toxic power. These facts explain 
the influence of habits and conditions of life in producing sus- 
ceptibility to disease, and in determining the fatality of maladies. 
A perfectly healthy man is proof against germs. Cholera 
germs, typhoid-fever germs, and other disease-producing mi- 
crobes may be swallowed with impunity by a person whose 
alimentary canal is intact. The gastric juice of a healthy 
stomach is capable of destroying every germ that lives. Bile 
serves the purpose of an antiseptic for the intestines, as the 
gastric juice does for the stomach. 4 
One of the most important functions of the stomach seems 
to be the disinfection of food. The idea that microbes and 
putrefactive processes are essential as an aid to digestion is an 
error which is supported by neither physiological proof nor bac- 
teriological facts. The normal stomach is perfectly capable of 
taking care of itself, provided it has a favorable opportunity, 
as I will attempt to show later in this paper. Nature has 
thus undertaken to protect the body against the destructive in- 
fluence of the poisons which might develop in the alimentary 
canal by means of the germicidal power of the gastric juice and 
the bile, and has afforded a protection against both the poisons 
which might be actually introduced with the food, and those 
which might result from bacterial action in the alimentary canal 
by means of the poison-destroying and the poison-retaining 
property of the liver, as well as by the marvelous eliminative 
activity of the kidneys. 
So long as these protective agencies are in active operation, 
the body retains its ability to resist the attacks of microbes, 
and, provided other conditions are normal, the vital resistance 
of the body is sufficient to cope with natural disease-producing 
agencies. When the protective agencies are crippled; when 
the, stomach no longer secretes a gastric juice capable of de- 
stroying microbes ; and when it becomes, by dilatation or motor 
insufficiency, the hold of every unclean and hateful germ, the 
flood-gates of disease are thrown wide open, the portals of the vi- 
tal citadel are unguarded, and the exciting and predisposing causes 
of almost every ill to which human flesh is heir are set in opera- 
tion. A clinical recognition of this fact has led many a wise old 
physician to insist upon the supreme importance of materia ali- 
mentaria as compared with materia medica, and to recognize 
the paramount importance of attention to the digestive functions 
in the treatment of maladies of every description. 
Granting the force of these considerations, it becomes a 
matter of grave importance that we should enquire with great 
solicitude, What is the matter with the American stomach ? 
That something is the matter is evidenced not only from the 
facts and arguments which have been presented, but from the 
facts which may be gleaned from a glance through the advertis- 
ing pages of any medical journal, newspaper, or popular maga- 5 
zine, or by an inventory of any druggist’s shelves or counters. 
The vast predominance of medicaments intended in some way 
to aid the digestive organs, over all other remedies either regu- 
lar or irregular, is a patent fact. Pepsin is manufactured and 
sold by the ton. Peptones, peptonoids, malt preparations of 
various kinds, diastatic and other digestive ferments of every 
possible form, are manufactured and sold in enormous quan- 
tities, and swallowed with avidity by the victims of digestive 
disorders, in the vain hope of finding relief. The questions of 
most practical interest in this inquiry, are — 
1. What are the causes of this general failure in digestion 
recognizable among the adult population of the United States? 
2. By what means may the functional disorders of digestion 
and their consequences be remedied ? 
This subject is altogether too large to be comprehensively 
treated in a single paper, but I wish to call especial attention to 
the results of some investigations which I have undertaken, 
looking toward the solution of these questions, and which I 
believe throw some light upon them. 
From Hippocrates down to the present time, medical litera- 
ture has abounded with maxims relating to eating and other 
matters pertaining to digestion. Some of these are recognized 
as the natural outgrowth of experience. Others may have only 
a whimsical basis, or no other foundation than the fancy of some 
prejudiced observer, the prestige of whose authority, however, 
has been sufficient to give him a certain degree of permanence. 
The purpose of my inquiry has been to bring to bear upon the 
etiological and therapeutic questions relating to indigestion, the 
precise methods which recent advances in the methods of 
physical diagnosis pertaining to the stomach have enabled us 
to utilize. 
NEW MODE OF INVESTIGATING DISORDERS OF DIGESTION. 
Before detailing the experiments which I have made, I will 
briefly describe the method of investigation of the functional 
activities of the stomach employed by me. Some fifty years 
ag°> Golding Bird, of Guy’s Hospital, London, discovered the 
interesting fact that free hydrochloric acid may be separated 
from the gastric juice by distillation. Hayem and Winter, of 6 
Paris, developed from this fact a method of investigation of the 
digestive work of the stomach by which it was possible to deter- 
mine not only the total amount of chlorin secreted by the stom- 
ach, but the exact relation of the different forms of chlorin, 
— free, combined, and fixed,— thus measuring the quantity and 
quality of the work done by the stomach in the digestion of pro- 
teids. Taking the work of Hayem and Winter as a basis, and 
adding thereto the results of the investigations of others, and 
the advantages of the experience gained in the careful chemical 
study of over five thousand stomach fluids, I have elaborated the 
method of studying stomach fluids wrhich is illustrated in the 
blank for recording results which is shown herewith. The first 
page of this blank affords opportunity for recording (i) the phys- 
ical and microscopical characters of the stomach fluid obtained 
after a test meal ; (2) the colorometric and other qualitative 
reactions relating to the digestive agents; (3) the digestive 
products and fermentation products ; (4) the quantitative chem- 
ical determination relating (a) to digestion of albumen, diges- 
tion of starch, (c) the fatty acids, and (//) the coefficients of 
the digestive work done. Of these coefficients I have estab- 
lished seven, as follows : — 
1. Relating to the digestion of albumen. 
2. Relating to the digestion of starch. 
3. Relating to the activity of the saliva. 
4. Coefficient of fermentation. 
5. Coefficient of solution. 
6. Coefficient of absorption. 
7. Coefficient of chlorin liberation. 
On the fourth page of the blank is shown a graphic 
method of recording the results obtained by these exact deter- 
minations. On pages 2 and 3 is presented a classification 
of the functional disorders of digestion based upon a chemical 
examination of the stomach fluid obtained after a test meal in 
over five thousand analyses. 
Considered in relation to the amount of work done, there 
are four general classes of indigestion: Hyperpepsia, in which 
there is excessive stomach work; hypopepsia, in which there is 
deficiency of stomach work ; apepsia, in which there is no 
digestive activity whatever; and simple dyspepsia, in which the MSIfldON OF FUNCTION! DISOB OF FOE STOMACH, 
IN RELATION TO PROTEID DIGESTION, 
Based upon a Quantitative Chemical Examination of the Stomach 
Fluid Obtained after a Test Meal, in over 5,000 Analyses. 
EXPLANATION OP CLASSIFICATION. 
In the study of over 5000 stomach fluids, I have found it possible to include all cases of dis- 
order of the chemico-vital processes of the stomach, as regards proteid digestion, in four general 
classes : Hyperpepsia, hypopepsia, apepsia, and simple dyspepsia (following the classification of 
Hayetn and Winter). Hypopepsia and hyperpepsia present respectively two and three main 
subdivisions, each of which, together with simple dyspepsia, is divided into two tpyes, according 
as coefficient {a), the measure of the quality of proteid digestion is, == or —. Each of these types, 
together with apepsia, is again subdivided in relation to fermentation, into two classes, without fer- 
mentation and with fermentation. The characteristics of these several classes, subdivisions, and 
types are as follows : — 
HYPERPEPSIA. 
The characteristic feature in hyperpepsia is A'-}-. The significance of this is that the free HC1 
and combined chlorine (H C) are found in quantities sufficient to produce nominal hyperacidity, 
there being excess of stomach work, not regarding quality. There are three subdivisions : — 
1. Hyperpepsia typical, all kinds of work in excess (A' -(- H --j- C -(-). 
2. Hyperpepsia without excess of HC1 (A' -f- H — or = C -(-). 
3. Hyperpepsia without excess of combined chlorine (A' -|- H -f- C — or =). 
Each of the subdivisions of hyperpepsia presents two types : — 
(1.) a signifying that the proteid digestion is normal in quality. 
(2.) a —, signifying that the proteid digestion is inferior in quality, neutral chloro- 
organic compounds being present. 
Each type is subdivided, with reference to fermentation, into two classes : — 
[1.] Without fermentation (x o). 
[2.] With fermentation (x 4-). 
HYPOPEPSIA. 
The characteristic of hypopepsia is A' —, the significance of which is that H and C are not 
found in sufficient quantities to produce a normal degree of acidity. There are two subdivisions 
of hypopepsia : — 
1. Hypopepsia typical (A/— H —). 
2. Hypopepsia without deficiency of HC1 (A/— H = or -}-). 
Each of the subdivisions of hypopepsia presents two types : — 
(1.) a =, signifying that the proteid digestion is normal in quality. 
(2.) a —, indicating the presence of neutral chloro-organic compounds. 
Each type is subdivided, with reference to fermentation, into two classes : — 
[1.] Without fermentation (x o). 
[2.] With fermentation [x -j-). 
APEPSIA. 
In apepsia there is no normal proteid digestion. The characteristics are a neutral or very 
slightly acid stomach fluid (A o or —); the coefficient of proteid digestion is zero (a o). There are 
two subclasses in apepsia : — 
1. Without fermentation (x o). 
2. With fermentation (x -}-). 
SIMPLE DYSPEPSIA. 
The characteristic of simple dyspepsia is A/=, the significance of which is that H and C are 
present in sufficient quantities to produce a normal degree of acidity. Simple dyspepsia presents 
two types : — 
(1.) a =, signifying that the proteid digestion is normal in quality. 
(2.) a —, signifying that neutral chloro-organic compounds are present. 
Each type is subdivided, with reference to fermentation, into two classes: — 
[1.] Without fermentation {x o). 
[2. ] With fermentation (x +). 
For convenience in writing prescriptions these general classes are designated as follows: Hy- 
perpepsia, Hyp.; hypopepsia, Hop.; apepsia, Ap.; simple dyspepsia, Sp. 
The subdivisions under each class are designated by number as follows: Hyp. 1-1-1 would 
indicate a case falling under the first subdivision of hyperpepsia, of the first type (a =), without 
fermentation ; Hyp. 3-2-2 would indicate a case belonging to the third subdivision of hyperpepsia, 
second type (a —), and with fermentation ; Hop. 2-1-2 would indicate a case of the second division 
of hypopepsia, of the first type (a =), with fermentation ; Ap. 2 would indicate a case of apepsia 
with fermentation ; Sp. 1-2 would indicate a case,of simple dyspepsia of the first type (a =), with 
fermentation. 
Explanation of Symbols.— The quantities which are utilized as a basis for the classification 
of cases in relation to proteid digestion, are A', H, C, E, a, and x. The significance of these several 
symbols is as follows : — 
A represents the total acidity as determined by acidimetry. 
A' represents the acidity indicated by the amount of free HC1 and combined chlorine present 
(H -f- C), the combined chlorine being taken at its full value. The value of A' in a given case is 
determined by simply adding the quantities represented by H and C. This value shows the quan- 
tity of work done without reference to quality, and is the basis for the division of cases into the 
four great classes: Hyperpepsia, hypopepsia, apepsia, and simple dyspepsia. 
H represents the quantity of free HC1 found by quantitative estimation. 
C represents the amount of combined chlorine present in a given case when the proteid diges- 
tion is normal in quantity. The combined chlorine represents the same degree of acidity as the 
free HC1. There is likely to be present, however, a greater or smaller quantity of neutral chloro- 
organic compounds, which, possessing no acid value and no nutritive value, give to C, as determined 
by the estimation of chlorine, a value greater than it really possesses. The true value of C is shown 
by a, the coefficient of proteid digestion. 
L represents the amount of lactic acid found present, expressed in terms of HC1. The actual 
amount of lactic acid is twice that indicated, but its acid value alone is of interest in this connection. 
a, the coefficient of proteid digestion, represents the real value of the work done. It is deter- 
mined by the following formula: A ~ . a is simply a numerical expression of the nutritive 
value of the combined chlorine represented by C, its true acid value and its nutritive value being 
considered as identical. As the value of the combined chlorine is rarely found at par, the coeffi- 
cient is considered to be normal when it does not fall more than 10% below par (.90 to 1.00 is con- 
sidered as a =). 
x is the coefficient of fermentation and indicates the amount of fatty acids present. It is based 
upon an actual determination of the amount of lactic acid and volatile fatty acids present. When 
this amount is less than .005 grams per ico c.c., the case is considered normal (x o). If a larger 
quantity of fatty acids is found present, the case is considered to be one in which fermentation is 
present (x-\-). _ T—E 
m is the coefficient of HC1 formation. It is obtained by the formula—> in which T rep- 
resents the total chlorine and F the fixed chlorine. The normal relation of the chlorine set free 
from the basis, to the total chlorine is .66. To put the result on the basis of 100, in harmony with 
other coefficients, it is only necessary to divide the figures obtained from the formula by .66, or 
multiply by .015. 
aand x as a mixed coefficient : In cases in which a sufficient amount of stomach fluid for the 
quantitative estimation of the fatty acids (lactic, butyric, etc.) cannot be obtained, approximate 
information in regard to the presence or absence of fermentation, and the amount of fatty acids 
present, may be obtained by the formula A x **-. If the result is greater than unity (1 -(-), fatty 
acids are probably present; certainly so if the figures are much above unity. If the result is less 
than unity (1 —), fatty acids are either not present or the quantity present is insufficient to neutral- 
ize the neutral chloro-organic compounds represented in C, and consequently cannot be very great. 
When determined in this way, the coefficient is mixed, and relates to both fermentation and proteid 
digestion, and hence is represented as a and x. 
By J. M. KEll_l_OGG, (VI. D. 
The symbols under each head indicate the characteristics of each individual form of quanti- 
tative disturbance to which the stomach is subject. 
HYPERPEPSIA. A +. 
1. a — 
2. a — 
1. Without fermentation (x 0). 
2. With “ (x 4-). 
1. A' + H -f- C -f- Typical 
(Both HC1 and combined chlorine in excess.) 
1. Without fermentation (x 0). 
2. With “ (x 
i 1. Without fermentation (x 0). 
; 2. With “ (x -f-). 
2. A' -f HO, — or = C + 
(Without excess of free HC1 [H].) 
1. ° = ] 
2. a — < 
I 1. Without fermentation (x 0). 
!_ 2. With “ ([x 
1. a — ■ 
2. a — - 
1. Without fermentation (x 0). 
2. With “ (x +). 
1. Without fermentation (x 0). 
2. With “ (x -f). 
3. A'+ H 4- C — or = 
(Without excess of combined chlorine [C].) 
HYPO PEPSI A. A' - 
'1. a == 
2. a — 
I 1. Without fermentation (x 0). 
{ 2. With “ (z+) 
1. A' — H — or 0 Typical......... 
(All elements deficient.) 
1. Without fermentation (z 0). 
2. With “ (*+) 
1. Without fermentation (x 0). 
2. With “ (x +). 
2. A' — H = or + 
(Without deficiency of HC1 [HJ.) 
f 1. a = 
[2. a — 
1. Without fermentation (x 0). 
2. With “ (x 
A PEPSI A. A o or — a o or — Ho. 
1. Without fermentation (x 0). 
2. With “ (x -f-). 
SIMPLE DYSPEPSIA. A =. 
1. a = 
1. Without fermentation (x 0) (normal). 
2. With “ (x +)• 
2. a — • 
1. Without fermentation (x 0). 
2. With “ (x -f). 
Results of Physical Examination Respecting the Position of the Stomach and 
other Abdominal Organs. Results of Qualitative and Quantitative Determinations Re* 
lating to Salivary Digestion and the Stomach Fluid 
Obtained after a Test Meal. 
No 
Mr Date, 189.. 
Test Meal. — Regular Breakfast, after Lavage 
Time of Digestion: h m 
PHYSICAL AND MICROSCOPICAL CHARACTERS. 
Physical. Normal 
Amount c.c. (40 c.c. 1 x/i oz.); Disintegration ; Color 
Residue grms. (2ogrms.); Mucus ; Odor 
Microscopical.— Blood ; Pus ; Misc 
Bacteriological.— No. of microbes per c.c. (30 c.c. = 1 oz.) 
General Characteristics 
Yeast Mold 
Acid formation Gas production Liquefying 
COLORIMETRIC AND OTHER QUALITATIVE REACTIONS. 
DIGESTIVE AGENTS. 
Free HC1 Congo Red Resorcine Dried Residue 
Pepsin.... Rennet Ferment.... Rennet Zymogen.... Bile.... 
DIGESTIVE PRODUCTS. 
Proteids.— Syntonine.... Propeptone.... Peptone... . Albuminoids.... 
Starch (Lugol’s Sol.), Blue, Violet, Brown, Yellow, Colorless. 
FERMENTATION PRODUCTS. 
Lactic Acid f Acetic 
Alcohol Volatile Acids -j Butyric 
Misc ( Formic 
QUANTITATIVE CHEMICAL DETERMINATIONS. 
DIGESTION OF ALBUMEN. 
Normal quantities.* 
Total acidity, (A) grms. (.180-.200 grms.) A * 
Calculated acidity, {A')** “ “ “ A' 
Total chlorine, (T) “ (.300-.330 “ ) 
Free HC1, (H) “ (.025-.050 “ ) H 
Combined chlorine, (C) “ (.155-.180 “ ) C 
Fixed chlorides, (F) “ (.100-.no “ ) -^—-=.66 
DIGESTION OF STARCH. 
„ _ . r Acid am’t in 5 m grms. 1 c.c. con- 
Saliva, Reaction ] [ ? . 
I Alkaline » verted .1 grms. m m. 
Maltose, (M) grms. 
Dextrine and Soluble Starch (D) “ 
Fatty Acids (from fermentation) (L) “ 
(Lactic acid grms. Volatile Acids grms.) 
COEFFICIENTS OF DIGESTIVE WORK.* 
Gastric j Proteids («) Fermentat'n (x).. 
Digest’n I Starch (b) Solution (jy) 
Salivary Activity (c) Absorption (2) ... 
Relation of HC1 set free to Total Chlorine (m) 
Proteid Digestion and Acid Fermentation (a and x) 
Diagnosis. — Classification 
Remarks: 
Prescription; 
. r. 
’ t-' ' 
* The acidity (A and A') and the quantities of chlorine in the different forms of 
(T), (H), (C), and (F), are expressed as HC1. The values given relate to ioo c.c. of 
stomach fluid. The amount of fatty acids, chiefly lactic (L), is expressed in grams of 
HC1, which should be multiplied by 2 to indicate the actual amount of lactic acid pres- 
ent. ’ The amount of maltose (M) as well as that of soluble starch and dextrine (D) is 
expressed in grams of equivalent dextrose. 
tBy noting the sign following the symbols in this column and coefficients (a) and 
(x), and referring to the classification, the diagnosis of any case in relation to proteid 
digestion and fermentation may be easily made. By transferring the figures to the 
blank for “Graphic Representation,” the indications will be seen at once, the analy- 
sis thus furnishing a basis for rational treatment and the proper dietary. 
** The calculated acidity (A') is determined by the following formula: C -j- H — 
L = A'. 
ft The normal amount of work is, in the case of each coefficient, represented by 
1.00. The figures given usually represent the percentage of deviation from normal. The 
coefficient of fermentation represents the number of milligrams of lactic acid or com- 
bined fatty acids found in each 100 c.c. of stomach fluid (expressed in equivalent HC1). 
The sign -f- indicates presence in normal quantity; -\—|- in excessive 
quantity; — in deficient quantity; o (zero) wholly absent. 
GRAPHIC REPRESENTATION 
Of the Results of the Chemical Examination of Salivary and Qastric Digestion, Based upon the Study 
of over 5000 Cases in the Physiological Laboratory of the Battle Creek (Hich.) Sanitarium. 
Case of 
ARRANGED BY 
J H. KELLOGG. M. D. 
>The figures in each of the above columns relate to a 
particular quantity or quality of stomach work. The 
point at which the line starts indicates the class to 
which the case belongs, and the degree of hyperpepsia 
or hypopepsia, as the case may be, if the figures fall out- 
side the normal limits. 
The figures found in columns headed A', H, C, A, 
and a relate to the digestion of albuminoids, or proteid 
substances. i 
The column headed S relates to the salivary diges- 
tion of starch, the figures having reference to the quan- 
tity of sugar (maltose expressed as milligrams of dex- 
trose) found present in the stomach fluid. 
Coefficients.— The columns headed a, b, c, x, y, and z 
relate to the coefficients of the several kinds of work 
done by the stomach. 
Column a relates to proteid digestion and fermenta- 
tion. The figures below the normal line in this column 
represent varying degrees of deterioration in the quality 
of the products of proteid digestion. The figures above 
the line to the left roughly indicate the degree of acid 
fermentation. Both conditions may exist together. 
Coefficient b relates to the digestion of starch. The 
figures in this column represent the relation between 
the amount of maltose, or completely digested starch, 
found in the stomach fluid, and the total amount of 
sugar, soluble starch, and dextrine found present in the 
same case. The coefficient is determined by dividing 
the number of milligrams of maltose found in each ioo 
c.c. of stomach fluid by the total quantity of maltose, 
dextrine, and soluble starch found in solution, i.oo of 
course represents the conversion of 80 per cent of the 
starch in solution. 
Coefficient c represents the degree of secretory ac- 
tivity of the salivary glands and of the starch-converting 
power of the saliva. Normally, 10 to 12 c.c. of saliva are 
produced in five minutes, 1 c.c. of which is capable of 
completely converting .100 grams of starch in five min- 
utes. Taking 10 as the normal quantity and 5 as the 
normal time, the coefficient of salivary activity is ob- 
tained by the following formula, in which Q represents 
the quantity secreted and T the time required for con- 
5 Q 
version : — X — = c (coefficient of salivary activity). 
T 10 
Coefficient x represents the degree of fermentation 
present, as indicated by the number of milligrams of 
fatty acids per 100 c.c. of stomach fluid. 
Coefficient y represents the total work of disintegra- 
tion and solution performed by the mouth and the 
stomach. The figures representing this coefficient are 
obtained by dividing the amount of residue obtained by 
filtration of the stomach fluid, by the total amount of 
stomach fluid obtained. In normal cases the residue 
equals one half the total amount. The coefficient is 
found by the following formula, in which A repre- 
sents the amount of stomach fluid and R the residue : 
A 
' = jy, = i.oo (in normal cases’* 
2R 
Coefficient z represents the work of the stomach in 
the absorption of fluids. This coefficient is obtained by 
dividing the normal quantity of stomach fluid which 
should be obtained viz., 40 c.c., by the quantity actually 
obtained. 
Coefficient m indicates the relative amount of chloriu 
liberated in the form of free hydrochloric acid. 7 
change in the work done by the stomach is normal, the 
change in the stomach work being qualitative rather than quan- 
titative. By these studies I have been enabled to subdivide 
these several classes as follows : — 
Hyperpepsia, into three principal classes, and twelve sub- 
classes. 
Hypopepsia, into two principal classes and eight subclasses. 
Apepsia, into two subclasses. 
Simple dyspepsia, into four subclasses. 
This makes twenty-six different varieties of indigestion, each 
with its individual characteristics. The study of over fifty- 
three hundred analyses made with painstaking accuracy accords 
with the methods which I have very briefly described. I have 
not found a single case which did not fall in one of the classes 
named, and have found examples of every class, although some 
of the classes have been represented by but a very few cases. 
I conclude from this fact that this classification is complete. 
I will not here enter into the details of classification, as this 
is shown in the blank referred to, which also sets forth -the 
particulars of the method for obtaining the several coefficients. 
The technique of the chemical methods employed I have given 
in other papers ; my present purpose is simply to exhibit the fact 
that the method of investigation is not hypothetical nor uncer- 
tain, but has a definite and scientific foundation. One feature 
of the method of investigation pursued is to such an extent new, 
and develops facts so interesting, that I may be pardoned for 
presenting it at length. The feature referred to has relation to 
the digestion of starch in the stomach. 
THE STOMACH DIGESTION OF STARCH. 
The subject of the stomach digestion of starch is one which 
seems to have been almost wholly neglected until very recently; 
and even yet the majority of our text-books on physiology teach 
that the digestion of starch in the stomach is a matter of little 
or no consequence, the supposition being that the activity of 
the saliva ceases very soon after the food enters the stomach, in 
consequence of the inhibitory action of the gastric juice. 
Within a few years, however, the fact has been established that 
the active principle of the gastric juice converts starch into 8 
maltose, not only in a slightly alkaline medium, but also in the 
neutral or even slightly acid medium ; and that, in fact, the 
digestion of starch proceeds more actively in a neutral medium 
than in one which is alkaline. Hence the alkalinity of the 
saliva appears to have for its purpose, not the direct increase of 
the activity of the ptyalin, but the prolonging of its action after 
it enters the stomach by the neutralization of the acidity of the 
gastric juice. Thus the saliva is enabled to act in the stomach 
with even greater rapidity than in the mouth, and may continue 
this action for half an hour or more after the food has been 
swallowed. This is amply sufficient time to enable the saliva, 
if a sufficient quantity of it is mixed with the food, to convert 
into maltose a large portion of the farinaceous constituents of 
the food, provided the food has been sufficiently well divided to 
present a surface large enough to bring the saliva promptly into 
contact with every particle of the digesting mass. 
I have studied the salivary digestion of starch by two 
methods : — 
1. By the establishment of a coefficient of salivary activity. 
This is done by a comparison of the quantity and quality of the 
saliva with the normal standard. The quality of the saliva is 
determined by the method of diastasimetry devised by Sir Wm. 
Roberts, an English physiologist, some years ago. The saliva 
is obtained by making the patient chew a quantity of paraffin 
gum for five minutes. 
2. By the determination of the relative amounts of maltose, 
dextrin, and soluble starch found in the stomach fluid. The 
coefficient of starch digestion in the stomach is based upon a 
comparison of the amount of maltose with the amount of 
dextrin and soluble starch. The saliva acting upon the starch 
in a test-tube is capable of converting eighty per cent of it into 
maltose. Probably a larger per cent than this is converted in 
the stomach on account of the absorption of the maltose as 
formed, but I have thought it best to take eighty per cent as the 
standard for comparison ; that is, to require that the stomach 
fluid, to be normal, shall show but twenty per cent of dextrin 
and soluble starch to eighty per cent of maltose. 
I have been surprised at the large amount of maltose found 
present in the stomach fluid. In an examination of 965 stom- 9 
ach fluids by this method, I have found an average of 2.3 grams 
of maltose per 100 c. c. of stomach fluid, or 2.3 per cent of 
maltose. The average amount of maltose, dextrin, and soluble 
starch combined, representing the total digestive work of the 
saliva, is nearly four grams, or four per cent. In some instances 
I have found as much as seven grams, or seven per cent. 
An interesting fact which I have constantly noted is the 
much higher percentage of maltose in cases of hypopepsia as 
compared with hyperpepsia; for example, the average propor- 
tion of maltose in hyperpepsia is 1.9 grams per 100 c. c. of 
stomach fluid, and in hypopepsia 2.6, or 35 per cent more than 
in hyperpepsia. The average coefficient of salivary activity is 
precisely the same in hyperpepsia and hypopepsia, showing 
clearly that the difference must be due to the difference in the 
acidity of the stomach contents. The average per cent of 
maltose in twenty cases of pronounced hyperpepsia was 1.8, 
and the coefficient .60. In eighteen cases of pronounced hypo- 
pepsia or apepsia, the per cent of maltose was 3.7 and the 
coefficient .89. In other records the total amount of maltose 
in hypopepsia was more than double that in hyperpepsia, and 
the ratio of complete conversion was fifty per cent greater. So 
much for the methods employed. 
EXPERIMENTAL RESEARCHES RELATING TO STARCH DIGESTION 
IN THE STOMACH, 
Water biscuit, 
well chewed. 
Water biscuit, 
not chewed. 
w Raw flour. 
-e- Raw wheat. 
Total acidity (A) 
.142 
.140 
.204 
.136 
Calculated acidity (A') 
.156 
.132 
.186 
.128 
Total chlorin (T) 
• 2q6 
.284 
■332 
.272 
Free HC1 (H) 
.050 
.028 
.056 
.052 
Combined chlorin (C) 
.106 
.104 
.130 
.076 
Fixed chlorids (F) 
.114 
•152 
.I46 
.144 
Maltose (M) 
1.088 
.272 
.OOO 
.OOO 
Dextrin and soluble starch (D) 
.812 
.548 
.300 
.448 
COEFFICIENTS. 
Digestion of albumen (a) ' 
.82 
•97 
I.OO 
1.00 
Digestion of starch (i) 
•71 
.42 
.OO 
.00 
Salivary activity (c) 
t *7 
I.II 
1.14 
*•37 
Fermentation (jr) 
5 
II 
6 
6 
Chlorin liberation (in) 
.80 
.70 
.85 
•7* 10 
I will now call attention to the results of some experiments 
which I have made.1 Selecting several healthy young men, by 
an extended series of experiments I undertook to determine 
some facts in relation to the hygiene of starch digestion. The 
above table represents the results obtained in a comparison 
of stomach fluids obtained after (i) water biscuit well chewed; 
(2) water biscuit broken, moistened with water and swallowed 
without chewing ; (3) raw flour ; (4) raw wheat, the meal con- 
sisting of one and one-half ounces of solid substance mixed with 
eight ounces of water in each case. 
Several points of interest are to be noted in the foregoing table, 
the first and most conspicuous of which is the fact that the 
saliva did not act at all upon the raw flour and raw wheat, 
as shown by the total absence of maltose in the cases repre- 
sented in columns 3 and 4. The small amount of dextrin and 
soluble starch shown was perhaps already present in the raw 
grain, but this point I have not investigated. It is clear, how- 
ever, that no sugar was produced when raw starch was taken, 
whereas the amount of sugar produced after the ordinary test 
meal was more than 1 gram in each 100 c. c. of stomach fluid ; 
in other words, the stomach fluid contained more than one per 
cent of sugar without taking into account the amount which 
had been absorbed. 
The figures for maltose in column 2 represent a test meal 
in which little or no saliva was mixed with the food substance, 
it being swallowed without chewing. Thus it indicates very 
slight action of the saliva, the amount of maltose found in the 
stomach fluid being but a trifle more than one fourth the amount 
obtained after an ordinary test meal. The amount of soluble 
starch and dextrin was less than half the normal amount in the 
case of the raw flour, and but little more in the case of the 
raw wheat. 
Another point of interest is the increased amount of lactic 
acid found in the test meal taken without chewing, represented 
in column 2. The coefficient of fermentation which represents 
the number of milligrams of lactic acid (expressed in terms of 
HC1) found in 100 c.c. of stomach fluid, was more than double 
1 A considerable portion of the following facts have been presented in another paper 
entitled, “Experimental Research Relating to Salivary Secretion and Digestion,” 11 
that found after the same kind of test breakfast properly masti- 
cated, represented in column i. The results of this experiment 
distinctly associate fermentation with imperfect mastication and 
imperfect salivary digestion. 
Another fact noted in a comparative study of the results of 
the analyses of over five thousand stomach fluids, which very 
strongly confirms this idea, is that starch conversion is. usually 
complete in cases of apepsia, while lactic acid is conspicuous by 
its absence. In nearly all cases of apepsia which I have en- 
countered, numbering about forty in all, the most delicate tests 
for lactic acid have failed to show its presence except in the 
most minute quantities ; in most cases it was entirely absent. 
Another fact of perhaps even greater interest has relation to 
the digestion of albumen when the wheat was eaten raw, in the 
form of either flour or wheat. The coefficient of proteid diges- 
tion in both cases, as is shown in columns 3 and 4, was 
1.00, indicating perfect elaboration of the albuminoids. From 
this it appears that raw gluten, or the proteids of wheat, is di- 
gested more perfectly when taken in a raw state than when 
cooked, the very opposite of which we have seen to be true of 
starch. 
The digestion of raw starch may take place in the intes- 
tines, by the action of the pancreatic juice, but cannot take 
place in the stomach, for the reason that the saliva has not the 
power to penetrate the cellulose envelope of the starch granule, 
and hence cannot digest raw starch. This fact coincides in a 
most interesting manner with the biological fact that man is by 
nature a frugivorous animal. In the process of ripening, the 
starch of fruits undergoes a hydration similar to that which 
takes place in cooking and in pancreatic digestion, whereby the 
insoluble starch is converted into soluble starch, dextrin, and 
sugar. This explains, also, why well-ripened fruit may be eaten 
raw with impunity, while unripe and farinaceous foods of all 
kinds require cooking. In his diet, man, like his nearest rela- 
tive, the monkey, being naturally a frugivorous animal, may eat 
fruits in the state in which nature has provided them ; but when 
he introduces other natural products into his bill of fare, he 
must adopt artificial means for securing the preparation for 
digestion which nature makes in the ripening process of fruits. 12 
The coefficient of chlorin liberation (m) is very nearly uni- 
form, indicating that the hnastication and the cooking of food 
have little influence upon this digestive function. 
The coefficient of salivary activity (y) was determined inde- 
pendently for each test breakfast. Its practical uniformity indi- 
cates that there was no essential change in the character or 
quality of the saliva to account for the differences shown by the 
totals in relation to the stomach digestion of starch. 
THE INFLUENCE OF MOIST AND DRY FOOD UPON SALIVARY 
SECRETION. 
A series of experiments made to determine the influence of 
moist and dry food, natural food-flavors, and condiments or un- 
natural food-flavors upon salivary digestion, developed very 
striking and unexpected results, which I quote from another 
paper in which the outcome of these researches is presented 
in greater detail :— 
The quantity of food or fluid was, in each case, thirty 
grams. The food, whether solid or fluid, was taken into the 
mouth in small portions and chewed for a few seconds, when, 
being rejected from the mouth, it was received into a small ves- 
sel for weighing. The length of the experiment with each 
substance lasted exactly five minutes. The difference in weight 
between the substance after chewing and before, represented 
the amount of saliva which had been added to it during masti- 
cation. I may add that the solid food used was granose, a dry 
and well-cooked preparation of wheat in thin flakes. 
Thirty grams, or one ounce, of granose increased in weight 
59.79 grams, or two ounces. 
Thirty grams, or one ounce, of granose, with two grams of 
common salt, increased in weight 58.80 grams, or a little less 
than two ounces. 
Thirty grams, or one ounce, of granose sprinkled with pepper 
increased in weight 59.1 grams, or not quite two ounces. 
Thirty grams, or one ounce, of granose, with 5 c.c., of strong 
cider vinegar, increased in weight 55.9 grams, or about one and 
five-sixths ounces. 
Thirty grams, or one ounce, of moist bread increased in 
weight 31.1 grams, or one ounce, 13 
Thirty grams, or one ounce, of raw apple increased in 
weight 38.1 grams, or one and one-fourth ounces. 
Thirty grams, or one ounce, of water increased in weight 
2.92 grams, or one tenth of an ounce. 
Thirty grams, or one ounce, of milk increased in weight 2.82 
grams, or one-eighth ounce. 
Thirty grams, or one ounce, of pea soup increased in weight 
5 82 grams, or one-fifth ounce. 
Paraffin chewed for five minutes produced 20 c. c. of saliva, 
or two thirds of an ounce. 
The facts developed by the above-mentioned experiments 
furnish the foundation for most important therapeutic rules for 
the management of digestive disorders. It will be noted, on the 
one hand, that one ounce of dry granose chewed for five min- 
utes so stimulated the activity of the salivary glands as to enable 
them to produce almost exactly two ounces'of saliva, or three 
times the amount normally secreted by the young man who was 
made the subject of the experiment; on the other hand, the 
amount of saliva secreted when water was passed through the 
mouth amounted to a little less than 3 c. c. in five minutes, or 
about one seventh of the normal amount. With dry granose the 
amount of saliva secreted was more than twenty times as great as 
with water. 
With moist- bread the amount of saliva secreted was almost 
exactly half that with dry granose. 
With milk the amount of saliva produced was only about one 
third more than that produced with pure water. 
With pea soup the quantity was just twice as great as with 
water, but the amount was still only one tenth the amount pro- 
duced with dry granose. 
This fact places before us in the most graphic and emphatic 
manner the necessity for the use of dry food in cases of salivary 
indigestion. Instead of feeding our patients with malt, pancrea- 
tin, diastase, and predigested foods, we have only to require 
them to chew dry food ; and in so doing they will develop in 
abundant quantity a starch-digesting ferment of greater value, 
because better adapted to the human stomach, than 
any possible artificial digestive agent which could be adminis- 
tered. 14 
The use of “slops” is one of the most common dietetic 
errors among the American people. The American eats in a 
hurry, rinses down his food with copious draughts of tea, coffee, 
iced water, iced milk, or iced tea, and in consequence the 
salivary glands are not stimulated to proper activity, and so the 
amount of saliva produced is altogether inadequate to digest the 
starchy elements of food in the acid medium of the stomach 
contents, and the small amount produced is so diluted that its 
efficiency is greatly impaired. What wonder that starch indi- 
gestion is coming to be an almost universal complaint, as shown 
by acidity, eructations of gas, flatulence, and a great variety 
of stomach disturbances, to escape from which multitudes are 
continually swallowing quantities of magnesia, soda, neutraliz- 
ing cordials, and alkaline mineral waters of various sorts, to- 
gether with malt extracts and other digestants ? 
The inability to'digest starch is doubtless one of the great 
causes of the inordinate consumption of beef and other animal 
products to which the average American has come to be ad- 
dicted, not altogether in imitation of his English cousin, but as 
a method of escaping the pangs of starch indigestion. 
The abundant provision made in the human body for the 
digestion of starch, —first, the saliva ; second, the bile and pan- 
creatic juice ; third, the intestinal juice ; and finally,the liver, 
— is evidence that nature intended man to subsist largely upon 
farinaceous foods. The arguments of the “natural food” ad- 
vocates, who insist that man should live upon fruits and nuts, 
are based, not upon physiological facts, but upon the patho- 
logical experiences of the disciples of this doctrine. The writer 
having an opportunity, a year or two ago, to examine the stom- 
ach fluid of one of the most earnest and stalwart advocates 
of the fruit-and-nut diet, found the stomach greatly dilated, 
and almost completely inert. 
I have cured many scores of chronic and very obstinate 
cases of dyspepsia by simply requiring the patient to subsist 
upon a dry diet, whereby he was compelled to thoroughly 
masticate his food. A favorite prescription with the writer, 
which is applicable to most cases of indigestion, is two or three 
ounces of dry granose at the beginning of each meal. This 
introduces into the stomach an abundant quantity of saliva, 15 
— probably from four to six ounces in most cases,— and in- 
sures efficient starch digestion in cases of both hypopepsia and 
hyperpepsia. It also serves to mitigate the acidity of hyper- 
pepsia, and operates to prevent fermentation by the rapid so- 
lution and conversion of the farinaceous elements, thereby 
promoting their absorption. I am inclined also to the opinion 
that the maltose produced by the salivary secretion exercises in 
some way a controlling and beneficial influence on the processes 
of stomach digestion. The density of the stomach contents 
must have something to do with the chemical changes which 
occur during digestion. The presence of maltose in proper 
quantity may be the means of aiding glandular activity and 
absorption. 
This is a subject which I am endeavoring to investigate, 
and upon which I hope to be able to throw some light by further 
experiments. 
At a recent meeting of the American Medical Association, in 
a discussion which occurred upon a paper read by the writer, in 
which vinegar had been condemned on account of its powerful 
inhibitory influence upon salivary digestion, one of the speakers 
suggested that the stimulating effect of vinegar upon the salivary 
glands, thereby promoting the secretion of saliva, might more 
than counterbalance the inhibitory influence of this condiment, 
— in other words, the extra amount of saliva produced by the 
vinegar might more than balance the lessened activity of the 
secretion resulting from the presence of this acid. The same 
thought was expressed in reference to salt, pepper, and other 
condiments. I consequently subjected this matter to experi- 
ment, with the results already stated in this article. The 
amount of saliva secreted when salt, pepper, or vinegar was 
added to the granose, was in each case less than when the 
granose was taken by itself. In the case of vinegar the deficiency 
was much greater than with the other condiments. 
We see from this that dryness is the property in food which 
stimulates the salivary glands to activity. A perfectly dry food 
excites the maximum amount of activity. The degree of stimu- 
lation produced by a dry food, such as granose, is indeed sur- 
prising, the amount of saliva secreted during the five minutes 
required for the mastication of the somewhat bulky granose (the 16 
young man masticated the food as rapidly as possible, ejecting 
it from the mouth as soon as it became well moistened) being 
twice the weight of the granose itself. The slightly lessened 
stimulating effect observed when pepper was added was probably 
accidental, as the figures agree as nearly as three experiments 
with granose alone would be likely to agree. However, the 
amount with vinegar is perceptibly less, showing that nature 
does not propose to waste energy in secreting saliva to be 
spoiled ; in other words, a substance which destroys the activ- 
ity of the fluids produced, is not capable, apparently, of pro- 
moting the activity of the salivary glands in the secretion of 
saliva. I do not undertake to lay this down as a general prin- 
ciple, but it seems to hold good in relation to vinegar at least. 
I have planned an extension of this experiment as a side-line of 
this interesting inquiry. 
Another experiment of interest in the same connection was 
made for the purpose of determining the relative value of natural 
flavors ; that is, such flavors as are found in natural and whole- 
some foods, in stimulating the secretion of saliva. 
The mastication of an ounce of apple within five minutes 
produced 34 c. c. of saliva, 3 c.c. more than was produced in 
the mastication of moist bread. The proportion of water in the 
apple was certainly not less than that in the moist bread, neverthe- 
less a larger amount of saliva was secreted, resulting doubtless 
from the stimulating effect of the natural flavors of the apple. 
I have not space in this paper to go further into the prac- 
tical deductions which may be drawn from these experiments. 
The subject is a comparatively new one, as almost no experi- 
mental work has been directed toward it, probably in conse- 
quence of the generally received assumption that the activity of 
the saliva upon the food ceases as soon as it enters the stomach. 
More recently developed physiological facts in relation to sali- 
vary digestion, which are very clearly stated by Freirichs, 
Ewald, Gamgee, and other excellent authorities, must lead to 
a revolution, not only in relation to our way of looking at stom- 
ach digestion, but also in relation to the therapeutics and die- 
tetics of a large class of digestive disorders. 
The extensive use of malt preparations of various kinds and 
the benefit recognized by many physicians, arising from the em- 17 
ployment of diastatic ferments, substantiate the statement pre- 
viously made in this paper that the inability to digest starch is 
one of the most common conditions existing among dyspeptics. 
In the examination of more than fifty-three hundred stomach 
fluids, I have found that the conversion of starch was complete 
in less than three hundred cases, and in quite a large number 
of cases there has been chemical evidence of little or no conver- 
sion. It is evidently, then, a matter of importance to know what 
substances, if any, interfere with starch digestion. The fol- 
lowing is a brief resume of the observations which I have made 
upon this point: — 
EXPERIMENTS RELATING TO SUBSTANCES WHICH IMPEDE 
STARCH DIGESTION. 
Oxalic acid: Time. 
i—io,ooo No action. 
1-15,000 , . 35 minutes. 
1-20,000 19 “ 
1-30,000 4 
Lemon juice : 
1-200 No action. 
1-500 42 minutes. 
1-2,000 9 “ 
1-5,000 7 “ 
Orange juice: Time. 
i-200 ii minutes. 
l-5°° 4 “ 
Apple juice : 
i-5o 45 “ 
1-200 4 “ 
Vinegar : 
1-200 No action. 
• . 40 minutes. 
Experiments were also made for the purpose of determining 
comparatively the influence of the same substances upon the 
action of malt diastase upon starch. The preparation of dias- 
tase used was a malt extract, one c.c. of which was capable of 
completely converting one-tenth gram of starch in two minutes. 
The following were the results : — 
Oxalic acid : Time. 
1-2,000 No action. 
1-5,000 , . 5 minutes. 
1-10,000 2 “ 
Lemon juice : 
i-io No action. 
1-200 2 minutes. 
Apple juice : 
X-IO 2 minutes. 
Vinegar: Time. 
i-io io minutes. 
1-200 2 “ 
Hydrochloric acid : 
1-4,000 No action. 
Lactic acid : 
1-200 No action. 
1-2,000 5 minutes. 18 
Several points of interest may be deduced from these ex- 
periments. A few may be briefly mentioned : — 
i. Acids of all kinds inhibit the diastatic action of both 
saliva and malt, but human saliva is very much more suscep 
tible to the inhibitory action of acids than is malt. 
We find here an explanation for the observation previously 
made by patients, that sour fruits disagree with them ; but to 
test the matter further, I administered a number of experi- 
mental breakfasts in which vinegar and other acids were added 
to the stomach fluid. When one-half ounce of vinegar was 
added to the meal, it was found that the coefficient of starch 
digestion was reduced to .64. With the juice of one lemon, the 
coefficient was reduced to .29. 
These experiments show very clearly that vegetable acids 
as well as the acids of the gastric juice have a decidedly de- 
terrent effect upon starch digestion, and hence that they must 
be withheld in cases in which the digestion of starch is per- 
formed imperfectly or with difficulty. It is also apparent from 
the observations previously made that it is in cases of hyper- 
pepsia especially that acids must be withheld, since in hyper- 
pepsia starch digestion is already more or less interfered with 
by an excessively acid gastric juice. 
The observations of Roberts, as well as my own, show that 
tea and coffee inhibit the action of the saliva upon starch to a 
very remarkable extent. Brinton, Wolff, Debove, and Reymond 
all assert that caffein diminishes the activity of the peptic 
glands, which accounts for the deleterious effect of tea and coffee 
upon digestion. 
Gerard has shown that chloride of sodium, when taken in 
excessive quantities, interferes with gastric digestion by provok- 
ing a profuse secretion of mucus, whereby the gastric juice is 
neutralized and its action upon the food impeded. 
PEPTOGENS VERSUS DIGESTIVE FERMENTS. 
With reference to substances supposed to aid digestion, it is 
surprising that so small an amount of attention has been given 
experimentally to the influence of pepsin upon digestion, when 
the enormous quantities of this and other digestive agents used 
are taken into consideration. 19 
Some years ago Mosso, by experiments upon a dog, deter- 
mined that the stomach of a dog of ordinary size was able to 
furnish pepsin enough to digest seventy kilograms, or 165 
pounds, of albumen. This fact was ascertained by passing 
through the dog’s stomach 2000 litres of water, acidulating the 
same with hydrochloric acid, and determining its degree of diges- 
tive activity. 
More recently, Georges has demonstrated that the use of 
pepsin is absolutely valueless in cases of insufficiency of the 
gastric glands. The wines of pepsin, papaine, and pancreatin, 
either with or without hydrochloric acid, are, according to .De- 
bove and Reymond, valueless to supply a deficiency of pepsin 
formed by the glands in the stomach. My own observations 
agree exactly with those of the authorities mentioned, in this 
respect. 
After having employed pepsin for many years, on the strength 
of authority, I have for some time past abandoned its use alto- 
gether, along with other digestive ferments, with the exception 
of malt, having been utterly unable to see any good results what- 
ever from its use. What the stomach requires in cases of inac- 
tivity of the gastric glands, is, not a substitute for the normal 
product of these glands, but an increase of the activity of the 
glands. Peptogens are needed rather *than peptones, pepto- 
noids, or pepsins. Proteid substances are the best of all pepto- 
gens. The natural flavors of foods and the dextrin developed 
by the action of the saliva upon starch are also peptogens of the 
highest value. The fact last mentioned furnishes another plea 
for the use of dry foods by dyspeptics, thus securing thorough 
mastication. 
In an experiment which I made to determine this point, it 
was found that the quantity of hydrochloric acid present in the 
stomach fluid after a well-masticated meal, consisting of water 
biscuit and water, was nearly double (or an increase from .028 
to .05 milligrams per 100 c.c. of stomach fluid) that obtained 
after a test meal which was not masticated, from which it ap- 
pears that thorough mastication encourages the production of 
HC1, as well as pepsin. 
One of the very best of all peptogens is gluten. Eggs and 
milk are also peptogenic substances of value, particularly eggs. 20 
The peptogenic power of gluten is well shown in the following 
cases:— 
After an ordinary test meal the amount of free HC1 was 
found to be .046 per 100 c. c. of stomach fluid ; the amount of 
combined chlorin, .232. In a test meal consisting of one 
ounce of water crackers eaten dry, and one ounce of gluten 
mixed with water and swallowed directly afterward, the amount of 
HC1 was found to be .064 per 100 c. c., and combined chlorin, 
.284, or an increase of forty per cent. In another instance the 
amount of free HC1 was increased from .036 to .130, or 266 
per cent, and the total acidity was increased from .260 to .354. 
In a second meal, consisting of one ounce of pure gluten 
well chewed, dry, and eight ounces of water swallowed after- 
ward, the total acidity was increased from .260 to .398, the com- 
bined chlorim from .216 to .294, and the free HC1 from .036 to 
.046. No better evidence of the peptogenic properties of gluten 
could be asked for. 
The popular idea that pepper, mustard, and similar sub- 
stances increase digestive vigor has been shown by experiments 
to be erroneous. These substances, like common salt in excess, 
increase the flow of mucus without increasing the production 
of pepsin or hydrochloric acid. The production of pepsin and 
hydrochloric acid can be increased only by natural stimuli; 
that is, the peptogenic substances which nature puts into our 
food. These consist: (1) Of proteid substances which are in- 
tended to be digested by the action of pepsin and hydrochloric 
acid ; (2) Of dextrin, the substance which naturally precedes 
peptone in the order of production in the digestive process; 
and, (3) Of food-flavors which by their reflex action increase the 
activity of all the digestive glands, as a preparation for the 
digestive act. 
The secretion produced by mustard, pepper, pepper-sauce, 
and similar substances is for protective purposes only, the stom- 
ach pouring out a quantity of mucus which is spread over the 
mucous surface to protect it from the action of these abnormal 
and irritating substances. Alcohol, which has been supposed 
to be so beneficial to digestion, my experiments show to be 
equally destructive and injurious. This is well shown by the 
following experiments : — 21 
The subject was a young man aged nineteen years. The 
analysis of stomach fluid, with the usual test breakfast and with- 
out brandy, gave the figures shown in the following comparative 
table, which relate to the number of milligrams of chlorin 
expressed in HCI found in 100 c.c. of filtered stomach 
liquid:—- 
Usual Test 
Breakfast. 
Usual Test 
Breakfast 
with 4 oz. 
of Claret. 
Usual Test 
Breakfast 
with 2 oz. 
of Brandy. 
grms. 
grms. 
grms. 
Total acidity 
.240 
.086 
.016 
Total chlorin 
.328 
.2l6 
.306 
Free HC1 
.032 
.OOO 
.000 
Combined chlorin 
.268 
.120 
•034 
Fixed chlorin 
.098 
. I l6 
.172 
Coefficient 
•77 
.72 
•47 
Peptones and propeptones were found to be notably dimin- 
ished in proportion to syntonin in the stomach fluid contain- 
ing brandy. 
These experiments were repeated upon different persons, and 
with alcohol in different forms, as gin, brandy, wine, etc., the 
quantities being made such that the same amount of alcohol, 
about one ounce, should be taken in each case; and the results 
were found to be practically uniform, and essentially the same 
as have been given above. The accompanying comparative 
table shows very clearly the great diminution in the chem- 
ical activity of the stomach produced by alcohol. By a careful 
study of the table, it will be noticed that the young man who 
was the subject of the experiment had a more than normally 
active digestion. There is no excess of free hydrochloric acid, 
but an unusually large amount of combined chlorin, indicating 
what might be considered a physiological hyperpepsia, since the 
quality of the work done was but slightly below the normal stand- 
ard, as shown by the value of the coefficient a. Four ounces of 
claret caused the complete disappearance of the free HC1, di- 
minished the combined chlorin ipore than fifty per cent, and 
also diminished the quality of the digestive work done. The 
test made with the two ounces of brandy shows almost a com- 
plete paralyzing of the stomach, or apepsia. The free HCi 22 
disappeared entirely ; and the combined chlorin, representing 
the useful stomach work, was reduced to .034, or one eighth 
the amount done under normal conditions. This influence 
upon the digestion is exactly what would be expected of a drug 
like alcohol, which is a paralyzer of protoplasmic activity, an 
anesthetic, and a sedative — and not a stimulant, as has been 
erroneously supposed. It should be added that each prepara- 
tion of alcohol was diluted with water, so as to make exactly 
eight ounces of fluid in each case. 
STUDY OF THE GERMS OF THE STOMACH. 
Still another question of interest which I have made the 
subject of experimentation is the relation of food to fermenta- 
tion. My experiments in this line are yet (December, 1895) 
incomplete, but one or two facts of interest may be noted. 
The relation of a coated tongue to indigestion, especially that 
form frequently termed “biliousness,” is universally recog- 
nized. It is equally well known that the appearance of the 
tongue when coated is due to a growth of micro-organisms. 
The tongue is coated, not out of sympathy with the stomach, as 
was formerly supposed, but in consequence of the development 
upon it to an abnormal extent of micro-organisms in connec- 
tion with a similar abnormal development of micro-organisms 
in the stomach. A bad taste in the mouth is due to the devel- 
opment of ptomains which are not only disagreeable in flavor, 
but toxic in character. The absorption of these ptomains 
from the stomach gives rise to headache, vertigo, mental con- 
fusion, and the great variety of other symptoms of which bilious 
persons complain. 
Studies which I have made with reference to the relation of 
conditions of the stomach to urinary toxicity, lead me to be- 
lieve that many symptoms which are attributed to morbid states 
of the nervous system, are really due to autointoxication grow- 
ing out of morbid conditions in the stomach, which are, to 
some degree, at least, indicated by a low coefficient of albumen 
digestion. A low coefficient indicates not only imperfect diges- 
tion of albumen, but the production of a proportionately large 
quantity of vitiated albuminoid substances which ar$ worthless 23 
for nutrition, and which appear to possess toxic properties, 
giving rise to languor, drowsiness, headache, nervousness, 
and possibly also to neuralgia, rheumatic pains, and other 
symptoms commonly recognized as belonging to the arthritic 
diatheses. 
Within the last few months we have undertaken in the Labo- 
ratory of Hygiene connected with the Battle Creek Sanitarium, 
under the supervision of Professor Novy, of the University of 
Michigan, an extensive investigation of the microbic life of the 
stomach, for the purpose of determining, if possible, what re- 
lation there may be between microbes in general or any specific 
microbe or group of microbes and the various pathological con- 
ditions of the stomach, particularly in such functional disorders 
as biliousness, migraine, catarrh of the stomach, etc. Dr. 
Turck, of Chicago, has been for some years engaged in this line 
of investigation, and has developed some most interesting and 
important results. I am giving particular attention to the study 
of the subject in connection with the peculiar idiosyncrasies 
which patients frequently present in reference to such articles of 
food as milk, fats, meat, starch, etc. 
An interesting fact was developed at the beginning of this 
investigation which I wish especially to mention, as it emphasizes 
most decidedly one point relating to the hygiene of digestion 
and the therapeutics of indigestion. The first step in the inves- 
tigation was to become familiar with the microbes which are 
normally found present in the stomach. Several healthy young 
men were accordingly selected, and test breakfasts, each con- 
sisting of one and one-half ounces of granose, a thoroughly 
sterilized preparation made from entire wheat, mixed with eight 
ounces of water, were administered. From nine stomach 
fluids obtained after this meal, only two cultures were ob- 
tained, seven of the stomach fluids having been found per- 
fectly sterile. In the two instances in which microbes were 
found, they were very few in number. The test meal was then 
changed, and water biscuit, consisting of flour and water baked 
in small cakes, were substituted for granose. Germs in great 
abundance, with yeast germs of various sorts, at once appeared. 
Ordinary fermented bread and similar foods likewise gave plenty 
of microbes in nearly every case. 24 
Since the above observation was made, careful bacteriolog- 
ical examination has revealed the total absence of germs in more 
than twenty additional cases. In fact, it may be said to be 
demonstrated that with sterilized food, no germs are to be 
found in the stomach at the end of an hour after eating. 
This experiment shows very clearly, not only that the stom- 
ach is capable of destroying the microbes which are incidentally 
introduced along with the meal, provided the food is thoroughly 
sterilized (at least in the case of a cereal food), but that the 
stomach does ordinarily do this, and hence that the action of 
microbes in the stomach is not essential to the normal processes 
of digestion. 
The chemical investigations made after the test meal are 
likewise in accordance with these results. In a case in which 
the coefficient of fermentation was found to be three, after a 
meal consisting of granose and water, the coefficient was found 
to be ten after a test meal of baker’s bread and water. 
The reason for these results was evidently due to the presence 
of yeast germs in the bread, as the material was the same,— 
wheat in each case. Granose consists of very thin flakes which 
have been very thoroughly cooked by both moist and dry heat; 
wrater biscuit consist of ordinary flour baked in cakes half an 
inch thick, so that the interior of the cake is not exposed to a 
sufficiently high degree of heat to thoroughly sterilize it. The 
center of a loaf of ordinary baker’s bread likewise does not 
reach a sufficiently high temperature during baking to destroy 
the microbes which are always present, being contributed by 
the yeast and flour, as well as by the water used in making the 
bread. 
Recent studies which I have undertaken for the purpose of 
determining the relation of such germ-infected foods as cheese, 
meat, unwashed fruit, etc., have given some very interesting re- 
sults. For example, in the case of cheese, with which five 
experiments were made, the stomach fluid, though practically 
sterile, gave rise to more than 17,000,000 colonies for one ounce 
of stomach fluid. Scraped beefsteak, in the condition usually 
furnished for table use, gave 788,580 colonies. Unwashed fruit 
(grapes) gave 535,240 colonies. Fermented yeast bread gave 
rise to 45,300 colonies. 25 
In a future paper I hope to be able to present many inter- 
esting facts upon this branch of the subject. 
The technical portion of the bacteriological work done in 
connection with these studies has been done by Dr. Geo. W. 
Burleigh, bacteriologist of the Battle Creek (Mich.) Sanitarium, 
with the collaboration and assistance of Prof./F. G. Novy, M. D., 
professor of bacteriology in the University of Michigan, and a 
bacteriologist of large experience. 
Out of many hundreds of experiments which have been 
carried out in the Sanitarium Laboratory of Hygiene. I have 
given only a few as illustrative of facts which may be gathered 
by this mode of study. The conclusions to which I have ar- 
rived as the result of their investigations thus far, may be briefly 
summarized as follows : — 
1. The stomach digestion of starch is an important digestive 
function, and one which requires consideration in the treatment 
of dyspepsia. 
2. The best means of promoting salivary digestion is the use 
of dry food and its thorough mastication. 
3. The use of strong acids, even vegetable acids, is preju- 
dicial to the digestion of starch in the stomach. 
4. Thorough sterilization of food is important as a means of 
aiding the stomach in ridding itself of microbes. 
5. The use of vinegar, condiments, tea, coffee, and alcohol 
is prejudicial to both salivary and gastric digestion. 
6. Pepsin and other digestive agents, with the possible ex- 
ception of the diastase of malt, are practically valueless as aids 
to digestion. 
INFLUENCE OF MALT UPON STOMACH DIGESTION. 
I have made a possible exception of malt in my statement 
respecting digestive ferments, for the reason that we find 
rare cases in which the saliva is so deficient in quality, even 
though abundant in quantity, that its digestive work must be 
very imperfectly performed. in such cases the use of malt in 
liberal quantities might prove beneficial. However, by com- 
parison of the digestive activity of malt with that of saliva, by 
Roberts’s method of diastasimetry, I have found that two parts 
of average saliva are equal in digestive vigor to one part of 26 
malt; hence all the good effects which may be obtained from 
malt, so far as its digestive qualities are concerned, may be 
obtained by a little extra mastication of food, thus securing a 
more liberal admixture of saliva. 
I do not wish to be understood, however, as indicating that 
malt may not be otherwise beneficial. It is unquestionably an 
excellent food, and doubtless aids in some way in promoting the 
digestive process, either as a peptogen or as a regulator of the 
process of absorption. 
A young man whose stomach fluid after a meal consisting of 
one ounce of gluten mixed with eight ounces of water and swal- 
lowed, gave the following figures : Total acidity, .248 ; free HC1, 
.076 ; combined chlorin, .184, furnished after a meal consisting 
of one ounce of liquid malt mixed with one ounce of gluten and 
the usual quantity of water, a stomach fluid giving the following 
figures : Total acidity, .340 ; free HC1, .132 ; combined chlorin, 
.190, an increase of free HC1 in this case of nearly eighty per 
cent, and also an increase of combined chlorin, which could 
be attributed to nothing except the malt, thus demonstrating 
very clearly the peptogenic property of the malt. 
In another paper now in preparation, of which this is a brief 
abstract, prepared for this occasion, I hope to present, by 
means of a detailed report of a large number of experiments, 
the views which are scarcely more than hinted at in this paper, in 
a clearer light, and, if possible, with still more conclusive facts. 
The interesting researches relating to the chemistry of di- 
gestion which have been conducted in Germany within the last 
few years, by Boas, Ewald, Leube, and others, and the consid- 
erable degree of success which has attended the application of 
these results to therapeutics, has recently created an unprece- 
dented interest in a class of disorders which, although exceed- 
ingly common, and perhaps invested with greater intrinsic 
importance than any other class of ailments, has heretofore 
been very greatly neglected. For some time the methods formu- 
lated by German investigators, particularly the colorimetric 
methods of Ewald and Boas, were accepted without question 
as a satisfactory means of precise diagnosis, in consequence 
of the evident advantages which they presented over methods 
in former use. Investigators in other countries, particularly in 
France and England, however, as well as practical clinicians in 27 
the leading medical centers of Germany, soon began to dis- 
cover serious defects in the practical application of these new 
methods of examining stomach fluids. This skepticism has led 
to important experimental inquiries for the purpose of deter- 
mining more accurate means of diagnosis. 
My own interest in this subject has been stimulated by a 
desire to meet to the fullest degree possible, the therapeutic 
demands of the patrons of an institution which receives annu- 
ally several thousand persons suffering from chronic ailments 
of various sorts, a large proportion of whom present some form 
of digestive disturbance. Some twenty years’ experience in the 
treatment of chronic invalids in this establishment has thor- 
oughly convinced me of the paramount importance of precision 
in diagnosis in relation to digestive disorders, not only in the 
treatment of maladies generally recognized as having their seat 
in the stomach, but in various dyscrasies and chronic maladies 
which, until very recently, at least, have not been recognized 
as having any very direct relation to digestive derangements. 
My purpose in this paper has been to call attention to the 
accurate methods which are now available in the study of the 
functional disorders of digestion through the exact chemical ex- 
amination of the stomach fluid obtained after a test meal, and to 
the interesting experimental inquiries which these methods en- 
able us to undertake, whereby it is possible to ascertain exact 
facts of great importance in relation to the hygiene and thera- 
peutics of this very large class of ailments. 
In the great majority of cases,— and usually those in which 
the greatest and most rapid improvement has taken place,— I 
am not able to show the results by comparison of the analyses 
of stomach fluids, for the reason that only one examination was 
found necessary, and the patients, being satisfied with their im- 
provement, did not care to submit to a second examination 
merely for scientific purposes. A second examination has been 
made, however, in 516 cases, and in 127 cases, more than two 
examinations have been made, so that I have had abundant 
opportunity not only to test the accuracy of the method, but to 
demonstrate its value as a guide in the application of therapeutic 
measures. However, I might append many scores of cases as 
illustrative of the excellent therapeutic results obtainable by 
the employment of this exact method of directing therapeutic 28 
effort. But as this paper is already longer than I desired to 
make it, I will only add the following briefly stated cases, as 
illustrative of the practical results obtainable after the failure 
of other methods : — 
The patient, Mr. C , a professional man, aged forty-two 
years, had suffered for a number of years from disturbances of 
digestion, which had finally reduced him almost to a skeleton, 
and rendered him incapable of pursuing his ordinary profes- 
sional duties. After consulting numerous specialists, and em- 
ploying all the means within his reach, he finally came to the 
Battle Creek Sanitarium. On examination, the patient was 
found to be suffering from marked dilatation of the stomach, 
with considerable hyperesthesia of the lumbar ganglia of the 
sympathetic and the solar plexus ; was very anemic, the blood 
count being 4,880,000 ; was unable to digest anything. Within 
a few hours after taking food into the stomach, the patient in- 
variably began to suffer pain in the left temple, which gradually 
increased until he became nearly beside himself. Relief was 
obtainable only by evacuation of the stomach. The stomach 
was unable to tolerate the smallest amount of free fat, and its 
aversion to starch in any form was almost equal. The results 
of the examination of the stomach fluid at the beginning of 
treatment, and again four months later, are shown in the table 
below. In the first column are given the results of the first ex- 
amination; in the second column, those obtained in the last 
examination. A number of examinations were made during 
the four months the patient remained under treatment, most of 
which showed progress in the direction of improvement: — 
Case I. 
Normal quantities. 
1. 
2. 
Total acidity 
.232 
.184 
Calculated acidity 
44 44 
.300 
.182 
Total chlorin 
.... (.300-.330 “ ) 
.418 
.366 
Free IIC1 
(.025-.050 “ ) 
• °S4 
.030 
Combined chlorin . 
.... (.155-. 180 “ ) 
.246 
•152 
Fixed chlorids 
.114 
.184 
Coefficient of albumen digestion 
... (1.00) 
.70 
1.00 
“ “ starch 
.... (1.00) 
.67 
.46. 
“ “ salivary activity 
.... (1.00) 
2.00 
•5° 
Fermentation 
6. 
3- 
Chlorin liberation 
X.IO 
• 75 29 
By a comparison of the figures given in columns i and 2, it 
will be noted first, that the patient was suffering at the beginning 
of treatment with extreme hyperpepsia, the calculated acidity 
being 50 per cent higher than normal. It will also be noted 
that the coefficient for the digestion of albumen was 30 per cent 
below normal, indicating the development of a large amount of 
toxic albuminoid substances in the stomach from the imperfect 
digestion of proteids, a fact which could be ascertained in no 
other way except by this method of investigation. 
The figures given in column 2 indicate a return to the nor- 
mal standard in the most important particulars. Both the total 
acidity and the calculated acidity are normal. The amount of 
free HC1, which in the first examination was nearly forty per 
cent, above normal, was practically normal. The coefficient of 
albumen digestion was normal, and the coefficient of chlorin 
liberation, which was 10 per cent too high in the first examina- 
tion, was even a little below normal. The coefficient of starch 
digestion was below normal, being even lower than at the first 
examination. This was evidently due to a temporary change in 
the efficiency of the saliva, which happened to be at this time 50 
per cent, or one fourth that found in the first examination. I 
know of no reason for this change, but have frequently noted a 
fluctuation of this kind in the digestive power of the saliva. I 
find that the saliva, like the gastric juice, is variable in quality, 
in rare cases presenting a degree of efficiency ten or twelve 
times the normal, while in other cases it is much below the 
normal standard. So great a variation as this, however, is not 
observed in individual cases, although cases are not infrequently 
encountered in which the saliva shows at times double or even 
more than double the efficiency which it does at other times. 
Improvement in the patient’s general symptoms was as great 
as that indicated by the examination of the stomach fluid. He 
gained nearly twenty pounds in flesh, was relieved of the head- 
ache, no longer required the use of the stomach-tube, and was 
wonderfully improved in general vigor. He still, however, 
found it necessary to exercise great care in diet, on account of 
the permanent disability resulting from the extreme dilatation 
of the stomach. The important things to be gained in a case 
of this kind are the correction of morbid processes in the stom- 
ach, improvement, so far as possible, in the muscular tone of 30 
the organ, and the establishment of a dietary adapted to the 
patient’s condition. 
Case II. 
Miss C—■—, aged thirty; received into the institution Aug. 
20, 1895 The leading symptoms presented were distention 
after eating, accompanied by nervousness, depression, head- 
ache, giddiness, palpitation of the heart, disturbing dreams, 
thickly coated tongue, sour and offensive breath. The patient 
was thin in flesh, weak, and unable to continue the duties of 
her profession. Examination of the blood showed the hemo- 
globin to be 79 per cent of what it should be, and the blood 
count 4,400,000. 
The results of the examination of the stomach fluid at the 
beginning of treatment, and again after a few weeks’ treatment, 
are shown in the following table : — 
Normal quantities. 
1. 
2. 
Total acidity 
(. I80-.200 gms.) 
. 100 
.174 
Calculated acidity 
<4 44 
.100 
.270 
Combined chlorin 
Cn 
Cn 
J 
CO 
0 
.170 
.270 
Coefficient of albumen digestion 
•55 
.67 
“ “ starch 
(coo) 
•55 
.71 
Fermentation 
5- 
0. 
The physical condition of the patient had improved corre- 
spondingly in every respect. The stomach, which was at first 
prolapsed two inches below the umbilicus, was restored to nor- 
mal position. The improvement in the blood was shown by an 
increase of hemoglobin to 93 per cent. The fermentation had 
disappeared, and the amount of work done by the stomach 
in the digestion of albumen had nearly doubled, while the 
starch digestion had improved nearly 30 per cent. The patient 
was discharged practically well, with the understanding that she 
would continue to exercise care in regard to diet, and should 
for some time longer employ such exercises and simple measures 
of treatment as had been found advantageous. 
Mrs. H , aged fifty-one years. The patient was much 
emaciated, having been a chronic invalid for many years, suf- 
fering from eructations of gas, regurgitation of food, nausea, 
Case III. 31 
daily pain, burning, faintness, heaviness at the stomach, aortic 
palpitation, gaseous distention of the bowels, constipation, 
drowsiness after meals, morbid taste, dryness of the throat, ac- 
companied by great thirst. On examination of the stomach, it 
was found to be prolapsed three inches below the umbilicus, 
the patient having an inguinal hernia on her left side. The 
right kidney was prolapsed. The patient had suffered from 
most of the symptoms present for fourteen years. The liver 
was prolapsed to the umbilicus, and had been mistaken for an 
ovarian tumor. The patient suffered frequent attacks of jaun- 
dice, accompanied by intense itching of the skin; had' been 
steadily losing flesh for a long time. The hemoglobin was 
found to be 70 per cent of the normal. The results of the first 
examination of the stomach fluid in this case are shown in col- 
umn 1 of the following table ; the results of the second exami- 
nation, made a few months later, are shown in column 2 : — 
Normal quantities. 
J. 
2. 
Total acidity 
.020 
.080 
Calculated acidity 
it a 
.086 
.112 
Total chlorin 
.... (.300-.330 “ > 
.238 
.128 
Coefficient of albumen digestion 
.... (I.OO) 
•23 
•71 
This patient’s case required not only long and faithful treat- 
ment, but also an operation for the cure of the inguinal hernia, 
and for the restoration of the kidney to normal position by 
nephrorrhaphy. While operating upon the hernia, the oppor- 
tunity was improved to replace the stomach, suturing it in 
such a position as to support the liver also. The stomach was 
held in position by buried silkworm-gut sutures, carefully ster- 
ilized, and did not give any apparent inconvenience. 
As will be noted by a comparison of the figures given, the 
coefficient of albumen digestion improved more than 300 per 
cent. The total amount of normal work done by the stomach 
was proportionately increased. The patient accordingly made 
a very appreciable gain in strength, flesh, and blood. On leav- 
ing the institution, examination of the blood showed hemo- 
globin 93 per cent, blood count 4,150,000. 32 
Case IV. 
Mrs. I , aged twenty-five, a recent patient, had suffered 
for six years from indigestion, with constant pain in the 
stomach, and occasionally severe chronic pains and fainting, 
which were relieved only by an emetic. During the first year 
of her invalidism she was troubled only during the summer, 
but for the last year the stomach disorder had been constant. 
The patient complained of a bitter taste in the mouth, heavi- 
ness after meals, flatulence, severe constipation, requiring the 
daily use of the enema, giddiness, swelling of the hands and 
feet, pain in the region of the heart followed by fainting, 
extreme nervousness, insomnia, attacks of vomiting, and fre- 
quent loss of consciousness (nervous apoplexy). Pepsin, pur- 
gatives, tonics of all sorts, dieting, etc., had been employed, 
but without benefit. The patient was steadily getting worse, 
and at the time she arrived she could scarcely rise from her 
chair without assistance. The tongue was exceedingly foul. 
Examination of the blood showed marked anemia, the hemo- 
globin being seventy-five per cent, of the normal, and the 
blood count 3,700,000, or eighty-two percent, of the normal 
number. The white corpuscles were reduced to a greater 
extent than the red, there being only sixty-one per cent, of 
the normal. Physical examination of the stomach showed its 
lower border to be three inches below the normal position. 
There was extreme hyperesthesia of all the lumbar ganglia of 
the sympathetic. The patient had also some pelvic pain, 
probably due to a diseased condition of the left ovary, which 
was prolapsed and very sensitive; but this evidently had very 
little to do with the patient’s general suffering. 
Examination of the stomach fluid showed very marked 
hyperpepsia, the following figures being obtained: — 
Total acidity (A) 276 gms. 
Calculated acidify (A ) 288 “ 
Total chlorin (T) 366 “ 
Free HC1 (H) 058 “ 
Combined chlorin (C) 230 “ 
Fixed chlorids (F) 078 “ 
Maltose (M) 1.440 “ 
Dextrin and soluble starch 980 “ 
Fatty acids (from fermentation) (L) 005 “ 33 
The following figures were obtained for the coefficients: — 
a, Digestion of proteids 92 
b, Starch digestion 74 
c, Salivary activity . . 30 
Fermentation 5- 
Solution 96 
Absorption 15 
The patient was placed at once upon a dietary consisting of 
granose, a perfectly dry preparation of wheat, in thin, thor- 
oughly cooked, well-baked flakes, and bromose, a preparation 
of malted nuts in which the starch is digested and the fat 
emulsified. Lavage was ordered at the outset, and at its first 
application there was brought from the stomach an astonishing 
amount of undigested food, the result of the slow absorption. 
Before coming to the Sanitarium, the patient had been living 
upon malted milk and cream, the worst possible food for a 
person in her condition, a dry diet being indicated. A change 
of diet and the application of Swedish movements, stomach 
massage, fomentations, electricity, tonic baths, and other meas- 
ures, secured immediate relief from suffering, and by the be- 
ginning of the second week the patient showed a gain in 
flesh. At the end of three weeks she was walking several 
miles daily. She had gained in fourteen days exactly fourteen 
pounds of flesh. The dynamometer showed a total increase 
of strength amounting to 825 pounds. The patient’s cheeks 
were rosy, her lips red, eyes sparkling, and tongue clean. The 
old symptoms had disappeared, and she declared that she 
was well enough, and insisted on going home against protest, 
as a sufficient time had not yet elapsed to insure permanency 
in the improvement, except under the specially favorable con- 
ditions of a rigid regimen and carefully adjusted treatment. 
This case is introduced as an indication of what can be 
done for the relief of stomach disorders by the exact adapta- 
tion of diet, regimen, and treatment to the patient’s condition. 
Many similar cases might be cited. One lady, for example, 
gained twelve pounds of solid flesh in one week. It is more 
common, however, for patients to gain more slowly, but a 
rate of three or four pounds a week is not uncommon. A 
gentleman patient reported an increase of forty-six pounds in 34 
six weeks. A chronic dyspeptic, who had been confined to 
the bed for several months, and under the so called Salisbury 
treatment had made no progress toward recovery, gained a 
pound a day for four weeks. 
These cases might be multiplied at great length. Of be- 
tween four and five thousand cases which have been treated 
by the methods outlined in this paper, those have been very 
rare indeed which have not been greatly and rapidly benefited. 
Many instances might be recorded in which patients gained 
from ten to forty pounds of flesh within a few weeks, being 
meanwhile actively engaged in appropriate gymnastic exercises, 
— a fact worthy of mention, since flesh and blood obtained 
in connection with proper muscular work is a much more 
valuable acquisition than that secured by rest-cure methods 
alone, in which case the gain often disappears with great 
rapidity when the patient is placed upon his feet. I do not, 
however, wish to discount the importance of flesh and blood 
acquired by means of the rest-cure, as that is an invaluable 
measure when other means fail; but a gain of flesh under 
work indicates a change for the better in vital conditions, 
which gives promise of permanency in the patient’s improve- 
ment. 
Patients improve under exercise not only in flesh but in 
strength. The total strength, as tested by the dynamometer, 
has been frequently observed to increase from five hundred 
to fifteen hundred pounds in a single month. It is not an 
uncommon thing for patients to more ttyan double their total 
strength within a few weeks. 
This nice adaptation of treatment and diet to the patient’s 
condition is only possible by the aid of an exact diagnosis. 
The technical details of the method employed I shall under- 
take to give in another paper. It will 'also appear as an 
appendix to a recent work on the stomach by Debove and 
Remond, which the writer is now translating from the original 
French, and which will soon be published by the Modern 
Medicine Publishing Company.