Further Experiences with Direct Electrization of the Stomach. BT MAX EINHORN, M. D., Physician to the German Dispensary and Instructor In Clinical Medicine at the New York Post- Graduate Medical School. REPRINTED FROM tllje Kfeto ¥or& SBciical Soutnal for July 8, 189 S. Reprinted from the New York Medical Journal for July 5, 1893. FURTHER EXPERIENCES WITH DIRECT ELECTRIZATION OE THE STOMACH By MAX EINHORN, M. D., PHYSICIAN TO THE GERMAN DISPENSARY AND INSTRUCTOR IN CLINICAL MEDICINE AT THE NEW YORK POST-GRADUATE MEDICAL SCHOOL. In my paper,* A New Method for Direct Electrization of the Stomach, I put much stress on the necessity of ap- plying the electric current within the stomach—a fact which has been previously recognized by different authors. At the same time I devised a new method of direct electri- zation, which frees it of all the difficulties with which it has hitherto been connected. The novelty consists in that I employ a deglutable electrode. There is no need of my lingering on the modus operandi. The same is known to ail of you, and is fully described in the paper mentioned. About a year later I published another article, entitled Therapeutic Results of Direct Electrization of the Stom- ach ; f the same contained several experimental investiga- tions upon the effect of direct gastro-electrization on the gastric secretion in man, and besides a detailed description * Max Einhorn. Medical Record, May 9, 1891. f Ibid., Jan. 30 and Feb. 6, 1892. Copyright, 1893, by D. Appleton and Company. 2 FURTHER EXPERIENCES WITH of all the cases I had treated by direct electrization of the stomach during eighteen months. There were twenty-nine cases in which direct gastro- faradization had been applied, five in which first direct faradization and afterward direct galvanization of the stomach were administered, and one in which the galvanic current was given alone. The resume of this paper was as follows; Direct gastrofaradization proves to be useful in many ways in most chronic diseases of the stomach. The favorable results appear very clearly and pretty quickly in those cases of stomach dilatation which are not caused by any obstruction of the pylorus, but merely by the relaxation of the muscular coat of the stomach. Here the gastrofaradization is beneficial, no matter whether in these cases there is hyperacidity or sub- acidity of the stomach contents. Oases of relaxation of the cardia (eructations), and also of relaxation of the pylorus (pres- ence of bile secretion in the stomach), were very favorably in- fluenced by faradization. Here the result was most markedly pronounced, inasmuch as, besides the subjective amelioration of the patient, the objective examination showed at the same time the absence of bile in the stomach contents (there was, however, only one case of relaxation of the pylorus under observation). Direct gastrogalvanization was administered with very good results in cases of obstinate gastralgia; several of them had re- sisted every therapeutic means, but yielded to the influence of galvanization.” As I have mentioned in the above-quoted papers, the literature on the efficacy of direct gastro electrization is very scanty—i. e., very few have been treated by this method. Stockton* is the only author who has treated a larger series of cases by direct gastrofaradization. Since the publication of the two papers referred to on * Charles G. Stockton. American Journal of the Medical Sciences, 1890, p. 20. DIRECT ELECTRIZATION OF THE STOMACH. 3 direct electrization of the stomach no experiences hy other authors have thus far been communicated. Ewald * only mentions that he had very good results with direct gastro- faradization in two cases of ructus. This author recom- mends the same treatment in all those cases where the mus- culature of the stomach has to be strengthened. Ewald approves of the shape and form of my electrode, but men- tions that he finds it difficult to get down into the patient’s stomach. For this reason Ewald has modified my electrode by using a thicker rubber tubing around the wire ; the tub- ing corresponds to No. 13 Charriere, and is about a milli- metre and a half thick. J. Rave f has treated two cases of dyspepsia by direct gastrogalvanization, and speaks in favor of the deglutable electrode. I must say that the insertion into the stomach of the deglutable electrode offers no difficulties. The principal point is to put the electrode far back into the pharynx and to let the patient meanwhile drink something. It is advis- able to have the patient drink slowly about a glassful of water, and to have a talk with him, in order to detract his attention from the procedure. The electrode usually soon reaches the stomach, and it seldom happens that it remains lying in the fauces. If this does happen, the patient must eat a small piece of bread and drink some water; the elec- trode will then find its way into the stomach with the bread. I have applied the deglutable electi’ode to more than a hundred people, and met with only one who was unable *C. A. Ewald. Berliner Tclinische Wochenschrift, 1892, Nos. 26 and 27. •(• J. Rave. Contribution d Vetude du traitement des dyspepsies par Velectricite, Paris, 1893. (Henri Jouve, Irnprimeur de la Faculte de Medecine.) 4 FURTHER EXPERIENCES WITH to swallow it. In this patient I had to use an electrode with a thicker rubber tubing (analogous to Ewald’s modifi- cation) which could he pushed into the stomach. He, however, was a timid man, without any will power, who did not believe in his being able to do anything spontane- ously. When told to swallow, his reply was, “ I can not.” In all other cases the deglutahle electrode has been suc- cessfully applied. After the first application its insertion is much easier, the patient being accustomed to the pro- cedure. The principal advantage of the deglutahle electrode consists, firstly, in that we are able to apply the method in people not used to the stomach tube, and, secondly, in that the thin cord does not cause any uncomfortable feeling to R.Kny, ICo.Htf. the patient during the entire electric sitting and does not provoke salivation. Another advantage lies in the circum- stance that the deglutahle electrode can be administered even in those cases in which ulcer of the stomach is sus- DIRECT ELECTRIZATION OF THE STOMACH. 5 pected, whereas the old stomach electrode could not he in- troduced in them for fear of causing perforation. By means of the deglutable electrode * a regular course of electric treatment of the stomach becomes possible in many cases and is facilitated in all. After these introductory remarks permit me to report my further experiences of direct electrization of the stom- ach gathered during the past year. A. In Reference to the Physiological Effect of Direct Gastro-electrization.—ln my previous papers I have proved by experiments that direct gastrofaradization ordinarily in- creases the secretion of gastric juice—i. e., there is found in the stomach a higher degree of acidity (caused by HCI) during electrization than at other times. The question arose whether this increased secretion of the stomach under the influence of electricity continues for some time after the ap- plication of the current. In order to decide this point the following experiments were made : Case I.—S. EL, twenty years old. 1. December 17. 1892.—When fasting, drinks a glassful of water and swallows the electrode, which is left in the stomach for ten minutes and withdrawn, electricity not being applied. After forty minutes the stomach contents are obtained by means of a tube and examined: HOI +, acidity = 42. 2. 22d.—When fasting, drinks a glassful of water and is gas- trofaradized directly for ten minutes. Forty minutes after the drinking of the water the stomach contents are obtained and examined : HCI 4-, acidity = 52. 8. 25th.—When fasting, drinks a glassful of water and is gas- trogalvanized for ten minutes (negative pole in the stomach). * The attachment of the cord to the capsule of the deglutable elec- trode has been accomplished by Richard King & Co. (11 Park Place, New York), the manufacturers of the instrument, in an excellent way. The cord is screwed into the capsule. The size and form of the elec- trode correspond with the accompanying figure. 6 FURTHER EXPERIENCES WITH Foi’ty minutes after the partaking of the water the stomach contents are obtained and analyzed ; HCI +, acidity = 20. Case lI.—T. M., twenty four years old. 1. January 10, 1893.—When fasting, swallows the degluta- ble electrode and drinks a glassful of water. After ten minutes the electrode is withdrawn, electricity not having been applied. After half an hour the stomach contents are obtained and ex- amined: HCI +, acidity = 14. 2. 12th.—When tasting, drinks a glassful of water and is gas- trofaradized (the deglutable electrode within the stomach) for ten minutes. Half an hour later the stomach contents are ob- tained and examined : HOI +, acidity = 18. 3. 2Jfth.—WThen fasting, drinks a glassful of water and is gas- trogalvanized directly for eight minutes (the negative pole being in the stomach). After half an hour the stomach contents are obtained and examined : HOI +, acidity = 20. 1. February I}, 1893. Whep fasting, swallows the deglutable electrode and drinks a glassful of water. After ten minutes the electrnde is withdrawn, electricity not having been applied. After thirty-five minutes the stomach contents are obtained and examined : HOI +, acidity = 46. Case Hl.—o. H , twenty-three years ohh 2. sth.—When fasting, drinks a glassful of water and is gas- trofaradized directly for ten minutes. Thirty-five minutes later the stomach contents are obtained and examined: HOI +, acid- ity = 72. From these experiments it seems that the electric action ordinarily increases the lICI secretion even during the first period after faradization. How does the absorbent faculty of the stomach act im- mediately after electrization ? You all know that we are able to examine the absorbent faculty of the stomach by means of potassium iodide. The patient takes 0-2 of iodide of potassium in a gelatin capsule. The saliva is then tested by means of starch paper and nitric acid every minute or two. If the starch paper moistened DIRECT ELECTRIZATION OF THE STOMACH. 7 in the saliva shows a slight violet or bine discoloration after the addition of a drop of nitric acid, then it indicates that the potassium iodide had been meanwhile partly absorbed from the stomach and eliminated through the saliva. In order to see whether direct electrization of the stom- ach hastens the absorbent power of the same, the following- experiment was conducted in like manner on several people : Firstly, the individual drank while fasting a glassful of wa- ter. After the lapse of ten minutes iodide of potassium 0-2 in a gelatin capsule and 20 c. c. of water were given. The saliva was examined every minute with starch paper and nitric acid and the result carefully noted. Secondly, about a week later the same individual while fasting drank a glass- ful of water and was treated with direct electrization of the stomach. After this iodide of potassium 0-2 in a gelatin capsule and 20 c. c. of water were given and the saliva ex- amined as before. The results obtained in both trials (one without, the second with, electricity) can thus be compared and the influence of direct electrization studied. Of the many uniform experiments made in this respect I shall report three as examples : Case I.—L. T., twenty-four years old. 1. August 23, 1892.—While fasting, drinks a glassful of wa- ter ; ten minutes later he takes iodide of potassium 02 with 20 c. c. of water. After 1 minute = no reaction. “ 2 minutes = “ “ “3 “ = “4 “ = “ “6 “ = “ U tf U = *4 “8 “ = + violet coloration 2. 30th.—When fasting, drinks a glassful of water and is gas- trofaradized for ten minutes. He then takes iodide of potassium 0-2 with 20 c. c. of water. 8 FURTHER EXPERIENCES WITH After 1 minute = no reaction. “ 2 minutes = “ “ “3 “ = 41 44 o 4 “ _ u -<• uga u a 44 6 4* = + traces. 4> 7 44 = + violet discoloration Case ll.—Th. S., forty-four years old. 1. December 19, 1892.—When fasting, drinks a glassful of water. Ten minutes later he takes iodide of potassium 02 with 20 c. c. of water. After 5 minutes = no reaction. tt 0 g tt u tt Y g u g it g g g g g9g “ “ “ 10 “ = + traces. “ 11 = + “ “ 12 “ = + clearly. 2. 26th.—When fasting, drinks a glassful of water and is gastrofaradized for ten minutes. Then he takes iodide of potas- sium o'2 with 20 c. c. of water. After 2 minutes =no reaction. it g it it g it 4 it it it tt g tc tt tt tt g tt tt kb it tt _ it t. “ 8 “ = -1- traces. “ 9 “ = + clearly. “ 10 “ = + strong reaction. 3. January 2, 1893.—When fasting, drinks a glassful of water and is gastrogalvanized (negative pole within the stom- ach) for eight minutes. He then takes iodide of potassium 0-2 with 20 c. c. of water. After 3 minutes = no reaction. g4g g “ it g tt t. tt DIRECT ELECTRIZATION OF THE STOMACH. 9 After 6 minutes = no reaction. “7 “ = + traces, a s “ = + “ “9 “ = + much. 1. January 8, 1893.—When fasting, drinks a glassful of water. Ten minutes later he takes iodide of potassium o’2 with 20 c. c. of water. Case lll.—Samuel H., twenty-four years old. After 2 minutes =no reaction, a g a __ u u u 4 a __ u u “5“ = “ “ “8 = “ a Y u u i. “ 8 “ = + traces. u 0 it _ _j_ .t “ 10 “ = + clearly. 2. 15th.—While fasting, drinks a glassful of water, and is directly gastrofaradized for ten minutes. He then takes iodide of potassium o‘2 with 20 c. c. of water. After 2 minutes = no reaction. “3“ = “ “4 u _ u u “ 6 “ = “ ‘‘ “7 “ = + traces. “8 “ = + clearly. “9 “ = + mucin 3. 22d.—While fasting, drinks a glassful of water and is gastrogalvanized (the negative pole within the stomach) for eight minutes. He then takes iodide of potassium 0-2 with 20 c. c. of water. After 3 minutes =no reaction. (t 4. a _ a a a g a __ a a “6 “ = + traces. a fjr a _|_ a “8 “ = + much. 10 FURTHER EXPERIENCES WITH From these experiments it appears that the absorbent faculty of the stomach is increased by direct gastro-electri- zation (faradization or galvanization), a fact whicb hith- erto, as far as I am aware, has not been experimentally proved by others. B. Experiences of the Therapeutic Effect of Direct Elec- trization of the Stomach.—As I have already fully described in my last paper a large number of cases treated by direct gastro-electrization, I shall now refrain from a detailed de- scription of different cases and shall limit myself to a brief report, giving in tables all the cases recently treated by this method. All cases contained in the accompanying tables are those of private patients of mine who were treated by direct gas- tro-electrization with the deglutable electrode in the course of thirteen months (from the beginning of December, 1891, to the end of December, 1892). The time of electric treat- ment for each patient and all other necessary points are given in the tables. Table I contains thirty-one cases treated by direct gas- trofaradization. In eighteen all subjective symptoms of sick- ness disappeared ; in seven there was a great amelioration— i. e., a subsidence of nearly all the symptoms; in four there was a noticeable improvement, and in the remaining two the condition of the patient remained unchanged. Tables II and 111 contain merely cases with complaints of severe pains in the gastric region (gastralgia). On Table II will be found those cases which were treated first by the faradaic and thereafter by the gal- vanic current. The galvanization was administered in these cases for the reason that faradization in some of them effected an improvement only, but no cure, and in some again no change whatever. The final results were very good. In six the gastralgia, as well as all other symp- DIRECT ELECTRIZATION OF THE STOMACH. 11 Toms of disease, totally disappeared, and in the remaining two, in which the galvanic current had not been applied ong enough (each of them had only three galvanic sit- tings), there was a marked amelioration. In Table 111 three cases are reported in which galvani- zation alone was applied. In all these three cases the gas- tralgia was of an intense nature, and in two of them com- plicated with slight heart trouble. In all three cases the gastralgia disappeared. Summary.—Thus there wTere forty-two patients treated by direct electrization of the stomach. Only in two no amelioration of the condition could he noticed; in all others there was either a complete disappearance of the subjective symptoms or at least a great amelioration of the same. Besides the subjective sensation of amelioration in the patients, in many cases there could be noticed at the same time a better appearance of the patient; in several cases an increase in weight was noticed and will be found reported in the tables. In those cases in which no men- tion is made of the weig’ht in the tables, either the weight was the same as in the beginning of the treatment or the patients did not keep a record of it. In several cases an amelioration of the objective symptoms could be noticed— i, e., the chemical analysis of the stomach contents showed an improvement of the condition. The references to these points will be found on the tables under the heading “ Re- marks.” After having discussed the main characteristics of the tables I would like to mention a few points in reference to the electric treatment. 1 gave to my patients the usual necessary drugs ; a few only partook of no medicines what- ever. I modified and prescribed diet only when necessary, and advised suitable hygienic measures accordingly. I ordinarily applied the electrization every other day 12 FURTHER EXPERIENCES WITH during the beginning of treatment; afterward—i. e., after the lapse of two to three weeks—twice weekly for about three weeks, and thereafter once a week for some time. As a rule, I begin to decrease the frequency of the sittings when I notice a decided improvement in the condition of the pa- tient. Even after a complete disappearance of the symp- toms it is advisable to continue the electrization (once a week) for some time. According to my belief, it is of importance to apply gastro-electrization upon a certain plan. Thus it will not appear superfluous to give a detailed description of the electric application I generally employ. The patient, when having the deglutahle electrode within the stomach, opens his clothes, so that the abdomen is ac- cessible. The key of the deglutahle electrode is connected with the cord (negative pole) running to the battery. Gastrofaradization.—Sitting, ten minutes ; at first large plate electrode at the gastric and epigastric region for five minutes, then a small ordinary sponge electrode. The elec- trode is at first moved up and down from left to right in the gastric region (sometimes, principally when there is consti- pation, one goes with the electrode over the region of the colon—ascendens, transversum, and descendens—always be- ginning in the right iliac region and stopping at the left iliac region (duration, two minutes)); thereafter one proceeds from the gastric region from right to left to the back, and remains at the left side of the seventh dorsal vertebra for one minute. [At this place the current can be applied quite strongly, and most of the patients then experience a slight sensation within the stomach; the patients find it difficult to describe this sensation; some assert that they experience a dragging feeling, others a feeling of weight, and others again of pinching. All of them place this feel- ing within the stomach and locate it opposite different DIRECT ELECTRIZATION OF THE STOMACH. 13 heights of the abdominal wall.] One then returns to the front, moving the electrode gently up and down over the gastric region for two minutes, gradually decreasing the current, and thus ends the sitting. The strength of the current has to be of such a nature that it causes distinct contractions of the abdominal walls ; but it is not well to have the current so strong that the patient experiences pains. Gastrogalvanization.—Negative pole within the stom- ach ; small sponge electrode. Duration, eight minutes. First, two minutes below the ensiform process (during the first minute the current is gradually increased to its necessary strength) ; then for three minutes moving the electrode up and down the gastric region. After this, one then goes to the back and remains one minute at the left side of the seventh dorsal vertebra, returns to the front, moves the electrode around the gastric region for one minute, and remains then quietly for one minute below the ensiform process. During this time the current is gradually weakened and the sitting ended, the strength of the current being ordinarily fifteen to twenty milliam- peres. Before concluding this paper I should yet like to dis- cuss a few points with regard to galvanization. I have al- ready in my previous paper emphasized how effective this current is in gastralgia. Tables II and 111 seem to confirm this. The amelioration ordinarily appears by degrees and not suddenly. First, the pains are somewhat less severe, thereafter they begin to remain away for some time, and at the end they disappear completely. This gradual disap- pearance of the gastralgic pains seems to indicate that the beneficial effect must be ascribed to the galvanic current and not to mere suggestion. Among the five cases of severe gastralgia, fully de- FURTHER EXPERIENCES WITH scribed in my previous article,* there were two with vitium cordis (cases Auguste K. and Th. G-. XL). Among the eleven cases treated by galvanization, reported in this paper, there are six with more or less distinct heart trouble. In all of them the galvanic current exerted a highly beneficial effect. Not only did the gastralgic pains disappear, but very frequently the heart action of the patient took a de- cided turn for the better. Thus, for instance, Patient Paul W. (Table 111, 3), when beginning the galvanic treatment, had an accelerated and intermittent pulse ; later on the same became normal as regards frequency and rhythm. Morris S. (Table 11, 8) previous to treatment used fre- quently to suffer from fainting spells after meals ; afterward these spells ceased. It seems, therefore, that the galvanic treatment not only exerts a favorable influence upon the stomach, but that it has a tonic effect upon the heart. According to my opinion, it would be justifiable to give the galvanic treat- ment a trial in some affections of the heart, even if they are not complicated with gastric disorders. Perhaps they could be treated by the same method of galvanization—i. e., having the negative pole within the stomach. Under all circumstances, however, I would advise administering the galvanic current in every case of gastralgia complicated with affections of the heart. As a resume of this paper permit me to submit the fol- lowing conclusions: A. Regarding Physiology.—l, Direct gastrofaradization ordinarily increases gastric secretion, even during the first period after electrization. 2. The absorbent faculty of the stomach is considerably accelerated directly after the gastro-electrization (faradiza- tion and galvanization). * Loc. cit. DIRECT ELECTRIZATION OF THE STOMACH. 15 B. Therapeutically.—l. Direct gastro-electrization is a potent agent in the field of chronic (non-malignant) diseases of the stomach. 2. Gastrofaradization appears especially useful in most cases of dilatation of the stomach and enteroptosis ; fur- ther, in atonic conditions of the cardia (ructus) and pylorus (presence of larger amounts of bile in the stomach), and in chronic gastric catarrh (gastritis chronica glandularis). 3. Gastrogalvanization is almost a sovereign means for combating severe and most obstinate gastralgias, no matter whether their origin is of a nervous nature or caused by a cicatrized ulcer of the stomach. 4. Gastrogalvanization exerts also a favorable influence on several affections of the heart complicated with gastraigia. 10*7 East Sixty-fifth Street. I. TABLE OF CASES TREATED BY DIRECT GASTROFARADIZATION. No. Name. Age. Disease. Principal complaint. How long sick before electrization. How long treated. Result of treatment. Remarks. 1 Robert P. 28 yrs. Dilatation of the Fullness, belching, About 4 mos. Disappear- stomach, com- crampy pains, di- 3 yrs. ance of all bined with hy- arrhoea. symptoms. peracidity. 2 Murray F. 19 yrs. Do. Fullness, belching, About 4 mos. Greatly pains, constipation, 3 yrs. improved. Josef P. 21 yrs. despondency. 3 Do. Bad taste, pains in About 1 mo. Disappear- the epigastrium, 2 yrs., with free intervals. ance of constipation. symptoms. 4 Edward K. 63 yrs. Do. Belching, crampy About 3 mos. Greatly pains, diarrhoea, 12 yrs. improved. weakness. 5 Aron L. 36 yrs. Do. Complete anorexia, 6 yrs. 3 mos. Do. weak feeling, con- stipation. 6 James G. 43 yrs. Do. Anorexia, pains after each meal, consti- 5 yrs. 3 mos. Disappear- ance of Eight pounds gained during treat- ment. 1 Benjamin B. W. pation. symptoms. 23 yrs. Do. Anorexia, pains, con- 1 yr. 3 mos. Do. Eleven pounds gained during treat- Jobann St. stipation. ment. 8 33 yrs. Do. Belching, constipa- tion, burning sen- sation in the scor- biculum. 12 yrs. 1 mo. Improved. 9 Morris G. 24 yrs. Do. Mitral in- Anorexia, belching, 2 yrs. 1 mo. Greatly 10 Gustav K. sufficiency. pains, constipation. improved. 26 yrs. Do. Mitral in- Anorexia, belching, 4 to 5 mos. 1 mo. Do. 11 sufficiency. pains, weakness. Mrs. S. M. About 30 yrs. Hyperacidity, Burning sensation in the scrobiculus, 4 to 5 mos. 1 mo. Disappear- ance of 12 Miss Stella B. belching. symptoms. About 34 yrs. Enteroptosis com- bined with hy- peracidity. Do. 4 yrs. 6 wks. Do. There was real gastroptosis. Ren mobilis dexter. Patient before coming under my treatment had undergone for three months the meat and hot-water regime. She looked like a skeleton. After four weeks of the electric treat- 13 Mrs. Pauline F. 43 yrs. Do. Inability to eat, burning sensation after meals, weak- ness. 2 yrs. 6 wks. Do. ment, gained nineteen pounds. The gastrodiaphane shows the situ- ation of the stomach between the navel (small curvature) and the symphysis pubis. Ren mo- 14 Mrs. Henrietta C. bilis dexter. 45 yrs. Enteroptosis com- bined with hy- Anorexia, belching, constipation. 12 yrs. Improved. Real gastroptosis. 15 Mrs. Antonia B. peracidity. 36 yrs. Enteroptosis, gast. gland, chr. Anorexia, burning sensation after meals, constipa- tion. 5 yrs. 3 mos. Disappear- ance of symptoms. Eight pounds gained during treat- ment. 16 Mrs. Gussie W. 34 yrs. Do. Do. 4 yrs., with free intervals. 2 mos. Do. 11 Mrs. Editha Sch. 35 yrs. Do. Anorexia, uncom- 6 yrs. 2 mos. Do. fortable after meals. 18 Carl Sch. 36 yrs. Do. Anorexia, burning sensation in the scrobiculus. 1 yr. 1 mo. Do. The examination of the stomach contents revealed after Ewald’s test breakfast before undergoing the electric treatment no free HC1; two weeks later free HC1 19 Walter C. 28 yrs. was present. Do. Poor appetite, belch- 8 mos. 2 mos. Do. Real gastroptosis (gastrodiaphany). ing, bloated feel- Ren mobilis dexter. Has gained ■ Bi 1 men. First, no free HC1; afterward, HC1 + . 20 Miss Meta Z. About 30 yrs. Gast. gland, chr. Anorexia, heavy feeling in the chest after meals. 5 yrs. 3 mos. Do. The gastrodiaphane shows the stomach one finger-width above the navel (small curvature), ex- tending to about two to three fin- ger-widths above the symphysis pubis. Ren mobilis dexter. In the beginning, no free HC1; 21 afterward, HC1 present. Mrs. L. L. G. About Do. Anorexia, bad taste, belching, bloated 2 yrs. 3 mos. Do. Ten pounds gained. 40 yrs. feeling. 22 Chs. H. Alb. About Do. Poor appetite, epi- 1 yr. 2 mos. Do. 44 yrs. gastric pains after meals. 23 Mrs. Cora A. 32 yrs. Repeating; gast. Aggravated belch- 5 yrs. 2 mos. Do. gland, chr. ing, anorexia, pains. 24 Marx D. 48 yrs. Do. Aggravated belching, bulimia, vertigo. 3 mos. 3 wks. Do. 25 Aron L. 50 yrs. Atonia cardiac et Vomiting, belching, 5 yrs. 5 wks. Do. When fasting, the stomach con- pylori; dilat. ventriculi. severe gastralgia. tained at the beginning gastric Juice and bile; after a while there was no admixture of bile, and later on no fluid, in the stomach when fasting. HCi was 26 Alfred K. Atonia gastro-in- Belching, bloated present all along. 28 yrs. About 2 mos. Greatly In the beginning of the treatment testinalis. feeling, diarrhoea. 1 yr. improved. one hour after the test breakfast there was no free HCI; after two weeks’ treatment HCI was present in normal amount. Pa- 21 Miss Jennie F. 30 yrs. Dilatatio ven- Anorexia, gastral- 5 yrs. 3 mos. Do. triculi. gia. 28 Johann C. 32 yrs. Dilatatio ven- Belching, poor ap- 3 yrs. 6 wks. Not much triculi, hyper- petite, often diar- improved. aciditas. r hm a. 29 Henry R. 40 yrs. Dilatatio ven- Absolute anorexia, 4 yrs. 3 mos. Improved. Besides the stomach trouble there triculi, gast. pains after meals. was a vitium cordis. One hour gland, chr. Be- after the test breakfast there ginning atro- was never found free HCI; ren- Harris B. phy. net was present. 30 32 yrs. Do. Belching of a very offensive gas, oc- casionally vomit- ing. 6 yrs. 6 wks. Do. There was no free HCI present one hour after the test breakfast, although the acidity was high, caused by the presence of or- ganic acids. After three weeks’ treatment the belching disap- peared, the organic acids were less, but free HCI could be de- tected only after faradization. Upon my advice the patient went South for further recreation. 31 George W. St. 62 yrs. Anaemia pernici- Constant pain in the 1 yr. 3 wks. Not osa ? Gastral- scrobiculus. improved. gia. (From December, 1891, to December, 1892.) 11. TABLE OF CASES FIRST TREATED BY DIRECT FARADIZATION, AND THEN BY DIRECT GALVANIZATION OF THE STOMACH. [From December, 1891, to December, 1892.) No. Name. Age. Disease. Principal complaints. ..o> M • C ... £ C.S o S O '+H O |g| a *3 £ 03 With what result. bo C2 • § g.a £ S g ° O 02