Between 1944 and 1949 total gastrectomy was performed for gastric carcinoma in 63 patients by members of the surgical staff of the Johns Hopkins Hospital, principally by Longmire1and Scott.2Subsequently 17 patients have undergone this procedure, so that at the present time there is a series of 80 patients who have had a total gastrectomy. Many of these patients were seen preoperatively and have been carefully studied postoperatively at frequent intervals during this 10 year period in the gastroenterological clinic by one of us (M. P.). There are profound physiological changes in these patients as a result of the anatomic alteration. There is decreased capacity for ingesting food; frequent feedings of small amounts are necessary. There are profound nutritional and metabolic changes, with resulting mild steatorrhea, inability to digest complex carbohydrates, attacks of postprandial hypoglycemia and hypokalemia (dumping syndrome), and failure to gain weight.3There are