CHAP, ii.] 'FLATULENT' DYSPEPSIA. 173 



and found that the collected gastric juice only possessed digestive 

 properties when HC1 was added to it. 



More recent observations 'however shew that there are ex- 

 ceptions. Sassezkis 1 examined the gastric juice in nine persons 

 suffering from febrile affections and found the HC1 only very much 

 diminished in those cases where there was, besides, a very marked 

 dyspepsia. . Edinger 2 examined several cases of fever (one case of 

 typhoid with vomiting, two cases of recurrent fever, and one of 

 intermittent) and found hydrochloric acid present in all. 



2. Gastric Digestion in Dyspepsia. 



Clinically considered, dyspepsia, or indigestion, denotes a complex 

 of symptoms common to various disorders, characterized principally 

 by abnormalities in the gastric digestion. Having regard to these 

 symptoms we may still adhere to the time-honoured classification 

 of dyspepsia into flatulent dyspepsia, acid dyspepsia and atonic 

 dyspepsia. 



Flatulent The causes of this form of indigestion are numerous, 



and may be due either to an improper diet, either as 

 regards quality or quantity : to acute or chronic catarrh of the 

 stomach, to atrophy of the glandular elements, changes in the 

 muscular coat, presence of ulcer, cicatrix of an ulcer, or cancer of the 

 stomach, to a diseased condition of other parts of the digestive tract 

 (insufficient mastication, disturbances of salivary, pancreatic or 

 biliary secretion) : to general diseases (anaemia, gout, tuberculosis), 

 or to diseases of other organs (diseases of uterus, cardiac diseases, 

 nervous disorders). 



The changes in gastric digestion are due to fermentative changes 

 which the ingested food undergoes and are brought about either 

 by the character of the food, the insufficiency of hydrochloric acid in 

 the gastric juice, or the prolonged stay of the food in the stomach ; 

 hence this form of dyspepsia, when very marked, is almost always 

 associated with dilatation of the stomach. 



The only points, which we need consider, concern : (1) vomited 

 matter, (2) condition of the gastric juice, (3) flatulence. 



1. Vomited matter. Vomiting is a usual symptom of this 

 form of dyspepsia ; if but little dilatation of the stomach exists, the 

 vomited matters are small in quantity, consist of food either un- 

 altered or often in a state of fermentation, frothy and smelling of 

 yeast, or of an acid or rancid smell ; sometimes there is an admixture 

 of bile, at other times of masses of mucus. 



Microscopically we find large masses of sarcina and of torula, 

 besides the elements of undigested food. 



1 St Petersburger med. Wochenschrift, 1879. 



2 Deutsch. Archiv f. kli7i. Ned. Vol. xxix. p. 565. 



