174 'FLATULENT' DYSPEPSIA. [BOOK n. 



Chemical examination shews the presence of acetic, lactic, and 

 butyric acids. The hydrochloric acid is either altogether absent or 

 present only in small quantities ; pepsin, according to Kussmaul, 

 is always present. Kussmaul found it absent only in one case, in 

 which enormous masses of a fungus were contained in the stomach. 



The acids present are the result of fermentation of the ingested 

 carbohydrates, as was first pointed out by Frerichs ; this would 

 explain, on the one hand, the presence of lactic and butyric acids 

 (as well as CO 2 and H), while on the other hand the alcoholic 

 and acetous fermentations would result in the appearance of alcohol, 

 CO 2 and acetic acid as final products. Both these forms of fermen- 

 tation may go on at the same time 1 . Besides these acids, we find 

 unaltered albumen, sugar, and starch present in the vomited 

 matter. 



If dilatation of the stomach be excessive, or if almost complete 

 mechanical obstruction exist, as in cases of cancer of, or cicatrix at 

 the pylorus, the vomited matters, or the stomach contents which can 

 be withdrawn by the stomach tube, may amount to a large volume 

 (2 4 litres). When allowed to stand, they usually separate into 

 three layers : an upper one, consisting of frothy mucus, a subjacent 

 la\er of liquid, and a sedimentary stratum at the bottom, containing 

 solid masses and particles. 



The gases which are evolved in this form of dyspepsia have 

 sometimes a composition similar to that of the atmospheric air, 

 except that they contain more C0 2 ; when, however, the fermentation 

 process is fully developed they consist chiefly of H and CO 2 . 



According to Popoff 2 , in some cases, an inflammable gas is evolved 

 (Frerichs, Friedresch, Ewald 3 ), which proved to be marsh gas. Hoppe 

 Seyler believes that this gas is derived from the intestines and is 

 not formed in the stomach (?) 



The following numbers exhibit the composition of the mixed gas, 

 in cases of this kind. 



Frerichs Popoff Schultze 



C0 2 in 100 parts 20-57 12-82 26-56 in 100 parts. 



H 20-57 32-32 32*30 



CH 4 10-75 0-34 



O 6-52 7-90 7-36 



N 41-39 46-96 33-44 



In the cases we are now considering, pyrosis is often a symptom 

 in addition to vomiting. 



If the gastric juice be examined (by means of stomach-pump or 

 stomach tube) several hours after the patient has vomited, it is found 

 to contain only traces of hydrochloric acid, while pepsin is. present. 



1 Schultzen, Archiv f. Anat. u. Physiolog. 1864, p. 591. 



2 Berl. klinische Wochenschr. 1870, Nos. 38 and 40. 



3 Archiv f. Anat. u. Physiol. 1874. 



