CHAP, ii.] 'ACID' AND 'ATONIC' DYSPEPSIA. 175 



Acid This form of dyspepsia may often occur in perfectly 



Dyspepsia. healthy persons; at other times it is associated with 

 catarrh of the stomach and other disorders. The vomited matter 

 often consists of a clear fluid, mixed with more or less mucus and is 

 of intensely acid character. It has been supposed by most observers 

 that the acidity is due to lactic acid (Richet, loc. cit.)', this seems 

 to be especially the case if much mucus be present. McNaught 1 

 found however in several cases the acidity due to increased HC1 

 (often amounting to 2'7 per mill.). Sir W. Roberts has fully con- 

 firmed the observation of McNaught. He has drawn particular 

 attention to the sudden paroxysmal attacks of cramp of the stomach, 

 which are apt to occur in the course of acid dyspepsia and for which 

 he would retain the term of 'pyrosis' which has been somewhat 

 vaguely employed. In connection with these paroxysmal attacks of 

 cramp, a sudden gush of saliva into the mouth is very frequent, and 

 Sir W. Roberts has found that the saliva is in some cases of remark- 

 able alkalinity, able to neutralise 0'125 per cent, of HC1. The 

 secretion of this alkaline saliva is the concomitant of the pouring 

 out of a highly acid gastric juice 2 . 



Atonic As this form of dyspepsia is often dependent on 



Dyspepsia. general malnutrition, due to some altered innervation 

 of the secreting apparatus (nervous dyspepsia), the changes in the 

 gastric digestion are similar to those seen in anaemia. In these 

 cases the gastric secretion is deficient in quantity, the hydrochloric 

 acid being often only found in traces. In some cases, the reaction 

 of gastric juice is however distinctly acid, but this is due to the 

 presence of lactic acid in large proportions. .As in atonic dyspepsia, 

 Pavy often found increased secretion of saliva, this may possibly 

 account for the abnormal fermentation and with it the presence of 

 lactic acid. In many cases however the salivary secretion is not in- 

 creased (Wilson Fox). 



Dyspepsia in Any cause which profoundly disturbs the nutrition 



of the body may act as a predisposing cause of con- 

 pulmonalis. . J T-\-/L * j- * r 



sumption. Disturbances of digestion are very fre- 

 quently precursors of the disease, and presumably favour the infection 

 of the organism. Such being the case, we should expect to find 

 abnormalities in gastric digestion in a considerable proportion of 

 cases of pulmonary consumption. 



If we consider, moreover, that as a result of the tubercular pro- 

 cesses a condition of secondary anaemia is very frequent in phthisis, 

 we shall be led to surmise that gastric digestion will be found to be 

 abnormal even in a larger number of cases than those in which 

 dyspepsia appears to have been a marked etiological factor. The 

 observations made by Brieger 3 , bear out the surmise. 



1 Brit. Med. Journal, Dec. 30, 1882. 



- Roberts, Lectures on Dietetics and Dyspepsia, London, 1885. See p. 81 et seq. 

 5 Brieger 'Ueber die Functionen des Magens bei Phthisis Pulmonum/ Deutsche 

 mcd. Wochenschrift, 1889, No. 14. 



