176 GASTRIC JUICE IN PHTHISIS, CATARRH, ETC. [BOOK II. 



Brieger made 300 examinations of the gastric juice, secreted after 

 test meals, in a series of 64 cases of Phthisis. In severe cases, only 

 about 16 per cent, exhibited a normal digestion, the remainder 

 suffering from a more or less marked insufficiency of the digestive 

 process. In 9'6 per cent, of these cases there was absence of the 

 normal constituents of the gastric juice. 



In cases of medium gravity, 33 per cent, alone secreted a normal 

 gastric juice, all the remainder suffering more or less seriously from 

 gastric affections, while in 6 '6 per cent, the secretion of a juice 

 occurred in which the normal constituents were absent. 



The observations of Brieger have been fully confirmed by Hilde- 

 brand 1 , and agree in the main with the experience of physicians 

 specially conversant with phthisis. 



3. Gastric Digestion in other Diseases of the Stomach. 



Gastric The vomited matter consists of undigested food 



Catarrh. often mixed with bile and mucus. 



The gastric juice is diminished in quantity, and if there be much 

 fever the hydrochloric acid is absent. 



The stomach is also lined by large quantities of a thick tenacious 

 mucus. (Direct observation by Beaumont in the case of A, St 

 Martin.) In cases of alcoholic origin the stomach contents may con- 

 tain large quantities of acetic acid. 



In acute gastritis, produced experimentally by alcohol, etc., 

 Ebstein and Grutzner 2 found, on examining the mucous membrane of 

 the stomach hardened in alcohol, that the chief cells were small, 

 granular, and stained deeply with carmine ; presented, indeed, in a 

 marked degree the appearance of 'active' gland cells, a granular and 

 shrivelled condition of the chief cells ; he believed this to be due to a 

 continuous formation and secretion of very small quantities of pepsin. 

 The administration of large quantities of alcohol produce all the 

 symptoms of acute gastric catarrh with diminished secretion of gastric 

 juice. 



Chronic We have here either the symptoms of flatulent 



Gastric dyspepsia with the changes described above, or, in cases 



Catarrh. O f verv j on g standing, those of atonic dyspepsia. 



Gastric The changes in gastric digestion vary according to 



Ulcer. the symptoms. 



At times, gastric digestion is perfectly normal, at other times we 

 have symptoms of atonic dyspepsia with corresponding change in 

 the secretion ; when ulcer has undergone cicatrization, arid is so 

 situated as thereby to cause mechanical obstruction to the passage of 



1 Hildebrand, ' Zur Kenntniss der Magenverdauung bei Pthisikern,' Deutsche med. 

 Wochenschrift, 1889, No. 15. 



2 Pfliiger's Archiv, Vol. vi. p. 1 and Vol. vin. p. 122, see also Grutzner, Neue Unter- 

 suchungen iiber die Bildung und Ausscheidung des Pepsin. 



