METABOLISM IN THE STOMACH AND INTESTINES 611 



Secretory Disturbances 



There is of course some question as to what constitutes an abnormality 

 of gastric secretion, for even with the older but far more with the newer 

 fractional methods it is noted that quite marked- variations may be found 

 in absolutely normal individuals with apparently absolutely normal diges- 

 tion and varying, as also the motor functions, to a certain extent with the 

 build of the individual, whether of the herbivor or carnivor type both, 

 according to Hurst, to be regarded as normal types. It is therefore with 

 reference to a rather elastic normal that we define the secretory anomalies 

 as hyperacidity, hypo- or subacidity and anacidity, hyper-, hypo- and 

 achlorydria, or achylia, or perhaps better expressed as hyper- or hypo- 

 secretion, as fistula studies, as well as animal experiments, seem to show 

 that the gastric juice has a practically constant acidity, this varying in dif- 

 ferent human beings between 0.35 per cent and 0.56 per cent. Most in- 

 vestigators agree that there is often, especially in pathological conditions, 

 no parallelism between the amount of acid and pepsin-zymogen secreted, 

 or between the latter and the chymosin or rennin-zymogen perhaps the 

 best argument against the identity of these two pro-ferments. 



Hypersecretion, Hyperchlorhydria, Hyperacidity. Notwithstanding 

 the rather wide limits of normality, there are nevertheless a number 

 of pathological conditions in which a real increase of acid occurs, either 

 as a direct response to food stimulation or as a continuous process. This 

 may occur as the gastric equivalent of a hypersthenic neurosis, or in cer- 

 tain organic diseases of the cerebrospinal apparatus; it is usually met 

 with in the early stages of chronic gastritis due to a variety of causes 

 usually acting over a long period of time, such as improper foods and bev- 

 erages, alcohol, tobacco, highly seasoned foods, foods that are mechanically 

 irritating, especially those imperfectly masticated, foods and beverages 

 that are too hot or too cold, tainted foods, bacteria and their products 

 arising from diseased gums, tonsils and the accessory sinuses; it is often 

 of reflex origin, especially from pathological conditions elsewhere in the 

 digestive tract, notably the appendix, although frequently from other 

 sources, as a retroflexed uterus, an uncorrected error of refraction, etc. ; 

 it is met with in more than half the cases of gastric and duodenal ulcer, 

 persistent hypersecretion being especially prevalent in the latter as well 

 as in benign pyloric obstructions of various kinds and frequently in 

 chronic appendicitis; it is not unusual in chronic constipation and in- 

 testinal stasis, while it sometimes appears to be of purely psychogenic 

 origin. Whatever the cause, all present the same general picture, although 

 varying in the individual case in extent and in duration a real increase 

 in the amount of acid secreted, probably not the secretion of a juice of. 

 higher acid content. In these cases, as a rute, there is a marked inhibition 



