612 THOMAS B. BROWN AND JOHN H. KING 



of starch digestion, the protein digestion is more complete this being 

 often materially helped by the delay in emptying time of stomach usual 

 in many of these cases although here as in other secretory disturbances, 

 the effect upon body metabolism is not so much a question of secretory 

 anomaly as of associated motor disturbance and intestinal involvement. 

 Even as regards bacterial growth in the stomach and the effect of high 

 acid upon decomposition and fermentation, while it is unquestioned that 

 increased acid has an inhibiting and possibly a truly disinfecting effect, 

 it is again the state of the motor activity of the stomach that plays the 

 major role, and if pyloric obstruction is marked, there may be consid- 

 erable bacterial growth even with an excess of free acid. The ordinary 

 putrefaction of protein does not, however, occur as a rule in these condi- 

 tions, but carbohydrate decomposition yeasts and sarcina? probably play- 

 ing the leading role with formation of alcohol, acetic acid and carbon 

 dioxid as the more usual end products. These end products as they are 

 aboorbable should lead to specific metabolic changes, even if temporary and 

 too slight to be recognized by the usual methods of examination. 



Speaking generally, although there are many exceptions, increased 

 gastric acidity is usually associated with a delay in emptying and con- 

 stipation, which may in its turn lead to further delay in emptying time 

 by a reflex pylorospasm and hypersecretion of gastric juice. As a general 

 rule, the hyperacid gastric contents tend to lessen the fermentative and 

 putrefactive processes in the intestines, while the diminution or absence of 

 free hydrochloric acid in the gastric contents is usually associated with 

 an increase in these processes. 



Hyposecretion Hypochlorhydria Subacidity Achlorhydria 

 Achylia. The diminution or absence of hydrochloric acid, or of this 

 and the pro-ferments as well, is met with in a great variety of conditions. 

 It is often found in many infectious diseases, notably typhoid fever, 

 and the late stages of tuberculosis; it is frequently associated with in- 

 testinal parasites, especially uncinaria; it is frequent in myocardial and 

 renal disease; it is the usual picture in the later stages of chronic gas- 

 tritis; it is not uncommonly found in gout, and is frequently met with 

 in chronic infectious arthritis, although here the achylia is much more 

 probably the effect, not the cause, of the disease, while in gout the ad- 

 ministration of hydrochloric acid undoubtedly has a favorable influence 

 on the purin metabolism in a certain proportion of cases. It is usually 

 found in pernicious anemia, where according to a few observers it plays a 

 real part in bringing about the characteristic hematopoietic and metabolic 

 changes. In pellagra and sprue, subacidity, or oftener achlorhydria, is the 

 rule, but in the one case the unbalanced dietary, in the other the marked 

 change in intestinal mucosa and pancreas, possibly due to a monilium 

 infection, unquestionably plays the major role in the profound nutritional 

 disturbances met with, the achylia playing a minor part in increasing 



