METABOLISM IN THE STOMACH AND INTESTINES 613 



the intestinal disturbances. In hyperthyroidism achylia or achlorhydria 

 is frequently seen, as also in myxedema, and in the former probably 

 plays a part in the diarrhea so often met with in that disease. In cancer 

 of the stomach, and even in extensive carcinoma elsewhere, absence of free 

 hydrochloric acid is the rule, except in that group in which cancer has 

 developed upon an old ulcer base, while in linitis plastica, which many 

 regard more as an acellular scirrhus than as a cirrhosis, absence of acid 

 is the rule. In high grades of ptosis with atony achlorhydria or hypo- 

 chlorhydria is the rule; in chronic gall-bladder disease lack of acid is 

 frequently found. It is frequently seen as the expression of an asthenic 

 neurosis, and peculiarly interesting are those cases of complete absence 

 of acid after sudden shock or violent emotions, often temporary, but some- 

 times persistent, and associated with intractable diarrhea, often leading 

 to quite marked nutritional disturbances. 



According to the careful experiments of one of us, absence of free 

 hydrochloric acid is not accompanied by a diminution in the pancreatic 

 secretion, even though the acid-prosecretin mechanism is wanting, but the 

 absence or diminution of acid must markedly affect the activities of the 

 propepsin and chymosin, even if they are, as is seen exceptionally, not 

 materially diminished as they both need free acid to become activated. 

 There is apparently no connection between the amount of acid and of 

 mucus secreted. In all cases starch digestion in the stomach is less im- 

 peded, while proteolysis is practically absent in cases of absence of acid, 

 and diminished when the acid, although present, is found in much less 

 amount than normal. In the case of connective tissue, the absence of 

 hydrochloric acid means that this substance passes through the digestive 

 tract practically undigested, and this is one of the causes of the associated 

 diarrhea, often markedly improved by the elimination of meat from the 

 dietary. The lessened protein digestion, in the stomach, however, does 

 not necessarily mean any protein loss by the body, provided that in- 

 testinal digestion be not impaired both as regards its secretory and its 

 motor functions. In many cases, however, the marked decrease in the 

 emptying time of the stomach due more to patent pylorus than to in- 

 creased peristalsis, so usually found in cases of diminished or absent hydro- 

 chloric acid the far greater number of bacteria that reach the intestine 

 and the improper preliminary preparation of the foodstuffs, both as re- 

 gards digestion and physical properties, are likely to lead to enteritis of 

 greater or less degree, sometimes associated with diarrhea, sometimes 

 with constipation with a corresponding effect upon the digestion and ab- 

 sorption of food and the general nutrition of the body. In certain cases 

 of the diarrhea so often found in achylias of various origin, notably the 

 neurogenic or psychogenic group, an enteritis cannot explain the picture, 

 which we have therefore felt might be caused by the need of free hydro- 

 chloric acid in the elaboration of some antiperistaltic hormone. Whatever 



