614 THOMAS E. BROWN AND JOHN H. KING 



the cause of the diarrhea, if marked and of long duration, it is inevitable 

 that malnutrition will take place often to a very marked extent, and noth- 

 ing better illustrates the normal protective function of the stomach than 

 this group of cases. 



The specific influence of hyper-, hypo-, and a-chlorhydria upon the com- 

 position of the blood has not been definitely determined, although Von 

 Noorden(y) (g) believed that the normal increase of alkalinity of the blood 

 at the height of digestion was "particularly well marked in hyperacidity." 



Notwithstanding the very considerable amount of work done upon the 

 effect of secretory disturbances upon general metabolism with results often 

 very conflicting, the question is still practically in the same state as when 

 years ago Von Noorden wrote "disorders of gastric secretion, provided they 

 do not prejudice the intake of food and are not complicated by motor dis- 

 turbances of the stomach or disorders of the intestine, do not appreciably 

 affect metabolism and the resorption of food, except that of connective 

 tissue in cases of achylia." 



Motor Disturbances 



The three main functions of the gastric musculature are to preserve 

 the proper tone, to furnish peristaltic movements of sufficient frequency, 

 depth and force and to bring about a proper pyloric control, this last 

 under normal conditions being affected by the character of food taken. 

 The systematic employment of radiograph and fluoroscope has revolu- 

 tionized our views of the motor activities of the stomach in health and 

 disease ; it has taught us the quite distinct functions of the cardiac sac 

 and the gastric tube; the contractions met with in hunger; the antiperis- 

 talsis seen in pyloric obstruction, while as to the cause of the normal 

 contractions Alvarez' views of the metabolic gradient are very suggestive. 



Metabolism may be affected in many ways by motor disturbances of 

 the stomach by vomiting due to various causes, by motor insufficiency, 

 by increased motility, by the associated secretory and sensory disturbances 

 and by the effect of such disturbances upon the appetite, the intestinal 

 digestion and the condition of the blood and urine. 



Vomiting is a symptom of many gastric diseases, as well as being a 

 frequent, concomitant of other diseases intestinal, renal, cardiac, neuroses, 

 endocrine, etc. Its mechanism is usually a tight closure of the pylorus, 

 marked peristaltic and later antiperistaltic waves, contraction of dia- 

 phragm and abdominal muscles and relaxation of cardia. Of gastric dis- 

 eases, it is met with especially frequently in ulcer, in pyloric obstruction, 

 chronic gastritis, carcinoma, neuroses and reflex pylorospasm due to a great 

 variety of causes. If excessive or persistent it may lead to very marked 

 nutritional disturbances, as the quantity of the food and fluid is markedly 





