616 THOMAS R. BROWN AND JOHN H. KING 



to some obstruction at the pylorus due to a variety of causes pylorospasm 

 of local or reflex origin, ulcer, carcinoma, cicatricial contraction, pressure 

 from diseased conditions of neighboring- organs, gall-bladder, pancreas, 

 mesenteric glands, etc., traction on a congenitally high pylorus by a 

 markedly ptosed stomach, pyloric gumma, etc. If the motor disturbance 

 is slight, the nutritional disturbance may be practically negligible, but if of 

 high grade, the food remains for too long a time in the stomach, with, 

 as a rule, perversion of secretion, decomposition, fermentation, and a fall 

 of the food intake below the body requirements with increasing inanition 

 leading to the picture of acute or chronic starvation, dependent, upon the 

 rate of development of the obstruction .and the response of the gastric 

 musculature to the increased work imposed upon it. It is the one con- 

 dition of importance in which marked fermentation or decomposition 

 is likely to be met with, the extent and character of these changes de- 

 pending upon the degree of motor insufficiency and the associated de- 

 rangement of secretion. In a certain group of cases the subsequent gastric 

 dilatation simply represents the result of excessive work and the gradual 

 weakening of the muscles under the strain, in others, changes in the wall 

 due to the underlying process or the associated inflammatory changes 

 play a larger role. Incidently the extent of motor insufficiency and 

 gastric dilatation is not necessarily present in the same degree. It is 

 very interesting to follow the gradual evolution of the symptoms in these 

 cases, often first an increased appetite associated with the stage of com- 

 pensatory hypertrophy, sometimes lasting a considerable time, some- 

 times gradually lessening, dependent upon the relative time of appear- 

 ance of degenerative changes in the muscle and the character of the secre- 

 tory disturbances, then fullness after meals, pain, vomiting sometimes 

 after meals, sometimes at comparatively long intervals, increasing thirst, 

 oliguria, increasing signs of malnutrition and tissue starvation unless ap- 

 propriate treatment, usually surgical, is employed. The motor insuffi- 

 ciency due to weakness of the musculature due to intercurrent disease and 

 increased by ptosis rarely reaches a high degree unless pyloric obstruction, 

 sometimes due to low grade inflammatory process, sometimes to hyper- 

 trophy of the pylorus, develops. In cases of marked motor insufficiency 

 if associated with considerable hydrochloric acid fermentation of the 

 acetic-acid-alcohol type, in the absence of free acid of the lactic-butyric acid 

 type may play some part in producing dilatation by distention but more by 

 the effect of the products of decomposition upon the wall of the stomach. 

 While increased motilUy of the stomach has as a rule no influence upon 

 metabolism unless associated with intestinal hypermotility, in vomiting 

 and in motor insufficiency, if at all marked or of long duration, marked 

 nutritional disturbances are bound to occur. Marked obstruction to the 

 entrance of food into the stomach as in carcinoma or stricture of the 



