622 THOMAS E. BROWN AND JOHN H. KING 



exception of cancer. In the atony and motor insufficiency associated with 

 high grades of ptosis, hypochlorhydria is the rule, real achylia very fre- 

 quent, and the fermentation and decomposition met with may be prac- 

 tically the same as in obstruction due to gastric cancer, with, however, as 

 a rule not the same amount of putrefactive changes. 



Atony may develop secondary to gastritis of various causes. It may be 

 due to long lasting wasting or febrile disease, it may be congenital, it 

 may be neurogenic and represent a lack of balance between vagus and sym- 

 pathetic, it may be secondary to pyloric stenosis due to a variety of causes, 

 but whatever its etiology, unless transitory it offers the substratum for 

 subsequent serious motor disturbances with profound nutritional dis- 

 turbances. 



The f^cute dilatation of the stomach met with after operations, or 

 during the course of certain infectious diseases, notably pneumonia and ty- 

 phoid fever, has associated with it many symptoms the cause of which has 

 not been definitely determined, notably tetany. The weight of the evi- 

 dence, however, seems to be against this condition being an autotoxemia 

 but rather in favor of a neurogenic origin or of its being due to duodenal 

 obstruction, possibly a gastro-mesenteric ileus, or to acute gastric hyper- 

 secretion. None of the explanations is absolutely satisfactory, but what- 

 ever the cause, profound nutritional disturbances with acidosis occur, and 

 often death unless relief is obtained. 



Gastric Neuroses 



In many cases of nervous affections of the stomach, nutrition is not 

 affected, but in those in which the appetite is markedly affected, as 

 anorexia nervosa, or when persistent vomiting is found, or where hyper- 

 motility is present and is associated with a corresponding condition of the 

 intestines, nutrition is bound to suffer, and in some of the cases, notably 

 anorexia nervosa and nervous vomiting, the intake of food may be so much 

 diminished as to lead to marked starvation. 



On the other hand, in the cynorexia or bulimia met with in certain 

 neuroses, hysteria and mental diseases, as the manic phase of manic-de- 

 pressive insanity, a very marked increase in food intake may .occur with 

 increased weight mainly due to increased deposition of fat, probably in- 

 creased heat production, and an acceleration of general metabolism. The 

 same picture is produced by the overfeeding used so extensively in the 

 treatment of gastric neuroses, gastric atony or in states of malnutrition 

 following various infections or surgical operations, in all of these con- 

 ditions the weight increase being materially helped by the mental and 

 physical rest which is usually insisted upon. Metabolism as well as weight 

 is increased by such means, a real increase of activity of the body-cells, 



