340 MORBID ALTERATIONS IN DIGESTIVE ACTIVITY. 



in the presence of high fever no saliva at all is secreted. The saliva secreted 

 with lower grades of fever is cloudy, viscous and it usually becomes acid. With 

 increase in fever the inertness of the diastatic action also increases. After the 

 crisis the amount of saliva and the activity of the ferment become subnormal; 

 likewise in the presence of diseases of the kidneys. After chronic illness of long 

 standing the production of ferment frequently diminishes. The secretion of 

 saliva is increased by morbid irritation of the nerves of the mouth, as from in- 

 flammations, ulcers, trigeminal neuralgia, so that enormous quantities may be 

 poured out. Mercury and jaborandi-leaves cause salivation, the former with the 

 simultaneous occurrence of a stomatitis that induces reflex secretion of saliva. 

 Diseases of the stomach also may increase the secretion of saliva, in conjunction 

 with paroxysms of nausea and retching. Viscid, ropy saliva, due to irritation 

 of the sympathetic nerve, is secreted, together with some vascular disturbance, 

 in consequence of active sexual excitement, but also as a result of certain psychical 

 impressions. The reaction of the buccal secretion becomes acid in the presence 

 of catarrhal conditions of the mouth and, further, as a result of the decomposition 

 of accumulated epithelial cells in the mouth during the prevalence of fever, as 

 well as in cases of diabetes mellitus, in consequence of acid fermentation of 

 the sugar contained in the saliva. Diabetic patients therefore suffer frequently 

 from carious teeth. The secretion of the mouth in infants also has a slightly 

 acid reaction unless the greatest cleanliness is observed. 



Disturbances in the activity of the gastric musculature may appear, as a 

 paralytic phenomenon, with distention of the stomach, and a protracted sojourn 

 of the ingesta. With more marked grades of the disorder decomposition and the 

 production of gas take place. Diminution in muscular activity may give rise to 

 dilatation of the entire stomach. Incompetency of the pylorus represents a 

 special form of gastric paralysis. Derangement of innervation, central or periph- 

 eral in nature, may be the cause; further, actual paralysis of the pyloric sphinc- 

 ter or anesthesia of the mucous membrane of the pylorus, which exerts a reflex 

 effect upon the sphincter muscle; finally, also, interference with the transmission 

 of the reflex within the center. Abnormally increased activity of the gastric 

 musculature will, as gastric diarrhea, hasten the ingesta into the intestine; often 

 vomiting occurs. In nervous individuals so-called peristaltic unrest of the stomach 

 is at times present, in conjunction with dyspeptic disorders. Spasm of the cardiac 

 orifice or paresis of the inhibitory nerves of the cardia also occurs. Rarely, in the 

 presence of stricture of the pylorus, true antiperistalsis of the stomach has been 

 observed. 



Gastric digestion is delayed by all severe physical and mental exertion and, if 

 this be of more marked degree, digestion may even be inhibited. Also sudden 

 emotional disturbance, as well as reflex influences from other organs (uterine 

 dyspepsia), may have this effect. Probably these factors exert an influence upon 

 the vasomotor nerves of the stomach. Impairment and abolition of the secretion of 

 the gastric juice may, under certain conditions, be purely nervous in nature, as in 

 cases of nervous dyspepsia and gastric neurasthenia. Complete absence of the 

 gastric juice is found in connection with atrophy of the mucous membrane, prin- 

 cipally in cases of pernicious anemia. Also excessive secretion of the gastric 

 juice, continuous flow of the juice, and likewise excessive production of acid may 

 depend upon derangement of nervous activity: nervous gastroxynsis, chiefly 

 observed in women. Excessive production of hydrochloric acid occurs in asso- 

 ciation with round ulcer of the stomach. 



Inflammatory or catarrhal affections of the stomach, as well as ulcers and 

 neoplasms, disturb normal digestive activity, as does also the excessive ingestion 

 of foods difficult of digestion, of sharp spices in considerably amount, or much 

 alcohol. Griitzner observed in a dog that the mucous membrane secreted con- 

 tinuously under the influence of a chronic gastric catarrh, but the gastric juice 

 was deficient in pepsin, cloudy, viscous, less acid, even alkaline. The introduc- 

 tion of food did not modify the secretion; the stomach, therefore, never actually 

 comes to rest. At the same time the chief cells of the gastric glands are turbid. 

 Accordingly it would seem o: advantage for patients suffering from gastric catarrh 

 to eat frequently, but only a little at a time, and in addition use a 0.4 per cent, 

 hydrochloric-acid solution as a beverage. Small doses of sodium chlorid appear 

 to aid gastric digestion. 



In the presence of enfeebled digestion, the cause may be deficient formation 

 either of hydrochloric acid or of pepsin. Both substances may therefore be 

 administered as remedial agents. In the presence of enfeebled gastric digestion 



