MORBID ALTERATIONS IN DIGESTIVE ACTIVITY. 341 



and motor insufficiency decomposition of the contents of the stomach into lactic, 

 butyric and acetic acids often takes place as a result of the action of lower organ- 

 isms. Small doses of salicylic acid are advisable under such circumstances, 

 together with some hydrochloric acid (notwithstanding possible heart-burn or 

 acid eructation). The administration of pepsin probably is but rarely imperative, 

 as this ferment is only seldom absent even from the diseased gastric mucous 

 membrane. In the presence of marked dilatation and a protracted sojourn, the 

 proteids in the stomach, notwithstanding the hydrochloric acid, undergo putre- 

 faction, which, however, does not as a rule have an injurious effect. In cases of 

 gastric catarrh and cholera, albumin has been observed to appear in the gastric 

 juice. 



Gastric Digestion in Patients with Fever and Anemia. Beaumont, from obser- 

 vations made upon the man with the gastric fistula examined by him, found 

 that only scanty secretion of gastric juice takes place in the presence of fever. 

 The mucous membrane was deficient in secretion, red and irritable. Dogs, 

 which Manassein had made febrile from septicemia or profoundly anemic by 

 venesection, elaborated a fairly active gastric juice, characterized especially 

 by a deficiency of hydrochloric acid. Hoppe-Seyler examined the gastric juice 

 from a patient with typhoid fever in which disease van de Velde found no free 

 hydrochloric acid (for the parietal cells are destroyed under such conditions) ; 

 as well as in cases of gastric carcinoma also, in which disease there is, as a rule, 

 no excess of free hydrochloric acid and found it absolutely inactive for artificial 

 digestion, even after hydrochloric acid had been added. This investigator properly 

 emphasizes the fact that the diminution in hydrochloric acid after such conditions 

 favors the development of a neutral reaction of the gastric contents, by reason 

 of which, on the one hand, digestion in the stomach can no longer take place; 

 while, on the other hand, abnormal fermentative processes must take place, 

 with the aid of developing micro-organisms and sarcinae ventriculi (?). 

 Uffelmann found that, in patients with fever, the secretion of a peptone- 

 forming gastric juice ceases if the fever sets in violently, if a condition of 

 great weakness develops, or if a high temperature persists for a long time. In 

 any event, also the amount of gastric juice secreted is diminished. In the presence 

 of fever the irritability of the mucous membrane is increased, so that vomiting 

 is readily induced. Also the increased excitability of the vasomotor nerves of 

 patients with fever is evidently detrimental to the secretion of active digestive 

 juices. Gluzinski found an absence of hydrochloric acid in the acute febrile 

 infectious diseases. Beaumont observed that fluids were rapidly absorbed from 

 the stomach of a febrile patient, while, on the other hand, the absorption of pep- 

 tones was diminished, on account of the frequently accompanying gastric catarrh 

 and the disturbed activity of the muscularis mucosas. 



Many salts disturb gastric digestion, if added in considerable amount, par- 

 ticularly the sulphates. Of the alkaloids, morphin, strychnin, digitalin, narcotin 

 and veratrin likewise have a disturbing influence. A small amount of quinin ac- 

 celerates gastric digestion. 



As the digestive activity of the stomach can be replaced by the pancreas, 

 it is evident that dogs may continue to live without profound disturbance of 

 nutrition after extirpation " of the stomach. Langenbach observed a similar 

 result in human beings after operation. 



The secretion of bile undergoes a change in the presence of acute disease, 

 as, for example, fever, in that it becomes scanty and at the same time more watery, 

 and that it is poorer in its specific constituents. Should the liver undergo 

 profound structural changes as a result of the morbid process, the secretion of 

 bile may cease completely. 



As a result of the decomposition of bile (acid fermentation?) gall-stones 

 form within the gall-bladder or biliary passages. These calculi may be white or 

 brown. The former consist almost entirely of laminated cholesterin-crystnls. 

 They are generally about i cm. in diameter, but they may be the size of a walnut 

 or even larger. The brown gall-stones consist of bilirubin-lime, together with 

 biliverdin, bilicyanin and choletelin, and also calcium carbonate and phosphate, 

 often mixed with iron, manganese, copper and other precipitated heavy metals. 

 All gall-stones, like urinary calculi, possess an organic supporting structure. 

 Some are rather spherical, often studded with mulberry-shaped nodules. Those 

 packed together in the gall-bladder become polished, from mutual attrition in 

 consequence of the contraction of the walls of the gall-bladder. The white gall- 

 stones often contain lime and biliary coloring-matter as a nucleus, together with 



