OF THE ALIMENTARY CANAL ill 



mucous membrane reversing the activity of the 

 gastric juice, but the continual presence of an 

 abnormally powerful combination of acid and pepsin 

 breaks down the resistance, just as is seen in an 

 exaggerated degree when a healthy man dies suddenly 

 during the process of digestion ; the supply of anti- 

 pepsin fails with the circulation, and a big hole is 

 dissolved through the stomach wall post mortem. 

 It is highly probable that hyperchlorhydria is a 

 cause as well as a consequence of gastric ulcer ; 

 certainly it determines the peculiar punched-out 

 character which the typical round ulcer assumes. 

 It is significant that more than one such lesion is 

 frequently present, as though the excessively acid 

 juice resulting from the irritation of some initial 

 abrasion not only had deepened that lesion into an 

 ulcer but had determined the formation of others 

 also. It is again significant that the typical punched- 

 out ulcer occurs just where the acid has access, and 

 nowhere else — at the lower orifice of the oesophagus, 

 in the stomach, and in the first two inches of the 

 duodenum, while in the jejunum it is unknown 

 except at the site of a previous gastrojejunostomy 

 opening, and not even then unless this operation 

 has failed to cure the hyperchlorhydria, which usually 

 means that the orifice was too small or badly placed. 

 Another evil consequence of excessive HCl is spasm 

 of the pylorus, which may lead to dilatation of the 

 stomach. A curious and suggestive symptom is pyrosis, 

 a periodical copious secretion of saUva, probably de- 

 signed to neutrahze the acidity when swallowed. 

 In infants, Willcox and R. Miller have stated that 



