112 STUDIES IN CLINICAL PHYSIOLOGY 



there are two types of dyspepsia causing pain, 

 wasting, vomiting, and constipation. One is con- 

 genital stenosis of the pylorus, in which the HCl is 

 subnormal but the pepsin (which may be conveniently 

 tested by the curdling effect on milk) is excessive ; 

 and mucin is also in excess. The other is " acid 

 dyspepsia," in which the HCl is excessive and the 

 ferments are subnormal. In this case peristaltic 

 waves may be seen, but the pyloric tumour is not 

 felt. The prognosis is very much better than in 

 congenital stenosis, and operation is not needed as 

 it so often is in the more serious condition. 



Enough has been said to show that hyperchlor- 

 hydria and its advertisement, " hunger-pain," are 

 more than an inconvenience to the patient ; they 

 are in many cases the consequence and in other cases 

 the precursor of serious organic mischief which may 

 lead to dilated stomach, to chronic gastric ulcer — 

 which in its turn is very apt to become malignant — 

 or to an abdominal catastrophe from perforation of 

 the stomach or duodenum. 



When the hyperchlorhydria is not associated with, 

 or precedes, ulceration of the stomach or duodenum, 

 the appendix or gall-bladder is probably at fault. 

 The appendix, for instance, may show adhesions or 

 stenosis. 



Sherren found the appendix normal in only 4 out 

 of 65 cases of duodenal ulcer, and 5 out of 41 cases 

 of gastric ulcer. Moynihan, Paterson, the Mayos and 

 others have shown that the majoritj^ of the gastric 

 and duodenal ulcers met with on the operation table 

 are associated with appendicitis. The sequence is, 



