380 PATHOLOGICAL VARIATIONS OF DIGESTION. 



and other small globular or rod-like fungi, which give a similar reaction 

 (Nothnagel, Uffelmann). Bienstock, who has devoted attention to the 

 microbes of the faeces, finds two kinds of bacteria in all faeces ; both 

 resemble B. subtilis (Fig. 148) very closely, but they are distinguished 

 from it by their mode of development. They do not cause any 

 fermentative action. There are several other forms found in the faecal 

 evacuations, under different circumstances. 



The changes of the intestinal contents have been studied on persons with <an 

 accidental intestinal fistula, or an artificial anus. 



186, Pathological Variations. 



A. The taking Of food may be interfered with by spasm of the muscles of 

 mastication (usually accompanied by general spasms), stricture of the oeso- 

 phagus, by cicatrices after swallowing caustic fluids (e.g., caustic potash, mineral 

 acids), or by the presence of a tumour, such as cancer. Inflammation of all kinds 

 in the mouth or pharynx interferes with the taking of food. Impossibility of 

 swallowing occurs as part of the general phenomena in disease of the medulla 

 oblongata, in consequence of paralysis of the motor centre (superior olives) for the 

 facial, vagus, and hypoglossal nerves, and also for the afferent or sensory fibres of 

 the gloss-pharyngeal, vagus, and trigeminus. Stimulation or abnormal excitation 

 of these parts causes spasmodic swallowing, and the disagreeable feeling of a 

 constriction in the neck (globus hystericus). 



B. The secretion Of Saliva is diminished during inflammation of the salivary 

 glands; occlusion of their ducts by concretions (salivary calculi); also by the use of 

 atropin, daturin, and during fever, whereby the secretory (not the vaso-motor) 

 fibres of the chorda appear to be paralysed (p. 287). When the fever is very high, no 

 saliva is secreted. The saliva secreted during moderate fever is turbid and thick, 

 and usually acid. As the fever increases, the diastatic action of the saliva 

 diminishes (Uffelmann). The secretion is increased, by stimulation of the buccal 

 nerves (inflammation, ulceration, trigeminal neuralgia), so that the saliva is 

 secreted in great quantity. Mercury and jaborandi cause secretion of saliva, the 

 former causing stomatitis, which excites the secretion of saliva reflexly. Even 

 diseases of the stomach accompanied by vomiting, cause secretion of saliva. A 

 very thick tenacious sympathetic saliva occurs when there is violent stimulation 

 of the vascular system during sexual excitement, and also during certain psychical 

 conditions. The reaction of the saliva is acid in catarrh of the mouth, in fever 

 in consequence of decomposition of the buccal epithelium, and in diabetes mellitus 

 in consequence of acid fermentation of the saliva which contains sugar. Hence, 

 diabetic persons often suffer from carious teeth. Unless the mouth of an infant 

 be kept scrupulously clean, the saliva is apt to become acid. 



C. Disturbances in the activity of the musculature of the stomach may be due 

 to paralysis of the muscular layers, whereby the stomach becomes distended, and 

 the ingesta remain a long time in it. A special form of paralysis of the stomach is 

 due to non-closure of the pylorus (Ebstein). This may be due to disturbances of 

 innervation of a central or peripheral nature, or there may be actual paralysis of 

 the pyloric sphincter, or anaesthesia of the pyloric mucous membrane, which acts 

 reflexly upon the sphincter muscle; and lastly, it may be due to the reflex 

 impulse not being transferred to the efferent fibre within the nerve centre. 

 Abnormal activity of the gastric musculature hastens the passage of the ingesta. 

 into the intestine ; vomiting often occurs. 



