DYSPEPSIA. 409 



the stomach itself necessarily leads to the same result. Excess 

 of the gastric juice is rare. As a rule, the juice is deficient in 

 relation to the amount of food taken, whether from excess of 

 the latter or from absolute diminution in the secretion, for 

 instance, in debility after illness. Again, either the pepsin or 

 the hydrochloric acid may be deficient, or impeded in its 

 special action. Gastric indigestion is occasionally of nervous 

 origin : depressing mental states readily arrest the action of 

 the stomach ; and morbid impressions, originating in the liver, 

 intestines, kidneys, or uterus, often have the same effect. 



Disorder of the muscular functions of the stomach may also 

 cause dyspepsia. Feebleness of the churning movements 

 leads to imperfect exposure of the food to the action of the 

 juice ; feebleness of the expulsive efforts delays the removal of 

 the chyme, excess of which arrests digestion. In other cases, 

 excessive peristalsis hurries the food into the duodenum before 

 the process of gastric digestion has well commenced. 



If from any of these or from other causes, the contact of the 

 food and the gastric juice be deficient, the process of digestion 

 becomes disturbed. The secretion, unable to effect complete 

 conversion of the proteids into peptones, produces some partial 

 chemical change in them ; the other constituents of the food 

 are also broken up ; and what with the unnatural products, 

 and, in the case of a heavy meal, the excess of peptones them- 

 selves the process of digestion is completely arrested. A 

 decomposition occurs, associated with the formation of organic 

 acids; the sugar, starch, and fat probably become partially 

 changed ; and the contents of the stomach are converted not 

 into the normal chyme, but into a sour, fermenting mass with 

 abundant development of gas. The stomach becomes dis- 

 tended, and the neighbouring organs impeded in their action, 

 especially the heart. The nerves, vessels, and glands of the 

 stomach are irritated by the products, so that the mucous 

 membrane swells; the rosy hue passes into pallor; and the 

 surface is coated with a tenacious mucus. The gastric and 

 associated centres are powerfully excited; and impulses are 

 sent out which lead to hiccup, eructation, and vomiting. If 

 these do not give relief, the contents pass into the bowel, 

 irritate it also by their excessive acidity, and give rise to 

 duodenal dyspepsia and diarrhoea. Even when the urgent 

 symptoms have subsided, the morbid anatomical condition 

 remains for a time associated with an excessive secretion of 

 mucus ; the digestive power is arrested ; pain and fulness are 

 felt ; and loss of appetite (anorexia) and nausea are complained 

 of. All these symptoms will call for relief by treatment. 



In chronic dyspepsia the attacks are much less severe, but 



