CONSTIPATION AND DIAKRHCEA. 287 



Martin, when fever occurred, a small amount of gastric-juice was secreted ; the mucous 

 membrane was dry, red, and irritable. Dogs suffering from septicemic fever, or rendered 

 anaemic by great loss of blood, secrete gastric-juice of feeble digestive power and containing 

 little acid (Manasse'iri), [In acute diseases accompanied by fever, the inner cells of the fundus- 

 glands of the human stomach may disappear (C. Kupffer).] Hoppe-Seyler investigated the 

 gastric-juice of a typhus patient in which van de Velde found no free acid. Usually no free 

 hydrochloric acid is found in cancer of the stomach. The gastric-juice of the typhus patient 

 did not digest artificially, even after the addition of hydrochloric acid. The diminution of 

 acid, under these circumstances, favours the occurrence of a neutral reaction, so that, on the 

 one hand, digestion cannot proceed, and on the other, fermentative processes (lactic and butyric 

 acid fermentations with the evolution of gases) occur. These results are associated with the 

 presence of micro-organisms and Sarcina ventriculi (Goodsir). Uffelmann found that the secretion 

 of a peptone-forming gastric-juice ceased in fever, when the fever is severe at the outset, when 

 a feeble condition occurs, or when the temperature is very high. The amount of juice secreted 

 is certainly diminished during fever. The excitability of the mucous membrane is increased, 

 so that vomiting readily occurs. The increased excitability of the vaso-motor nerves during fever 

 is disadvantageous for the secretion of the digestive fluids (Heidenhain). Beaumont observed 

 that fluids are rapidly absorbed from the stomach during fever, but the absorption of peptones 

 is diminished on account of the accompanying catarrhal condition of the stomach, and the 

 altered functional activity of the muscularis mucosae (Leube). 



Many salts, when given in large amount, disturb gastric digestion, e.g., the sulphates. "While 

 the alkaloids, morphia, strychnia, digitalin, narcotin, veratria have a similar action, quinine 

 favours it (Wolberg). In some nervous individuals "peristaltic unrest of the stomach." con- 

 joined with a dyspeptic condition, occurs (Kussmaul). [Prosser James directs attention to the 

 value of peptic and pancreatic salts, which are preparations of common salt mixed with pepsin 

 and the ferments of the pancreas respectively.] 



[Artificial Digestion is aifected by various salts according to their nature and dilution. The 

 digestion of fibrin by pepsin goes on best without the addition of salts, being diminished by 

 magnesic sulphate, sodic carbonate, and sulphate. The digestion of fibrin by pancreatic extract 

 is accelerated by sodic carbonate (Heidenhain), and retarded by MgS0 4 and Na 2 S0 4 . The 

 diastatic action of the saliva and pancreas on starch is greatly accelerated by NaCl (2 per cent.), 

 while Na 2 C0 3 , Na 2 S0 4 , and MgS0 4 hinder it (Pfeiffer)^] According to Schutz, artificial gastric 

 digestion is retarded by a 2 per cent, solution of alcohol, and also by a solution of salicylic acid 

 (06 to *1 per cent. ). Buchner, however, finds that 10 per cent, of alcohol does not affect artificial 

 gastric digestion, while above 20 per cent, arrests it. Beer hinders digestion. 



F. In acute diseases, the secretion of bile is affected ; it becomes less in amount and more 

 watery, i.e., it contains fewer specific constituents. If the liver undergoes great structural 

 change, the secretion may be arrested. 



G-. Gail-Stones. When decomposition of the bile occurs, gall-stones are formed in the gall- 

 bladder or in the bile-ducts. Some are white, and consist almost entirely of stratified layers of 

 crystals of cholesterin. The brown forms consist of bilirubin -lime, and calcium carbonate, often 

 mixed with iron, copper, and manganese. The gall-stones in the gall-bladder become facetted 

 by rubbing against each other. The nucleus of the white stones often consist of chalk and bile- 

 colouring matters, together with nitrogenous residues, derived from shed epithelium, mucin, 

 bile-salts, and fats. Gall-stones may occlude the bile-duct and cause choleemia. When a small 

 stone becomes impacted in a duct, it gives rise to excessive pain, constituting hepatic colic, and 

 may even cause rupture of the bile-duct with its sharp edges. 



H. Nothing certain has been determined regarding the pancreatic secretion in disease, but 

 in fever it appears to be diminished in amount and digestive activity. The suppression of the 

 pancreatic secretion, [as by a cancerous tumour of the head of the pancreas], is often accompanied 

 by the appearance of fat, in the form of globules or groups of crystals in the faeces. 



I. Constipation is a most important derangement of the digestive tract. It may be caused 

 by (1) Conditions which obstruct the normal channel, e.g., constriction of the gut from stricture 

 in the large gut after dysentery, tumours, rotation on its axis of a loop of intestine (volvulus), 

 or invagination, occlusion of a coil of gut in a hernial sac, or by the pressure of tumours or 

 exudations from without, or congenital absence of the anus. (2) Too great dryness of the con- 

 tents, caused by too little water in the articles of diet, diminution of the amount of the digestive 

 secretions, e.g., of bile in icterus; or in consequence of much fluid being given off by other 

 organs, as after copious secretion of saliva, milk, or in fever. (3) Variations in the functional 

 activity of the muscles and motor-nervous apparatus of the gut may cause constipation, owing to 

 imperfect peristalsis. This condition occurs in inflammations, degenerations, chronic catarrh, 

 and diaphragmatic inflammation. Affections of the spinal cord, and sometimes also of the brain, 

 are usually accompanied by slow evacuation of the intestine. Whether diminished mental 

 activity and hypochondriasis are the cause of, or are caused by, constipation is not proved. 

 Spasmodic contraction of a part of the intestine may cause temporary retention of the intestinal 

 contents, and, at the same time, give rise to great pain or colic ; the same is true of spasm of 

 the anal sphincter, which may be excited reflexly from the lower part of the gut. The feecal 



