438 Disturbances of Digestion. % 



tion is disturbed in two ways in disease, the gastric secretion be- 

 ing 'affected in the first place and in the second the gastric motihty 

 being more or less affected. Usually both factors are involved 

 at the same time, being directly or indirectly dependent upon 

 each other. Disturbances of secretion are for the most part 

 characterized by such features as diminution of the gastric juice, 

 decrease in the proportion of acid (subacidity) and of pepsin 

 resulting from degeneration of the glandular epithelium in acute 

 and chronic catarrhs, anaemia, etc., or by continuous secretion of 

 gastric juice without intervals ol rest (caused by local inflamma- 

 tory stimulation of the nerves of the mucous membrane). In 

 the latter condition the secretion is apt to be poor in its hydro- 

 chloric acid and peptic enzyme, and its increased volume accounted 

 for by hypersecretion of mucus. The secretion under such cir- 

 cumstances is likely to be of diminished functional value, or to be 

 entirely incapable of digestive action, such a condition being 

 termed dyspepsia. Although the passage of tlie gastric contents 

 into the intestine is the principal -factor in preventing serious 

 prevalence of bacteria in tlie stomach, the acid of the gastric juice 

 has a part in restricting the growth of bacteria and the occurrence 

 of putrefactive changes in the viscus. A gastric juice poor in acid 

 must be decidedly diminished in its antiseptic action, and for this 

 reason a num.ber of types of bacteria grow luxuriantly in the 

 stomach in dyspeptic conditions. The gastric contents are often, 

 in these instances, found to be neutral or alkaline in reaction, and 

 putrefactive fermentation is present; where in spite of deficiency 

 of hydrochloric acid an acid reaction prevails (dyspepsia acida), 

 this is due to the formation of acetic acid (from alcohol, yeast 

 fermentation) and lactic and butyric acids (from glucose, through 

 the activity of bacteria). 



In other cases there may exist a hypersecretion with excessive 

 hydrochloric acid production, or the latter (hyperacidity) may 

 obtain without any increase in the digestive fluid (as a result ol 

 special conditions of irritation), with the effect of inhibiting starch 

 digestion and causing gastric pain and vomiting (Krehl). 



The products of fermentation and putrefaction of the gastric 

 contents act as toxic irritants upon the mucous membrane, and 

 may occasion further degenerative and inflammatory changes in 

 that tissue. Under these and other circumstances, which induce 

 (whether from circulatory disturbances or from the local lesions 

 and toxic influences) paralysis or weakness of gastric peristalsis 



