TOTAL ABSENCE OF THE GASTRIC SE CRETORY FUNCTION (ACHYLIA GAS TRICA; ACIILORIIYDRIA; NERVOUS AN ACIDITY; ATROPHY OF THE GASTRIC TUBULES; ANADENIA VENTRICULI.—AS remarked before, this curious affection, although classed among the neuroses and functional diseases of the stomach, is often dependent upon an actual atrophy of the gastric tubules, which may have been due to a granular gastritis, symp toms of which last had not been evident. The writer has described this affection at length in the Amer. Jour. of the Med. Sci., Nov., '95. The history of the cases he there details and that of certain others he has since observed renders it not im probable, as he there holds, that many cases of this affection originate as a local exhibition of a general neurosis or as a general neurasthenia, or through some process of nervous inhibition. Through a long-continned action of the causative factor, the suppression of function leads finally to atrophy, of the non-secreting ;lands, without the existence of a pre ceding or accompanying gastritis. It is, however, important to note that in a number of cases studied by Hemmeter, from which lie was able to obtain frag ments of the gastric mucosa, in nearly all glandular gastritis was evident with the glandular atrophy.
In cases of absence of the secretory function the acidity of the gastric con tents is persistently practically nil, being merely that of the food previously in gested, macerated in the fluid coinci dently taken. The gastric contents for purposes of testing must be removed by the tube at a time after a meal when digestion should normally be at its height and a fair amount of free HC1 evident. The acidity of the filtrate then, after the simple meal of bread and water (2 ounces of bread; 12 ounces of water),—the con tents removed in one hour from its in gestion,—is from 4 to 3, instead of from 30 to GO, as calculated on 100 cubic centi metres of the gastric filtrate, a measured amount of which is titrated with deci normal sodium hydrate. Pepsin and lab ferments are absent, but traces of the pro-ferments are usually evident. (For detail of methods of examination, see the paper on this subject referred to.)
This disease may exist quite symptom less and with preserved general health, or there may be present (as a result of a coincident marked atony of the stomach) anemia and dyspeptic symptoms refer able to the atony. Gastric carcinoma should be carefully searched for.
The treatment consists in endeavoring to restore the secretory loss, if it is sus pected that atrophy of the tubules has not yet occurred. The use of the intra gastric douche with weak solutions of HCI, and a bitter infusion, alternated with douches of soda and of salt; the daily employment of intragastric elec tricity, and of HCl before meals, all as detailed in the treatment of chronic gas tritis, are then worthy of trial. If im pairment of the motor function exists, this, at least, is benefited or removed by this treatment even if secretory loss can not be restored through atrophy of the glandular elements. Attention to the general health is of prime importance; the accompanying neurasthenia or the manifestations of a neurosis must receive the most intelligent management.
Later, when persistent efforts to restore the secretory function are resultless, the further use of IIC1 is unnecessary. In tragastric electricity is then employed, if at all, merely for its effects on motility. It is useless in any stage of this affection to administer IIC1 and pepsin, expecting to obtain a digestive effect. An active papain and diastasic preparation must be employed instead, or an extract of the pancreas used, if the indications, such as debility and blood-impoverishment, sug gest that digestion in the bowel by aid of the pancreatic secretion, is not occurring.
The Motor Neuroses, — HYPERMOTIL ITY is that condition in which the gastric motor function is abnormally increased, the stomach-contents passing too rapidly onward into the bowel before gastric di gestion has been completed. Hyper chlorhydria very commonly co-exists with hypermotility, and is presumed to orig inate the latter sometimes.
The treatment of hypermotility is largely that of hyperchlorhydria.