THE CONVICTION OF THE STOMACH AS THE SEAT OF INDIGESTION.
One may now ask—how is an outlet to be found from this maze of causes and effects? How is one to discover where the mischief begins and what causes it? For the only rational way out of the difficulties that beset the treatment of stomach disorders is to detect where and why the error begins.
If the cause of indigestion arises in the stomach, in how many different circumstances might it have origin? This can only be answered by a reference to what has been already said about the structure of the stomach and the functions it fulfils. If the complaint arises in the stomach it will be associated with food in some way, with Let us look at each of these for a moment. A well-known recipe connected with the making of hare-soup began: "First catch your hare." So in stomach disorders, before the stomach can be the seat of indigestion, food must gain entrance to it. Now and again one will meet with a case in which the sufferer complains of what he calls indigestion, but he goes on to say that food is no sooner swallowed than it is re turned, and on close inquiry there arises reason to doubt whether much of the food really gains entrance to the stomach at all, and to surmise that the food, or at least a large portion of it, passes down only a certain distance, and is immediately returned. This occurs when the entrance to the stomach is blocked, as by a growth at the lower end of the gullet, or a narrowing there. In such cases it will usually be found that solids are returned at once, and that liquids go down more easily, specially if sipped slowly. A person who suffers from such a condition will probably lose strength and flesh vtry fast once the condition is fully established. Frequently the food may not be returned im mediately, for the lower part of the gullet may dilate to form a kind of pouch in which the food may lie for a time.
But let us assume the food has gained en trance to the stomach, its proper digestion depends upon (1) Mixture with a sufficient quantity of gastric juice containing hydrochloric acid and pepsin in certain proportions.
(2) Movement and mixture of the food by the action of the muscula&layers of the stomach walls.
(3) Removal from time to time, by passing through the pylorus into the duodenum, of portions of food as they become re duced to fluid.
(4) There must be no admixture with the food, either before it enters the mouth or afterwards, of such substances as would tend to slow down or arrest the digestive process, or set going abnormal forms of fermentation. Certain drugs do this.
(5) Finally, there must be the complete empty ing of the stomach, by the exit through the pylorus of the last remnants of the meal. The passage of fluid materials through the pylorus in any quantity probably begins from 1 hour to 1 hour after a meal has been taken. In the case of a moderate, soft, and easily lique fied meal it has come to an end in about 3 hours; in the case of a large solid nieal the stomach may not be empty for 6 or 7 hours, even in health.
These things being noted and understood, it is clear that indigestion will arise sooner or later under circumstances we may classify as follows:— I. The quantity of gastric juice may be either (a) deficient in quantity, or (b) of seriously altered quality. The latter will happen if the juice contain too little acid or too much acid, or if the pepsin be inert or wanting.
In the one case, deficiency in quantity or in quality, the cause may be poverty of the blood supply to the stomach, or it may depend on actual changes which are slowly taking place in the glands of the stomach, by which they be. come atrophied or wasted, and unable to pro duce active gastric juice. In the other case, where the acid is in excess, this may be due to an almost exactly opposite condition of glands, in which overgrowth has occurred by excessive blood supply, engorgement of blood vessels of the inner coat of the stomach. Such a condition is easily caused by too stimulating food-stuffs, or by excessively large meals, and abuse of stimulants and condiments. It will be clear, also, that the failure to produce proper gastric juice may be due to the effects of the constant irritation of an ulcer or to destruc tion of the glands by a new growth, such as cancer.