Gastric gland

“ In such persons some kinds of food, well digested by a normal stomach, will act as an injurious foreign body, and be felt as such by the over-sensitive stomach nerves, and the gastric glands will respond with a large flow of secretion and much acid upon agencies that produce no such stimulation in a normal stomach. ”

“ If food is taken into the stomach when in this condition it becomes coated with this mucus, and the secretion of the gastric juice and its action are delayed. These facts show the value of a goblet of water before breakfast. This washes out the tenacious mucus and stimulates the gastric glands to secretion. In old and feeble persons water should not be taken cold, but it may be with great advantage taken warm or hot. This removal of the accumulated mucus from the stomach is probably one of the reasons why taking soup at the beginning of a meal has been found so beneficial. ”

“ We are at liberty, however, to suppose that the fat on the one hand is of importance for the inhibition of the gastric glands, and the alkalinity on the other for the restraint of the pancreas. Thus the gastric glands and the pancreas, notwithstanding the presence of excitants, are maintained by milk at a certain but not too high degree of activity, a matter which is in every way desirable in consideration of the easy digestibility of its constituents. ”

“ In many cases the glands that secrete the gastric juice are feeble; in others they seem cramped, and far from ready to act when food is presented. The hot water has the same effect on them as it has everywhere else on the body—that of stimulating the circulation and bringing about natural action. It looks a very frail remedy; but when we can, as it were, see these glands opening and filling with arterial blood the instant they are bathed in this same water, and see how ready they become to supply gastric juice for digestion, the remedy does not look so insignificant. ”

“ Towards the pyloric end of the stomach the true gastric glands are often replaced by mucous glands. There are, nevertheless, not a few Teleosts in which special gastric glands are absent, as, for example, Syngnathus acus, and several species of Cyprinidae, Labridae, and Blenniidae, etc. In at least two genera (Gastrosteus and Cobitis) , belonging to widely different families, gastric glands are present in certain species but absent in others. ”

“ Every day so many hours and so much energy are required for digestion; a gross torpidity, a carnal lethargy, seizes on mortal men after dinner. This may and can be avoided. Man's knowledge of organic chemistry widens daily. Already he can supplement the gastric glands by artificial devices. Every doctor who administers physic implies that the bodily functions may be artificially superseded. We have pepsine, pancreatine, artificial gastric acid—I know not what like mixtures. Why, then, should not the stomach be ultimately superannuated [Pg 112] altogether? ”

“ This is owing to the frequent concurrence of the two conditions, the gastric symptoms taking precedence of the others. The more complex nature of the intestinal function is another reason, intestinal indigestion having more modifications in its phenomena. In the stomach there is only one active secretion; in the intestine there are three, all participants in the act of solution. An alteration in the quality or quantity of one of these—the bile, for example—would lead to different symptomatic results than would follow another defective secretion, as that of the pancreas, for instance. ”

“ Next to rheumatism in the order of frequency, we must place those gastric derangements which pass under the denomination of pyrosis, gastralgia, morbid sensibility of the stomach, &c. It very seldom happens that a patient complains of a gnawing pain in the stomach, without also mentioning that he is subject to the ejection of a clear glairy fluid. There is often tenderness at the epigastrium, but the tongue, which, for the most part, assumes a pale, pasty, sodden look, occasionally, however, presenting nothing uncommon, has very rarely the red tip and margin, indicative of mucous inflammation. ”

“ From what we have just said it is evident that the proper emptying of the stomach and, therefore, the proper carrying on of the whole process of digestion, depends upon the formation and outpouring of ample supplies of acid-containing gastric juice. A failure of gastric secretion is bound to be followed by a failure of the stomach to empty itself. Instead of going on to the small intestine where digestion is completed and the digestion products passed on to the blood stream to be used by the body, the food mass lies inert in the stomach. ”

“ But we are liable to be misled by pain: gastric pain is not a characteristic symptom; subacute forms of the disease may exist without any fixed pain; the sensation is rather that of burning, uneasiness, and oppression of the epigastric region. The appetite, as a rule, is greatly impaired—indeed, the sense of hunger is rarely experienced—and nausea and vomiting frequently follow the ingestion of food. This is especially the case when catarrh of the stomach is associated with renal disease, portal congestion, or chronic alcoholism. ”

“ While anorexia, indigestion, vomiting, and epigastric pain and tenderness point to the existence of a gastric affection, the malignant character of the affection may be surmised by the development of anæmia, emaciation, and cachexia more rapid and more profound than can be explained solely by the local gastric symptoms. The value to be attached in the diagnosis of gastric cancer to the absence of free hydrochloric acid from the contents of the stomach must still be left sub judice. ”

“ The treatment in chronic gastritis is very like that in the more acute form; that is, it must be combated by removing the cause. Lack of fresh air and exercise have much to do with the development of chronic gastritis, but even they combined with a judicious amount of rest would be wasted without a proper adjustment of the diet to cover the main points of the disturbance. As has already been mentioned, the cause may be a lack of gastric juice or it may be an excess of it; it may be intensified by an atonic condition of the organ or from the food passing too quickly into the duodenum. ”

“ In addition pepsin and muriatic acid may be given with each meal in proportion adapted to its amount. A life in the open air, and an occasional soapy wash will do much to restore healthy gastric functions.
CHRONIC GASTRITIS IN THE DOG. Causes: faults in diet, musty food, foreign bodies, poisons, lack of sunshine, retained fæces, parasites, ill health, chronic diseases, icy bath, septic drink. Symptoms: irregular appetite and bowels, fever, foul breath, red tongue, tartar on teeth, dullness, prostration, vomiting of mucus or bile, tender epigastrium, arched back, fœtid stools, emaciation. ”

“ Frequently, when several of these balls have been given at the same time, they have all been seen in the antrum after the stomach was otherwise empty. Here they remain to be softened in time by the juices, or to be forced through the pylorus later, for solids do pass into the intestine. Thus when the teeth neglect their work the stomach attempts to perform their function; the relative inefficiency of the gastric method of grinding and its interference with the normal gastric activities point an obvious hygienic moral. ”

“ No digestion goes on in the stomach nor is the food passed on into the small intestine to be digested there. We can expect nothing else than that indigestion will come on. It appears that in human beings, with their high nervous organization, simple weariness may suffice to hinder the outpouring of the nervous disturbances upon which gastric secretion depends, so that one may not be worried at mealtime, but may be simply overtired and still fail of digesting the food. ”

“ As has been pointed out, gastric digestion is primarily a process for the conversion of proteid food into soluble products. It would be a mistake, however, to assume that the digestion of proteid foods is complete in the stomach. Stomach digestion is to be considered more as a preliminary step, paving the way for further changes to be carried forward by the combined action of intestinal and pancreatic juice in the small intestine. The importance of gastric digestion is frequently overrated. It is unquestionably an important process, but not absolutely essential for the maintenance of life. ”

“ It then descends, through the oesophagus, into the stomach, where it becomes digested, and, in a great measure, dissolved, by the gastric juice, which is secreted by the arteries of the stomach. It is then pushed through the pylorus, or right orifice of the stomach into the duodenum, where it becomes mixed with the bile from the gall bladder and liver, and the pancreatic juice from the pancreas. These fluids seem to complete the digestion: after this, the food is continually moved forwards by the peristaltic motion of the intestines. ”

“ The gastric surface is concave and adapts itself to the fundus of the stomach, while just in front of the ridge separating the gastric and renal surfaces is the hilum, where the vessels enter and leave the organ; in front of this the tail of the pancreas usually touches the spleen. The renal surface is as a rule smaller than the gastric and, like it, is concave ”

“ The functions of the stomach are almost invariably disordered in gastric cancer. Sometimes, especially in the early stages, this disorder is only moderate, and is manifested by the milder symptoms of indigestion, such as uneasy sensations of weight and fulness after a meal, nausea, flatulent distension of the stomach relieved by eructation of gases, and heartburn. ”

“ Leaving aside the vexed question as to whether muriated or saline waters can be regarded as direct excitants of gastric secretion, it cannot be doubted that the prolonged and systematic lavage of the stomach, ridding it of viscid mucus and hastening the removal of retained fermenting foodstuffs, must favour restoration of a healthy state of the mucous membrane, and thus indirectly promote its secretory activities. ”

“ That due mastication of the food is essential to healthy digestion, which will be promoted or retarded in exact proportion as it approaches or falls short of this point, is a fact so generally known as scarcely to need comment. Suffice it to add, that, if food be introduced into the stomach unmasticated, the gastric juice will only act upon its surface; and after a number of hours it will be either rejected by vomiting, or pass on into the intestine, to give rise to cholic, bowel complaints, or flatulence, and very frequently in children to a serious attack of convulsions. ”

“ Gastric juice is secreted continuously, but quantities sufficiently large for examination are not usually obtainable from the fasting stomach. In clinical work, therefore, it is desirable to stimulate secretion with food—which is the natural and most efficient stimulus—before attempting to collect the gastric fluid. Different foods stimulate secretion to different degrees ”

“ Hitherto we have been accustomed to regard the phases of digestion, gastric digestion, pancreatic digestion, and intestinal digestion, as almost separate processes, any of which we might increase indefinitely without doing any harm to the patient. We forget the relation which each bears to the other; and yet such a relation undoubtedly exists, for we find that when pepsin is mixed with bile it is precipitated and rendered inert. Further transformation of foods by the gastric juice is thus arrested as soon as the chyme leaves the stomach. ”

“ We know, for example, that, at the commencement of digestion, the muscular contractions of the stomach are comparatively slow and feeble, and that as chymification advances they become rapid and energetic, as if to remove the chyme as fast as it is formed. If then new food, for which the feebler movement is best adapted, be introduced when digestion is far advanced and the energetic motion going on, may not this disproportion be itself an impediment, and co-operate with the deficiency of the gastric juice in disordering digestion? ”

“ Experience shows that the delicate stomach suffers severely from these causes. In some instances, the long unemployed organ secretes an excess of mucus, which greatly interferes with digestion. A sufficient amount of food at breakfast has a direct influence on the digestion of dinner; in which process, large quantities of gastric juice—a fluid charged with nitrogenous and other materials—must be suddenly extracted from the blood. ”

“ There is evidence that about two-thirds of all the cases of cancer of the stomach originate in an old gastric ulcer, and the constant eating of hot food is perhaps enough to account for the remaining third. The delicate gastric cells, more abused than any other cells in the body, are bathed in a highly acid medium. It is no wonder that departure from their appointed path accounts for thirty per cent. ”

“ In the same way may the liver be functionally deranged, or, judging from the destruction of matter during the febrile stage, a slight fatty infiltration of the organ may even occur—conditions which are apt to pass away with the exciting cause. The gastric irritability, whenever present, may be of nervous origin, though the vomiting, and particularly that of black hemorrhagic matters, observed in exceptional cases, evidently depends upon a hyperæmia of the stomach. ”

“ An important fact, as explaining the liability to passive hæmorrhages, is the existence of a generalized fatty degeneration of the capillaries and smaller blood-vessels. The stomach, as stated, always contains more or less black material, sometimes fluid blood, such as may have been vomited during life. The folds of the gastric mucosa are swollen ; here and there are arborescent patches of congestion, and ecchymoses. Observers are not agreed as to the nature of this congestion— whether it is passive or inflammatory. ”