HYPERCHLORHYDRIA. A FAIRLY constant set of symptoms appear in about onehalf of all stomach cases. They might be described in the following manner : Usually persons from fifteen to forty years of age; in all walks of life; well-to-do, and otherwise; no respect to position or social standing; but constant sufferers. They will tell you that after eating a meal, say from one to three hours or more, they have a sensation of fulness in the epigastrium, with pains radiating through to the back and extending to the region of the heart, or extending over the abdomen. Oftentimes they have a burning sensation which is accompanied by eructations of a warm fluid rising in the mouth and called water-brash, or is accompanied by expulsions of a foul smelling gas which has a choking sensation in the throat. If this gas does not make its appearance through the gullet, it remains long enough to produce marked distention of the stomach as well as acute colicky pain in the intestines. After these conditions have lasted for months, and many different remedies have been tried without results by as many different physicians, the patient becomes very irritable, despondent, and even melancholy. Headaches appear, mostly hemicranial and periodic, leaving as abruptly as they begin, only to return shortly. The memory is poor, to gether with insomnia and depression. They round out a set of symptoms similar to neurasthenia, or marked anæmia occurs. The appetite is almost always good and the weight is not changed. There is usually intense thirst, and the urine is free and frequent, is slightly acid in reaction, is deficient in chlorides, and indican is increased. But at times the acid is diminished, and this diminution of acid in the urine during digestion is a rough measure of the increase of H Cl in the gastric juice. Often times there is nausea, with vomiting, preceded and followed by tenderness over the epigastrium. At the time when the stomach is empty these patients are free from pain. The ingestion of food and drink almost immediately gives relief to the symptoms for a short time. These symptoms generally end with the evacuation of the stomach. The bowels are usually sluggish. All of these conditions correspond to a disease known and described as Hyperchlorhydria, which has been spoken of so often of late that many different views are expressed about its supposed origin, and as many more about its course and treatment. Many of these symptoms may arise directly from the stomach, or reflexly from the central nervous system, which in these cases suffers intensely at times through the absorption of toxines from the stomach. Some authors deny the existence of persistent disorders of secretion which are not produced by an anatomical lesion of the gastric mucosa, and the majority of writers consider all the dynamic affections of secretion to be neuroses. No one will deny that secretion may be disturbed through the nerves which control it. Prolonged study and careful investigation have led to the conclusion that disorders of secretion are not always due to an alteration of the mucosa or to a neurosis of the vago-sympathetic system. The normal stomach does not secrete when it is empty, and at most only 10 to 20 c.c. of gastric contents can be removed when the tube is introduced into the normal stomach in the early morning before breakfast, but sometimes when the stomach tube is introduced at this time it will be found to contain more than 20 c.c. of a liquid rich in H Cl and the digestive ferments. When a figure of acidity of 70 is reached after an Ewald's test breakfast, there is always present a hyperclorhydria. Hyperchlorhydria denotes a pathological increase of the H CI in the filtrate of the gastric contents at the acme of digestion. The causes of hyperchlorhydria are those common to a large number of other diseases of the stomach and are as often found in the constitution and temperament as in the mode of life and the alimentation. The abuses of condiments, the eating of large quantities of red meat, and imperfect mastication, are common causes. It is most frequent in the arthritic and the neuropath, in neurasthenia, hysteria, and in melancholia. It is quite frequently associated with intestinal autointoxication. It is common in colilithiasis and renal lithiasis, in chlorosis and in nicotine poisoning and malaria. Mental and moral causes play an important part. Cerebral fatigue may mark the beginning of the trouble and illustrates the close relations existing between the brain and the abdominal sympathetic. The trouble may begin immediately after a particular meal, or it may, and generally is, more gradually developed after a meal composed of starches, cereals, sweets, vegetables, fruits and fats, causing discomfort and pain at the height of gastric digestion. The diagnosis of hyperchlorhydria can be frequently made by the existing subjective symptoms; discomfort or |