Synonyms

Gastric insufficiency (Rosenbach1); myasthenia ventriculi (Boas).

Atony of the stomach designates a condition in which the muscular action of the organ is retarded and weakened. It occurs as a frequent complication of many digestive disorders, and also of other diseases which greatly weaken the constitution. Thus we find it accompanying chronic gastric catarrh, hypercblor-hydria, neurasthenia gastrica, tuberculosis of the lungs, grave heart affections, and the like. Sometimes, however, this condition exists as a primary neurosis.

Symptomatology

If atony occurs as a complication to another affection, the symptoms of atony will be overshadowed by those of the principal trouble. If it exists alone, the following characteristics are fre-quently present. An uncomfortable feeling of fulness appears after meals; often there is eructation of gas; the appetite is diminished; headaches and constipation are frequently present.

Diagnosis

The diagnosis is based upon the presence of the above-described symptoms and the detection of the following points on examination:

1. The splashing sound is easily produced in the gastric region, even if the stomach contains only a small quantity of chyme or liquid. As a rule, the area over which the splashing sound can be produced extends from the margin of the ribs on the left side to the umbilicus or somewhat below it.

1 Rosenbach: Volkmann's Samml. klin. Vortrage, 1878, No. 153.

The same phenomenon has been observed by Richet1 in the case of a man with a gastric fistula. Fear and great anxiety have a depressing effect on the gastric secretion. These facts clearly show the influence of nerve centres within the brain upon the gastric secretory function. There must, however, undoubtedly exist some nerve mechanism within the stomach itself which regulates the secretion; for after section of the vagus and sympathetic nerves supplying the stomach, the latter organ will continue to produce its ordinary secretion after the application of an irritant. As in the neuroses previously considered, conditions of increased and decreased functions exist also in these cases.

After having described the functional disorders of secretion under special chapters (Hypersecretion and Achylia Gastrica), we need say here only that in most instances these affections are of nervous origin, either protopathic or of a reflex nature. This latter theory has been especially advocated by Charles G. Stockton,2 of Buffalo.

Frequently, however, disorders of secretion may secondarily accompany primary neuroses; thus tabes dorsalis and other spinal lesions are frequently associ ated with hyperchlorhydria and also with periodic gastrosuccorrhoea.

Neurasthenia and hysteria may be complicated with either hyperchlorhydria or hypochlorhydria or achylia. The symptoms which these secretory disturbances evoke are the same as if they were the primary affections.

1 Ch. Richet: "Du Suc gastrique chez l'Homme et les Animaux," Paris, 1878.

2Charles G. Stockton: Medical Record, 1894.

Hypochlorhydria of nervous origin is sometimes met with without the association of other nervous symptoms, and it is then quite difficult to establish the diagnosis between this affection and gastric catarrh. Absence of tenderness on pressure in the gastric region and a perfectly clean tongue point rather to the presence of a neurosis. Sudden changes in the condition of the gastric secretion (heterochylia [Hemmeter]) speak likewise in favor of a neurotic character.