General Remarks

Deviations from the normal process of gastric digestion not based upon pathologico-anatomical changes are considered as gastric neuroses. We are accustomed to ascribe the different functions of the stomach to the action of special nerves. Although physiological experiments have not as yet enabled us to discover special nerves governing secretion, motion, or sensibility of the organ, still clinically many facts speak in favor of such an assumption. The neuroses of the stomach are also occasionally designated as "functional disturbances." The different gastric neuroses may appear either separately or, occasionally, in combination with each other. As a rule, these neuroses occur most frequently in women, especially between the ages of seventeen and forty; in men also the middle period of life shows a predilection for these disturbances. As a predisposing factor for these neuroses the following conditions must be recognized: severe mental exertions, worry, unusual excitement, sexual excesses. The recognition of the neurosis is not always very easy. The principal point of importance is the exclusion of any organic lesion of the organ.

The following symptoms, which frequently recur in gastric neuroses, have been especially well described by Boas,1 and will facilitate the recognition of the nervous element of the affections in question.

1. The entire nervous system shows more or less deviation from the normal. There may be present headache, insomnia, conditions of depression, or, on the other hand, excitation, increased sensitiveness. Objectively there may be an increase or diminution of the reflexes of the skin and tendons, hyperesthesia at some, paraesthesia or anaesthesia at other places. Frequently there exists constant or intermittent polyuria. The general condition may be good or various degrees of emaciation may be present.

2. The digestive system is characterized by a condition of "labile gastro-intestinal function." The subjective symptoms are not always necessarily connected with the act of digestion. The digestive complaints are usually independent of the quality and quantity of the ingested food. Dietetic errors are, as a rule, not followed by any aggravation of symptoms; while the character of food does not have any influence upon the severity of the symptoms, there are occasionally some other factors in the way of climate and surroundings which play an important part in the amelioration or deterioration of the condition. Objectively changes in the condition of gastric secretion and of the motor function of the stomach as well as of the intestines frequently occur. Thus complete anacidity may alternate during a short period with normal secretion. The condition of the motor functions of the stomach frequently changes. The state of the bowels is also very variable; thus constipation frequently alternates with diarrhoea, or, at a time when the bowels are regular, an acute diarrhoea may suddenly appear.

1Boas: "Specielle Diagnostik uud Therapie der Magenkrank-heiten," 2te Auflage, p. 204.

According to Rosenthal,1 the neuroses of the stomach are best divided into: (1) Sensory, (2) motor, and (3) secretory neuroses of the stomach.