Like affections of the heart, disturbances of the liver are also almost always accompanied by gastric symptoms, due to a hyperaemic condition of the stomach. Thus in icterus and cirrhosis of the liver the stomach is the first to manifest various symptoms. Here, as in most other diseases, the secretory function of the stomach does not show any constancy; in some cases the gastric juice may be normal, in some increased, while in the greater number of cases it is diminished.

Diseases of the kidney are also frequently associated with gastric symptoms. Thus nasea and vomiting may be the first symptoms. They are caused either by excretion of urea through the gastric mucous membrane, or by the retention of that substance in the circulation and the irritation caused thereby upon the brain. Biernacki 1 has made a series of examinations of the gastric condition in renal affections and found that in most of them the gastric secretion was greatly diminished. Allen A. Jones 2 likewise frequently found achylia gastrica among patients with kidney troubles. Stone in the kidney may give rise to similar gastric disturbances. I have observed in a patient suffering with renal calculus, achylia gastrica which had existed for a long time, and given rise to many severe symptoms. After the removal of the stone by operation the gastric symptoms at once disappeared.

The condition of the stomach in diabetes has been examined by Rosenstein3 and Gans.4 The gastric functions were found very variable. I have had the opportunity of examining quite a number of diabetics with regard to the gastric functions and must say that they do not show any constancy. Normal and abnormal conditions of secretion are alike found.

1Biernacki: Berl. klin. Wochenschr., 1891. Nos. 25 and 26. 2Allen A. Jones: "Gastric Conditions in Renal Disease," New York Medical Journal, January 19th, 1895.

3Rosenstein: Berl. klin. Wochenschr., 1890, No. 18.

4Edg. Gans: IX. Congress f. innere Medicin, 1890, Wiesbaden.

In a case of chronic arthritis deformans and in two patients with severe gout I found acbylia gastrica. In several instances in which only slight symptoms of gout existed, I frequently found byperchlorhydria.

The existence of gastric symptoms in malaria is well known, and Leube1 first described several cases-of very severe gastralgia with absence of fever, which were due to malaria, as the successful treatment with quinine clearly proved. The malarial origin of the gastric symptoms will be apparent if they are intermittent and appear only at a certain time every day or every other day. I have observed several cases of obstinate vomiting due to malaria, but in most of these instances there have been, besides the gastric symptoms, other manifestations indicating the true nature of the condition. The gastric secretion here also does not show any characteristic feature, and is frequently diminished.