Samuel S. Fels

A self regulatory duodenal mechanism for gastric acid control and an explanation for the pathologic gastric physiology in uncomplicated duodenal ulcer.

By a direct approach in the human subject we have demonstrated the presence in the normal duodenum of a mechanism which is brought into play by a concentration of acid peculiar to the individual. This concentration for any meal, is represented by the peak of free acidity reached after the particular meal. When this concentration of acid reaches the duodenum a mechanism is activated that depresses gastric secretion and is responsible for the descending limb of the normal gastric curve. In the failure of the normal response of such a mechanism, obtunded by the ulceration and inflammation produced by duodenal ulcer, we believe lies the explanation for the high acid extra-gastric curve seen in this disease. That such a failure of response does occur, we have demonstrated in duodenal ulcer patients. If we combine our present findings regarding gastric secretion with the influence of the duodenum upon gastric motor function which we have previously described, we have for the first time, in the disturbance of one mechanism an explanation for the characteristic clinical gastric findings in uncomplicated duodenal ulcer—hyperperistalsis, hypertonicity, hypermotility and hypersecretion.

THE EFFECT OF DUODENAL STIMULATION IN MAN UPON ALIMENTARY AND ADRENALIN HYPERGLYCEMIA

Excerpt As early as 1825, Leuret and Lassaigne33from studies on the horse and dog wrote that the causes which determined the secretion of pancreatic juice were analogous to those which influenced t...

The absorption of hydrochloric acid by the human stomach

We were able to study the question of HC1 absorption in man by inducing sufficient duodenal stimu lation to arrest gastric evacuation and by using phenol red as an indicator of that arrest. This was possible because phenol red in concentration of two milligrams per 100 cc. is not absorbed by the human stomach. Hydrochloric acid in concentrations of approximately 0.5% or 1% is not absorbed by the stomach when such solutions are in contact with it for periods up to 30 minutes. Hydrochloric acid meals of 0.5% concentration do not completely inhibit gastric secretion, while 1% meals do cause complete inhibition.

A THEORY EXPLAINING THE LOCAL MECHANISM FOR GASTRIC MOTOR AND SECRETORY CONTROL AND THE ALTERATION OF THESE FUNCTIONS IN UNCOMPLICATED DUODENAL ULCER

Excerpt The symptomatology of duodenal ulcer is due in large part to the disordered gastric physiology. It is also true that if an adequate explanation for the disordered physiology were available,...

The factor of occult hepatic and biliary tract disease in some cases of allergy

Experimental anaphylaxis in the dog yields adequate evidence for the role of the liver in the shock produced in this animal. There is also some indirect evidence in the literature of human allergy that disturbed liver function may play an important part in some cases. Our own studies indicate that occult liver and gall bladder disease may sometimes be of primary importance. Stimulation of the liver cell by intravenous Decholin therapy and the removal of a diseased gall bladder have yielded strikingly good results, usually in patients who showed evidence of liver dysfunction, objectively. A working hypothesis is offered to explain the satisfactory results obtained. We would urge a study of the liver and biliary tract as part of the diagnostic survey of the allergic patient.

THE EFFECTS OF THE REMOVAL OF THE THYMUS

To the Editor:— The inadequate and irrelevant quotations and misinterpretation of our reported data ( Science 87: 20 [Jan. 7] 1938; Am. J. Roentgenol. 39: 263 [Feb.] 1938;The Journal, January 28, p. 290) on which Hashimoto and Freudenberger have based the major portion of their article in the April 29 issue ofThe Journalare so at variance with the actual facts that we feel a rebuttal would not be caviling. With a single fact evident from their limited research, they have criticized our data, subjected our results to explanation never pertinent and consistently tried to interpret us away from our actual observations. From the data which they present, their article might better have taken the form of one sentence: There were no recognizable changes following thymectomy in male rats 25 days of age. With this statement we would be in complete accord, because the destruction of the thymus by

Is gastric secretion or digestion impaired by a mixture of carbohydrate and protein in the diet

Five people, free of any organic gastro-intestinal disease, were studied by repeated fractional gastric analysis following meals of distilled water, a pure carbohydrate, a pure protein, and mixtures of the two. Four had a normal gastric acid response and one was an achlorhydric. The studies were done in order to test the validity of the claims made that mixtures of protein and carbohydrate interfere with proper gastric digestion. The gastric secretory studies included the usual titration of acidity to Topfer’s and to phenolphthalein, hydrogen ion determinations, total chlorides, and quantitative pepsin. Gastric digestion was followed by quantitative determinations of reducing substances and amino-nitrogen in the separate fractions. More than 6,000 determinations were made on over 900 fractional specimens in the course of the studies. The results showed that: