GASTRIC SECRETION IN FEVER AND INFECTIOUS DISEASES
Authors: Hsiao-Ch'Ien Chang
Journal: Journal of Clinical Investigation (1933)

In febrile conditions derangement of gastric function constitutes one of the common symptoms.It may be either in the form of motor disturbance or manifested as secretory anomaly.For instance, nausea or vomiting frequently marks the onset of many acute infections.Anorexia as a rule persists throughout the course of such illness.These phenomena point to an impairment of the tone and motility of the stomach and have been attributed to the action of toxins on the gastric musculature (1) (2).They usually disappear after the disease process subsides.The secretory disturbance, on the other hand, may not be quite so apparent.Nevertheless it is not any less common.Achlorhydria has been found in various acute and chronic febrile diseases (3) (4).Faber (5) in discussing the etiology of achylia especially emphasized the importance of these febrile diseases as factors causing complete suppression of the gastric secretion.He believes that typhoid fever, more than any other infectious disease, is frequently complicated or followed by achlorhydria because in this disease there exists an intestinal infection and the stomach is there- fore more easily affected.Faber also interprets the secretory changes on the basis of an anatomical lesion, probably in the form of gastritis.It is his opinion that the postfebrile anacidity is very likely to remain for the rest of the patient's life.While infection and intoxication have been generally held as the explanation of the observations quoted above, Meyer, Cohen and Carlson (6) have approached the relationship from another point of view.In their animal experiments these authors were able to obtain the same change in the gastric juice from fever and from application of external heat.Under both of these conditions gastrin, injected subcutaneously, failed to induce a normal secretion.When the temperature became normal the restoration of gastric function was prompt.This definite but transitory depression of the gastric gland cells was therefore considered to be directly produced by the elevation of temperature.Most previous clinical observations concerning the gastric secretion in fever have been made with the Ewald meal.As the meal stimulus is not reliable as a means of detecting the capability of the stomach to secrete acid these observations require confirmation under conditions of maximum 155 156 GASTRIC SECRETION IN FEVER stimulation.Moreover views regarding the pathogenesis and duration of postfebrile gastric anacidity have not been uniform and it seems desirable to elucidate these questions further.In the present investigation histamine was employed as the stimulus and a special attempt was made to follow the behavior of the gastric glands after the subsidence of fever. MATERIALThis report is based on a part of the gastric analyses on 1000 patients by the histamine methods done in this clinic.The subjects were all patients in the Peiping Union Medical College Hospital.They suffered from various infectious diseases, mostly typhus fever, typhoid fever, and pneumonia (Table 1).In all 106 cases were studied.Of these only 17 or approximately 16 per cent had had fever for more than two months and might be classified as chronic cases.The average duration of fever for the remaining cases was 14.9 i 0.71 days.The temperature of the patients at the time of examination ranged between 37.4°and 41.30 C., the average being 39.16 i 0.070 C. All but five patients were between 10 and 39 years of age.In no case was the age less than 10 years.One hundred and one patients were male and five were female.The normal values shown in Table 2 and Figures 1, 2 and 3 are from data of Chang and Chang (8).