To conclude this lecture, we will take into consideration a question
connected with the matter we have just discussed. Since the contact of
food with the gastric mucous membrane has no direct influence on the
secretion, is its entry into the stomach devoid of all connection with
the secretory process?
It can hardly be doubted that, under normal conditions, the stomach is
the seat of certain definite sensations, that is to say, its surface
has a certain degree of tactile sensibility. This sensation is, as a
rule, very weak, and the majority of people become accustomed to pay
no heed to it in the normal course of digestion. They obtain their
sensations of general well-being, and especially of satisfaction
from the enjoyment of food, without taking cognisance of the factors
contributing to them. The feeling of general hunger, however, is
referred solely to the stomach.
On the other hand, all of us have met with men who could describe
exactly, and with gusto, how they were able to follow a special
tit-bit, or a mouthful of a favourite wine, the whole way through the
œsophagus down to the stomach, especially when the latter happened
to be empty. Naturally the gourmand, who directs his attention
continuously to the act of eating, can in the end distinctly perceive
sensations, and even call them up to the consciousness, which in other
people are normally masked by other sensations and impressions. We may
therefore take it that the satisfaction derived from eating is caused
not only by stimulation of the mouth and throat, but also by impulses
awakened by the passage of the food along the deeper portions of the
œsophagus and by its entry into the stomach. In other words, food which
merely passes through the mouth and throat produces less enjoyment
and excites, therefore, a less feeling of appetite than the food
which passes the whole way into the stomach. The appetite, the eager
craving after food, is, indeed, a very complex sensation, and often
not merely the need of the organism for food material is necessary for
its excitement, but also a condition of thorough well-being, together
with a normal healthy feeling in all parts of the digestive tract. For
this reason it is easy to understand how patients who have diseased
sensations in these organs, and who have no feeling of appetite,
no desire for food, remember the sensations, whether consciously or
unconsciously, even when they are no longer present. Cases are known
to neuro-pathologists where people with gastric anæsthesia suffered
from this loss of appetite. Such patients are no longer conscious of
having stomachs, and dislike the idea of eating because the food, as
they express it, appears to fall into a strange empty sack. In this
way one can also conceive how the appetite becomes lost in cases of
long-continued obstruction of the alimentary tube. The patients forget
their stomachs, and in such instances direct introduction of food into
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