nr DIGESTION IN THE MOUTH AND STOMACH 183 



total gastrotomy. On suturing the duodenum into a blind sac, 

 the continuity of the digestive canal was re-established by uniting 

 the cardia with the duodenum. 



Some time after the operation, Deganello performed an in- 

 teresting series of experiments on this patient with the object of 

 determining (a) the digestion, assimilation, and consumption of 

 proteins, which he calculated from the amount of nitrogen intro- 

 duced and excreted by the faeces and urine ; (6) the intensity of 

 the putrefactive processes in the intestine, calculating from the 

 ratio between the inorganic and the conjugated sulphuric acid, and 

 the amount of aromatic substances in the urine, more particularly 

 of the phenol, indigo blue, and indigo red. 



The most interesting of his results may be summarised as 

 follows : 



(a) Forty days after the operation (first period in Deganello's 

 experiments) the digestion and assimilation of nitrogenous sub- 

 stances were not normal. The faeces, under the microscope, showed 

 almost intact muscle fibres ; and of the ingested nitrogen 1S'22 per 

 cent was eliminated with the faeces, the physiological average of 

 excreted nitrogen not exceeding 6-11 per cent. 



(fi) At this time the faeces also gave indications of very 

 intense putrefaction, as shown not merely by their foetid odour, 

 but also by the marked reaction of indigo blue and red, and by 

 the ratio between the ethereal and the inorganic sulphuric acid of 

 the urine, which had altered from 1 :4'5 to 1 : T72. 



(y) Three mouths after the operation (second experimental 

 period) the digestion and assimilation of proteins had considerably 

 improved, the nitrogen excreted in the faeces having come down 

 to 12'92 per cent of the nitrogen ingested. This agrees perfectly 

 with the data of Carvallo and Pachon, De Filippi, and Hoffmann, 

 who made their observations some time after the operation and 

 found that nitrogen assimilation was almost normal. 



(8) In this second period the ratio between the ethereal and 

 inorganic sulphuric acid varied between 1 : 84 and 1 : 5'6, showing 

 a marked diminution of the putrefactive processes in the intestine 

 as compared with the first period. This result agreed with that 

 obtained by Hoffmann, who investigated Schlatter's patient 5 

 months after the operation, and found the ratio almost normal. 



From these complex results we may conclude that the 

 stomach is not absolutely indispensable to life. After its total 

 resection the digestion and assimilation of proteins diminish in a 

 first period, while the putrefactive processes of the intestine are 

 much increased. In a second period all these processes are 

 improved and gradually approximate to the normal, by a process 

 of compensation as to the nature of which we are ignorant. At 

 the end of February 1900 (i.e. more than 2 years after the 

 operation) this patient was reported by the surgeon to be well, and 



