DIGESTION AND ABSORPTION IN THE INTESTINES. 799 



est for starch. That starch may be eaten in larger amounts 

 than sugar without raising the percentage of sugar in the sys- 

 temic blood above the normal level is in accord with what we 

 know of the digestion of the two forms of carbohydrates. Dex- 

 trose requires no digestion, it is absorbed as such, while cane- 

 sugar needs only to be inverted. Starch, on the contrary, requires 

 the action of ptyalin or amylase and subsequent inversion by 

 maltase. Its absorption will, therefore, be much slower than that 

 of the sugars; In fact, it probably goes on for the period of four 

 or five hours, during which an ordinary meal is making its progress 

 from pylorus to ileocecal valve. During this period the entire 

 quantity of blood in the body is passed through the mesenteric 

 arteries over and over again, and it is probable that even in the 

 portal vein the quantity of sugar at any one moment rises but 

 little above the normal level, and this small excess is held back 

 by the liver cells, so that the systemic circulation is protected 

 from becoming hyperglycemic. 



80 far as the carbohydrates escape absorption as sugar they are 

 liable to undergo acid fermentation from the bacteria always present 

 in the intestine. As the result of tliis fermentation there may be 

 produced acetic acid, lactic acid, butyric acid, succinic acid, carbon 

 dioxid, alcohol, hydrogen, etc. This fermentation probably occurs 

 to some extent in the small intestines under normal conditions. 

 Macfadyen,* in the case already referred to, found that the contents 

 of the intestine at the ileocecal valve contained acid equivalent to 

 that of a 0.1 per cent, solution of acetic acid. Under less normal 

 conditions, such as excess of sugars in the diet or deficient absorp- 

 tion, the large production of acids may lead to irritation of the intes- 

 tines, — diarrhea, etc. 



Absorption of Fats. — Numerous theories have been held in 

 regard to the mode of absorption of fats. It has been supposed that 

 the emulsified (neutral) fat is ingested directly by the epithelial cells, 

 that the fat droplets enter between the epithelial cells in the so-called 

 cement substance, that the fat droplets are ingested by leucocytes 

 that lie between the epithelial cells, or lastly that the fat is first split 

 into fatty acid and glycerin and is absorbed by the epithelial cells in 

 these forms. The tendency of recent work is altogether in favor of 

 this last view, and we may adopt it as expressing the theory gener- 

 ally accepted at present. During digestion the epithelial cells con- 

 tain fat droplets without doubt, but it seems probable that these 

 droplets are formed in situ by a synthesis of the absorbed glycerin 

 and fatty acids. The border of the cell is said to be free from 

 fat globules, — a fact which would indicate that the neutral fat 



* Macfadyen, Nencki, and Sieber, loc. cit. 



