HUNGEK AND THIRST. 19 



of the stomach produces a sensation of repletion of this 

 organ, but the sense of hunger is not relieved ; but if, on 

 the other hand, the nutrition be active and sufficient, the 

 stomach is frequently entirely empty for a considerable 

 time without the development of the sense of hunger. The 

 following observation bears strongly on this point : In a dog 

 with a fistula into the gall-bladder, the bile-duct having 

 been tied and partly exsected, digestion was so much in- 

 terfered with that death from inanition took place in thirty- 

 eight days ; and although the animal took food abundantly, 

 the appetite was voracious and never satisfied. 1 The same 

 phenomenon has sometimes been observed in cases of diabetes 

 accompanied with great deficiency of assimilation. The ap- 

 petite is preserved and hunger is felt by persons who suffer 

 from extensive organic disease of the stomach, and the sen- 

 sation has been occasionally relieved by nutritious enemata 

 or by injections into the veins. 



An interesting and curious case has lately been reported 

 by Prof. Busch, of Bonn, which points almost conclusively 

 to want of assimilation of nutritive matter by the general 

 system as the great cause of the sensation of hunger. In 

 this case, which will be more fully detailed hereafter, there 

 was a fistula into what appeared to be the upper third of the 

 small intestine. The patient was a woman, thirty-one years 

 of age, in the sixth month of her fourth pregnancy, and re- 

 ceived the injury which resulted in the fistulous opening, by 

 being tossed by a bull, one of the horns penetrating the ab- 

 domen. She was seen by Prof. Busch six weeks after the 

 injury, at which time every thing taken into the stomach 

 passed at the upper opening of the fistula. Although the 

 patient took food in large quantity, she became extremely 

 emaciated and weak. " The patient at first had a most vo- 

 racious appetite ; she never felt satisfied. She continued to 

 eat, even when the first portions of food which she had taken 



1 See an article by the author, on a New Excretory Function of the Liver. 

 American Journal of the Medical Sciences, Oct., 1862. 



