UKDERNUTRITION 19 



a. movement obtained by sterile water ej?ema at the end of a fast showed 

 no change in the bacterial flora from normal. It is advisable to give 

 enemas every two days to patients fasting for therapeutic reasons ; this is 

 of value, as the bowel movements tend to be more regular when feeding 

 is recommenced, and the intense spasms noticed often on breaking a fast 

 are avoided. 



After a prolonged fast, there is found in the stomach only a small 

 amount of mucus material, which is not acid.- However, in a gastric test 

 rneal on a woman who had fasted twenty-four days, there was obtained 

 fluid less rich in free hydrochloric acid and enzymes than before the fast, 

 the hydrochloric acid secreted being proportionally less in quantity than 

 the enzymes. The fluid was still quite capable of digesting food . (Ruti- 

 meyer, 1909). Inanition does not affect seriously nor permanently the 

 power of the digestive glands to function properly. Gastric and intestinal 

 motility are unimpaired by fasting. 



Indican was found in the urine of a dog throughout a one hundred and 

 seventeen-day fast, and for the first fifty-four days of a second fast of one 

 hundred and fdur days (Sherwin and Hawk, 1914). It has been noticed 

 that the amount of indican in fasting in the urine seemed to be pro- 

 portional to the amount of nitrogen in the urine (Gautier and Hervieux, 

 1907). As indol formation in the intestine from bacterial action on pro- 

 tein (putrefaction) is supposed to be the source of indican in the urine, 

 some doubt has been raised as to whether this is the whole source. 



In fasting, as in various pathological conditions such as diabetes and 

 infantile diarrhea, one finds an apparent increased fatty infiltration of the 

 liver (Mottram, 1909). This is especially marked early in fasting and 

 where there is no fluid intake. This fatty infiltration . is only apparent, 

 rather than real, for chemical analysis shows no more fat present, but 

 rather fat in different chemical combination (Wells(e), 1918). This fat 

 begins to disappear as fast progresses, and the fat supply of the body 

 becomes less. 



Circulatory System. Undernutrition almost invariably leads to di- 

 minished metabolism or heat production. The subject is quieter and 

 spends less energy while being undernourished. The result is that the 

 circulatory system apparently has less to do, and so one finds certain facts 

 of interest: (1) the heart becomes smaller; (2) the pulse becomes slower; 

 (3) the blood pressure becomes less, including the systolic, the diastolic and 

 the pulse pressures. 



Measurement of the size of the heart of Levanzin by percussion showed 

 a total width of ten and seven-tenths centimeters before the fast, six and 

 five-tenths centimeters on the thirty-first and last day of the fast, seven 

 and five-tenths centimeters four days after the fast was broken and eleven 

 centimeters five months later. In men taking a lowered caloric intake, 

 a diminution of the size of the heart has also been found. Examination 



