608 THOMAS R. BROWN AND JOHN H. KING 



this by a very brief survey of the various diseases of the stomach and the 

 metabolic picture to be expected from the associated secretory, motor, 

 absorptive and excretory abnormalities. And yet, due to the marvelous 

 vicarious functioning of the intestines in gastric disease, it is remarkable 

 how markedly diseased the stomach may be with little or no apparent 

 effect on the general metabolism. In its finer details, however, we cannot 

 help but feel that there must be minor changes in the finer mechanism 

 of metabolism met with in variations in secretion, in motor function, in 

 absorption and excretion and in bacterial flora and the products due to 

 their growth and multiplication which are not recognizable by the com- 

 paratively crude methods at present in vogue and waiting for their elucida- 

 tion for greater refinement in biochemical methods. As Friedreich 

 Muller once said, "It is absurd to expect to solve the most complicated 

 of body-processes by anything less than the most refined chemical methods" 

 and this, as many other problems in medicine, must wait for more in- 

 tensive chemical and possibly physical methods for its explanation. 



Function. The function of the stomach is a manifold one it acts 

 as a reservoir for the ingested food, it breaks up and liquefies the less 

 liquid portions, it aids in the digestion of certain foodstuffs, it propels 

 the liquefied material and fluids into the intestine for further diges- 

 tion and absorption, it plays a slight role in absorption and a more 

 important role in excretion, it disinfects the food to a greater or 

 less extent, although there is much difference of opinion as to the 

 efficacy of the dilute hydrochloric acid as met with in the stomach in 

 this connection. While many of its functions can be performed vicari- 

 ously by the intestines, nevertheless the stomach must be regarded as 

 an OTgan of real importance whose chief function is to spare the in- 

 testines, and which, if deranged by disease of considerable extent or of 

 long duration, is likely to lead to nutritional disturbances unless excessive 

 and often quite impossible care is given by the patient to the choice and 

 preparation of the dietary, with the entire elimination of connective tissue 

 as the stomach juices are absolutely essential in its proper digestion. 



It is hardly necessary here to more than briefly touch upon the 

 physiology of normal gastric digestion ; the work of Pawlow, Bayliss, 

 Starling and their followers has given us a clear 'picture of the secretory 

 side and of the role played by the psyche, the appetite, the nervous ap- 

 paratus, and by gastric hormones in this process, while the equally im- 

 portant work of Cannon, Carlson and others has given us a clear picture 

 of the motor sphere under normal conditions. We have always felt that 

 the weight of the evidence favored the view that the juice as secreted 

 by the gastric glands is always of practically the same acid contents, its 

 apparent variations being due to quantity, not quality, of juice secreted, 

 to the varying admixture of food and saliva and gastric mucus, to 

 variations in the motility of the stomach, and to the presence or absence 



