610 THOMAS R. BROWN AND JOHN H. KING 



there hyperchlorhydria with pylorospasm and marked delay in 'empty- 

 ing. 



To again quote Howell, "The preliminary digestion in the stomach 

 is important as regards the protein food from several standpoints. 



"1st In the matter of mechanical preparation of the food and its 

 discharge in convenient quantities easily handled by the duodenum. 



"2nd In the more or less complete hydrolysis to peptones and pro- 

 teoses whereby the subsequent action of the proteolytic enzymes of the 

 intestine must be greatly accelerated." 



The motor mechanism of the stomach is of course so arranged as to 

 permit a very considerable diastatic action of the ptyalin of the saliva and 

 the conversion of a considerable amount of starch into soluble products 

 and here again variations in secretory and motor functions as met with in 

 different gastric diseases materially modify the extent of this digestion. 

 Again the work of Mendel, Osborne, McCollum and others has added 

 a new note of interest to the whole subject of nutritional disturbances 

 in digestive diseases by their conception of the vitamines, essential to 

 normal metabolism, and the lack of a realization that this factor plays a 

 real role in the changes of certain dietetic treatments of certain digestive 

 diseases as for example the complete elimination of fruits and greens 

 in the treatment employed by certain physicians for ulcer and enterocolitis. 

 A lack of appreciation of the essential nature of these substances is cer- 

 tainly the cause of the obvious nutritional disturbances so frequently met 

 with in patients who have been kept upon too narrow dietaries for long' 

 periods of time. We have, for example, seen several cases with scorbutic 

 manifestations who have been treated with extreme qualitative dietetic 

 rigidity for high grades of atony, ptosis and motor insufficiency, in which 

 by the return to a better balanced dietary with fruit juices and green 

 vegetables included, there was a rapid disappearance of the symptoms of 

 scurvy, while nothing is so beneficial in the clearing up of the gastric 

 and intestinal symptoms of pellagra as a marked increase of proteins and 

 fats to the diet usually markedly deficient in these ingredients. In 

 fact the whole study of inanition and malnutrition must be in a sense 

 rewritten in part by this comparatively new conception of a new and 

 essential factor in the process. The study of the effect of deficiency in these 

 essential substances has been rendered possible on a large scale by the 

 war and post-war conditions of Eastern Europe and the work of Mellanby, 

 Chick, Hume and many others has added immensely to our knowledge of 

 the subject, notably in regard to scurvy and rickets, while McCarrison 

 believes that he has shown that a deficiency of certain vitamines is the cause 

 of certain gastric and nutritional diseases in many in association with a 

 low protein and fat, high carbohydrate dietary, and that this new con- 

 ception must be kept in mind in explaining the associated nutritional 

 disturbances. 



