METABOLISM IN THE STOMACH AND INTESTINES 615 



diminished aggravated by the increase in expended energy associated 

 with the condition and the tissue-starvation acidosis with which the con- 

 dition if at all marked is almost always associated, due to lessening of 

 carbohydrate metabolism and increased destruction of fats, with lessened 

 ability of the blood to carry carbon dioxid, and the formation of the 

 acetone bodies. 



In this as in many other conditions associated with an insufficient in- 

 gestion of food, such as lack of food, lack of appetite, fear of food, sito- 

 phobia, insufficient absorption of food, mechanical obstacles to the intake 

 of food, neoplasm or stricture of the esophagus, cardiospasm, we meet 

 varying phases of acute or chronic starvation, inanition with its caloric 

 and its protein insufficiency, for with too little food the patient must live 

 on his tissues, energy being furnished by the glycogen and fats, but with 

 steady loss of protein from the less important organs if the protein intake 

 be below the minimal requirements, this minimum being increased by 

 fever, exercise, and lessened by rest. It is not necessary here to go into the 

 details of the metabolic changes, the division of the tissue losses between 

 protein and fat, the early utilization of glycogen and body fats, the later 

 utilization of the proteins, the heart and nervous system living at the 

 expense of the less important organs, the marked diminution in the chloride 

 elimination in the urine, the later increase in calcium, phosphorus and 

 magnesium. Absolute starvation is met with in certain diseases of the 

 digestive tract notably carcinoma at the cardia with complete obstruction 

 while partial inanition is very common in digestive diseases with dim- 

 inution as a rule both of protein intake and total caloric energy; in all 

 cases the metabolic changes are obviously dependent upon the degree of the 

 starvation, although in certain diseases hunger and insufficient nourish- 

 ment are relatively well borne, apparently due to a peculiar adaptability 

 of the body to the abnormal nutritional conditions. 



Hypermotility is the rule in the majority of the achylias, due in the 

 main to the lack of pyloric tonus, as hyperperistalsis is often not asso- 

 ciated with it, while in certain of the neuroses and in hyperthyroidism 

 both hyperperistalsis and hypermotility are found. In other conditions, 

 notably pyloric ulcer and acute or chronic appendicitis, hyperperistalsis 

 but longer emptying time is the rule due to the associated hypersecretion 

 and pylorospasm the cause of many of the painful gastric symptoms met 

 with in these conditions. Early carcinoma of the lesser curvature is not 

 infrequently associated with hypermotility, while in duodenal ulcer either 

 a true or a paradoxical hypermotility is usually met with, with as a rule 

 marked peristalsis. In all these conditions the effect upon metabolism de- 

 pends upon their effect upon the intestine, the presence or absence of 

 diarrhea, enteritis, etc. 



Motor Insufficiency represents a delay in emptying time, sometimes 

 due to marked weakness of the musculature, congenital or acquired, oftener 



