METABOLISM IN THE STOMACH AND INTESTINES 623 



this being especially helped by marked increase of the proteins in the 

 dietary. There is nitrogen retention, the fats are stored up as fats, the 

 carbohydrates as glycogen, while in protein overfeeding there is at first 

 a slight increase in nitrogen excretion, but if the protein intake be not too 

 great, there occurs an early adaptation by the body to the new diet. As 

 to the increased heat production, Rubner believes it is due to the cleavage 

 of the protein molecule into its nitrogenous and non-nitrogenous con- 

 stituents. 



Gastric Disturbances in Other Diseases 



In a great variety of diseases apart from those of the stomach, the 

 associated gastric disturbances often play a role in metabolism. In gout, 

 we have often an achylia, as also in many cardiopathies and nephritides 

 and this may play a part in nutrition, possibly as one of the factors in 

 the diarrhea so frequently met with in the last two conditions. The 

 marked vomiting sometimes met with in retroflexion of the uterus may 

 produce considerable loss of weight, while this plays a similar role in 

 many of the acute intestinal diseases, as appendicitis, although fever and 

 infection probably play a larger role. Vomiting and diarrhea if present 

 in hyperthyroidism adds to the loss of weight already caused by the 

 endocrine disturbance. The gastric picture, achylia and often vomiting, 

 plays its part in the nutritional disturbance of pernicious anemia, while 

 the loss of appetite and frequent vomiting met with in acute infections un- 

 questionably accelerate the loss of weight so characteristic of these dis- 

 eases. The intractable vomiting of the gastric crises in tabes dorsalis 

 mainly accounts for the rapid loss of, weight, during the attacks. 



Gastric Operations 



There is practically no abdominal operation that is not followed by 

 rapid loss of weight and acidosis, the latter unquestionably lessened by 

 the glucose-soda solution given by Murphy drip. This is peculiarly likely 

 to occur after operations upon the stomach gastro-enterostomy, pyloro- 

 plasty, resection for in all these cases early starvation and underfeeding 

 for a considerable period of time are essential if good results are to be 

 expected. But in these operations other factors may influence nutrition 

 large resections are apt to be followed by diarrhea, but the fact that the in- 

 testine soon adapts itself to the new conditions if proper care is given 

 to the dietary, illustrates anew the fact that gastric digestion is not essen- 

 tial. Gastro-enterostomies may be followed by vicious circle and persistent 

 regurgitation of food which seriously affect nutrition and may necessitate 

 a secondary operation, although to a certain extent the reflux of alkaline 



