624 THOMAS R. BROWN AND JOHN H. KING 



fluid into the stomach is one of the causes of the comparative success of 

 this fundamentally unphysiological operation, for almost all cases are 

 followed by a greater or less degree of intestinal indigestion and in a few 

 cases a jejunal ulcer may develop to affect nutrition by loss of blood, en- 

 teritis, diarrhea and vomiting. 



The recent study of basal metabolism by the newer methods has, not 

 added much to our knowledge of nutritional changes in digestive diseases. 

 It has shown that in the constitutionally inferior neurotic with nervous 

 dyspepsia the metabolic rate is a little low. Cases associated with mal- 

 nutrition also generally show a low metabolic rate ; thus it is usually met 

 with in cases with persistent vomiting, while in malnutrition associated 

 with carcinoma the* metabolic rate is low, although if we have one of the 

 cases with marked toxic manifestations the rate may be, on the contrary, 

 high. It has furnished us a satisfactory means of differentiating the 

 vomiting and diarrhea of hyperthyroidism, in which the rate is high, from 

 nervous vomiting and nervous diarrhea in which the rate is usually low, 

 and it unquestionably may be of some value in showing the effect of the 

 results on medical or surgical treatment, notably in cases where nutritional 

 disturbances are an important feature. 



By and large, however, the metabolism in digestive diseases is largely 

 dependent upon the effect of the associated secretory and motor findings, 

 the presence or absence of concomitant inflammation, infection or fer- 

 mentation upon the nutrition, and it is practically impossible at the present 

 writing to discuss specific metabolic changes from the standpoint of the 

 individual organs. Perhaps nothing shows this better than the absolute 

 dearth of literature on this subject. 



The Intestines 

 Introduction 



As the physiological processes of the intestine are so manifold and 

 complex, it is to be expected that any attempt to correlate the complica- 

 tions arising from disturbances in their functions would be met with un- 

 usual difficulties. This is particularly true in regard to the disturbances 

 in metabolism associated with diseases of the intestines, for the diseases 

 of this tract have no specific metabolic complications. It is only through 

 derangements of the physiological processes that the body metabolism is 

 affected, and it will therefore be necessary to review briefly the physi- 

 ological functions of the intestines which influence the metabolism of the 

 body. In no other way does it seem possible to trace the somewhat in- 

 definite metabolic complications resulting from diseases of the intestines. 



