626 THOMAS K. BROWN AND JOHN H. KING 



the difficulty in controlling the conditions which would be necessary to 

 analyze the various disturbed factors. It would involve the control and 

 analysis of such complex factors as absorption, excretion and ferment 

 digestion. In addition these are so closely interrelated that it has been 

 a discouraging task to try and unravel their complexity. These difficulties 

 have, to an extent, kept experimental investigators from the field. Con- 

 sider alone the complexity of the intestinal chyme. It contains: 



(1) Gastric and pancreatic juices for the proteins. 



(2) Bile and pancreatic juices for the fats. 



(3) Saliva, pancreatic juices and succus entericus for the 

 carbohydrates. 



When the intestines are diseased .there follow disturbances in the work- 

 ings of the above-mentioned secretions and through such disturbances the 

 metabolism may be affected. It is necessary to discuss briefly the results 

 of such disturbances in the body metabolism. However, it is not within 

 the scope of this article to deal broadly with the metabolic complications 

 associated with disease processes in the accessory digestive glands, as the 

 liver and pancreas, but only to touch upon the functions of these organs 

 which are intimately associated with the intestines. 



The bile secreted by the liver is closely associated with the absorption 

 of fats and any marked retardation of its secretion causes a loss of fat to 

 the body which may result in considerable disturbances in nutrition, such 

 as loss of body weight. This occurs largely through the failure of the 

 bile to render the fatty acids and soaps soluble and not through lack of 

 emulsification of the fats. Such disturbance is often seen in severely 

 jaundiced patients, in whom a considerable degree of loss of weight bor- 

 dering upon emaciation may result 



The pancreatic juice must be absent over a long period of time to 

 produce any effect on metabolism. When such a condition occurs, it is 

 the absorption of proteins and fats that are mostly affected. Extreme 

 grades of pancreatic insufficiency lead to most marked nutritional dis- 

 turbances, through which the patient may eventually reach a state of true 

 emaciation. It is in such conditions that marked grades of azatorrhea 

 and steatorrhea occur. There is little known about the temporary in- 

 sufficiency of the pancreatic juice or whether different grades of pan- 

 creatic insufficiency occur. Furthermore, there is no definite informa- 

 tion regarding the effect of absence of the pancreatic juice upon the other 

 digestive juices, nor upon the motility of the intestines. A certain amount 

 of vicarious functioning by the intestines for the pancreas can take place, 

 so that mild grades of pancreatic insufficiency may occur without symptoms 

 or complications. However, long standing and complete absence of the 

 pancreatic juice eventually causes death through emaciation, from the 

 nutriment of the food draining away unused in the feces. 



