-THOMAS R. BROWN AND JOHN H. KING 



In general, it is the nutrition of the body which is upset but them 

 is no specific effect on the metabolism, peculiar to this group of diseases. 



When the inflammation goes on to the chronic form the body metab- 

 olism may be only slightly affected or very strikingly, as seen in the 

 condition occurring in infants spoken of as atrophia infantum. A con- 

 dition of true marasmus develops in which the infant is reduced to skin 

 and bones. The nutrition of the body is so interfered with that eventually 

 emaciation and cachexia supervene with terminal lethal infections. The 

 slighter grades of chronic enteritis lead only to moderate loss of weight 

 and strength, associated with weakness, irritability and depression. 



Ulceration of the intestines may be caused by many different processes. 

 In fact the etiological factors are so numerous that Nothnagel has gath- 

 ered them together into six groups. Only certain of these groups interest 

 us here. The classification may be found in Barker's "The Clinical 

 Diagnosis of Internal Medicine," Vol. Ill, page 548. 



The effects of ulceration of the intestines upon the body metabolism 

 are determined largely by its localization, its extent, and the complica- 

 tions which it causes, such as cicatrization, adhesions, perforations, hemor- 

 rhage and obstruction. There is no specific effect of the ulcer itself upon 

 the body metabolism, unless it be in luetic ulceration when the spiro- 

 chsetse may primarily develop there and secondarily invade the body, pro- 

 ducing disturbances varying according to which of the systems of the body 

 it attacks. 



The ulcer^ which it is of importance to consider are those due to 

 necrosis, as simple duodenal ulcers and peptic ulcers of the jejunum and 

 ileum. The simple duodenal ulcer is generally located on the anterior 

 wall and about 1 cm. distal from the pylorus. It is an unfortunate situa- 

 tion, for when it cicatrizes it is so apt to lead to secondary dilatation of 

 the stomach and its position on the anterior wall permits of perforation 

 directly into the peritoneal cavity. Again, the cicatrization can involve 

 the papilla of Vater, producing obstruction to the outflow of bile with 

 jaundice and obstruction to the pancreatic duet. Perforation and hemor- 

 rhage are particularly prone to occur in duodenal ulcer in contrast to 

 gastric ulcers. However, on the other hand, malignant degeneration of 

 duodenal ulcers is less common than in the gastric type. Peptic ulcers 

 in the jejunum and ileum occur most commonly after gastro-enterostomies. 



In the simple uncomplicated ulcer of the duodenum, the metabolism 

 of the body is influenced to a varying degree, dependent upon the extent 

 to which the abdominal pain, associated with it, interferes with intake 

 of nutriment. In many cases the nutrition is but slightly influenced and 

 the patient keeps fairly well nourished, with only moderate discomfort. 

 On the other hand, the great pain associated with the ulceration may 

 force the sufferer to live on a very insufficient diet and great loss of weight 

 and strength result. When there is obstruction with dilatation of the 



