116 STUDIES IN CLINICAL PHYSIOLOGY 



THE PHYSIOLOGY OF GASTROJEJUNOSTOMY. 



What effect is produced upon the functions of the 

 ahmentary canal by the operation of gastrojejuno- 

 stomy ? We have to ask : (i) Does the food pass 

 through the new opening or by the pylorus ? (2) 

 What is the effect upon the gastric juice ? and (3) 

 What is the effect upon the absorption of proteins, 

 fats, and carbohydrates ? 



Some light has been thrown upon the first of these 

 questions by watching with the A'-rays the course 

 taken by a meal containing bismuth oxide, and it 

 would appear, as might have been expected, that 

 both routes are followed, unless either the pylorus 

 or the artificial opening is or becomes greatly nar- 

 rowed. On this subject the writings of Cannon 

 and Gray may be consulted. 



The former used cats with a normal stomach on 

 which the operation had been performed, and natur- 

 ally the tendency was for the meal to take the pyloric 

 route. 



Hartel* has made a study by this means of 22 

 patients operated on months or years before. About 

 half of them, including those in which pyloric stenosis 

 was found at the operation to be severe, emptied only 

 by the new opening ; in the others the food took 

 both directions. In one case it appeared to pass out 

 only by the pylorus. 



The effect upon the gastric juice is nil if it has 

 previously been normal ; if hyperchlorhydria was 

 present, an efficient gastrojejunostomy appears 



* Deut. Zeit. Chirurg., igii. 



