iv DIGESTION IN THE INTESTINE 231 



from the mesentery. He was accordingly forced to cut away the 

 entire segment of intestine, which was covered with the exudates 

 produced by immobility of the intestine. When the operation 

 was complete he saw that the lower incision was 15 cm. above the 

 ileo-caecal valve ; the part removed, measured immediately after 

 the operation, was 3'30 m. long; obviously therefore the upper 

 incision must have been in the jejunum. 



A series of measurements carried out on the dead adult subject 

 in the Anatomical Institute of Cracow showed that the length 

 of the small intestine may vary in man from a minimum 

 of 5 - 60 m. to a maximum of 8*70 m. More than half the small 

 intestine therefore was removed in the boy on whom Ruggi 

 operated. 



The post-operative history was unexpectedly favourable. After 

 a few days the patient was fully convalescent, but for at least 20 

 days he cried day and night from hunger, although he was allowed 

 a relatively large amount of food. At the end of a month, his 

 nutrition improved, and all bodily functions became regular, 

 defaecation included. It should be noted that the child had no 

 fever throughout the course of his illness. 



A month after the operation Saggini made experiments (un- 

 fortunately incomplete) on 3 consecutive days, on this boy's 

 metabolism, from which the following positive data can be utilised. 

 In the 3 days of experiment the boy's weight increased 500 grms., 

 as he was fed on an abundant diet, rich in nitrogenous and starchy 

 foods. The faeces only contained small quantities of nitrogenous 

 matters, carbohydrates, and fats, as compared with the amount 

 ingested in the food, showing that the processes of digestion, 

 absorption, and assimilation went on physiologically, in spite of the 

 serious anatomical loss of small intestine. 



On repeating the same experiments on metabolism, 3 months 

 after the operation, for another 3 days, he found a marked 

 increase in weight as compared with the first experiments (1*7'600- 

 23'100 kgrms.), and an almost perfect equilibrium of balance 

 between intake and output, as deduced from the fact that during 

 the 3 days of investigation the boy's weight went neither up nor 

 down as a whole perceptibly. This shows that, in 3 months after 

 the operation, the child had made up the loss of weight due to 

 obstructed digestion during the period of illness prior to the 

 operation, and the enforced abstinence or scarcity of food in the 

 post-operative period. 



Everything in this rare case of extensive resection of the small 

 intestine indicates that the functional adaptability of this organ, 

 which is the principal factor in digestion, is much greater than we 

 should suppose a priori. 



VI. Owing to its muscular coats the intestine is an organ of 

 movement, with the office of gradually driving forward the chyme 



