214 STOMACH DIGESTION. 



(as thick almost as gruel), one cup of tea, two rolls, and half an 

 ounce of butter. 



" Personally I felt most concerned about the obliteration of all 

 chemical activity on the part of the absent stomach. I soon per- 

 ceived that adding pepsin and hydrochloric acid to the food was 

 theoretically as inadmissible as it had been found practically value- 

 less. The alkaline fluids of the intestine at once neutralized the 

 acid, and rendered the pepsin inert. 



" Fortunately, it soon became apparent that, despite the absence 

 of acid pepsin, proteids were readily assimilated in the intestinal 

 tract. 



" Does Gastric Acidity Influence the Decomposition of Intestinal 

 Contents? This moot question received contributory elucidation 

 by the careful study of the patient's discharges after the operation. 

 The urine and feces were examined every day at the chemical 

 laboratory of the university. Products of abnormal intestinal fer- 

 mentation or decomposition (skatoxyl and indoxyl) were either 

 not at all found, or else discovered only in traces. 



" These observations tend to corroborate the views of von 

 Noordeii, while they negative the opinion held by Kast and Was- 

 butski. The most recent results of laboratory experiments 

 announced from Professor Baumann's institute, viz., that hydro- 

 chloric acid inhibits intestinal decomposition, thus received no 

 support from actual observations in the living human subject. 



" Does Removal of the Stomach Affect the Rapidity of Intestinal 

 Propulsion ? Observations on this point are still being made, and 

 at the present time I am unable to present any very definite con- 

 clusions. The patient objected to swallowing charcoal. Huckle- 

 berries were at three different times found in the passages twenty- 

 four hours after having been swallowed. 



" The Urine after the Operation. Apart from a daily recurring 

 diminution in the quantity of excreted chlorids, the urine of this 

 woman has remained normal since ablation of her stomach. The 

 daily excretion of chlorid of sodium has been found to vary be- 

 tween the limits of 0.6 per cent, and 0.95 per cent. It should be 

 stated in this connection, however, that, complying with the wish 

 of the patient, her food is prepared with less salt than that of the 

 other ward patients. 



" Miwoscopic Examination of the Feces. The stools were well 

 formed, of normal consistency, and light yellow in color. The 

 microscope showed large numbers of fat-globules, and fatty 

 crystals, some undigested vegetable-fibers, but no undigested 

 animal-fibers or connective tissue. Large quantities of triple 

 phosphates were observed. The number of micro-organisms was 

 normal. Altogether, repeated examinations revealed no note- 

 worthy departure from a condition of perfect health. 



" Vomiting ivithout a Stomach. How can a person vomit with- 

 out a stomach? No matter what theoretic physiologic notions 



