THE FOOD REQUIREMENT OF THE SICK 47 



Except in the cases just mentioned a decided diminution in the absorption 

 of fat, e. g., as a result of disturbance of the gastric ehemism, has not yet been 

 observed. With insufficient or increased HCl in the gastric juice, and also in 

 complete achylia (apepsia), the fat appearing in the feces does not amount 

 to more, or to but very little more, than the usual percentage. 



On the other hand, unusually large amounts of fat are found in the dis- 

 charges in disease of the intestine (amyloid degeneration,^ tabes mesenterica,^ 

 chronic intestinal tuberculosis with chronic tubercular peritonitis,^ fatty diar- 

 rhea [Biedert *] )'. 



Eegarding the laws of albumin ahsorption in the sick, v. Noorden ^ has 

 demonstrated the surprising fact that the absence of HCl in the gastric 

 juice, in spite of its great importance for the peptonizing of the albumin bodies 

 which is necessary for their absorption, nowise influences the assimilation 

 of the latter. Patients with disease of the stomach, with anacidity and with 

 hyperacidity, showed a quite normal power of albumin absorption in the 

 intestine. 



But later, in cases of apepsia gastrica * and of pernicious anemia ' in 

 which not only HCl but also the digestive ferments of the gastric juice were 

 absent, slight diminution in the absorption of albumin was observed. It 

 must, however, be remembered that in these conditions there is often not 

 only independent disease of the mucous membrane of the stomach, but (as the 

 anatomical findings in individual cases have also shown) actual atrophy of the 

 glands in the intestinal mucous membrane. Hence it is easily understood 

 how, in the absence of any peptic effect upon the albumin in the stomach, 

 the vicarious intestinal digestion which ordinarily occurs does not produce 

 complete absorption. 



The slight albumin losses in the feces, which amount to from 11 per cent. 

 to 15 per cent., instead of 7 per cent, as in health, in these cases and also in 

 complete occlusion of bile from the intestinal canal, are in sharp contrast with 

 the great losses which occur in occlusion of the pancreatic juice (Deucher, 

 Weintraud, he. cit.). 



In extensive disease of the intestinal mucous membrane (as in an atrophic 

 nursling),* in intestinal amyloid disease," in extensive intestinal tuberculosis ^'' 

 great losses of nitrogen have been observed in the feces. 



1 Fr. Muller, loc. cit. 



' Ad. Schmidt, loo. cit. 



s Weintraud, loc. cit. 



4 Biedert, Jahrluch der Kinderheilkunde, Bd. xxviii, p. 21. 



6 V. Noorden, " Die Ausniitzung der Nahrung bei Magenkranken." Zeitschr. f. Iclin. 

 Med., Nr. 17, p. 137. 



6 Strauss, " Un1;ersiichungen iiber die Resorption und den Stoffwechsel bei Apepsia 

 gastrica." Zeitschr. f. klin. Med., Bd. xli, p. 280. 



T Erben und Steyskal, " Kliniseh-ehemische Studien." Zeitschr. f. klin. Med., Bd. 

 xl, p. 165. — Morazewski, " Stoffwechselversuche bei schweren Anamien." Virchow's 

 Arehiv, Bd. clix, Heft 2. 



" Rubner und Heubner, " Die kunstliehe ErnJihrung eines normalen und eines atro- 

 phischen Sauglings." Zeitschr. f. Biologic, Bd. xxxviii, p. 315. 



' MUller, loc. cit. 



^'^ Weintraud, loc. cit. 



