48 ANALYSIS OP DISTURBANCES OF METABOLISM 



Conditions of stasis, as in disease of the heart, do not cause decided loss 

 in albumin absorption ( Grassmann ^ ) neither are diarrheas of mild grade 

 combined with a decrease in the assimilation of albumin in the intestine (v. 



Hosslin).^ 



We know from the researches of v. Mering that the absorption of carbo- 

 hydrates in the intestinal canal (in the form of sugar) does not take place 

 so much by the chyle tracts as by means of the circulation, and that they 

 are introduced through the roots of the portal vein into the general circula- 

 tion. We might expect that circulatory disturbances in consequence of stasis 

 of the portal vein and in uncompensated valvular disease would seriously 

 interfere with the absorption of albumin. 



The investigations of Grassmann in persons with valvular disease did not 

 show any such influence from disturbance upon the circulation, and many 

 later studies of assimilation have not demonstrated a decided decrease in 

 carbohydrate absorption. Even in Deucher's investigations in patients with 

 occlusion of the pancreatic juice from the intestines, the absorption of carbo- 

 hydrates is complete. Nevertheless, the pancreatic juice contains the most 

 active saccharifying fferment known. 



The negative results obtained probably depend in part upon the unreli- 

 ability of the method previously in use. It was therefore a matter of great 

 importance when A. Schmidt with a uniform diet (test diet), and by means 

 of a new method (fermentation test), taught us to discern the finer disturb- 

 ances in the absorption of carbohydrates. 



In numerous investigations undertaken in association with Strassburger " 

 he succeeded in recognizing a pathological condition (in which the clinical 

 symptoms were not very pronounced, but, nevertheless, were sufficiently char- 

 acterized by an incomplete digestion of starch) as a not uncommon disturb- 

 ance of function of the small intestine (in a broader sense, including the 

 pancreas and the upper large intestine). Only by a quantitative study of 

 metabolism can a positive diagnosis be made (intestinal fermentative dys- 

 pepsia) . 



In conclusion we must refer to the great importance of quantitative clin- 

 ical researches in absorption, in the healthy and in the sick, as helping us to 

 decide upon the merits of the nutritive preparations with which chemical in- 

 dustry has flooded the market during the last ten years. The new albumin 

 preparations, in particular, have thus instigated researches in the clinic, and 

 the studies in metabolism upon which the employment of neutrose, eucasin, 

 tropon, plasmon, and roborat are based are certainly not few. The degree of 

 absorption as shown by quantitative investigations in metabolism, together 

 with practical experience at the bedside, will always be the best measures of 

 the actual value of such food preparations. 



1 Grassmann, " Die Resorption der Nahrung bci Herzkranken." Zeitschr. f. Idin. 

 Med., Bd. xv, p. 183. 



2 V. Hosslin, Experlmentelle Beitriige zur " Frage der Emahrung fiebernder Kranker." 

 Virchowis Archiv, Bd. Ixxxix, p. 95. 



s Schmidt und Strassburger, Deutsches Arch. f. klin. Med., Bd. Ixix, p. 570. 



