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Determination of the glycogen and lipid content of samples of liver obtained from patients in the course of operations on the biliary tract indicated that the diet high in carbohydrate and protein advocated by us 1 was more effective in decreasing the fat content of the liver than in elevating the glycogen content. The present study was undertaken to determine the effectiveness of intravenous administration of dextrose during the twelve hours preceding operation in increasing liver glycogen in patients with disease of the biliary tract. The value of giving intravenous infusions of dextrose solution to patients with disease of the biliary tract in preparation for surgical treatment has at times been overemphasized. Nevertheless, when used as a supplement to a suitable diet and not as a substitute for diet they appear to be useful. Many of these patients show histologic evidence of hepatic damage at operation, and it seems of

The frequency with which gallbladder disease follows pregnancy 1 cannot be considered a mere coincidence but must be the result of some altered condition in the biliary system in pregnancy, which predisposes to gallstone formation. The relationship is well illustrated in the data of Fallon, 2 who in 1927 analyzed 1,100 operations on the gallbadder and bile ducts and found that 700 of the patients were women who had borne children. We 3 have shown that alterations in the chemical composition of the bile accompany biliary tract disease. Our earlier studies demonstrated that damage to the gallbladder wall is accompanied by profound changes in the composition of the gallbladder bile. 4 Not only is this true of gallbladder damage but the liver bile may be altered in its composition by damage to the liver parenchyma. 3 One must, in addition, take into account the possibility that either gallbladder bile or

Although it is generally believed that attempts to improve the resistance of the liver to injury from hepatotoxic agents is a contribution of the present century, elaborate studies in this field were undertaken during the nineteenth century.1It was, however, the experiments of Opie and Alford2which led clinicians, at least in this country, to believe that a diet high in carbohydrate offered direct protection of the liver from the necrotizing effects of chloroform. Their work received confirmation in the later experiments of Davis, Hall and Whipple3and Graham.4 The unfortunate interpretation which clinicians placed on the results of these investigations led them to conclude that a high concentration of liver glycogen would in itself protect the liver from injury from a wide variety of agents, that the detoxifying power of the liver was proportional to its glycogen content and finally that hepatic regeneration would proceed

It is only slightly more than a decade ago that Rous and McMaster 1 published their observations on gallbladder function. Besides extending knowledge their work gave quantitative confirmation of much that had been done previously. Since then a great deal has been accomplished, as can be seen from the review recently published by Ivy; 2 but as yet knowledge of the normal and pathologic physiology of biliary function is incomplete. The excretory, secretory and absorptive functions of the liver and gallbladder and their associated ducts in health and in disease must of course be intimately correlated with the chemistry of the bile. It is with these aspects of function that we, as well as numerous other investigators, have concerned ourselves. Under normal conditions the hepatic bile of the dog maintains a fairly constant chemical composition (figs. 1 and 2). 3 Although this is very likely true for man also, we

The preoperative preparation and the postoperative care of patients with carcinoma of the stomach have assumed increasing importance during the past decade, and during this period there has been a steady decline in the mortality associated with radical gastric resection. The importance of the nonoperative phases of management is now so clearly understood that no surgeon interested in this type of surgery would consider operation without at least attempting to correct certain of the abnormalities which exist in nearly every instance when the patient comes for resection. THE PATHOLOGIC PHYSIOLOGY OF GASTRIC CANCER The parietal cells of the gastric mucosa normally secrete hydrochloric acid at a concentration of about 165 millimols or 0.6 per cent. A variety of mechanisms are probably involved in the process of neutralization, so that the actual acidity of the gastric contents varies widely in the same person from time to time and in different persons.