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INTRODUCTION THE STIMULUS for this study evolved in part from an unusual case of acute, massive pneumoperitoneum occurring in a child after perforation of an ileal ulcer opposite the neck of a Meckel diverticulum.1The extreme abdominal distention with encroachment on the thorax, as shown in figure 1, was deflated by paracentesis, and yet at the time of the operation, less than one hour later, the distention had returned to its original size and the respiratory rate had increased to 45 per minute. Where did such a large volume of gas come from and how did it accumulate so quickly? The outstanding work of Wangensteen, Hibbard and Rea2and Singleton and co-workers3has established atmospheric air as the major source of gas in distention secondary to acute intestinal obstruction. It would seem that exogenous air must also have been the predominant source in the case cited, for

It is generally agreed that the administration of amphetamine ("benzedrine") facilitates the reduction of weight. This effect of the drug was first reported in 1937, when patients receiving amphetamine for other purposes were observed to lose weight. 1 Since that time a number of papers have appeared in which the drug has been reported to be of value in the management of obesity. 2 However, it has not been demonstrated by controlled experiments that the drug actually causes a reduction of body weight. The mechanism by which the drug apparently facilitates the loss of weight has not been settled. All the possible mechanisms have been suggested in the literature and are summarized in the following outline. The drug acts to facilitate the loss of weight: By increasing the expenditure of energy by increasing the basal metabolism as does dinitrophenol or by increasing muscular activity by

In the attempt to find a method of producing experimental achlorhydria, we studied the effects of a large variety of substances on the gastric secretion of man and dog. Although a diminution of acid secretion has been produced in some instances, no method that is practical for clinical use has yet been found. We wish to express our appreciation to Miss Vivian Bass for her technical assistance. Part of the expense of this investigation was defrayed by contribution from the E. L. Dawes Fund.

The following factors as determinants of chronicity of ulcer of the stomach and upper intestines have been discussed: (1) infection, (2) mechanical effect of food and motility, (3) blood flow and fibroblastic reaction, (4) allergy, (5) nutrition or digestive disturbance, (6) corrosive or irritating action of gastric contents, and (7) mucosal susceptibility. Experimental evidence is cited which shows that the roughage in or consistency of the diet in the presence of a factor conducive to connective tissue proliferation is conducive to the formation of a chronic gastric ulcer in rabbits. Experiments have been devised in an attempt to evaluate the mechanical, nutritional, chemical and mucosal susceptibility factors in the etiology of intestinal ulcers following gastroenterostomy. The evidence shows that all these factors operate and that the mechanical, chemical and mucosal susceptibility factors are the most important. On keeping the mechanical factor constant and varying the chemical factor (the change in the chemical factor leads to some change in nutrition, which could not be avoided in all animals), it is shown that the chemical factor is the most important. On keeping the nutritional factor constant and by analyzing the chemical, mechanical and mucosal susceptibility factors, it is shown that the jeJunaI mucosa is more sensitive to the irritating action of gastric contents than duodenal mucosa.

Resection of at least 66 per cent of the stomach in 10 out of 12 dogs resulted in varying degrees of compensatory hypertrophy of the gastric remnant. It is believed that the hypertrophy was due to rapid eating of large quantities of food due to the polyphagia incident to inadequate digestion. The jejunum at the stoma was also hypertrophied. The emptying time of the stomach was permanently decreased in spite of the hypertrophy. The acidity of the gastric contents returned practically to normal in from three to five months. Jejunal ulcers developed in 3 of the 12 dogs.

Karaya gum will absorb and hold a large quantity of water. Karaya is not attacked by B. Welchii in vitro, but is slightly fermented by yeast. Experimental evidence fails to prove that Karaya is appreciably disintegrated in the alimentary tract, for feeding Karaya to dogs does not increase the copperreducing substances in the feces; does not increase the sugar excreted by depancreatized dogs; does not effect the D:N ratio in phloridzin diabetes. It does tend to increase fecal nitrogen excretion, although the effect is variable; it does not appreciably affect starch digestion in dogs receiving an excessively high starch diet; and does not inhibit the utilization of vitamin A in rats.

INTRODUCTION The choice of drugs for use in rhinologic practice has occupied much of the literature of rhinology, but the question of the most desirable method of administration has been the source of only limited investigation. The purpose of any method of administration is to apply the therapeutic agent to as large an area of the nasal mucosa as possible with a minimum of trauma or damage. Ease of administration and adaptation to self medication are important secondary considerations. In any comparison of different methods of application of drugs to the nasal mucosa some drug must be sought that will lend itself to all methods of administration being studied. Thus an investigation of the use of nasal drops, nasal sprays and volatile inhalers requires an agent that can be used either in solution or in volatile form. Certain of the synthetic vasoconstrictor amines lend themselves admirably to this requirement. The

Since gastrectomized dogs do not develop pernicious anemia,1 it is pertinent to determine whether substances effective in pernicious anemia are present in the liver and stomach of dogs.We have prepared dog's “desiccated whole stomach” according to the standard method and have given the preparation orally to patients with pernicious anemia. We have made extracts of the dog's liver and have injected them subcutaneously. We have also fed dog's liver to pernicious anemia patients. These materials were prepared from recently sacrificed dogs.Dog's desiccated whole stomach. In a previous report,2 the desiccated whole stomach of dogs was fed to 2 pernicious anemia patients in doses of 50 gm. (dry powder) per day for from 8 to 12 days without observing a response. Later both of these patients responded typically, one to oral equine liver and the other to liver extract subcutaneously. We have extended these experiments to include 5 additional pernicious anemia patients, making a total of 7 patients. A slight increa...

Ferguson1 was able to produce uniformly in rabbits gastric ulcers which persisted from 2 to 8 months or longer. He incised the anterior wall of the stomach and at the point of incision removed a piece of mucosa and then closed the stomach by a silk suture, the rabbits being kept on a diet of hay, oats and carrots. It occurred to us that this observation provided a method of studying the effect of diet on the healing of this experimental gastric ulcer.In our first series of rabbits we found that if a lesion was made in the posterior wall of the stomach in which no silk suture was present and one in the anterior wall in which a silk suture was present and the rabbits placed on the stock diet of hay, oats and carrots, that the posterior lesion healed in 30 days, but the anterior lesion did not. This showed that the silk suture was a factor in delaying healing and that in the absence of the silk, diet played no role in delaying healing.Anterior lesions of the Ferguson type were made in 29 rabbits. Twelve were...

In the experimental study of the cause of jejunal ulcer following gastro-enterostomy, 3 factors have become quite evident as playing an etiological role; first, the irritating and digestive properties of the gastric contents; second, the motor drive of the stomach, and third, the possible greater susceptibility of the jejunal mucosa as compared to the duodenal mucosa to the first 2 factors.We have devised an operation in the dog for the purpose of analysing the relative role played by these 3 factors. The operation consists in (1) dividing the duodenum about one inch below the pyloric sphincter and the jejunum about 12 inches below the ligament of Treitz; (2) then the distal end of the jejunum is anastomosed to the proximal end of the duodenum; (3) the distal end of the duodenum is closed and the proximal end of the jejunum is anastomosed (end-to-side) to the distal ileum about 15 inches from the ileocecal valve. The gastric chyme on being ejected strikes the first inch of the duodenum and then passes int...

Since aluminum hydroxide is employed extensively as an enzyme adsorbent, it appeared possible that when administered orally it might interfere with di: gestion by adsorbing gastro-intestinal enzymes. Experiments conducted to test this hypothesis showed that relatively large doses of aluminum hydroxide cream did not alter the nitrogen or fat content of the feces of three normal dogs on a standard diet. This confirmed preliminary in vitro findings.

In taking note of its assignment to set up standards by which to evaluate the end results of the different methods of treatment of the after-effects of poliomyelitis, the Committee first made an effort to define the boundaries of its task. In the present state of our understanding of poliomyelitis the uncertainty of diagnosis is well recognized, and it is a matter of common knowledge that any large series of cases, whether they were gathered during an epidemic or in interepidemic times, may reasonably be supposed to include examples of other diseases. The first requisite of evaluation, then, accuracy of diagnosis, is approachable but not ideally attainable. A second requisite for the fair comparison of two forms of treatment is equal sampling of cases. In this respect poliomyelitis affords unusual difficulty. The expression of the infection varies in any epidemic from negligible or even undetectable symptoms in one

The value of cattle liver and desiccated hog stomach in the treatment of pernicious anemia is established. The "active principle" has been reported to be present in a number of tissues. 1 Our work was undertaken to determine (1) whether horse liver contains the antianemic principle active in pernicious anemia, and (2), if so, its relative concentration or potency. A positive finding would increase the commercial source of liver, since many horses are slaughtered daily at Rockford, Ill., and the meat packed for human and canine consumption; and it is possible that the yield from horse liver might be greater and the extract lend itself more readily to purification and concentration. It is also possible that horse liver extract might prove to be more efficacious on oral administration and hence render the necessity of intramuscular injections unnecessary in those patients who do not respond to cattle liver given orally. 2

GASTRIC SECRETION—GASTRIN The secretory response of the gastric glands to a meal is due in part at least to a humoral mechanism. This has been amply demonstrated by means of transplanted pouches of the stomach. 1 Just what proportion of the total secretory response is mediated humorally is difficult to determine. There is still no direct evidence to indicate what area or areas of the gastrointestinal tract are the site of action for the stimuli which give rise to the humoral phase. It has recently been shown, 2 contrary to earlier views, that the fundus is sensitive to chemical stimuli, although less so than the pyloric region. Whether a humoral mechanism is elicited from either area is not known. The weak point in the gastrin theory has been the difficulty in demonstrating that the humoral secretion is due to a hormone rather than to the absorption of secretagogues or to

Factual evidence that is slowly being accumulated both in this country and in Canada, although it is as yet meager, shows that nutritional deficiency disease prevails in many parts of the country. 1 Sebrell 2 believes that it is no exaggeration to say that at least one third of the American population is eating a diet which is not adequate in all respects. Basing our judgment on the requirements which modern nutritionists consider as optimum nutrition, not mere adequacy, we believe that widespread improvement in health is possible. The evidence of malnutrition is not restricted to low income groups or families on relief but is just as apt to be found in the middle and upper class families. Although it was suspected that the average American diet might be well below the optimum in certain essential nutrients, there was no means of proof available until the classic publication of Stiebeling

Clinical experience and experimental observations indicate that the consistency of the diet may have a bearing on the healing of gastric ulcers. That the physician believes the consistency of the diet is an important therapeutic item in the management of patients with ulcers is shown by the fact that a liquid or soft diet, with or without a preceding period of starvation, is used in all the generally accepted therapeutic procedures. Bolton, 1 in his book on "Ulcer of the Stomach," stated that in his opinion "there is no doubt that diet influences the production and propagation of ulcer of the stomach." He stated that "excessive amounts of imperfectly masticated, and hurriedly swallowed food of `indigestible' quality, although alone being unable to produce the initial lesion, yet are able to assist in so doing, and in promoting the extension and delaying the healing of an ulcer of the stomach." The fact

Thomas1has reported two cases in which edema occurred regularly and only during menstruation. One of these patients was given hypodermic injections of anterior pituitary extract and later the gonadotropic substance of pregnancy urine. With the latter therapy he was able to prevent the edema. Sweeney2reported observations on the body weight of forty-two normal healthy young women. Thirty per cent showed a gain of 3 or more pounds sometime during the menstrualcycle, usually just before the menstrual flow was established. Some had a true pitting edema. Okey and Stewart3have also followed the weight of twenty women students and found an increase in weight of from 1 to 3 pounds (453 to 1,360 Gm.) in one fourth of their subjects. Almost all the students who showed the gain in weight gave histories of menstrual headaches or discomfort. Eufinger and Spiegler4observed a tendency to

The importance of an impaired nutritional state in relation to night blindness and other visual disturbances was recognized by the ancient Egyptians 1 as well as by Hippocrates. 2 Until 1934, when Jeans, Blanchard and Zentmire 3 reported the results of their studies among Iowa school children, night blindness was considered to occur rarely except during periods of religious fasting, famine or war. If one is to accept the increasing number of reports in the literature, poor dark adaptation due to subclinical vitamin A deficiency occurs in approximately 40 to 50 per cent of the population. Several excellent reviews 4 have appeared which discuss the theoretic as well as the practical aspects involved in the study of night blindness and dark adaptation. The clinical literature has been summarized by Jeghers 5 and by Sloan. 6 The work of Tansley 7 and of Fridericia and Holm 8 stimulated further efforts to verify