The absorption of sugar has been studied by Voit and Bauer, Schoenborn, Strauss, Leube, Plantenga, Deucher, Zehmisch, and others. Deucher gave a patient during nineteen hours five enemata containing each 40 grammes sugar, and got an absorption of 77 per cent, that is to say, 154 grammes were absorbed. Plantenga working with smaller quantities got good results. Zehmisch giving 152 grammes per rectum got an absorption of 103 grammes. In these observations conclusions were drawn from the amount of sugar or dextrine recovered from the stool, that is to say a known quantity of sugar was given by the bowel, the sugar in the foeces estimated and the difference taken as the measure of absorption. Exception has been taken to this method of observation. It has been urged that under the influence of micro-organisms sugar is split up, and is absorbed or passed in the stool as the products of bacterial action, so that what disappears from the bowel contents has provided no nutriment for the patient. This view is supported by Reach. He shows that 60 grammes dextrine given by the mouth has the effect of raising the respiratory quotient, while the same amount given by the bowel does not definitely raise it. He considers that the amount of sugar absorbed by the bowel is very considerably below the amount absorbed when given by the mouth. Dextrine, he finds, is better absorbed by the bowel than sugar, and does not irritate the bowel to the same extent.

It seemed of interest to ascertain how far sugar was broken up by the influence of the micro-organisms of the bowel, and especially the bacillus coli communis, the most important microorganism of the intestine. It was found that the loss of sugar reached a maximum after four or five hours of incubation. A large number of observations were carried out. In all the loss of sugar was below 1 per cent ranging from 0.49 per cent to 0.77 per cent. With the exception then of Reach's observations, which cannot be accepted as conclusive, the objections to the use of sugar as not being utilized, but as being split up before absorption, are wholly theoretical. The amount lost by bacterial action seems in reality but small, in fact, below 1 per cent. In support of this view, one may cite the observations of Kausch and Socin, who have demonstrated on animals that milk sugar and galactose, when given by the bowel, appear to enter the liver, and are converted into glycogen.

Table VI. Table To Show Absorption Of Sugar As Average Per Diem

Observation.

Sugar of Enema.

Sugar Absorbed.

Caloric Value.

I. . . .

4775

43.8

179

II. . . .

38

38

155

III. . . .

6185

6185

253

IV. . . .

5712

50.61

207

v. . . .

88.14

811

332

VI. . . .

3908

3696

151

In the clinical cases pure dextrose was used. Table VI shows the results obtained. In all the cases the absorption appeared good. In observation 3 where 61.85 grammes were given daily, all appeared to be absorbed. In observation 5, 88 grammes were given, and 81 absorbed. The absorption seems to vary in the different cases, not with the amount given but rather with the varying capacity of the individual for absorption.

The caloric value obtained from the use of sugar ranged from 151 calories as a minimum to 332 calories as a maximum. In none of the cases was there any irritation produced by the dextrose, a disadvantage which has been urged against its use. In no case did alimentary glycosuria result.1

Table VII shows the relation between the caloric value of the food given, the caloric value of the food absorbed, and the loss in the patient's weight. The table seems to show fairly conclusively that the observation data may be considered accurate.

1 The absence of bowel irritation was probably due to the use of pure dextrose. Commercial dextrose may contain impurities, such as sulphuric acid, which would induce bowel irritation.

Table VII. Relation Between Food Calories Used And Loss In Patient's Weight Average Per Diem

Observation.

Food Calories.

Calories Used.

Loss of Weight in

Grammes.

I. . . .

1,777

645 = 35 per cent.

367

II. . . .

939

405 = 48

246

III. . . .

869

431 = 49

405

IV. . . .

894

273 = 30

519

V. . . .

567

344 = 60

584

VI. . . .

428

240 = 56

892

The figures in column 1 diminish from above downwards, so that in observation 1 a much larger amount of food was given than in observation 6. Column 2, showing the calories used, diminishes from above downwards, but it is to be noted that the percentage absorption is not in proportion to the amount given. In observation 1 while 645 C. were absorbed (equivalent to only 35 per cent of the food given), the wastage was large. In observation 5 while only 344 C. were absorbed, the absorption equalled 60 per cent of the food given. The loss in the patient's weight increases from above downwards in the table. When little food was absorbed, as in observation 6, in which only 240 C. were absorbed, the loss in weight is greatest, equalling 392 grammes per diem.