Paterson showed that there is a reduction of the chlorids in the gastric secretion, but the amount is not sufficient to materially disturb digestion. So far as the beneficial effects of the gastroenterostomy on the ulcer are concerned. Dr. Gilbride believes that there is an increase in the rapidity with which the stomach empties itself, together with a lessening of the irritating effect of the gastric contents passing over the surface of the ulcer; and that there is also a reduction in the

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... acidity of the gastric contents. As to the effect of the short circuiting of the gastric contents on the secretions of the duodenum and pancreas, Dr. Gilbride mentioned that Pawlow is of the opinion that it is necessary to have the acid gastric contents pass over the surface of the duodenum in order to excite this secretion. However, Wertheimer and others have shown that this is not necessary, as was pointed out by Dr. Paterson; that when the gastric contents escape directly from the stomach into the jejunum there is an excitation of the secretions into the duodenum. Dr. Walter a. Cannon, Cambridge, Mass., did not consider gastroenterostomy a drainage operation. In the stomach there are peristaltic waves going toward the pylorus. There results from these waves increased pressure on the food as the pylorus is approached. If there are two openings for the food to go through, the pyloric opening and the stoma, the food will go out through the pylorus rather than through the stoma. Another result of these waves, he said, is that the peristalsis, as it mixes the food, mixes it in the pyloric end rather than in the cardiac end of the stomach. The food comes out through the pylorus as a thin fluid. It does not go out through the stoma because of the thicker consistence the food has in regions somewhat remote from the pyloric opening. The observations which Dr. Blake and Dr. Cannon made were made with the Roentgen ray, and there has been some question whether the pictures seen were true pictures. However, their results have been recently confirmed by observations made in the College of Physicians and Surgeons of New York City. A string was fed to dogs with a small bag of shot tied to the end of the string. In almost all of the cases it was found that the string passed out through the pylorus and thus into the small intestine. Many other observations were also made. The stomach was connected with the lower ileum and also with the colon, and the animal, for a time, gained in weight, which could not be possible if the food did not go out through the pylorus. Dr. Cannon thinks we are justified in concluding, therefore, that when there is a double way, the natural and artificial, the natural passage will be taken and not the artificial. Dr. Paterson, he said, mentioned one case in which they had a large opening, and stated that the food went out both ways. That was true only when fluid food was given; in this case semisolid food went out only through the pyloric opening and through the stoma. Dr. J. W. Draper Maury, New York, thought that it might be interesting to direct attention to the experiments just referred to by Dr. Cannon. At the Surgical Research Laboratory they took a dog on which a gastro-jejunostomy had been done. The animal was fed with a piece of meat wrtu a small bag of shot tied to it. After several days the animal was opened and the course taken by the string, which had been tied to the pterygomaxillary ligament, was studied. A number of such experiments were carried out, and in but a single instance had the bag of shot passed out through the stoma. In every other case it passed out through the pylorus. In the one exception the string passed down through the stoma, but instead of going on it came toward the pylorus, entered the stomach again, again passed out through the stoma and back into the stomach through the pylorus, completing two cycles. A second series of experiments was made to show whether the food passed through the pylorus or not. A very low gastroileostomy was done. Animals so operated on invariably gained in weight for a short time, about a week; then lost weight very rapidly and died; probably not because of the fact that the stomach was not functionating, but for other reasons. Another series of experiments was done with a piece of string. A gastroenterostomy was done at about the middle of the ileum and allowed to heal thoroughly. Then a piece of string was fed and attached to it a piece of meat of undigestible type. The free end of the string was tied to the pterygomaxillary ligament and left long enough to come half way down between the pylorus and stomach. A few days later the animal was fed fat. An hour afterward the animal was opened, and the lacteals on the oral side of the meat were gorged; those distal to it, between the meat and the stoma, were empty. The conclusion is either that no fat goes through the stoma, or it may be that no pancreatic juice was able to pass the temporary obstruction. Dr. Herbert J. Paterson, London, England, thought that experiments on animals are open to criticism. He said that we are scarcely justified in assuming that the conclusions drawn from observations on aimals hold good for human beings. The experiments in which animals were fed on bags of shot are undoubtedly of great interest, but at the same time the interest is an academic one, for he, for one, is not in the habit of feeding his patients on such indigestible food. It does not interest him as a surgeon whether bags of shot pass out through the pylorus or through the anastomotic opening. Such experiments interest us as scientists, not as surgeons. The practical point which Dr. Paterson endeavored to bring out is this: that whether the food passes out of the stomach through the pylorus or through the artificial stoma-whether the pylorus is patent or not-the existence of a short circuit between the stomach and jejunum has for practical purposes no effect on the metabolism of the human body, while we do know that it has a very beneficial effect on gastric ulcer. Therefore, he submits that when the operation of gastrojejunostomy is deemed advisable clinically, one need not, on physiologic grounds, hesitate to perform it.