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Article
November 8, 1919

THE METABOLIC GRADIENT UNDERLYING PERISTALSIS

JAMA. 1919;73(19):1438-1440. doi:10.1001/jama.1919.02610450034010
Abstract

Why does food normally go in one direction down the intestine? Why sometimes does it go slowly and haltingly, giving rise to symptoms of indigestion? Why sometimes does it turn around and come back through the mouth? These questions are fundamental; and the future of gastro-enterology as an exact science depends on the fulness with which they are answered. Until we obtain such physiologic knowledge we must face the fact that in practice we are trying to repair a machine, the normal structure and workings of which are largely unknown to us. Naturally the results are often unsatisfactory, just as they would be if we were trying to repair brokendown adding machines or wireless telephones.

What could the heart specialist learn about the arrhythmias until Gaskell, McWilliam, His, Keith, Lewis and others showed him where the beat normally arises and how it is transmitted from sinus to ventricle? Given that

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