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For FEBRUARY, 1827.
Art. I. 1. A Treatise on Diet, with a view to establish, on practical
Grounds, a System of Rules, for the Prevention and Cure of the Diseases incident to a disordered State of the Digestive Functions. By J. A. Paris, M.D. F.R.S. Fellow of the Royal College of
Physicians, &c. &c. 8vo. London. 1826. 2. A Treatise on Indigestion and its Consequences, called Nervous and
Bilious Complaints'; with Observations on the Organic Diseases in which they sometimes terminate. By A. P. W. Philip, M D.
F.R.S. &c. &c. 8vo. London. 3. An Essay on Morbid Sensibility of the Stomach and Bowels as the
procimate Cause and characteristic Condition of Indigestion, Nervous Irritability, Mental Despondency, Hypochondriasis, &c. &c.; to which are prefixed, Observations on the Diseases and Regimen of Invalids on their Return from hot and unhealthy Climates. By James Johnson, M.D. of the Royal College of Physicians, &c.
8vo. London, 4. Lectures on Digestion and Diet, By Charles Turner Thackrah,
Member of the Royal College of Surgeons of London ; of the
Societé de Medicine pratique de Paris, &c. 8vo. London, 5. A View of the Structure, Functions, and Disorders of the Stomach
and Alimentary Organs of the Human Body, with Physiological Observations and Remarks upon the Qualities and Effects of Food and fermented Liquors. By Thomas Hare, F.L.S. &c. Fellow of
the Royal College of Surgeons in London. Svo. London. 1825, 6. A Familiar Treatise on Disorders of the Stomach and Bowels,
Bilious and Nervous Affections : with an Altempt to correct many prevailing Errors in Diet, Exercise, &c. Being an Exposition of the most approved Means for the Improvement and Preservation of Health. By George Shipman, Member of the Royal
College of Surgeons in London. 8vo.' London. 1825. 7. A Letter on the Medical Employment of White Mustard Seed. By
a Member of the London College of Surgeons. 8vo. London,
1826. I T is somewhat humiliating to the dignity, and mortifying to
the pretensions of the medical art, to find often, that its Vol. XXVII. N.S.
highest stretch of acquirement in reference to practical value, does not extend beyond the dicta of unassisted reason, or indeed the nice instinct of common sense.
A formidable array of title-pages we have here presented to our readers. The authors of the several volumes are all men of considerable respectability, some of them of no small professional renown, and the subjects of which they treat are of high and general interest. What then, it may be asked, is the sum and substance of the information they convey? Do they not commence and terminate by manifesting what was sufficiently manifest before, viz., that sins against the stomach are sins against the whole frame ; and, that if you go to undue lengths, either in the quantity or quality of your food, you will be visited with more or less of immediate suffering, and encounter considerable risk of radical and lasting mischief.
In spite, however, of the common-place with which treatises on diet and digestion must necessarily in part be made up, they will, if properly executed, be found replete with interesting matter. It may also be urged in justification of this class of works, that dietetic, like religious precepts, how obvious and important soever, require to be repeatedly eno forced and practically applied. A particular mode too of putting even the most common truths, may occasionally be productive of beneficial sequence. There are no persons, for instance, unconscious of the impropriety of lengthening out their daily meal to the extent of producing even the slightest uncomfortable sensation in their stomach. But we verily believe, (shall we condescend to say, that we speak now from our own feelings and experience ?) that this impropriety will be more forcibly than ever impressed on the mind, after perusing the striking observations in which Dr. James Johnson expatiates on this one particular.
At any rate, the physiology of that organization through the medium of which matter exterior to our bodies becomes converted into an actual integral portion of their substance, cannot fail of affording to the contemplative and inquisitive, materials of interesting research. It is principally under this feeling that we engage in the disquisition connected with the general subject of the volumes before us; and we are not without hopes of being able to furnish a paper which shall be both instructive in its philosophical bearing, and useful in its practical application.
It may not be uninteresting, in the first place, to exhibit briefly the general anatomy of the digestive apparatus, and to explain the rationale of the digestive process ; extending in both cases the signification of the term digestion, to the whole of the changes which the ingesta undergoes. It will then be our business slightly to advert to the connexion which obtains between the digestive and other functions of the animal economy;-to treat of the questions respecting the kind and quantity of food and drink which are best adapted to the demands of man;-to inquire into the principles and sources by and through which the digestive process becomes interrupted ;-to dwell a little upon the remote and indirect, as well as immediate consequences of such derangement; and finally, to speak on the best methods of prevention and cure, as comprehended under the heads of Diet, Regimen, and Domestic Medicinals.
When food is taken into the mouth,' says Mr. Hare, it has simply to undergo mechanical division from the teeth, assisted by the tongue and furrowed surface of the palate, and (to) receive an admixture of saliva, which is a chemical medium of fitting it for assimi. lation with
those Auids which are supplied to the stomach from other sources. The motions of the jaws and tongue tend to promote the secretion of saliya by the stimulus which their muscular apparatus communicates to the respective glands. The teeth furnish the first mechanical step towards the digestion of our food; the saliva furnishes the first chemical step.' (Hare.)
• After due mastication and the free effusion of saliva, the tongue places on its back the pulpy mass, and contracting on its base, pro. jects the load into the pharynx--the principal cavity of the throat, or, as it may be considered in the present discussion, an expausion of the common alimentary tube. At the time that the tongue propels the mass of food, the muscles elevate and enlarge the pharynx, as the mouth of a corn-sack is held for the reception of grain.
• There are four openings into the pharynx ;-the first, that which communicates with the mouth; the second, that which communicates with the nostrils; the third, that of the glottis which opens on it from the air-tube ; and the fourth, the esophagus or gullet, the continuation of the alimentary canal to the stomach. It is apparent that, in deglu. tition, the food must be wholly excluded from the first three, and enter only the gullet. Accordingly, we find, when the tongue casts it from the mouth, the passage to the nostrils is closed by a fleshy curtain which, hanging from the palate, is carried backwards andupwards by the action of appropriate muscles and the pressure of the descending food; while the entrance to the air-tube (the windpipe) is covered by a curious little lid, which the tongue forces at the same time on the glottis. These structures are peculiarly beautiful and well deserving attention. (Thackrah.)
It is said, that the celebrated Dr. Hunter never lectured on the anatomy and physiology of that structure, the above brief but good description of which we have borrowed from two of the writers whose works are before us, without discovering
more than common ardour in his style of expression, arising from his admiration of that wonderful adaptation of parts and principles which is so exceedingly conspicuous in this portion of the animal structure and economy.
The gullet, passing down between the vertebra of the back posteriorly and the wind-pipe anteriorly, terminates in the stomach, at its left extremity. This organ, the stomach, is a membranous pouch, which lies across the upper and left part of the abdomen, immediately under the diaphragm, and between the spleen, which is on its left side, and the liver on the right. It is not, properly speaking, at the left extremity of the stomach that the opening is made into it from the gullet; for there is a considerable curvature from the orifice, by which the food that passes into the stomach, is partly prevented from returning; while, at the opposite extremity,--that by which the organ is connected with the intestines, - we find a thickening or doubling of its coat, which so projects from the orifice towards the intestine, that a sort of valve is formed, also preventing regurgitation; and a ring of fibres is also found here, which constitutes a sort of sphinctes to the stomach, yielding and contracting according to the demands of the organ under different circumstances.
We shall not enter further into an anatomical description of the intestines, than by stating, that along a great portion of their internal surface, numberless small vessels arise by open mouths that are destined to convey the nutritious part of the food into the blood-vessels. These vessels, which are called lacteals from the milky appearance of their contents, pass, in their way on to the blood vessels, through a large number of glands, called the mesenteric glands, and which are often the seat and source of much disease, especially in the infantile period of life. Having traversed these glands, the lacteal vessels become fewer and larger, so as to form a set of trunks that ultimately unite into the Thoracic duct, which opens directly into one of the large veins of the body (the subclavian), and thus pours the chyle at once into the mass of circu. lating blood.
This is not the whole of the digestive or assimilating organization ; but we must here suspend our description, in order to point out the alteration which the aliment undergoes while yet in the stomach, which alteration constitutes the main portion of the digestive process.
Upon the internal surface of the stomach, a tine membrane is every where expanded, which secretes the Auid called the gastric juice, respecting both the quantity and quality of which, much discrepancy of statement has obtained.' This has partly arisen from the extreme difficulty attendant upon the collecting of the liquid unconnected with other secretions that are poured out from the same membrane which supplies the liquid in question.
• It is moreover by no means improbable,' remarks Dr. Paris, that this liquid may vary in different stomachs, or even in the same stomach under different circumstances. Majendie observes, that the contact of different sorts of food upon the mucous membrane, may possibly influence its composition. It is at least certain, that the gastric juice varies in different animals; for example, that of man is incapable of acting (readily) on bones, while that of the dog digests these substances perfectly. From the best authorities on this subject, the true gastric juice would seem to be a glairy fluid not very diffusible in water, and possessing the power of coagulating certain Auids in a very eminent degree. Dr. Fordyce states, that six or seven grains of the inner coat of the stomach infused in water, gave a liquor which coagulated more than a hundred ounces of milk. Some authors have regarded it as colourless and without taste or smell, while others have described it as being acidulous. Dr. Young, of Edinburgh, is stated to have found, that an infusion of the inner coat of the stomach, which had been previously washed with water, and afterwards with a dilute solution of carbonate of potass, still retained the power of coagulating milk very readily. We see, therefore, how unfounded that opinion is, which attributes to the potation of water, the mischief of diluting the gastric fluid, and thus of weakening the digestive process. The coagulating and efficient principle, whatever it may be, is evidently not diffusible in that liquid. After one fit of vomiting, should another take place after a short interval, the matter brought up will be little more than water with a slight saline impregnation and some mucus; it will not be found to possess any power of coagulating; which, Dr. Fordyce observes, evidently shows, that even water, flowing from the exhalents, and which we should therefore expect would throw off the whole of any substance from the surface of the stomach, is incapable of detaching the gastric juice.
The gastric juice, Dr. Paris adds, 'is remarkable for three qualities—a coagulating, an antiputrescent, and a solvent power. The well-known experiments of Spallanzani, of Reaumur, and of Stevens, are sufficiently satisfactory as to the last of these qualities; and the coagulating principle is rendered evident, as well by what has already been advanced, as by the fact, that milk coagulates instantly upon being exposed to the action of the gastric fuid, even out of the body. But the experiments of Thackrah have thrown some doubts on the accuracy of Fordyce's inference with respect to the power of this fluid in correcting putrefaction. Upon the whole, the change operated upon aliment by the digestive juice, is more