Diseases of the stomach and intestines;

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] II

i^

■"" • m ■ • •

• : ..: :•

CuPTUnHT

WILLIAM WOOD & COMPANY

TRE ITBLtHBF.rt!!

■OOK COMPOfimON *»D ELKrTRI'TTPINO CO.

1ST AND mn VILLIAH STKIKT,

KIW TOBK.

\2iiU

AUTIIOE'S PREFACE.

Mv friend Dr. Ilurd, of XewlmrT]x>rt, to whom I am nlrcwdj indcblod
for an expcllvnt translation of th'e Uiird rulame of mj " Ije^ona de Cliniqu6
ThcrnpcutiquD/' lias ui^ked pcrmissioii to ^%-e to the American tnedicnl
{lublif fuch jiorlioii of the first voUiini' im [iGrtainN Lo Diseafi^s ot tho
HtoiosL'h and lutaitines. I am quite viUiug to accord to him this privi-

I Imoir of 1IO stndy more faertiintiiig tlinn that of dinwsee of the digee*i
tire Cube, and it is nnv to which 1 Imve dt'vott^ [mrticular nttuntion.
Qoitv retwutJT now lij^lit Iuls \nfvn thruwu uii thesv alToi;ttoii8 by th» bril-
Itant dJKOTcrics of Armnnd (innticr nnd Chtirlcs )3ouo]iani Oanticr has
idiovn D8, b.Y chcmii.'al rcsearclic^ of the great<>st iiit«ireRl, that tlie tiring
prodnceB toxic nlkaloidii, leiicomaines which arp conntantly being
it«d by tbo diffcront eniuiu>toriv» of the i?poiiomy, uiid ia particuhir
by tb* digertive tub*. The procyea of •.ligeatioii itself givea riae 1o bbcH
luxin alkalotdn, and it ia Eiif1it'i<>nt, an Brioger hne dnmont^trated, to bring
{■rtric juir« in nontact with tibrin to m-f them piyxlnced.

Bnt let Home jdiyniulugicHl or pitthulugtcal circiimittjLnce oome in to
aatgmroi tbe proiluction of tliese to-tic Bubatanoes, or opiK»o their elimiua*
tooQ, tWrc will then Hii|)crvone gciienil symptoms which will \Hry in in-
tsudty according to tli« qiUDtity of the jioiMri whi<:h hait jwuetratud tbe
tieoiMnny.

Boucbard b»a jraintctl out one of tbo jnithological conditions the most
alculabuii to faror this emjtoisonmcnt^ namely, dilatation of tliu momach.
Bt iho dii<ord<?ni wliieh it inducvs in the di};;D»tive fuiictioDK, by the jmtri 1
A^tncntiition* which it favon^, by th<) profound ultertilionB in the genonti
sntrition which it ontailH, diUitation of the stomueli ought henceforth lo
TV a dominant place in the ]N)thology of gutric affections. We have
Miv of tlie factom of n great numt)er of general states wliow ongia
tiitui far bei-n nnrcrognized.

Upw taany women u-ith ill-deBiied nerrous Bvuiptonis owe ih(»c isymp*
to uothing but dilatation of thcatomacb? IIow many rheumatic
ita Tith mnltiphi mnnifefltatioiiB eonnootod with difTerent Tiaeera^
aiv] twpeciiUly tbe lirer, arti in r«Ality only victims of gustroctoaia?

IV

ai'tiiob's preface.

In lliia work, wlioee publicatimi wiis miierior to the official prorontga-
tion of tlieee fuctK, Iho latter iiro biil liriv^y alludiHl to, but ntongli is
Bt»tc(l to tsliow the importHnt }imL-ti(»l RoncluKioiia tlciluciblu frum those
rpsmireht'8 of Gimtiur luid Boucluini. mid tlio frt-sli iinpt-Uiti whicli ihey
liuvc );iv(>ii to tl)« Btiulf of gastric nffoctioiie; ro^orchoB from whioh
t>atholofri-''t<t cannot fail to [)rofit.

Altliougli tliitt work is entitled Duxjiiscs of the Ktomacb niiJ IntestiDcti,
it » leu a treatiao on the imtliologr of those affnctions than on the tr(«t-
ment, to whioh, in fin^t, all otlwr eonBid<'nitions mo mnd(> «iil)or<liniit<!. I
Imvo given cHiwclal attention to foode nnti to ulimeiitation. In Ihfw dis-
orders hyg^ionic thcnipcatics occupy the finrt place. Tho patient will be
much more likely to And tlio moana vt his curu iu the obsi-n-aiicH of a
strict und wcll-rogulat«d diet than in t!io mlmniiittrntion of phtirmiicenti-
cal drug&

In urdor to give more system to my exposition of tho different thera-
peutioal mtinns nhieh the phyKiciun may employ in the trciitment of
stont&t^h iiffeotions, I have adopted a division uf dyepepaiait whitilt ia
establiflL«d vu a phyi>ioLogi>^U litt^io. 1 recognize, howcvur, that tliis divi-
sion i«, from a ulinical point of view, ul together urhitnin'. 1 aiii iu fact of
opinion that tlio woni dvHiJttpKia is destined to dieappuur from tho rtoiiologi-
cal category of dii^eawn of ih« sUnnm^h, nnd that wo ou;;ht In xubi^titiitc
for it the lunne of the iiurtiuuliir ^telriv, iutc^tiual, or otiier It^jiou of wliich
the dyKpe{Mia is the eyiuptom However, the term and the dassifioation
havo a certain utltiti' from a therapeutic point of view, and I tnut that
the rcproflnetion in tho Uiiitol Siai*'* of a work which hns hiul a insider*
able euecees in France may not ha without prolit to American phytiii^iaus.

1 thank Messirs. Wm. Wood and Co. for the pains which they have
taker, in tho tyi>ogni.phiciil execntion of this hook, which has bt'en imued
by thorn in a convenient and elegant form. For tlw piimllel colnmn at-
tangcment of notes uudor thu text of thu French odition, tht-y ha^o sub-
titituted an itrrungcment which I trust will be equally advantageous,
whereby the notes in their )iro)wr order arc niadu to succeed thu chujit'Or^
1 hop© that this disposition, wliii^h is not altogether to my liking, (though
prcfttrrcd by the tntu^liitur), will not Icud the reader to neglect thunu
not«8 which luive cost mc ^rcnt labor. I hnve especially to tliank my
frteud lyr. Ilurd for tlie nxsidnity, painBtaking and aitcuraoy witli which
ho has translated the«e lecturea.

' DCJAItDlX-ItKAl'DBTK. .
pAJtlS, FrxSCE. Jfajf. 1898.

TRANSLATOK^S PREFACE.

The pTRwnt Tolnme tnny be considered by Amnricnn reaflers aa tho

coBtiBontioii ot tho work on "Clinical TlicrapontiM " imblishod Ifwt ywr

|itiT(!. S. DariH r>f IK'troit. IMulitk-EH many tliut linrn remi Mr. Davii^'s

piMkation and U*«tptl its pructioil nhanictitr, witt welcome another book

tbu Hsme uuthor. who is ttour favoiBbly known hh a rlitiiuil

Iwr tlw worUl ovor, niid whoec niimc the pa«t sixteen years has been

|4> idcntifinl iriUi crcrything thiil is |»rogrcHHive in thrrajieiitics.

TA obriate nnr mtHiimlunttaiidinf;. it Ih iifCL'saury to irtabo that tliese
ks haTo not n.p[K>nrfiI in thifi country in tho ordpr of th«ir publicfttiuu
Pruioo, The work cntitlpcJ " (.'linicnl ThortipftUticK," pnblish^Hi by Mr.
ttatw, u rvnlly the third and last volume of the Affwwi rfr f.'liniqnf TTrcrn-
prnliqitr, (if which the present is the first vohime, with the omission of the
fmt ftirt, ]M-rtaintiig to Disetises of thu Hi-art ami Aorta.
^m Tho order of th<^< np])i.>»runeo of this emc^ wsu as follows: Vol. I., On
Hvt Tratment ot D'm.H)ev» of the llvart, Aortit, ijtomuoU and Iulc«tinv8,
n 1879: Fourth BJid rwvisfd edition. 1835. VoL IL, On the Treiitnient of
I Kawsee of the Lirer, Kidne^'^, Lungs, Pleura, Lnrynx, and Pharynx,
f 1S8?: Fonrth edition, 1SK5. Vol. lit.. On tho Treatmont of IHiwaBes of
L tin.' Xurt'ons Syt<tcni, General Discasea iiud Fevers, ISt^ll: Fourth and ro-
[ TBwd edition. 1886.

^B Tlu* entire work luui jrone through four editionii in Franoo, and has
^^pm tnuislnte<l into Itiilian, 8;Hinii4li. and Riiwiaii. Tlie tmntiliition here
^^■vaented to tho AmcrJcun profession is from tliu fonrth and rcviwd
^^^vncli itlition, whieh appeared in 18S5. In tbiH work I have hud the
■yin[)athy and corporation «f tho Fronoh nuLhor.

There arc two wnys of troaling th<>r»iwHticji. Oriu h from the stand-

floint of thu roiut-dy. Thia la Llie ordirmrv niethoii of works on thvmjwn*

tkm. Tlio phyncnl and chemical properties of ilie medicnmetit are

bet), then tlie phvKiolo^ieal action and the effects under morbid

JCion^; from theev cnnriiderntianB itittu luv UeriTod which art! d««i|^iied

of n?e in the treatment of ili6L>a^. Tho fium of theec data oonnti-

Vt TK<kN4I.ATuK d PREFACE.

tat«a UatcmSkletlioa. and umbmooa tW empirical coQClnsiona, the studies,
tlic reeearcliee, tlitt U'liUtive efforts of countleeis geiifnitioatt. ^luii inuy
often !mre gone wrong In bliu past, but he has not been altogetbvr wrongs,
'L'herc bava always buun Kiuk pvrHuUK, mitl thtsrv liavL* ulwiiys )i(h>ii buinano
«nde&TorB to relieve anil cunt t)ioni, uiitl out of the accumulated fjqieri-
«noo of centiirirs thu tbcruiwuticK uf tu-dujr biu comu down tci ua as u snr-
vival of tliti ilLti-st.

The se(M>iii1 mclliuil h the consideration of tbcm|M>utic8 from the titand-
point of the di«iam'. Tbi?, capeCTnlly when tfie concrcto representation
of the injilody,— Ibe [wtieiit, — in preaent, in tlie cliiiiwil mi-lhod. The
(li«eii8c h fir»t describt^d, vitb the iiympt<»tnif and physical itigiia by which
it may l>n knonif ; tb« elements of a Houmi diitgnofiiH and prn^iofiis are
stated, nml iudioations for relief and reetoration iii-e Bought for from the
reeotirccH of liygieno and mi^icine. It ib hardly Tie«o8»ary to siiy that the
preiient work, lut far un it ie properly a treuti^e on C'linicnl TherBiwiitics,
foUowH the Becond method, emphaMS and prodomiiiancti being given to
tlierapeutic& If conaideniblo attention is devoted to pathology, symp-
toiue luid diatpion?, it is that a eti^nger illumiiiatioii may be bronght to
be&r upon the really e«»entiid imrt, the treatment.

■To Uln^mto the a1>ovu rumarkK: what is really known about many a
diMAH vould fill u large volume, while what is known about the treat-
ment may he eomprist'd in u few p&gu». The buey pruutitionor doubtless
needs the large volume, but he ooetls especially the ehapter on /henifiett-
iic*; and the volume that givoR liim a bandy rBHumr- of the re^ult^ of a
wide experience in the be«t modee of l«'atiiig disease, will bo the book
which will be of the most practical value to liim, (see, tor inotautx-, how
tlie study of the myelitea may bo abridged; for, directing hiii attention to
the processes whieh determine metlullary diseaaex, the physician . tB not
obliged to distinguish the difforcnt myelitcR which ai-e cailtKl syatematic
myolites, eucli as i)cler08i» of the posterior columiu, sclcroeis of the lateral
columns, «tc- What he luwi to ask of therapeutira is means to c»ppese the
oonnectivo tiasne induration which prodiiceR thnoe patholo^neal eimngHs. *
The same may l>e said of the gennral tretttmunt of gaatralgic dy^^pepsia
and gastralgia, as is pointed out en piige 11^; and other illuetrutioug are
abundant.

Such a usefnl guide-book of jaaetice is the work of D«janlin-Be«n-

• Clinical Tbcroiieirtics, page IM,

J

TRANSLATOk's I'RKFAOK.

vn

inrUi m which miicli tlint. in ordinary text-booka on Materia Metlica and
(■wtice, i*rather emldiirrRssing than helpful to thp practitioner is oinitUnl;
«failp Uie importnnt data, net forth in iitroiig light arid groupet] in a few
itleriy genenilimtions, imlit-ato lo him wbcre he cuu he truly uiwful,
iheie hia intenritiittoii is ilvmiuidvd, as woll tm the liaiihs of that ttit(;rTuii-

To ilo miob work oa ttiie veil, the clinical inrtnictor mii8t have extra*

dinuy roeonrcffc at his command. Uc mtrnt see <]iaeiua« in their mant-

Fftld aud diversified forms, uiid iti their relation to diffurunt constitutions,

DWlandy before liim; hv niui^t not only Itave ii keen personal interest in

bboiei, bat be muRt hare a L-orps of rompotent itsKiiitnnts to reconl

erratiottB and to tabnlat« tho results of therapeiitin t«ntativcfL 1'iifl

Done of the diaeaae nmler mediation mnt^t >« rritioalty watched, and

l&Toiabte iiHxiiti(»tioiiH duo to tiic remedy muHt Ih> c-arefnlly disorimi-

jiaUfd from Bncb modifications aa hub Holely the nwalt of imturnl eiforta

uwan) cure; b; no moana an easy taak, and demanding the critical

louDm of a maxtur. It is ncodk^Ha to Huy thiit it is only in our large

biHintdii tliat these couditionu of 8uc4--vsiifnl clinical teaching t:an bv found.

Valuable aJi oTer muit he the oontribatioiiB of phx'slcianit in private pmo-

tioe, {and 1 do not mean io di«|>arfigo tach contributions, for many ft

Imtuble country praotilioner. likv the Into .1. Marion Kims, lia» made

Talnable discovericB and been u lienefactor to the prof««ion), yet it is to

the grott tt'orkeni in our largt^ hoftpitaU that we are to look for tlio moat

pnotioal and thorough toeting of romcdios.

Rat lhi» ia not idl, Cliniral observution must go hand in hand with

Bolojgicsl experimentation. If thfl "provingti" nf medicinal Bub-

in non-toxic doeee by hi-althy human Kubjeeta Imve proved utterly

of all uwfnl rPHult«, it m not so with experimental toxicology in

lU, and moet vfiliiuble kiiowk-dge has buen gitiutMl by (tucb experi*

itation. No one at till ecniversinl witli modem tlienL|)eutici« will deny

An important plai^u in ntivf ii.4ittgiit>i) in nil workx on Uienipeii ti(?6 U>

>Kio effwcla, aa determined in tho «aae of each individual drug by

fnl experiitiont. *-'linii-al ex[M;ricnce is elnddated and eoufirmod by

prinieiitjitiun on aniirialK We owe hero a debt of gratitndp to tho

pQcli ami Gormanii, and he wlio would duly appreciate what phmnlugl'

experimenbition ha« done for medicine, must acquaint himself with

works of Continental pbyeicians, wbo Lave diatinguTidied thnmsclrea

' laboratory reaearchea us welt as by cliuical provings.

Vlll

TRANSLATORS PKEFA^K.

Few [wwoiw of our day Imvi; nioru uomplvtely naliaitl in themselves
and in tlivir Kurrotindings Uie conditions for Bucou»ful clinioil Btudy and
tcachiTig tb&u the author of tliia vork. liU Iioufb of labor an' divid«<t
bttwircu the lttbomtor>v the Itospitul, bit lar^v privutu clionhdu, tiie buoks,
aud ibe several loarued eociulies lo wUicti hw belungn. Tl'm early training^
was imder sucli tnasturs ue Behicr, Volgieau, TrouHM'uu, Cluuwuigaiic,
Mujftindic, and his daily ufiMX'iatoe nro the magtiiU^e in the profoe^ion in
FriUice, 8UcU m Jwcuoud, See. Huebanl, Detwive, Koucburd. Viilpiau!
and Itroim-Soq 0111x3. Al Suiut Aiicoiuu he hmt t>fi«Q {)L\*«iciau-in-cbief, '

an oflico vhicli tie now liuldu at the Cochin, Thoru the administratioti luiai

' I

Iftlelj ervct«d h Gue ampliitbi-utro uiid pbyisJologicaJ atid chemical labora- '
ton,- UK adjunetd to hiJi clinical teacliing. Join to ilii-n hi^ position aa'
editnr-in-clitct of one of llie ItJouUng mudieal joiinialR, the nulletin <teii-l
onil dc Tli/^rajH^utiqnc, and it is not to be wondertM] at that he has e\'er'
k«pt abreast of the lioHt niediuil work of tho day. and that hts '* Lomotil'
de riinif)ne Thfnn»e«tif]«c " is an epitome of the useful bibors of hifl
cont^mporarieH, or well n« of hin own valuable uontrihuliunK to th<« haal-
iiig art

T)r. I>ujardin-Rcaumeta has alreaily been qnitc a volumiiiouB writer.
TTia earlier writingB on certJiin dtBeiuea of tlie Hpinal eunl (Locomotor;
Ataxia, Cleular Truuhles in Spinal Difwofles, Acuto Myelitif) uctracwdi
wide attenttotl at the time tliey appeared, and the trcatiRe on Aeute
Myulitiii is etill aa autliority on thti mibject. On ihlmoat all the newi
Djodus of treatment aud tlie new remedies of tlu'' jiiist twenty years he hns
puliiisliod elabomtL" Hrliuk«. The foliowing ileserTi* Hpeetal mention:
" Uv-i»oftrelii« on (iel^enuum;" " Ue*>aPeheR on XntritivL- LavemeiiLs; "
"On the Treatment of jViieurisms of the Aorta by Electro-Puucturc;"'
" I^wearcbe8 on Pplletifrine^' "A Study of Boldo;" " Reatakrchos on I'boa-
pbunis Medication;"' "On Kx|)eelaney as a Method of Treatment in Acute
Kbcumatism;-"" "Studies on the I'hymologiad and Tli<>r«.[K,'utio AiipHoa-
tiona of the Ammonia Cnmpoiind&," ntc.

The " Kxperimental liesearehei! on the Toxic Power of the Aleohola"
is a work of great merit, and wiis piiblinlied in 1.S7S. The reader will find
in the long eliaiitcr on Complex Aliments (Uietui-o III.) a roaum6 of the
more importiuit conehisions of tlukt volume, also of the Hmaller work
whieh Kucceeded it, and which id eotitloil: " Researches on Chronic Alco-
holic Poison inp."

Tlic "lUctionnaire de Th('rni>cuti(iui--"iii fouf large TOlomos, which

TKANSLATOrV PRtCFACK.

IX

Qtif; lowanl ilx completion. i« also » luborimiit iiii<UTtji1(iii[;. Here
vrnmintt wliicli llvgieuo or Mcilirino utilises lor tho cure of ilianiwe ia

tiri'l]' tliKcuwed,
The mdcr of tho following work cunnot f&it to remark H\o large {itace
iuatngacd U> lirgWne in t\if trratmciit of iist^oM'. Tlio utilitjrnnJ
(Moeaity of pure air, of emitabie cxerciiie, of i\ proptr dietjiry re^jimen,
^, we everywhere insisted upon, ami cmphiiAittit) put iiiion UoucluLnlat's
tion that ccinlogT Ih as Inil iH|iRni«bli9 to thempt^utics aa is In'^ieiie,
er'^p ikluiinistnitioit of meilitnuiM;. In fact, in ll)<> pn-Htinc-e of ii eick
on, the first qaestion to ask. after luiring ascertjiiiipil the maliuly, is
li&t ii! tlie cause? aiid oftoii the answer to this qtioistioii indicstco the
ly. In rtJiiforniit/ with the Tiewa of thti uutlior a* to the importance
lijgienef (espt-cially iii the treJitment of tlie dvsiiepaiiis), Ihe first five
Jijrtor* arc devoted to the suljjwt of regimoii.whicli pl«y« m prepoiidomnt
l|«rt ill the cniisatioD of tliu stomacli diaeanes an well aa in their trent-
nt It 18 not possible for tlio pra^^titioiier to Ije too familiar with the
iijPClB emhmoed in thew> ehiipterH. .\ great atnountof raliiable Informa-
n, moreover, will be found conJensed in the notes. I cannot toft
;ly exhort the reader to Ktndy eeipecially this purt of the wnrk. which
pta » concise u snmmurr of the fruita of CuntinentuI reiscarch.

Tlie chapters on the Dy^'peiteiut; aud Xetirotu's of the Stomach, on
tT and Cancer of the Stomach, on Tho Vnrion^ Inteetinnl Dixowcg, will
iffruud prolltable for study; in fact the diHtMu<iv heiv discussed are tliosv
itbe onliniwy practitioner will he oftenest cnllcd npon to treat.
If I hare taken any liljertii'£ with tho notes in portians of this work, it
itwen iu the direction of abridgment ami «omli?neation; uomy I have
■Itt^ether in order to bring the wcuk within tlio immher of {n^tye
pnicribed by the ]iul)liHhur. 1 liuve endeiivored to inuke tho work
Jdghly American, both by addenda of my own, and by adapting It
liont to tho U. S. Pharniaoo]xL»ia.

TaANSLATOR.
NSWBUBYrOST. Ma8»., June, 1&90.

CONTENTS.

LECTURE I.
PKiaiUKDlAi. AUUENTAKV PRINCIPLES.

funt

finoiART.— The Dl««**« of ihe Rtoin«cli— ftetwrnl TlitrapcutUw or I>l«-
easMOf ihv StoiitiM'li — H}'gi(>i)ic T)icra{MfUtie(i — EtiologUiil Tlierii[)eu-
Uc» — Divisioiis—C'onpeniiiiK lii^it-Htti — Aliiiientx «im1 AllnteiiUitiOQ —
IVfliiition of Fowl— Nntriljilit.y mill Dijtfstibilily of FooiU— Kxiwiri-
iii«nu (lerfonueHl on Man — (iafltrk Fiffluta^ — liite«lliuil Fit<(ulaii —
Foods diiScult or «4i«y of l>it^-t(tiou~l>iviFion of iUiuic-titjiry l*rm<u-
|Ai»— DlgMtion of Albmuinold Matt**!*— Th^ ftastrli^ Jiiln* — Albu-
ininoMi StilwIiiiKt* — Ppptoiifls. Ihpir <'li»nictyr», llwir Viipiipliiin. Ihi'ir
Nniiirv— Nutritive Value of Alltiiiuitioid Principles— Digetit ion of
StATcli. of 8UK1U', nntl of Fut— ^line Priiii'lple*. .... 1-18

LECTURE n.

COMPLETE AND COMPLEX ALIMENTS.

[ART. — roiupl«t« AlilueuUi— Milk, its rout jKwitlnii—Higvst Ion i>f
Uilk— Milk 1>iet— Wh<?y, Ittt Oin|x*?ition— Th» Wlivy Curp, it* A<1-
iruitnicMKrulDiwulvaiifAKfji — Koumiwv Itof'nuiiMwliion— R|oc» — Com-
plex AliueiitB, thnr ilivisioii— M<«lii, their dtviiiiuii — Digestion of
Moato— Nutritivo valuv of Htwtit— VarietJvii— .\xyuioua aiwl MoUuyui-
tUB AUtUPDts— ComiMiriBuii Ijctwecu the llvcb ot Uauiinal»t of Fistu
o( CmMaceuia and of MoltuvkK. ItMti

LECTUltE III.

COMPLKX ALIMENTS.

lART.— Advantage of Ko«st«i M^tite — The Appetite — Raw Meats —
Thfir Mo<k« of Atlminlntratiori— M«»l Powiltrit— Their Fabricntiou —
Tfaeir Uode« of Adiuiiiielnition—Soup— Peploifviiitiis SiibstAtioeB —
BMfT«a — M««t Juio* — .\iiimcari Bi.»nlltni— F.itraclBof Mi-int— BoileJ
IfMt^AUmMitH of Vi-Kvtablc Orijiiii—Hrpnil— The Grape* ('ure—
Uqnlfl AlliiienI*— Wlniw aixl Alroholte I.i4|ii»n(— Ti^it hiiiI Cofttf —
Pptatiltf WultTB— NftturjU w»l ArtiSclol Table Waters— < 'in id iiiicnte—
Toteooo 8S-«i

LECTURE IV.

ALIMENTATION.

hliT. — R«^iuen uiil AlliticnlAilou — I'tiixtli^ hiiJ K^wjiinitor}- Poodi)
•UrliiffV TliMjry- Basin of Aiiuientation— tlxcliuive Itcgiiuen*— V'eg.
i-Hei — Nlimgviiiiii* Diet — Kvil.-" iif nii Kxcliwlve rhft— Mli«l

Die! — Nalritfv* Equivnl^'nt*'— Qtiantit j- of Aliiiicnt]<^ — IiisulDciciu Ali-
nieiit»tIoii— Bxcescive AUinentntiou— Peiitf^eiiotm SIttttent — liuliin-n
tioii— U>'H|NfpKi» of HJKh Liver*— iiwiiltly of Aliim-rit*— Hecrelion of
Gastm Juipe — UijfMtive SenM- (Mwonliiig to RlondJntV— FnlHlfl<>arlon
erf AlUuouts — InU^rvnl Iwlwt^ii MwJn— Duration of (Jiwtrifi Ditrration
— Ri^ilJirlty of iV[(«lN— liidiifmt ible FooJw— Biat-tnaw iii Dietetic
P IV,* (rill til II us ll.i-7

LECTURE V.

QN KBUIMKN.

Summary, — Kx(*rPiw*— Its Uilliiy — rtymniistlcs — VaH(tti»<)i — (twemliiil)
0>iiiimetics— AMominnl (Jyinniwtlcji— Tmltifiig— Prju-tioe of Works
of Clmrity — Inrtiifnce uf the Air — (iity Air ami *^iiiitry Air— St-d Air
—Moral Influt-nu^H— IiIIl-ihuw — Coitu» aittt MnKliirtmt ton— Clothing —
Tiffht hoeing find Tiffht SnB|iaoderB— Hydrotliempy— Sea-Bftth*—
BathB iu trvueruJ — Tbu Esorvtu

tt-ti

LECTURE VL
ON LAVAOE ANU HAVAUE OF THE STOMACH.

(stomach WAaHLVii AXU VOKCKU VKKUIXW.)

8t:MMAKY. — lAvngie of the Stomaclj— Hlstorj'— 0|)emtive ProcHsiut
The StomacJi Syphon — Ite IntroJwcliwi — Liqiiidis to Kuipioy iu l^iv-
a^ of ihe ritoiiwifih— Topicnl (LppIlRations to iho Gastric Mmtihr«iM—
t^iHiifity of the LUpiliI— Htoiiimrh Pniii|>— UiiviitP' or Foirwl PwHJinif
— Allmuutiiry I'owdvre — Mcut Powdcrf— I'ariiMWeoui* Powders— (ii««-
liliain^u] Tube of Ltie Author. ai-ioo

LEtnUKE VIL '

DIVISION OP DYSPEPSIAS.

SUMMABT.— Tho WwasoB of tlw> Stoiunrh— Th«' I^yspepsiap— Dcftnttlon—
ClaMification ofth*- l)yispe[Miad — Hupcal l>ygiiei>>i«— Stonmclml Pys-
I*|»»iii— liilfslliini I>yape[jHiii — Vurietir> of Stuuim^luil Dycpi-pitiM—
Butnis of tliv UlH)<NilIi*jiIiou— i>i»onl(>i'!i of ilie MukhUlf Cotit — Atunie
or PItituieut l>ybpep6i«— Voiiiitiiife— lUsonl^rs of the Mucous Coal — I
Puirid. Acid, Pitiiiti>iin nY!i|»«psia— DiHoiilerHof thp NVi-voii» System
— Reoae of HiintriT luul Tliirst— f-iiuitrMliEk* I )yiip<<[w«iti — Anorexia. —
Dyton.-xii» — Htfterophimia— Variotieh nucortiing to tht^ iutir(.'h of the
8yiit|imui8— Accideiitul Dyspt'iisiii— VarivlW tM'i.!or(litiK to the Age
— liyKlH-iiMltut of Infjinpy ami Old Ap'— Syiiijrtomatiu Uyspeptiias—
Aflcctioue uouawutivc U> the DyR{>c|>si;u< IW-llO

LECTUKE VIIL

OS PCTRID nVflPEPSIA.

Si'MMARt.— Putrid nyaiiepsin — Its Symptoms— Putrid <fai>itri(< K^rtneD-
twlione— Onfwilc Alltaloid* — L.>noomrtinfi» ami IMoiiiBitien— Tliwir
Toxic Action — CUiiical Proceieies lo Doteruilne the StHl« of tin- 8ecre-

CONTKXT8.

xm

'at tlio rtitNtHc Jiiloe— KtotnHcli Explorent— Stxiitp");— Ijivngwi ■

o( the Acidity of the fJnutric Jiii^c — Reagents — Tmib of tlw

>iBwtUv« Powpi— Uelhocl of Leiibf!— Tl)rni|>ftitiu InUk-ntioiia — P»i»-

I ciii — Mode ol PrciuinitiiMi — AiiivIuopouk I'e[]Kin — Elixir ot Pepdin—

Cpiyc«Pol« of PepaJQ — PepM>in>ntm« Substnn^wi — Apid Medieotion —

pLLMUi* — Cnrtiivorwu* Plniit)'— Bk-U-tk- Kulntof AbrnvntotioiL— Begi-

men— llj-JrotUemial Trealmwit 111-I3S

UXTUltK IX.

OK" ACII> ANn PITL'ITOUS DYSPEPaiA.
i'BT. — Arid T>yB|H'iw:«v — Pituiloiiu PjBix'twiii— Trt-ntiiMait of Acid
Dyspepsia— A IkftJie* — Vicliy Water— ViiIh Water— Influenoe of 8udu-
tiOU on Ihu Acidity i>f thv <■».->< ric Juice — Employ ut Inert PuvriK-n? —
ftiltwwHi'fl Powd(?r— IVwdt-ris uiiJ Pilb of Trciussiuvu. Rndius and
ftradriii — lUyieiiic Treatiuoiit— Wines— Treatmcrtt of Pliiiimii*
L>v»|>vpr ill— Milk Did— KouuiiiM*— Lavage ol tlit tjtoiuttch — Tlienoal
Treaouent. 184-148

i.HXrruuK X.

iEATMRXT OF ATONtC DYSPEPSIA AND OF DILATATION OP
THE STOMACH.

AmiART. — Functiotuil Tmul)l«« of the UusciiIat Cottl — Atonic l>y«p«p-
I »iit— Platulciit l>>a|>cpttia— llilatation o( the Stomach— L'alhcteriKin

)ot ttu^ Kloiiinch- Plutrin;ii>Pii1ic-ii[ Mmiii>— Tetaiiiziiig Mralii»Liiii-iitK—
L Bitt«r Dr>o|Nf of l<*uiii<: — Hilloi-b — l^iiawia-t'cluiiilK*— Hitter PtiMiiii)
I — Al>!«jrhciu Powdfft- — Mi-nhnnii-nl Miiwi if«--ToiiEinU 8loiiitii-li Unli-
I ration- Stoumcit Piiini) — Kiwiririly— Dti-IutioMwins— HyJrotlierapy
I — <jyuiiiA»tk« — Thcruud Trvutmeut Ii4-160

hi,

LECTl.'KK XI.
TREATMENT OF VOMITING.

BtioiARy.—V'oniitlni;— Definition— rauNP'M—THetfltIc Trealinent — G«iie-
nil ni«<aii»— Pot ionx of Klvl^r* — Pl)i»t»r of Diacliylou— Of Thwiao —
Of 0|>luiu — Hydmte of CUorol in Bea-sickneM, and " LaiKl-«ickti«(« "
— liijrcliiHiK of M<ir[>hiiic — Vouiiliiift of Prc>nM«icy — Btupluyiuent of
AIpoIkiI— <>f Pepsin- OfTinclureof lo«liHt>—t'reosote— Ether Spray—
— TobawoSraokiiiit — Nerv'ons Vomiting— Hydrotherftpy-Broiiifdoof
PoiaHJaui -Vomit ine Due to LvBiuiis of tb*? Kidue>*a— Of th« Lun^
-VomtUugs of the PiiihlsicuU lei-tn

LECTURE XII.
TREATMENT OP NEUROSES OP THE STOMACH.

duiARy.— C«nlia]gl»— Owtml^Ic DyRpriJ^ia niid OnJtlralicia — Trea^
iu«»l liy Preparatlonfi ot Opium- Morphine, fliloral— TrwitiiiMit of
Dburdcrvof tbeSeoeeof Uuutfcr luid Thir»t—I>>-»orexia— Anorexia
buuliiiiia — E««^<IltiMl Aiiwiiiia — Hygienic TreatmeDt — PbanuacitiitlcKl
Trmtiiioni— Artillcial AliiiiwiiUillon- Oavajfe- Ancniml Prvpara-
U«u— Tbenual Trctktuictit 174-lM

XIV

CONTENTS.

LECTURE Xin.

BUCCAL AND iNTESTISAL DYHPKrSIA.

SiMMAKY. — Sill i Til —Siamhy Dyspopsla — Dietetic Trentiiiput — Ph«nn«-
ci-iirfoa] TrwLtiiienI— Diiwttiiwi— KxInuTl o( Unit— liiToHliiiitl T>y(i|M|>Kln
^liiU'j'tiiinl JhUw — Bilci — i'aiHicvatic Juice — I'&acreatiit — [leo-coical
D>-Bpep«ia— I'reiiaratiori of Paiicrcjitiii— Eui»eiJtl« PneiMratloug. HJ7-1U6

*

LKCTl'KK XI v.
SEC<)NI>AR\ DYSl'EltiEAa.

Sl'mmjihv.— Swnmlarv l>yn|»?]»"iB»f— (."wrdiiip, ll»|Nitic. Tiibetic Th-sp^p
fliaa — (.'liloroik^ l>)n]»cjisitt— Evila uf tli« Fen-uttitioue JlrJu-ation—
I>iall)eiii'. f*croful«UB. H«fr|>Wic, ArtliritioDseiwimiiia — T>i»onU"n> 0»ii-
M-oiitlvv ((I the DyspeiMius — Nervous Troubles uf Haslr'w Origin—
Btouiaclial ViTtigv— Abdoiuinnl Aiigiiut— Multi^^lc FvruirtMf IJyapep-
»ia— Coudunlons l»»-208

LECTURE XV.

THK DYSPEPSIA OF NEWBORN INFANTS.

SUMMAHT.— Uy»[»epHi»o/ the Newly Bi>rii— Allirepsia— The Milk of the
Hiiiunii Fell iiilu— lilt (^iiiijHiMirioii^lTji Vi(riiLtiniii> — MeaiiH of Deter-
luiiitilg the Value of Mjlk — Laotometer — ExAiiiiiiiaiun 'if the Niirviing
Wwmau™Slat« of Hwtltti or Oinnini! of the NiimiiiK Wimiaii— Influ-
ence on Ills Uilk — How Often cihoukl a Biiliy Ih' Niinwwl— Artilleial
lActatioii— Goat's antl Cw»'« Milk— Tlw Niirniii« Bottle— Oatmeal—
Weniiiiiir— Hyi^ii-nto ItuU's o{ the Newly Iturii — Cuitnti|iaiioil — Dlar-
rliuui— Ciuplvyiueut of PhoH[ihaIe of Ume 207-23(1

LECTURE XVI.

TRf:.\TUBNT OP CLCEK ANI> CANCER OF THE STOMACH.

SUUMART.— Uloer of the Stomaeh— Syiuplom*— PliamiaceutlwLl Trwit^
jueul — Nitrate of Kilver— I't-rohlori.te of I roii— Bluraulh— Chloral —
OpiatBH — l^va«e Dietetie Treatment— Milk Diet— llniieer of tbo
Htoiuacb — IlidlnjltleM uf l>iaffii<>Ki» — 'rnmtitient — By I^iviige— Thera-
]K'Uti<.' IiiilienTionn AeeoriliUK to Seat of the Cancer — SiirKJeal Inter-
% eiitiou in Cancer of the .Stomach — tifftrotomy- Gastn-ctonty— (ia»-
I i-onttuuy 837-244

LECTURE XVII.

THE INTESTINE FROM A rilERArEUTIC STANBPOINT.

SliMMAKT.— Aiwtoiiiy and Phy»ioloc>' of the Intestinal MiircMm— The Iis-
teiitnml (JhuulH— FunctioiiH of the Iiile-itiiiiil Mucusa — AbHijr]itiuii.
Uucretion. EUiuinution— FniLftiuna of the MueoMiof the Laive Jiite»-
t iiiv— Exiierimoiital Researehe*- Ijavenientsof Mwit Brtiths inal Milk
—Their Iiiefllnieripy— Peptonize"! Irfivi^iiient«— Their Nutritive Power
— Tlieir Preparation— AdtiilniHtraliun of Mi'dicaiiieiit* by tiw R«e-
tum— Mwllciiml LMVriuentB- Suiipiwitories — MiiM-iilar Coat of tliti In-
tMtliie— Uovcitieiila of the Intesttiie— InlUieiiceof tht; NorvoUBS>*B-
teto. 245-45l>

CONTESTS.

XV

LECTrRE XVJIL

THE HTOIENIO TitKATMKNT OP CONSTIPATION.

rxai

JrUM iKT.— Pt-tinitiou of Couvtipution— uountp of the Aliuientar>' Uolut
- InteKUiiHt Cali^ull — Defpcutloii — FwftaJ Mattt>n>. CoiniNwitiou^
lluietn uf CoiuiliiMition— HyKiviiio Tn^iiditcnt nf (Joii»>tJ[mtu»i— In-
fluencv of AUiuimtatlon — VeKetahle Diet — Friiibi — BtivuniKes) —
W»iei^(;iliii»t)'— Kififiw— Oyiiiiuuitia" — Influvnt**]) of Habit^ — Mor:il '
Inlltiencefl — Hydrothempy— AjipUpjiTioiui of Cold Water— Donoh*s —
lAVMnnntm thi-ir llixtury nnil <>riticiii— MuititUvttioii:^ tti tlip Itidtru'
Euttil— The Atre of l^vemeiito — Action of Ijiveiiientn. their Adviii;-
iumI l>Uaaviuitu|rf« JWO-873

LWrruRK xrx.

ON SAUNE PURGATIVES.

IT. — Purftativcw — diiwifl<-Jiiii>n of I*iirg»tlvr»— By tlwir ElTfcl —
By Ilwir I'by«iuk)|ricHl .Vrttnii— PiivMwIwgiwii Kipvriiuents with Pur- '
Citives — pTCMWHSHi of Ex])eriiu«ntiLtioti— itoiiearchM on Kallno PurRii-
Mfw — E][iwritii«iitt> of Colin, Murvaii, anil Vulpliui— Iiitorpretatlon
of the Fnfts— Action on Hip MusRUlar C.'onI — l*hy!<ictlo^lfii1 l>ivtKl(iti
el Pu iTfnt I vmi— Saline I'lirRntivwi— lliffoi^nt Tonic Actioim of tb&
.Suits fif f'oilm Ma^ii«>ila ami Pi itivli^Sa Iik of Smln— SuliihiUc of
Nwla — ShII^ of Mr4cn*«m — Siilplmtf ami Citrate of Ma^iipsia — Malts
■■f pi.iiuwii—Furpitlve Waters— Sodlc ChloriU« Watvn>. au<i Mtidrn^-
KUka Sul|>liut« Wulvn. d;4-283

I

LECTUKE X.\.

kCCIIARINE. DK.VSTK; AM) MECHANICAL PrRaATIVES.

iv.— Saochiirioe PurpatlTPs — Manna— Honey — Veuftal Non-Onu"
tic Piincaliv** — '••»'ii» I'lilp — Tfiiimrindfi — PnitiMi — C^li<>laf(nftii««~
t'aloiurf— Khuharb— Podopliylliii— AliJt-h— DrasTic PunfiitlvK*— S««i-
iia — Jala)>— {w-aniiuoiiy— Imlinti JulapiTurpvth^-CrotoiiUil—Miumii-
lar l*iirp»tiv«i — Hollnilonnii — At r»|iine— H yi^wyanim^Eloi'trii'ily —
Pxinnitlvw with I>ofal Action— %rhilH Mtit^taril Sf-wl — Oily Puivi-
UvRi — Ciuittir Oil — ']'liiTH|>i-iitH> ApjiIk-atiotiK— PurgntivuH Applii^il I"
tlie Trautiuvut at CunbliiJulion— Kt-numv of Treutiucnt. S0&-SOj>

LECTUHE XXI.
ON THK TRE.\TMENT UF INTESTINAL OCCLUSION.

■

SniHARY.— IntMllnal Occlusion— l*atho^ny—t*ymptomB—Diagnoato of
Caiu*: Conaiii, ProtiabI»<, I' uiH-rialn — OiagnnwU of tlii< 8(>at of tint
Oacliuiou — Tre«tuieiit — Pur(calivw— Mechanical Meonii — Uerctiry —
LaT0nit*nt« — FV>rr¥<l Irriitation- InjfctliMwof Air. of Cartionlf .Wit]
— LATeinentfl of Seltzer Water — ljiveuie»t« uf Tobaeoo— Puuclunw
o( thn IntMtmen — Coffee— Bt- 1 liidu una— MassttKe — El«;tri<'-ity— Sorgi ■
calTrratinvni — TemiinatioiiofStniinfiilntionn^Cholce ofthe Opera*
IkHi— |ji|MrotoMiy — Ent^Tostoiiiy- Moment fop iht' 0|K>R«tU>n. 30(t-81

IVl

CONTKNT8.

LEtTUKE XXn.

THE TREATMENT OF DIARRH(I:a.

BUUllAJtT. — DiarriKBa — Causes and Palhogeny — Alimeotar)-. Va«*-
Blotnr ninrrbtiM — ninrrhoxt rn>nt Exe^tM Mr t'ontmctility— I>inJh(t|io
I>larrh4i« — ThprajM'iiiic Indii'ntioiiH — Not ull Dfarrhoios to be *'ured
— Hyglitiilf^ Tn«iiii)'nt — Milk iind K^tw Miuit— Intliifiiimt of (Vilit—
I1ianaaceutii>Al Treatment— Inert Fowders— ^Vstring^nte— Blsnmth,
ChaJk. Taiiriiu. «nil Rliatiuiy— OxS'leuf S^iik' — An-rxiMiii<Ftir flitbauni-
(■«*! — <_>i>iiim— Mor]iIiiiii'— At*<jcuitioii iif l]i<44> IlilTereiit 8uhElaiioeH —
LitvemetitM of Iprvac — Tli# niivrrinea <tf ''liiMrcii— ClmU-n* Ii)fiiii1u]iL
— TrtwtiuMit of liifiuitile I>iiirrb)DEi«— Uulnrinl Dinrrhica— The l>iarr-
h«« of Wanii Couotrioe— DiarrlitBa of Cochin China^Theruial
Wu1«n ill UiarrtioMi. . , Sltf-K!

I

LECTUKK XXIII.
ON THE TREATMENT OF DYSENTERY.

SITMMART. — Dyseiiterr— Aspect of Fwval Blatt«rB at Different StAfjee—
Pbiuiiuiceuticul Trt-atiiwiit — BIikhI I;<.-ttiiie — ( ■nltiiativivs— Acrrin-
gent*— Calomel— I pecao—BnixUlan Me«ho.l — Sfgdiiiln Pills— Ailiiii-
thus QUuidulotia— Ca.tApliutine— Uy^en ic TreAtment. . . 334-344

1

I

LECTURK XXIV.

ON TTIE TREATMENT OF HEMORRHOIDS.

SCMMART.— Hflinorrhoids— The Heiunrrhoidal Wine— Their Coun»— Eti-
ology — M4><>hAJ)i«AJ Caa<i£6 — Atinl Siuisiii— Active l.'nui>f«— Diathotie
{.'a«U«»— Wyiiiptoiiiutol<i^'y — Hemnrrhoiilnl llin — TherajM'utit' tmlica-
tloDD — Ouglit Pli™ tn Iw CuredT— Hjiciiiiif Tn-ariui>iit — rimriiiHccii-
ticfti Tr<*ttr»»>iif— I»urgativc»i— Anti ln-iiiorrlniiiial Meilk-Liiea— Haiuii- I
iucIIh — 1<i(H'aI TrwitJiiwtt — Furiaid DilnljitJon of (lie Amif— (llperativc "
PnH'wlni* — 8urgicul Treatment — DilTerent l'r«cesrie«— Htiuiorrhoidal
Swelling — Prol&peiu of tlie Anutt— Artificial Fruductiou «I Ucaior-
rbofak. a4S-«S

LECTURK XXV.

ON THE TREATMENT OF INTESTINAL WORMS.

ly.— Iot«rtinal WoniiH — Their Trwituient. — Oxywrw— Antlicliiiin-
tlf! IjtiveiiientH — (ilyrt-rine l^avi-iiifiitn — BtiiiiXKnilfjrien of Mennjrial
Oliitnu'iit— LnmlirkviiiJen— Migration <tf l.ujtibricoidBw— ("aloiupl —
Corsitaa Mohs — Wonu SetjJ — Sautiiniiie— Twiiiiu*— Tlii-ir I^'rcquency
— Til*- rnariiifil anil tlio Aniied Tietiia — Development of Tieniiui—
TwiiifugeH and TH?iii<.-tdeii — Pumpkin Seeds— Kouafto—KtuimJa— Male
Fern — Pometr«>-uate Bark — The Pelleti^rinee— Tlicir Phyniolaglral
Actloii—TlirirMoJcof AdinliUstration— Tanuateof Pelletl^riiif— Tliy
BothriocepbalnB. . . . , 38i>-3',

LECTURE L

PlttMnKDIAL ALIMENTARY PRINCIPLES.

SnciUBT. — Thf I-hseaees of the Stomacli — Gencml TlicnipfuticB nf Dig-
eawsof the Stomach — HyK'*"'"* Thprapoiitic* — Etiolopc-al Thempen-
tics — DififflOiw — Concerning tngesta — Aliments imd Alimentation —
ripfinition of FnoH — Nutribility wid Dipwiihility or Foods — Exiwri-
mentfl pBrformwl on Man— (Jastric Fistulas — Intestinal FistolM —
Food* difficnlt or etsv of Digwtion — Divigion of Alimentary Prinoi-
p)fg — D^wlion of Albiiininoiil Mfitt«rs — The Oa^tric Juire — Albu-
^ tninoid Sabrtanres — Peiitrmes. tlicir ('hunu;U.TB. tbfir Varit-tiea. thoir
^h Nature — NatritlTe Vulac; of AUiiiminoiil Principles — Dtgoetion of
^^ Starch, of Sugnr, and of Fat— Saline Principles.

^B fiRXTLEllEX : Tho (]i»cnw)! nf the di^stlve orjianR. like thi! tlisoflffi's of
Htte higut, are affections which, notwitlMUndiiig their (.-tiruiiicity. ({uitu
«fUn ettow what can he ftccamplishod hy thempeutics when well nndor-
itMd and directed, therefore I Imvc chosen this rabjoct at tho oontinun-
iHmnf my inBtrnction in ('lini«il Tiic^rnpoutiai.

From the Terr )>eg{nninf^ of your pnictici*, you will often be consulted
vitb reference to functiomd troubles of tlu* di^t^^tive tube, und lu these
•'•*rier«, generally of long dniiition, present tUemaelTufl under nmni-
M Mtv} cver-Torring aspoctg, you will }n> oblifr^l not only to institute
the proper trpatment, but to niuJify it in acL-ordanpe with the cliang-
tag U>naa of the uflfi-ction. [ii our ho8]>itjil service toii Ituvc u vast
fitUforobeerration; our vthhIh ^■oi Apurt for mule pivtivnle will nt any
linw dbtplny to you, in thoir nioutt viiriod formn, cases illvstnitiro of the
dMvnic stomnch nuUftdlnK; our Saint Miiry's wiird, devolpfl to eliildrun'a
diMUB*, will enabiu tou to study tlmt int«rti»tiiip ly|ie of drapHpsi;! wliirh
■> peonliar to yoimg infantt^ It in in ba»iiig myself on ull tlu'si- tacts,
*Ueb pui diuly before your cyce, tliftt I am aIjouI to devote tlivse lectiim
to llw rtudy, from b nlinifMl point of view, Hmt of the therapeutics of
*flKtiotiB of the Klninach. thun of tlioM* of (he iiit<»stinp.

Rot before entering npou the consideration of tho treatment of mch
•* tli*ee affections, it eeenis to nio desirable to occupy ttuvenil Iccturoa
•nh till* g«'ner»l thirapcnties of diiuirdei'^ of the digi-rtire Appnratue. In
iWv ](!ctnn<s I propoite to make otto]»gics1 and hygienic thorapoaUus
BtuHi sdc by Hide, and shall show yoii the ndrtkiita^ to Ite dprired from
- fta >««""■ of treating the subject, and the tiecet>eity imponcd ou one who

J

DISEASES OP TQK STOMACH.

would bo socccesful in tbo therapeutic management of goetric and intW'"
tiiial miilndice, of w*"!! ntiderrtniKUngthciiitriratapheiiomeniiof tligi«tioii.
Hence it is tliat I Imve siinimari7.ed ia the cliajiltfrs iwrtalDiiiir to Hint sub-
ject, the moet reoeul acijuisitiouB of modem phyuiology respecting aJimeiitA—
and alimentation. ■

'* Alt thonipcutics ib eompriay! in etiology, "«ijb I*rofo*sor Olisiiiffnrd;
if thrrt! wnro noeded, gcnti^mon, b rontimuttmn or dtimotiKtnition (if this
tuct, the treatment of disi'uiiex of tbc rtomocli, and in particular of dys*
epein, would fumisb ue s»ch dcnioustration.

Among tho caasw which havo tbo most infiuoncc in the development
of functioiinl troubles of tlie Rtnmimh, wc must aiwign the firnt plat^e to the
bad hvgieiiir coiiditioiut in which ho rounv people livt*. lUid wu hIulII find
ill this (.'hit)>ter of hygienic therai>«iitiv« both tlio wtirce of the e^il and
. remedy; in fact, it will often be biifTicient to corrcet the hygienic errora
' Boe the morbid rtntc diw»piM>ar. This is then, you perceive, one of tho
lost important ]M>int« in this }Kirt of our prm:tii;al study, namely, the
aaBOciatioii of therapeutic etiology and hygiene with a view to more intel-
ligently combating tho dyetiepHiu.

In order tiio more methodically to eot forth the details of this Ta*t
chapter which wo begin to-day, and which emltmces the Rtudy of tho
trcattnoot of the dyaijcpsias. we wilt follow, if you pl«we. from the wand-
point of hygiene, the old claflslfication of ITall/^ — that is to Bay, wo will
consider in their order the ingulu, the ^estft, tho cirfumfusa, tho appli-
cfitn, tho ejrrp.ta. and Iha i/eiiilUia. In eaeh of these divisionB we shall
aee at once the influence of the bad hygienic conditionit which determine
•ffectjous of the stomaeh; this projx^rly beloiigs to etiulogioL) thorapenties;
tlien we shall cxitmiuo Xhv advuntage^i whi^'h tho physician may obtaiu
from hygienic means in the troiitment of thotw diKooees; this will ooiuti-
twte tlie tnio hygienic iheniiieutics.

The iuye«(a are the most fre<iuent cause of the ftiiictional troubles of
tho stomach i thevefaro we slmll elwdy at considerable length the in-
fiueiicc of food ami of nlinienlation in the development and treatment of
dyspopfiin. Perhaps these details will SHem toyoii very long and very tire-
some, but tliey ure abt^iliitoly imeoisary in ordur prtiperly to establish the
foundation of alimentai^ hygiene. liecent diecoTeries respecting the
physiology of digestion will And here their proper applieatiou, and it ia
inipoi<i>ible to trace tlie rules which Nbmild ilirni^t ullmenbttion, without an
accumto knowledge of the modilicationx wiiicii foods undergo iu the
ooonomy.

This subject is of the utmost importance, {;ciitlemcn. therefore I sluill
bo obliged to consider it under nevcra] lieiule, and these are the divisions
which [ jiropose: We will begin with the study of fooils, and we wUl
divide this study into thrL-u jHirts. In the flr^t part we will examinu
iXia primordial alinmitartf principles, tlial ia to wy the Biibstancea which

PUUIUSDIAL ALUIKNTABV FBINCIPUfS.

pf owo ce chAract4>n]M tho alment: in the 8«con<1 \axi we will
oaraelves witli foDil» whicli miitaiii all the princi[)Ics neccHHiry for
anttition, tliat is to nj, with tho complete tdment; ill a tliinl part wo will
Aal; th« other foods under tho imnic of fmnpi&x alitntnh. Fiually,
KfOllsDivn, when once these fact^ hiivn hcon tixtn] in ynttr miiiilR, wo will
pM in reriflw the aggregate of tht-'se ttlimeiits, »iid the curn tu he tuken
m diK teloetion of ihcdiut; or in other woi-ds, I sIiaII ^acnas aimenta-
li»n. Such is the plan which I ]>ro]KKW to follow.

ffrgirp the iiamo i>f fooii to every siilwtniioo which, whm introduced
inlotke («onotnj hy the diftnBtivc tulw, eerves for nutrition. Itut hefore
iflmidiing the irtudy of foodB. I muat examine with you one of the most
StbaH points of tho question ; vhat are wc to imilcrstand hy the wortlc,
ntfihte raJue of an aliment, or mtfrilfUili/, imd digc-stivo raluo, or digesf-
*%/ This 18, 1 rciwat, a rery diflioult point, and before adoptinjj iiny
voncliuion whatever with regard to it, I shall liave to Klute the extwri-
BxB^on which luavi; lic-on hiiai'd the etiidy of the digeRtihility of fooils. I
■Uioujy concern myself with oxperitnetiti mode on man, for the digcetire
iWlie iif fooilx i» RO vurinhle with the ruiimnl (tpt^rlea thiit it lit diftietiit to
CDOpare that whi^^h takes {iliu^e in the dog and in the ruminaut with
ihtt takes i^aoo in the human siihject.

SNDe, as SpalltiniiLni, lure introduced into the stomach hollow bulbs,
Wm W sacke containing nhmeittiiry eiih>^ncc», iind then wbon theite
Mhsor tahes were exjielled, whelhiT by T»miting or hy defeoation, they
Iwe noted tho Diodiflcutions effected in tlie aubataiicea eonCuiiied in their
blbrior. Thus itwaa thatSteTcna* taking mlTautJure of thefiiculty which
BJ^SE'ler poeseaeed of swallowing foreign bodies and then easily vomiting
tin ip ag&in, was ennbled to study the digestibility of alimentary stib-
riuoea. These experiments have little valui'; they, in hurt, deprire the
llinients of the muscular action of the stonutch, and only the elfoots of
iapiegination hy Ihv jja*'''''*^ juiceare obeonod: moreover, as those foreign
were rendered at indoterminato hour^ it wa8 difficult to obtAiti
le roRultx from thin experimental methnd.

In other instances physiologiBU liave protiuil hy the ability which
Mk peraona have had of vomiting at will, as in the case of OoeBo, whero
th»Mmiting used to come on after swallowing a mouthful of air; or else
•tucnration has been taken of what was going on in the stomach where a
nnieation had been estiibHshed Iietween that organ and the outer
by mmuH of a jientuineni fistula.'

Ssch ohserratioiis Hoiutniont made on his Caiia<Uan. Alexis St. Mat-
rtill more recently and even mnrf rigoroufiy. Chnrle* Kichet on
luiinetL Marcehn, on whom Profesiiur Veriieuil liad suucunfully

fltovrait In Milne Edwards' Lemoiuon Comporatire Pbysiology and Anatomy.

4 DISKASJQB OF TU£ STOMACH.

pmctiaed gostrotomy.' Ton all know the historj^ of this \wi, who, in ce
sequence of baring accidentallv swullowed same cuuBtic potash, hod com-
ploto obliteration of tho a»ophap,iB. Verneuil. br tho opemtion of gns-
trotoniy, enabled him to lire, and wb&t was most extraordinarr. thix boy,
thus deprived of bis ceeopliagng and unable to drink, succumbed at lut
to tnln'iTnIom brought on byaljUBO of alcoholic liquor, wliich he was in
the habit of introduciiijr into hin K;f8tc-m by his ga«tric fistnla.

It watt by rtneon of his careful obeerration of this inaii that Oharlee
Richct bos been able to give to the world that painstaking and imut^rlr
st-iidy on the gastric juice to which I uhall hsTc occasion often U> rvtee
whilo on the subject of digciation. ■

This method of obscrralion, although superior to (hosi- Iwforc men?
tioned in tho information which it givoa rwpocting the digest ibi I ity of
alimontti, nevertheless Lackg completeness. The dige^^tibJIity of Ffxid can-
not, in fact, Ijo judged by the results of the function of any one jmrt of
the digratirc apparatus; it can only be appreointcil by the results of the
aggregate of the digeatiTe forceu. Hence the data ohtainwJ by such cx-
porimoHts as those above rocntionod concern only the digoetibUity of cer-
tain aliments in the stomach.

The operation of hirngc* of the stomach hu* likewise been applied to
tho Htudy of the digestibility of food, and it hao eniihk-d Lctibc. n» we
shall see farther on, to estabhsh th<t basis of the diagnosis of the different
afleetions of tho stomiu^h; hut the wimc criticifim which we liave juet had
^Dccasion to muke with rrftTi-ncc U» the cvperiinmitH of IJwiuninnt and
Biclict is applicable to Lciibc's researohes, which, though very important
from the point of view of the gastric digestion, give us no information
nttpocting the eorapletc digestion of alinients-t

The experiments of I^eube, I jUlemamt , and tlmse still more recent
of Bniunc, made on individuals affected with artillciul aiiue, whereby
these physiologists were enabled to exainini-- at u given moment matters
introduced previously into the digestive tuljo. seom betU^r to fulfil the
ret^uireinentK, and great uceount should be ma<le of observations obtuiiiud
in this way.' Wluit do these observations teach ? They show us that cer-
tain Bubstanocs mpidly traverse thedigeHtiTc tube, hut without undergoing
thera very appreciublo mofUHcations; this is wliat happens to foods con-
taining vogetablo collnlose. Will any one say tliat these aliments are
more digestible than others because they more rapidly traverse the intes-
tines i* This would he a mistHke. It it^ in fact, not enough in order
that a certain food may merit the qualification of digestible, that it shall
puss quickly from the month lo tho miiis; it must be of « character to
funiish to tlio economy tlie Urgest possible amotmt of nutritive elements;

• See Lectins VL

f L^iihe, DinitKfhcJt Archtv far Klin. Uedlcin, xxiii., I888l p. 1.

FAUIORDIAL ALIMEHTART PRtSCIFLBS.

6

• while diiitinffaiBhiiig tbc nutritive vuluv from the digwtive nklne
iilimcMit, 1 would eay nitb TroiisscAu: " Tlie mont digestible food
U flut which famiehes to the economy tho g^r'atost ^jimntity of rcjMiratiTo
ritOMitB, while ttonuuiding the Icnst possiMo labor oii the p&rt of the
dipttire forces."*

DvDot, hoirevcr, think, ^ntlemen, bh»t the moat natritive foods are
tb» Duist digoBtihle; nc aliull see, on the cotitmry, that ccrtaiu subAtAQOes,
ofaTtry nourishing ohaitictAr, are of slow nnd IrLtionoiix di^^tioii. It
■ nmwwrj to remember, moreover, that theru iiri.- miiiiy c»U!m>s which
tomen to modify the pnicist.- rult^s which one would fuiii estitbhsli trom
ttRpoibl of view of the digestibility of alimcntd; it would indetrd be diffi-
coh (o-diy to cloM nlimentaTy nuvttcra into foode hard und t»ej of diges-
tm

One of the principal ohstuclm to nich cliu«ificntio]i in the fact of in-
Aniu) ptediB(iositioii: one jhtsoii, in fuot, dijjcets substuuceii which would
■IdStily produce in another person an mdiepositioii.

Aild to tliis the jxiwcr of habit, which enahles the digestive tabo to
venninodiLto itself to thin ur that kuid of fouj. If on thin |x)int the wnnt
(^ onifonnitr ia very f^rent. there is, ou the other hand, unutlier juirLicu-
to m wliich ever>'body ib agreed, both cliniciaua and physiologists,
■umjy. tbo itnport»neo of the state of cohesion which the aliment pre-
Hiti; tlw mors feeble thin cohenion, in other wonls. the more linely divided
lit alimentary Wins, the more rapid is the digestion. There oxirt in
tqnud to tbia matter of colieaion very great di9ercuc«i< in the aame sub'
rtmoe, according to the varying aspoots under which it is prosonted, and
MOllg a more cnriouH than the rejtulbi which Schitf gives n^xpi-cting the
figalibnity of a (luantily ot uibumL-ti, whvilier tuki-ii in a solid and cum-
{Mnaas, or whetber admiuistered in a state of fine division. We shull
fa''^ BoreoTer, to return to tJiis queation when wo take up the eabject
, <f thmentary |towdor«.'

Tb« primordia] alimentary principles form three dixtinot gronpa. The
8nt tt compomi of the tiastie-making or nitrogenous elcmentii; these aro
MMtilatod of ulhuminouii or protein sulmtancee, t'> which the name liaa
tdMlcen ^ven of r]uat<*mnry eiihsttmoes, booauiw they consist of a doAnito
KiBAer of atnnw of oxygen, hydrogen, atrbnn, and nitrogen. Those of
ttiaaoond group, called rfujiiratory. orliydro-airhonncwma clemontj»,con-
(tMattbo «uf:ur<. the 8tarcbea,»Dd tlie fat«. Tlie hiet gronp comprvhenda
' ituirgAuic substances, such na th« salts of potassa, eoda, and lime.

Ve will proceed to ftudy the action nf digestion on each of thorn prin-

Ijet na rommem-e by the digestion uf ulhtiminoid mattei?, which

almuat oiclusivuly by the £iuitric juice. JJut beforu exphun-

'TrouaMmu, On AIim«ntan' PHnriplw from UivpoJntofaVJewof their Dif^osti-
l Niitritiru Value. Tb^<i«d« Conc«un,1888.

6 DISEASES OF T1I£ STOMACH.

ing tho meuhnnism of this (ligeition I most briefly recall to your miniU
the principnl diLtn concerning the two Caotors wbtch uiw here founri to-
gether; 1 TvttT to tho EBfltric juico ou tho one huml anti to the protehioas
oom|H)uutl8 on tlii! otiicr.

Since the first lahore of Ri-aunmr* on tho (ii^entiTo Botion of tho
jiiici'8 of ttiP stoniaph, followed by the enriouR firjKTitm-nU of Spallanram
on digestion, the- atiidr of tho giutrie juice hius lieuii fomjilettil litlU- hy
little, uiiil tti'iluy WL- ure able, thanks to recent rcsearchca, uud eepeciall]^
those of Charles Uichet, to have « tolerably complete understanding of
tliU eubji'ct.

When wo ezamiite this juico wu find tliat it is conipos«l of two emcn-
taal piirts; on Bcid ingredient and iin anotized mnttcr. Tliu imturu of this
ftcid btus been Ion;; diisciuwud, aud it it curiuu? to review what lias been
written by phyaiologista on thia subject since the eammencemont of this
ceutury. Somo, asTiedonninii and Gmulin,f think that the acidity is due
to acetic acid; others, aa HIonHlot. attribute it to acid phueplmtc of lime
ThcMC views iirc now no longor ciiLertiiincil, uiid t<Mlay the dis[>ute is
between lactic and hydrochloric acids. While BerzcHuu, Chevreul, Leu-
ret and Liumigne, Lehmanu, Smith, and more recently lAlwrde, think
that thn fret? acid in giiatric jiiice is lactir, we hoc IVout, Ohildrcn,
Schmidt and Maiy iiiuitituiii timt it in hydnwliluric, 'J'he experiineiit« of
Charles Uichet seem to us to have closed tho debate; they demoiistmte
ttiat this nciility is due in groat part to hydrochloric acid, and that the
latter preaenUi itflelf in a (ttete of (combination with an azotized aubstanca
under tho form of chlorhydrate of leucine.*

As for the aiotized matter contiiiii&d in the ji^trio juice — diaooTonsd
by Eberle in 18:u, saparated by Schwann in 1836, «tiuliL>d by Wasflman
and Papenheim, this «n)ii«laiicc, dosoribwl under the nami* of gnxiprase, of
cAjiMOSiW, oi pepsin, has Wen the subject of mimerons rceearches. Itut in
order tliat the gustriu jiiicu niay [lossess digi'ftive [>ro[)ertiuti, it iii necotwary ,
thai tho pepsin »]m\] Ue associated with its acid, and this union is bo eewn-
tial to digestion, that in the L>»timatioti of certain physiologist*, SchitT in
partieular, the acid and the albuminoid matter form a compound body
described nnder tlio nunic of ehhrh^dru-pepfic acid. Such is. in brief,
the constitution of the gastric juico. Let us now take up thflt of tJic pro-
teinaceoiie or albuminoid aubHtunce.*

The a.lbutninoid principles havo a oonRtitutton almost uniiorm, and
Bocording to MiiiiJer. tho fandamental part of tbceo proteioaceona anl>-
stftncea is a body to which ho has given the name of protein; X some are

* Mem. <le r Al-imI. (Its Scieut^es, ITnS.

f Tiedemitim rind Omt^liii, Ex[iL>rirti'-nUi1 Roscarvlies an Digestion. L^uret And

IProteia (ir^wroc, Ui«ij is ubbuned by diMotiriiig aa atlbiiniinoid matter in »a

ritlMORDIAL ALIMENTARY PKISCIPLES.

FT*

I

igiible, othon insolnbia [Tniler the influence of beat and at acids they
tnreiA iasuliiblu f)rvc)piliiiU« wliioh are &ii isomeric niodiflmtioii of the
■ImailMid material whirli has furnished them.

In preeenco of curtuiu ri^unts, iiin) in |)articalar of coacuntrated
nitfic Kid, there ia pwlaced a yellow precipitate to which has been ^ren
tk naae of Satithoprofeic acitl. Wilh add nitrate of lOL-reuiy, or the
nigsnt <rf MiUon. you obtain a character i^tic orange-retl color. The
qulmmTyalbiinunnid subsbinoeH arc Tcry nHdnly diHtribnted throughoat
Btsuicmatton; they oonstitute the K^-'lutiQ*-' <*! bom-s. the luusvuliue or
■jQtui9 of meat, the Gbriii of bluo<{, tht< cHKeiii of milk, the albumen of
(Jt the gluten of bread, etc.*

ffhen yon bring them in contact with tlm surface of the stomaeh, or
wfaea jo» pmctiee ariiCciul di^etion, thca^atbumiuoid mutton) in tlic prea-
acettt^sstric juice nndergo dilferent mmlitimtinnii; at Hrftt precipitation,
viDeompletc solution of ihu ulbumirmuii mibisUtnce, Mialhe, who has well
lUditd .tliLti problem, called the new body thus formcfl atmifoDH albumen;
rt » what is depcribed at the prcsont day under the name of nyntouin,
tliicb it (imply the result of thu action of acids on }>rotcin matters.
Then if the urtioii of the gaKtrie juice continu»t, Uiero eupervenea another
■tdiScition of tht^fe albuminoid inatU^r^ vrbieh &c(|uirL> ni>w properties;
fn obtain what Miiilho has called albuminnitf, and lyohmann, jjeplonf.
Vbat differencea are therv between thu aibuminoid matters timl the
piftoiiM? ThcBe, numely, that while the peptones prescnro the chantch^r-
itic reaclUma uf albuminoid matters. Dint is to say, while they furniwh
Millou'a reagent (nitrous nitrate of mercnry),the characteristic orange-
color, and while thry ^ivu witli oonccntmtLHl nitric acid the yellow
pceipitAte of xanthoproteic acid, they have at tfao samo time lost the
pnper^ of coagiihiting under the influt'iicu of heat and of acidti; mori>-
■ttr.vhile the albuminoid mncters an:^ )>«Lrcely 8un.-eptiblu of dialysln. the
iBptones readily diffuse themBeln-a thnmgh animal membmnes. Finally,
vhnjf&u inject into the reins of au auimal nu albuminoid subetanoi.' not
■oJiM, you find it in the urine; it is not so with the peptones, which
nttaorbed into the economy, and not a tmco of which is di«covomblo in
U« Brine when the quantity injt'ctedia not too large. Such are thnefwentinl
4iBtrtiu%« which scpamie the albuminoid muttont from the peptones.

Bqt physiological chemistry has gone eren farther than this; Ueifltuar
Wnade it the ntbject of a BpociaJ study to aec«rtain the differetices

^wou ■olution of potosea, maintainisl at a tem^iemturo of &0' C. On adding to
^ thAwii a slijtht «xovw) of iic>;liu aciO, yuu ebtuin u ffelatJnuiiii precipitate,
PntMo. Mulder's Dna]ysi;s La Ct< Hti Mk On. Protein is iusotuble fa water.
•Mid and •^Xivr.

'Ttiit ikll>iiiiiin<»d iiiDttsn proporly m called ore: tbt- ulbumnn ef ckjt* (ofall
•■■■ttfa). iillium<*n of 111* mtuculor plBBEua. tlie Kwniin of Mi^iruin, vitellin, grlubiiUn.
InuiVlobiii. cii»*in, ktpimin, tlw tlbrin of hlond, the musouUne of mucclM. Die
itaki af i^latine himI tflulrii; llitr <-(«i;r'il»l''') albiimciM, cookcil muncuUne, osacine.
eit

8

DZBSASEa OF TI[B BTOMAOII.

lietween the variouB peptones, and has described nniiiGroiis varieties.
3ia» found sncceseively jMiraiwiptone, metapeptone, djspeptoiie, and even
till) peptones a, b, e. '

I «1mll uot (inter into tbi: duacnpiion of thtseti difTurcnt kinds, bccauae
the Tivvfl of lldssTier ore not universally adopted, and lor sevoral yoon
tlicn- \\iii IwuD ft t(.'ndi?uoy on thu |Rirt of physiologists to ubandon liia con-
elusions; th« opinion now prevalent — iiiid it i>t tliw vi«w supported bj
Uenniiigcr, and is i\w more mtioiml — boing, tliat the poptonee difTfir
aooordiuj^ to tb« aubettauce which Cnnusbca them, bo that it would bo
inoumbuiit on us u> study BUcuusxively the Sliropeptones, the atbumi[H>p-
tonw. the ca«ei peptones.

If rhitniatry ia inrapabic of giring by analyoui the diffcrviicefl which
exist iu tiivtitumicoiLst.itutiou of thcae |x^ptoIlL•tt. l!ie application of polar-
imetry ahonre that thoaa suliHlsneea modify in n diffurent manner po)ar>
iioA light, and thig faiit warrants us in thinking that each puptono ought
to constitiitp an individnality.' *

iVa for tliD naluru of the iif]it.i>ntiH. then; iirc tvfo notions prevalent.
Aooordiug to the fii-st, these bodies nro polj-nicrous forms of protein ml>>
atanoes; according to tlio Bocond vievr tlieru ie a upooinl molecular modiflca-
tion, and Wiirtz, 1 loppf-Spylfr, TTenninper ropard the peptonization of
ulWminoid nmttcre uz a hydration of tliosu snbfitiinni». The alimentarj
principles dissolve more or le^a rapidly in the gastric juico, and in ths
order of their digestibility; oasoiu i» tho most rapidly digested, then ooidm
flbrin, and tafltty albumin.*

Aa for their nutritive value, it is welt shown by the exiwrimoiita of
Magendifc, of Lvurot, of Loaaaigne, otTiedomaiiiinndOmL-lin, of lloccker, of
Togard, of Bro\irn-Si'«|uard,and of ITammond, that takun singly these albu-
minoid matters cannot «np[>nrt human or animal lifv. and in or«ler that
they may acquire u real nutrilivc valiii? they munt be ansociated together."

This U, you Ki'tf, n very iniportunt fiict, which uxpiTimontson animals
have doniomitratcd, and which exiwrimeiitatioii on man haa well brought
to light, iu itN coiUiVL'tiuu with the <|iiu(;tton. to-day forgott«n, and vet so
interesting, of gelatine »oup. first bnnight into vogue by Darcet. " Thia
brubh. in furt. instead of Bustuining puliuntti was found to bo destitute of
till nutritive vuluo.

Wo8luillB(!e,however, that conBldered under another aspect,thi«qne8tion
iloi«orvea to bu sttiilied anew, anil that if certain of tliL'SL- !(ub!!tanceii taken
singly art) nut nutritive, tliey may nevLTthclcHu favor the secretion of gaslriu
jtticv, and in thia way, if in no other, pluy an im[jortant part in digention.

Is this role of iieptonlaation reaerved excluaivety f nr tho stomach?
No; if tlio greutur ymrl ot Lliu digt'etive proeuss gui-s on in iha preaenci* of
the gastric jnice, it must still !» owned that other hiiuids »ccret«d by the
digestive tube poBfiesa the same |)ro()frtii^s. Olumlu llornard, Corvisart,
Sleissncr and Kuhnc have iu iact uhowu that the paituruatio joicu

PKLMORDIAL ALIMEXTARY PRlNCriT.KS.

9

^..

ttmfom Albnminoii) nutters into pepUine, and iiia fennf nt having tliia
fn|ttrty ia trypeiu; vbat chotocterizcs tbo action of this f«Ttneiit h tlmt
ilcui]rodDoe in an Hlkiitine meilium the tmnttfornrntion into peptone,"

ltlusbe45U Hf«erU<il ihiit Ihu iiit^-stiiial juioe [)uit8fi«e!4 Lliu sumo prop-
<itf. bat here the matter is not ao cle&r, for witbouldmiyiug tho pre»-
tnnot this jotre some have affirmed tlmt it hafi no (ligostire propE^rtice iit
4lJ. [Am of opinion, from cipt^rimcnti! to whicli 1 eholl roturii later, that
tbe intestinnJ jaioe does have a rmil digeMtivo pmporty. feeble though it ho.

Such is the dig«etton of albiuniiioiil mattvrii whiuh curtain phvsiulo-
fBta, md in particular Charles Richet, h»ve oonsidered un a veritable oxi-
iidon, Wo arc thoQ led to bclicvo that this purticiilaruct of digfstion
iiiairt of formcntatioti, nnil ttiat between fcrmcntatioii, peptonieation,
ud jmbefactioii, tlie points of (contact are very close. You will see, aa
K proceed, how useful i^ this Idjea of fermentation in the explaiiatiou tmd
tnatnent of certain farms of dyspupsia.

Th* focatonts are the !<iibject of a rinitu spocial digoetion. It is the
wHtiatj glanda and the pancruus which fiirniati tha elements of this
digestioo, which consists in a 8]>ecial action of thai bativ wiiich DuUrun-
lultliiooTerod and described under thi.> name of diiintiise, iu the fermented
fniDof cereaU, iind vhich MinJhe found in mliva; it iii thiii body which
BuafDnns starrh and rondern it uwimilablc.

This tranKforuuition is VL-ry complex, and has been the imbjoct of in-
ition by MuecnUis, O'Sullivmi, and i-Kpecially William lUilwrtB. who
diOTm ua tbat thi; molecule of rtan^b iindcrgoi>6 traiiefonnatioit, on
litt w«? part, into a pjirtirnliir sugar, multoHe, ami on thi.> other into a
HTira of doxtrinett of uu inferior type, to which Ims been given the name
otiviiro dr^frine."

This action is limited to the eali%'ar>* glands, bnt is continued in the
dipAiru tube, and Cliark's Kichct lia« shown thut tbo acidity of the
■ciinach, io^tead of weakening the traiUiformation of amyliuieoni^ matters,
MIsbly favors it^ But take note that the gnnlrio juice of itself is iiicap>
■hb of vffecting this transfarmatioa. It is not so with the aecretion of
iW pancreas, and th« retnarkablc kbora of HonchArdat and Sandnis have
pal into clear light the saecharifying action of jNtncreutic juice."

A* for cane sugar, (.'laude Bernard was tlio flr«l to show that this sugar,
in onler to bo assimilat^Kl, must go through a process of dige^tioii, and it
)>tbe iQlestinal juioo that hm the cnrious property of transforming cane
•npr into invert«<l or assimilable sugar. Kieliet ho*, howovcr, bIiowh
^t tfais property of transformation of miie sugar into inverted sugar
tevolKfj be attributotl to the saliva (Researches on (tastriu .Tuiue. ]i. 11<I|.
lie pTL-eeuce in great qnantity of these sucdtarine matters in tlie stomach
WswU the digwtive proocw in a nntuhie manner."

KuiBllr, fatty matU'ra are noither modiliod by the ga»tric jnic<?, nor by
t^ lUira; their digestion is rvaervod for the pancreatic juice whioh

10

SISEASIS UP THE BTOMACU.

©mulBiflM them. I CBnnat, gentlemen, h)o ewmoBtly call yonr fttt«nt»ii
tu the important r61e of tbe pancreuii, which, plwct^ at the turminatiun oEfl
die buccal ami gaatric cavitiwi, haa for fuiirtiwii to complete the cligeetiVe^
prooeeaeB whicli hBre boon going on in tltv»o part« of thu digititiro tnl)e;
it« eecretion mudiQos not '>nly the albuminuid an<l focnlctit mutter? which
bnTooBcapcd the action of tho salivn and gustrtc juiou, but it aleu possofiHc>s
tbeexclufflre property of digestiug fatty matters. Quito MKHjntly Oefrvsiie,
who has made the atudy of the pancraitic jtiicp tlio BiiWject of long re-
acunihee, hius attributed to thrvu distinct fcrmonla found in tliia liquid, the
tUrcK) propertiea vhich I have just mentioned. Atmflopain lias for funo*
tion to BBcoharify stAroh. tleapnin f&vora the breaking up of fat, while
Intfo^in diswlvL'8 the aiimeiilary nllniniinoid niattrr».

As for the aalina sabetancee, they arc al^o a£ iisefiil aa the histogen<>tic
und rMri)initory principle-*. IJebig a long time ago showed thi« fact, and
the mori! rooent (■s|JiTirauntii of FointtT aro in thiB ruigsiHi di'muniiLrative.
Ill fact all uiiimalg die rapidly when deprived nf the K&line ingredients of
fond. Bfing hiut shnwn also, with rerpiMst to the Halt« of pntiuwi luid aoda,
tb»t while in the meats there etirts an eqiiiil proportion of the salts of
80fift and potimh, in vepetahli's, on the contrary, thu Baits of potuah pre-
dominiite. Hencu thu imiKirlimco of addin;^ common mlt toa vcgetabk- dtel,

Such are, gentlemen, the mnditioiiH which preside over the digestion
and alworptiun of thu primoniial alimentary principles. In the neM
lecture weshu]) enter still moru deeply into the<]'ieetiou» and shall take up
the subject of complete and conipler aliments."

KOTES TO LECTURE I.

'floMO, of G^Rnm*a, put to profit the faculty which he poaKBsed of
Tomitinp at will on Hwalfowin]; a mouthful of nir, in studying the decree
of digi?stibititv nf alirnfiit*:. Ho remarked tlmt tho 8u))»tance« which wvt«
the most easily digested, i.e., in ono or two hours, wore: raw eggs, milk,
veal, lamb chaiM, the dc^h of young fowU. broiled frcGli lUb, spinach,
•sparagn*. artichokoii, celery, coolced frail*, apples and prunes, gruel, stale
breed of wheat oi- of rye, potatoes and wiyo.

Other eiibBtunwii were not digniitcd till at the end of four, five, or six
hours; such afi pork. (!(>okcd bloi>d. hard-boil l-U eggs, oysters, salads, lot-
[tuoc, chicory, waterrressuit, laibbuges, wiuliUowerB, carrots, onions — raw or
cooked, rtuliahet). pibitry.

Other HubataiiLM.-.i, iinidly. were very difficult of digention, and remained
a long time in the stumaoh: such were tendiiioua and aponeurotio

imrts, fragments of bone, the rind of pork, mushrrtonia, truffles, fatty mat-
ers, nuts, Hweet almondei, piHtachios, poanutH, coeoannts, raisins, orange
peel, preserved citron, string Iwans, also the aeeds of grapes, of cherries,

gnmoe, applee, peui-s, eta, as welt »s the skins of those fruits, all ol which
0886 found to uu coiiipietcly iudigtMtible.

^^HP pniMOftniAL ALTMENTART PKINCTPLK8. 11 ^|

^H Pt. Ifamninont bavinf; for eorfrul you* oIiHcrvcd tlio various phages of ^|
^^■SMtion in a rultiist Camidiaii. AUvxiti St. Martin, who was the Kiibjcrt ^H
^^nrnttrla of th<' titnmnrli. cotiscciitivv to u f^n-slmt wuiiml, has givon cho ^^^H
^H liiihwiuji^ tablu, which iudicstce the resnlt of his expcrimoute: ^^^|

Hkmi Thus or

^'tntvincArioH.

^1

In SToiuca-

la ViAU. ^H

rur, 1 B. M.

rkET.

H. ^1

trlMi

frnod

b(>il<'d

raw

roaslf'd

stewed

roasted

roosled

broiled

bruili'd

niw

boiled

boiled

boiled

boiled

fried

boiled

boilwl

roiisted

boiled

fried

bi-oiled

raw
■tewed
roiut«id
broiled
broiled
boUed
brulled
fried
boiled
muil«d
roasted
rousted
boiled
boiled
ruclled

mw

boiled
Iwiiled
Ixiilrd
buikd
boiled
boiled
boiled
boiled
wiirtnttl
broiled
fried
boiled

8 ao
s m

4 (Ml

2 m

3 Id

8 80

s w

8 80
8 00

5 40
8 80

4 00
4 15

s in

R 15
4 80
4 13
8 IS
8 00
8 00

s in

8 00

8 00
4 00
4 80
4 00
4 OU
4 00
4 80

a 80

4 80
880

8 SO

4 00
4 15

3 00
1 80
8 80
8 45
8 00
8 80

8 ao

820

4 00

5 SO

boiled
raw, entire

stewed
roan ted
roustvd
mnitti<ntnd
cut Hns
cut Bno

iiiiutlcatet)
eutira p.

masticated

taw

inastifstfil
uanui&ticated

laostiditcd

entire u.

divided

raw
inn>iti«»toil

divided
raw

eatirv p.
nia&tirutiid

745^^H

7 80 ■

629 ■

1 ■Vt fl
H ■

8 00 ^M
8 IS ■
980 H

00 H
19 80 H

80 ^M
tiSO H

8 SO ^^H

680 V

18 Oft ^^H

10 Oft ^^H

7 15 ■

19 00 ■
H 80 ■

0000 ■

18 SO 1

»4» ^M

^^■^U t — 1,

Bee/

Vml. fraah

^W -fil»

^HfeBi^ bM(. <r«K*tab1« imd bn^iul

^ — p_ t — 1.

12

SISBASSS OF TlIE RTOJfACTt.

Tendon

CartilaKO

Cariilvfiv

Apimt'urowa

BilU<'. lll^-fH. Mtlld

jBorK-, Iiiik's M)lid

[Ben.n«, \n}d

eod, nlitat, traih....

Jread, coin

/okccorn

Ciik», Hpon^

DullipliDff, [l|)I)IO

Ipples, Mur, lain}

Lpi>l«fl, «oar, mi'lldw.. .
^JLppln. aweet, mulluvr.
~?iLnijii|iH ,

PoTMiilKi.

Pttn>iii[iK

LiiLrrat, ofuaga

' Carrot, onin^i! ,

C&rrot, uiiifiiT^

Bee tit

Turnips, Hut .<..

PotuKn-n, Imh

Pvtutws, lrie^)l

PoUitoe«, Irish

ytux Tims or CBmrnnnoai.

IxanMucR.

IhViau-

l^n>.

■. ».

Pntr.

n. ■

cntire p.

S4 00

boilod

4 »

ni(«»licAt^

10 W

dividt^d

13 00

boiled

8 00

b^Ilcil

6 SO

I'liure p.

m 00

■■iitIrK J).

m 00

boiled

S 80

buk«l

a w

mmtticsktcd

480,

bokud

« IS

]

baked

900

1

baked

S 80

broken

« 18

boilod

X 00

nut

2 00

en tin jk.

IH 00

luw

3 00

maatii'aited.

» 30

raw

1 SO

mBBttc»t«d.

« 4A

lioiled

380

n>a»liod.

6 4ft

buitud

uotiri' p.

13 15

raw

(Mitin; p.

1« 00

boilod

a 18

mcutbcil.

< 43

ontlmp.

i:i so

raw, da

17 15

bulled

a 40

boiled

s an

lioilud

8 80

niaahed.

8»

ualire p.

14 00

toosud

S 80

• Prof. Vemenil made a very interesting communication to the Academy
of ML'ilitriiKi c'oiicoming this pnliRiit. in whioli ln' miiiut**i_v dn*crilwd tlie
trillittiil ODcration which he performpd on him. This report will Iw
(onnd in tiic Uullutin of the AwmU-iiiv, Kcseioii Ocitolier 'l\, \ii7G. Tlie
following is a brief resiimi- of tliis vane: R. M., agud Hcrenteen vejirs,
mnsnn's appTcntice; on Febriuiry 4th swiillowod by niijttftke a solution of
muHtic potaah. ThisacciJcnt detertninc^ ii very inten»' inflammation of
the (Bsophagus ending in \U complete olililwrsition. Prof. Vertieuil per*
formal guEtrotoray on July 3lith, auil by the month of November the
patient was completely cured.

' Jjftllomiind, n^pcrimontinfj with individnnU poesesfiing an artificial
aniu, hiut rcmiirked tliul voKi't'kl^le subatunces sojourn in the stomiu'-h oiic-
Iiiilf lui long 118 uiiimal foods, and tlmt thL-y iirewrnt themselves nuich more
speedily at the fintulous orili(-t>. T\m pliysiotogit^t linn notiot'il that Ij(.-iin8,
iMjag, lentilfl, potatoes in a mivehed, state, undei^o little alteration; mw
iriiitd were not changed; epinach, priiuiy, eti-. , nipidly provoked diarrhtea
and apijearwi with tu*ir usnal wneet and color at tho "month of thd fistula.
Milk also caused a looneueai, aim at tlie eml of half an hour to an hour
appeared in the form of curdii. Mnanl meats in thea> indiTiduala ho-
jonrned longer than bread uiid boiled nieiit«.

(■'rem his nnnierods t-xpL-rimenta (wliieh we are obliged to omit],
Ltillcmand luis orrived at the following coiiclnHJoiii*:

1. If it hu true that tlinee alimentary mibiilancett which are the most
oninuiliied hvh thoae that noiinsh the most, and vice-versa, it does not
follow that they are more promptly digested.

2. On tho oontrary, the work of digestion is the more protracted and

PBIMORDIAL ALIMENTARY PanfCIPI.KS.

13

jminfnl the more of nutritive materials Ihe food contuinB in n given bulk,
mi rifC'ivrm.

3. Puods do not leave the elomiirli in t.h« nriler in wliieh thfty«r« iiitro-
ilnoed: it is nut thoi«e wliich nro ihv nicwt iiltfriul bv digv^liou wbicli ure
IkefiiBt to {Hue tho pyloriii*. )>ut tlioiw which, oontuitiiii}^ more of uUmeu-
tnjr mMeriuIsr arc in«st rcfnirtorF to ih« digestive fun-t'S.

firaimn Hhs rtiil morr rwiently tniule snme <)bs(-rr;ition8 on a snl)j<>ct
|iMBesfiing sn Hrtitirin! nnim in the Biiwill intt^tiiie, ahoiit twenty-four
offlitiraot^r? from the ilco-cwrail valve. According to this obecrvor, tho
diTtoi.- is uutitnd during fasting nnd acid during digestion.

'riie aiitcomi mi^mbnine is alwaya alkaline. Yrmh intuit, ingpsted tiy

month, takes three hount to AjiiM^ar nt tlie fintula, and ut the end of

I or SIS there renmiu ao more truci-s of it,

' Leren has recently mad*" n iium))er of experiments toncbinp the colw
mii of aliments, wUieh go to eontinn thow of other exju'rinntntei-s. Ha

Ce to » dog two ounces of litjuid white of ere. »»(1 k'Us Uk- animal uu
rufterwanl; tho stomach is found coinpleh^y itmiity. 'I'hen he gives
lauurtber dog an ounce of white of egg hard boiled, and kilU him two
bfflinaftonrard; in the utomiK'h is diaco^'ered half an ounce of undigested
*diitP of egg. To another iniiiiiul he adniiiiietera three ouuei-ji of hard
haiWd irlut* oF egg, and afti-r three hours one ouiiee of this hwdened
is found m the titorn!«;h.*

*Lrt)dn« is present normally in the ixincreae, spleen, thymus, thyroid,
ud nliniry glands, tho liver, Itidneys, ttunrarennl naiiHiilen, thn bniiii iitid
ll« Iraiphatic glands. !t luw for formula C.H„N<V J*- erjutallizia in
tkile pMMs. Inwlubie in ether, it di«colT(« in 27 parts of cold water,
■ad BMra readily etill in warm wator. It meltit ut ITU" C. Tn-utetl to a.
bi^liPT temperature it deeoinjttMfts into CO, and amyUmine, t\II^,?^(>,-^-
('-M ,11 ,N. It foniis 4.'oinl)iniition.4 with acids and basea In the t>tom-
k.'h leucine is combined with KCl in such a way as to moderate somewhat
tin .irtioii of Uie acid, and it is proUibly uiider this form of oombiiinlioii
tint the liCl is M'eruled by the gu8E.rie glaiuh).

The formula of ehlorhydrate of leucine is HCl. C.II,,NO,. This is
Umr that Clmrlefl liichet pr()fee<U m the eeareli for Irurine: " Having
jxpared an infusion of the rennetri of eight calvei<. I obtained alxiut S(K^
f-t of II chlorhydrie solution, the addition of Iiydroi'hlorie afid being
Mt«Mtfy to remove the active substances eontained in the mui:oiia mein-
hnna. and prevent putrefaction. Thi.s dilution wiis treated bv a itutH-
WU quantity of earlxinalo of silver recently prrripitjited, ami slightly
^■<«l. and tlieu filtered, eo a« to by completely ileiinved of hydroehlori'e
*o4. Ou uaHsiilg through il a eurrent of tnilfihuretted hv^irogeii tliere ia
fwdphatea in the state of sulnhidB the oxide of silver wliich is foniieil
IB [art during the reaction. Itnt the sulphide of ulrer uaiinut all bo
"laated by hitnttion: it is ncceemrv to eviijionitt^ the supernatant liquid
■KvW in a vHcuum or at a moderate livat. When the liuuur i» evaporated
W I mupy consistence, it is treiLti>d with Ijoiling alconul till all the iu>
P^^KAts aro diseoJved. We thus obtain a tsolution of leucine, of tyrosine,
IHnich like t(iibstJin<^r.s. while the pe|itnii('A, the sulphide of silver, and
t^ainernl silm are in»>oUib!i' in thojie enndttions. in tlioalcoholic liquor
'*>Ponte>l, then ubandonod to \Uv\i, wu note ihd preeeuco of tryooino
gJ^sptciuilT of leucine. "

u

DKEASES or THK STOMACIC.

" These eight renneto whon treated Ijv 2.5 grommee of hydnwl
acid, gftTfl about 5 grammwi of loocme. 'J'hG qnantitr of tyrosine is
ierble. By eeitarabe crrstolliitatifnia, it ia eaav to isolate Imicitm from
tvroeino, himI ootaiii boOi iii a iiiil1icii)nt Rtate or purity to d^turniirii) their
o)ieinicn) and crystallographio cluinicti'n). " (Kioh(>t ou Gastric Juice, p. 45.)

' Itobcrto has ktoly foniid in tho Kitetric juiov u couguUtive fennetit.
In his opinion the cougHlativc jiroiK-U'ty of pinlriu juice is not due to th«
peiMiin: and iiroordiiig to tlu' ei]H>rimi>iitx of Bruckt^ iind iif Biirgor, tliero
iani certiiin pepsins whii-h do not coaguUU' milk. Neither ia this eoogu-
iKtioii due to tlie acidity of iiw gnatric juice, for the mme cougnlatiTe
Ivrmunt ia found lu thu [umiToatic juice, which ualk&Un«.

'Accordinjr to HeiiningiT, who oporatwl with 10 por cent watery aoln-
tions of iK'ptonu, tiicsB pL-iitont-s iiru uot eonpultttcti oy heat, nor by HCI,
NO^ K,ft(),. or aci^tic. cold or wiimi, or iiftiT the tuMitioii of the neutral
■altn of ulkalinu miitidti. Alouhol pruci])itat£B curdv iftakeRr BOliiblo in
writer, even after prolonged contart witn aluohol. "Kl givM a nxldiufa
brown precipitate: tanuin, a voliiuiinoiiH white pnwipitjitu: ho ulso picric
3(Md. Uilimy »dt8 give no pnn^^tnitate, but the addition of a drop of arid
ja fulIoWLHl by an ubtiiLdmit pret'ipitaio. Hohible \a excess of the lutid, and
reappearing villi thv addition of water. The solution of thv biliury sidtx,
when hut little coiiwntnitpd, gjvos witli acetic acid but elight tiirhidity;
hut if von add a nolntinn of peptone, a thick preeipilato follows, wiiii^hls
a comfiination of pept/>neH with biliary a^'iils; aleobol contiuiiiiig a litll©
HCl docompoecH it. Ukint; th« biliary ucidn and Icjiving liydnichlorate of
peptone. The rua<!tiori of tlie biliary aalts with jwpttire is vary notico-
abfe, but in no way (diaracteriHtic. fur albumen, librin, syntonin dissolved
in HL-utic acid iHtliave in tho same way. Tli« solution of peptonea is
Btained grt'c-nish hhie by siilpliatc of copjwr without precipitation; if yoii add
excetH of potiuiai tho liquid lu^unit-s ti niiigiiifiueTit deep (?oloruttiin. Tho
sliadc is of a beautiful row color if the fjuatitityof cupric cnilph. omployod
is small, and panvH to purnh'. "-nd finally to bhie a» the proiwrlion of the
cupric salt is greater. Tiie purple color is due to jwrtiiil aljpiorptiuu ol
tho croon rayn; tho yellow and l>lue raiiintioii!' arc twpuilly (.mfecblcd.

I/ifjurir fitp. jmtaH/tit aiut fitynr. — The jicploncs prevent the reiinction
of I'Vhling'H S()lution bv suKur, or mlhcr, they prevent the precipitation
of the etipric oxide pnKiueed. (Gvlatluv, creatine, tyrusin, leucin, glyco-
fioil, etc., do the eame).

Acrliile of Lend. — No eflfect

Mtrcnrk Oihirhie. — White procipitat*, mlubloincxoeosofpotatijB, littl*
soluble in water or exoi'ss of tho mcrourii' ohioride solution.

yUrat-p of Silrer.—^o rea<'tion; after tho addition of a little ammonia
you obtiun a white precipitate. Hohible in ammonia and in nitric acid.

Anhifdrotif Aivttc Arid. — Dry prptono heatini to 80" C, with this re-
tgont (10 grummetj dc-eicxutted iieptoue, 25 grammcii anhydroiut accbio
acid), soon heiwmen liquid, and taked a light brown tint. Gert»iln curious
^oa(^tionfl follow, m the heat ia maintained, and the mixture \i submitted
to Tariona ohomiiail reiageiils, for which wo must refer tho r«uJ«r to Hen-
niugct's tlicKia.

doHceutrattd yUrie .IciV/.— A yi'llow color, [UkHsing to orangn-red after
the addition of aminciuiii (.luiitho-proteie iicid.)

MiNonKt Tent. — A roge color.

The solution of peptone in glacial acetic acid takes a yjolet-bluo

J'KIXOKOUL ALIMKNTAHY PKINOIPLKti.

19

I nm add Balpliuric acid, aud at tiie smne time f^ives a f«oUo greon
fiuiUMMDoe.

Vitb refCBrd to t)iu forniution of pqitoiivs in tho stomac)): ucconliiig
itttisner, albuminoiil tiuitlt'i-H in that vIscuk br»uk u]i into utisiitiilable
BB. and into parapt-ptoiia not suiicL'ptible of midt^r^otiif* trunafnrmii'
: Uler by tlie action of the gafltric jiiirc. According to Mulik-r und
Bnke, pnntpentone mny iiltimatply undergo eonTereioii into [wjitoiie,
"'Jfl deitira tnis, and adds that if, nfter having i&olnti>tI the mnipop-
c, you eubmit it to ortiSciftl digestion, you cannot succeed m trana-
ning it into peptone; but thut. on th» contmry, it hocomca Ices itnd
iKilnble, and rpaemhiiw more and nion? dysppptone.
Molapcptone ijt ^inwipitnted by onncciitrutod mineral acids. You will
Curl it in great 4|uantity iii Ibf uiatt«nt voniitud by infants, and it ia pro-
linrwl by thtf digtwtion of casulii. Bif tlie prolonged action of pRpwin,
it ia tmn'aforitiul into {wptone.

lHfl{icpt<Miu id tlie insoluble residue which results from the prolungvd
artioo of gastric juice on caeein; it is insohible in wut4.-r and alooliol. and
KM longL-r niodifieil by pepsin. Wfaou you extract from Hie pruducta
4 ttomacb digestion pontpoptoue, motApbptono, and dys^peptonc, there
itil mnain, as It[i>iBEncr obsorveK, th(- three pentoncn, n, li, c.

The 7>eptone a is precipitated hv fcrroryanidB of pota*siun] after th»
iition of a little noetic acid; It in lOso prccipitatod by oonccntmtcd nitrio

riiptone J in jiretipitatfj by fi-rrocyanido of jHitatKium and acetic
nut propipitat«l by coiKjentnittd nitric acid,
the |>v]>toQtt c i« not precipitated by eitlior nitric ftci<i; or ftTroc>-ftnid«
llMBium. Thia peptone mouc is regarded by Scliiff oa the deomtive

.of digiwtion.
ttt {wptoiiee a, b apd e am eoluble iu wst«r and dilute acids.

'The )M-ptoue3 arc laevogyrous, and according to the ohstM-rationg of
viaut. the dvviation of 1 degree of the siicclianmetvr of Solvit corru-

to M> uulligraiiitnL'S of Jibrine iR'pt'Mii>, ItHJ minignimnieij of mvo>,

I peptone, 104 miiligrammes of gelatine peptone, 14l> of albumin pep-

iriwolved in IW cub. cent, of water.

Aocording to HenninceT, casein |>eptQiie [>o«8eii«es a rotator}' power
auch more elo^-nted tlmn nbrin jwptone.

IIi?nuigcr coneidura aim as too groat, the diflurence between the rota-
b«T |jover of ulbumiu-peptone and that of fibri u-peptone, iiidirateil by
i'misBrt.

•According to Mialhe tho peptones are isomoric modifications of albn-
tiiMiii Riibfitanc^s, Adamkievrick, on Im [mrt, niiiintuiuH tliat thoy ore
>lUimiRoid matteradejmved of miniTal Kiltx.

Bprtli and I,chmnnn have enmlmt^ this view, and have affirmed that
<Jw Dcptuncs an,' " polymfrcs " of alburaiuoiis inatU^rs.

TluB view It not accepted by all the cbeniisls: Wurtz and Ilnpjw Soy-
'vdaiin that the peptones are farnitNJ by a bydratiou of albuminoid mat-
tm.

DtmninKer had etitdied the action of dehydnting Babetauces on fibrin-
Hjtme, and has thus obtained a body wliich reMmbles syntouine freed
^ iu trill by dialvsis: hence, act-ordrng to this chemiat, the poptoneg
I Ironi a Sxaiiou of water by the albuminoid matters; and the pep-

16 DtSRASEH OP THK STOIUCIL

oxaluric

■i6 inay hcnco hv Domiwrcd with the uncmic ncicls, mch an allosuiiicT
luric, etc., wliicli rrault from the action of initer on the ureides,*

" Iliinirnonil, after haring dubjected himself to an ftlimentatJon excia*
Hirelj of nlbiiniiii, fixind: I, tliat there was no fall of bodily heat; S. tlutt
lie hccnme eniocint^t]; 3, that thn riuantity of nlbumili increasfxi; 4, that
tile praportioQ of uzotizcU siibetancvs augmented in the urine. After
ten lUiyef of this cxcluaJvc atimonludoii he wns ohligml to Imve off; diar-
rlupft. abclomintil puinit, and t»>phnlalsiu having acquired a groat intotipity.
Puring ten otlipr days lie nte nothing but itarch, aad he etill BHfftfrc4 I
cruelly from pyrnaJe and frutii Iiuaditcuc, and the loKt in weight vaa yeb i
greater thiiii under a ihl of albiimiu.* ^

"The idcBof Papin in 1681, of Changeux in tTT5, of Prouat in 1791,
of employing for food Relatino *'Xtra-cl<>d from Itoneg. wan tiikpii up iigaiii
by Daroet, in ISIO. who deviBod n wnv of preparing poups from g<.'latino
oxtntctod from bonca by »t«im. ]

There wm »l onee a great furor for this new aliment, and a gelatine
fai'tory wsia estaldti^hed at Cros-Caillon, mid worka of the same kind were
iitittitnted at I'ans, nt Li»le, at Nyone, at Stmsltonrg. in Hut«ia, in LVliind,
in Holhiiid, in Muxioo, and in Now Orleans.

At PariB, from the seventh of October. 1829. to IfMO, the appumtus
of the Iloepital St. l-ouis furniBhed t,4(i:t,!i.i{> litres of gehiMne boud, I
and T,i.M(t kilopranimes of fat, and tbp»e prodiict« nerved for the I
preparation of .i,4Ti(i,'.iOl alimentary gel»linon» rations. Tttiriiip tbi« ,
elevtM] Tciirs there were (including wiek, <!onviile*icont», employewi, and
pnuperi)). 04,54'^ jK-rsons fed on this gelatine diet. In the drug shops
and grueerics gelatine eonvertcd into thin Hukca or tubletB wa« a common
urtieb* of trade for culinary preparations.

Complaints, however, were made of this diet, for patients subjeotcd
to it did biuily; the e.\i»erimenta of Donnf, of Ma^endie. of I^oceur. etL'.,
came to throw discredit on the value of I Hireet'K preparation; h conimis-
BJon was iiominat«d by the Academy of SL'ieucfctH, and ita eoncluaiona wore
not favoiablo.

It is true that other rommiwiinns, such as the one nominated br ihe
Aeademy of Pnri», in 1814, liml ailniitted that gelatine Koup prefxired l)v
the procees of l>arcet was quite ns agreeable oe tbo ordiuary houlUon of
the liospitals. Despite all tliiit, despite ita ar^lent defenders, Oiniitlin,
Arago, Halxae, etc.. the " bduUlim a la rjelatiae" was almost completely
discarded from hospital and itrivate nae. There are the conclugion* o"f

[the Kd-cailed (itlatiim (hnimissioH ;
1. DogH allow them»ulvea Iodic of hunger by the side of their gelatine
food, after luiving partaken of it or not, during the first few days.

'2. ]f iimti^ul of this in.tipid gelatine these animala were ^irun that
agrcciible jffhf which the porlt butoliers prepare from a decoction of iho
dilTerent pari^ of tlio hog. and tho giblets of fowU. the duge cat it with
sn-eat reliah the (irst few days, then they will touch it no more, and they
die about the twentieth day, almost us soon ii» if tiiey liad not eaten.

3. If you asKociate the gelatine in notable qiiautttj with a small pro-

•Hcnnigor, On llie NfttuMof llie Peptones. 1878. p. 57.
f Hill Hill »ml. Rt'M'ArcLiEis on Uie NiitrJlive Value of Albumin, SIaivIii oadl
emple^'ed tisnn Exelusivii Alliuent. TrauK. Am. Med. Amoc., 1B5T.

PRIUORDIAL ALDIEHTARY PRINOIPLXS.

IT

bread, or of rami, or of botit, the imtmiklB live longer, bat they'
pvT ton, and tbey perUli about the sixtieth or eightieth <hiy.

i Firutily if too bxpcTiinfiiit with the liroth ot meat alone anil tliab
vkeb m(ult« from a mixture of a little quaulity of meat and an cqmra-
Intoffulatine, you iiotioe that tUe dof^ wliich Hpotnlily 'be<!ame lean with
gtUine eoapt recoror their I'liimp condition with timt made from tneat.*

"William Roberto has HtudtctI bhi> (^ompamtive action of popsin and of
tnpgin on albuminoid mJLtten<, and has pointt'd out this intuicsting fact,
ihu pepwn attjickj mnch more nipidly than trypsin, the albumin of
t^. bnt ihut with n^pcct to milk, the digestion is much niurc oomploto
^ aitb trrpiin t)tsa with popKiii. f

"Will ism Robert?, who hus inreatigated with jfroatonrothedigortion of

Ijcciilent mattciH, ha« shown, in accordanoe with the cspflrimente of Mas*

I of O'SiilUran, of H. F. Brown, and J. Heron, that under the in-

__. ol diaxULMi the suppjfceti brcakinff «[» of the irtareh moloculo

i<\,II,.0.,), into one molocuk' of dextrine and ojio of grupc eugw, is not

'Un-tk accnmte. and tiuit wn ought to rajusidor this molecule aa consti-

tut(<(ll>y the reunion of it ^reat number of other moleculeH, and tliat tbe

tftui raaction should be reprewiitetl bv the following formala.
10 (C II„0..) + S (11,0) = «(C U,.0,.) + 3 (C„II.,O.J
Soluble starch. Wnter. Maltoao. Aehrodfxtrine.j

" i>?Ten maintiiins that gastrin juice chan^nR ntarnh into dcttrinn, hut
Eumot transform the latter into gtucono. To dcmoniitnite this, hi' Uirntt
nowctarch into a liquid in whiim iiui< Itnen mat^emted the niunouK mem-
Waae of thi; etomach of an uuima.1. and imniLnli.itcly the slaroh bu» lotst
ib inDpcrty of becomiu^ btuu by tincture of iodine. This cluinKe. he
an. in due to the jwpainu and not to tlie acid, but the moditlcution of

Itki'stamh stops there, for the lltjuid thus obtained cannot rwluce Barrea-
Vili'i wlution g
"Cane sugar, or ■occharoae, whirli is obtained from the tnigar c:Lne,
Bqile. beet, undergoes in the living plant tiio ni'tioii of a fi>rnioiit which
tnMforou it into invoitod sugar. The iutvi<liiial juicu Iiuh tliu samo
frupertT. and acts ue u fcnncnl. transfunuiug cuiiu tsugw into iuvortod
r, sfl the following furmula shows:

C..H„0., + 'i LI.O = t',,H,.0., 4- C„H..O,.
Ssooharoi^c. Water. Dexlrow*. L)u>vuloae.|

* (Paptn, A nnw way of SottuniiiR Done:* and Uiasalvio^ out tlioir Nutritive Idt
(mtWau. Part*. WSH. ChauK^nx. uu th« Eximiitioii of OelaUnf Truni tifntr*, 1775.
^nam, A B«>ww«y of Impr,iving Iho Dii-l n( Soldii'i-d, ITfll. l>.in'pt, Blonioir oii n.
'•vaaamof B)dracliagtJit.-(I<-lulini>urtSuLKiUiiiiM![n)ni Ronvn, Piirin, 18i&. flirar
Aa-bport oa tli« Enifiloy of Bonn tK>latin>' »sa|inrt of tin.' Aliint'iiturj' lUyJme,
kwB, 1881. DoDii^, Expvi-imeata on the Pr»perlieii of (klittinc, IS-II. Ma;^--ndie,
^foflintlicnDmr'oribeGi^latiQcCoinniisflioD.1641. htcteur. Bx|ferin]«>ntKOD tlie
Ebob frf be Oelattnom Solution la the HAlcl Dieu, 18U. Bemanl, Coun da

* ffilliAm B(>lii*rt«, On Uiu DiKi'^iivff Ft^nin-iitH. Lotidtm. 1^1.
lOUulliran. Jour. Chem. Society. [873, ISTIL f. H. Brown tuid J. Heron,

'**- Chem. Society, 19T9. WiUitun Itoberts, Oa the I%i»tivi: Forments.
tt«Ti>iL Traf(fiil»(iiial»diex(It> rExtomai.'.
IChuoIr* n>T(itirH, I.«9J>tM4i)rlM|)h6oom><a«iid<! Uvjo, t U., p. 86^ PbH*. 1970.

4

18

DI8RASES OF THK STOJIAOH.

'* NumerOHBexperimRiiLi of Kcmmerinli, IJebig, V'oit, Porster, Bischoff,
otc., linv« xhown tlio nopi^witvand Imiwrtitnf.'eof iwlu in diet. A<>i>ortling
to Komnivrick tbf nutritious cffocLof uu-al brotli is due to the »iilt-s or
potiifih which it conluiiw, uiv\ the rcsidiiuB of the mout, without thcM! Hilinr
o]eaionta, CBnnot mtHLaiu aaiiiLalH iioumhoil on them.

tilschoS hu8 seen a dog fed on lirofld ulotie have an attack of acute
muiiiik, tliuii, nt the end of a little time paralveis showed it8i>lf iii the liiud
limhs. If lh» vx|)onmoTiL were coiitinnud, tliti doi; would iutjviUibly suc-
cumb. H-hil« it would r«gaiu its health ou having its proper ooumbment
given to it lig&in.

Foretop has given jiigenns, mice nnd dogs food very poor in silts, and
bus ramarkod tliAt Uio niieo lived '.^O to 23 days, the pigeons 1 3 l-r> -Ht days;
tioe dogs 'id to 3G diiye. The cxpcrimcut« of JJoussiugault on bull* Imve
a1»i> shown the immrtaiire nf wdtt) and their utility in ulimontutiim.

Aec'.oniinff to lliirbior, a miui ought to eiit everv daj in one Khape or
another irom half an onncc to an ounce of common silt. When a man
cunnot from any canm: obt2iin the nuooseary quantity of siill, hu eiitlent
the (uitue phyniial ailments uk the animals, he falls into a state of languor
and en feu moment, und praaenta al the end of a certain time, all the Bymi>-
tonis of the mo.ft pronounced aniemia from diminution iu the production
of glohules aud albumin in tlit? blood.

LECTURE n.

COBtri.ETK AND COMPLEX ALFMENTS.

SpHjuBy. — CompI«t« Alimcntt) — Jlilk, itsOonijiosition — Dijrwtion of Miik
—Milk Diet — Wlu'v. itfiCompoaition — TIr> Whey Curt-, its A Jvantages
aitd DuaUTsntiigc^^-Kniimifs. its Composition — Eggs — Comjik'X Ali-
mente, their divi»imi^M cutis, thoir dirision — Digfestioii oE Meitts —
Nntritivv vuliii; of MuuU — Viirititiiw— AzyiiKHimmil McUbviiious Ali-
inent« — (.'oniparieon botweon tbu flvsti of Manimul)^ of Fi»U, of Cruoitf-
oouit and of Itfolhiaki.

GRtTLBHKN: In the preceding leciurn wn hiivo stinJicil the digestion
ft the iminediftt« alimentarr iiriiiciplcs; tlit-su prmcii'It-a Uikon «nuly citn-
KiHrri* Tor uutrition, and do iioL bLxiuuiu rt-iiUy iiliiiiciiU. fxt'Kpl on con-
dirion nf bdng ««ocijitfd to^tjther. When you And them comhiued in
Niblile proportions in th() »»mv iitimcntury tmhstanoL*. yon can ray that
fm have a complete fiUmi.-nt; wlion one or m<>ri.-, oa tlit.* contnirv, pro-
doaiiiutP, or are lacking, you have » coinplox nliitieht. It is tlic stndy
rf Unw complete and complex foods tluit I »m about to iimlertako with
^bo-day, from the Hpocial point of x'ww of tlic ctiologiml and hyginnio
dmpMitH-jfi of ufTvctionii of the- Ktomaoh.

iTtB truly complete aliinontH are few, and wo can really give thia name
^\a two substuuc(<s, milk »iid c;^. Milk in fstct conUuEus albuiuiiioaa
adtenB, caseine, lacU>-prot«ilL anil albnnii-n: fatty niatt«r» — tmtttrr; a «to
^niw matter — lai:ttMc, oritugiir of miik: lUid cvrUiiii suUne principles,
F^iiiT^tos and cliloridcs. We find here, then, us you sec» all the immedi-
dtfriwiploA which I liaTe dt-Bcribi'd in the prei'ioiig loctiin-.

Iiball not ill thi:« placo dwell on tho chi-mioal and comjKtratiTe study
** "ilk. but when I come to siwiik of the dy*iM.'p8ia of new lioni IuIwr, I
*M mum to thia point at some IcnxtU. mid eball then sot forth tliu di{-
fciWEw which milk prosenta according to iu twurce. I inU'ud jitHt now
lotncapyyoar time only with tho aoiiBtdention of millc iii genoml, and
■»a»pkiymcnt in tlie adnlt'

TbcKiaTD thv cbungcfi tlmt milk undorgoca in the prcHonce of gartric
]"«■: Firet of all it coagulatfls from tho action of tho giiHtric juice; tho
■""Isble essoin wliich ruaulta is tranHforiuod, uailwr tlio inflaoncD of
P'twi, into a soluble ]>epb>ca8eiR: tlien the gaatric jnico nccing still
""^wr M a fprtnent on the sugar of mitk or lueUxw, the milk ferments
ad is formed.

20

DISEASES or THK STllMACK.

Chnrles Riohet has BtudiiMl with care this special action of digestion
on milk, aud baa demouMtraUHt two lactn tbat ans very imporUnt from a
therapeutical point of view. The llrel fact is that milk i^i, m to 8p«uk.
tbo regulator of iho acidity of tbc gastric jaicc; tlkat is to eay, that wliile
A little quantitr of gaittric jnice may very rapidly induce the lactic fer-
Tnentatiun in a great quantity of milk, a vety small quantity of milk in
pnaeiici; of u grc-ut (juaiitity of ga«tric juice, dimioishcs or uttt-'tiiiatea the
acidity of the latter. We shall see later tUo utility from a theraiwnUcal
atand-point of this regulating proporty. The iK'oond important fact is
that lactone when alone in tlio presence of gastric juice does not ferment;
it ia in fa<rt notu^saiiy that lhcr« be in the mixture a ct-rtain quantity of
casein in onli^r tiiut the lactic fermentation mar tuke plovo.

The digestion of milk is the speediert of all digt-Btionn; it is the ali-
ment wliit'b the most mpidly ponetnito« the economy, while demanding
tho least jioHsihle digeiitive labor. Aa for h» nutritive value, this ia not
at all doubtful; tho solo alimeut of the infant during the tirst months
after birth, milk funiiahes it the elements of rapid growth; in the
adult it may, when oniployed nloite, likcwiee siifllee for alimentation;
and you will often oljserve that certain patients subjeote^l to a rigopoas
milk diet, obUiin by this regimeii a BuBicient nutrition.

Milk ta un adinirablu medicament iu curtain fonns of stomach aHec^
tioos; it is oren, as you wtU eec, almost the only treatment of catarrh
and of ulcer of thi« organ. When we eome to treat of these disorders I
will show you by facts the ntility of this tlierupcutic meiuuL

Whiit I dcairc to eslabliidi now i» the miumer in which you should
institute tho milk rcgimcti. When you hare occasion to order a milk
diet, you will take cure generally to pro»«.'r)be milk which is mw and un-
cooked; in fiiet the nwirer you come to tho living milk, that is to say milk
just lui it coniLis from the udder, the more fuvorable arc the conditions for
the ubBorption of this utinient. Uoiling cauees the milk to lose, in coagu-
lating, certain athuminous principles, and diminiHhes, within narrow limits,
it is true, the digtuitibility aud uutritivenci>8 of this liquid. Vou will
employ, then, in most caneR raw milk, and order one, two, or three quart*
a day to be taken. Add to this regimen milk porridge, and you will thus
haw institutetl what has been dceignatetl under the name of milk diet.

To cause milk to be tolerateil by tho stomach, and to faror its digesti-
bility, C8[K'ci«lly in cases of acid or irritative dyspepnia, you will do well
to ss90ciAt«4 with the milk cerlnin aIkalinL> priiiciplirn whitili stiall contribute
hy their preBonco to modcnito the iicidity of the gastric juice. Ordinarily
vith oaoh quart of milk. 1 order a tumbler of Vichy, St. Jean or VaU
water; vou can also medicaito each cup of milk with n tableFi<oonCul of
thwe mineral waters.

One of the inconveniences of the milk diet rexull^. not from the ali-
ment by itself, but from the iuaurmountable dtegust which its prolonged

OOMPLKTK AND CAMPIiEX ALIMENTS.

21

HOT cmaoB id ccrtaio piUluntB. Ta Overcome this repiignanoo, it hse been
propowd to aromatize this liquid with <litToreiit cg^>tici.>«, anch m aniMt^
«na01a,etc. Them nicaiis niaybc! iiiory or 1«bs sueuyesful! npvi>rtheI«!eB,a»j
a general mle, it will not do to prolong the milk regimoii against the will
of the patient, for an won as Uiu dlagniit inunifoet» itHolf, in spitu of all
toa can do. tlic patient will refuse to continae the milk, lLOW«rorn««c«sarf ,
H may be for liia reetoration.

Aiiotlwr preparation of milk which aim give;* excellent reRulta in affec-
tiam of tho stoniacli is vrliuy. You will ubsunra it« good effects in certain
alcHUo drspepoas, in stomaclis fatigued hy excesses of the tabic, and in
eertain hypooliondrtaeoB of gastric form, which Bosquilloa has described
mdw the name of bypoohoiidrinc ilyRpo|win.'

Wlir'V 14 milk minus its futty rimitcr iiinl itti casrin; it contains then
tbe lacEoae and tbv ealta of the milk, as wc-ll oe tin.- proti-in niiitturs which
barg not been precipitate*! by the rennet or the acid ivliich hiM Iwon
oaed in its prepanUiou. But, ae Cliarli-s Kifhitl ba« n.>iimrk«(l, in order
that thin nutrient boverage may be iligestible, it is necessary that the
cCMtjrniatton iind precipitation of the caacin shnlt not be complete, for if
th*' wbry were completely deprived of oaaein, it would become quite indi-
gwtible, by reason of tho ab«_>iice of fLTrnt'iitatiou of the naccharino
matter. Id certain caws we ««e whey badly supported; tlue. you may be
nre, remlti lesa from indiviilnal pre(lisp'»iition than from a faulty prepa<
ration of the whey, whidi docs not coiibiiii enough niacin to iniltire fcr-
rasstatioti, thia fermentation being absulutely nocesEary to impply to the
digeative tube an acid neceMary to digestion, namely lactic acid.

Oarrit'Te, Amn. and Ijabat have shown how the whey cure estnbliitli*

ftcats nrv conducted, nnd today in Swita-rland, in TvtoI, and in Ilun-

gtrr, yon will see numerons stations of this kind. It is principally in the

entim of Appoiizell. at AVeislBwl; in tho Beruiwi' Oberlanil, at Int^'riaken;

ia Tyrol at Isclil, that are found the l>est known eetablishmenU where

t^lcind of titutment ispnictiticd,whi(-hcon»iHt!< in taking in the morning.

fiMiag, a uoall cnpfnl (alwut a gill) of whey, and a quarter of an honr

■AMiraid, the wme <iuaiitity. Thu juttient is nta<]e gnidually to incrcMO

tteimountin^-sted without at themme time turryiug it too far, in which

ncnt Ttnniting and colic a^ould be exjicrienrefl. '

A« Atmu ba» judiriouely remarked, in thi» treatment the ntiment plays
•Ij I Kcomlary part, and in estimating the fHTorahlo resnlts obtained iu
(Mrie ftffection?, diio erodit should bt* given to the ojiun air, to oxercifte.
■nd to the DumeroDS excntinonfi (on foot and in carriage) which eojuurners
tfttlMge r^:icm8 of mountains unil«rtake.

Urtbe ride of whey, then.> i» unollicr of tho milk prp[)araiioi)B which
■In has an important rAlu iu tlie treatment of gastric disorders; I refer
tekonmise, or fermented milk.'

Thpre arw, yoa know, on the plains bordering on tJie Caspian Sea, oer-

n

DISEASES OF TilK STOMACH.

tiiin Tartar iLnd Kirgliizos tribes, which jn^pBra this f«riaei)t«f) Ixn'erage
from tiioru's milk, mul it is to the t«iitfi of these |ieople tliat the rich in-
biibitaiiti) of Hi. Pctc^rsbiirg miil Moscow ara wont to ropair to sock cure
from |>ulmoiuu'y compliiinw. in Fnince it is (ut a remilt of the Iftlwrs of
Landowski, Mint utteiitiun haa beuii ho generully culled to tliis quMtion
of koumiw, utid wv am able to^iiv to give to our i^uitieut?. not eiacUj
the triif koiinii.*» mwlu from miirp'« milk. I'lit a kouniisa from row'fl milk
which hft« uiulvrgoQc the aimc fin-mciitation, and po«M)UOS Kimilar thero-
pciitje |)rupc!rti«s.

The iiiinit^ Kafir is giron to thin fenneutiii milk of thw cow. This
Kefir is to-day very much in use in Uai«ii), and is pix'iarwi by nieaiis of a
spociiil kind of furmviil. wliich is found cbictly iu Oiuvoeuis, and goes by
the iiain*4 of Kffir graian.

This fernuMitwl milk, which yoii havo often seen fjm])IoycHl in our
hoBpital warcl^, m a whitish simrkliii^ li<iiiid of u Inrti^li luid quiu' pro-
nounced buttery odor, and lioa bixtn preecrrilxtd under the fulicitouti name
of milk of champai^i*. Liko the wim? of tlint immo, it contains alcohol
and mrlMiiiiir m-id, and licmdet), riuMiin. NUgnr t<[ milk, and laiitic iwrid.
This spirituous beveragw quite 8|Kwi]ily cauw?»i iiitosication. and is mmlici.
nally a [xiwerful tonic, which has a e]»ecifi! use, an yon will pee, in eouhling
118, iti the case of an inobriJito »ffcct«d with catarrh of the stotuacli, to in-
stitute a milk diet troatmcrit which does not at the mmc timo abruptly
deprive the patient of alcohol, a dopriration which, as you know, may in
oertnin LikHus dcUsrmiiui ^rove coiiscquencf^'^. It Is. in a word, a ueeful in-
tcmiediary between the habitual alimonlation of the dnnikard, and an
exoliisiTely milk diet. Unfortuiiatoly, the f>cculiai taste of koumiss \b
unplcnaint to cerbiin pHtienlfl, and it in sometimeit impnwiiblH to ofTeet iU
administnttiuti l>y i-easun of this dixri'lish. Tliu dosH to administer varie*,
Bceorditig to the strength of the patient, from one to four gtaea:s; but it ia
necessary to bear in miiid that in persnm that are feeble, this bevenige,
whioh eontftins rmiHidorable ninnhol, may dctermino a brief intoxieatiou.

It has alsn been projKised that milk Nliall be niiide use of to introduco
certain aubstfincos into the stomach, nnd medicinal milks and wheys hare
bciTi fiihricjilcd. TIiwsp arc |MU'ticularly appropriate for the treatment of
alfoctioiiis other tlian those of thu stunuieli, and L idiall not treat of them
here.'

Rpga constitute, like milk, a complete aliment; they contain, in fact,
azotixt'il inatlvrK (.dlmmici, vitelliuf. yt-llow coioriiij" mutter, extract of
meat), fatty substances (margarine and oleine), and t^ts.'

Thev also constttuto an aliment often wall supported, and of eaffv rti-
gcstibility; but wp ouglit to noti> here the marked influence which ewik<
ing exerciscH on tbi» digetttibility; while, in fjict, wift boiled e^sarc rapidly
pcpt<miaed, pfrpa hard cooked arc of bIow |)ept»iii nation.

The complex aliments are very numerous, and we will, if you plcaw;.

OOSIPLETE AND COMPLEX ALIMENTO.

25

onler to tako a mfthrxlifal enrrey ot Uiom, diriilti them into tvr> gm

f^ODI^: iolid alini«tit'» and lk|ui<L aliinviits; tlie (Irst liATiii^ tui orijcia
licb onablee ustucsUbliHli two sub-dit^UioiU!, lioUdiiUuuiuUiuC ((j)iiuiuuil
A (b) of vegetaliK' nn(riii.
The &ni luv coiuriituUxl bj the flesh of tnammala, birds, dehoa, and
enutoccans.

Meftta are digtwtM almoitt cxoltisiTcly in th« stomach. It is iDtcrcntinK
to know bow th<^ peptoiiizatioti ot tbiis axotizt-d ulUtiHnt k vHwUjU. ^c]iitt,
and more recently Charies Kicliet, have fitudied this digestive process:.
they hare shoirn Lh«t wboii von osamino »ttentivoly vhut bucomiM of
morsels of muacnlar tibrcg introduced into tho stomach of nuinutis or of
men, the sabjeots of giuitric* fiKtuIu, yuu oliwrvo a diaeoctation of tlio
moacalar man, then imbibition witJi gantric juices, vhich mtxlify tbt> co-
heaum of the oina:le, rednoing the latter to the state of muscular fibrillie;
•ad jon Buo tho urcolunuuu broki-n in plocve, allowiug thu giwtric juico to
peaetrate into the inU'rior of tbe libril and detttruy th(> myol«mma, liroiik-
it^ it op into little fniginBiits, wliich tliuti nion< ruulily undergo the
•ction of this liqnid. Jlorcoii'er, while thi'^ longitudinal strintion of the
■nude diisappcttns Lho tmn&rcrse etriation, which, yon know, (^Iiomet^T-
the muaoolur fibrt>3 of nnimal lif«, and which is described under iha
mo CFfBowtoauV stria;, iti more pronount^cd; then at the end of acerUiin
'. all the aolid maacular mass is peptonized and trau^onni-d into a
uid I'ulp, which pencitnitcrs the economy in tlie fltflt^^ of jwptone.
Leven has had ninoh to «»y on the digestion of n»oat« by tbc stomach,
■ad be itas made uuriiorouB exjxinments on which he baa baaed hia theory,
rliichaoconU to the stonmeh only a mechimieal rt'ile; acRonling to him
the peptonization of mrats is not cITL-ctLil in this ur]|ptn. but nilbur tn tho
inleitiDo. In thu stomunh there is nothing but einiple impregnation by
Uw (patrie jnioe.

When you read the fxperimpnt* that Ijovon has made m peferoneo to
this sub)i>cU you see ttiat they are tir from giving support to the viclu-
ittv riev which ho maintains; tlu-y twe m only to demonstrate one thing:
Mndy, that in tlic dog. when once the peptones are formed, they pasa
ifridty into tho intoetinoK without sojourning in the stomach.'

VTlut da we in fact see in thene reaonreheR ? This, namely, that when
Me sdnunistcr» 2C0 gnunities of moat to a dog while failing, the gastrio
fVM^it first hardly apprecizible in the lii-i<t liniir, bt'coniM very abundant
totki ■poond and third; then the alimentary mass is reduced to pulp, and
■ ilin this etato that, impellod by tho miisctdar Qbres of the stonnich, it
P»tetnrtw the intewtines. Rnt this tmnsformalion of tho meat tbua re-
"iMd to fine gmnulutionis ia not a purely mcchaniciil but nither an ux-
^*^y chemical acL In short, tlie»e fiictit coint) to the rapport of all
"Bl«l(now thus far relative t^ at/imiich digestion, namely, that meats^
•* W digrrted, havy m-wl of a double action, uiecbanieul and ubemical^
P'^'aod In the stomach.

24

IJIBKASES Or THE RTOMAOH.

NcTertheleea tlie tendinous matters *nd the tata do not nndcrgo the
I action of the gastric digiMtioii, and remain iiniittjickwl hy the giistrio juice.
We know, moreover, that the!« fatty xulirtunceit find in Ihu first part of
the intuiitiital uiual a ti<|tiid iMlHpti.*d to their digt-iitioii. biit it is noc so with
the curtilaf(inoii8 luid tibrons Auhstaoontt which resist the different digc-s-
tive fluids. The epithclisl tiseiifs, ispecially, prewnt tiu- gr*(itort rwist-
nnco to the action of those JuicpB, and it is even owing to lhe»e epitlielial
KiihiitjinceH, which conntilntu in certain entoxou a tnemhmue di?scriU-d
under the name of chUiitoun membraiie, tliiit tlii-se latter are enabled to
livu in the gftstrio jnice without undergoing digeetion. Such ie, in gcii-
oralf the aetion of gastric juioc on the moate; hut the digflstibility nf theiie
aliments depends on n niimbi*r of circainstiuici^R. The age and the kind
of niiiit and its mode of prK|)iiration Uiivi- a great inflneuce.

From the }H>inL of \iew of Taricties, one may distinguish the meats of
mammals, of birds, of fUhee, of molluskft, and of cmstncetiTiK. In the
group of mammalK we have our ordinary meats, lK>pf, million, pork, eto.*

If we are to judge from the experiments of 1k-auniout, and from
ordinary experience, the most dipe-stible mwit is mutton, then l>eef, and
laetly ()ork. But the age of the animal has, as vte have said, a nota>)le
inlluuneu oTi the digestibihty; vonl. for instancp, is more digestible than
beef, and larnh than mutton. It is eatiy to undc^rstand that the more
ready disintvgmtion of tlicso meats, due to their young age and lessened
eobcsioii. rendent {^tuptonization more prompt. I ppeak, I* it underetooil,
of digi'Htibility, and not of nutritive value, for in the hitter ease tlie order

* Proust in liis Treatise on Hvifiiin'. fflvos the tollmving 1,-iblo (bun-owecl Troiii
Oauli>;i-), which indicat«s the ixniiiHaition of tUv tlilTvront niwili*. TIhia, 100 |nii-1«
of tltD lenn ot tlie follewfng riieat}i. deprivint (■( their t«iu]inous portions, coiit&tii:

KsniM of
meats.

Beef

Veal

Ooot's raent.

Pork

Mutton

Poultry

Frug-'M tiutat.

SaUnon

Cup

Sole

Mackerel . . .
Gudg«oa ...
Sal

8.2(S

a. a?
u.io

1.(13

s.n

8.03
l.*i
4.S4

laO. 48.%
il9.0i!:{

12

Sit;

111

ttoB

IS.SO

15.91

n.u

16. a«
ifl.riO

1.1,25
18,50
UT?

IBM
10.31 I 2.03

l.ftO

8.»
3.01
0.50
4. OS
».16

$.4S

2.»3

s.s:

1.86

D.OT

9.56

1,31

....

l.UO

a. 58

5.73

l.V!)

l.flO

n.lH)

8.73

O.M

0.S8

1.43

8.4Q

. . . .

0.10

1.78

■ 4.4

4,7fl

1.45

4 . .

2.M

8.498

1.00

> - - -

«.74S

6,7fi

a. 780

- . . .

3,»7«

3,000

iSM

OOaCPLETE AND COSIPLKX ALIMENTS.

95

be ravaned; it b in fact the adnlt animals wliich give the most
[onflBiMta
Among tlie birdfi vc must (lUtiiiguiisli the commi^u fowl and tlie vrild
ifLftnd Yrom the jxiint 'tf view ol <iigt>3ti))ility, the latter presents spocial
inditwnB. to wliirh I'rofoesor Giiblor lius ciillwi atU'ntiou. Tlitfau birds
itpkDitf. you know, iinrlergn a certain degree of putrefaction, nud geu*
nJl; nn* serveil on our tabica a littlo " high." This putrefaction ia a
wt of fcrmcatation which reetJinblcB in certain points peptonization, and
tltii verjr aooount favora Htomuch djgi'stiun. Thuiie aliments, whi[>li
lUer hM charavtvrized hy tho happy word mttmymoiis alimvnts, in con*
ion to the asffmcun aliments, bring with them their fennent;
note -wbich aru high (u littl'-- tainted), eo;irurout, koumiss snnr
itiev and bnttnntiilk, tht< Rimttcd (;heL>m>ii (and Hiich as arc old and
imUily), came into tliis catt-gory. So vhen you hare to treat oertuiii
faeble stomachs in which the oocretion of gastric jake is tardy and defl-
acnt. you will onler game timt it a Httk^ high.

Aj for fish, th«y aro divided into three groups; those with white meat
whiting) — thesLt are curtainly thn most digtatiblu, but are
nonritihing: those with yellow meat (salmon), are more
^wly digested bub contain more of nutritive principles; luatly, thoKc witli
hi neftt (the mackerel and eel), are very nourishing btit of laborious
i^artion, because they re(|uirc digestion in tbe intuetiniw.'

HoROVDr, Prof. Almen, of I'jisal, has recently published a very coni-
ffele analysis of the fleah of different liehcK, fresh, cured* and in the dried
tatt, u oompArcd with the flceh of beef. [See next pugi-.]

Cnurtaoeans and Molluelut are also much in una us articlci^ of diet. I
diH anly allude to oygt*irB, which are rapidly absorbed and constitute
a BJeful aliment in certain alTectionn of the stomach.*

Do not think ttuit the cOniiMJBition of thew^ yarioii!' Tiinds of meat \t
Ttd*ly (iiffcpont. Compare, for instiince, the nnalysea furnished hy Schutz,
i»ui, Goutier and Almeu, and you wilt see that between the flwli of the
of beef nnd of the oyster, there are great siinilaritiea of composition. "
node of prnpumti:m of themr direra ntimenl« him a great deal
t» do with their digMtivo and nutritive properties. In order not to de-
nig too much 8pae<> to a oonsidenition uf thin question, I shall here
giTe jiirticular attention to the meats only. Ought the«e to be «at«n
aw. roart«d or boiled f Bnt this isa que.ition which, in order to be treated
■tuAKitority, rc<iuireB certain dctaili) which 1 will defer till the next
IfMSIt.

ini I

r^ Ttddy (j

/ /

11 tf o^ fi

'■:= C" i^

OOMPLSTE AND COMPLEX ALDIK^TS.

27

NOTES TO LECTURE II.

' Th* mo«n <lonsi^ of mitk is from 1033.2 (minimum) to 1038.8 (maxi-
iud). The milk of the liuman fomiOe has an average dcQUty of irom
'1«4 U> 1030.

In a recent investigation iumUmU tlu> pxpeiimciual "creche" (niirBling
department) of the Foundling lloepit«l, M. Henry Fcry ha* estftblished
tkfoIkiwiTig avrrage, from the p<iiub uf view uf the compurativo couipoei-
tioii of the difforont kimls of niilk.

llBAN COMPOSITIOK. PER LlTHE.

W«t*-r.
Dry eitTOct,
Batter, .
Sugar,
Casein,
Baits,

Woman's.

lOaiLSO

graiumes.

<KH), 10

153.40

:6.14
10.53

lOIJ'^.lO

gniinniea.

ftH.OO

118.10

30. to

69.30

l■0..^O

4.50

CoWs,

1033.40
g rani 111 i>A.

123. ati

34.00

52. m

6.00

(JOAT'R.
10.13. ft."!
gr.iiiiRiMt,

14:4.34
tiO.f^S
48.511
44.27

y.io

T\m follon-io}; table j^ven the comjiontion of the nshott from 1000 parte
ofvooiait'e AD(t cot's milk.

tWoman**,
C'bk>riilo of eodium, . . . .1.34
" ** iKitaJwium, .... 0.41
Phos. lime, 3.9.^
" nxla traces
*' maKnewB, ..... 0.27
" iron tracea
Ou-)n>iiaI« tnxin,
lAc.tatf of HOtlfi,
PUioriilt- of calcium,
.......
P

Cow"«.
0.81
3.41

3.87

truces

0.87

traees

Total,

6.98

8.96

men has wm^times hoon found to (^-.viiit normally in milk: it is
_^_pnt«eiit (10 percent.) in tlif coloetrum and milk oi the how, which
WW not conUiin casein. E. Miii-chanil haa remarked that when cows are
ilond ilieir milk becomes quite rich in albumen. Besides the subatancea
HntiottMl abore, there have been fountl in milk, gaiteu, suuh uh oxvgen,
ijilrojien, nitpogen, irni oiftrlwnic; acids, nich aa liictie. butyric,' and
iliac, area, hicmiitine, eholrsferinc ajtd lecitliiiie in wornxn'tt milk.

Divvnt pireumstanaai, mon-over. influence tliu eom|>06itiun of tnilk; the
itinuUc, fnrroundii^fs, rpjKwo, fntit'iio. jiliment«.tion. gt-stalion, the act of
■ilkinj; and ditKiieu. During r<>]io6i> tho milk ir richer in liiUter; wilh »
tltet there i^ more bulLer, and milk may oven bu nuulo to ac(|uiro

28

VISEASJCS OP TUB 6TX)HA0I[.

difforoni ijnalities. Mnrcorpr vhen a bitch lias been ted exclunively on
moat, nlbiimoii is sp(>ti to a|iiti?iir. Acwrdinn to Ijunwigne, before pnrtu-
ritinn cow'h milk oontaiitA iilinrmnii. Milkiiiji; hiut aluo nn infltieiicr. In
fact ut tho commtiiivmi-iit ul mUkiap, milk ip k'ss ricli in vrcam and
butter. Aorordinit toQuwvuiinu. it (Wliiaiiis «t tlio beginning aix iHircent.
of *!reiim, at t!n> mitMlt^ 1.: iwp w-nt, : »uil at th« eml iO per i^-iil,

TLc compoeition of niillt clian^w (Inrinjf sioknoae, h«no>:' at this time
milk tthouM be reji-oU^l, Ilu8s«n linfi reninrkfil tliat the milk of coh's
afTixL'tixl U'itli ]iIit)iit(iK is much rii:-lit*r in j)hospltst«H. atiH MerlHTg^r lia«
noted in the initk of a oott aflfected with hoof aiseawi the presence of car-
botiat6 of ammonia. In r«rtiiiii rattne, luatly, pua and blocxl nrc found.

Tn fine, varioiiH medicinal Rnhstances ingfisted by im aninial are found
in the milk. This it is which has sugges'tPfr the idea of giving guch miUc,
tliuii becomt- modidmil, to eick infuut^t or udiiltci,*

'When milk is fS[H)8ed to the air iL eoaguIaUw and the cottgulum floats
in the midst of a ^^TRenieh yellow lii^uid (whey) containing tlie eiigikr und
the Halts of thn milk. In pharmacy whey ia prepared after tho following
formula of tho Codex:

Take of mire cow'e milk one qnart. llcot to ebullition ftnd add little
by UtUo & ifulllc:ient quantity of the folhiwing solution —

IJ. Acid tHrturic gr. xv.

Water 3 ij. M.

When the coagnlum is well formed, strain off tho whoy- I*at the
whey agJiin over the fire, with the addition of the white of one egg beaten
up in u little water; brin/ it anew to the tjoiling point, pour in a little
«old water to settlo tho froth, and as ewon as tho liquid beoomeii clear filter
it through pti]H;r.

l}}\y proiHMwa the following speedy means of obtaining whey: Hi-at iip
the wliJU.' 01 an egg with a littlt' water; add successively a ((iiurt of milk,
and lire or aix teaajKfonfula of vinegar, Or an e<|utvalent quauuty of tartai-io
acid flolntion, taking cure to agitate well the mixture. Bring to a boiling
point, (H)ur in a little water to settle tho senm and filti>r.

In the moMntuina whey is preiwired from fri-s^h milk by means of
rennnt. 'Ilie milk ie suupended over the firo in large kettles, the rennet
is addefl, and the milk is brought to a boiling jiolnt, then Hlcimmml and
strainnd thmugh ii eloth, and the whey in put into wooilen howl« ]»r*!-
vioualv ftcaldod, these WwIb are set into larger woodeu bowls, the fimullur
being "kept Keparuted from the larger by a stratum of quite warm water;
the whey is generally drank wln^ii warm; in soma stutions, however, it
is taken cold.

Vm/i/KtsiUiiu of \V}u>f.~\\'\ivy fruin towV milk contains alrout 93 por
oent. of water; l.(J8 ]H'r e(>nl. of ulbuniinoiil nuitLur«, (albumen and nuem):
5 per fi'iit. of Ktigiir of nulk; O.Uti of fnttv nmtteiv; 0.410 jht a-nt. of
Baits and oxtraetivefl, The Halttt con«it<t of ehlorides of swliuni. and pota»-
aium, lime, |X)ta86H, magneua, ferric pliosphat*', phosphoric and sulphuric

* Henri Fery, Com{wrative study of tlie Milk of Women, Asuma. C.Qvt» and Ooato,
Pari", lf«4. Payen. Precis historique et pralJriiie dfa mibsU iiiiiiienUir«w, IW-V
Mi<:li«:l hv\y, Trait6 de Hygiene. Wiirtz, Did. de CliJaiie, 19S9, i. tii. Uuwon.
Milk. Cream, and Butter. 1878. Pi\>tiRl.. Trait* d" Ilyfc-iine, 1877. Coulier, Diet
encyclop. dea sciences ni^dtcaluB, S scries, l. iv.

COJtPLKTE AND COSIl'LEX ALUIENTS.

29

fe

schIb; of thcwj mlu KCl largolj predominates; of the acids, ]>li08phorio ia
in much the larger proportion.

"AwNmlinj? to l>r. lU-Ift, tho whi'v tresimunt gciienillv roquircs six or

lit wteka at I be lyiigtiat. At tlifiWginning of this treatment, from a
I to a hftif pint of frefih wlieT is tirank in the morning; then tlif puticnt

Ma walk in the open air for « quarter of an hour, th^n drinks anotbcr
cop of whey. If no int«fttii)Hl or liigcaiivc domngt'moni.i nii{>on-onp, tho
pitirnt will Boon get arcaBtnmoiltodrmkmg foiiror tivutiimbU'rftilftuiiiiiy.

Some persons cannot tolwnite whoy: il ojipn-ssM ttio stonuiL-b and aome-
tinK-fi provolccii vomiting, dolio, ga^itml^, and slight jutnidict'. It has
btcnpropoM-d in tlu-st! cases to "cut" tlie wlieir with tho mineral (gaseous,
■llulinc and c-von ferngjiiiouv) waters. In tim way it in ^onidtimcx bettur
bornv. llie la«te uf wlu^v is a titilo insi^Md and somctiiuet! is di^iidi-dly
trnpleaeant to pati«nt3, but tbcy soon got need to it,

Ihiriug til* whey tnwtniont, pal iuit« are snbjected to n epocial rrgime.

Aocortiiiig to Carri^re, the strong nn-aU, game, veal. Ami even fish,
ibotild Ixt intcrlictt'd, and iiintwtii, snoh alinit'iits should I* permitU'*)
u mntton. |>oultrv. and prcfcnibly. tlic lirrUictous vegetables dcurivi-d
of llieir fibres, and propiired with milk and sugar or even huttnr and fat^

To p«tivnt6 very weak and omatMati'd, n moro tiiibHtaiitiuI azotiuid
wmriehmcnt should bo given. In thv caec of Icraveramonta characterized
by cxccn of irritability or of crfUiiBin. a moro bbind dicit should b« prv
Khbed. Such personit may eat to advantjige stewed fruits whiclt aru of
euj digestion. Dr. Holft a«lvjtie8 to be rhan,* in the admtniBtnition of
faruttoeoaa and saccharine fout]^; the nuuntity of food per diem should he
aaatly refpilatml: if wineif are allowed they should \» well dijutt-d with
water; and distilled liqiior« nihoiiid hv furhidden. 'Dia order of the meals
dttold be judiciously arranged ajid exergiee should be insisted on."

'Ijongknown in tho writing of tnivelltrs, and in the trcattsos of ocrtain
p}ijnriani>, koumiss, or fermented mitk, miieh employed in Russia, did
nflC till reoentiy enter into the therapontiwt of Kmnft^

Koumiw ia a sourish alcoholic K-vvrugo. prepan^d from the milk of
aaem, amea, reindeers and even eo>v's: that uf the three tlntt is jnxifuruble.

To make Qiis drink, the Tartars ordiiuirily chou»e luurc^s of a medium
ife, »ud such as bave rccentlv foaled.

Thtee live in herds, antl an? pa3tHn^, when this is popaiblc. in
neadows where tho kavil growg. a kind of gnu^ uiiieh is atid to render
the milk more savory aitd more abundant. Dr. l^ndowski has recoutly
pnblisheil an tnten-eting treati»! on koumiHii, and ho indicates tho follow-
ing modes of premration.

.\mong tho Kirghiites and the Kiwhkira tha milk, freshly drawn,
is put into a leather bottle, uf cunit^il form, triangular, round at
the base, allied mfxt by some, and luursottk- hy uthcnn; the«e Ifathcr
bottlaa are of horsebide, untanned, but liarderied and smokei]. Ke-
fon poariug in the milk, a little old dried koumyn is put in the
bottle, to play the part of ferment; this is ailled Kora, Tho liquid is
•timed by mcoju of a rod Axed iu the iioek of tbe bottle. After tbree

• Anin. On the Whey Can. Bull, de Ther. t 74. p, H8. Cnnipiv. Th" Wliey
Tr(k£ui<-itt of Duaaso la Oermaay &□<( SwtljuirlBiiil, INIH). l.abut, Tli<^ WUey Curo
' OiHswta. AdaL An la Soc d*Uydi\>loKiir, Pariti, 1874. StruuM, IMil. dv Mvtl.
Id» Chlr. iiruiaiucH. IS74.

30

DISEASE OF THK ST05IACU.

dayd" chominff mkI exposnre to a temperature of 20° or 25° C, the koiira
is made. Otiior triljoe prt-|iarc koiimies with rcost, and keep it in i^ttiiiu
JUJTS' Tlie liquid thus obtained i« bluieli wliUo. of tart aluoliolii? lJiMt«,
and frothv wlion Ijottled. Acconiing to tlu' di>Ki^»o of f(.>nnL'i3Uiti<)n,
tlirec kinds of kouini6« arc montiouud: I, a weak Kind, of on<.- day's fer
Tnt'7ttatinn ; 'i, a mi-ditini kind, tvro i^r three dap cdd; A, a strong kind
ld«r and more dis-igpeetibio t*i tlir' ta,«tn. Ily tlio sidp of konmiss there
galyzynic, r product of the formnntation of u mi xlure of tiMOs' and cows'
uk. Thifi liquor, n-ecinblin^ kouniias, haa boun rucummuiidod

mi

to f^ive koumiBs ininiei)ia,toly before or after

Snhepp (1S65).

fjiiulowtiki advises not
riit'al«.

When jjutictits, and oajiccially women, caiumt acquire h liking for thi»
drink, be advistw to sweetoii it with sugar or with Boiue aroinatif syrup, or
to give small quantities and frpquontiv. Liimlowski advisee also not to
gire wine immediaU'Iy iiftcr the koiimik-'.

The following analysis of kouniisd ia by Stalhberg of Moioow:

Alcohol,

Kntty mnttors,

Hagur of milk.

liuctii^ acid,

Casvin.

Suite,

CO..

K<>iiinib«
8 Dtt)-* 01<L

. 1.65

. 2.05

. 3.90

. 1.16

. 1.12

. o.-;8

. 0.75

Kouiniag»
S .Monlhft Old.

. 3.2a

. 1.05

. 0.S8

. 2.D3

. 1. 1-,'

. o.-m

Tlu'sr liming
tit yellow or

Tiio CancasianK pr^ixirc fconmrsji ivitli emittR of i'^fit:
arc found in nil the Hmssiau pliariiiaciv» undL-r tin' fmjr
brown f nigirieii L*. Four large KjKumfulH of llieiw bruised graiiiK are pliu-ed
in u decanter of the capacity of mtlier more tlmn a quart; then a quart of
milk it) uddod. Tho decant«r ia left uuato|t|n.-d, at a temperature of 18°
to 20" C. for eight or ten hours. Tlie liipiia is ugiluted tvt-ry libur. then
Btniliied and ]iourud into four little botlles, wbii-li are not quite filled.
The bottles arc waled, and kept at a temperature of from IS*" to 20° C.
It is the custom to liegin by taking two or tliivc glaAsee of this bevenice a
day, and the qnantity is increased to thirty glagstw, taken during the day,
a few niouthfnlu at a time.

TucliniKky f;"'*-"'* ^'"^ ^*''"'*'"S '^'''" *" »how tho moditic^tionH nndt-r-
g»ii(? by milk tu ita uun version into thin kind of kcmmistt, culled AV/tr.

Albatnins,

I'"at8,

Sugar of milk.

Lactic arid.

Alcohol,

AVat*r and Baits,

Density,

Fredi Cow'a UJtk

Oi'din&ry KcQr,

. 4S

. 38.

art.

SO.

. 4I.iiO

. 20.025

0.

9.00

0.

8.00

. STS.

. D04.9T5

. 102.S.

. 1IHS6.*

* Luniluwtikj' On Kouinis.i unil its Tlirmpcutic rfA>^, Paris, 1874, BooneviUe^
On Kim miss. Prog:. Mcil., AuKiwl, 1S74. Labadiii La^ravc, On KoumlMt noil (U
th«mp«utic a.pplicatloti.-t, iisx. Hebd., 1874. Polli, On KoumiM at i

COMPLETE AND 0O3IFI.EX ALIMENTS

31

, *^0D will 6nil in oor drug storea mcalkinol wlteys containing; iliveni
JI^DMe which more or lesfi mortify tlieir proijertiea; for inslAUce, then-
npnrgatire whey, made hv !*we«"teninj; wliev witli mnniLa, peacb-flowHr
nnp, or l»v addin^r « pnrgntiv)' aall. The " uperient whoj is made by
xidiDgUifr jiiictsof certftiii bitttr pkiits. Weiss'ewh&v contains etiJorific
tnd luirjcativi! Hiilwtuiiws : Viui-SwictrirH has si-nnii, (ilntilmr unit und
bmj'. IjiStly, it faui even hwm pTO|»osi»(] to' makp. umler the nann* of
vher powder, an artificial whey coustiluteU Ijy a mixture of milk su^r
ttd'ntuinite.*

'Tlir qualitj of e^ys Tariea somewhut — according to the food eaten Ity
tfaeknimal; theegjpi of cerbtin In^t^ctM, for iustaiicp, htire un odor tuiil
mw that are dingrccablp.

Be^des hens' oggs, wc oceaaionally And in the market the e^^ of
diek^ gaew. tarlceys. and even hustan^H.

Tha mean weight of tlie hen's egg in from 50 to CO j^atumes; the xh«ll
^ETamnMs; the white 3C grammeti; thu yolk IS fcrumui«;e.

Tbe shell contains irn albumiuoid matter, mid is constituted by car-
Wnatesot lime and magnesia, and by {diogplmte of lime; a membrane of
libaminoiu nature separatee tho elieJJ from the white. If you compare
li* qnantit)' of nitrueeii. «»rl>on, fat, and wat-or, contained iii eggs ami in
milk, joQ will find that aii egg weigliiiig ^l* gramme* is equivalent to lUU
paanis of cow'a mdk.

Tlic white ia formed of albumin (12 t<» 13 ficr wnt. acconling to
Pawn), ciintaincd in loo«- cells. You find there also traces of carbonate
of twin, glucose, and of urea. The yolk hae, according to Oobley, the
IoII«vil;g compOBitiou :

I Water, 61.4dS
Vitelline H.TfiO
Extract of moit 0.400
i Jhirgarinf and oloino, . , 21.3(f4
Fattv mattor& { Oleic and marearic Qci
Ph(
Cbl
Chi
Fbc
Ak

margaric Qcid«,

■> </ii!ic uiiii mitrganc aciuv, , i,X3ii>

I Clioleeteriuc, .... 0.4S9

PhoBjiho-glyceric acid. 1.900

iChlftride of'aimiioiiium, 0.034

rChlortde of sodium, of potasaium, sulphate oE

potash, 0.277

, Iliosphatpof liraeaitd maguosia, . . . 1.033
^Axotizod uud coloring matters, traces of lactic

acid and iron, 0.863

.326 > 2».9e8

100.00

There is an aliment mmetinie$employe<l in Fmnce, esteemed cspueially
> Rninat which is )in.-{iHrL>d from the eggs of ct>rtuin li:she!i. ediiecialiv
Ami of the sturgoon; it is called caviar. This, auuordiug to Payun, ts
tt» composition ol caviar t

Xltan. 1974. HaMton. Mtlk. Ctvam and Butter, 1S78. \V. PodiTsoteld.

, B fpintpnted liquid from cavr's milk. Kiev, 18B4. 3il GJ. (Tlietie are only a

rottbf Ihliltu^rapbii'sU n>f«n>n(i-t> tliat inl)flil 1h> rit«i.|

'Tldd Ann. dp 111 Moo. UmI. de Moutixrlljer. t XX., p. 489L

82

IIXSBA8B8 OF THE S1X»UCIt.

Water,

Dry Bubstanco.
8*2.50, fonnecl of

Azotized matters, .
Patty mihtters.

OrgBnic non-nzotizod mnttore,
Minora! eubetsQCM. eontaioing
4.825 of common taltj .

37.500

Ki.-.'OO
0.825

100,00 •

"The operativp proooilare praployeJ hj Ijeven is an followii: It oonrisbi
iupvini; to » fuKtinf; ilog u ocrtain qanntity of meat, and in killiiti; the
ammiU uv suction of tlu- Tjull> iLt an epucti more or Icba tUetunt from ibu
meal, ana. in exnininin;; tlie «tato of the Hloiniu^'lt and the ii»;]K>ct of the
nlimoiitHrv bi>)iiH. Tliiu is a rL'tiUini' ot liia <.'Xpc'rini<>nta:

AVith you gminmoe of niwit tlio fitomafli is disUiiuled; during the iireL
hoTir the gastrin jiiiri^ is not w?crcleil. thi* lioliis i» inlill drv. but » great
quantity of poptic li<|U)(l is neeuniulati'd In tlif glands. Inuring the bi>c-
ond hour the gastric juice begins to be secrt'ted. and the surface of thw
aliment begins to be moiatened. During tlie thin! hour the aliment is
impreenstod in its entirotj', and rodur«d to pulp and togmnulations: this
transfirmation takca place slowly, and htw? an avcrflpc duration of twolr*
honra for 200 gruinnicH. Yoii iiovur Bnd but cm i-xflu-saivtily fcoble fiuan-
tit^ of peptone, and this is uuver in relation to the quanttty of aliment
wnich has been taken, f

•According to Payen, tha eel, when dkinned and depriTed of all its un-
eatable substance, lius the Followiuf; compontinn:

Water, 6S.07

Ar.otized ni&tter» liaving two jiartaof nitrogen, . 13.00
Fattv mattors, repreeenting 63 ]ker cent, of dried

matter, as.SG

Mineral nibatJuiocH (aslit'e), 0.77

Non-jizoticed matters and loss, .... 0.30

flo.oy

* Much nee a iimdo of tlio oyster, tlie mussel and the lobster, aa escn-
leDts, therefore we give their audysia aooordiog to PayeiL
Ilctow is the aniilysiH of oysters:

Water 80.386

Axotixod matters, N.01

Fatty matters, 1.51S

Salts by inctnttration y.BOS

Non-aKotizod Bul^Htancce and loss 1.395

Freah oysters are of ea*y digestion, when cooked, however, thev are
indigoatible. Payen had the notion of t'ompuring the total weights of
oysters, shells im-liided. with the quantity of etionient substances obtained
from them, and he uscertHinod that a down oyeterg, weighing 1,402

" Gobley, Chemical Beaoarcbes on the Yulk of Bgg, Jour, de |ibariiiacie.
1M7.

t Liven, Tiaitfi dea H&la^JM de I'E^omae, p. 47,

COMPLKTIf A»D COMPLEX ALDrKNTS.

33

(•raanioc, will ^t« a natritivo raluo of 111 graiainc«, repro«cntiug about
S gnmracK o( nitrogen, or {(Hguali'bitity and niitrttivn qiuilitv being i9t]{i-
pwd to be twiiia^ a little mare thHii ii tenth of tlio mean dHilj ration of
i tan, K that t<>n dozen of OTstfrs voiild bo roquired to constitute the
dtib_ntioiu in asoiiwd mbstanccfli.

The sea lunaBpl. more indigeBtiblo thau the cookod ojifter. haJ tlt«
folbvb^ oom position :

f. Water, 7ft.T4
lOrganic szotiacd 8ul«luncc« {contiuuing 1.804 of
uitrogeii) 11.72
FattT mattcni, 2.42
Salts, 2.73
*
n

Otitic Don-axotizcd sulKtiincu and logs.

100.00

Tlio mcaloDt subBtanc« of tlie lobstor has tlio folloviag ooinpo»tioii:

M<!a1. Soft Intvm«l PikrU Efcg*-

WaUiT 76.618

S4.315

6'i. 'JS3

Azotixnid muttorH, . . 19.170*

iy.l40t

ai.993J

Fattv inatlere. . . 1.170

1.444

8.234

Uiueral mlUt bv incinem-

tk>a. . . 1.833

1.7W

1.938

S[oii*«zotnGed matters and

loBB, , . . 2.213

0.3:i4

4.S9;l

Il>l).OtH)

UKI.OOO

iiK).m)0

ITilltam Roberts hue bIiowii tlrnt ovstcrs ought to he (-Titun raw luid not
antetl, in diet, the little yellowish tnius whicli euiiijtitutt->!ii in the njster
(l>(iaoet (lAinty portion, is the liver, which is e>carc«]y unythin^ but a
■Ml of f;lvL-(i};yn. This liver contains also dnrin^ life the digestive fer-
ul vhicfi is inherent in it, lutmely the hvpatic duutaw. By tin* simple
Kt of mutic«ition, theae two substances are brought in contact, in euch
■ ny that the glycogen ia immniiatety digrsU^ hy its proper diastiksej
TitMtit tho intervention of anything eluc; the mw or partiallv cooked
ifttr, then, is (ltg««t4<d of it»>>ir, but this advantage i» lost in ooolcing, for
Imu, cren of tnocloratc inteneitv, destroys the ferment uanoRiatcil with gly-
tagm. We Tn»T iiiM that alcohol Aov» the Nime harm ao heiit. iind pre-
Wnh tlie Hction of diaRtii&» on glyoogen. One should not, then, drink
viae with oyvtere, but nth«r niilk.g

*Vitit)gtn = i.ti. fN=1.87. tN = S88.

|Pty«D, Hirnolres niir lea matidroH ^tuaea i>t Ica propri^t^ nlJinentalrMi do
k«halr dM dUlir«atB poiswn*, Comptcs rondtis da I'Ac dca bc, ItOS). Pbm-
^, Ebai m^cal nir leu hiiitren. Th^ de Puru, 18ia 8alnte.!ktiiri«. Da
rtndtM M dt aon om^ commo uliiiii>nt. d i-(iii)iiu> n<niMp. in Lecdinw rvlalivet^
*^. Lyon. 188k Allan), Du iHiiitHuii coiutid^r^ L^imiiitt ulinwnt ilniw Im trrnpaaa-
(MMvtmoiimim.Pt«:.,'n)^il<rP»riH. IVM. R^vi>j)16-Paritte. CodajiI jratioiu hyi?.
«I*flo^ wrI«Bh«ttre«.Oat m*(l. de Piiris. a»B*p., I. i.. 1S46. <to»on« (U.-M-
^ . t/tai vutImi tn<>lliUH|U<.« ci>iuid6r6i i-otnnic aJimeDta, tiH-<li<-unipnt« et |io[aM>oti,
T>>i-h lie r^jiB. ISM. Ferraod (E.\ Ostrfenomle : buhn« luxiquoK pL Imltrvs
3

34

DISEASKS OF TU£ STOUAOIL

" Schutx givcB tlio following aDolTsiii of tho snbetanco of beef ns coj^
pared witli that of the curp:

IJ«J. Carp.

Filirine, cellular tisiue, nerveg, vesselx, . M.O 13.0

Albumin 4.3 S.2

Gxtrtbct (eolublf? Ja alcohol) and mlt». . 1.3 1Q.0
EsLract obtaiiicd br tvutc-r, aud suits, . 1.8 1.7

Phoepbat«(!, traoee traoea

Pat and loss, 0. 1 tncea

Water, 77.5 80.1

IVO.O lUi).0

comeetibtM diveTB«s. Lyon, 186S. Dulno)?. Empoia. paries inoules, Ou:. defutnt^
1813. BiirrotTH, An at^couul <it twQ i.iuutt of duatl) fiviii ctLtinj^ muesvlv, Loih
don, ldt>V Douchaixlut, HoU- nur rem poison n. [ler les moulc-!). Ann. ct'hygl^«,
1" B^r. 1. xvii.. 1887. Dut-hct^nA. Em|>(>U. |wr l<4t moultm, Juum. ■!« chimie
m^diculc. i" s^rie, t. iiL, ltM7. liockel, Ebsai aur la inoul« OonHDunSt Tfa^sc^
IHOT. Itiilbaud. £tu(le hur tVi»[>(»i.->. (ukr 1<« moults, fiirii. 1870. Dediunbr*,
Di<-t. onoycl. ili« %i: m^diciil>'K. Bi-ivnuirtO, Triiil^ d'hygitlne, 1877.

William Roberta, Lvs fcriii«i)U di^^^tils. Revue iiiteroaticinaile (lea acienoes
biulohHiiuc-i, I8H1, t. riii., p. 89. 205 vl 320.

LECTURE in.

COMPLEX ALIMENTS.

SnauBT. — Advantages of Roosted Meats — The Appetite — Raw SfcHts —
Their Hodosof Administration — Meat PawJer*— Their I'libncatioii —
Their Modiia ol A dm iniHtrat ion—Son]) — Peptogenous Substances —
Reef Te* — Heat Juice— Aniwrican Bouillon — Kxtraol* of Mi-at —
BoUe>d Meat — Alimpnt* of Vegetable Origin — Bread— The drape
Cure — 1>iquid Alimciite — Winw and Alwholic Liquon — Tea and
Coffee — t'otable Waters — Natural and Artifioiil Table Waters —
Condiments— Tobacco.

Vaich ahould bu preferred, raw or rntvutcd meats? Roast dipjUs are
tmch better for ordinary dlot. and this results not hiiI; from tlie coiiwr-
ntitB bjr Ktafftinf; or broiling of the nutritive qualities of the moat, but
■bafrtna the derelopment of certain odorous aiid iizotized priacipleK, sach
mtmmaome, -which render thoiiu meats apjHilizing. In tact, gentlemen^
4e sot forget that it is not srafllcictnt that a mibatance should be aimply
ubitiTe, it most aUo gratify the taste.

NuneroDft experimeiita on man and an nnimnis hnro woll shown the
ilprtuioe of thu ta£l«, Kiglit,. and Hniell in promoting the digestion of
■liBenta: and when, in common parlance, oui-'s moiuh is said "to
Wv" at the |>erceptiou of a kind of food nhidi is ])alaUib]c, eicprw-
■10 it roftllT given to nn exact phyeiologiciil fact. In th© case of the
Cuadian observed by neauniutit, and of Maroelin, the nibjeot of Charles
Kdut's atndioe. m well ait of snimala under ex i)eri mentation, it wiut only
MOHuy to place before them an appetizing kiml of food, in order tliut
■D4ir the iiiflaeaM of that wiuntion, of multiple origin, in which taete,
■ill and right piny a complex purt, there «houlil bo immediately pro-
ceed B lecretion, nut only of saliva in the buccal carity, but also of gae-
^iuon OD the surfocv of the atoinaeh.

When Richet introduces! into tlie stomach of Marcelin an alimi^ntary
Mnd, it was nooesHary Ixwidwi, in order to eatiafy his appetite, to present
b bim, and even make liim chew at the same time certain appi^tizing
WhiUaoes; and yet bo had complete oblilemtion uf the cpsopliagns, and
(^ Goowquentiy existed do commuiiicatiou bctwtwu Uio buccal cavity
■•1 the stomach.

Tod ■!><•, then, how essential it is thai hy tTie happy ehoiee of alimen-
ices, meats shall bu reudurud ao ap[K<tixing as [xxiBible. All

36

DiaEAS^ OF Tinc errouACH.

uuutera of tho art of good living, and Itrillnt-Surariii at their head, bat'e
iusiuted on this multiple influcnco of the sight, the tast«, and the smell
on digestion, an inSimni^ti wliich doBB not »tui> at thc)»e purtiRnlar wnws,
and whicii innhidea tlie place^ wticre one wit*, tlm cumjiaiiy one U with,
and tlic tbouBiuid debuls which mnHtitnte the talent of the cifi«ittier and
the tact of tlie huaU If I tiisijit, gviitieincn, ut euch length on this point
it iii in onlor that wb may l>o iil»lc txtttcr to pa^ judgment ujton this voiy
interesting (jui'iiilion of raw anil couktKl nioattt.

Itiiw nient, intrmiuccil into tlientpeutics by Dr. Weisse,* of St. Petere- ,
burg, is uow, m you know, largely u«>d in tho troatmimt not only of I
affections of the lungs, but also of the gtomach uml digestive tube. It
ha» been cluimod ou thi^ory, and perliapa with rviuuin, that ruw nuiat is
more nutritive and more digesliblo thau cooked meat; but it had b««n
forgotten thiit due nccjiiint should \h\ mmle of tlu^ agreeable Uuite which
Tout meats aSord, and the almost insurmountable disgust caused by raw
meat. This very umiaKiun, gentlemen, osplaiiia why there exist in rr^gard
to tliis nmtt«r opinions so differHUt. '

However tliis tnny be, raw meat rendem n« great service. Consid-
ered by tilt- patient rather aa a medicine tluui as an aliment, it is taken
by him when ho refuses to submit toan dzotized togimen. Yi>u will donbt-
les« have numernus oc^nasitms to firL-SL-ribi? this inoiit. IVrmit me, then,
to dwell a little longer on this subject and to point out to yon certain
preparations which will enable you, at leaat in part, to obviate tho incon-
veniences arising from tho aspect and taste of the njw moat.

Ordinarily lioef is tlie meat whieh !b employed. To avoid ati evil
which Mimctiraea results from the usage of this kind of meat, viz., the
production of the uimnned Uenia, Becrnix has proposed to make n»c of
horses' flesh, which does not contain tho cy»ticercus of this tn;nia. \hi-
fortimatoly tho horse is only eaten in the large (ritiee, and notwithntiLnd-
ing the nutritive and digestive value of this meat, which wo had an
o|)port«iiity pretty tliorouglily to test during the Kiege of Paris, its use
liitH nut yet bt-eome general among na. You will ov«ii sec certuin peraone,
belonging es|>ecially to tho inferior clasaes, refuse absolutely to make u»
of thii^ HlintiMil.

Yow will then take the fleshy part of beef, freed of its celhilar and
fatty nmtleni, then nf(<>r having hashed it as finely aa iioasihlc, or jHu^ud
it, as eonie phyaiciana prefer, through a coarse si^va, ym will give it to
your patient, in its natural state it you like — and il ts worthy of note that
the majority thus eat it, with a spoon — or dressed np in different ways. A
very tdigihle preparation is a kind of porridge which Idibenlc lias denomi-
nati^d medicinal lapieva fmrridp. To prepare it. you incorporate with ft

•Andricu, On the Treatment of the Diarrhicnof IntntiU, and wtpwIaUy on tli*
Medioatton by Jlilk iind Raw Meat. Th&e ile Paris, 1800. No. ^3.

COMPLEX ALWENTS.

37

M^fvil w«U-flavoro<l porridge of tapioca from one to two ounce* of raw
be«f ; you have thu-i a mixture which rpaembles by its color tomato soup,
■ad hM no diMgreea1>1« taste.

^H Lobtmlt' nx-ommt-nda to miike this mrridgn in the followinc raaiiner:

^■ToQ bcKiri Ijy preparing a tolerably think tapiona porriiljjp, sua you let it

^BntiafHcieiitly. so that it ohnll not ('xeiviRc on thc> nioiit the inilncucc of

^^raa m<xl«rato cooking. Thvnthu iniiat. tliiL'ly Kcmin-'d aiut in tbc fr>nit

ofai^rfiKrtpulp, is Huspendcd in alittluuold brutli. thi.- mixture Uiiviiig tltt-

atfoct juul KoinusteiiCT* of tomato soup. I^ittlo by little now lliy tapioca

porridge is pour^ upon this mixture, care being token to stir itconxtATitlj

I with a BpooD Yon obbiin in this way a perfectly homogeneona porridge,
n vhicn, when it liau been ])roperly made, tlie meat is louiid so well rUa-
niiad tbit no one on «flttng it wonUI know that it wak thurc tuilosit pr«vion»-
; ntdd. ^Vc have a habit, hiva [<abonlr, of prescribing raw mi-ut in this
•ay, and of sprrinK it to the patient under the name of medirinat lapuira
jr^ffife, and we rhargo the person instrueted to miike it not to divulj^e
ret to the puticnt, a« fiu- ue tlic addition of tLi- raw meat ie eon-
' i. Tb« plan imccevda admirably, and rev Imve at-if piittoiit^t with
I Uwmost de)icat« etoniachs aak for the porridge as a luxurv." {Tribune
^M^ioate. )$:5, p. 471.)

^r ^00 can alao, according to Vldnl's method, incorporate this meat in a
it«rw with potatoes or apinach, which will disguiae thu rod color which
MOM to liare so much to do witb the rcpugnunuo whidi patients manifest
t» eating this raw meat; yon con, Jinnlly, if yon prefer, make use of the
prvptation recommended by niv colluo^ie. Audboiii, under the name

Thia is the way Andlioui prepares hia " btef purfe '*: *' Reniore all the
ftnni parts from a curtain iiuuntitv of a fillet of beef: lieat tlie meat with
thi Bat of a knifo, then miWet it to the H(.-tioii of a blazing fire on n
grvliroD. turn f ren uently, antl anlt. Place thini broiled meat on a pLuttvr:
CBl It up into amull pieces, and pre** out the juice Itv means of a large sjioou
oraortarpttitlo. The moat si^inmittMl from the juico is now to be retUK^-d
to ptiln by haxhiog, then by bruising in a mortar, it i» thun to be wet
■p»itn tno juice orerioaaly prewied out, and the whole pusBei.1 through
Biwra."

Yoo know that for children. Trousseau, who was one of the prouii-

■vt Mdroctttc* of this mode of tre-aimeiit, prtiscriltcd, under the name of

^mm of Daman, a mixture of raw meat and fruit jelly. '

Toa may also, for dillicnlt imtients, employ the pr«|Hirutions proposed

'Tronand I^illier.'

lAtvly we liato eeen Taiintod the usage of a mixtnre of niw meat and

"tokey, and in nome of oar liospitala and asylunw this preparation is given.

Itiiin my opinion one of the wor»t preparationa of raw meat; its Terj

SiP^MDce is repuloTe, and besides, the jimlonged iiae of the spirit a«M>-

_BU(d witli it may cauKc serious gastric disturbance^: if, tlien-foro, th«

be economical, and bare the merit of koo]>ing well, it ia not a

laGsaont to preacribe.

S8

DISEASES or THE KTOMACtl.

An yon nnt wnll an'nre, the inf^ivtion of raw meat may be a cao
taiwwornt in the htiiimn nubjuct. uiitl such a conwquencc liM quite
followLHt tho use of tliis aliment, therefore I am of Honor's opinion, who
tliinka that coiwidering tho abuec of raw meat in tho dietan,- of phiUlren
und lulults, it would bo well rot to [irL^Hcribfl it, i>xiTe|)t in a (.•aitt^ of uliao<
lute nooeanty, and to employ insteud of bwf or horeiM' flvsh (lliu latter
being TKTvly ohtjunublu), mutton, which dooe not contain tiie cysticei'cus
of tho twiiia, hut mtlior that of tho c^enuntu cerebralU whicli hiu for its
exclusive ecat tho brain of tho 8ho(*p.

But all these pr^pnrntion!) of mw mcnt lend to-duy to diBappear in
coiiM-'quoncci of thu introduction into thempeulics of muftt powder, which
proaonts all tlio lulvHutogt-s of raw ment without any of the (lisadTsnh)go&

To enbetitlito for frceli meat, so littble to alteration, a eabetanco quite
RH nouriehing and capable of being kept any length of time, hue long boen
an object of ilettiiv tuwaril wliit^h pharmacists and hnmaititarians have
labored. Undvr the tuiine of fa.ittf(t, of pemmu-ttH. of earne necca, tho
natiroB of South America liare from time immemorial mado ubo of moat
drieii in tho aun, and pulvcrinod at th« moment when it was required for
fooil. But where this need of mrait in a coiiveniont form for kcopiug is
espeoiaJly felt, is whcru tiicro in di-mnnd for the food Biipply of colW'tioiw
of men, such att armieit, where every soldier is often obliged to carry with
him tho wtions of ee%-eral davs. AVe neeil not, then, be enrprieeil to find
that the orijfin of theao alimentary powders is traced to th« dietary oxigen-
cit« of the wddior's life. It wast LoiivaiE, Chief Minister to Louia XIV*.,
who YTftft the tirst to apply to army uses the powder of nwai, and the proo-
eee which ho indicat«« for its fabrication, ia almost the same as that which
wo employ to-«lay.*

In 18&G, at the time of the Crimean war, a new trial was mady of
meat jKtwder for amiy alimentation, but sineo then this preparation has
been alxiudoiieil and it iioeilwl the more recent experiments of Dubore (o
call anew attention to this point.

TO'dny thtK question of moat powdors has not only beoome a aubjeot
of alimentary thoRipeutics^ but alao ona that greatly concerns the dietary
of tho aoldier, and Kim has ahowu in a rooont work its fundamental
importimoe and the numeroiu rosearchea to which it haa given riao.'

To^y it is by the thousands of kilogrammes that this meat pow<l«r
is made. I oaiinot licre enter into a description of the divers indu^rial

* Vide Colombicr's Treatise oo Hilitarj' Hj-^An«, 177S. We loam rrom this
ta«aU»i^ Uial Sf. Louvala got hU hint rroiuuiOrwntwIiiM^:* of drying nMsaX in the j
aun. (hvn inilvnHitAff It, He cnnstnictMl targv ooppar (tiitnms for this purpose : |
IkiMO fiintuii'K iv«(v larpt t^ooii);!! lo contain mgtit w(iol« oxen. Louvais* meat
p0W<lor ^-Mitc intt; vrry genvcal um.- On« uuuoe bvtiod in water wna suffldcDt for
a OMal for four won, aud a iMnutd of fnssl] itMat nuda an ouaoe o( the dried I
powder. ^A

COMPLEX ALIMKNTS.

39

iustitat43il fnr thu fabncution of those puTrilcn!; I b!uU1 only rc-
th*t oae miij reAdily pru)Hiro at home ft meat ^-owdcr which has not
perlttpe the finene«s of that luuad iti conim»rue, hut which is ufteii well
locapted by the pntiont. The proceRe consists in taking hoiletl bot*f.
ImkJB^ ib as finely as pORsihle, fn-vJiig it of futby niatt«rH, then jilncing
jiorer ft ee»-water bath oi boiling wittor, and whi-n oiicv Ihu itimt id wHl
palreriiinj; it in a coflcc-miU which but ibt f^imng well tightcncil.'
Whiiterer may be the mode of prepumtion , the powdere of meatoon-
labout the emne qnantity of nibrogpn. (as Yvon has shown):* a pro-
Da oscillabng between i:) atul 14 jier cent,

Ckntesimal Composition.

Omoai.

iB««f.

VBoet...

Hi)nKAi.8^Ta.

lOBoef...

m

.40

.ase

.528
,318

1.IS5

0.7871
to U

10. Ma I
e.750l4
6.5847
8.4827. (H»:a.SW( 1.275 21
6.471 3
O.lldiS
4.471 4

Q.440

0.103
l.«7

0.270 1.

0.B7511.

i.umn.

10.83

e.400'S.830

S.7504

a.sso4

3.M
4«0

8.4001.131

O.aRTO.Ml)

O.I4lt
O.WS

0,450

0.M3
U.0»»

1.170
1.805

IS.

O.BUO

I.IH5

1.930; IS.

O.lttS I.

.n

10.

0.80

3.60
6.30
4.10
4,46
4.80
0.14
4.70
1M
to
IS.M

a.M

5.40

5,10

to

13. «^

N'mi-joBX.

EscRUSeiiUUDiH

13.98

.e»i

13.03

18.

0.ffi00.18713.975'7g.7

o.aiolo

1.05010
8.400!0
.840,0
I.S8SD

1.3880
I.31HU

0.S5I

08713,51854.7
10714.030,04.0

loaia.iw.^T.i
am la. 4112 ."MI. 5
a;i-;i3,2fi.'ifitf.3

28014.493 73,3
;i40U'.41IOiS8.^

0.020

0.9100.
0.851 lO

I6U

13 .006

I9.N60
175,13. 1S7

0.7580.01713.018 74.9

53.0

68.3
70.4

H»w mttnX = 78.7.

Monorer, my pupil, Dr. Knbiti, nf Ithoimn, hnj> nhown in thn theein
'vUdi he wrote amier my dire(?tiun. tliat iM.'ptoiiizaLion is tlii^'i' timeR
Vonnpid with nifut jtowdcre Umii willi mw ineut.f And this reHult is
■Mly explicable when you think nf the molecular condition to which tho
■Ml powden arc roducod, a »tiit^ of Ic-i^oviied o>h(>sion and Biieneas of
^indon, which permit* reiuly j»nnotrBtion by tho grmtric jnipo, Finailv>

*T*Oll. On Meat Powders. Bull, de Tlil^mp.. Joil 10. 1881.
^KoUn. On Artiltcml Alinifntuti^a witli Meat Powders.

Thdm de Paris,

40

DIBKASBS OF TirB aTOMACH.

as tlioKc nicnt powi)«iv roprwcDt firt> timM their weight of frceli meat, you^
itt, onuu SBH th?ir Kuperiority over tlie |>re[mratioiiK of raw hie-hI. ^M

llii-re i* but one dniwliack conmwU'd witli llie«e powder*, which in thrir
relatively high price, hut this can in a mea«ure he obviated by pnn-imaiiig
tlic American powder, which is quite cheap, or by suhatituting hor« meat
for \nxt in the jirt>[Jiiration of meat |jowiler; if you chfHWtJ to resort to eiUier
of thusj kinds, ynu can have very good moat powth-rs nt th« low price of
six fnincs per kilogruTtime. fl

You will trw)Ufiill_v be calked upou to teat tlic vuliio of these powdcrt,
wliieh, like nil othi^r tmhiHtrial productH, am liahie to falsi lu»l ion, or inay
Ijtxjomo Mpoil(>d, This hittor altemtioii is ouo of thu ohstaeleg 1o the
gpneral cmplojTnent of meat powders; heiic-o it in thnt we nee mann-
faiiturors doing their utmofct to reader thou- produch! proof aguinat ehunge.*

How ought TOU to order tliesG muut powdcra to be taken ? Thia is n
[fflint of some imjiortaiiee. Formerly wo weru in the habit of prescribing
tlic jHJwder in mixture with warm broth or href tea; to-day JJebove and
mvfit'lf have found that tbu lit-nt mftbod ia to givf it e<>Ul in thu form of
milk punch thus prepared: I'liujo in an empty bowl a couple of tablettpoou-
f uU of meat )H>wder, add one or two tablos{XK)nful8 of old rum or Bourhoi^B
(or the ei^iiivident nf some aweet wine), and luilf a pint of irdlk or water,
sweetened suOiciuiiUy. In tlic case of patietiU who euiinut bear ulcohol
ill any eh&po, you can omit tho spirit, using instead enccharatod i-anilla
{Miwder in ({nantitieft of one or two npoonfulB; this gives a very agrocnble
taate and flnvor to tho untrient inixturL-.

It h»8 been remarke<i that the animid hiate of the meat powder 18 often
heightened when it is injrved warn; at the same time exception should be
made for ithocotate and for the feeuieiil prepumtiun Bold nnder the nnme
of nicahoiit; the meat powder may be taken hot or cold in eoiiibiniitiun
with either of theao without altering their tunti^'. I shall retnrn to this
subject when I oome to speak of " Forci-d Ahmentation," and I shall
then show you the immense advantages which may be derived from meat
powder, which in all c!ireumHtaiiiM;ii should be mibatituted for the prepara-
tions of raw meat.

There is another meat prepnmtton which has given rise to interesting
diacuBsione, namely, " boiiillun " or broth. Till quite recently, jdivHicians
have been divided into two jMrties, tho one affirming, the other denying,
the nutritive properties of this preparation. The expcrimenta of Sohiff
(iOablc us to deeide tbiH c|ueHtion.

This phj-siologisL has in fact shown that tho sneretion nf gagtric juice
ig not uiiliiuited, and tlwt it siilliueB lo give to a dog when fasting a con-
ffldcrnble ciuantity of meat, to obaorre this scoretion arT<isted under the
ilillucnce of aueh alimentairy nnuw in exc«»iit. The allmentarv matters
then constitute a Vfritabk- forcijju Iw.ly, and are got rid of by vomiting.
It is thid state which is known under tho name of UuUgpMtion d cra/mla.

COMPLEX ALIMENTS.

41

(capdouB indigetitioii) ; but in this connoction bbcru is u ver>' iittonsting'
4(M7ntii>ii of Sctuff's, luunc-lv, thut it sutUcvj io introdact.- certain sub-
itiBoes into tfav circulation in order to sen inim«diut«ly UiQ gastric Juice
mM^ ajiew nn the stomachal hiticoue mombntiio/

Among thcM fmbstatweti dextrine tteems to ]ki!»pj» thin proper^ in the
bj^oi (ifKrotf, anil iu uiiinmls that hart- bfcii goi^id with food, and
■toe Bt«ina«lia have ccaaod to aecrote gastric juico, it siiftiL-os to intro-
doM & solution of dextrine, wKuther by ititmvenoiis injection or by the

ilfctnm, tn ranse the digestion of thin mass of food ia go on immediately.
It is to thcffo latter subetaiiCRH that HchiSl line givuii the immo of f»f)tO'
$M»u, that is to lay, sabRtancfiS which promote the aecretion of gaetrio
^ioe and thereby {wptomiRitiou.
' 3t ia. gentlemcu. n eignineant fact that soupa and broths, whabcrer^
may be the moile of prepikmbioR, whether you follow Ik^glu's, Liebig's or
Dnral's method, contain just tlivsi- pc|>logeiiouB mutters, aud the custom,
banded down for ageu, whit-h Baiictiuns the iiaage of soup before the prin-
dpsl mm], fiudM striking support in this discovery of modem phynology.
Of little nutritive value by itaelf, broth iiidH the digestion of foods by
rapidly penetrating the drcuUtioa, and eupplyiug tUc matvriuU necossary
Httrr the- Bocretion of gsBtrio jnic-e.'

^B By the vide of meat broth belongs another preparation, called by tlie
^fkngtish beff-Ua, which hasa precisely similar action. To make beef-t«u,
TOO cut up into littlu fnifrmi-iits a piecu of biMifBtLuk. and mact-nito ia
^"jmtcr whoao b^mpeniture is gradually raised to near the boiling point.
H^oti thus obtain qnite a sapid albuminous liquid, [wssossiug niauifeet
^BKptogenoiu properties.

^F It is not (|uite tile BBD]o with iho preparation called Amcnoan
"bottilloD." wliich ia of considerable nutritive value by itaolf. To pre-
paid this broth, it sufHceti to place in an iron kettle alternate lavei-a of
amc and of vegetables, and to subject the whole, without the oiidition of
uch water, to prolonged cooking over a hot waterliath; yo« thus obtain a
aid wbich gelatiiuzee on cooling, and is a Inie mvut jctly.'
There haa also been iimch commendation of mpat jnicc got by squecx-
tiicv* of meat [lartly broiled ou both fiido* over the fire. Tliis kind of
:ioe ia not as nutritive an one might HUp]io«i>. [ pass in silence all the
pharnuMwntical prcpumbiona in which moat Is said to lie dtaaolved
nthiclcs more or loss complex. In these syrupB or wmcs of Ix'cf tho

really luees its nutritive pro[H-rtiL'>B and cannot act as an aliment.
Tbts leads me to speak of a product vliicli has had a great |x)pukrity
tn Europe, owing to the n^initntien of the chemist who gave hitt patronage
to tliia preparation. 1 ullu<le to Licbiy's f.rlraci. In regard to tliia aub-
(taac«> aa to beef-tea, nunitfroua diflcuasious have been raised, and contra-
dietory oxperiments hare bH>n invoked. The extract of moat hy ita>lf is
not nutrient; it is a peptogcnous liubstance which may aid in tlie aecrvtiou

42

DIS£Ae£8 UF TU£ eTOUACU.

of gastrio juice, but vhich famishes the eoonoiiiy only aliments insnffioicnt ■
for the nulritiou. Mdller hm in fact ahowu thiit in iinimnls. vxtnu:t of
meat dow not nourish, and Kimmrrich biut gone even further, he ban
shown thnt tbo Hnlmul fed oxclueivvly with this oxtractf dies eoonor thaa^
one iiibjcct«<l to n rijcoroae ubetinoDCo. fl

You will, tbvu, nee thi>9e extracts with raoilemuon, and as tax as jiosei-
ble employ genuine broth, which presentB great advantagos over thesQ
preparalioiia. "

In this stn<l.v of meat broth, vu have examiuvd only one of tlio ait*
of lUo (juPBtioii from an alimentarj' point of view, the litiuid product;
there reinuiDB for coneideratiou the solid jiart, the meat itself, which may
be utilizcMj. The nutritive value of boiled meat Id coiinidomble, lUid
almost equal to timt of roost moat, iiovcrthelcw it is Krvntly inferior to it
in taale, being much leue relished; hence it \a neintaeary, in my opinion,
ag fur ns possible, especially in hospital pn:cUcUj to Gubnititutu roti^t for
boiled meut in Uic dietury of |>atifnt«u

In this rviipeut the Eiiglieh arv ulieud of u& TluB is without doubt
the ruition clmt coiisumea the most meat, and is the moet particular in
regani to the way its meats aro eookod. In their liospitalB the English
discurd the iiw of hoiletl meal, ami prpfer ihow immense " chunks " of
TOaet mutt wiUi which you uie ull iu»|iittitit^-d. Here isiiit example which
we in Prance ought to follow, and inatoad of boiled meat, the habitual
ration, wo ought to oat more roaet meat.

Piimlly blood, that " flowing flesh " as Bordeau calls it, luis boon ad-
Tiwd in the treatment of etomucli alTections, and we see at the present
day preat numbers of poreous resorting to the slaughter hfluson of our
great fities to drink the blooil aa it comes wiirm from the Rlnnglitered
animals. This repugnant practice hiu no good Hcientitie wiirrant, and
nothing either in the domain of physitilogical research or of clinical dis-
covery goes to show thut blood is stipcrior as a food or as a medicine to
the flesl) of animate."

Of Into there have been introduced into therapeutiM, alimentan,- puw-
dem made with dried blood, and under the name of hirmopidritte. Paul
Bort and Kegimni luive given vogue to » prRparatinu of their own. Oner-
der, moreOTcr, bam shownalltLeaflvantagcsUeriTable from dceiccuted blood
in forced ulimeutation, and we HhaU rctuiii to tbid subject, under the bea^l
of " gavage. " *

W© come DOW to alimenta of vegetal origin. liCgumes and cereals,
along with fniite, conetituto the principal alimenta of thie group.

The cereals occupy the first rank, and, it miint lie admitted, consti-
tute, like milk and eggt;, an nim,ost eouiplete alimenU Wheat; in fact.

• (Si-e OticNlcfs ftrticlM, i^ptwlueed by me, in the Tticrapeutic Giuctte, 1833, p.
4ti2, and ISfH. p. 40. Timia.]

COMPLEX ALDrENTS.

u

MWi uotiaed nuitton: gluten, albumen, caeem and vegetable ii^riii;
myiiupoas mattcnt; stamh und dortrino; h sncchtirino principle, glucose,
ihlibt^ mmtterx luid DiuK5nil malterB in gn-at^riir leaiabnndiiDCO."

Ltfcnmcs and LiTtuin roots ItAve a similar composition, an yon may
JDdp liT th« analvsb of Payon, and the differeticw pertain chicQjr to the
(ml«r or 1m« quiintity of starcliy matterR and tlit* poomcB» in aaottzod
I oblaDcea.

^m Vith reftruacv to tlio digestion o{ animal food, wo Iwrc soon that epi-

^V tbdium and its deriTatlTee resist solution in tht; juicen of the alimentary

V cuil; IS for TegotoblM, ccllnloBo poBwssce the »tmo propcrtv, and paetioe

Umogh the digestiro lubu witliout altHriLtJon. The aliments of vegetal

flrigin are not digmtwl by the gastric juioe. bat by the saliva and »ecr«-

timi of the puncretui, and if it bo true that the digestion of feculents is

mitina«d in the stomach, it novcrthclcetj borrows few of the elemeiite

thwpfor from the putrin juice. Hence vnu will r«commend to person*

•Jio niaVo use of a TegeUble diet, to tliorougliiy chew their food, in order

titat the aUmeniary mam may be well impregnated with aaiiva.

On thie point it ia necessary to insist when hoam are eaten, or fried
potatoes, for if m»*rti«ition i« incnmplot*, the hulU of the one, the hard
OGeUng which forms ovi*r thu other, will keep thu inferior of the miuis
from the aetiou of the salira, and yon will find in the uiattci-s vomited or
in the fttoea theae aliments andigcated. So when you are consulted by
pereona who «it rapidly, recommend them to taki> their icgnmos ia the
fonn of Moupn or Htews (thoroughly Ixiilt^d), ue in tiiiR fitate they are more
aoonsible to thi'ir proper Snids, the eaHva and ]iancreatic juice.

Apropos of these regetable foods, I cannot too strongly protest against
Leren's opinion that cabbage ha« a most injurious oticct on thv mucous
mwiliiani' of the utomach, an elTt-ct resembling tliat prothioed by aloohoL
It is pOKsibltf that the dog may digest cabliage badly, but it is certain, on
Uie other hand, that this vegetable, very nourishing, by the way. and of
Uwrioiu digestion for certain atomaohs, ia ordinarily votl supported, and
I cmnnot refer you to any Iwtter exampk'.'i proving the truth of what 1
ay, tfaiui to our peatniitii, who malso boili-d L-abbage «) large a jmrt of their
living, aud who generally have good wtomm^hs. There is, theu, little war-
nui for [^even's condemnation of this vcgctuble. "

Axnong the ordinary alimentary preparations, tho one moeit generally
in nao tbe world over is undoubtedly broad. Hence great iinportannt ix
■ttacbed to tbe way in which it is made. Dread po^i-essen a nutritive
Talne dependent on ita modn of preparation and the substancea which it
oonteias. I cannot here enter into the details of this quostion, which you
wtO And fully treatwl in bo nmny popular works. (See capooinlly Oraham'a
Treatiae un the Chemistry of Bread Making. London, 1880. ) I shall hero
allado only to two points; first, to a {xipuhir opinion whieh needs to bo
,tvd, y'lz., that the whiter the bread 16 tiie luu nourialaag it ia. The

I
I

I

44 DISEASBB or THE STOMACll.

analyaefl d Payen end Violet show that the riclmc!* in luotiaed nmttei
augment* with the quaiitT of tho bread, and timt breads whii-h an.' tbo
vhitvHt, i.e., thom* of first qaalitj of flour, an? the most noiirisliing.
Again, (and this is the- hccouiI ]>oint to which I wish to rail your nttoD-^^
teon) the cruat is more nourishing than the crumb or soft part." ^|

Th* qnestion has been much <li»cu«*wi whether it ia well to add bran
to flour in hrnvd-molcing. Voii well know that by r(>[)uBted boltings
millers succeed in depriving flour of the bran which it contains, and that
meal is thus ohbuneii whi<^h ia more or lem white. From an alimentary
point ol viow the eeparution of the bran is a good thing; even,- body
BCK>mii agreed tliat in equal weights, bread wbinh containB bmu us \vi»
nutritiouH than bresid which ia freed therefrom, and in the annj bran is
considered us n UBtlnas eiicuiubrance to hreacL

This oxclueion of bran is ))crhai» a good thing ob rcepocts the dietary
of healthy ndnltK, but from a Hiora]X!utio point of view, the matt«r is
difTerent; aiialyms iu fact showB tliat the mineral matlera, anil in [larticii-
lar the phosphates, are not uniformly diBtributL'd throughout tlae wheat,
and that they exist in greatest, abundance in the huak. So, when you
deprive flour of itH bran, yon deprive it at the same time of its pho^ptiati's
and it^ailtii: but ibcsu lattt'r hiive often an important role in t lie alimenta-
tion of wet nurses and of children. When I come to treat of the dyspep-
sia of early life, I »hftll sliow you that the only nieaiis of introducing phos-
phates into the economy ie to employ those which have already undergone
a tiatiii-a! at^aimitatioii, and to prewrribc hrau bread or certain legunuis
which, like the eomnion bean, contain ii great quantity of phuHphatws.*

I ^hIlll pass rapidly by the fruits, and shall only atlnde, from an ali-
mentary poiat of view, to the advantages which may be derived from the
grapo cure. Ripe gnipeu, of good i^unlity, taken in suffiotent quantity,
produce good resailtK in certain atonie li yii]wpsiiis. and partieiilaxly in those
accompanied with consliiaitiou, as in the gouty dyapeiisiii. for example.

These are the principal rules to follow: yon will direct the imtient to
cat before bin meali< n certain quantity of grapes, which ho must himself
gather from the vineK. and they had better be eaten while being gathered;
jou will, moreover, do well to choose those kinds which nmke the hnitt
wines, and which are the beet table grapes. Those should be rejected
which have toujL.'h skin and pnlp, and contain but little sugar. The
quantity to be eatnn varies with ea^^h individuiil ; when n sense of satiety is
felt or of Btomach futueiu, the patient must stop, or even a little before
this sensation.

This kind of treatment promotes relaxatiott of the bowels and does not

• In AiiKM-it-ft tlieie ix a )H>|)uIar hvUd Umt l>nm bread will luvwrvi; the teelli.
Kulp cites a mimbr.T of itisUwices whew, its he afBrmn, llii; ttvc iis« of this kind of
bi-eiitl hiis siLvi-J the tt^otlt (luni fulling out and from dec&y. Transoetions of Uie
Jliiaotaijuiu; Uvutul Society, Muy, It^.

COMFLKX ALIMENI^.

45

Ibe mppettte, 'bnt mther RtimulaUw the functions of tlie 8toina<;h.
But here-, as in thv case of tbo vhcv cure, it musl be; ounfi'wod th&t b
IhoDButd circuoutiUMW forvijpi to tike grape favor the beaettoial rc«ult
I nughc for: exereise in the 0[)en air, the pleasant surroundin;^ vtc.'*
^m Thiirabjectof gra|Mi care will aeryeasintemietliurj between tlio slnAj
^B of toiii and ticiuJd utimcntA. I come now U> the cuimdcnition of thQj
V iMer.axKl shall &r»t spuik of the iiilluutiui: of iipintuous liquore on dieuiaei
rftlwstaanat'h.

Tba influeucc of the alcohols Id deplorable, mid in tliis boe|)itnl in our
mile wants vre »ee, oftettcr tlia.n from any other canse, dys^x^jiRias rL-8idt
btm tbc ulmsL* of arilont Kiiirit«, or uviiu from thr eimpK- iiki t)f theae
^ iDt«zicatitig b«JVeroKe)<, whivU aru «o K«-nurally of bud t|UiUil)'.
^H Two prin<.'i]>al caui^ti Bulliuiuntly explain thv production of these dya-
^■fepna*; the augmentation of the acidity of thegasiric jitico on tbo oiio
^P huld, and the n-tardation of iligcMimi on the other. Cliitrles ]{i<-het, by
hil oi|H!riiucDlt) on Murculiii. Itaa furniehdl lu prucioiui Jatu n;«i>t'Ctiug ,
liie Gnt of these etiolop^jil luctorn. In fart, if you examino diirinij or
ajnn from digw^tion th<; UL'tdity of the j^Lslrii.' juice, lui CluirW Etiehet hiia
dwe, you will see thiit it is represented during f»8ti:ig by 1.3 in weight
of hyilrochloric ocitl pt-r litir, and during digestion by 1.7. But if you
inCnx)nc« into the etomach a little alcohol, the acidity immodiatoly tieea
to S.7, aud even to :i and 4 if Hourbon or Cognac be used.

It aeema, (hen. to-day demonstrnte'l that the introdnt-tion of wine or
distilled spirits into the Htoiniieli lia^ for it-i lirst effect to double au<^l evc-ii
treble tUu acidity of Ibc gii«tric juiue. If to this yon join the irritant
iotion of the alcohol, an action which makes itecK r^peoiftlly felt on tho
fflBOOUS raerabranes, you will liaro au f.i;pIanation of the pheiiomeiia
vkicii develop tltemaelvca in drnnkanls, and find exprei^ion. a* fur as th«
MonuMfa u concerned, in a congeries of syniptoma to which baa been giren
the name of acid di/spepsia.

H t]i« action of alcohol iji prolonged, there ia no longer nimple funo-

^^jnal dirturbnnce, but real inAnnimation of the organ; you witness what

^■le (jormans doecribe under the name of etitarrh of the stomach. In this

^RMc the abnonnd •ciditr determined by tbo spirituous liquors too long

^FiDnlinuix), briiigi about, at the end of u certain time, a dimiutttion in the

■■cretioD of the gastric juice, and an increase in the secretion of mucus,

vhirh then girosrisuto those peculiar pitiiitouB troubtva which cluiiao

tcriw! the d.rspcpaia of drunkanls.

Uachner, by his precise exporimenta, mndo by mcane of tho etomaeh
Bpbon, or by artiflcial digeations, has tihuwn tliat ulcoliol always, ovqq in
Boall quantities, retards thi> peptonization of aliments " *

All tbfiH alcoholic bweruges taken in excrt^t lU-U^-rmino tho wmv mor-

fiuckaeriaUeuttclteArcb. f. KliiL Mvd., xxix., V&

I

46 DISSASXS OF THE STOMACH.

Ijiti atatos. At the nine titiie it is important to diBtinguisli in this regard
liquoni of gnm] t|i)alitv from tlioso that arv impure or sopbiaticatcd. In
our rtwuiirclicfi on the ttnic twXton of tlie alcohols. Or. Audigfe and I B«*r-
taineti that tbe vmimiaoiiiiu^itl detiTmiiicii by tho InHer is tho grratcr and
th« more inU'uaQ the more uuliko vinous atoohol tlie spirit is which is
dmnk, and tliat the maximum o( injurious resull* ia couuod liv iiolato
spirit.

Tho couctuvloii ut wliicli we iirrivo in thul work is th&t from tiic point
of view of hygiene it ia deeiraWe by anccessivt' rectifications to hrins the
alcohols of conimoroe to tho eCato of uthyl alcohol, for viuuue Hpirit ia ihe
Inast dAiigennts of all the intoxicants. It will not do, howuver, to forgot
tluii tho iibuiw of uthyl spirit, evun of the puroat quality, entails gaetrtc
diffiiAtoi'B of a deplorable kind."

Ah for wines, it may be aafsly aftirmed that the fitnm&ch is tlie best
judge of tlioir quality, and I nowl oidy rvfcr you to your own personal
. cxptirienoc in confirmation. When nt a dinner yon have imbibed wines of
bm! ((uidity resulting from fraud in their muiiufaeture, you will oflvn
experience in the night time, under the inflQcuce of thc«e sophisticated
lifjiiors, even when taiken in motlertttion, emnips in the stomach, a senw-
tioQ of burning in thiil rt'gion. and abundiint iieid LTUctnlioiis: if, on thH
Other hand, you have drank the same quantity of wine of good qiuili^
exempt from noxious adulterations, you never suffer aach syraptoma. _

Therefore, gentlemen, we are obliged to attribute in largo part the
dyitpepsiift of the working population of our cities, on the one hand to the
shamefnl falKifieatifms of the bevt'ragea servwl under tho name of wine,
anil on tlie otlitT, to the deplorable habit of taking these ntimnlating
liijuore. and especially white wine, while faeting, thus directly putting, and
without the in termed iation of food, th(»e alcoholic Irevemgea in contact
with the mucous membrane of the stomsclb

Beer and cidor produce the same effect as wine, and quite recently
Boenrt liikB pointed out to the Academy of Belgium the diflRatroue action
of tlie abuse of tho l>*er8 known aa Havariaii.

You will, then, forbid your dj-8]H-ptie patient, with tondeucios to acidi-
ty of the stoniacli to make habitual use of ardent spirits, whether in the
form of distilled or fermented lirinors. Vou will, on the contrary, permit
these beTenigee, or at least their moderate use, to peraoiw affected with
atonic dyspepsia, a dygpepsin in wliich there is look of gastric jnice secre-
tion, and tho aHdity of the gastric juici- is lielow tho nomml. It is in *mch
caAs as tlieao that you will do well to recommend the glasa of ale or vine
after each meal, and here again you will give the preference to some good
vinous bovorage, which ia, as I hnve beforu to]d you, the least toxie of the
alcohol io rtimulaiits.

All the conclusions which I have just stated arc in accordance with,
and in fuut based upon, our exiK-rimental rcsearohes on tho toxic action

0OMPL£S ALLUKNTS.

47

I of ttie alcohols, nscarchcs to-;laj confirmed by thnoe which haye juet ter-
niiimkil at thi- pigKvry wliicli vn lately oHtabliKhud in onu of the abattoirs
of IVifc In oMcr to answer tin* nhjootioriii whioh Imro l>wfi iimtie apiiiiat
onrfonnor method of experimentation, which cotimUxi, as you know, iu
niiidly killing dogs by injecting under their skin variiihledowaof iilcoholii,
ngRT« the toxic agent to our hogH by mouth, a entail quantity daily; thus
drtetinitiing in tliesc niiimaU chronic alcoholism. Hero again we a3»>r-
UiMd poeitively tlutt the more the liquor differed from vinous xpirit, the
mm Durkod were the phenomena of intoxication and poisoning.

Tlwae experimenla were matlo ^nth eiglitoeu hoge, which for threo
ran were dowd with certain diiiiy ijnimtiticH of the diflcwnt alcoh(d»;
the mtaa dote waa I gramme 50 pc^r kilogramine of tlie weight of the
aniiual, ao that the animals were made to ingest each from 100 to 150
^nuDDies per day.

The r«6alts at which wo arrived with our eighteen gubjcets belonging
to the two aeriea, did not preRsnt anything like the well-nigh mutheinuti-
cal preciaioQ which we olitained in our tlr^t ro^c-archos ou acute alcoholic
poinning.

N>eTerth«len we have to note certain pointa which hove a real intcrcrt.

Tfeobaprvfld iu particular that in every caae the crude, impure litinora

illplilegms), produced remilta more injurious than the rectiHed liquora.

for inatauoe, the hog to which was given the cnide grain spirit auc-

to the effects of alcoholism; the animal that got thv crude beet

vbitkey, and which w« slanghtoreii in the course of the oriK'rimentation,

pmentcd congi(«tionR of the digestive tube, of the liver, of thfl langs, and

adieroma of the aorta. Tht! hog that was doaed with lh« impure; potato

•pint and wae also killed by us, hai\ the mont marked heimtic congeetion&

On the other liond, those aiiimttls to which wo a<lmiriistered the ethyl

tkiohol, potato spirit ten timeii rciTtilted, ami other ret^tilied alcoholR, pro-

amted few leaioiui or none at all. TheM.- facts then authorize ua to believe

tliat ihe latter, vix,, the rectified and purified alcohol» i)08He«8 a relative

ianiuiity as compared with tho former, whoJ« noxiousiietw commoiiez-

ienoe has everywhere recognige<I. And if wo were to classify the ulco-

ila aooording to their toxicity, wo should say us the remit of our ra-

Karche** that the Iva^it harmful, by far. are ethyl aluohol and potato sjiirit

ten times rectified^ which is nothing more nor leaa than ethyl 8]iirit. almost

pure, Tiien come the relatively impure alcoholit of beets, grain, potatoo8,otc.

It will be remembered tliat the hog which got no alcohol, auccuml^

toapalmonary affection, contractod in the rigorous winter of ltlT9-18dO,

which proved to bo a veritable sclerosis of the lungs.

The hogs to which wc gave absiuthc, and the tincture of abainthe,

pp u a u ntwt on interesting M>rie« of plionomenn. Unlike those which were

urtihed on food eoutaiuiug alcohol, they manifested during their in>

I lag

48

DI8KASBS OF THE STOMACH.

toxication, n c<*rfftin excitation. Trpmbling wna not more marked io^j
these nnimals than in eomo ct the alcoholizod subjects, but tliev preaentet^H
coiitnu>tiiro of Uio limliii, nnd n finite runous hv[K>ra^Htlicttia of tiw »kiii.^^
It tiiifliouil. in fact, to touch lightly koril' jiart uf th« cutaneous surfw^c to
pStare spasmodic contraction ensue in llu^ musolcs of tbu 4.■xtreInitil^8. Two
of tlic hoge of the accoitO Beriva had voiivuUtvo Beizuron, which Beemi-«t to
be of an e])iIeptifonn charactfir.

In line, to complete the detail of expfiriments which have cost ug m
much in money, and about tlirt-e yv&n of caruful obsL-rvation, we ohnen-i^:

1. That the aJrohole, udminietcrod in a alow and continuous tnunniT,

ormine in the hog, nt the end of a cortmin tiiuv, unatomical lesions,
^%hich consist in congestions and inflamniationB of the digestive tube, and
of tko lirer. without at the same time attaining tu that degree of interKti-
tinl hqtatitis which is noted in Imrd drinkers in hiinmn kind; in conges-
tion <^t the pulmonnry parenchyma,, which nmy go as far its apoplectic
extra\iu«ttons; in Bthpronmtoua degeneration ef the largo veseels, and
especially of the aorta, and tinally. in sanguineous effusions into the sub-
itance of the muscles, and in the cellular lissne.

S. That these lesions, inappreciable at tile end of thirty months in
CMM where othyl alcohol was given, and alcohols hariiig other origin than.
vinous fermentation, but which had been thoronghiy i-ectiRotl, ar*> verv
conspicuous in subjects to wliich have been administered crude spirits,
whether from Iwets, grain, or p«tat«ea.

3. That preparations of absiutlio are oepecially baneful m their effects
on the nervous system.*

By the Hide of these spinluous liquors we mnst place the stimulating
beverages so much employed in our day — tea and aofft^i.

For a long time there has Ijoeii dispute respecting the red action of
these two Hnbstnnnes. which withalcdhol constitute ji/wriMj foods {/lUtufutt i
iTipanjne): sowvi pn*tend they are benelluial. others that tbev are injuri-
ous to health. Both views are corrcet; everything, in fact, dep<^nds on
the habits of the individual and the Himnlo in which he IIvlm;.

Tea, in inirticular, \% » stinuilntiiig U'vonige veiy mueh employed in
the countries of the nortli, while in the warmer southern latitudes its
ntility is more doubtful. As for eolTeo. habit plays a considerable iwrt.
and many a [lerson who luu< boon nceustomed U» drinking slrong coffee
Bfter each meiil will fliid hiK digtwtion retiirde«1 or arnwtod if h« mows to
make use of this beverage. It miurt \k rrnionibcred. moreover, tliat if
the use of noffoo is often beneficial, its abuwi in»r amso palpitations of tlie
heart nnd imvimnia. eoni|M<lling Its nlundonniont."

You ought, Uien, bcforv prutoriblug or forbidding Utose boveragvs, to

* 8e« the artiole* enllt]«4 " GsperttOMital RmmiivIu-* on Ctuoaio Akobolic
POinulllg" in TlirraiteitUcGiUBctte. JiUyand Aiitfxutli IStti

COMl'LEX ALDIBXTS.

49

tikt intooonsidcrfttion tho babit««( tlio [»ti«Qt, and the ctimnto in whicfa.^
b« livtK. Wluit I oan iiffimi U that in oar farming diiitricta t)ie ingeotioi
of mIm during' ibu beat ot Kummi^r unil Ihu fatiguu of tb*> biirve^t twwKin
rtaScn oansiderable seirice. It is to coffee tliat onr troojis in tbe fur
tut, eipoaod to the li«al of a tro)>i«il enn, resort in order to eapport the
fill] etiei^M, am) any fuiTMitugo thi-rphy derived \>t iiltrihntnbln to thi*
itiBmlition by this twvenige of the ci>iilni1 nerrous sj'Hteni, unit tlieiiee iif
tH Uif fuQcUous of tbc ecouomy. lu liu8 been shown by tho reauarclies of
JvoBio Janeiro phyRicintiis Fort and (iiiimaraes.

1 Binst ber« protMt against a viilgur prejudice which bos no real fouodn-
liin, ud which will Romptimcfi occiuiion motborH of familiro to oonxult
]HL It has been held ttmt coffee cauH<?8 thv wbiteti io youitg womva.
TUsin not tbe case. Coffee of good quality, taken with milk and eufraf)
X ui eioellent beverage, of which a largo part ol our population purttiko
wahont the kmst eri] effects.

Vatcr pl>y* sIm> an important r6te in alimentary bj^ena I oannot
fcrPB tnwt this question in il« entirety, and aliall have to refer j"Ou to your
UntiflM on llygicue. Permit me, liowever, to call yniir nttenlion to
ffrtwfi points of this subject which conct>ni mori> partioulitrly the hygiene
of djvpepties. The nature of tiie watprs hiw u notiihie infliieiiGi> on corlnin
dfipepiiaa, and we frniuently mk hucIi affuctiouii caused solely by tlie
iMfc of potable watiT of bnd <iunlity.

[ EHtut also point oot to you tbe eril as well aa the good effeot^ front

m tdimentary point of riow, of tho use of cold water and ice water.

Talcpn in lonaU qnanlitii>!i ioe-enid drinks are agriHUhle and may Ktimiilaio

tlv digestive functions: but tht> »dt7kntnt;e tlitis accruing is mure thun

, »aiilerb*lan«ed by the dieadvantagve r*.'8ulting from their emptoymvnU

HThi» inflneocc of cold is to impair tlu'' tone of tht- gti^trie and intestinal

H Bucoas membrane, and tho free utu^ of ie*< water is often followed by dys-

f peptic s^-inploni8 and dtnrrb(i:a. In tbc ITuiK^ Stutcs. whi^re great tue n

wtiti of ioe-water, and where it is drank to escem, then.' are often seen

itteloped ander it« inSuvncc dyspepsias qnito m serious and rebellious as

tbtw which ariw from the immn<lemu> »h> of alenhol.*

Uinenl waters are of con side ral^Ie utility In diseaKps of the stomach,
nd r ahsll indiotte later, under the head of the diffenrut kinds of tbrao
•ffnctiona, the waters which the physician may employ and wliich liavv u
imi nwdieuial vsdne. In tbiv conueetion I have n word to say alioiit thoee
■uwn) vatant called tnhtr trntrr.'. A gr<wt [mrt of then waters oome
fmra Pimnoe, from Kpringii in which carbonic acid abonnda. The waters
4f St Oolmier, of Momy-C'bat«auneuf, of Condillac, of Coumn, civ..,
Wlong to thi« gwMil>- Thoy are •«/('■ himrhmaU wntern and an.- chiefly
diuactarisod by tho abundance of carbonic acid wbicli Iboy contain. In

* Tl-isstAtementisdoubti-d.i-TiQDa,-

AD

DISEASES OF Tire STOMACH.

tiemuny wo lure tho ApolUnarU water, of wbicL tliero is such
coiiKuniption in England and Ameriua, and the Beltxer vator in the
Duchy of NaesBU.

I'hi" usage of ikll thcAO waters is blooming more a,aA mom fAshionnblc,
wjil IjPiioflciiil posultflnrw (lonbtlesBiittjuiietl therefrom. Thp prosencp of
carhoiiin iit-id BtimulHttw the action of the gastric niutxnm meuilimno. and
ill thm vny iiiJs dijj^Lioii. It uHU not, hnwcvrr, fin to ahuse Uitrm. and
ttiio rvDuirk. itf LUjwciaUy ttpphcatlc to the nrtilicinl Soltzcr wutors. More-
over, the coil sura ptioii of thfj«o lalter. although very prat, tends to
diminish from ilnj lo day by reusoii of tho very low price at which the
nalural iiiiiu'ml waters iirc eold. mul it rauet l» oonfeeseii thul the latter
hftvu u ^i*at ml vantage over the former.

The" arlifloi:il wutcnt. in fiu't, <lo not priwcnt th«t cloee nnion botvroen
tilt) wutor and the eiLrlionie-airid gas which chara<'terizt>s tlie imtural
wntors, BO that tlio effervesL-ent gui". instcail of being eet frew slowly, and
littic by littlf, 118 in tbt* cnec of the I«tl«r, t8 evolved quite raiddly, and
dotvrniincfl ihnfl. hy the mere fact of its liWration in bulk, an action
nUbor iiijnrioiiii tliiin fwvorivhle to the miiooufi niembmne of the stomiioh.
llenou you ought, in the enae of certaiu dyKpt^ptics, to forbid the employ
of ihcuio wntt-rH, nor should you in any event continue their ui<u n long
tiuif, for thu Hloiitach rvudily becomes habitaat«d to them, and if tbcy
are then left off, it minoe its accustomed stimulation, and digestion is in
roni«<«|uenco more or lew imitcded. This becumoKa real inconvenience to
the jMliciil, who enn no longer out hin meui without his minerul wat«r;
it id H sort uf boudi^- thai bad bctlur be avoided."

t ought also, from tlie point of xipw of atimcDtary hygiene, to aay
■ODiotbing nlMUt ooudimonts and tolNtcco. (-ondimenU are largely need
in the pn'paralion of our food, but it will not do to forget that when too
long indulgwl In, or too freely taken, they determine irritation or even
intliuumation of llw inut^nue mvmhranc of tliv sIijuuicIl. Hi-nct;, while
rvcofpiiiing their utility, 1 advise you to b« spari&g in tbeir uae. It it
««lK)oiaUy in hot countrius, wIutv Kuro|M>»ns by roasou of the tropical
beat And their appetite declining fmro day to day, that the custom pre*
vaiU of n^*90rtiiig to condiments. But insUtwl of the stat*' of tho stomach
tH>nig ameiiornteil thereby, it is in the end enfeebled and exhaastvd by
tbeM> pxvitanta.

Wlwupver you hnve oc>t*»ion to treat stomarhs impeured by tbe too
|in)longnl tisagiT of highly ^^-a^oned viaitilx. itc earrrul not lo proscribe at
oneo the employ ot condimcntd altogi'lhor; for the stomach, habituated to
it« daily einntant. wilt no )ongi<r digest its fo<Kl. The better way, th«r«-
foTv. will U< gradually to diminish the <]nantity of condiments iu daily
uns so OS littlo by little to ncoustotn ibe stomat^h to alimenta not aeamned.

Id Uie at(tni<.> dy»iM))mas you may. on iha oontnnr, recommend the
Ati\f uac of UiM^«oiidit)MuU ill aaiali .<)aantitiM *

J

COUPLKX AMMUNTS.

51

I AiH finifih th\a 1o<>ture by a f<>w n>m!irk)i on tho influoiioe of totwiooo
nlto itauiu-h a.iid un •llgi-.etioit. 1 v^vU know lliat the iii>o of to1j«ooo
bulrat Hi) inilirvct relation to alimentation, but the habit of smoking i»
m tMy preralent ami pt-rsDus luMiBtoil tiipn-tu arc a) wont to niiort Ln
tktr pipu or cigmr uftur mvuld, tiukt tliu subject may ap})i'opruitvly bu
■IMcd to here.

ilraad; in a formoroouraa of lectures pertaining to diBeases of tlie
inrt, I pointed out to yon that the abn.** nf toWrco deterniinos in mme
pmoas palpitations and attacks of luigiiiu; smoking may ulso, wbt'n niadu
I Ticf, provoke dyspeptic tronblm compariililo in a measure in tho»>
ouuedbyalcoboliciitimuliuitfi. Ik'nuu wi- bavit tho dyspi'psiiu of »>niokcre,
■Bilogciu U> the dyi«[>epia of hurd dniikeni. ReviHot, who Iins Mitrnalizoil
tbeee facta, has shown that the immodorato nao of tobactio produces a
ifiKisl stony of tho dij^cgtive fniietinns.

Hooh, gi^ntlemnn. are the considerations wliit-h J desired to presfnt
rektite to alimentary hygiene. In the ni<xt kvtuix" we sliiiU Btudy fooiU
in Uieir aggrej^toi and I shall discuias what has been called the ulimentary
ngimcn or alinionUttiou.

KOTES TO LECTURE III.

'According to I'&yon, the comiKwition of roiutt hoof in eliws of three
Dtimetres in thicknuss, cut from a portion of the lillct free from fat, ia
f follows (in U«)i»rtB):

Water, CEt.BK

Urbon U.IH

Nitrogen :i.5S8

Fatty niatteni &.19

Miiiernl nmlters 1.05

ItBttM'tUAlc Corn position. Roast MoAt. Dhoil Sutwtanrc

Water, il9.H9 O.OO

Azotixod matt«ni, .... 32.93 1G.18

Ffttty Bubstanocs, . . . . &.19 i;.S&

MiuerHl mattcre. .... 1.05 3.60

Kou-azotizedmattera^Bulphuraudlom, 1.04 3.07

100.00 100.00

Mnarolar flesh eontains, l)eflides, fpRe lactic aeid; the imlphur jsin nnion
TlUl tbo a2oli7.o<l (ir}{uiim nuiltt>r. Tlie earbon in mlrunite<l fmni the
SS.83 of axotiz4.-d mnttore and the Ij.XSof huty mitLtvr*. Theuiim-rAl mnt-
tcncome from the tulU found before incini'rution, and inclnde the Iiiiht'h,
|ntwdi, itoda, lime, and mngiieHiti, in niiion with aeids, plirKi])horio, luotif,
iDOBcand hydrochloric; thus we hiive nhoephates of lime and ni<^[nc&iti,
hctatM. and inontos of potaah, cldoriuua ui puUmiiun iiud eudiiun.

52 DI8EABB8 OF TAS STOitACH.

Accordinf; to Plav&ir. the compoflition of roa^t m«at and mv iue
rsBpsctiTelj is m follows:

RoaHt BMf. Kkw B*mt ^^

CftrboQ 53.59 51.83 ■

Hydrogen, . * . .7.89 7.fr7 ■

Nltnwen, 1&.S1 llkOO ■

Oxygen, S4.31 S&.$9 ■

100.00 100.00

' Under the numn of rofuerve of Damas Tronnteau gave tnout reduced
to pulp, and mixed with (■iinant jelly or conserve of rospa. Jaennel
{Formnlnry), pives the following formalfe of Revpil and of Adrian:

Grammce.

n.) Taku of fillet of raw beef 1,000

Sa{)iir.iU) ean!f)tllv niid reject the Aponeiiroeee and tbe
fatty mattcT; lia»h finely; bmiso in a wooden mortar. Add:

Powdrred sugar, 20

Ohloride of Rodiiim, 15

** " potft8«iura, 5

PowdtTtfd black iifppcr, 3

M. F. S. A. The fillet of beef may be replaced by veal, fisli, or fowL
Take in quantitiee of a teaHi^oonful several times a day:

(2.) Mkat M^KMiJ^AiiK. (Adrian.) fl

Onjiimo. ^1

Take of Glkt of beef, 60 ■

Oommun tult, I ^|

Fruit jolly, 15 ^

Heduce the ttllel of beof to a pulp; add the salt, then the frnit jelly^
and iiiis.

Yoo may alao incorporate tbo pulp of raw meat with sjTup of gooae-
berries or cherrirH or with broth.

Ai" intermediate bptween meat broth and mw moat must bo platwd
moat jellv.

This Id the fonnula proposed by llevtil:

Grainmea.
Take of beef miiBcle, freed from fat and hashed, . 500

Water 1000

Common mlt, 3

Cblnrido of potaaaium, ...... 1

Carrotd. turnips, onions, of each, .... 30

Boil the whule over a hIow Qre till it is reiluoed one lialf. Strain into
a mould a,nd allow to oool.*

■Yvon haa proposed the following pleasant combination of raw meat>
gelatino, and sweet almonds:

Onunmm.

Take of mw meat (fillet) 250

Pure gelatine. 80

Sweot idmniiclB (hulled), 76

Bitter " " fi

White sugar, 60

* Reveil, Medlcnments Nouveaux. p. flS.

COMPLEX AL15IKKT8;

53

Tbr ■imonila are first hulled, tlien hniiaeil in a wwlgpwood mortar,
«Tth tlio nit-Ht anil siig-ar, into a homogencou-t tuuite. In onlrr to oljlttiD
1 bftlcr looking pnxliiet, and at tin* samt> riniR rfmovn any fibr»>8 of the
mnt whioli miiy have tuKuipMl tliv uctiou of the ntortur, tliie jmfte irin;
i<r uwnl tbnmgh a L-olunuvr. TUv pui|> tlius obtaiiiud litu; a rmiy color
UKl ft vtnrj afrreeiible savor, ivnembling in nothing raw mmt. It may tw
liMtrrod « long tun« evvn in sonimcr. provided it be k«pt in b oool'diy
fkoa.

U von wish to obtain a liquid preparation you can dilute a cort^n
qiintity of the paste with wattr, talcing the same nreosmlions aa in th«
mmtion of a linctiis mtkli> by nif-ans of ftlmona \nuitt^. You obtain
on in emnlsion of a light rosy unlor whosu emcll and tastv mwmble
thu of iilmond umiilKion.

Yvon giv€« another method of preparing the cmulaiou.

QnacoBm.
Take of

Aftw meat, .... ... 00

Sweet almonds (hullw]), Ifi

Bitter " " 1

Whit« imgar, 16

Bruise in a mortar the meat, the euear, and the almonds, and add Iho
(jaatitv of water nocessary. TIip whole slioiiM now be iiresst^ thruugh
■ Rminer. You will thuH obtain tin omuigioii wbieli wifl k<>c>{i without
imtiiiiatioii for at lcn£t twc»ty-fonr boun, and oreii after that time u
rnulT for nao by nimply niuiking.

To render the meat more uourishiTig, yon can add to the |m«to before
dilating it with water, the yoiks of one or more egg*, or use milk in
Bakbe the emulsion.

Laillier, ptuirmaeist-iii-cbicf. bus gircn tho following preparation
thick ia in use at tbu liitiaue Asylum, Suiut Yon:

Oinniiiica.

Bbw meat (scntped), lOU

Pulverizinl migar, 4U

Wine of lUgnolB, 20

'Hnctiirc of canellft, 3

Incorporate tho mgur with tho raw meat in a mnrl)le mortar, then
nld tito wine and eanitlln. The mixture thun obtained iuu the appearance
of aaxToahtde, with an ugn.i-abl« snror.*

*Tbe qumtion of alimentation by meat powder* Bcenis to-daj to liave
k(B ■olvra by Ktm. ITudor tho form of curfinii-hen (paokagee), not ex-
oadfflg S gTBiDin«9 in weight, and which may ho boiled tn SSO gnunmea
(ilcmt one half pint) of water, you have nil tlie nutritiTe elements of a
tuftinahing brotfi enitablo for a menl, and two »uch atrtovches niitBvv for
t ti)« ilaiiy mtione of a man. The price nf the total ration ie Hcarcelv half
V^Mac In (icrmuny great ueu ie made of an Anieriotu'imwder known
' the name of r«riii' prnti. \

' 8»p. At- Phami- April, 1H74. jii»l Hull, do Th^i-. t. Ixxvi., p. KM.

tKlnL L' alimcn latum On nulilal. (JourikiU dun M-ieiicm inilituinn. jtiiaaoAU
IKtl Imx, De Tali mental ion rnlionnpllvvl jiniUqui<ile« iu-iiiies(bracli. in 8* Park,
191.1 MHa«rt, Armee- uuJ Vulks-Eni&hninjr. 'i v^l. in H*. Berlin. ]fm^. ItAnn-
fcos. VcAucbr ucbvr den Nubiwcrth. di« FlciaclinieU ■■CBt'ne-Fura"^D«nibM;lii!

54 ^BlSmpir TltK 8TOMACII.

'There arc numcroiie indurtrial proccssoi for th<- fulirication of meat
ipowditr. This is the wiiv ]JttS!>Itrr dcscrriliL's tlK>st> methofls:

Deiin-atwH pure and fimph, — This prooess. a«OTrdinjj t'l Atlmii,
coiuist^ in i'li408iiif< l^eof of ^o<wl (iimlity, rcmovju^ tliv fiit. tvuJoim. ami
Mpotiuui-uHi-H. Hiid ciittiitg it into slices TIr'Sv slices, about tlic sJxe of
tue luiiiil sii'i a little nioro tlwii a reiiiinicUir in tliifkiiess, ure pliiwii in
« tightly-closeil bukiiig pan, vrheiv tlioy ooolc without losinp a drop of their
juice, Rnd without any allcnitioii uf the ulliunien of l.lii.- tilciofl wliioii iin-
pregnales tlit-m; tlni-y ar« then drietl In u well-ventilfttcd OTen, livatiHl
to u ttinijRTiiluro of N(V to !tO*^ C.

Tlic eliccK of bfof thus obtained are of v. fiti« thfstnwt color. Their
oilor and siTor rcw-mblc that of roiist niwil; tlii-ir lihri'8 on MH^tion »re
soon to l>e roBe-c'okm'ii. They rctnri'sont ~';i per tiont. of Iho meat oni-
ploycd. They arc lastly pulvoViie'l and aifted with care.

The powder ia of u leddi^h {jray color, Klifrlitly biiUv. of a dpc;t(W
Iwtffy odor. From the point of vifew of its ehLiniiiul chanicti-n!, the ynw-
der and tho alicoa uf dried meat sire tdciiliutl: ttoiitiihiiiig tho i^amc qiutn-
tities of nitrogen, fatty nialtcra, lactat^^a, phft-qilintew. estmt^tivu and
aromatic m«ttei>i, that is 1o nit. an BBsemblitgitr of varied itlinieiitary priii-
ciplce of the highoet nutritire vahio. This* is the pmot^sj' (jwrfeeteii), of
the 'rartare and South Americnn?. The oiw Yw\>-Mt:. their meat iu this
way to preoBrvc it from the int^-iiHt' cold, thu other fnim the heat of their
climnte. ThuK made the meal serves for long journeys W land and Ijy
(oa. It iii,*then, a method of preparation aanotioned by usage and by
Bciunce.

A second made of maniifacturo is tliat by coctioii and dtwicvation. i
After live hours »i Ix^ilinu, (hu meat \^ lakun from tint kettlu, jnit on tho |
prewjt, and then Iiashed; tliUB preiwrid it ia placed on trays wid eubjecti-d
to a heat of Jm'^ in a fitove; afft?r twelve Imnrs of de^ic^atton, it i« pulver-
ized \o be Hf;aiii ihorouphly dried in a «tx>ve,

ThlB prepanition, to !x! diatiiiffniitlied from fht pntnter nf hetfsieab
furnished by the lirst mode, shoidu he called the jiuir/frr uf hailed meat.
Its color Ih that of lUiiKs, its taatu is iiinipid and its odor faint.

It repreaenlii 20 per eent. of the meat employed, that is. .3 per cent.
lc*e than the powder of beefsteak. This 3 per cent, reijresents so many
purt.s in every hundred of nlimentiiry principles lost in IIjl- bmih and in
tile scum. Kueh principlea its itlbumen. gululme. fatty, cxlmelive and aro-
matic matters, an<l m particular lactates and phosphates, being almost dll
nv<|iiratory alimeiit'ii or aliments; of di^uvimiiation, so that the 'M per cent.
of ju'oduct obtainerl — axotiKe<l aliments piir excellence — are found deprived
of elements efliiabie of rendering them assimilable.

The tliinl procesti eoiit^ii^ta m hivjihin^ the raiv meat, in soaking it in
water, and washing it till it i;i cumpletLilv dwolorizi'd; then it is put in
the presH au(3 wi<>kt*d utter the manner of boiled meat, atUtrwunl ihor-
oughly dried in the stove, and rediieed to powder.

'I'his jin-tiumlion. eveiL more than the [Towder of boiled meat, is de-
prived of uluumuii. of fallv, ammntic and extmctivo matters, of laetatas
luid plioBphaUa, in fuel uf elements useful in all re«peel*. whether m

'-^

mililnirartx]. ZnitiHrli., October, 1^3. IVOfunif Jcr Fieisi-hconaorvfU "C»rn«
Pinu." Rolh's Jill in^in?ni III ilbi-iilk' Ij«iMiiii;;i'ii iiml Foriwliritti*, vU\, ISSS. p.
ST). Hri!>«Wr, On tlio Employ oF Mont PowUera i» llm Diclar}' ol Ih^Suldicr.
Ardi. dn Med. t-l Hiunii. Mililttii-e, SupU, IBfeJ.

COSIPLEX AiJMKNTS.

55

I (tieme making) elements, or ae adjaTants to digestion and aasimila-
tin.

Thii prooem maj he oallod tJio mtixcufinf proww, and tlio powiiiT thiiB
obUBud tht potcfUr of wmjvm'ihc, T!iii< powder is almost wliit*. ruarlj
nqitJaiKl iii(Mlan>Uf% It rt-iirt-sent^ K |»ur t-t'iit. of meat ciiiplovinl, i.e.,
tfttiXM. less tliaii th(? jM)«ui'r of hoiltn] iii«it and six ptTi-i'iit. liws than
tk|wvili>r of lM4*?f.-iU'jik. Aillumgh it i», taking; L't|iiai wi'ightji, atill rii-hor
In nitmp-notis priiicipli!!* tlun thv j)OT(lor of In'ofstvuk, il is iiifurior tut un
iJiwnt to till? |M)w»1lt of btiilctl niwit.

In wwtbmg t]ii» mt-at to the ]K)iiit of dauolorixatiun, and in rerooTing
lU Uw^uicoe, it is not oidy ronAercd inodorous but indigeistil>le, not to
■T uuawtmiliiblp.

A fourtli prtx»«e i* omploywl wlion tti*- meat* are vpry fat. TIk^ m«aC,
Irwdfrom Uie Burfac* fats, iw Vol] un from norrcs and apoiK-nro***, is lisishcii
(no in a hashing machine, Ei)t'ca't nut in thin layt^rs dti trays, and drEic-
aliit in a *(uit*bly ventilateil stove, at n innximnni temperatiiro of 4.VC.
TV miat \s then jmi^prl on to thn emaher, tlien plnowl in a lixiviating
■ffsntu^: tlifii twnx- ita volamt; o( alcohol at 9^" ia poured \x\)an it. and
ilualiowcd to mw^fnitualNJiit tvrr> iKnire. aftt-r whii^li thu liqnid is tumod
ofl. A iifw and tfjual quantity of aliwliDt is then pouTL-il iijion tliu mt-at,
■nd removed after a (^mplo of liours of contact, ami this prociass is €;on-
tan«i till the liquid wliich is drawn off from tlie apparatas comes out
dnr,

The moat Ihna lixiviati'd, m th'-n piuHod to the prosH, and tlio rosultitig
»lw •wrrted to u ttovi-, tliw tfmiK.'ntturc of whtca is gra^lually raised t»
Iltl', llu-n is r«Iuced tn an inijiiil]ii«liK> pnwdrr.

Itwtcmmn diMftareH that the mt'^it i* rliu»> di*privod of all ilR putrid olo-
tttjtte |not of it« putrt^cihlo olemf-nt*, i*inoc it i« compowd of nothing bnt
Ibwr) without ita nutritive valui: and il* di;;i'stiliility licing at all im-
|Btn>d. l»ut rather Homnuhat improved. Tin- |mwdfr thus oi)tainc3i1 \n of
■ tmiiiifnl chainoiii color; it in absolutely udurless, and may he kept in-
tWuitrly.

f'rtr»e pura. — The American powder i)n>8entrff it*'ir under tin* iispcct
if* lliw |)Owd*.'r of a pale brown color, aii<l abmkitt^ly dry. Ita faint odor
" Ht diaagrecable, and its savor, slightly saltv, resembles that of beef.
TV proceed of manufartiiro is kupt a srtcn't. I'he voluiao of the meat is
■ohiKil about a w\th by the pro<"ei« of drying.

Thii m««t iMwdor keeps wi'il in all eountricis and in all climatOB.*

' Vvon'ti mode of testing these powders is as follows:

1. Ktrst ex:imin<> niieroM-opirulIv. Hy the abuiitlaiice of strtatod flbrco,
}Da will judge of tlie eare whii-h JiuK Ijwn u^e(i in ihu fiibriciition of the
pndw, both from the point of view ot desiccation (whether or not Iho
Ml wss lower than 100 C. ) or from that of the nhoire "f material. 'I'ho
piaoce of burteria in Voiiiiiderable nnmlien will alwayB indicate tho
enmmcefn^nt of dooompo«it4oiL,

3. In deti-ruiaing the amount of watx-ry extract, in meat driea at
IW' C) you will he guidod: by the soureo of the meat, that of Aeft/'givrng

* A<ln>n Oh lh« RAIn of M<--at PuMilvra in Tlierapeutira. I*itriK liVU. RrntMcaiB
Un U«ni Powik-r^ (KiilJ Af TliArap.. 15 }i''[<l. IXKt}. K<tbin. On Arliliiiiil AJi-
aMlAtiot) oikI Mfiil Powdwnt. Tli, >iiiiiiK<iiitl, ItUS. Kobia, Oa Ariitlviol
1 iieaX Puwam. T)i. il>.> i'AriN, IMU.

ol Aliiaon- ^

S6

bSlfiiBES OF THK STOMACH.

an avflrago of li jver ct-nL tJiat of the buroe^ 17 per cenL of drit*!! extract:
liy th« mode of prepbrntiAn, — tho mflftte which Iiav« been cooked, foniieh-
iiij; only a fe«l)k' junporlioii of watery uitrnct, not eiceeding (i per cunt,
and ofutik not mon> lliiiii l.b ])or uant.

You fihotiUI test for the fixwi ealts; specially to dotormine if the
rjuatititr of chloriile of aodium l>c normnl, and if tlie moat powder haVB
been miidi^ of fresh meat, or meat cooked or wtishod.*

'Afteran excewnve meal, pepsin iaoften wanting at an advanced period
of tlio digestion, h m^rioil during wliicli the stomach 8till rront«in8 8o1id
alimcnU not tmnciornu-d. In his experiinonbi on iinimiik. .VliJff ro-
niarkod that tho dcraiijcud digestion rapidly undorgoy* rustoi-ation if the
animitl is made to ntviillow, or if then- tie admin inU^reil to it in lavement,
Bomo broth or dextrine. " Never," Riys WnhilT, " have I twen in tho dog,
in(li^et>tion.i cHnBe<l by forced repletion of the gtomacii resist a sufficient
do«! <if doxtrine."

Tha luImiiiiHtnitioii of dextrine or of bouillon ^in the form of soup or i
iHwf tea), to luitientti affected with dyR[M>pKiH hy inautlii;i«Minv of pepsin^ I
liiu given Sidiitf the Hittie residti^ as were nott-ti in 1iii< experimeiitt< on ani> I
Dials. He Imd oecaision, for inKtuiice. ti> trout )i man Jigcd lifty yean*, who
after each rnuid wils Lakun with a sfiisation of fnlne.>4i and dieteiuioii, of
ffenoral malaise, of wi'i|<ht in the linihs, often ac(.>ompani«d hy ccphahil jfia;
ne had also aciil ermUitions whii'h ilid not eeaae till live »r kijc lioursafter
eatine, along with the oilier uitcomfortahlo senwitions. Hnring digestion
the undomen wiw i|i»teiideri, the tontino furr-'d, tlie mouth ]«i«ty without
naitfca or vomiting; thuru was no fever or pain at the epigaatrium. This
Btate of luulaiitc hatk protluoed a dii^ust of food, and the forces weru en-
feebled.

Supposing that there vras iiisufllcieiicy of gaotric iaiec dnring the liret
Btogo of digestion, SchilT caused llie paliont to take two hoiire before
meals, a email ipiaiitity of broth, in ordur to funiiali him at the meal time
a suflleieticy of jH>[»in, to facilitate the dij^>b-tivv procoBs &s soon as food
shoidd be intmdnred.

I'liilcr tl» inflnnnce of thin trefltmeiit the malaim ditnppeared, the
forooH were re'(<8labtiHlKM], and aftr-r a whort timo recovery waa complete.

* Begiti's recipe for broth U as follows (the quantity of 7S litree being
intendnd): I

Take ..f '

Watt-r, .....
MctU hy woight, with tho b(inoB,
l^egnmeR, and iwt vi-gi'tahles.
Common sail, (elduhile of eoitium),
Uoiuted onions.

75 litrea.
31,243 grammes.
6, '340 "
34U "
220

It iatfEcntial moreover: 1, that tin- kettle shall not contaia more than
75 litres: 'i. that the meat iihail I»p honed raw. and bound hy strong threads
into hiutdlea of altont thre>e kilogninmies eaidi; 3, that the bones shall be
cnislwd and plaoeil in Hil- bottom -if tlic kettle; 4. that the meat, tivd in
iBM.'kiigi.'s. shiill be pla»-i'd on a juTfonttcd (also iMllMm, nl>ov(* the boTiu<:
o, the water mimt he poured on cold, it is then gnidtially brought to the

• Yvon. Iw'. cit.. p. ST.

I

I

I

COMPLEX AI.IMENTB. 57

LpiliDg [loint, ami tlie skimming is commenced {the ecam is well formi-d
bKvtra tlw »ePond and thin! tinun*): tliRn tVie vlmlft is allowed to xiiiiitiur
(itttbMl Tiolcntlr) till tlio sixtli hour; then tlii> lire is aiitTcrivi t/) cckj]
down. Ml*] one Itonr aftvi'vard tbu Ii.-gumi.-s. tbt- mviit, auti the hrotli are
mnorMl from thu krttl«. It is nwvNsir)' tliut the nalt. ax wull hh the rege-
UblMiud roasf^ti onions, sliiill he luldvd, Uie lutter f>tiveluped in a course
d«Ui, after tUc ekimmiuiic i» compU'to'l.

U'lirti. at the vni of seven hours, Uie operation is CuiBhod. the liag
Mnlautinc Iho vi^elabiw is romovwi. Ibon tiii' ful»n botttJin c-ontaining
tiMboilea nimt; the latter isalluvrml foru wViile t'> dri]} owr the kettle
aiid the fat is skimmed o3 from tli« top. The liquid product ia tlieu Qt
far we to make Aonp of or pottage.

pHTHu rM-ommcKmls to ase only tlio pur(>at vhit^ eall. not to inchulo
among th<^ {K>t plants, cobbo^s, onions and tnrnipK, which hv their trnl-
plinroas pnnlncfa and their fermentable juiro niter tlin arnma nf thi' hrotli.
and titid to make it xour; he would rather diminifdi thiin augment lliu
qnMitilT of Togotablc^ and omit the onions, who«o odor and »iTor uro uu-
plnmnL

LJebigadTueH in onler to oliUiiii in tesH than an hour a good hrnth,
tfloke a Kilof^mme of beef freed from fat, to cut it into small pieeeii or
cTTfi ha«b it. and soak it in a quart of cold water; it is then gitiduulty
tnli-d to tb« boiling point and skimmed: then salt isaddi^d. mid aftvr a
frv moiuents of ulight ebullition, vou liavu quite a )<troug brutb, and one
IM may be eaten with relish. Th'n >.>roth, subk'ctcd to & hot 'wati.'i- bath
■ml eraporated down, givps a entt extract whioh keeps well, and may I»e
Bwrf i« i>rop«re broth anew wiiit.

'ITietiroth willed Lmhirf* Htrfnrjihrnini^ broth is made with 250 grammes
otfneli hcuf. luialit-d and mikt-eratod in 2tiO grummes iif distillnl water, to
■Well has heeri added four drojw of strong hydrmdilnrie acid and five

Gimnu^nf vtdt. After one hour's nuioemtion, it is strained through a
tltrr flivvi.', or linen cloth.

Itavml has wloptwl the (oUowing formulu for making broth for certiiin
iBdostrinl wtablisluaouts:

Take of: K., Gmnimea

f^nlinarv beef, 3 500

Water. 10 500

t'ommiin salt. ..... 76

Legumes, carrots, locks, parsnips, turuipc^ 600

Three cloTCK.

' [yi^Ton liax made some cx])orimcnt« regarding' the nntritive ralue of

broth, and bo luw endtovorwl to iisecrtain the fjuantity of soluble jwptonee

obtainable thcrefmm. He hiui tbnwn that it \b at a tempnmtunt of 40" C.

that the largest amount of n^iit^meti is pnidiin-d, and whi>never yon elevato

ibf lemjH'nturo, you diminiith the ftiuintity ^^f the jieptonos; n quantity,

worfovcr. excwwively f«blc, sinee broth eoutains of penloniaible material

•mly OHt thoHsaiuUh part of the weight of the meat employed, and/nwroffs

tkoH*attdihs of the organic matterii und salts; heneo I.e<r«n refuses broth

A place in tb« class oi aliments properly tio-calk-^i. Hi.-, however, allows

tlui it is a stimulant of the stomtich and augments the m.-crulioQ uf gastric

juice.

fl^/'tM. — In making btt-f-tea it is well to take equal quantities by

58

nisEASBS or the stomacit.

weight of Irivii het-t and rold wntcr. The bcr( (nhciulii firet bo ciit up into
fliid [Hprrs. anil jillowcti to miWH-ral*! hd hour in eolil wbUt. wliich sliniild
llitHi Im' h<'iit<>'l Klowiy U) uliullitiou, boilud twu miiiututt. tliPii Rtmincd
uudc-r i)rfssUR-.

Amerinin "liouillen. " — Take of 61Ietof bcof, AOOf^mmce; this hIiouUI
be<Mry(unyrre<-'d froiiioellularLisiijo. fat, and flltrt-s; cut ititi. biln no Inrgisr
than a good-fiizeil ]ioii, tiiul pluced in a tiglit kettle vitU a eVwui c»rrot,
uiid covntil clnscly; this kettle is now placed in n lareer iron kettle lllled
witli biiilin;r water, whiL-h iekept boiliiicsix houn. Tlie iiiiiTe thus formed
is {wnriu) olT nud llio nwluu inHtnuDMl t)irouj;li aeloth, it ia then ullowed
to f«ttlo and liio closir part fepn-mted from the deposit,

' HVhc* fiHfi /ti/nipif tif iwn/.— In (iemuiiiy and In I'rance a grrat num-
Iier of wines iind synipH of meiit arc miiniifiietiired. The Iinsit formnin is
(hdCj.'ireu by Uovcil uiidcr the Dame of ayru^i of viUtcuUnt, and i^ oa
(ulluws:

Tftke of: Qnunmi

l-'loah of vool, washed, trood from ta.t and baelied

tinulv,

Water, ' . .■

Pnre hvdrnclilnrie ni^id, .....

Cliloridfc of ]K>t)W3iuni,

" " ifodiuni,

Mix and astute from time to tlmo. and after twelve honm of tuaeera-
liou, exiiFL-SB and fiilor. After Imvtri}; athk-d itutlicient wal4,>r to make 500
cmmmffi i)f liouor, add IWU grammes of sugitr, and diasolvo nt the tem-
pratnreof S.'i^orWC.

*• Tanret hua endeavurad to aseertain by unalyNts the nutritive value of
the juice of meat an d of Americiiii bn)th. After having for four hours
siil>jei;teil to heat over a Iioiliiig s«:«i--water bttth lesin meat t<p which were
added tteventi slices of critoI, and onion, a ^miill ciiiaiitity of leek^ and a
pineh of ailt, Tanret obtained » liquid reiirt-seiiiin^ alwiil a <(imi-tor jjart
of the meiit iifli-d, ii-iz., i'lb ^tftrimes for SW gnimmea of beef.

As fgr the jilico of meat, in sfjucczing ii jdirp of U-rfsteak after broil-
ing it i\ few moments over the tire, he ohtuinnd in jniee nliout oiie-foHri.h
[iurt of tho nu-M employctl. 'J'he American broth gave of dry extract
about the Rftb piirt of iU woifcht: thu meat jniet- runhitned mineral inattrrs
in tho proportion of one-tenth of its weight, while thu white of egg li>aves
from lu to \'i |)pr i-ent. of dry reBidiio. If, then, we admit that the nutri-
tive value of the rcdiduo of tim juiee of miuit \» equal to tliut of dried
albnmuu. we have thi« euutr term of eomptLrition. by vrhich to estimate the
value of u given (jinuiUty of meal jiiiee. The white of one egg (^average
size) weiglu 40 gramme^B; now 5l>[> grammes of meat (the rump) gives Via
grammei) of jniee; yon have therefore in tills jniee tUp value of the whites
of ihrei' eggs. (Taiin't.)

"Albertoni has studied the action of pepsin on living blood, by injecting
the former into the veins; he haa observtrd tli-it this practice la followed
by great diminution of tibriu, and retardation in the coaeiilation of the
hlooiL*

* AJbcrtoni, Action of Pi>iiKLn on Living- Bioud. ISTS.

i.afUrilM>ooation and dceortlcalion.

rtwuu

' FVw, ilried and iJ«oortii.«U>d

Uiik

Vrtdw

"lBLoTen*sexpi>riniciit,lic giivi> t^m rii^itip lUvg sixtrminimoeAof cooked
Mbbip miKtl witli nearly tli<! enme quantity of lani; th« HniinftI was
kflM una hour iiftorwmrd; no piatric jiiiw riis foiinl in the etoiruicfa, or
■Itjluiilfi: nothing bnt an unormou« quantity of vrutcr from thu niigorged
'mit of tJuit vistrniiu*

"la bread -mnkiug. the quality and quantity of th« water employtti, the
bHiduig. the iniMli> uF f<>rmuiitiitioii (kind of yejuit) itnel LIk< inauntT of
«ookfag. are all raiiofrned in the quality of lti« product. The kind of
tear njKd haft a stilt greater influence; Ita source, wbvthco- pnrc or mixed,
tbcther w^il ;;round nnd )io1t«d. etc.

In ihp connu-y tlie bnqid iu gt>iiom11y of inferior qunlity tn thni in thi)
'■"ty, Th*- wheat is often of jMwr quality, boiiip Imdly hnrvt-etcd, and tho
Ikmr poorly crouml. Mmn-liiiies iricomplctrly ilivt-sU'd of iw hmn. or, it
an OK, miiEed tritli Lho idpiiI of other ifniins, niu-h n» Imrh'y or hnrkirhoftl.
la Uw cttT, inoreorer, friwh brewtr'a yoftst i» oommoiily employpd, in the
'matij t£e yeaet is oftc-n kept till it Buuns and 8|K>iIs, und tliu roBultii^
Wnd n Boar mil hmvw

bnssd mwlo from first i)uidity of flour is more nntrltians tlinn brtwl

L«v>^it, MiiJiulio^i do rENi'iiiiiu', p. 78.

(JO

3F TIIE STOMACH.

miule from eecund quality, as ia oeen from the autUysU of Violet, showit
the quantity of Qitrogcn per UM) i>art«.

Flour Xo. 1. K = 3.05
" " 2 " 1.05
" " 3 " 0.92

III tUi'' following table Violet ebows the difference betw««u the cru8t^
and tbe crumb:

Crust. Cruiub.

Water, 17.15 44.45

Asotized matters (insoluble), gluten and

the like 7.30 6.92

Axotizpil niHttere (eoluble). albumen and

the like .\70 0.75

Non-iizotJKi-d matters («olublo), dux-

tririi!. siigur, etc., .... 3.88 3.79

Stan-h, 6^.58 43.55

Ftttty matters, 1.18 0.70

Mineral matters, 1.21 0.84

100.00

100.00

Army bread in Vniust is mada eiclonvely of wheat from which hy
bolting the bran luw been oxtrsetod (20 por cent.); fomiorh- only 15 per
cent wiiB rcraovwd by bolting. This is Pogpiuto'B unalywis of army bread:

WfttBr 34.17

8ugar 1.03

Dextrine 1.09

Starch, -14.50

Azntiy*"! matters, S.85^

Fattv m;ittors 0.70

hnm 6.07

Fiseil mnttcre, 1.39

Low, 0.20

100.00

The following is Pajen'g comparative analysie of fine flour and bran,
in 100 parts:

Stanh and dextrine,
AsoUzed t<ul)etance8 and dlae-
lasc-pniiciplee in the bran,
Kfttly matters,

C'vlhiloeu

Miiiernl mbittAQcefl,

Water, . . . .

Coarse
l>i-nii,

60.4

13.0

5.6

. 4.03

3.0

14.0

Coarse
A our.

62.9

Fine

U.43

14.45
1.25
0.06

1.80
14.22

100.00 100.00 100.00

It will be Mwn from this table that bniu contains K-hm starch than flne
flour, an(i 1»?hb of aaotized mattcra, but more of fatty nutters, of cellulose
and of miner-il nmtters.

COMPLEX AJ-rMENTS.

61

"niero mn on tlio continent nti morons stations ronovnod for tbe grnpo

can (Doricheim, Krenznocti, Grunbrrg, liingen, otc.). Acconling to
Heaiy atw) CheTnlier p-ape juice contains:

t Albuminoid matters, 1.7

Sa^ar, ^m. 13 to '-iO

MlniTul mleiaQCCS, 2.

Watar 75 to 83

100

Tie white grapRi most i-inployeil are the ClnwaeUui pnipts and tlif

PlBiBii petit ifris; the blank SFU[)cti iirn the /*r/tV 7jh(i- unit the lioniih

lid arajm. Aceording to Itotnrpan, piipi'S from vinoo grovfinfi in a

d^ Bou and in a cold and nioiKt country urc? watvry. aliglitly ttwei't, and
miblv' acid ; tber ara laxative and «vcn purgative; thu elTi'<;l is the con-
Cntit th« grai>e'coniM fruui a larvyxpwayx^ Miil, Gni[>L« timt grow in
tnaillic, granitic, or voicanir eoU Arc diuretic, but they uro aluo alwajA
uottat; a» for those which iiri^ grown in a new soil, thej are gBnendly
link ironiatk! and hare moreover :i de]iroB8ant effect.

* BiKluier in hia orpcrimcnt* yn mtiflcial tligestiom! showed that a cnbio
enliiietre of albumen niaiutiiiiied at ii tt'ni|K'mture of 40'C. hi '-'0 cub,
enltmetres of vater a<;idniat.od with a fixed (juantity of hydrochloric acid
nddnted vith pepein, niulerweiit peptonization in sis to eight honrn.
If to the Riixlur« was added & gmall quantity of alcohol, not exceeding 10
went, of the entire weight, the results wore not upprociabiy jiitered.
Wrtvfvn 10 and ^'0 per ci>nt, neptonization wafislowm; Iteyond :^0 per
ant. it WM completely arrt'ste*!. In another seriesi of experiments he
■•ie IMO of the tntjo Fnticlier; he p»*c to some patients with lieidthy
ttOCiw^lis thctumc kinds of /iwd, to which hu added niriiiblm quiuitilivtt of
llcoholic beverages, then he wmtheJ out the Ktomucli cix hours afterwanls;
hr foand that bei-r and wine when taken even in meilemtiim slowed diges*
lim, and larger qnuntitteii <itiil more retarded it, while thosa beverages in
■in Urgvr qiukntitica stojiiied dige-stion ultogetlier.

" Ib a work published by them five years ago, Dujardin Hcaiimetz, nnd

ind^', fihowed by a sprics of exiterimrntal reaejircheft, whieli nfinsialod in

^ftemining acute poisnning in animalu, that the alenhDlfi are endowed

nth 1 toxic power whieh in mrinble. Thev sinceeeiloil in limling for eju:h

ncmbrr of the alcohol series, the fixed tiiMc dose, i.e., the niutium t|Uiin-

lily which in cxjrre«iK)ndenc-e with the weight of the animal eiperiinenl«i!

on (so nunv grammes of the spirit fnrsri many kilogrammes of weight),

niiA produce death in the space of from 'ii to Stt hours, with gradual

■od ppraistent lowering of tlie t^iniK-mtiire. Tliey found tliut the niediiini

qpoDlit; of t'thyUe alcohol sure Lu cause death in the ttmo indic'situd is

^l^t grummespor kilogramme. In other words, if the animal weiglu-d

V ktl«gnuKuneB (GO pounds), -J40 gnunmes (^ ounces), of ethviic spirit

vnU M rf>qnir«d to produee a fatal result within M lioun*. ^Fhe mo«it

toxic spirit they aawrtoinwi to Iw (wtato npirit, or fusel oil; of which, to an

tiUAM weigliing 30 kiltigmmmee, two ounces wuuld be a FiKMHlily tntul

The following tahk will be of tntoreiit in summing np tlieoe resulta of
atiM« ilooholio iM>ie>oning, which thcw cxporimcnt«r8 haro cadoavored to
' on ■ thoroughly sciouLifiu bttsis.

62

Dl!iK,4SES OF TMK flTOUACl!.

Daoux <»' Toxicity or thb rRnoROiAL ALcoHOLa,

Ofoup ot alcoluilK.

pMlKDnclon of thr BlrahoLi Bnil IhrU
derlraUm.

Alcohols of fermcnla.
Uon.

Alnoholn nnl of
mcntattoQ.

fpr-

Iso-aluohol.i

PoIv-aUiink- ittvoluilx.

Derivatives of &lco-
1 10 la.

f Ethylic (ilcohol (C.H.O)

I'ropylio nk^ihol (0)11,0). . . .

Btityliu alcoh.ll (O.H,»0)

Am^'licalcoliiil tC.11,,0). ...
l" Chemically pure niethj'l alco-
hol (CH.O)

Orilliuirv wikhI spirit

I (EniMttlivlic hI^-oIioI (C^Hi«0).

I Cvlyiic iilwlwl (CHmOI

I*o.]>m|ivlio aloolial (CJUtO)

CJlv.'tTtnV ((;,H.O,>

I Aoplit- ulilphvile (CH.O)

{ Acetic otliffi(C,n.O„C,O.J. . . .
t AM-toiiL-(C.H,Oi

MrdloTn (oxlc doae* pvr kfl»
^rarnnib at wri^bt.

iDthapuJV
■Utr.

Onuninw.

8.00
S.BO
9. DO
1.70

8
7.60

In (tiL- Mat?

OrBniimv.

7.75
S.75
1.83

i.m

t.tKt

8. 70 M 3. Ml
A..V)t<i».O0
1.00H>«.00

4.1)0

6.00

By the wnn) pure alroliol i3 tiK-aiit. alcolio! marking IW* t\ with tile
alcohol nmetm of Hav Lii«»HC at tli« tempeiallire of 15\5 C.

Afi for tii(> difitillofl liqnora of oommoroo thoeo are tlio conclueion« of
tho Froiicli csi»ci-imC'iit«re:

All the distilled liquors (eniii du vir), ftiid alcoliols of coramcrrc are
toxic, fintl thoir dtilptcnonif nt^tinn is in rvlatioa: t, with tiiu origin, of th«iie
alcohols; 2, with tUvir di-iircc uf purity.

I. Origin vf tite DiiitiufU I/it/uors. — The origin of these liquors plavs h
preiioiniomnl fiiiie from tlio point of view of tlii-ir toxit; action, mid thin ia
tho order in which we arc k'u lo i-lasB the difTurt'iit products on winch we
have i'xiieriniciit*'d: I, alfoliola anil apirita of wine: -. idnohols of cider
siul iwrrv; 3, itlpohoU ohtaiiiml hy distilliition of the rrnrc of prappg; 4,
{fi-jiiii Kpiritit (from di«tilI>ition of whcnt, ry*', oti;.); .'), Iwot B|>irit (from
Ix'ft iiifusioiiB and beet molueaca) : 6, potato apli-it (jirorcd to bo tho most
tuxic. of all).

Thin rlitwtiHnitio)] iK in hiirmony with tho recont dia-overies of Isidnro
Pii'iTL'. who hiia shown thnt tlio tiqiior» of oomnierco contain in variable pro-
ijortions a cijrlniii immlwr of alcohols. If spirit of wine is tho IrjiBt
noxious of all. it is bwiiu*; it consists alniost wholly of ethyl alcohol, but
the orrlinary vinous epihU am gt-noniily coiitnmitmtcri by poiiiionH other
than uthvl alcohol, lor they are a Uttto more toxic Uun cUui i^pirit wken
chcniiculfy ]mre.

The existence of ft certain quantity of propylic, cenanthjlic, andcaprrlio
alcohol and thoir products of oxidation in the mirita of grape marc, cfdor
uiid jiorrr. oxplaiutt the higher toxiv power of ttieac atcoholiQ bevi;n^;e8 aa
coiupar^'d with spirits of wine.

It is pibrticnliirly in griiiu and buc^t e]>irit that iRidore l^(>rru has dc-
toctcd tho cxiatfUfcof propvh hwtyl, and amyl alcohols; hence their gnait
noxionaiioH) \a rxiilaitu-d. If the fi|)irib) of jiotjitoea liave wjctncd the inoist
toxic of all, it is hecanis*! they contain Tariablw but large projmrCioiiB of
esA'titial oili) which are, aa we know, couiposei of butyl iilcohoi and fusel
oil.

'i. Purity of (he S/iirifg of t^immsrre. — What wc have just auld in a
proof that in oixlur to render I'ui** toxic any spirit of comineroe we must free

COMPLEX ALIUSSTS.

63

hton cerbiin impnre pmductc whioh it caiitiimn. tmch ah nmyl alcnVinl. TTa
lam, in fiti't, smoii in oiir I'xrKTimpntB that tlmn* I'vist fi-om n tnxii^ ynint
of view differctiofs bvtwt-oii tliv rcctitk"*! epint* iiii-l tluwr proiiiK-t* wliioh
imIct the iiune of pkUgma rusiiU fruui the itiii]]jlc ilistiilutioii uf fiTmc-iit«d
nuUrnL

\i it iKMsible to rectify spmtnous liquors othor th&n tlio»o of tiuoub
nrftn, Ki ttiat tlifj fhall contiiin no intoxicant Init ethyl iilcoliol? This
^stftivMimt wliitrh we <»unnt *t>\\(}, bnl what wv can afTirni. is ihnt. it is
«f int highuBt ini(>orlaiioo t^^ ntttiiii such ai«sntt. It woulit hUo Ih> lii^hlv
aiitsDlA2is>ua to liiiil pRicticul {ihTEicul uiit) chonii<»l teste which witl
viMr. iiR to iletf^rt in all itl<OTholii; bcVL-nigca tliu prtiiciice of tbi.' divers
iMioU vhich comiwMt thnm. Hut till such rei^^ntJi rIulU hnvv bcun
(ottitd, nnd scionco siiall l)o in poRsession of nome mire moana of idvtjtify-
tTiEoll Tiiixinii^ imptiritien. wu think thut in caa» whvro tin- t-oiutumption
fliwifiit BpiriW is rpgiirilpJ iuiiie<5e»oirj% il will bt» well to employ only the
i\wA from \-ino«a fprmentiitioii or iliatillatioii. In cAiintrios
t^piriUi cuiinol Iw ohtuuiixl, tlie entluikvor t<li(>u]d bo iiuuk- by
'larxf—' ' ' * 'ii-ations to Itvv i\\v hIooIioIs of all impuri- protlucrtK. elimiiia-
tiaj: 1 I bill tbtf elhyl. Viv o|)itif>, loo, (bai it i« highly ox|MHlit'iit

1a«[ilH<M- lit l<.-;i;islative and fiacal meDmiivfi the u'lultemtions ami fnli^itica-
tiawof hfjiioni, soi^ommon cTerywhorp, Hiid whirh help to inalte the n>
l>bis of sjiirits such an HbomiitiUinn.

All tbcw couclusion^ Aro an evident conftrmation of etatietioal re-
Mrtites which luivn bn-n liiiihTtukcn to anrrrtjiin the m^'ajtra proiluced.
ln«Ji'oIiolie bevnrages. It \» in thu Sranilinnvjan countrip-'i, wlierc potato'
fliitilcpy it) almoAb exnhisivniy niUMl. that a IcoholiRni nttniiiR it« mnximum
of ititcwilv: it ix nitiJ in thtrM countries thai Majnins lluss ^\o the first
»ritti-n dKHTriiilion of the ))utboIogical i-Hl-cIs of iiiti<mpcninro. If in
«Uiw pirt* of tlie Xortliulf^oholismulsotimlii riumproiis victims, it i« liirgnOy
«Tiiig to the fact tluit Ijcet spirit nnd grain Hitirit tiro thun? couBumi-S in

fint tliM> troth np]M<»rB in still clearer licht wh«n we limit the inquiry,
» Uiiicr hit* 'lone, to Fraiiw; ho ban, in fHPt. shown us bv his r<'mii.rk"ft-
WHnrts. that tlie crimes and miodemcwnnrA which result from thf abiiiK*
of aicotiolic Htiiiiiilantx are in ilire<it reliition with tlie uai^e of tilcohots
oiWr than tho»*fi fnniishfd by vinons ferincntaiion. It is in the ilujHirt-
9m\a where tho vine do«8 not ^pow. thnt wi> gee nleoholism rhf ni<wt
ivmlcnt. and if in conntriva when.' tlif vint- tlotirislies llierc iiro now iiiiil
ttwn found drunkiuxbi. this is due to lbL> pn-s><n<'(- nf larffi- dij4tilk>rios which
mtail the fNiiisnmptioii of other liquora tliun those of tlio viuc.

'EiItad) Smith rrgnrds tvn itK an exctto-reepiratorr ajrent; he sbvs.
If, that a strong' infusion, taken cold, in the dose of an ounce every
itixi beet rvmnly to fortifv the xyst^m against the elTccts uf exct-it-
IIo alao crniftiders fresli cream, like tea, as an ese(>lleut respim-
nlant. (Foods, bv Kdwani Smith, in International Scientific
Stu, pp. 3!i8 aim 34T.) Tho phyHiologirjil effeetH of rolfi>e, from a hy-
nie point of view, liavc been exliaiiBtivelv studied by Fort and GniniarHos
Kio .laneiro. Fort nuiiutains tliat coltee acXst on tho or^ns and fiinc-
»tu hy exciution of thv cerebro-spinal axi& lie thinks that coffee in not
jtpnnttft aliment {aliment (CipargM), but that it augments rwther than
' lishM the waste of tho organiem. beinir. whst bo rallH. nn aliment of
"itur\>: th» tiow t« also shared by fiuimaraes. wbo hoe also found
the oripanio oombustioae augment under the action uf culTee.

G4

DISKASEa OF TIIT STOlIACn.

T)k-M' ATtf the cont'luicions of the rcscnrohcs which OuimAraea under-
took at tite luboratorv of Kio .rxneiro: ColTuii iinpri?«8C8 on the urgfaiiimm
{irufmiiid niD'lifu-atioiis. It <!tniuimlie!< tlit> giiSL'i^ of the btocHl. ii>> wl>II as
the consumption of feculent anil fatty hydii>carbonux:eou6 alimeuta. It
au}i;inenl4 the fornintion of aujrar anil urea, and by accelerating th** pvoc-
essL'S of <liMi«8imilntiou, it renders [XHwible eocondarilj' tiie incrciiwd coii-
yumiition of inixetl, and eifeciiillr uzoliz«i) iilimont*. the type of wliii'h i«
meat. In enabling thn nrcaniKiii to conmime and appn)i>riatc more footi,
and in favoring its restoration, coffee, rs a vahuible auxiliary to hard work,
and is to hcf rei^ommeiicied to all who Uwl an atitive, bUHV lifu.

" T\n3 imtor of St. Galnn^r contain** n little btcarbonate of lime, wxla,
ami miignf.'sia; about one j^raminn to tlie Ittru. It is eaturaled uith CO,.
Tilt) Cbatainn<!uf water oontaiiiH tiin-e^ramntt>fl eodio hicarbonatu U> tho
litre, and one to two vrdsotC'O,; thatof ChaipldonhasofioiHno in^cdicnta
Bciircnlv half a gninimo to llio litre, it in well cliar^d with t'O,. SeltztT
wator fias in *ach litre twice ite volume of CO,, and about one dnu-hm of
Rdti". Apolliiuiris, popular in England and Amcriwt. como!< from tlio
Valley of Ahr. UHar tho Rhim*. Ita sulinn (lonstitut^nts are ehielly tairbon-
ate of soda and chloride of aodiurn. The wator delivered to commerue U
urtihcially ehar;^ wiLli CO, fpia hefortj beinf; sent out; dilonde of eodlum
ia also aclllud in the proportion of ouv gramme to the litre.*

• In this corntrjr wc havrno natural alliiiHncrffiTVf;»cfntw»trr« which romparc
wlLh thoRc ot Miitie fi|iring!i on the Conlinont. such lu Violiy. (or inKtunre. Con-
grvfs wiitor(froni8ur«lojnt)ionl*iin» jrt litre y,!J4W milliKruinmcK of <HJ,, 1K4 mil.
tigrani mt-s of sudiiioi bicau'Wiiatv, ami A,8C4 milli^:ra[iiiiL<» of sodiiini cldoiulc.
Tlii'i'i! ai-L' sovi-nil uiliirr of Uic SarB.toga. uprlngii tliat uImi (rouLuin tivu CO,, tintl
*.n- iilt;»Iino ; niuny oItli^M> vrftt«t«»r« articles of eommi?rvo ; lli<> Hutboru eupG-
ciallj. The Saratoga waters are much la use aa table watera.— Traiiik

LECTURE IV.

AlilMENTATION.

SmuARv. — Begimen And Alimentation — Flsstic And RsKpirator; Foods

I^Liebig** Theory — Basis of Alitnvntation — Exoliipive licgimptiB —
V^etable Diet— Nitrogenous Diet— Kvils of an Kxclusive Uict —
ILixfd IHet — XutrttiTe EquiTnIeiita — QuuJitity of AUmoiita — IntinSi.
cient Alimoulation — Excegsive Alimentation — Peptogeuoii8 Mattertt
— Indigestion — Dj-si«?peiii of Itigh Livf-ni — Qimlitv of Alimenta —
Secretion "f CJaetric Juic« — PiKestivo Souao (occoiding to Miomllot) —

IFtUitiattion of Alitnents — Interval between Moala — [>umtion uf Qas-
trie DigBBtion — Hi>gubrily of Mcala— Icdigostiblo FoodB — GxactHMs
in Dwtotic FrescriptioDH.

Taxkn in it« largest acoeptAtion, tho n-ord regimen signifies Qot only
kliatentatiun or thcalinionUiry rTgimc, it comprulientU al#ouU tho dictotic
wmaa wbieb tlie jihvKician cuii iii»ke une of to preserve the hettlth or U)
tm}ml diaoue. It U in tljia wnsc, f<entIcmL^ii, cliiit from thv point of
Tin of affections of tbe atonuicb, 1 sball interpret the word regimen.

WtttfaftU pass in rovicwthc hygienic mcuint< which liavo nn influonco
ftnike development or cnre of giuilrie iHtionlcra. In the first ntnk wo
[■Bt pbce ulimcntAiion, or the alimuntary rf}^imc.

In the previous lectures I hnvo considered digestion in its relation not

tlytothe immediate alimentary principles, butul))o to aliments which

I ingostod constitute alimentution. Tho lattfr han for il« end to supply

I mewu of nutrition and to repair the incKwcuit luiMeii of Uie tK!onomy.
Tbne toweaaro of two kinda; tbc one pertaining to azotized, tho other
li hjilro^arbouaceoue substances.

licbtfT, Rompnring the nrgiuiism to a miichine, wiis tho firstt to c«Uiblish
iki> two-fold dimion of f<>ods into p)u«tic (liistogonetic) EoimIb, detiigned
la (Tpair muscular losttcs, utid respiratory footls, whoM' futictlon iit to bo
bBTbed in the economy and supply luiinial IicHt. This theory of Liebig
laiancQ boeii moditlod, and tho hibors of (,'laudo BeniiunJ, Scyler, Voit,
Pettftnkoflvr, Tranbe, eto., haTe bIiowu that it will not do bi liken ahso-
ittt^-ly the phenomena of nutrition wlilch Uikc [tluct; in the orgunimn to
Uuw which ur« produced in a centre of comltui^tion. But doepitti uU
UkMenaervstions made toLtcbig'f cLo^^ification, it ik not tho Ices true that
itiito this dortrino tlwt we are indebU'd for tho ability to ostablisb mli-
■eientific IraneK.

6C

DKEASEB OK TIIK STOMACIL

The inccseant wnstiwoF the ecunomy, asotixed losfwd by the arine and
faocai nuitters, cnrbonaceouA losaeB liy the lespimtion, vary ikcconliiig to
circuttutoiicui — the atuto of fL^poao or of futigm% the umuuut of work
doue, age, aex, and even i::lmmtv; you will readily uiidei-staud then tluit
th«'alii»OQtary rogimen iiitondcd to ropttir thosv loaam BbouJd also vary
at'conHng to all tliese oircumBtances. I can here ouly pve you au average,
and indic-ato tht- dutu which should guide you in the selection of h diet

Here aru tliv fundamental facts: A nian loeitt ou ati iivcnigu ukIi day>
20 grammos of iiitrogeu, and burns 250 grammes of carbon; it is necessary,
then, that tho azotized and carboiutceouti ingredients of hitt food Bhall
J'lirniuli this amount of nitrogen and carhon. Those elements may !»
found fXoluBively in the vogelable kingdom, or auiumi kingdom; in fact,
as wo liaro Iwforo seen, the cereals contain a certain quantity' of protein
siiljHtanco, while the meats and azotixod mattem have, s«80ciat(^d wit)i
them, a certain quantity of fnt. But it must be bnrne in mind that a re-
gimen purely vegetal ou Iho one Imiid. or purely animal on the other,
although it may suffice for nutrition, [Hveents nevertheluaa aeriouit in-
conveniences.'

Tn the t^atie of an exoloEiively vegetable diet, a man, in order to obtain
thc! proportion of nltrogc-ii which Ik- nuedB, ought to ingest a very large
quantity of food, and for this very reaaou be will Iiuuvily lax certain por-
tions of his digostivo ttibe: while, on the other hand, il ho confines hiui-
HPlf entirely to an iizotized regimen, he must, in order to obtain the quan-
tity of carbon nw^L-asary for respiration and animal bnat, consume au
abnormal tpiantityof meat, which will also be a acvere tux on his digestive
organs and particularly on his stomach. A purely azotized diet, more-
over, rapidly produces enuieiation, and it is ou Ihie fact ttuit Bi'itliit-Savarm
and Banting have founded the regimen which they recommend for oboe-
ity.

From tho point of view of affections of the stomach, these excluiuvo
regimnuH present great diaaiivantnges; in fact, while meat eaters ani lia-
ble to acid or atonic dyspepsias, those who live on a Tegi.*tal diet alouu are
more Likely to experience grave intuistinal disturbances. But I cannot
too much impress upon you that liabib and climate play here a prupon-
donuit r<Mc, and according as a nuin is obliged to contend againat thc
aevere oold or excessive heat, his diet ought to vary. Tho people of the
North arc obliged to live largely ou azotized food and oat a great deal o(
fat. Tlie people of the South, on the other Laud, find a modurutv diet of
vogotablofl and cereals all that they require.*

For our Utmpenite climateB a mixed diet is host; tliat is to aay, a man
ought, in order t<j satisfy the wants of hi?i economyj to deriTo from a plas-
tic uud u respirutorii' ulimeut the principles iiwooiwary for hi» untrttion.
To thiB euhject of rcuxvA diet, im{>ortant laborn have been directed; Bons-
fiingault and diyen, Itasing thomBclvos on p^-siological data, havQ

ALLMENTATION,

67

lidiod (or man and for animslt*, a mmIo of nittritivc t^nirnlcnts, that is to
my, the qoHntitj of ilifft^reiit foo<lE iii>L-4^AsiiTy for uutritiun, butli iluriiig
Uio perind of restuiid iluritig liuit of [alior. In orik-r that you may lie
lUe better to judge aaO apprtM^iutc the rules wkich ehouM aervo as a baais
[lurtliimUbliahinoiit of n dietary regimen, I here pinco bofore your oyea
t tibiB vhieh represents amlcr a Ht^hematic fortn, iilrendy put in usagQ
br a llussian phyiticiiin. Dr. Do Ncilata.* tlic dutn furnished hy I'tiycu,
[■oil wliicb will cuitbte you rapidly to estimate the coustitutioa ia carbon.
tntn^i aod water, of tho different nlimonti^

Is oonnilting this table, which I have prij|«iretl with gri-at onre, it will
beeuj' for yoa. I repent, vn adjiut. nccurding to circiumstuiici-s, a rcgiunvn
atfflaoDt (or the daily needs. Alimentation, in fant, may be insiifScienti
Mfl&mtit, or excessive; this dopoiida on two cir^umstaacos: on tho qnaa-
ti^of tho ulimi'ntary muss, and on the nutritive quality of the nlimcnts;
(iir, HProf. Boutrhiudat liaa said, "it is not whiit uii« eats which girea
hia flrvn^, hut what one utilizoa." Let us. then, study this iiuo^tioa
Qoder these two aspects, quantity and quality.

We must take for our guide exporimontal physiology. You already
kna* that, from the point of riew of insiifficient nourishment, it lias fur-
Biifaed OS vnluablf lUtu. M I will cite- htTi- only the- rvsL-nrrhus of Chossat
ul of Boucliardat, iti order to oall your attttittion to the effecla of inaoi*
tin which lutve been bo well eetahlishtK) by these two writers. Itunffi-
omi ilimenution ontaiU ti-niibles which ntleca different parte of the
(coDomr, nnd end in cauiuiig deutli.

AccordinR to Frof. Bouclmrdat (Thosis on IneufliuiL'nt Alimentation),
■limenttlioti is sufficient when it ia ao regulated that, all the functions of
t^ economy hoing normally performed, the attribut»;« of heitllh are pre-
«n*d, and no wasting is obeerved ; the food elements Iwing pmctirally em-
plmd for the rc{wir und in early life for tho deTclopment and jrrowth
*f Ibe otgaas, by adding to their subi^taiice or by luakin^ good their

It IBAT b« mid a priori nnd tnily. that in ordinary conditions the ali-
nwntition is insuffiniv^nt whc-n th'O food digested and utilized in not pn>>
inrtional to the expenditure.

Alimentation may be insntHlcient; 1, by diminution in quantity; S^
iiy innffleioncy in qnnlity; 3, it may bo sufflciont in appenranou, both as
mpects qnnntity and quality, bat' prOTc insufficient for imrttcular reusons,
(■erbid intoh-niiKx-, diseaBO, convulcHCunee, a^u, sex. climate, season,
ucniN% efeo<).

!■ & genoiBl way the effects of inmiffloiont alimontatioQ, so well de-
■nbtd hj Boochardat and I'hosKat, are as folloivii: 'I'lioro is a diminutioo

Kedots. Compoimtiv* Tabl« of Uie Composiiion of Food* and Drinln.

68

UBEAtiiB OF THE STOMACn.

in the w«igbt of the body. According to diosBat, dtAth urrircK when
thfl weight of the l>ody ie n-daced by -iO pt-r wut. of its natural etandurd.
First thp atiinials prnw lean; the muscle* losP tlioir atroiigth, mid become
pale; the si-cix-tioiis dry up more or leas rapidly. In some cases buuger
makea itself keenly felt, in othcre tliid mnae is totally ubolished.

At tho sami? time, circulatory and reepiratory distiirbaacws arc noticed;
the beatings of tlio heart nre nnfooblod, and tho rwjpinitory movpmcntfl
are dimiuiKhud; tho tcmpcmturo of the body is lover&d; it may fall ns
low as 90" F.

Tho modification which the blood undergoes, ftocording ta Bocqnerel
and Rodier, are aa follows: 1, tho quantity of water augments considora-
bly, at the mme time that the Holid mattent which tho blood hcilda in soln-
tioii diminish: "i. diminutiou in IIk- ([uiLntity of globules (130 grnmmwi.
110, lOU and even hss); 'i, diminution in ullfumen, which descende from
80 gramm*.'* to lio. mid even 'lO: 4, fibrin mrely dimimslieii: 5. tho in-
oi^nic salts also nnder^ diminution. Thow dtffcroiit mwIiiioationR ex-
plain the dropBiL-s. thi- homorrhugcB, the anaemia, which m often follow
iusuQictmit alimetitiition,

Sometimoe delirium, agitation, and hallucinations are observed before
tho individual falle into oollaiiep, or is oarriwl off by an intercuiTont dis-
wisb; an acute ga.*!tn>-enteritis i» often the i^anse of the fatal temiination.
The offocts of insufficient Blimuutalioii make themselves felt, more or Ic-as
nipidly, iiccording to the l^;c, oex, and habits of the patient. Thna rnfanta
euoc'umb first. tl>L>n old poopli', thoti adulU.*

InKUfficiency of alimentation produces diaastrons results on the utom-
ach; It frequently detcrniiiRis in those long deprived nf food severe pain
in the regioit of that organ, real gastrulgic ily6i>cpEia« that arc very dis-
troBsing. I think that we are to look for tho cfluso of these dy^pcpKiiu; in
a tact pointt'd out by SchilT. This erjieriraenter, oontnirily to the opin-
ion held hy the physiologistt. who assert tliat the giurtric jtilce U secreti'd
only wlicn the alimfub pcnetmtea the Btomach. maintJiina thai if it lie true
tliat in a fiistiiig animal the gastric juice does not show itself during tho
first houfB of iibatiiienee, it is none the leas certain, however, tiiat after a
certuiu time this secretiou does api^ear on the surfar.o of the mucous mem-
brane. Now it iii probably to the presence of this gastric juice when
there is no food toabsorV^it, tliat arc due the {minful sensations experienced
by tile patient who is subjected to inRuftteient alimentation.'

When food is taken in too grout quantity, there arise troublee of two

• CoSlard de MarWgny, Exi>erlm»inta.l RMiearcltMi on th« flffopbi of Abnttnencc.
Jour, iltt Pliys. ik- Ma^vnilie. 1S3)*, t. viii, Hehray, The Innuenc« of Ia!<iilUi:ient
Aliiiient.itioti on llir Aniiniil Riinoiny. (Tliwe ilr Piu-in, I8SU.) Piorry.Oa Ab-
)>(iiiciii-i>. laititlleioiit AiinientJitlon and otiier Dn,n^i>ra. (Jour. tiebd.,l«3U.) ClitMKats
Ex|)enmcntnl ]I''s<-ur(.-hc.s on Inaaitian, Paris, 1844. Boucbordat, On IiMufficient
Aliiiwiiluluiii, Piiria, ltU2.

ALIMENTATION,

69

kiadi: flrat, acute sTraptoniR constituting cnmmon iniligostioti or aoute
dnfepua; sevood, disturlKiiices of a slower order, nnd siiprvening afbvr
wme time a« the result of too abuiHliuit alimentation. Sclnff tiafi given
ftdHi and prv^isu oxpluufttion of tlio*.ii facw: lio lias shown tliat tlic flow
of^Btric juice is not alwayii pruportiunal to tlie quiuititv of alimonbs in-
ftUA. If it is true tbHl tbu «!ert<tiuii of tlii^ jiitot' uugmoiiUt at tbe
mooNQt of t]ie repast, it is cert-tiii aI»o that when there is too large a maas
of ilimcQt&r; nuittors in thu etomach, the eucrotion U ixm\n:tu\oi; and in
oricf to repi-oduce it, it is notx-ssiir)- to intrmhirc* iirtitir^ially hy the rec-
tum or hy thu Yeins, cortaia sulj^taiicL'ti uUkxl ^teptf^jtiums, which posaess
tittpnipeity of reetoriiig the secretion of giutrie juice.

Vn»t happens to in<liriduale who inakc um of too luiofcisod u diet?
Tbe gwtric jiiice not biiiiig iiblo to digest the whole, these nxotiicod mih-
MiMai pUy the |mrt of rerJlaWe foivJgn bodioE, and acconlitig to tlie state
of (olNaiice of th« 8tomacli, they are rejected by vomiting or else piiss
dotrnwmrds into the intestines, provoking severe mliirky [niitis.

ApnpM of this fact, via., indigi^iition liy r^iswn of the intnxhiotion
into the stomach of too highly azotized fuutl, I have a remark to nuikt> bj
n; Dt digreasion. Wheu you t-vt a great fiuantity of uteat, you neud to
ttTtf as much na iKtwible the Heorotton «f gastric juice, and to »iigni<<nt
in n Bunsare iu acidity. Wo htive si-cn ttuit iK-ptogeiious mntterst promrilo
llii>aecreiion,aiid this pnuticai cmisequciice iiri<ii'e, Lh»t high livenoughl,
■t tb# beginning of their rt>i)a^t,. to take a gi-L^at quantity of soup. We
trtbere altu> the phydiologiml esplanatlon of a rustoin ^'itb nhirhyon
an probably all familiar, vix., that of taking oniou soup after a pLcutiful
■■al; also the habit, nanctioned by Continentid uaage, and doubtless
WnrfcJol in promolmg the acidity of tbe ga*tiic juice, of drinking a eer-
tiin (juantity of wine after a hparty niL'iLt dinner. You know, in fact,
t^l alcoholic heverngce do augment the acidity of tiiu gastric juice; heuve
brs sort of phywologicftl fatality, high livers are hard drinkers.

On the other hand, individuals who miike use of a non-nxotJzed diet,
Uil eat moderately, may without inconvenience abtstain from alcoholic
Xiionlants; and here, gentlemon, there is justjlicubion for the gnmnd
(■km hym cvrtuin Anierican vegcturian tempcran<-e sect, which, in in-

tnlcating abBtiueuue fruin arduut spirits, han uW suppreuwl the use uf

xnimal food.

Bat, to return to tlie suhjoct under oon«)dcnition. I have given yna

Uk eX|^»imti<>ii of tQdig(.-Htion u trnpula; th« same explanation is Appli-

I to the dys|)epsia of high hvers. Tills dysjK'pgta rvaidtj! froin two

ices: on the one baud oxeessive fatigite of the niRi«ular and

■aocMU coats of the Htomach; nn the other, irritation of the giwtrie and

iolortiDal mucous nn<mhrauv by tbe prcs^uoc of snijstances not peptonized;

oD of which nianifeicts itself hy au atonic or irritative dyspepsiUj so fro-

forat in persons who are addicted to table excesses.

70 DISEASES OF THK STOilACH.

Tlicrc w another causi- — indirect it is trnc. ncverthelesB mil— of d]
pepem \>y e>iiperabiimlaiit iklimentntioii; unmely, ibe prceoiice in tho blood
ot ail escMB of uric acid. In fact, the uric diathesis, whicb uriaes from
cotiiiK an PXCPSR of nitrogenous food, rleterminps, ni? yoii will »w>, gouty
or arthritic dTBjwpsijw in [latiwuts affected with this diatlirfiiK. ITciioe
then, M & means for avoiding affectiona of tlie stoniatOi. yoii should iVTum-
niend «obrioty, and without going so far as to ordt-r the severe regimen ol
Cornaro, it is proper nevertheless to regukte iu » sago and ru04)erate
manner the (jnantity of ulinionU which one ought to take each day.'

vVftcr hnviug had soiunch to 8HJ of the quantity of olijm-uUt, I come now
to a ctpneidcmtton of their quality. It is not vaongh to introduce into the
Btomaeh a corUin ciuantity of food-materinU in order that they may
gervc for nutrition. It in necextiary tlutt the HubstaiiceR ingested sliatl
pouKMt nutritive qualities, and the very fact thfit an individual lims filled
his Ktomach with victiiala and hoe allayed hia hnnger. in no proof that be
hae tak«n adequate nourishment. N'ow this i^^ what tinfortunatciy hap-
pens very often in the case of our laboring population, where wo fre-
quently see men and women (*«jMtcially the latter), who. able to appropri-
ate but a email aum to the purchase of their daily rations, endeavor to
make «p in the quimtity of thoir food what it lacks in quality. Uere,
too, physiology gives us an explanation of these tturt&. Sohiff hiu* ]Hiint<Hl
out the mintake of bin predweMsors, and of Beaumont in particular, who
thought that all that it was iiccewMry t^^i do, wiw to touch or locally irri-
tate the mncoue membrauo of the stomach in order to svv the sccrotioa
of the gartrio juice utart, and this fluid ooze forth under the influence of
tlie irrilJition; liylias proved that if thert' in a iiL'crotion in thesL> cases, it
ia not gastric juice but mucus. In order to re-eptablish the regular sccn^
tioQ of gastric jaico, it is necessary to give di^cittible alimonti), and Schiff,
on cuu«ing Anj^ to swallow innutritious bulusee containing only silica, ob-
tained no K>(?rt!tion of gastric juice.*

In uxplKuation of the above fact it will not do to admit the opinion
of Blondlot, who attributed to the stomach u particular sense, the
digostivw eeusc, enabling this organ to secrete gastric jniee proportionally
to the nutritive vain* of the food intrt«lufHMl, hut we must fall hack on the
fact, before stated, of the pnnetnition of iXiptogenons siibstanct-s funiiahed
by the food itself. It is, then, easy to nndeTstnnd how it is that individuals
who ingest a great quantity of sulwtancos having little or no alimcnUiry
value, thereby determine a profound irritation of the mucous membnino,
and suffer all tlio eyinptoma of irritative dy8]M»paia. Every day, guntlemen,
you wilt hv witncsHc» of cases of this Icind in our hospital wards and'
especially among the female {Miticnts.

But it is not ouough that the alimentary subBtjince shall present a
sufficient nutritive qnality, it must also be ot pure ([iiiillty. not ini|)aired
by cliange or by adulterations and faluiflcatious. I ciuinot here enter iuCa

ALIUKNTAIIOX.

71

I

detaOs of thiii question tit tlie qnality of aliments, and their MsiGca-
liou, and shall have to refer you to your sixx-'ial truutJaL-a arnl works on

Itiinot enoagfa bo liaro determiQ^l llw qufiTitity and qiinlityof foodn,
ititklBo neoeeeary to regnlnto with prr.R{»nn Ihv time for mc-alB, mkI tl)e
nlBml Iwtwoen thvnu [jf<t lis examine » little tJiiu {wrt uf the quL-nttion.

Tbednmtion of tbcgiutrie tli^'stion doiit-ndson BeTeral circumfituiicui,
and espodallr on tbe natnre of the alimeiita inln>du<>oil into the tdnmaeh.
tr* hne alnswly shown that in the riigostion of meat, the alimentnrjr
Moi cannot jass the pylomA till it is rcdnred to the slat*' of pulp under
tlie tsfiaenoe of the Rhemiiail and mcLihanical action of tlie stomach.
TkoB, on the other lumd, eubetancea are introduced which are not iit-
hefted bv the jnices of the etomach, such aa vt^table matt^^rs imd tatM,
l^cnjonm in that Yiwius i« longer. The pylonw, in feet, lata itass only
iknlMtanceH which arc r<.'dtt<;4;d to a »emi-!iquid Ktutfi by the BiomoclL
(roienJly thcjw aliiiient<< remain two or throe honrs in the cavity of tUft
dnaach, when, at the profier iiJonu<nt the contractioua of thU organ xag'
mm in iut^DsitT, and force them into the intestine.

It is necemary, then, to allow an interMtl of at Iciuit three or four hoars
htvten meals. I know, however, that habit haa a ^-at deal to do in
TtffKi to this matter, and you will sometimes see pcreonti who Imve never
tODplainod of their utomnelix tronhling them, and who ncTortlioloss cat
Wt ime mml a day.

»1d tbiR connection, j^-ntleniun, I can Init cxprene the regret that the
lagtaiM of cor tnodem life have oMi^n^d iie to abundon the L-uetoni of our
fcthm, a coKtom followed to-ciay in Germany, Switiwrland, and America,
aid whicb consista in having the principal meal of the day at noon.
Tbare » another point wiiich t^^u cannot loo much imprcntt upon your
^Ijpepliee. via., the Importance of regularity in mutls. -Tltia is a vital
BHtlarf and ono may aiy in '.ruth, that in our profcaHion the jpvaler part
of the dyspopdis from which medical men »u(Ior result from two circum-
iteHTc, irregularity of mcaln, and the ar^tnty time devoted thereto. It la
tMttttmgh, in fact, to Imve regular houre for mmis, in onler that diges-
Udt may go on well, but the food mntrt also be thoroughly and slowly
MMbcatod. I have already alluded to the riecuKsitv of mastieatiun, when
^w ki n g of the digestion of amylaceoas matters, whieh have to undergo
tlie acbon of the tiailivit.

Thwefore, gentlemen, whenorcr as a result of their occupation, or for
■OT Mlier mwon, your patients are nnable to give bnt a limited time to
tbrir OMMlt, recommend them to make use cliiufly of a^tized and fatty
i&Bcata which for their digestion liicve no need of mlirary impregnation,
vrgb lafwtrtntly the thorough ninKtiejition of foo<l. How many dy[ipc]>tini
thoKUv, who are nble in araign ae the origin of their gastric troublej" no
tAaeaOBo but iuetilllcient maatication. In old peopie particularly who

72 DISEASRS or THE STOMACH.

are dEtprired of thoir tet.'th, this tnability to moeticato is a fri>qituiit caiiw
of disturbanco ol th« digestive functions. It is well, then, when dcalinx
with sut-li jiatii'Dts to ineist on tho nt^'ccseity of falso toulli. wl>i>L<]i are often
good giibstitiitea for tlic natural Uwtli, but where the artificial ]>]at«B win-
not be wum, thvrc in no ultcrnutivc but to insist upon the food being
taken minced or in a 8tat« of pulp.

If etitiiig between ihbilU mid irrpgularly is often productive of dyBpop-
Bia, it muitt bo remembered nevertlif]t«» that Llien* art* ctrcumist»nc<(?«
whore frequent alimnntiition utidur judiciotis direction coniditntat the best
moans of curv, and UrowuS^quard, in hia hiut« a» to the regulaiion of
diet for dyspfptics, ailvisutt, lu) tlie hoet nay of treating functional troublpa
of the stotmifh, that food »ha\\ bo taken, not at the ufiual time, but vv«it
hour oi the day in small fiuantities. [In di»eswa where the Hccretien of
gastrin jnir») is nil (or iK-arly do), tho food muist Ix.- liquid, t;n(di as niillc
Uid broths; here the rcUunee nwist be on the speedy absorption of ali-
mentary principloH. Thie is also the treatment of ferrore, whvre the digee-
tive fuiiuliou is 8UBpended.]

Such are the mica which may bo laid down with reference to tho ali-
muDtary- n-gimou, tut do not forgvt, gvutlemen, that tho dietary principlos
which I hiive just formulated can nerer bo applied in al! their rigorona-
ness, and that tho etomitch. :u Fonssagrives i<ay>t. 8cinictimL<« revolts against
the arbitrary fiat of tho physician. The idiosyncnutien of the digestive
funrtioHB aro often i-L-markablc and uniKicountahlc; what agrees with one
dcMLgrecit with another, and u kind of food reputed as indigestible, is
Bomctimet? home with entire impunity by a very dulicate storunub, so tliat
the proverb that " the most digeatible food is that which one digeata beat "
is simply a truism.

As you pursue your profession you will continually meet with the
most (.-urious iiTL<gularitiL*s in tlu.' [H-rfurmunt.'u of the digL-Hlive functions,
and you wilt need to study the whims and jireferences of the etoniaclu
of your pationtfi, and endeavor tri make your prviicnptians Imrnionize with
their individual prodiepositione.

All theao reatriutiuii!! whiuh I have pointed out ought not, gentlemen,
to prevent you from a rigorous inculcation of hygii>nic and dietetic princi*
pies, and I am quitt; of thu opinion of ITamelin, who insist-t that erer>'-
thing should he fixed by rule and Htriutly enforoed. Do not yiold to tho
caprice of the patient; endeavor, on the contrary, by tho punctiliousnesa
and Qrmiicfis with whieh yon lay down your diolL^tic regulutions, U> make
ynnr patiinit understaml the capitid iinportancL' you aasign to tliem.
" Whiit wo take by ouncw and ponnds ought to affect us as mucih as what
we take by grains and scruples " uaj-s llnxham. Thoao wouIb. gentlemen,
thi' phyBldaii ought always to have in mind when laying down the
principlus of the alinientanr' rej^mtiu. W'v shall rvturn to thi« subject
when we come to tho jiarticuhir treatment of the dilTereot affectjons of
thv stomach.

ALUlIOiTATlOK.

73

NOTES TO L^CTUEE IV.

' Daring tweiitr-four Ikoiirs an ndult mnn Iowa '^0. 15 grammes of nitro-
II, 240.(io of carbon, and 30 grammes of salts. Tho most simple t'om-
BHA^on of foods which ennblctt him to rcpuir thcxf Iojjsch ih a& followa:

GistniDes. NitrdKiiti. ('urtion.

.300 which ia equivalent to 10. + 44.

. 600 '* " " O.-iH + KT.SO

BottorHndfiiU, 60 " " " 0.35+ 50.08

Bwins, . . W " " " 2.00 -f SJ.flO

But this ia oiiIt haroly niifflcient to mijiplT the wantx of the economy,
and if hard work is to bo clone, this quaiitity'mast be incrMaed, and tbu,
(cconliDg to tiautier is the " rutiou. of work:"

OrkromM.
Kest 54-1 ) Nitrogen.

Bread WMi > which is equiralont to 28.74
Fat 93 )

CarboD.
4A9.00

TliaM, a<?cor(l)itg to La Porte are the alimentary rations of the French
prnnntc:

Vtarltf ratio II n ofafnrm lafmrfrrjf I'aurhise. — Brviul, 390 kilogminmeF^:
[wUiocs, 90 kilugT:tnuU4.'« : bi<itiis. Sh kilograniniee: park, 19 kilognimmeH;
"i!, 10 kiloerammes; w-ine, 1^3 kiloprfimmfs; total, ''iO kilogn>mmo«.
'J^ng per uay: 1 kitogrammn 1)72 grniiiim-i'. or 'i'i grammes of nitrogi-n,
^Kmmm«« of carlmn, and 80 gramtnes of fat.

Vtarlg miioiis of a laborer of the .Svrih. — Kye nicni, wheat and harloy,
440 kilognmmcs; pum, 20 kilogrumini.'»; potiituiv. ^^lOkilotmimmos; beuf,
3* kikigTammtra: pork, 10 kiIogranmu:!<; milk. IfiO litra.<<; bulLvr, 20 kilo-
cnmucs; bci<r, :16S kilnj^rammti*: total, 1,3117 kilogrammoK. ( tiring per
•lifln: 3 kilogrammes 74 grummcR, or 31 grammcji of nitrog«ii. 710
tmaanx at oarhoii, unci JOS gnuiimos of fat.

Annval rations of a French autilier. — Wheat bread, 3.")6 kilogramme*;
BUM* OS kilogrammee; fariiiaoeous and other vegotahlea, 73 kilo-
liuisuw; total, 531 kilogrammes. Giving par day: I k itogniniiite 4>7
(lunmps. or 22 grammo8 of uitrogc-n, 328 grHmuR<a of carbon, and 25
yninme); of faU

Aniitiol nUmuofa Fttttch sailer. — Bread or biscuit, 587 kilogramn)e<;
Dirai of diflonrnt kinds, lOH kJlograrnmes; diy legumes, 117 kilogrammes;
fat or bntler, C kilogrammofi 205 gnimmes; wmo, fll litres, or brandy,
nm or irhiriioyr 21 litres; coffoo, 7 kilogrammee, 300 ^mmw; total,
^16 kilogmmmw 600 grammes, (living per day: 2 kilogrammee 500
gnnunca, or id grammes of nitrc^n, 40li gmmmea of carlton, and 41
pamaui* of tm,L*

* De la Porte. Ilrgtone of the Table. Paris, mO. See also Dujardin-BeaumeU,
IMluniujiirc di- Tti6rdpcuUqu«, Art Aliment

74 DISEASES or Til E STUMACII.

' Vegetable mattci's do not comport tlienisolTes in tlic eamo maun^r aa
Rnimsl inattors in c1i|i;r>Htion aii<H nntrjiion, as Vnit has rIiowd. Thii«,
while in lh« purnivornus aninrnt the tiiiitt<>r8 nigesteti iirrivp nt the* rectum
oight<'pn hours or more after thn meni. in tho lierbivtmi tint vcgotible
mutturs rcitutiti iti thv intcstiiKt oftc-ri (or i-it;Iit ilu>8, uiui it gtvaL ]mrt is
not utilized. The rarnivora void but a small amount of yxcremunt, the
h«rl»iYora void muoh mure.

Voit h&a eliown us that a doc fed on nit-at, for every kilogramme '>f
weight, will piw« an ounce of solid excrement iier day: a man weighing
lou kilojjmmiiii'ti. u'ith n. luixtid diet, will void two ouneuu, nn ox, for evety
100 kilof^immori, 'iO ounces.

The investing mombraiie of vegrtehle subfttancoe — cellnloBe — dops not.
eaalr undergo diB»nciation, and is nut little digested; it is this, in fiict,
whieh renders vegetalilea bo indigestible. In this oonneotion, the follow-
ing experiments of Adolpli Muvvr Imve an intereet. lie took u dog Hud
gaxe it for nine days I.OUO gmnimes of bread u day, rcpremmtiiig 636
giumnieB of dried mutter; there were Toided 70 gmmmes of dried exero-
ment. The equivalent of the albumen of the bread van then given under
the form of mcnt. aud the elarch wtw rcplat:^'d by it« ivsjiiratorv eqiiivu-
lont in fat (2.4: l); the dog's ratJons uow eonsintud of 3T7 griijnnie« of
meat and 134 of fat; there were voided only iu grammea of dried exere-
ment per day.

The experimente of Meyer have thus shown that starch furnishes the
grcaieRt fimintity of excrement or waste rosidno of the simple nutritive
oloments,

FmnK Hoffrnann hoK remiirkt-d th.^t if cellnloHe be added tn a mini '3
fond, to th« meat, for iiistaiif!«, more exrrements are voided thjui if meat
alone be eaten, .\coording to Mevfr, tmiii breail, whieh eontaiiiii alt the
etunieuUt of wheat, dotennineti a more prompt eval^^atjon by the vury faut
of the indigi'stibJe cellulose which ia combined with it. li is not so with
ftlie flour wheuten breiid.

As one will readily see from thcBo facta, if b quite poasible by the in-

Zction of the excrements, and by their greater or loss quuiitil^'f to tell
kind of nonriKhment a man is fwl oil

With regard to the mloption by man of a etrictly vegetable diet, Bar-
wull hiiM obBcned that in individuaU whe rigT>ronKly abstain from animal
food, and who are called vegctariaiis. the vitjdity of the tiNsurg is very
low, and .wrginil uperatiouH performed upon them are likely to be fol-
lowed by gi-ave results; cicatrization tuki-ii place elowly< and thvre ofti-n
superven*.' abundant eiippiirutioiis or even sccundai^ hcmorrlm^fcs of con-
siderable intensity.*

' Schiff, as a reitult of numerous experiments, hne tiscertained that it is
from nine to mxtuun huum after a healthy digpntion that ihi' whIIk of the
Btomach contain their minimum of pepsin. In dogs subjected to fasting
it is not till the end of 24 lioum that tnere appears an approoiablo quan-
tity of pepsin, but after 4a houre it ia poMibk- to detect peptiiu even in
greater abundance. »or ia it necessary lo make ati infusion of the Ktom-
aeh. forviBart hu£ observed tliat iii ilogs dead from starvatinn, the
Btomacb was gorged with pepeiu, jut^t as if the dogs biul been killed in
full digestion.

ALtMEXTATION.

70

g to SchifF, iho HtUTniK-h sitiinitoa itsolf with pcpin Ht tbo
I CEpeiee of tlie animiil tis8iii-8. am) ivheii after a pmlntij^d fast Llm uiiinmlB
enier, m> to speak, into auto-digestion of thfitnBpIves, the rraorbed ele-
ments of tho or^^Dism net a[t4?r tint nmiinnr of true ptiptogRnooB sob-
tmoet, and cliat^ tho stomach with pepsin.

'Conmro (l46'-;-i. ">(;«) (ifter Iiiiviiig iitiniiK-tl tlie age of forty ;e«n, and
conaDitted numerona exoesaca, eiiUjectcU liimaelf to a very severe hyp«iuc
ji regiaiea: he took twelvi- oiinct-e of mliii footl |)pr »iiiy, and foarteen
I oimcM of wine, IK- lived in this way ti> he more tlmii » hundred year*
I M, ind !ii Ih*' age of lijjlity-thri'o iniblishoil a book on sobrjotj'. {JHx-
^ttrtiHtila fi/ti tohrin, PanAe. tSSS.)

^B TliiH ix tile war he expreitsrn himself on the stiitf^ of his hi-ulth:

^K " All thnw vho know me will certify tliat the life which I lead is not

a Jwt ttiid'languitjliiti); life, but li life tu ha|>}jy as one could wish for in

tbii world. Tht-v vill say tlmt I uin Ntill vi;^rou« uiongh to niouiit liorao-

lack alone: that! can not only iwcund with tirni dtuj) ii long fliylit of euiim.

It even climb n monntHtii: 'that I am always giiy. always in good spirits,

"i»ring all the pltwsurt!* of an honoat life. I tAke Inn^ walks, ann with

or terriers engage in the fatigues of the cIkisi*." He goes on to

that his sight and heariii<; art* rttill [K^rfeet at oi^hty-throevi'sn*, that

Dwnonr has not failed liim. that his teeth arc all euund. and tliat he

•leefaaiB well as he ever did: hisad^iincid life lirnl even bet-n blessed with

tmiHemuj yoonir children, with whoso sports he lores to engage. In Hue,

ho sttnbnteii hm pxecllent heidth, hia npc old age, and hia felieity U> the

can vliich for more tlian forty years he tiad taken of liis diet, reducing

UKqauility of his food (u,nd cnpHcially animul food), as he grew oM.

^Schiff took dogv. and after etherizing thetn from twelve to Rfteon hours
WIer ftfull meal, he tie<] the pyloniH to prevent the liquid seeretoil from
purinff iDto the tntetttine; then he intrndiK-ed by the (eaopbagiiR of tlinui
MUtUHMnd or pebbles in sutlicient i(iiiintitv t4>dtst«.'nd l.liir stoniiK-b more
vtenoompletely. It wim ho hk^ times {xissibli- to obtain from the stumueh
Ihiw or four dniebniE of an acid and timcottK lii|iiid. but it vias not puoii-
Ub to eanm the digestion, that is to ftiy, thi- transformation into peptone
Irj this liquid, of an appreciable uuantity of albumen. Sc-liift admits tlut
in certain cafieK he couhl compel ga«tric juice to 1» M;creted even in an
•nplj stomach, but it ie not newly formeil pepsin that i« obtained but
pcfBD with which the walls of tho stomach were ehnrged. and which nn
und st-epption pmvokcd bv an external irritant, has dissulvcd and bi-oiiglit
V) the snrTace. thus formuip a Httlc giistric juice.

la making his expLrimeuts UlondLr-t wiitj able to obtain by mechanical
niltotuni of tne etomtieh only from two to three dnic-hms of liquid minj;led
viUnnncoun mattere. when he o]it>nited »n the empty stouuu;h> but ho
•xnctimes obtained as much as three ounciM of ^uitrio juice when lie
vfitnlml on the etomneh full of food.

Conrisart hai* jirrfnrnu'd the same ex}M>riinonts and found that the liquid
nibctod in tho stoniaeh, after the most varied mechanieid irritations,
inmiiid only tnvc«« of digastive power.*

■ SrhtlT, physiology of Di}{<»tiMt, t. it Bidder and Scbniidt. Die VerdawuoK»-
«Ap iiQct tli-r HtoffwecJincI, IMS. Ticdmunn and Qimdia, Expcrimeobi on Dl-
IMmw. Blowllul, Tnul£ luialytiqiie de la iligestion.

LECTURE V.

ON HEOUtEN.

Sttmmaey. — Exardse — It» TTtility— 0>Tnnast!ra — Varieties — Swedinli
OjmJiarticB — Abdominal GymnaHticK — Tniining — PractJoe ol Works
of Charity — Influence of the Air— City Air and Country Air — Sea
Air— Monil Infliiencpa — Ulleness — C'oitua and Masturbftlioii — t'loth-
iug — Tiglit LiL'irig HUtl Tiglit Suspender^^HTdrotlieraiij — Sea-Batli»
— B&ths in general — The Excreta.

I HAVE told you tliftt under tlie name of nginien, w« understand, not
only alimcfnuition, und tho ruli<s ^'liicti govern it, but nltu ail other
hygipnic means whicti may l.te employed in the treatment of diBefisen. It
is tho etmly of those mcJinH icliicli we shall undurtuke in ibis lonturo.

And first, let us inqiiiruwhiit is tliv influuncc of exercise? It is of capi-
tal ini|K>rUiiii;i.', and.usClioiiml rightly aaya, 'one digests vfith his legs oe
well ft* with his stomach." Hence it is not ii!tog(*tIier owing to high
living, but to inaufficiont exercise as well, that we sec so many ptu-aons
jMMMWMid. of ample fortunbs wlio arc- »ntTiTera fi*om dyt^jifpsia.

In fact a great many people while making use of an azotizod diet, do
t4>o little work, or no work at ail; this di»pro|>ortion between exoBSsiii-e
diet and the trifling amount of labor performed is enough to engender
diseuM!. In siicb axaes. all tliut you will haVL- to do will ho to preecrilw
r«gaUr aaid methodical cxeroise, in order to aco the dyspeptic symptoms
vanish.

Recall to mind the patient who recently came to our clinic to t-onsiilt
us witli reforL-ncL- to a very oovcre atonic; d^T^pi-psiii; n'hi'n we iiitoriMgattid
thie man respecting the probable causes of his trouble, he explained, to ub
that boiug emplojt-d iu a railroad oltice, he could take no oxeroiw during
the day. and that duriiig the evening, being obligwl to balance hiBltooks,
he was compelkil to rpmain sitting. This, gentlemwi, is wliat you will
often v-itiieN< in the vase of clerks and book-kuciicni, and you ahould
bear it in mind when you have to treat snoh patients.

Bnt let 118 enter a littlo more deeply into this question, and se-e what
physiologiral experimentation teacheR. It brings tr> light thin interesting
tact, tlutt uljeuliitc ri'itow in ariimals. dogB for instance, immediately after
a nK-al, diminishes the activity of digestion, without c<us(icnding it, whilo
severe Gxcrc'ist* apptara. on tlie c<intrar\', to abruptly arrest the digestive
process. TIhib, when after having given n dog a heurtj meal, yon engage

OK REOniKN.

77

the rhaM>, and after aomc hoiira of exweaive running yon kill him
And open the stomacli, von irill 6nd <ligestion not completed. Thb fitct
haaa real importance; it ehovrtt iii cleftr light that after a cieal one kIiouIiI
i»itber engage in active exercise nnr In ali^ohite inaction, sntl in this
re{;Brd, the nap which snmc people ure in the hnbit of taking »fter their
mede. ii< quite u iDJahotis aud daiigeroiiB aa the forced labor which la
exacted of a man after a cupioua repast.

To combat the dyspepsias caused by the wnnt of e<]ui1ihnition between
tbe qoantity of food introilnced mul the Inbor huhituuUy pprformed, too
lam Aivere means; in thi? fir.'-t place, ^ynina»tic« tiitultigentk and
methodical It practiaed render great service in the treutnient of dyspep*
■aa, eepaaalljr those of young (wople, who, a» yoa know, are very subject
to foDctiooal troubles of the ntomach.

It is Dot (HtsitiHo to enter here into Uil- di'tui)is of gymnastici); auch
4ttul« yoa will find in the special treatises of Dally, Leblond. Bouvicr and
HiUairet. I can only indicate the gent-ral L'hamctt'ristica of these exer-
OM^ which you will often have ocawiou to verommend.'

fbirre are three grt^t varieties of gi'mnaHties, One kind, Rotnewhat

Olnplicatcd, is porfornicU with special appliances and constitute* tiifmnna-

tin trith apparatus, and ia thekind thut ia pra<.>tiiK<d in our Bchools and

colUfM, evoQ down to the present time. The means consist of ra|)e

hdden, parallel bars, trapezes, etc. Those cxercisoE derelop a certain

■fility in indiridaale, but they may Iw^ earried to i» dangL-nnis length, and

tbeTcall into play only a limited immtier of miiaelea, m thia method tends

■one and more to give place to a sot of gymnastic exerciseu or " move*

miti" which Ijiisnf' liiig for a long time* pnt in pmctice in the HApitttl

L im BnCinU, and which liave become especially popular in Germany,

^B lltii species of gymniutics ain be jiractised anywhere, and coii&itits in

^VWnacnts methodically executed. And in a rhythniical manner, move-

^K WMi, moreover, which call into excrri»> almntit mil the iiuiseiilar groups

^■of llw economy. This method, by far the best in my judgment, docs

^ViotdMnand ^v siK-cial appurutus. and nmy be undertaken without incon-

jV MiiciuMi hy adultH as well as children. It ia in use to-day in bonnting

\ KftooU a&d in the army, and will mtisfy the hygienic requirements of the

pwlor number of cases.

Than b still another kind of gymunstica, called Swedish gymniuctitM.

I Sweden occupies, as you know, from a gyntnnstio point of view, the tirst

plMe among the countries of the earth. Under the inspiration of Ling.'

il has inatitnted real schools of gymnastics, in which the profeaeors

■tthodioalh' demonKtmte evorything that pertains to the exercise of the

body. The exercisesare ba^ed on the following principles: when-

yvnt desire to effect certain movements, if the execution of those

nts K' opposed by any body, there is produced in the muscular

tliat has U) overcome the obstacle, contrnettuiis more or leaa

uner- A

78

DI8KA8K8 OP TIIK STOMACH.

gtttic Thpsc Swodiah gytnnnstH, then, make their patientc perfonn oertuiti
moTement^, while at thc> hhiiio tim« oppoaiug to some extent their execu-
tion, and it is hy tlie multi plied aud varied npplicntion of these meanatliat
tlioy develop nil the muscles of tho ccoiiomy.

While recognizing t\w great utility of this method, I think that if it is
likely to give good rirsultn in niiidutilur disoniers. it is not superior, from
the point of view with uliicli we are now contvmiMl. to the metliodicailj"
piwstieed movements constituting tho kind of gymnaetica of which 1 have
hoforo Bpoken. MoreoTer, tho Swedish mode di^mands the pTcwrice of a
master b}' the eide of each performer, whieh of itself makes thia method
more difficult of general adoption.

But the Swerlisli movement cure hix» receiTed a etiil further extenmon,
and h(i8 been applied to tho treatmout of viBceral ftffectione, and a sort of
vuireral pymnaMiex has hiwn devised, cnllRd liy the imme of aMtmiinal
kintftnthcrapi/, and Nvcander of Stockholm had indicated tlie princi])al
movumi-utB which one tdiould oxcoute to coiiihat dyapepsia and constipa-
tion.

As muoh, gentlemen, as I am in favor of gymnastici mothodicnlly
practised in the mnnagomont of dj-spepaJa, hv so much I am shy of tho«e
alMlnmiiial gymnastics which pretend to act directly ou tlif »totn»ch and
intL'stinuH, und 1 udvia' yoti to wuit befoi'e adopting, as a pnrt of your
practico, thoso paeseiii, those taps, and those shakings which cbaroctorize
this gymnastic system, till this kind of treatment has furnished results
scientifically determined.'

Yott will, then, recommend to your patients to practi&u moderate
gymnoetio exercises. You will insist on their attending to thi? before
muaU, once or twice a day; and you can, if you ohooso, augment tlie
muBcular exertion by adding exercise with dumb botU of rnrious eixes,
which hy their weight enable one bo improve and duvolop tho power of
the nmHcIcis.

Thece are vnriouB paatimcfl which conduce to t)ie sime end as gym-
nastics, I ri^fcr to fencing, swimming, rowing, etc. Uut it inuit bo home
in mind that these physical exercises develop almost exclnsively certain
muHcukr groups to the detriment of otliL-rs, licni:c 1 givu the preference
to gymnueticH; nevertheless, as the former arc often more enjoyable to the
patient, you wU! bo obliged to sancuou and order them.

TIiL- English, who are far ahe-ad of us in the jjhysical education which
they piovido for their children, liiivf long indicat«d the course to pursue
in order to attain the regular development of the bodily foroos. They
have ogtublinhed on sci(Uititic and medieul foundations quite a system of
rnlc8 described under the namu of Irainmy, having for its end to sub>4ti-
tuto for fat^-a cumpanitivcJy uaeleai ttnnc of the pconomy^ — muscular
libre, and thus to give in the least possible votume the ^rvuteat iiosfiblo
muscular energy. 1 Imve not time to cuter into the details of this quctt-

OK BEGIIIEN.

79

I

I

limLvhtub Boucliardathseao well dncMnted in hia treatise on the training
of Um pugilist. I con only tntco the principal points.

ThA tnuningconmsls in tlu^uclminUtration in Hnull bull: of an axotizod
ud tiuLritiouH ilitft. and in i;m-U)iii gnidi'd imd [n-og^ri"«!ivt' t-xeR-isfB of
thrbodv; «t the tiame time the functions of the fkm are energized by
Irw sweats and by liydrotlierupy, aud thu digustivv tube ut act<td upon by
oft repeated purgtttions. *

It a after nndt-rgoing ttiis training tlutt thu Englisli feel themsolTea
|«l«red for those priw cont^fsts of strength and agility for which thvy
are Ml famous, from jotmh and eportfi of variolic kinds to horae and foot
now uiwl rowing mfttohes. Oiir own comitrynicn seem to bnvo little
fmuJiuM (or theft« ii[H)rtive esurcineti, uud it in only oceaslonittly that wq
■w ■ few penaoM giving themBelreg with ardor to tfae«o lieiilthful and
wdnl gimics. Ilenoe it is that you mnst not hp afltoniehed to meet with
antiu^. should rou ejioak of gir-miiasticf to your i>aticiit«, and douo arc
iDan'n>lDctant to engage in t1i(>s(> hGiilthful practice-i titan our young girlii.
Tlw in in fact a fault in the wluL-atlou of Uie fumaltw of our country.
Wkik iu England all young f(?male» in ci^rtnin ranks of society engage
vith ardor and alacrity in horiwluck riding and other inrigomting cxvr-
1 metf in France, on th4> contmry, thesR sports arc held iu little repute
•itn ia the ooantry, and gymna^ticK are ton often considered distiist^fu]
ml weariioine.

Veooght, thvn, gentlemen, to encouragu with all our efforts tho in-

tmdnction of gymiiaatlca into the (•ducutioii of our youth, and especially in

xho pritnaty dasses of boys and girle. The young girl has as nuich need

M thne axerciseii an thn Imy, if not more; she Jt is who, when tihe lius

iUvbcd to tho agf of woiuunhood, will be tbv mother of the coming

flMKtion. and wt> should a« much as possible favor her physical doTeIoi>-

■miL Fbrdoii me this rligres^on, wliieh is not so renioto from our

nVfset aa you might suppose, for dygpepeia in the man as well as tn the

waoun nften deiwnds nn want of nsercise.

I Cbomol, stnick by thu iiifluunce of want of muscular oxerciso on the

^■ieteloiHnent of dyspcptriati, struck also by their frt^qiinncy in tlie wealthier

^HjluBna who have the most leisure, empIoyiHl an ingenious method to

^BlDalMt tbew affections; he txtuitnelle^l tho rich to works of charity, saying

V> thrf-m; "perform deeds of charity, hut do them yourselves; go and visit

tin'tkk, interest yourwlres in famiiios that are needy, go into their garrets

m (vilan, and succor them, and while doing good you will by virtue of

^bhii my viertion gut rid of the dys^icptic troubles that torment yon."

^■tos rngp adricc, gentlemen, is worth romemk-riug. [To not forget to

|)Tr it when oocnsion ofIor», hut remember as well tho importunc« of

^^^iJT t>!terfiw4 to young [>i>op)e aud itistfat on Uieir [terfonnance.

||H Uut-iloor air ha? an influi-nce as important as exi-rciee iu the dcvulup-

! nut and cure of indig(«tion, and it is a matter of common observation

I tlisl d,rsp«psia is more frL-quent in thu city than in the country.

80 DISEASES OF TIIK 6T0MACH.

Ton Icnoir, moreover, tliat for many a dyspeptic, all that is nocoseary
to prociiro timolioratioi) of thi> eyniptome and restomtioii, la life in ihu
open air, hhJ I tiiivp alrraiily mdicatpd to you the infliicnce attrilmliiljle
to country air iu tht; >Iitk and (impo Cttrue, so Yimous in the trcatoaenb
of d^'spepsios.

When an mliabiuml of the country comes to our cities, ho Hntierjrf>p«
a veritahle arclimaiizatioii, which affects eBjieriallj the digestive fmiL'tions.
and thin results not only from thu atmospheric conditions in vhiclt liu
finds hinisctf, but nleo from tho modificatiooa in Ibc alimi-ntury iv^imrn
to which Iio is subjected.

In the city, where a richer and more highly axotixed diet is enatoniary
than in tht- country, we often witness the development of a scries of dj-i*.
peptic troubles which iu the country, despite an alimentation often in-
complete and inmifficient, the laborer itlmoet never estpprionccB. This
difference results from the quality of the air r(«piri<d, an air whicli is mlit.
brinus in the country, impure and unwholeftomr in the city; and if in the
hospitals you ei'i- nffccitiiniH of the atormch resist our mndes of treatment,
although tho patient? nro mnde to conform to a well-directed dietary regi-
mon, this depends espueially on the insalubrity of the air whieh they
breatlie. In the open air the appetite is inoreawd, the digestive functions
become invigoruti'd, and if you add phy»ical i-xiTciBc, in many cnecs the
dysiHipsio will jjet well undet this double influenoe.

Si'a air luiu aIso n favorabio effoet. Wlien the inhabitants of onr lar;^
cities go to the ses-eide, they find their appetite rapidly improirfd. and it
is often the caao that they then pass to thu other extreme, and eat far in
excess of the wanttt of tho eystem. TJulees pro|Kr self restroint is -aeed.
Boon dyspeptic troubles HU|K.'rvone from nigeation of too great a quantity
of food, often of an indigestible kind. Such facts as theao aiv ofteu
ohservcd at our watering pkcps during the acuwm when strangers flock
thiUit-r for aea air and sea Uithing.

]Iow are we to explain thisfavonihlo action of pure air on the digestive
functions? Tliis is a question which Charleu Uichct liae well elucidated,
and which ir cxplic-ahle from what is knoivn of the action of oxygen on
the Kastric digeation.

The production of the acidity of the gastric juice is one of the uiost
interesting ]>oint« connected with the secretion of this fluid, and pbyBiolo-
giirta have labored to gnisp the mechtinism of this iwcretion, Claude
Bernard, by hia ingeiiious cxpurinu'nts hae ehown that the* acidity is pro-
durcd chiefly at the Biirfacc of the etoraach; analyiing more compk-toty
thiu phenomenon, Chark'x Uichct has «hown that this acidity is due to
the general action of oxygon, being the result of a veriUibio oxidation of
the juicex Mccrotod by the gnstric glands.'

These glands lake from thu capillary network with which tho tiiomach
is 80 richly provided, and which is always tui^id at the moment of digcB-

ON RKOIMKN.

81

nohiWo quantity of oiygen, «n*I this oxygpn, derivH from thp
irn'cs lor the oxitlation of the giutlric Juioc. Wo Uuve h«ns you
iw, ft fact of greiit importance. It uliows you the direct infliwnci! ot osy-
gM in the aoiitification of tho finiitrio juict>; it (.•xpliiine liou- it is tlittt
people who a]worb by the lungs un Atmosphere wliirh in mi wholesome iiuil
toraJRcirntiy oxygensWil, oxjierifliice all tliu oviU which n-siilt from a pmtp
qnlitj of the gastric juice 'I^hoso poraono, in fact, suffer all, or noarly
•11, the tninptoTDH which chanu;tori»> putrid d ppciM^iiM

Modemtv anil rv^ular fxurtridi-, wjilks in thu oi)vri air, sojourn iu tlie
twntry if it in imeeMv-, sojonni at the mountains, or at the wasidc: — thew
Mistitute, geiitleaien, as yon now soo, vory important elomants of trcat-
Bwt for th«> cure of dyBpopaiiw.

Certkin moml inflneneot notahly prtMliapose to tho d^relopraent of
ions of tlic Btomocb. You are well awarr how emntJonal nud moral
OB aBeet tbo appetite and digestion, and in this r(>gurd, guntli"-
, I have only to oal! to your rcmcmbranco your primary and tina!
miiltutionfl, luid the lo«t of appetite which attends these trials, mid
vbich is fortunately of traimiont dunition.

I>isappointmentf!. griefs, violent gxLssions, have a mnch f^reater
nflaem^e, and yoa may be sure that in very many co»C8, when you cannot
tAeve the deprewou of the patient, when you cannot ttfisua^e the grief
»l»ich he is experiencing, or drive away the wirt* which devour him, yon
on do notfatn}; to bcnellt hiit etomaoh nffeetion. What \n wanted is a
ind«f moral therapentice which ohall ^-ary with tho needs of each CMO,
It dofn little or no gnwl to prew-ritio mo«lieine under such eireumatanora,
the whole pharmact'Ulind arsenal is impotent; the physician niliMt uini
jki^Kr tluin tbiis, and biuiii}; hin eouiisvts on oonsidemttoiis thiit t4>Tid to
his inticrit, he mntit endeavor to act on the mind, or moral nature;
Ui« wne time wiug such means as arc cidcuhitcd tittle by little to
MiStnKte the painful rcmembranceii, and bring peat!« t» the troubled
^t

la such caeee as these, diversions of an agreeable kind, exercise in the
"pm ftif, joamcyings, entire change of eecue and of hftbiU, cironmntancoB
often ao oflicacioua in the treatment of dyspepsiaa iii genenil, will givo the
kWreraltB.

Choinel, who htu traced with the pen of a mnflter in his work on Dys-
pvpBH thai chapter on Moral Influenocs, points out a fact of which yoa
hivt eartunly aniti iriHtanoefi.

De givw UB a picture of a man who, after having by long and iiicessant
tpflicition to bnnneaH snoooeded in smasKing a considerable fortune (nnd
IbcKimwuntatioa is a]>plicftblfl toniauy u mun who hiis had i>n eleratol
in the array, or at the tiar or lieneh), finally comes to realize the ro-
hicb bun been the aim of his life; he shows ud, I repml. this man
te bis arduous labor, bud always enjoyed good JKiilth,
6

82

DISKASES OF TU£ STOMACH.

tittle hy littJo his flesh and big spirits, becoming dygpeptic and morose,
and g(>ttiiig well on]y by reftiiiuing the octJre life whioh ho had relin-
quished.

Many timee, certainly, yon must have been witneaeefl of eimilftr iacta.
The phTsiciiin himself i» not oxompt from such n lot, and I cnnnot cite a
hotter example thiun that of Sir Astley C'oopBr. This ilhiFt,i'iQn>« phyeiciiui,
after Imviiig won fur liiiiiw-'If u Mtimtioti pro-oniiiioiit in English Rurgery,
after liaTing acquired a largo fortune, futigacd with the )u1x)i« imi>0)«cd
by an immeneo pnictico, retired to one of hie estatos, expecting to find
there a well earned repone and a «ihn and tninqnil life. IVofoiind
mistake ! Autlej- <'oij|X!r bucnmu iiicroso and mdaiitiholT. lost all enjoy-
ment in his eitrroiindings, and to one of hia frieiula who uoiigratulatod
him on his new mode of hfe, he said he was so miserable that when ni-alk-
ing in hi>< imrk, he woiilil look iiroinid among the ftiio tret« whifh iidonied
it to nhoose one on nhit-h to hang bimtielf. lie endeiiroreil to re«umo
his practice, but it van too Intc, he could not ri-t^ovor hitt health.

So you see, gentlemen, that both intellectual And phy»icftl inaction are
prodis^KWing canines of Triiich grout ae^^ount uliouUl ho made, »nd when
you have dyNiwptit^ to treat, do not forget tn infcifit upon their perform-
i]iK u UL-rtaiii auiouut of work proportioufd to their phyucal ]K>wcrs and
mental aotivities.

J hflTo gpokun of tlio paestona mid of moral impressions, I must now
Ray a few woiiIb abniit Bexnal relatione. It is ecrtnin Umt thcuo hitter
huve a iioltthle iiiHiieni^ in the development of dysjiipsiafi, and almnst
ever)' day we see young iieople Ijeeome dyspoptios because they give tliem-
sclvos to ejccessoe in coitus. But apart from the oril of excess, there is
nJso the practiee of enitus imiiioiii;tteIy after a menl, whieh Bhould be
oondemned as dangerous.. There is in thi^ ease a cudden arreKt of digef-
lion in the period of its activity, and gmve troublee in the tiiuctionB of
the stomach are likely to ensue. Masturbation produces the same effect
as ooitUH, and mnny young men owe their dyepopsiae to this pa.uw« alone.
In Buch <»se« yon are likely to oIjs«?rve a peculiar sort of dyspepeia of
gafitralgic form, acoom punieil with crumps in the fllomach.

What hygiene comprehends under the name «i applwata — garments,
hatlis, hydrotherapy, play also an importimt part in the genesia of djs-
pajisia.

In reganl to ■wearing apparel, I liavB two pointa on which to anima<1>
vert; viz., the use by feimiltiH of the corstl on the onfe Iiand, and th«
disuse by men of suspenders on the ether. Excuse me for entering into
these detniU, whieh may aeom to you porhspii to be tririal, but wliich have
a nml importnneo.

As for tight lacing, it sufficua to recall to mind what Uikos place during
digeHbieu lu understand the injurious inlluence which a tight corset around
the waist may have. In the normal Htato after a hcnrty me-al, the 8ti>mach,

ON nEQIMEN.

83

^«e

■h IS the seat of an extremelv active oangcetioD, and the t*olumc of

■which is aagmentod by the (ilimttnuiry niatUirs whiiih it contiiinit, Blightly

ei{»lifU the pjiigAntric nigion, mid if by tirut« pi-eeaure you opgHjiu.' tlits

vxpnuion. Ton disturh profoundly the f^ieCric di^cstiun, aud this is just

lifti the coraet does when it is too cl«*]y hicwl. llcrico it is, gentlemen,

,t if Ton will take Dot« «if what hnjipcng at grvaX dinners, where it i»

le ciiflom for ladies to appenr in low-nvclttH] dresses, you will eve the

bdiea by joar ddv eating little, scarcely tasting the di^es; this is oer-

tainly not for want of ap[>etite, bnt for the reaaon that if they were to eat

too ubundaatly you would coon soo thom turn rod, and mSi-r inUtwso

diwomfiart — almost suflocatioii — nnder the inHuenoe of a digeittion dis-

torlwd by the conKtrit-tiun of the contet.

If ponible then, require of your female clientele tltat their coraeto
{aoK it is &ahionahl« to wear them, and tbcy cannot oppose the proralcnt
bduou), ahftll not oxereino too much oonrtriction, and if they ncc; to Iw
pusts at H public dinner, tltat they idiall no amuigv their toilet that it
dull not tnterfcrL' with their digestion.

In the case of the other sex, tlio eubject presents itself Bomeirliat
diffiipcndy. Young men finJ it innonveniunt to wear RiiRppmlpra, and bo
nv a tight strap aronnd their wajiil. Thiij i^ a nrett^'hed habit, and lias
the lonw Dl conauqucnces as have been before mentioneil in connection
mtb tigfat lacing. In order to hold op their trouecrs, a belt is required
vhich eb&U compren the tipper part of the abdomen mid the epigastric
npon. Daring tneiilR the belt ik>Ltj not yield and the eturoacfa, squeezed
ODl of ihape. cannot perforin its normal functions; therefore this is a
frequent canse of i)>-8pepsia, and you sluiutd recommend to your patients
tinn to w«*r suspenders.

Hiths hare also n tiotahlo influence, not in Ihc development but in the
trmtiuenl of dytpepsJaR. Yon will And that hydrotherapy nicthodicallr
Mpioycd, and cold batlis. are imwcrfiil anslliaricK in the cure of theso
iflbotiOttS, ecpecially vbon anociated with gyimiaetica.*

Rn faMtlw bavcRliioa beneficial inHncnce. but I must makn here a
nw TT E tion. It has now booome quite fashionable ui our largo cities to
■ad dysficptict) to tlie scA^ide for a part of thoHnmnier; (his practice,
(ttdeml cuy by the railroad, in undoubtedly beneficial to the nuijonty
of DiTiIids, whotfaer children or adnlts, but in its application to Dcr^'oas
ptientA it ia injurious. However much benefit feeble and scrofulous
duMren. ami the debilitated in gcnend. of Ixjth ^exes, may derive from
k Ajuum at thcee watering places, our neuropatluc and hysterical females,
yhum dysfK-ptic troubles are opt to take on tlio gaatralgic form, soldom
pt anything but luimi from seH-bathing. I hiive Rcen many a riervous
■flKtkm aggravated by this treatment. The excitant action of sea Italhii
BvofMEca the end in riew, and rhildren who befori* were simply fretful,
imcudurablo. Hut it iu ttijrcciully hi Uic cnee of nervous fem^lea

I

81

I)t6£.V9£8 OF THE STOUACU.

fb&t this excitation is the irioet prononnoed. On a former occusioii when
lecturing on DiBcascs of the Ronrt I pointed out to yoo the injiiriouB iii-
fliirnnc of wit- 1 lathing on thtw ilisruBra: l»cur in mind tliirn that the»e two
piiUiologicai coaditiuQs, vxaggvruUid ueuroputbv und i:ardiac affoctions,
eontro-indiciite the ne? of B«a-batli8.

Tbore is a point pertnining to this qttestioo wbieh ought to <>ngage
onr attention for » moment. What in the influence of Imtlis takon im-
incdiiit(>1y after mi-uU? Arc thuy likolj to he attended with grnTo or even
latid a<:cidi>iit«, a# somi* maintain ?

This is H rjuc'i-tion tljflicult to miewer. It is easy to nnderstend that
aft«r a hfarty meftl, and at llie mompnt when digestion commoncL^. im-
moTpion in nold watnr mair dL't<Tniiric a perturbation on the part of tlie
i!tcnmi.'h, and provoke an iudigci^tion which mity iteolf have grave con-
BGquencea. It ia also quite poaHiblB tluil a eongcative profsess gning on in
t}io stoiniK-h and ii^nddenly arrvsted, mnv d«t<^rinitKi in othur organs, and
in piirliruliir in the cnccphalon, congestiona more or less Derloug. Tht-ro-
forc 1 think that it it prudent never to take u uuld phingo immodiatelj
after eating.

It liUK been «iid also that two hoiipe after meals a cold bath can hflvn
no bad infliienre on digpstion. Neverthclriw at this |)eriod digestion ie
not iininbed, and moreover it Huh been shown tliat one may withont in-
oouvenienco eat when in the water; the rcetauraut^ in the great bathing
eetablisbnienti; are voueherB for the harmleHeiieBB of this praetico. As
jou see, gentlemen, on thin obscnre and difficult quetition eontrailictory
TirwB are held, and I ata unable positivclir to der.ide: I think, however,
tliat it would be al^f'a\-8 safer to wait tivo or three tiourx after meals before
indulging in cold bathing.

Finally tlie exenta hare a certain inHuonco in the production of dye-
IKpaiiL

We 8hal) return to thisqueslion more at length when we lake up the
subject of syraptomatie dyspcpeJas. lehalJ show you, then, that perturba-
tions in the seeretion of urine and porepiruLiou may hea eanw of dys-
pei«ia. I fihall alem show yon how inactivity of the intestine, iuid nc-
eumiilulion of fatail inalleri!, may react on the stotnach, embnrniBiang the
function of that organ.

Such, gentlemen, are the general eonsidemlions which I doeired. to aet
forth relative to tlie hygienic thera|>entic8 of diMiuseo of the fitomueb.
Vou will, I hope, cxenfle the great length of this exijooitiou, in view of the
capital imporlanee of dieteticH and hygiene In the treetmeut of thesw atTi-c-
tions. You know that I consider as one of the most uwrful iKiinte in
clinical thurajieuiioa, the poBsiljility of grouping together in the treat-
ment of diBcase therapeutic and hygienic mwanB, and yon see here how
great value i attar.h tn the latter.
• I haTe. perhaps, entered rather minutely into details wliieh may seem

OH KEtiLMXN.

85

lit yon to be tririal, bat vrhen jron are in active practice yon vill see tlio
bflaence Trhich theee tittle things bsve in the treittmeiit of afTeutioiiK of
the nomach. Nothing, in fact, ought to be conBidtmHl as trivial to the
I^jsiciaii wbkh lias to do with ihv wvllare of hit) patient, and he should
he as {vrticolar in inculcating tlie littlo lijrgienic ruJw M in ordering
KtiTe nie<liciiuil inibotanceH.

Bot Wfore Ix-ginning the study of the dysfieiiBiiw propfrly bo called, it
b nocwMBTj to ny » few word^ concerning tlic racchanioul methods of
Wfttment which bpo applicable to a largo iminbcr of gastric afFections,
1 refer to " lavage and gavage " (or stomach wasliing and forced feeding.)
Tbii cabject I shall take up in the next lecture.

IfTOTES TO LECTtrUE V.

'Gvmnastio oxcroiww aro divitlpd into thrm* jrroii|>«: 1, aotirc ox«rctM&
which the movrnu'iite are volunbirj'; 2, jiiiEEire oxcn;iiM;»; 3, mixed
ciwJ, in which are conccrnL-d both volition and an cstrmal force.
Actire exerciiius uiay ha divided into free morementa and nsstrainod
ftOTcnientx.

Free movements, which are made under the influence ot the will with-
out the aid of apporatuK. may b« executed by one jwwon aloiip ur by
■will pereona in concert; in the latter ciwe they constitute gencpal gym-

IVt consist in movements of the head, (flexion, extvneion, rotation
and ltU>ral inclination); movements of the trunk, (flexion, forward and
Uekvard rotation): morementa ot the upper limtis; iirm»^ (adduction,
aUnctioii. rotiUion, projertion fom-ards iuid bBckw;inis); forpjirm and
btndr(protiatkKi,sapinRtion, etc.); movt'mcnts of the lower limbu; thi^h,
(IntM), extonsion. adduction, nbdncttt>n, rotation inwards, rotntion out-
«ani«); !«. (flexion and extonsion); font, (flexion, extension and abduf-
Uod); finuiy. diveni genenU movements; walking, running, le:iping.
4iactiig, Rwimming, wrestling, boxing, etc. Th^ reatrain'od movcmcnu
tn extDcutvd Willi the aid of movable apparatus, which may be of a porta*
Ub kind, auch as dumb betls. clubn, iron bulla with roiw ^ling. leaping
join, etc, or non-|>ortnblo, such as the " (Kirlieo," roue liuhU-rs. tn>;H>x('8,
tbfarmewing, the windlass. Other niovementfl, atilt more rvatrictcd in
titeir nuiee, are mode by means of tixed appnratne, auch as parallel bars,
ixed tadaen. wooden librse*, etc.

AB»ng the jKWsivo exerciaes, wo should cUa carringo riding, yachting,
ua^tfe, and faradization.

LjwtlT, the mixed exercises consii^t in mnrement.ti whirhare both vnhin-
I«y an«f involunniry; horsehnck riding, Kwimming, the veloeipo<ie, and
tbe Swedish gymiuustica.

It dffpeuua on tnrcamstsncea whether theae movements uliall bo hygi-
i^or not; in fact, if it ia naeful to nike niodenito nxereiiito after meulii,
vxertiun kIiouM he interdicted, and ererythilig which greatly

86

DI^EAi^BS OK Tim STOMACH.

tales the mniriilar powers slimilil be reserved for the morning or evening,
whcrn iiptive digrftion in not. going on.

The usigu of gyiniiuetics ui< a kiiid ot trcutinent for uorroue disoafiest
gnch KB cliort'ii, hyaturiu. cpilciwy. and iii thu trutitmi-iit of scrofuln, was
long sine*.' intnKlucwi! into the KoHpitJitB, ami it was in 1S47 that l-iURnf
instituted his Gret medical gymnasium ut the Hopitut des Knfunte. thi>n
ut thf Suliii'tritro.

The clinioHl attendant causes tlw nervous jiatient. whether child or
adatt. to perform ma-rahes. racing, find tin.' various maiiipuvrea and more-
ments imlicatod hy the \>ri>f«sfior, and dn ring their exjjcntion all sing a
■ong whose rhrtli m corrosponds with the ]ire«criheil movemrnU, By these
mcuiui Iho general health is nijiidiy improved, and certain nervonn all^c-
tionB «Y6ii cured; chorea, for mmnco, oa tbo report of Blach« on this
mode of treattnont hue drnion»tmtoil.

These are the conclu»iona of thia report (MC-m de I'Aoad do M(-d.,
TOl. six):

L None of the modus of trt'^!^tnlent applied to St. Guy's dance (clion-Ji)
has given so great a number of uurtN! as gj'miiastics. whether usetl alone
or asHoeint^Kl with mi!|)liur luitha

2. Oyninaaticsmay be employed in almost all caws without the liability
to interruption bv the con tm-imlicat ions which at each step present tliem-
selvee in llie iisagL' of other modes of trenttnont.

3. C'lii-e ie obtained in ahont the same nnm>«r of daya m that de-
manded liy tliP employ nf aiilplnir hatha; but it seems more permanent,
and the sedation ghown iUelf from the first dayiL

4. At the same time thiit the diwrder of movements diaappeara. the

{general heiilth of the children improves in a runmrkahic iiiuiiner, and the
ittle patienLi go out, unt only cnreu of their chorea, but uIho of the anemia
which BO 'dttMi ac^ompmieR it.

5. Grmnaslio exercises which one might at first thonght regard as neril-
o«8, e8i)ecially in regard to the state of the cliildren who engage in tiiem,
offer no reid 'danger, and may hi- practiced in in any eeawn. anadvaQtago
which cannot be cluimed for the baths.

fi. It ia very important to divide the exerciaea into two categories: 1,
paBsive oxerciwa. which may be eraploved alone in the periml of the aSeo-
tion when the will has no control of the musoniftr powers; 2, jictive exor-
cises winch the children execute of themsolvcii, with or without the aid of
npparatnB.

• Pierre fTenry liing was born November, 17T6, and died in May, 1839.
He has hiul ddluwera in all parts of Kurope.

According to Ling, mueouiar movement cnorgiaea the arterial or cen-
trifugid cirGuhition, at the same time that it promoter the nutrition of the

{lartB which execute the movements, and this in a protmrtion rletermined
IV the amount of the exercise. One may by rt^Iatea exercises improvo
tfie nutrition in any mmwular grnniw he choosea. Every organ which is
(Jilt into action, aeW upon all the other functions of the eeomtmy. Mns-
cnlar ellort, for insUiucc, fixes the chest in inspiration, slows the rirenla-
tion of the pulmonary artery, and eonseipiently that of the largo vcina
which empty into the right heart, angmeiita the venous teuMum. congesta
the PiTfhrnm, etc. Strong inspirations fdllowed by txpimtion liave the
opposite effi'ct. The muiwles in compruswiiiK tlie arterial hiunchee during
their contrartion, cause a reflui of bluod to remoter regions in quantity
proportioned to the capacity of their cnpilbiry system, llericw thu vertigines

ON UEtilMK^^

87

fte corebwl conecrttons, th« ralpitations whioh fdU>r each actire exertion
art* rxporicncCTi or [HTsons siiujcL-t lo lliew Hortit of affrrtioiia. When tho
eootraction ceaaai, th« blood flown buck into the c»pillarjr network o( tho

To obtain tbeae effects. Ling liiu iiitttituted tliroii ordvn of ^]Cl>^ciee6.

Id the fint, the movemeatH aro siinpl^ aulivo ; tbvy aru niovt'tnentit pxo'

ented by tlu' patioiit hinuwlf; Htandiiig. walking, leaping, the onlinnry

grnuustio cxoroiBes, und the partial movcmente of tho body. In th't*

■eooad onlvr. which Tiing mlla order of active mssifv movenirril.i, the

fidirat makoi a inovemoiit whioh tho gymonst rusitsts; in the third order,

that ol fWtMtM acttv$ motvsiii'nt.-'. thi> gymtUMt compels certain displaoo*

meat* of the raemhers aguinst which the patient stnigglce in causing hia

mnaclM to contract.*

"rhew ore the divem maniptilHtiitim which Xiiaindor of Stwkholm
kMrom from the Swwiiah kitusotk'^ropfi to combut thu aflfCtiyiiB of the
fgattni paMagce. and in i)ui-ticiilii,r, cun^tipiition und dyBitcji^fii:

(a) I'tanea along the (-(ilon. i-ithiT Ju wholu cxumt, tir h part, '['heio
ftMtare made with the iialmrtr ttiirftwe of the hand, in a dirvution oor-
iMponding to the course of di^'i'^^tinn. T)u> aiibji-ct occupies u position
ctuob alkiva the abdominal mun^W to be relaxed.

(6] Paeaea in the trongyi-nio dirci'tion. — Both handa of the operator
memptoyed; thcte aro miulc to tnL-ct in tho middle line of the alxioniun.
Majf laid flatwise. They are then made to pHHB back and forth in opposite
dinetions, presnure being «»ud a<icciriiiiig to the ciiso. The abdomen ia
emilariT stroked longitudinally from the cn&iform cartilago to the pnbee.

(() (jyclical im»%-8. — TIu'mc are iiiinit; after tho Mime principles,

[i\ Vfemate» in a traiiKverse diretrtioii, — In these manninvreg tlie
mliprMd hands of the oiienitor are mode to thrust lin''k and forth the
llMot'ainteatinea, i.«., from left to ri|;lit und from ri^ht to left.

ft). Circular pn-iaturc)!. — The»« are umile In ti direction currespunding
totlHt of the digettttoti,

) Shocks of the abdomen. — The liand of the operator being placed
abdomen imprcHHcaon the inteKtinal maas energetic and regular

IDOflOL

f) Prwanro over tho nolar and wwral plexuses is also rocommended.
^eac are the manii-urrM which M. Nimnd^-r cmpUiyn agninEt con>
■tifmtion, und wliich, he mys. have the Hime effect aA rcTlul douchei^

Tlie Bubject atands with hu arniH exU^ndod in fmnt of him, and Used
to a npport; four ofK^ratora Kurroimd him, am) t>a»h bin pelvis now
Wkwardi, now forwanlis ao that the uiit^rtur abduniinal niuBcles aro
■rtnpltmea on the stretch, aomelimea relaxed, while the ussiHtatita exercim
>4ight (lcgrc« of preeBure on the abdomen at regular interralsif

* *• Six wwks ia ordinarilv the time rerjuisito t^i prepare a person for a
vnrtfiog or boxing match, or a race. Bi-gin by taking a blue pill ut bcil
Ime, and a 'bWk dnuight' in the munting, and rvpeat tliia medicinal
rtfnuen twice the lintt wtwk. After Kuitable purging take np your train-
■ag aaartuK. C'hoow u convenient hjLbiuttion Rome dirtanoo from a
^Dpnloiu oity: let your exurciaea be niodurutc at tlrst. to bo gradually in*

'Trouweaii and Pidoux, TraitC do TlWif»pcutii|ue (Conatiutlin PuuTa edi'

L a.. |i 135.
tSAc. .1- Ilv.Iit>l<i«rW, 8&UK-U of I>r«n>Vr 93. 1879.

88 DiSKAfiKs OF Jin: btomach.

crcueocl from day to dav u» your forcL« incrcua!, Tim subject who is andrr
tniiniiiff imiat riso t-arlv (lit 6 oVlock a.m.). wnsli himself witb carv, thim
Uiku a raw t-gc in hsU a giata of mmd shurry, Uu'ii walk two miles before
bteakfneting^at 10 o'clock). Tlie exercise must always bo pi-Ofiortiouwl
to Lbe iiitliviflual's cniKiitlon. The moru flesliy he is, the aioiv Kcvvru
iiiugt hi- his taek«. After breakfast ho will walk two miloH, iiitun-alutiiiff
no«* and then littlv miie of throu hundred yanis ut tho top of liis e]>G«(lf
und vtiditic in & nice of ii mile to bring on profuec sirmting, when he will
dry hiniRcTf by hriiOc nibbiiir with n townl. Then he will rt«uiii(> bi»
clothing itiid walk leisarely a 1itl:ic whito. If thirsty he will di'iiik n little
l)ulc sherry mid water. About U o'clock ho will Ukc a ftw nwallowe of
goiul ])ort, or half ii pint of old al». Hti ought ruustaatiy k> h:ive in bis
pocket a liiinl bisauil to jiruvt^iit hunger, lie will often avert tliir»t by
chowinR u piece of dried biHouit; this is better thiin drinking much litjuid,
which Iruds to ijcrapiration mid makes him Short windwi.' lit- will dinw
at 1 or Z P.M., and takv a moderate exttrciso, »uch n« HiMLrriiig. pitt-diing
qunita, or sn'iiigiiig dumb W-Ws (4 lb& weight). lk> tniiet then tukc
another walk of a mile in length. If the fatigue induces Blifpiuoee, be
nmy nap one hour. The Inst meal mnrt be at 4 oVIopk, five hours before
bofl time. He mnut abatain from emnking. All npiriinoHS liqnors {except
the eiiiiiU quftntitios permitted ns boforw mentioned) must be prOBcribed,
alno HoupH, milk, stewud mcu-t, and sfusonuU futwl. Lean mciit must be
eaten with plain bread and only enough in quantity to supply the bare
necessities. The howela riUHt lie kept regular onoe a day, (»fUT broak-
fttfit). If then; bo more than one 8l,ool a dav, loo much fserciHu h being
taken, and the amount must be dimriiislteti, or there inuet be a slight
cliungo in diet. The jiiirty niuet weigh bimself every day, ami when ho
shall iuive attained thedc■t^il*ed weight, be must limit hisexercisint to walktt
of iitlk- U-ngtli, without neglecting tho short riuiB to kei-p him in wind,
lie must take care not to wear damp flannel, must lub himKelf llioroughly
after si'vere exertion, and ehnnge Ins clothes after pRrspiriTig freely. Ail
dangerons kimlii of cxtiroiiw eliould bo interdicted.'**

'NotwithsUimliiig the contrary re-sulta obtained by Frerichs, the ex-
poriment of Claude IJemard iu considered tw weientifiL'ally esaet; it oon-
BiMtt in tho injection into tho veins of ii liaro of lactate of iron and ferro-
uvunide of potHHitinm: these two «dts whi'n put in contact, will pHxlnre
i'ntstiiiin blue only in an acid milium. In the stomachs of »niuialii under
experimentation, the blue colonitioii of tiie mucous membrane was only
api>nrenb on the snrfiK-H; the tubular gliindu pruiented no change of wdor.

Cliaik'S Itirhet having taken the niuwiua membrane of the stouiaeh of
a conger eel, rcduocd it to a pulp, and tivati'd it with water, separated
the infusion into two purta, which he placed iu flacks in a etove at u
temperature of 40"C. Into one tliwk he jiuissed oxygen gas for two Koufb;
at tho end of this time having miiaKiired tho acidity of both liqnids, ho
remarked tiiat the liquid which had been treated with oxygen ImU a total
acidity of U.49. while the other imlicated only {).'ZH.

Vi'ith the gastrie juioi! of other animalR the result wan tho same.

Moreover, aceonling to Matbiuu, tho ijnantit^ of oxj-gen contained in
the blood diminishes at tliu momout of diguKtJon.f

*0. Boitwoii, Tn^atifii; on Training, rrh<V dc Puns, 1877).

t Miilliieii and Urkiii, The fiiu-ii-s of the Blood. (Areli. d.- Itij-s.. 1874. p. 712);
Cluti'lua Rivhvt, On lln.- Cuatrii^ .luice, i>. 78.

ON lU^IMKN.

89

' Hydrotherftny mav have an important T61e in the treatment of dvB-

{irttedw, but u» Benft-liirdi romarks, it iniiHt l>c employt-d method icalVr

nil the methodt" put in use must he nonformc*! to tlie lesion which it is

to comtmt, 'I'hprfffore in dyHpepsijui duo to gout, to rhpiimatii*m,

fola. Ton mnFt ngsooiatc hpot and cold, and in three cases, dry or

it IS imliKftlfd hufon; thi; cold npplicutioiis. In the symptomatic

In^pcias; it is againitt the priniurv iklTi'Olioii that the- hvdro|)uthic; tnut*

nifnt shonM Iw dirw-ted. In tht3 dys|M>[i»i!i uiL-coin]iiiiiieil with plu'immona

<rf rxcitubilitv. vou i^houiil employ Wraiiered ininieraions, lottoni^ ittTu^iions,

mill warm douche*, wi-t wrappings of sliort duration. Dobs tlin dy«i>B|>Bia '

fiRflpnt il^if with tijirne wliicli •louot<? oxhnuetion of tlte torvvs of the

«ntire orgiinism I' you tiavu »n indication for tonifying appUcationB, such

u cold affusions, frictions with a wet cloth, sliower iTatnn, jet doucliea

^^ tic, whicli foristitnto, aceonliiig to Bein>-]iinli, tho most eflioftpioHS ]»ro.

^B K^OTe when it can bo lx>mo hy th<i patient. In ocrlaiii ciia'o of naiiidil

^RdT^peia, Tou will dcriTc advauta^u frota the applicntiou ovlt tltc vpi-

^■'pitrtiiQi o) Chapman's hot^wabcr lings.

The following amoDg other bihiiogniphical rflfercncoB perbun to 8u1>-
JKti treated in tnie lecture:

llrf«iri«li, D^ iuIa gyranastloa, V4>n«tii!i, 1560. F. Fullt^r, Mndii*inA CJymnas-

I ticK orTrwHi-H! of the Power of Exercise wilh Res|iect to tlie Animal Btwrtomy.

! laodan, ITOf. TiwioL, GymriiiKli'iui- itii'-ilii-iili' t>t oliimtvivuli-, uu t-sxiu Kur I'uli-
fiU (III Ric>uT«nivut et <l«-b ilitTfi-Lni ^ < i< lh du corps dtkiiB la cusv lits ij)»iadiea,
farifc IT^L Londr, GyiiitiiLiDiiiif mvni. al.- ou tVxitriitx' n.pp1i'iii^»ux orKanende
riiuume, (f apr^ lai lois de In pLysiologiis iJe Thygit^n^ ot de la tli^i-ajjentitiue,
(Wb. 1831. Amorm, Tniil^ d'^tluuitiou ])>iyniqu«-, j^yitiiumtiquc rl inoniU?. K.
fiKim. Baxtana, oii eAqiiisstiS dii pugilnt nncicn et modeme. London. 1820-34;
Mann) 4* gyiiiRa)itU)iii>, 1847. Dnlly, Cmikiolop^lv ou »elenco du inouv«>int>ut
■ka> Hi ni)>porta avi-c 1' Education, rb>-gi<*i)i: ct la. th^Rtpeutiqne. Paris, IbS'i. L«-
paDi(U»xt. TlitVw d>^ ?iiri». \*¥i. ViWa. Th^e di> Pariw. 1840. lyM*a(^. Oytti-
BMil^ue prattqUL-, ISW: Oymnnslupwi des rfptiioinellee, Pwris, 18.V1. TraitA
WMoibure dv la Kyniiu'tiqui- <'laK»i<|tii*, avtn^ i-lii^iitK huI^m jI rvt.%»Kir d(-?i oHtunts
tedMix wxes, Paris, 18ftT. BliK-tii', I>ti InLiti-rnciil (I«< lu (-linrri^ |utr lu xytn-
nriiqnr f)I£i)\. Sif t'Ai^ad. do m^d.. l^tVii, .Scliroher, Sj^t^niede j^mnnAtiqui^ de
cfaambn niUicale ct hy^^niqur-. Imn. [jur vuti Oonlt, Pariis ^ £diL, l^QT.
tUly UU, Flan d'uaa tti<^rapvuliiiu(> |iar le mouvement (aoetjonnet. Paris. 1)00.
MMUnj^, De la gynuutftiiiue sii^Iomc. Paris, l^KU. (Uuj>)>ort aaauol iL rSnslittit
nUlivj-^mnHrtique suMoise). Thcin. Programme de g>'ninaatlque sj'Ht^niikUijue
rt rslMnnfi, Bruxelloa, 1881. Caruo, Trait* prntiqoe dp (^'mniiiitiqiic de chnmbm
hyiEKuiue el mMicale, Paris, I8««. Uigot, Dc In prvpaKnt'cn do hi ^ttinw*-
ttiKduM I'ltmiM in vtlli'M i-t li-H 4t:i>lc9. Paris. li4S8. E. Hillain^l. Rapport sur
teivii^nnMit de la gyninas1ic|tii>, Pamt, IWK Oullurd, La {,'vniiiiutiqmt «t !<■«
«HRkai oarjKircla duns \i^ lyv^n (Bull, du t'Acad. du incd., ItJSSl. Duiu««nii,
■rirla GnoiAmQDE, Diet, de niM.. vt dv cliintr>;. )pniliiiiii»t, Pit'li>-r>', (lyni-
BMtl^w At ToppMont, etc., Paris, 18T0. Nyiiindpr, Ciyiuniutiquo latioiinollc
■i l ikii i . Puis, 1074. N. A. Lo Bload, Uauu«l d« ^yi^uaotiqut hy^iaiquc «t
nidiale. Paris, 18T4.

k

LECTITRE VI.

ON LAVA*;!-: AVD OAVAGK OF THE STOMACH.
(stomach washing AMD FOECKD FEEMSO).

Summary. — Lavage of the Stoaioch— History— Operative Procedure — The
Ktomiwh Sj-phon — Its I ii trod notion — I.iquitU to Kmploy in Ijivngo
o[ tlie Rtoniacli — Tojiica! ApjiHoatioiis to the Oaatric Mpmbrant^ —
Qnantity of the Liquid— Stomach -puinp—UBvagu or ForeeUFeBcIiiig—
Alinientarj' Powdera— Meat Powders — rarinaceoue Powders — CEaoph-
agc«l Tube of tbo Author.

OEXTLEJiEy: Lavuge of tiio Htonmch is a method which fjives astonish-
ing rosiilts in mniiy giuitrie nSocliouSj and 1 am tonlay uiio o{ the most
earnest iulvonit6« of this prsictice. In ^e wards of my hoBpital yon may
daily «t; beiK'Seial resiiU«. and nomutimea iiideud ruritahk rgsurrfctions
obtaioetl tlierely. If 1 exjtresa to-day tny opinion on this HtiLijuct with r>
mach po6itivon«£S, it is bocaase my first tontativeB made subeequetitly to
thp Inltom of KnBsmanl were not satisfnotory, but now, thank» to tha dia-
(rovury of Kaiurhrr, all iiii»nv<mieiic«s liave hn'H rpiiioved. aiwl we art*
enahled to utilize tlit? metlKxl to the greatest advnntugo.

1 have boon reproached for clianging my mind, but there is, as yot,
nothing; |torTa.iiitng to tlR'rapuutics «o absohUtly eottlcd ai; to exclude all
fiilare progress, and I Imve iilwuys been ready to welrome any imjirovu-
Humt ill miMles of treaUnmit, CB]H;eialIy wlitin they art) the result of
thorough ex]>enmentation, and if I have Iiad occasion to altur my views
roi^pi'etiiip lavage of the Btonmcli, it in because I have tried the new
niothods and found them pniotical and advaiitjigeous.

The idea of rornoving liquidti from the stnmach is of French origin,
and must In- orwHted toCiiaimir Ituniiult. Another Krunchmaii, Blatin.
in 1S;W, taughf the utility of washings of the stomach. It must Iks
admitted, howovor, that it waa KllHaniaiU who Brat Byatematizsil this
pr»ctir% and gnve it a definite jtlace among the regotireea of our profession. '

It was ill 1867. before tbn Cnngiess of (tnrman physicijin» held at
Frankfort on the Main, that Kusiimaul first made known, tlic residbs of
hiB olinicjd o.'qwriments with thoutoniiU'h tnlx.'. Ho employed the a>3oplia-
grail snunil, to whieh he luliipted a siirtion iiiid force syringe, and il. wiis
by virtue of this uppunitux, enlled utomach-pump, that liquids were in-
jected into or drawn from the Ktoniucli. The int;nnvcuien«e8 of this
instrument wc-ri thc«e: the introduction of u rigid tube wao paiaful.

LAVAOK ASD GAVAOE OP TUB STOMACH.

91

tnoreorer the oxtremity or the mnnd irritated the vral\» of iBe stomach,
BO after sererml trials of KuKsniaul'R ptimp. I al»iii(Itiiied this motliod.
Bat tbo tliaooTei7 which FuucHlt mtuli') in 1870. aud almost at tho mine

fcbmp> Oaer, in Germany, removed these diSiculties.
This discoTerr consifited in the poewgo of n soft and flexible tnbc into
tlte cavity of the slomaoh, and in the apiiliration of the physics] tlii^orv
of tbe srphon to the introduction into and n-inoval of liquids from thi«
organ. From this date I have multiplied the applicationB of thu efcomach-
^■^hon. and one of my pnpila. Dr. Joseph Laiage, hue comprised in his
^P^ircilent thegie on the treatment of dilatation of the Htomnch by " lavage,"*
k great nnmber of ohscrvationit. and for tcm yeara pniit I have so fre-
qneaily practteed etomach- washing, and with an miicli succets. that I
I taw hod Tcaaon to felicitate mreolf for tho part which I have taken.

How is lavage of the gtomncli perfommd? The answer to thin quos-
Qoa involves » description of tlie instrument usud. the m»jin«r of nsing
it, and the Uquidii cmploytsl for cleanaiug the stomach.

TIfVlHHUI.

The tube Fancher is of flexible caoutchouc, one metre and a half long
with an index on one aide, no that you may know the depth in centi-
■elTM to which the tubo Inw penetrated. Tho tubes are of three HiMtt,
N'a 1, S anil ^, the diameter of the first lx>ing eight millimetres, Uio
Rcoud, ten millimetres, the third, twelve millimetres; to these tubes is at-
bcbcd a ftuuiet.

In purch&sinjf a tabc Fancher, yon ehonld select one as smooth as
pMribte and with some degree of Htiffnees, so that you muy easily be able
(o tDa^Q it enter the stomach by Hucce^sive pushes (such tubm aa
Dtbove has recently caused to he made); us for the funnel, it should be
ofgbBt so that you may v^-atch tbv dL-^'t.-ut of Mm ItquitL'

These tubes Have lately nudergone great improvements, without yot
hilly attaining the idi'oi] of a hollow and resisting, yet quite supple tube.

93

1>ISKASK8 OF TKE STOilACH.

Ono of my collutgucrs, Audboui, liiis caustructod a sLonuoh tube on the
principle of the double uithcler, (two flexible eyphonx gluml togetlier).
wliito my friund Di'bove nuiltoB two pnrts of the sj-phon, and iiitrodiieoe
the o-ROpliJigeal part hy \he aid of a iityli't, vhich gives HtilTness and re-
mHlatico to it ThcK? iniprovemeiil* luivi* not oomu into (ifiicml ust-, i»
fact the simple tube may, by akillful management, give you all tho results
which yoii deuire.

I wlviHe ynii. when you nttempt for the find time to introdure the
syphon, to usu tiihc No, 1 (taking ctuv to sr>\vct one with th« rL^cjuisit*
ct<^ec of stLtlues^); thou, when your patient is need to a tube of this size,
yoii cHn easily Hooceuc] with a larjrer one.

The iutroduction of this iuelrumont can roadily be effoctod in tins
niaimur: Placo yourself in front of j'our piitiunt M&kc hiju oi>en
widely the mouth and protrude the tongue. Pass in the tube over the

back of tho tongno, andi when you hnvo the e-ttremity well in the throat,
me far as the hnso of the tongtio. inaktf th*? patitint swallow, and while tho
movcniunta of deglutition are being purfornied, push on your instrumcut
into the oesophagua. Vrlien once you have gained tho first [mrt of the
(CKiphagiii), you can cneily carry onward tho tube, by a succession of
pushes, and with considerable rapidity.

Some have proposed to render the introdaction of the tube easier by
greasing it with oil, vaseline, or glycx-riiie. l-'atty eubKLniices leave a
disagreeable taste in tho mouth; I am myself in the liablt of simply dip-
ping the tubo in Vichy water, or what is hotter still, in milk.

Ail soon aa yon have made the tube penetrate to the proper depth, as
indicuted by the Bilient index on the outside o( the sj-phou, you annex
the funnel, fill it rapidly with liquid; then, as &oon m you eee the liquid
disippoiir in the inferior portion of tlie funnel, you lower it instantly, con-
verting tho tubo into a. (.yt^hon, and causing tho liquid eontent^ of tho
st^miarh to How into the pail which you have placed between tho feet of
the jiatient.

lAVAOK AND «AVAOE OF THE STOMACH.

93

During the introduction of t}ie tube some dyspncuft is manifested on
^ttiepart of the patient. The cyoa are inj««tc(l, the face turns rod, mid
ti* patient pr©t*mU that he CAnnot ttrtotlie. Inautt, then, on the patient
nuking full respinttions during the npenuion.

To the d)*spntt!Si we niiutt aild njiuHea and vomiting among the nn-
[iciBBiit accompaniments of the operation : tliis nauttea is nmiiifuHtixl aa
•MB as the tube enters the ceeophagiis, or -when it reaches tlie stomach,
hi fooio TOTT sensitive indiridnida it is impoawhle to penetrate to the back
of the tbixKit without indnriiig vomiting. You can readily calm the:ae
nfexm by bromide of pota.'^Hium; in fact, it iu my cui^tom to givu bromide
intcni&lly, and apply it locally three or four dayi) before attempting the
fint laTHgc of the i^mach.

It is more diflicalt to avoid the irritation provoked by the preaenee
of the tube in the stomach. The vomiting, however, which cnMie»
frea this cause, ia more infrequent and can generally ho prevented by
introducing immediately into the gastric cnvity a little WBtCT. In this
nvTOQ will «>pRmte the wiilU of the stomach from the end of the tube
■ad will avoid irritating the organ.

The tolerance of tiie pharynx, of the cpBophagufl, and of the stomftch is
nwiily obtained, und I can affirm that always after three or four sittings,
p>tM-nt« mp[>ort withnnt any inconveniencn the presentii' of the tubr>. In
tteiyrfjort time they can effect the inlroiluclion of the tube ihemaelvwi,
■nd in the caae of the greater ]jBrt of my itatients, both in private prac*
tittUH] in tbe hoepttal, I leave to the patient himeclf, after tho fourth
Bttiag. the «ntire performanee of tho operation.

At tbe same time there are two circumstanc-eg which often present an
ioRnnoantable obstacle to the introiluction of the ejphon. These ere,
frit of all, oefophageul ^pasnu in ocrtuiii hyciterical fenialee, epusma which
it Buften difficult to ovorcomo, oven with n rigid instrument; Bpcondly,
■Inntionti of the epiglottis and tho poBterior jmrt of the larynx, which

|uenUy render the paange of the tuhu very puiufnl. With tbe exc«iv

lol cases of ihi» sort and such mechnniad olmtaeles as cancer of the
I have never found pationt« rchellioue to tho introduction of
tk Faucher tulio.

What kind of liquids and what quantities ia it advisable to introduce?
Ordinarilr we make um^ of some alkatine water, such as Vichy, or Vals;
K it may be plain water, with one half droclun to the qtuirt of hioarb.
ndai I sometimwi use, after the Ocrman practice, water ooutaiuing ouo
Udoac half drachms, to the qiuu-t of Glauber's salt.

In certain case* it is ncceesary not only to wash out the stomach, but
ilio todisinfetrt it. In other cases it i» ncci'^airy to alleviate cmmiw unil
faia Mated in the stomach; iu f^iH other cases thure are heniorrbagic
lendMicira to combat: henw dilTen-nt medicnteil eoUitions art* indicated,
the antiseptic Ittpiida t jiarticularise rv«orciu and boracic acid.

94 DI6KASE3 OF TUB 8T0MACU.

Audeer in very fond of rceorciuc, and 1 have mjsvlt made nameroos triale
of tliis modiciiuil agoiil in chronic gastritis. SolutJons of reeorcin, as
dilute as t per cpnt., are irritating, I»ut thty procure a complotu disinf(K>
tioii o( the coutunte of Lhv stonuwli; tlitTi;fort-' iu msiug tliis mtidicainont
I take care to makt> the solntion Tery weak (1.9., not moro tli&n fire
gniinmeH to the (^lutrt). Boraciu acid in Iho same proportion is m\m an
excellpnt d isiiifectiinL '

For thu puin in the stomach thu boat Mlution to employ Is the milk of
bismuth. Tea pint of water add fi^o draclmis of tho eiib-mtratc of bis-
muth: t!tlr oonetuntlv before introdui'iiig this mixture into tho Ktomach,
Htid when you have caused it to enter the gnstric cavity, let it remain there
for wveml minutes, that the liismuth miiy have timo to become depositi-d
iu tliiti Irtvers over the mnoous raembnme. To tlie milk of biamuth you
lubiy luhl eldoroform water and the carbon bittulphido water, solutioiu
which are mavlEedly ans^Kthetio to the gastric miiooiis inemhrikne. As for
tho homorrlmgf'jf, the best remraly with which to cdinbut tlu-ra istt weak
sohttion of iiurcliloride of iron; a tublvspi>unfiil of tlio lit^uor fer. jier-
chlorid. to the (juart of water. All theBe constitute the topical applica-
tiong or "dressings" on which you can boet rely.

Ab for the quantity of liquid Ui ii-^.-. this deptmds on the degree of
dilatation and oil the toiumnou uf t.h<' t^li>jiUL(;h. Seme imtienttt will bear
two, tliree, four, and OTcn fire quarts; in the caee of others a pint even
will induoo efTnrt» at vomiting. You will then have to determine by trial
the quantity which the ^mtient will tolemte. TTowever Bcnsilive nmy be
thu inatient'a tskinuMih. it ib a (pw"! rul« to cont-inuu the wiiMhiiifj ])rooei»,
till tho liquid which issues from the buoool end of the syphon is perfectly
limpid and dear.

There is generally little difllculty attending the removal of liquid by
tho Bvplioii; it 18 pnssible, however, that Bomc solid partick-Ji of fooil in tho
atomach may get ini}tikctud In the uyea uf the instrument bo tki to stop
t!iem lip. S'oH eau generally clwir these out by letting a little more
liquid run thrciugli the tube into the stomach. In other ca^s (eHpecially
where there is great dilatation) your tube mny bend on it«c1f Bu tlufct itn
lower extremity is ap|died to the tipiier part of thoetomticL; this may
happen in onlinary praetice from liaving intiwlncod the sound too doeply.
In thet>e eireiimstunQes tho syphon faila to work, for obvioiiii reasons.
You havo only t*i withdraw the tiil>e a few inehns to overcome the bend
and bring tho oi)en end in contact with (lie liquid. You can aid tho
evacnation of the stomach by preasnrc over the aUlomen, and by oiakin^
the patient congh, thtu obtaining thu expulaory contractions of tho
diaphiiigm.

Is the ftyphon aufflcient m all cases of dilatation of the rtoinach? Yes,
in tho immense majority of cases. WTieii, however, the dilatation is enor-
mous, and the stomach ia full of putrid liquids, as »omotimoa bappcna in

LAVAOK AND OAVAGK or TUK STOMACH. 95

' of th« pylortu, it U ntxamay, in onlcr to effect thorough cleims-
iug, tn i<inpIoy the ntomach pump, wtiitAi injects tho doterf^nt foliition
with motv torw, auil eualik-s it bi'tlerto rviich all pttrt«of tlu* atoiuach. I
an in the habit of asing tht) Coillii pump in these circumataDcos, which
ii i good upirotinj; and (oroe syringe, and is ouj of udjustmont.

To WBfifa oal the Btonm<-h iind <li^inf(-ct it-t (Ntntonta, to apply snitHbls
mealed dnMunga — Kuch iin> thu nMiilts which yuu may obtaiu from tha
eTplicn. But this is not all. You cati hy this metliod t&»\ the pfttiotitj
■ad pnwtise yrhut I>ebove calls euporalimcntatirm, wlmt Meen«t has de-
noniaatwl nrti&cioJ ^montation, and what 1 d^^sigiuiio under the com-
DOQpbce term. *' gacagt" (forced-foeding).

It was Debo?e who finrt. conceived the Imppy idea of applying the tube
of FiBcher tn tho aiimeiilation of patients. The rcenlta u'hich wo have
Ugethcr obtaiDc<) have rtimulutcd us to coutinuo our tlrgt c«e(iye, and
nico the first uotomunication of Dobovp, in Noveuiber, ItJHl, to the
Uilical Society of the HoapitalK, this ruethud huji cootiniied to undergo
improretnenta.*

DebOTO was the firat oim, moreover, to niako uso of mc-at in tlio form
of powder in thlii forced itliin<>tital;ion, and to obtiiin good rcioilts frnm
thic pnictkv. Formerly we emjiloyutl a mixture of niw luwit uiid eg^
Witnp in milk, hut dfupiie all thi* care tliut wus taken in mincing tliis
n* meat, the miztoru vob far from being liomogeueoux, and quita often
prticlM of meat in eu^penNon wonid Ktop up the tube, and prt>vont the
Alrtker descent of the liijuid food; and it vas found newsairy in these
ORt to Qse tabos of pretty Urge diameter. At the present day we ^
fidof theee tnconrcniences by using alinutntary powdern.

Of wlufct do those {•ovrders roneist ? They arc of tivu kinds: powderod
■Btf ud farinooeoos subetaticott cooked and reduced to 6. fine powder.
Tlie powder of meat ia obtained by drj-in^ tlio minced fibi-e of meat and
nwig the tomper&ture to I'iU" C. ; then ruihicing it to an extremely fine
|>b*(ler. At the pn'sent time, since our comniiinirAtions on the snhjuct,
■fwet number of njanufacturers fabricate these meat powders, and you
»iU find them in commerce under the denominations of jwwders of puro
■nt tod [towdere of the fillet of beef. The tli'st, whieh aro nompoHed of
WiB floah (a kind of meaC. by the vniy. very nourislung), are of gray
mW, and their odor mcallR that of duck's liver: thetic are the le«t
opBum^ The second, whose price is much higher, for it takes six
nkgrnnmea of fresh meat to obtain one of tbo powiler, are of reddish
ttier, ud hare the odor of nMut beef. Buch are reduced to an almost
■Vipalpable powder, and it is this rery finely pulverised condition which,
^ Mitbling each molecule of ment to be attacked on all sided by tbo
puuic juioe, explains to us how it has been possible witli this method to
nch unormoua qnitntitifit of thost- jxiwdon! to be absorbed. We

IJathia fact a direct illunlratiuu uf what 1 said to you in one of my

96

DISKAKES OF TTTE STOMACn.

prpTiou* cliapters, in rpferenoo to th« influenoe of tho molwuUr etatc of
bodies oil tlic'ir digestibility. We find also here another coiirirmntion of
tli« experiinent« of Schiff, which go to show thnt meut is oiio uf the bent
peptog«nouH eubstiUKics; in fact, tinder the influence of thei!e ponders of
meat, yon Till soo Htonmcbe tho most inactiro and f««blo rocovor thvir
fiuictions and the appetite return.

Tho farinaceous powder coii^i^ts of lentils, which fiimlsb u Sour of a
Tery nourishing and highly »KotJzed clianictor. Tbew fariniis were
originally niivd in tlii'ir ntw etuk'. thvn T^borv, Iiuving foaud that cooking
sagmeiita their digestire properties, c»UK(>d them to Ire cooked before
being reduced to powder, and it is under this form of farina of cooked
lentils that we genemllv administer it.

Tnurot haii udriKcd to chti&c the lentils to germinate before uidng them,
and Perret haa miule tho powder ont of malted lentils. Germination, in
fact, favors' in |)itrl the traiieforniation of foeuleiil matters, and in this way
aidx their digeittioii. You can in the sunvi way ntiUM the farina of
Indian cnrn, which is yery rich in fatty materials, and the mixture of
tliis powder with the powder of moat, either in equal proportions or ae
two ]iiirtB of meat to one of farina, constitntes an alimentary prwhict
very iit'ceptahle to even tbv iiiokI diflieult piitieiilM.

These powders may he mixed in a \'ariety of ways, aa may be seen by
oonsultiiig tho thesis of my pupil Robin.

In practicing forced feeding thei*e alimentary powders are incor-
porated with wuter or milk, in the proportion of alujut 200 granmiea
(between six and seven ounces) to a quart of tho vehicle. In mixing the
ingredients, be careful to add the milk little by littlo. m us to make first
of all a bomogeneonsi pBSte with the powder, which slowly nndei^es
(inlution in tlie milk aa it is added, and yoii get in this wu.y a liquid liaviiig
the consisteuce and the asjiect of chocolnte, and which is ready for use-

You see, then, the atlvantJiges which these me^it powders have over
the older prcpnmtiona made from row meut; they ore much more nour-
iohing in a smaller volume, and much mure digestible, and then) is no
danger of eonveyiiig Iienia through iheni lo your luitient. They are use-
ful dietetic agents when stirred in thin tnpioca gnicl, or bmth: one or
two sjioonfats of powder of cooked beef, and a spoonful of farina of
lentils, cooked or malted, or if you please torrefied com meal. GrncU
mnde in this way are very agreeable Ui the taste, and are well Imrne.
■ These are not the only advantages of these powders. They have
enable*! ine to simplify very much the operative procedure when it iB
desired only to praeticc artificial Iceding, and when washing out the
etomneh may Ite omitted. We see, in fact, that while in the ease of
patdents alTected with severe ^tricdittoNK-rs, tittle or no opposition is made
to the introdnction of the tube Fanelier, it is not so with persons not
auflering from profound troubles uf Lhu dtgu^tieu, but in whoDu ease forced

JLAVAOE AlfD GAVAOE OF THE BTO.MACII.

97

altmeatatton is deemed necessary. They nro apt to U- fright^nod at the
um and length of the t^phon, and to such hd extent, tlint thus fur tlie
mctlioii of Ifchorc has not been popular iti the privuu: pnicticu o( jihyid-
cauiN howcTtT eucocarfully it has been employed in the UoBpitale.

1 bare tberelore attempted to render the operatteu leee [saiufiil, und
tblB is the rc«ult of nij ondearor. After luiving verifit^t tlie fnct first
tangfat hj Ortitle, tbat in order to introdace liquid suliKbiTux-fl into the
ihKBAch alt that in tK^coBBory ia to pliicc thorn in tlit^' upper jurt of the
cmpbagiUf I have considerably shortened the tube Faitoher, and I liave
pran it a length of only twenty cL'iitim«tn'». Then tiineo the alimoiitary
miitare made with meat and farinii is thin and difRiient enough (o
trtnrrsc qaitc narrow tubes, I have diminiHlitd considerably the diameter
ol the tube> which is now only about the size of a largo sized urethral

Lastly, I have flattenea the pharyngeal extremity of the tulw «o
to render its inti«durtion ciiaicr. A whiileboiip stylet keeps the tube
cuTTcd, and a bu^ disk placed at the biiceal orifice {to keep the patient
frwuwillowing the tube) eoinplelcslhc first jiert of the appamtue. The
■KOlul part consists of n gla»< j»r. in wbicU 1 ]>lnee the alimentary mix-
t«m in UiB upper part ef whieh rcHt-rvoir air may be compresBed by
Mnt of an 1 ndiu-rubb>iT ballj a long [ ndia- rubber talio connecta the
I ■ojriMgeal p"rt of thif inslmment with the glass* jur.
^^ Tou pnH'tH<il in thiit manner: With the A'soplmgeal eound, furnished
^■^ ita Btylet, in your hand, ymt make your pntiont open widely liio
Hwtttik, patting nnt hie tongue, u^ if for a taryngoacopir examination;
*)tti t]u> right hand you introduce the tube into the bock part of tlie
AraO, and caUMj your patient to execute moremi'uts of deglutition, and
foa vhhdmw the stylet, taking care that the disk which terminates the
7

98

DISKASJ3 OF TITE STOytACJl.

tube dull come in fnmt of the mouth; you then plftco tho extremity of
the fre« tuhe whieli is attaelied to tUo Rlass jar, into the phiirnig«il
sound. Then voh compress the ruhWr hall aiitt the ulimeutury mixture
(HMBCS from thu rpfivrvoir into the ntKitphiiguK cif the patient; you aak blin
to mnkc efforts to swallow, nnd ilowly and progreseivcly you cauBo the
Uquiil in thi" gliuw resurvoir to pi'iiutrato the stunmuh.

YoH hftvu often seen me jierfonn this operuLiou in our hospital; you
hiire seen the rewllnefls with which jiaticnte consent to be fed in this way,
mi'I how mueli thvv prefer this method to tlio former, in which the longer
and largLT tube ie uaciI.

Thauktt lo gavuge we ttoo the appetite return, the liodily weight
incTPaso, the strength come back, and the facts wliioh Debove lua pub-
liahetJ. and tlmse which I liave noted, indicate the great fuliiro in rcsen-o
for this kind of trefttment, which ie applicable to all eoaou where nutri-
tion is ut fault, and ea|K3[:ially t» tuEtereiilosia

Such are the indications wliieli I deemed it important to present re-
lative to *' larage and gavago " of the stomocli. Now tlwt we have (ttitdicd
together t)ic ba«ie of the general therapoutic^s of stomach affections, wc
Bhnll entei- u[H)n the treatment of eiuth of these, and I shall devot« my
next chapter to geuei-al considonitious ou Lliu dytspepsimt.

NOTES TO LECTirRE VI.

' Boerhaave was the lirat t^ cKiunael the injeetton into the stomatih of
liquids by meana of an <esopliagi-'al tube; he, however, said nothing of the
removnl of those li<|uide. Coemir KcnnuU In 180'.' first recommended
meohatiical emptying of th^ Btomnch in oases of jHtieoning.

In ISIO, l>upuytri'n majio a large number of eitperimenta of tida kind,
und uhowoi) the hikrmlcssncss and the mlvaiitti^'n of mcchiintciil depletion
of thi' stomach. Edward Juices in Kngknd repciited these exiierimenta,
and pBrformed ono on himself that wnn of great iiiterent; lie took a
poisonous dose of opium, and thon cleared hig BtomocU by moans of a
stomach "immp, whicii he had inventetl. Thu instrumcntu usotl on theao
occasions were all nearly alike, eoiiHisting of a syringe and long cesoiiha-
getd tube. One of the tirst stomaf^li-pumpa van that invented by Phj-aiek
nf Philiulclpliia; [tend uf London also devirifd nti iiit<truiiK-nt wliicu Hir
Artley Ceotier adopted; Lafeirgue in France, umul a pijMte resembling
Bomcwhat tiie syphon.

Arnold in l^'>i9, Somen-ille about the same time, then Plosji constructed
soft flexibk* tubc-a and applied th« theory of 'he BVplton U^ the removal of
li(|Hids from the titumauh; all tliese hail fallen into oblivion, anditVM

"at

J mf\

LAVA«B AKU WAVAGE OF TUB BTOMACH. 99

experimentAl eiwiys of Oser nnd of Fancher in 1868, that

it the Rtomach beoanio curiijiit practice.

ft iraS. KUtin TOcommondoii tho omploy of an (Baopliaj^eal eniind to

wbeee apper frxtroraity n-iu iKi:i{)to<l the mnulii nf ii siie-tion pump; tin

■drind wmliing oat tliu stonutch by mnanH of thia tnbe in inflamed hUUui

of that TiBuuH. This operation voA not, howover, put in pmetico at tlint

In lycr, at tlie fourth reunion of <iiTni«n Xutuniliste iind Physicians
ai Fninkfort on tliu Main. EiiKsmiiul made known the ruHultH of his
ofifirt.], und it was at once adopted by Wiemeyer, Bartc-le, Roiob, and
" WrmpisU-T.

Accidents determined by the suction and forco pnrap of Kiuumaat,
which waa odaptod to a rigitl oeeopbageal tuLp. htivu often been obeerred.
ThtuSemsBen hoe aoen tlie mucous mnmbmnt! t^uckod into the eyea of
Uu tabo and lacerated; hemorrhagtes htirc iilso 1>een notei^, oiid ^Viesner
Mads osaea of tJio kind.

'Galante has conrtmctcd. according: (a Debovo's directions, a tube
hacher whivb docs not pr^^mt througtioiit itg outire length vaJU of tho
MH tiuckaces. The iiuerior part, which is to pcnctr&to the ttomnch,
{nwnts aoonsidcmble ihicknRBH, iind nn oxtromvly smooth surfnne, which
permita ito <««y intro<luction intn the ntonmch. tlmnkn to the relative
n^ilyof this tabo. Tliouppor pirt, whirh rnmainH ontaide of the buot^al
cantr, and vhicb is comivcttid with Lho syphon, ia of much thiuuur and
nKffe anppte caout4:houc.

'Paul Schliep employs for lani^ of tho stom&cb: I. bic^Hrbonutc of
vhen there is acid dysncpsia; 2, permunguimU- of polush in putrid
na; 3, phenie acid when the Ktoiniii-h contains vegetal panisites;
. tionc acid u a disinfectant: 5, tincture of myrrli in atonic dvB|>epsi^

J. Andcer baa ubcJ rteoroin lor disinfectant lavages. iTo tniployi
two per oenL soluliotu.*

' It waa November 11, 1881, that Deboro communicatoil to the Medical

cie^of tlie UoiipLtalstlie Rnt results of hiH practice. At tho beginning

imcnt« be mode n^ of n mixture of 200 gnimmeti of meat

with tvo litres of mitk. to which were added t«.-n fresh raw

''*fp.' He has since then subittiLnU-d meat [wwder for this tnixturt'. and

l^titb moans in phthimual patieuts he lius obtained a notable iniprovi>-

■vBt ill nutrition, ns has been nwiii if eated by an incrciiao in weight, and

intheipiantiLy of urea eicri-lcil during the twenty-four lioiirs.

Identicid ruBiilta hiivo bfi.'n oliUiiiied by Diijanlin-noaumetz, and bis
interoe Pinel haerocordcl the^w rostilt« in tlio Bulletin UV-iu'nil do 'I'hvm-
pntiqiie.

This forced feeding'luis never produced in tbe hands of Dnjanlin-
BcuDwts and L)«bove nny InuI •'IT<>''I.-(. In one -ulitary instiince, however,
Dmum btad tho misfortune to ptnulrutv the larynx and tmchea with the
Ube. and beforo ho was uwuru of it. a part of tlie uliiueutary nii-ttnrc lud
catemi the lironchi.

*Rchli«p. Deutsdiea An'lilv. !, Kiln. Med,, voL xiii.. p. 4M. Ancli<nr, Pie An-
il WNdung dm B«*orcio« Iwi Mo^ndlx-n, ttXc., hA. U.. IIoH S. Dii jnn) in -B<MUimetz
I aUCUIuw. On Rcsorcin und ito TliemiH.'utic Kmplov, Bull. doTlicrafh, 1801, t

100

IJI8EA8M8 OF TIIK STOMACH.

Umna nnd Wim hnvp of Ute girpn an excellent resnm^ of fho reanlts
of forrajtl fpcfJing in phthisis, and various other caichwtic stntos.*

" Dujiirdin-Beaumelz. De Tali men tation (orc^ ehnx Ics pliUiisicjuen, Bull. g^u.
de Th^nip., 15 Nov^nbre, ItWl. Dl^Iiovo, Dti tnuURii^Dt dn la phtlLjeie pulnio-
iwiii-tf |iar ralimc Illation fi>rc4e. Bull. g<^n Ae. Tti^m|i., 80 Novembre. 1881. Di»-
DOK, Ui- i|iip1ijiii<x in(i.>iiv4n it'll Is oit «*.'•.' iOi:<ntJt tli> rullrnciitiition foiv^i' i^lii?K tcs
phtbieiquc-s et deit uio.vi'os du ktt conjuKr, BulL g^n. dc Tli£ra)i., 1& Jaavit^r, 1883L
Pcnncl. De I'lLlimirntution nrtiflcielle chez Ips phtJiisiques. Bull, dc Tli^rap., IS
Mars. 1883. DiiJai'tlin-Boaiintc-tz, Sur (in nouvftaii proci^d^ de pava^. Bull. (f4n,
dc Tt>£i-wp., 1>^ July. 1>W1. Itcad aUo ILc disfruitsjoas of the Mcihcal Society of
thL> Hospitals of Paris, SH^aioDsol OrU)her28th. December Sad. and April l*th. 1888.
nli«<i IJiowH of thi> Sivii'ly of Thcnipciitios wf Fiuiii. Ki'iuionit wf NuvAmtu'-T »th,
De<^eu)1)vr Uth, ISai, and January SfiUi, 18B3. Murller, De l'al[m«ntatioi) arUfldolle
ell's plitJitHiqiicH, Rt^-utf Tnfdk»l<!d«Louvatn, Aodl »tH*'ptiTiibi'<'. lf«2.p, JJtta. Dp-
bov« ct Bnirn, Du lavnj^ii de I'estoinBc cL d^ I' alimentation artiHoioIle dana qtiol-
qiics nlTcvtiuiiH chroniquca dc roBtomac, t'rof:rt!?« Mfidit^al, ^i\ !i>rpt<:tnbn;, IV^.
QuJnquaud. L'aiinienliition artiBcl*)le. ReTue Scientillque. 1883, p. 32fl. Broca et
Wlii«,R«(>hcr«liA.t «ur la miratimenlation. Bull. R^n. duThiSrap., 1KH3, t-ov.. p. 38<l,
8S0, Wa, 441, 49^, Ml. BroL-a ct Wins. Bcchcrch^s aur la eurolimeatatioD. Bull.
de Tliimp., 18H8, t. cv., p.a&»,mi,W3, 441, 4i»0, 041.

LECTURE TTI.

DIVISION OF DYSPEI'RIAa

BnouJtT. — The Dieeaeee of the Stomach — The DyBpoiwiOT^Ppfiriition —

• Cbhsuflcatinn of th« Bjs^MipifUi — Buccal Jj^iijtepm — StuiiiuuhaL Dys-
pepsia— Intcetinal Dyiqiepsitt — Varieties of StomEicUftl Dvajjepeia —
Bmis of the CInseificatiou — Disordi-ra of tlio Muecukr Cojit— Atonic

I or FUtuleiit Dj-apojiaiu — Vomiting— Disonlern of the Mucous Coat —
hilrid. Acid, Pituitou* Dyspejiaii* — Uinordere o( the Nerrons Systera
— Sense of Hunger imd Thirst — Qiialntlgic Dyspepsia — An^resia —
Dysorexia— Hetfrophagiw — Vftrietics uccor^ling to the nmrch of tho
Sjmptonia — Accidental r>y8p4'psin — Vurietios according to tho Age
— Dyapeptnas of Infiiiiiuy and Old AgB'=Symptomotic Dyspopaaa —
AffL<ctioiL8 confiecutire to tho Dyspepsias.

GCNTLEUEN : Now that we know the hygien© and the general thcru-
pentiM appliaiblo to tho trcatmont of affections of tlio stomach, we may,
in continuing our nourse, go more deeply into the mibject, mid tjike up iu
tkeir order the divers discaMcH uf the gastric veutriolu. 1 shall, therefnrp,
b ihe following chapters set forth the treatment of the d.vs|icp»iiU!, of
BlotT and of cancer of the stomach.

By far tho largest «pnce niuat t»e doToted to dyspepsia. I well know
Wr ngae and indellnite is this won!, and the inronvenienoeB which it
pmimb; and 1 am quifti of the opinion of Hrinton. wliu thinks timt in the
tilraaccs made by clinical medicine and {mUielogical physiology this word
'npepsia is destined to disappear from noxology.

Kothing i« iu fact more ciirinus than, on surveying tho hiittorie* of tho
^r*l>^psiaa, to Bee how this term has nerved to cover doctruies widely
diflemit and opposite; but I must in»it<t that I am not here to give a
annt on ini«m&l pathology, and in the department which I have
t^om, namely that of clinical therajiontics, this word may etill render
■ gnat flBrvice. It embrace.':, it is true, after too confuned a. manner, all
Uk tknctionat trnuMitt o{ the idoinuch, but it enables um, in return, to
<bnHteTue by a single word a oomplox e>-mptomatic state which it would
1» dilBcalt for i\s to dengnale otherwise. 1 »1ul1I ki<up tbi> term, then,
^tfito its inconvenieneow, and shall endenvor by as mothoiiicftl ndiviition
■* inwhlo to clearly define the divert indicutionit and thcmjieutic uppHca-

bVbh

Ito not cjcpeut groat exactness from me in the Limits which I shall im-

103 DIBKASES OF TKK ATOltAOH.

pose Tipon mv snbject; it will often liappen tlut I shall overstep the obscure
boiiiidfl which wparatt' the functional troubles from real inflammntions of
the organ; aiitt you will twc mo iiicluUu iii ttie mmv cliuptvr, irritiitivu
(lyapnpeia with inlI»mm»tion of the gimtric; mncous niemhn)ni>; ymi will
h«&r nio ipenk of gastralgia in the eame conuoction vith ^uiTif iil dys^iopxiii,
and you will jwnlon these seeming lapges from ex&cl uiwology. for I slmll
sbon you tlml tla-se distinction^ which arc iK-rUiti}» juntifujii by iiiti-riml
patholof^, diaappeiir before the moAt essential port of clinical tntMlicine,
namely the trcutmeut.

Comprehending a great number of different affection?, dppepaia re-
quin;H division into Bcivcral boodB, and you will seo in thn Tii.rion» works
which have becu devoted to this enl^ect, dirieions that are more or low
complex.'

I shall flr«t of nil pive the Imisis of the cla«ai fteation which I pro]X)so
to aciopt and I whall endeavor to dt't4:'rmine on whnt phyniotogical dnta we
can cstnbl iuh a methodical ormtigcmcnt of the different (uncUonul diiiturb-
anoesdeacritjod under theg<>nprii?nameof dya[>epBia, You will ace, then, aa
we go on, that the ilelaile into which I shall enter art< not without praoliiail
atilitjr, and that they will enable us to deduce consequences important to
thurapt^nti(»).

'J'he plan whicli I am abont to trace may perhaps Hcem thcoretioAl, for
it is difficult to find a caeo which correspoiuin absolutely to each variety of
dysjiepeia: genorallVp in fact, yoii observe a mingling of types; modifica-
tions Hupervrno during the cnnrtic <if the disciiee, and a. piktient thut ut
the oiiect presented one form of dye(>epsia presents another a few montlu
Inter. 'Rut I niui^i inuiH thai theuj divisions have their advantages, and
thiti ia why I dt'vote more time to these preliminary considerations than
is my wont, for tliey will facilitate the fX])OKition of the themiKiutic
menna of which the phyisiuian omy make uisu in the ti'eatmeut of the
fnnctionnl troublfs of the stomach.

As in till! ea*o of every nymptomatic aggregate, we ought to study
several points in ronneclion with dyspepsia: the seat, of the functional
disorder: the march of the ditu-UBe; the etutu of the palieut ami the euuec«
that have determined the affection.

Let na examine those di(teit>nt {}oint&

The digestive act is not simple, it is, on the oontnuy, very complex,
while dyspepsia connotes the pnthologicnl modifications pertaining to
digeatiou iu its entirety, and us thie latter comprises three principal purt*,
the buo(^ act, the gastric act, and the intestinal act — you seo lliat to
each part may eomnii^>oud a functional diH^rder to whicli we have the
right to give the name of dyspeitsia.

Wc have, then, buccal, gastric, and intestinal dy^pcpfstas. The
fintC, or bmtcal dyspepfna, is little nmenablo to divisions; the latter (in-
teetiiinl dyspo|M;in) may be t-ulxlivldwl into dnodtinai, Otal, and Ufo-ctecal
//(/M/ir/iyin,

DrVTBIOtr OF DYHFEF8IAS,

lOS

I

Tbe functional •Jisorder of the stomach to which the word dyspepeia
■oit gencrnlly applied, » sni^Mjptiblf of numornuB inibdivisioiu, utd I
im obliged here to enter into minute eiplaniitionH.

to order muthudi<:ullj' to chveify tlic rariuuH porturtuktionii which the
HooMch may prewnt. we ehaU buvc to take for b&eis thi.> dlSurent oun-
ititnent parte of the organ and the mcxlifiontions whii^h tli? disease imposes
«D tbo ngalar hinctioiial perforiimncc of the soreral tissaoe.

The stomach. For the parposeii which nowooncem us, majbe regarded
liw poaseauig two cout«. thu muBcukr uikI the mucous; it n.-cL-iv<.-{4. iiiuru-
ftcr, btood-Tceaels and nervee. The functions of theec constituent p&rU
mn be modified in three difloreiit ways; there is either exatfg^ration,
iimimtion, or perrtnion. It in on ttiese physiological baBes that I 8hiUl
Mtabliah the Tancti4ai wliich stonuwrh dys^iriKsias precient

Lrt lu oonimuncu hr the nniscular coat, concerning wlioeu oflico I
4b11 hare more to aty when I come to the trentment of the atonic dys>
pepciafl. This coat forms, as you know, a complete investment of the
ftomacb, and if we may belieTe certain physioIogijiUi, and wtpeclally
l«T«i, it ban a preponderant rilo in ttu- functions of that risKiis. The
moKular tonio h&a in &ct for its ofIii?« to cause the alimentary 1>ohi» to
(■naked with ^lat-tric juice, and to bring it euecesxively in contHCt with
■n |Hrti^ of the stomach by means of tUow regular moremtrnts rath*d
ftrutailic. Wo may obecrrc in the ftinctions of this muscular envelojKt
tfaemodifioations wliioh wc have just mi^iitioned: diminution, exaggeration,
■no ponemon.

Tbo stomach mnsde may lose its activity; then the digestion becomoa''?
ikv, torpid, and little by little the frt^imadi allown itwlf to 1>erome di»-
Idkded andcr the influeticn of the iHirutii; condition of its intii^cuUr c«al;
tluf is tiie type that I shall describe under the name of atonte and j?fi/u-
^mkMi djfgpepaw.

^P In other cases the mnscular function fs exaggerated, the contrao
^H tiou augment in encrg>', thrro ih u mil pt^rvontion; sometimes the
^ fwtaltic movements are reversed and the stomach rejects its food, this
* vomiting; eometimea it in simply a regurgitation of footl into the biieea]
arity, a sort of rumination called mert/chm. You see, thou, that in rbe
flmctional troablctt of the muscular layer modiEicattons may bo produced,
|R<1 that thcBO cnablo ue to ivtablifh two variotiee of dyspopaio.

Let tu now, from the same point of view, study the mcicous c-oiit. It
a to thin that ttie stomach owuii '\\^ [mrtieular digostive action, by rirtno
of tha gwtrio juice secretion which hu8 the property of traiisfonning
•Ibnuinotd Eubt^Lnnccs into po|>ton(iB.

Proin the i>oiut of view of our cUktt<^hcation, wo romnrk that the
■ncooff ooat may be considered under two anpeot^; it iwitainu in fact
pfMB glandf and mncouK gtandx. The glands of the stoumi-b vou know
ittMhe internal wall of the rcntrielo. but if you make an attentive ex-

I

104

DISEASES OP THK STDUAOH.

luninution you will Bee tlut on Uie level of the groat cul-de-Bao of the
stoniacli aru sealod the tubular glands wtiicb contain in their interior the
coriiupclfts calleil pepsin corpuecles, while, <m thu oth<;r hiui<3, iti the
ifgion of th« pylorus tho glands arc deprivocl of these pnrticnlnr coq>na-
cleti; the Bmt Hucrote guitric juioo, the second mucus. We nmy, then,
«wtabli»h BtUl another division, according an tlio disorders bsve to do
with the»e different glands.

A* lor the gastric juice, caisDS are observed in vliich there ifl diminu-
tion in tliu Becretloii, and cnnsRifuently more or lei« diminution in the
activity of the xtoniachal digestion. Am the gastric juict? hiw the prujierty
not only of i^'onverting alhuininoid matters into pttptonen, but alno, as
Spallaniinni lias eliovii, of prerenting the jiutrefactiuQ of thesp Gubetaiicra,
yon will understand that one of the first signs of this funetionnl trouble
win be a putrid odor in the breath, nunh as in oljserved in certain eases
of dys)»eiMa, Tliorefore 1 ithall give to tlii« particular form of d>')«])epHia,
which corresponds to a diminution of gsfltric juice, the oamo of putrid
dysprpRiii.

In ether casea it ia not dimination that causoB the trouble, but axcem
of gastric juice secretion, which then acquires an exaggeratwd acidity; the
patients experionci' eructations of ftlimnntary mattera, arcompanied by a
pf(>nliar eciisalioii of burning and boat along tho cwophague. It ie thia
symptom to whiuh has been given the name ol pyrouin. I ahali describe
this variety under the nanie of acid dijsixpna.

As for the troubles due to por\'rrBioii in tho secretion, our chemical
and c-linicnl knowlodgo of the gnstric juice ie not far enough udTunced te
eniihlo MB Rctually to determine the special and intimate modilicatlons
which diseiLKea efteet in tht> nature of this liquid. We refer tu the two
preceding varietiea. putrid and acid dysjiepsia, the modidcationa pro-
duced in the constitution of this secretion.

>>om tho point of view of tho nocretion of tho mncouR glande, we are
at present awinnintt'd with hut one modifieution to which this secretion ia
Hubject, and wliich cunxiMtH in an exaggerated nnicotii! 0ux; this vxcetu
niauifeets itself by glairy and pituiUnis vomiting, so often oh«r.rved in the
courso of alcoholic dyepupaia. Wc may give to thia apocial form the name

of pittiltnUK rlys{>e[)»La.

I have alluded to tho blood-veaeoU and nerves; thu former are so
intiniafoly connected with the secrt^tion of gastric juice that we cannot
iK^parate the modiBcntioiis produced in theirirculationoE the stomach from
the disonlors which take placo in the fniictioua of the mucosa; therefore
we shall only concern ourselves with the riervea

From Ihu point of view of its nurvoiix i^ystem, tho stomach preaents
it«-ir under two a6|)ei'ts: first, as an organ ruceiviiig ini])ortant norvoa,
secondly, as the etat of u special 8en»^o, thut of hunger and thirst. With
mganl to tho last point, I am well nwan? tliat Schitf ha« fumi«ho(l oerioaa

DtVBION OF DTSPKPSIAS.

105

I

n^nneiitB sgiunst this doctrine, and that ho hae endtiiaTorcd in his Ijesaona
ffiOigeition to show by clcwrly nuinftfi^>d «xi>eriniciits that thin sciiko-
tiOM Wight not to l>e referred exclusively to the xtumuch, but tu ttie entire
•nmrny.*

t)e8pito the opinion of thiti lenmcd phyHJologint, I am not yet con-
nuoed, »,nd 1 continue tu think (without rnturiu;; farthiir iuto the
difficul^es of the sahjfwt) that the stoinac-)! lias ii predoniinunt r61o in
^ production of this |>articular gunsation calli^d thei eviiso of hiinj^or and
c( titint, and from the point of view of thosiiidyof tlio dyspi-psias, I
Ad) refer the diH>rdcniwhirh cuncvm thi:; ijarticuiur euiiautiou tu » fuuc-
txmal modification of tlic tttomach.

In its nilatioa to the nervuuti systein, digestion prv^nt^ this nota.hk> char-
•Henstic, that it is not acconi]Hinipil with jtikin. and tlmt for tliis function
to be nomuil, it maat ha unconscious. ljasi-g\ie, who has lengthily insieited
w tliia bet. has rightly said tbut from n ciiiui.-Ql point of riuw it in not
HuN^ to constitute dytq>cpaia thivt there shall be functional tnml)[i'» of
thertomach. th« patient miiet aUo be conscious of thc^su troubltw. This
hwled IHdouxtORay that dvHprpHia is a nearoflis. But in certain cir-
<Uiibutcue this nvuroisiB ac<]uircs u ^i^L-cial ucutvnvst; the patiuit i-xpt'ri-
•0MB daring digcj^on poinsi more or leos Bevem, and cramps, h ia to
Ah form that the name of fftixtralgii: dtfSfMjmtt lui£ been gireii.

h» for the eeose oi hanger, it may be nugmented, diminished or pcr-
Tho diminution of tht; ecuBe of uppt-titc is a frnqnont plieno-
you obecrve it in most acute and chronic ditieasea; it is called
nmana.

In oMier cas«8 there is morbid exaggeration of the eense of hunger,
vbiirh \» never satisfied; the patient is always eating; thifi is vrhat Lebort
ilB«<k«crib<.-<I under the uamc of d^sortxia, and which ia kuowu as bon-
limia.

rinally. perversion of this sense, or htieropltagia, manifeiit^ it««lf in
diSiTUQt unys, described under the names of ftica and jnalacia. Omiphetf/ia,
*hicfa Hcoxingor tuu noticed in ^uucmic negroes who eat clay, enters iuto
lia group. '

Sach are the different rnriotio^ into whinh dy&jiefisias of the Btomuoh
nj coaveniontly be rlajtsilled, and which in the coming chaptont wc shall
tikcBp in their order.

I hftveaud that the dysi>opBia« niay also bo divided aocording to tli«
nwtth of tbo oJfertion, and you will, in fact, »po certain writers, Chomet
fi Xonat in particular, mngc in the group of dyspepsias on aouto afTvo-
^tn vhicb by its syni]>lom8 rtttembtes them, namely accidaifa} tljfxjtfpsia,
'f "iigatHofit while Ihey resone the name of ordiuarf/ dynpfptia for the
^Iprtire dtsonlcrs which wo ehull study more particujiwly ia this oourao

lKtar««L

Age luu also a nutable influence on the development of the drspepsiiuii

106

RIftKASEB OF THE STOMACH.

ve sliall find here also n Uu^tt of cUaaificatioii, and we eliall luive to stndy
the dy6pep»in ofearUj life, and fhe dif^>epeia of old ag^. I shall devote sin
cntirp chiLpter to the dynpepsia of new-born infjint*, which you will often
bo called upon to treat, und concerning which yua will wajit xvitj preciso
iudicatioDtf.

Finally, the causes of the dyspepeiaa play a coiiBiderable r6le from tho
point of view of tri'atmont, and wo sliuJl »^oo thiit in many ciuvs if you
direct your efforts tnwnrd removal of the cause, yon effect disappcBrance
of tho diaoiusu. Yon will not. then, be surprtHod if I inKi»t eo leiijrtliily on
Uiu particular bruncli of tlivr&iwiltios, vhicli Profi-e^or Itouchardat had so
well charaetoriMd by tho word etiohgicnl Vterapeulica. Functional diges-
tive trnublcs roRiilt in fiict from a tlinnsfind canees; uoniotimes tliey tnko
their origin in lesions uf tin- alKlonuniil orpuis; the liver, the bladder, and
the ut<?ruH have here a prejujiiderarit i«irt, and yon will often m«st with
certain forme dcerribwl ns hrptifk di/^pfjma, iirincHs dyspepsia, or uterine
dyspepsia; sometimes the disorders coiite from an alU>ration of the blood:
the general diecunas the diatheKox, gout, antemia, chlorosis, [irovoke dys-
pepwiw — these arc the dyscnMic or dynhimnic difsprpMitx of Spring,
I »hall Ix! obli^d to return to &I1 tho»6 points whou 1 tako up the etudy
of the different kiuda of dyspeiwio.*

Lastly we shall have to confirler the aceidvuts conaecutiTo to the dys-
pepsiaH, and which Bean described under the name of secrtndnrtf ami
leriirin/ froubh-i of dif!>i>e.psia.\

I shall nnw entnr upon the atady of each of the varictios of dyajiepeia
which I have unumurated, and Bhall begin my next chapter with tho tnnt-
meQt of putrid dy^pepiua.

M"OTES TO LECTUBE VIT.

' Dyspepsia (medical term eo vague at the present day) htu itood for
many liitFen'nt nialarlirH, and huA had direrB p.i^ii(icHtions according to
the times and tlm writers. Under the iiMmes <i})R]ma, firadi/pnptia,
irnhfciUitaii i-pntriciili, intfmmrim i-pn/rir.uH, ronrjH'tio Imna, conewtio
debilis, debilifits fk'marki, cruiiiUin ccniriruH, fermnnlatia I<pm, rhtihfiaiito
liTna, gualr/tltiia. (jiintru-eiiknrlffift, neurosis of tJic sluvtach. ptLtiiD-inipxtinal
ncnrmis, dyiipepHia lias been studied from remote limes, fl ip{)ocnitoti con-
Bidore it on the conwKiueiio© of a want of equilibrium between nlimontation
and Bierrise: Aretfeiis, Olsus. (lalen. denciiK- certain mnl-U'mperaments
of the etomwdt, dividing them into varieties, baieh as dry, humid, ook), imd

warm; J. de Ooriij apeaks of dvepepsifl along with the bradypopsia and the

aud \ogel admit numernuA iiuIxiivii^ionH, (m>

apepitia of Qalen: Bauvagce

'SpriOfTi Byniptoiiiutoloti; V , vol. )., p. I'^O.
f B«aii, Treatise on D.vspegwia, rtu-iH, 161%

DIVISION OF DTSFXF8IAS.

107

ling to ib«ni anorexia and cairlialgia are distinct diseases,; while
tllOTt regnnls i]yi«rpopKia iw c«nwfd liy atony of the mnscnlar coat of tlm
'itoaiMh. Still InU'r Broiis«ii?, rofprrinjj iili tli^-sft diwa«>e to irritation of
the d^ecrtrre canal, mibHtitutwl gii»t ru-witirritiB f'^r dvBiK-'pHia. At tho Rtmo
nxdi Bairaii. T)»lmnH. hikI Andral, couaidurwl dvupL-jisia as a iieiiroiiifi.
Knneruiia wnrlca. memoirs, nm\ lh(>si>s lmv(> ainee been puIiliRliiKl on this
mVjwt; aiuoug tlifsv w« ninv spfcify the trvatir*ee of Valk-ix, Ucuu,
CboDel, Nonnt. Uiiipon. Willteme, Briiitoiu Ofuiinbfrs, Fox, Luton.
«ii, and recently tin- thixe d'ngrigution of Kaymoud and Ihu work of
Proiwor Oermam S<'o.

Since Sauvaf^ee, wlm admitted bo many kindd of OyspflpRia, minieroiis
diridona of the disease liave bcea pr«]>oaeil; we shall only give a few of

Cbomel gtndics only one kind of dyspepsia, what ho calls essential dys-
ppwift, and he limits fiis suhjwrt to the dijr''Sti'»' troiibU'B nf the etomaoh
ud inteetiues (atomachal and intHHtinal ilyRpepHiiiR}. 11^ dividoa dyiu
pejKM into accidental, tomiiomry (indip-frtions) and hiiliitual. Among
the latter be givua tbt- followine variftiett: 1, flatulent dysfKijidiii: i,
gHtn^io and enteralgic dY8[Ht{MUL; 3. Iiouliinic ilysp(^])eiia' 4, and dy»*
prpiia: 5, alkaline dysp^^paia and Uio dv)4|K>iit!tiL uf rii{iii<tH.

No[!at, like Choratl, divides dyeiwp&ias into a<-ciciental (or indigestion)*
ml chronic or habitual (the dysi»e|isiii.s properly so called). Under the
UBH of chronic dyqiujitiiiL, h<4 ile>KTi!ii.iM ^nslrto dvfiKiptiiiu its: 1, eimple
futiic or atonie dyspepsia; '^.(.ft^tml^^icor iicrvoiitidyi^pcpsia; 3, Hataleot
{Utrio dyspepsia; 4, actd ilyKpc'lU''i»; 'i, dys|)cpsiii by irritittioii.

In the intestinal djiiinepsiaB. \w recognises the fnllowiug ^■nrietiei': 1,
limplfl iotoetinal dy^pt-psui; 2, tintiilont int^Rtinal dysiiepsia; 3, iiit<;8tinal
djmpsia hy irritation; 4, dumluiml dyspepsia,

ProfeaKir German Sut% in liiii work on the dyspepKiaa, proposes the fol-
kivinff division: 1, glandalar dyapepeiati; 'i, iuucoub Uvspepsiafi* 3, neuro-
iHBuu' dys|)«p»iafi: 4, d>*a])cx>aia8 ab ingeafUj 5, dyspepsias mixed or
Mnnlex anmn;; from various nu'clianiRms.

Acoording tu I'rofeesor Gubler (cHtiie&l course of 1875), the various
kriBBwbich dyswpiaa present ought, from an etiologial and th&ra]ioiitic
Miat of riew, to ne classed in the follnwing way: I, pHittfnl and »ip)i«m<Klic
afr{«pna; "J, atonic dyspepsia; 3, aitarrhal and HtburnU dyBjxjpsiii; 4,
ioflunmatory drtiperain.

This u the dirieion which lluymond adopts in his thveis.

According to [;even. dyspepsia is not » functional trviililf. but resnlla
tnm irritation of the mucous memhi-anc^, an irritation whieh may spreiid
*id afloct the diven mcmhrance of the stomach. Germain S^-v luw aimt-d
to rertrict the dyspepsias to simple oheniicnl diHonlcra occurring in tho
pstro^intestinal KMrutions. AccoTdin^ to him, tht^e affeetioiis are rh-
ndin ehtmirat oj>v^Taliotut; th« cheniioal a1t4<nition is tho primonlial
'onra; tho other BympLnnis, audi as pain, di^U^ntion, vomithig, are only
ifilihcDOinetia of dy8[K<psi». Lastly, the nerrous troi)bk>8 wTiicb eiisuo
■n«&]j BBCondary effects.*

'Rivinas (A.-Q.), De ilynp^p^in. Frfotlia. 1680. Soh? I hammer (O.-C.). De
4>P*tala, I^na, IflM. (^u^at^, NonoloUiu nn'tlnHliciL, Amiti,-r<l»ni, 1748.
^Vel> Appnratua ud nowilogium m(<tliodirain, Am»tenittni, 177A. Cuileo. tM^
■Mita de mUvdnc |>raUqU0. tmd. pa.r HtnujiiiHon, Farix, IKtfl. HnniSBUuii, f-jt-
«Ms (ka doctrines mMicaliM, Paha, ltH7. llai-ru£, Tnut4 sur leu tfMtraJgtds ei

108

DISEASES OF THE BTOMACH.

P

'AccortHnjf to Lonjjet, hunger is the espreaaion of a general stal* wtieh
nmiifcetiK itfwll by » ejtttcitti imprL-asioii wliicli we refer to the placf wliero
it mttkes ib«>lf felt, »U1ioiig1i in nsalitv it hm not its sole scat in this pittcc.
In Ilia view, liiiiigur i>i procluceil bv a mocUDc&tion iu tlio Bi-imibility
of the stomach, tkiid it is supposable tlmt thiB eoiksitiou takce ite or^iti in
the mucoDB mwmbraiieof tlmt orpin, mnce thn iiitrniiuctionof inert ixxliea
into tbo pwtric ctivity sutftcoK to iin|K-iise it.

In hu Loisons on DiKostion, Sohifl pwwcg in review and roftitos tho
vininns opinioiiE put ftirth rL'«iH)i-ting tht k-iwc <jf hiinp;r. untl tho tlivpm
mimifpstjitinns of tliia pheiioTneiuin. Acc^irJinc to this phyiiiologist,
himcijr <Iop« not depoiid on ttie stnte of ninnity of tlit? xtomiu^li. winre wo
ni-i; uutly anintiili^. hul-1i a^ ^liiieo jjiei^ uiid liarua. fcul thv dv^iru for i-uting
when tiieir sloniaohs iiri- fur from Wing empty; nor does il ileiiend on
thu <!ontrHctions of lln* (•mi)ty stoniiK!h, for nucU eoatrac-tions are imftui^i-
ble in the empty state of that organ, since it lacks the alimentary mass on
whieh to net; and. moreover, the movements of tlie empty stomach ivr«
infrwjuent mid much less energetic than during *ligestion. SchifT, also,
docs not admit tho h^'pothosiii which iittribiitu^ nung^-r to eomprctwion of
thn Hmimry nervrs oi tho walls of the vontrirln, pri«ln«Hl hy the i-etmc-
tion of the emptv stomncOi; he denies also that tiie ruhhing apiinst each
ntliiT of the Willis of the stomw^h when void of food, niii tM> the cftuse of
Uic piiciionieiion of hunger: and he cites iu this comu-ftiou the iiistamw
nf ctTtain animuKs in whose Ktoiiiut:h» have bran found pehhloe und other
foreign bodies whieh Keemed to eauKo no iincfomfortiihle spneations.
liejuimont thought thut in the Btomach during fitting, the glands not
buiiig able to evju-uate tlie produetri of their scci-etion, ike inufous mem-
bntne becuine turgid in con)tet|uenee uiid that from this cariii> the sensa-
tion of huneor. Seliifl ri'jeeti this explanation, which dons not 8*x>m to
him to be defensible, since by a meclianical irritation of tin; mucoea, one
can cause the glnndit to secrete nn tibnndant liquid, nnd yet hunger does
not cease.

Tho osperimcnts of Sedillot — cutting tho pnoumocwtrics in the horse
and temptmg the antmul to ent immouiatelv after the operation, prove
that dirinion of the %'agi nerve« does not aholiHh hunger. Moreover one
ought not to consider the ganglia of the great Hympatlietic as the pathway

)e« cnt^ralKics mi tnalailii'K rervpini'« i.lo l>sUiiiifu- t-t de>i intpKtins, Paris. 1820,
3' eilit. Uiihiiiut, Diet., ni^tl. i:ii !)A vuL. ]Hl!9. Atidr.xl, ('liuiquv ui/^diciilc ou cholx
d'observ-atians rccueillies A Hii^pitnl tie la Chnril^. 4* edit... Paris, 180tl. Boau.
Lemons Rliniqui^ »ur Ia dyspeiwie {Unx. dos ln"|>., 1J*5U). Birau, Tro.it4 de U dya-
po]»ie. Paris. Ifflfi. Ohotufl. De* d.vs|i'?|isics. IS.")", Nono-t. Troitt ilea d>"ape]i-
sies, \Kfy2. (iai\»m. TriLit^ di> lii dvKp'iniit fimdi't tur rAl.iiiK- p|]ysioUi)j:i(|tie et
cliiii<:|U':. Paria, 11)64. Oaniad-Fai-d«l, Traits t lit rape utique dusvaux mintruLsi;
Trait^S dti* maladk^ clironk|ue», t. IT., P«rh, 1^(18, Willieine (K.-J ), Dc.t d3»pcp.
nie* diltLS c<t8,eDLli.'llc», leiirs naturea et leiii-s trajisformatians, Paris, 1868. Hu^
borslioafS.-O.), Patliologicul und Prauticul Olnorvutions oa Diseases uf the Alxlo-
nn-n. «U:., 2d edh.. Londtiri. 1863. Brlaton (TfV,), Lectures on the Diseases ol tlio
StJiiHiich. Sd edit, t.nndiiii. IMS. Chunibi'm. Sur 1« r%inio aliini>nTnii\i do la
dyspapsie. ct(\ (Brjiitlivviuti-'a Retrosp., V'.. 36, 16C&). Fox<W.), On tin- ])iii<nu!iis
and Treatment of Uie varieties of l>>-ap»i|)«ia, London, 1&07. Luton, Diet, de
ni^il. ot dt chir, pralnjiios, 1B70. HaTmond, Dos dy«pep§lo« (Thwie d'u^-^^tion,
Parfs, 187111). Lcvi'n, Traits dcsmidodivs de ri-^loinaiL', ItfTD, p, 2W. UvrioaiaS&e.
Di9( ilyspep&itat gaulru-lnleitliualus ^IiitroiIuctJuii. Paris. 1081),

DIVIfilON OK DYSPEPSIAS. KlO

c>f transmission of the »onmtion of huiicer to tfa« nerve centres, «inco
Brunncr ami llenson have ciiridMl tlit' HpTunrhnic nerveji. and found tluit
thin 4i() not prprent thn animalit op<>mt«(i on fram continuinfr to eait with
an spjwtite. The mrnff wns tin* aise with tliP l»rea on which Schiff
pnctiood sectiou of tht; two inuuirnDguaLricM', of the- iwu Bynii>atliutici$,
md Axtirpafcion of tli« ctt-liiu- ^.mglia. Anenci-phulouH fivtuseK liare lived
aereral days while K^iving indtibitiiblp Kipis of liuneiT: w*? ciLiiiiot. then.
place thn 'centre of the t«nsatioik of Iiuii^t in a Uetermined part of the
ootiTototions of tlie hemispheres (d««piUt the well known views of the
phn>i>oIogi8t«).

From his experiments Schiff concUid^s that the sensation of hnngor ie
independent of the lond atate of the ntomtich. The normal aproinplish-
mentof the Ktomnrhnl and intfxtinnt digpRtion does not stitlir^ to nmke it
diinpp««r, *nd it yields only to abitoqitioii of dig<>atpd infittcra. 'I'hi* es-

plains why tbu svnaitiun of hungur wa« co uculv and {lerustunt in txrttiin
"ly t'libiol. Dioiiis. I^ziiio. and Albin, wliere the iutcKtine nan

iOi»e«. criteti by
rf nhnormallv iiiKuflii'ient length: the nornml work of digesLion wiu not
inturruptod, but th« digested matters not hnriiig time to be ftbwrl>ecl tn
eolBcient quantity, were hurried through the idiinentary canal too rapidly,
and a certain port watt loet with the uxerementK. Moniover. SL-hitT has
ahovn that if in famiahexl animuts you inJL'ct nutrient Ii<}uids into their
Teins, yoD aSHiui^ tW hanger of these animals, which are thas nourished
vitbont there being any food in their gtomarhs.

It 18 the same with rc3|xict to tliirwi. The i*cnRe of thirf!t in not R>nted
in the b«*k of tho throat, forcompiete an«?ethc8i»of thepliarynx doi* not
annihilate it in unimtilit. The licRtion uf the glooHO-pluinF'ngeiil and
I lingiwl nerves, prnntineil on ewch side by Ixinget, didnot prevent the
^m dog» on whieh he operattv) from drinking as wont, and reBortion of
^P tho pitoumogiuftricD in tho uurvicuJ iL-giouH in dogs did not provoke lliu
H cesation of th'imt.

" Thirrt, therefore, like hunger, according to SahifT, is a general sensa-

lion. It in only alleviated by tlie absorption of water, and Dupuytren
ha« shown tliat by injecting \t-utcr into tlie reins of dogs parched with
thirst after long raiaug in the beat of the day, their thirst was completely
<\nenched.

' During times of famine, or sometimes even in the eonis» of long
joorwyB. certain Indian tribes etit tin argilliweouR <'«rth. containing osido
tt iron; they incor^¥>rat*> in this clay, niude up into cukiw, a little flmir
and fry it in palm oil. It itt not of this kind of heteropliHgin tlint we arn
■ow jtpraking, imt of tliat disease observed in negroes, and which Hen-
■tnccr attributes to the effluvia of marnhea. while llir«ch, denying this
palti'lal (malarial) tndTicnre, find« lb* principal cause in bad hygiene, in
innilKpient alimentation, in progreiwivo inanition.

The Keopliagism which Lie lieen oheorretl <:hiefly in the West Indies,
niBraiil, and in Kgypt, little by little, in the courw? of a few woekrt or
a Ira months, reduoeH the Kubjoct to a state of fntjil maraomu!; and pruK-
ttUun: rarely ttie disease Iftfts more than a vear, and it in rarely eurtNl.
Theiiiwse is prece<le<i by a perioil of general enfcublement, loi^itude, and
•Mania. The niuconK menibntne^ lo»e their color and the face becomes
"^1 H*}* ]mlpitutionti ennue on the lc«st efToH; the patient complains
™ fams in thi- t(oiniK-h lUiJ ha» an inti-upe ton^^ing for olay, which lio
wtgur* with avidity. With tlm uunatunil regimen there are vomitiuga

110 DISEASES OF THE 8T0HA0H.

and gastro-inteBtin^ troables; the enfeeblement and ansemia make rapid
progreBB; death ia generally preceded by general dropsy.

The autopsy shows an antemlc state of all the organs with serona
infiltration; the gastro-intestinal mucosa is pale; the mesenteric glands
are ordinarily tumefied; the spleen is shnui&en and Bmall, the liver and
heart enlarged.

LECTURE VTII.

•

ON PUTUm DYSPEPSIA.

Sl'UUABY. — Putrid l>T8p«peia— lU Hvinptoma— Pntrid Oastric Fcrmeii-
tatione — Or^nic Alkaloidfi — Leiioomaines and Ptomaines — Their
Toiic Action — Clinical Ptoci-kbps to Dftfrniino the State nf the Sec-re.
tion of the Gartric Jnioe — Stomach Bxptorers — Spoiige*i— Larages —
Tests of the Acidity of the trastric Juice — Keagoiits — Touts of the
Vigutire Power — Jlethod of Lenbe — Therapflutio Indications — Pop-
nn — Mode of Prei»aration — AmyliioeonB Pepsin — Elixir of Pepsin—
Glycwrcdc of Pepsin — Peptogenoii? Subetancea — Acid Moilication —
Ptiiana — CamiToroas Ilanta — i)iototio Kulosof Alimentation — Regi-
Bwn — Uydrothumitd Treatment

Is the previons lectnre ! Iiosed my division of the dj-spepsias on the
dwtarbBncea piorokcd in th« diftcrcnt functions of tliu Btoruttcb, and I
Aowed jou tiiat the mncons membrane, aa well aa. tlie muscular coat,
night bo patliologically modified iu three <liffcrcQt ways: tlioro may be
iWition, cxaggemtjoii, or pervoreion of function.

Without ttopping to give you a descTiptioii of the structure of the
oncooB menibranv of tlic stomnch. nhicU ha» been a imrt of your anatomy
nane, I will i«utH immediately to the Btudy of the functional troublea u'liiclt
diiB mucoue coat, considered as the Bocrctorj- organ of the gastric juice,
Ra; present. Thew disorders are of tn'o kinds: diminution or exag-
praiinn of the function; m for tlie troubles that are cliamctcrized by
pen«niou of tlii^ secretion, although such tierrcrsion donbtle«8 exists, we
•tt not warranted in conetitating thereof a epeeinl group, our eUomical
•nd cUnicnl knowledge of the gaetric juice Ixing so imperfect.'

I give the name of putrid dyK{>R)ii3ia to ttiv functional disorder arisii^
fnm the putrt-fuction of BubBtaiicua introduced into the stomach. This
intn&ction luu two aourcee: either it results from the diminution of the
■MTBtion or digpativo i>ower of the gastric juice, or else from too pro-
kniged A eojonm of food in the stomaoh in certain dilatations of tliat organ.

Let UK examine the firxt of the»i raitsw.

The diminution of the socn'tiou of gastric juice manifests it*clf by
■nnptome naturally dependent on abeenoe of this liquid, and oonswiuont
DOO-pvptoiuzatkm of azotizad aliments introducorl into the stomach, which
''•dily undergo putrid fermentation. Whotlier it l>e tlie lu-id of the
pane juice, rather than the pu^Miti, m Ohurluti Kichet thiukfr, which

I

112 DISEASES or Tire stomacti.

flpposee putrefscUon, it i* not tlic Ices trtic that the fact signal izc^I bj
SpulUneam is corroet, aiid tliiit the gastric juico prevents albuminoid
(Ribstancea from bpf^ominjr piitrcsconl. Tho priDcipul cymptoma of this
putrid dysjiepMa arc us folIi)Wn:'

After liHT iiig L'utcn, c8|JwniillT if thi; meal be composwl of nzoti2«d sub-
stances, the patient experieiicvs n ecnmtion of opprc«t>ion, of u load in the
epigustrie ri'gioii; hiu mwi] does not digest, in a word, he suffers tho dis-
comfort of a foreign body in the stomach. Several houre aftor the ingps-
tiori of aliments, colicky puins are fi-lt, of greater or less intrmsity, which
indicate that the alimentary matters buvo ut last iwuwcd the pylorus and
entered the iutentine. During the entir© period of Rtotnach digc«tJoii,
the brcstli cxJiales a more or k-^ fotid odor, and oructiitions of sulphu-
retted hydn^n raieuo, whence comeii tho name of sutphurtUed dysjiepsta,
whiub BoHcliardat has piveii to funrtionul etonuich troubles of this kind.

You have, moreover, lately seen in our wards » patient who presented
in a higli degree this Bpocial eymptom; it waa tho ouee of a man affccto*!
witli atonic and putrid dyspepsia witb dilatation of the «toruacli. We
gave him ruw moat to eat, and Komo time after tho repaet hia breath ex-
hibited in ft striking maauer the cadaveric odor of meat undergoing
putrefaction.

With these eymptoms are eometime» nswciated energetic contractions
of the stomach, wliich produce Tomiting; in other canes there is niusctilnr
parcsiB, and to the sum of the sj-mptoma to which 1 have given tho name
of putrid dyspepaia, aro joined thoao which characterize diminution of
tJie eontnictJlity of the muficular layer. It iu this imrctic condition
which distinguishes the second group of putrid dyspepsijw, and in which
we see cnormoua dilatations of tho i<t^)maeh — from whatever cause — re-
sultiTig ill the fermentation of eabstances too long coiitaiiie<i in that ris-
cus; 1 shall dcKiirilM.' theKc eaaug at some length when I uume to the chap-
ter on Atonic DynpepBia.

^^'bcther it Iw determined by the non-secretJon of gantric jiiicfi, or by
the abnormal fermentationti which aliments undergo ttuit accumulate in
tbeeo diluted Etomochi!, this form of dyspepsia has acfjuired of late a eon-
♦idemblo importance, and you will see as we go on that Bouchard him based
on these putrid tiaiiBfoniialions of foods a new medical doctrine.

Hinoe Selmi showed n» in \^^ that there oxiKt cjulaveric alkaloids, to
vhicb ho gave tho name of ptonuiiups, and especiatly since Annand
Gfttltior, by his brilliant reauandies penwtnitiug men- deeply into the
question, etttabtinihed the important fact that llie living animal cell as well
HH the vi'^ietal cell proditnes alkaloids; eiiicc, moreover, the lubors of
Bouchard ItavD proved that the economy imt'eBantly gyncrot(.-3 alkaloids
which arc eiiniinatO'd by the divers emunetoricH, and the toxivaetion of
Iheao divei-s alltaloulis lias become known, it lias seemed more .ind nioro
iMH;eRBary to antagonize these processt^s of pnb'idity, and you will see that
we arc ubJo to do tliia by fi}>ocia] thurai>eutic ugeuto.'

ON PCTBm DYSPEPSIA.

113

But let ufl TetBm to onr subject nnd 8tndy that form of putrid dys-
pIpBA detwrmiued by the non-ewretion of f^iutric juine. The HyniptumB
vKidi cluirBct<Tixi.> it ure familuu* to ^-ou ull, and rusult , as yoa know, from
tlic presence of azotiseil fltibetatice» which, not holng tmnHfnnned into prp-
toftw, act after tbc maanor of foroign bodies, and produ&e that soiksation
of opprennon and of weijjht of wliich dy8|w()tiRa complain. Ak for the
oolJcs aiid iiit4»tiiuii trotibk-s, t]\.vy iirt< t^'VpUiiiLil bj- Ihv irribition oc-
afiioned bv these undigested BiibstAnren whkh pam into the totestine, to
be later digc8t«d by tlic puiioroitic and inti^etinat juico, or to be rinally
Updled without having umlc'r;;oiio any mod iti nit ion.

By Iha Bide of tlii» jmtrid dyBjH'pBia. cliarHL'turiziMl by uon-«vcrL>tion of
gifithr juice, wo ma»t place the functional di«tiirbancus due to modificn-
tious effected in the gaetric juice itonlf.

In the foregoing Irctiirns, I luivo insisted on the noc<>«?ity of the union
«1 Uw acid with {wpBiu in order to effect popttmizatioii, and I havu j)oint<>d
rat to you the part played by these two a^-nts, acid uiid jM-]i<«iii, in tko
diprtinn of proteinous matters. The gastric juioLs may low a part of itH
•eidity, and this entails diminution of the netivity of the digMtivo iJi-occs*.
ItHtJiis stale that Chumul would deuigntite by the rather strange aji-
pdhtkm of aikaline (li/»j»qt.*ifi, and which we might more litly descriixt
M ifftpepsia due to iiDtu^citnci/ of ifadrir. juke. It has the eamo eymp-
tanu as putrid dyspepsia, the odor of the breatb \» less fotid. howi-vt-r, and
(nouBonly tho local or dirt'tl symptoiiiH, aa Ijuton obaervoB, amount simply
to a Mntttiou of weight and <li8comfort in tlic Ktoiniieli dnriiig digeMliori.

Thia diminution of the acidity of tlie gastric jiiion dejwiids on wreral
<»ia«. Boucliardat attribuU.-B it lurgt-ly to inaufliciency of thu cx-
OTitioD of urea by tho kidiieya; and eliminiitioii of this exorementitioua
pnnci|4e by tho mucous membmii<- of tho stomach and its tmusfonnatiun
lalo carbonate of ammonia, which at once neutmlizes the acidity of the
panic juioc*

<9nllard usigiu the domimvut role to excces of the sudoral sccrotion;
in hit Tiow, too abundant ucid sweats cause a diminution of the acidity of
tiiBgntric jutoe, and as proof, healh^gett this fact. thaldyKjwjifiiu from lack
fl( acidity of the goHtric juice, alfrcts. ilh a rule, individuals who are
*Utg«d to liTo in nu atmoa|)hvrc of high tvmix-mture. This itritor haa
ippiii'd thia conception to the explanation of other dyspepsias, such oft
thoie oucurrtiig in {H>rsuiis who tuke too violent ext'rciHe after menls, or who
'"« in plaora that ai-c nveriicatt'd, and thosi* wlio aro subjecl.<>d to forcud
■Bcliet, lik« Aoldivra, or to KxhuuHling labor, like farmers in harrmt
tinn.

Rat ^n will ask how can we recognize this diminution in the acidity
^libcgaatric juice? Thanks to the n>i«arches of the German pbyBiotano,

' Boiicfca*d«t> nvekcic Tn^atmcnl ot th-spcpnos. Bull de Thdr. t acvL, n.
Ha

\

114

OIBBASE8 OF TIIS STOAIAOU.

and iu particular, to those of Lfcubo, wc can to-diiy ascprtain by clinical
prowRsos l»oth i\w diminution of the iK'idity of the gajitric juice anii ite
(ligoEtiro ivclirity. and theso |>roc'08»CB uru now so Wfil known and so much
in TOf[Uii tbat »l the (.Wlsltad stations, all the patients afftctf-d with
atoniueh ditwrderv iindorgo thi>n> esamioiktlons boforo taking a oourse of
the wat^'^re. To nacpi'taiii the acidity or digestive jiower uf thy gastric
juicB, yon may make uw of three Dieaiis: lavage of the stomach, the
s{K>iigu method, and thv atoraach explorer.

A few words about each of thcw procodnros.

In tlio appliontion of the tent of lavagp, yoa introdiiCB into the
stomanh ahout a quart of water at tho ordinary tenipcrature: you let this
walfr ruuiaiu a few minutes, then draw it off and use it for the tents
which I am about to dc3cril».

Tliv 8|>oiige nmtlioil is the moet employed, it is also the most simple.
A Mnnll ijponge. to which i« attjiched a long silk thrpad, is coati'd ovlt with
gelatine or gum; the patient nwallnwH thin sjH)iigc while fnAting; it is al-
lowed to rnmiiin half an hour in the Htomaoh, then withdniwii t[uiik]y
by mcon8 of the tlircud, which the jHitient keeps between liis tcetli. You
can convunienlly replace thu 8|)ongo capsules siieli as aro employed in
Germany by the gelatine capfmlea of Ijeliuhy, whitrh am fountl in all our
pharmacies; into thoec cupHulvK a little pieeu of i>ponge with a long eilk
thread iwwvd to it ia equeesed, and the gelatine cover smoothed ^ver it.
The goliLtiiiP CBpsulo soon dixHolvt-u in the litonmch.

Il hu8 IxH'n objected to this method that, we cannot be dnre that the
sponge ever ponetrates dwply into the interior of the Ktoumch; moreover,
the«e little Kponges bring up but a minute quantity of the ^OBtric juice;
hence it is that I have Bubatituted tlio wtomach explorer for tho ufwnge
mode. Tliifi ox]>lorcr. which I here place bcfort* your oyex, i« fabriimtoii by
Galante. It comprehends, us you ore (Fig. 4), a stomach sound precisely
similar to thu tube Dcljove, luiviiig a length of liulf a metre; in the interior
of this tubs is a little glass bulb perforated at bctth ends, to whose lower
extremity is attached a little rubber tube to put tho bulb in comoiunica-
tion with the mncous membrane of the stomiLch; the narrow upper ex-
tremity of the gla»H bulb IB adnpted te another rubber tube wlneli is much
longer, and ends in a flack-shaped nibber ball similar to that which makes
A part of an ordinary epray producer; Anally a etout string enables ua
eK»ily to withdraw the glass reservoir. Tlie mechanism of this apparatus
IB cjifiily undcfHtood. Vou introduce the tube into the interior of tho
Btomach, then by means of the rahber ball you exhaust the air in the
glass bulb, whiflitheu admits giwrtrie juice; then you withdraw the sound;
when onee the tube is out of the stomach, you remove the glass bulb by
mcAnH of the string, and empty the gastric juice which you Imve estnicted
into a watch gUua) by moans of )>re3sure made on the rublier ball. The
apparatus is one of the most eimple, and its introduction and removal is

OS PUTBIU DVSPEPttlA.

115

ffxoecdtigly «aKr, «gpecially in indiTiduals who uro uaod to the etoniac'h
tube.

n»vmg obtained from the Htomach of your piitient, vhethor by the
tliu Dtomiich uxiflon-r, or by lavage, u certiiiti amount of liquid
, you prooe*^ tf> t*8t it in the following manner:
To ascertain its acidity, clinicinng in Oormany mnko ueo of a fall
ttrength mlntion of troixwiline double jcero; the mime irojmnUiif urn,
inuhlr trm, tripie zero has R-wn ^ivon \a ct-rtuin coloring: miit^^rialii obtained
Iff the lUrtillation of coal tar. In this conntn,- yon cirn eubstituk' for tro-
pieoliuo a subHtuiicd fabricatod by the tirin of Poirior and to which is
giTeB tlie name of Orange Xo. 4.

ris.4.

Under the influence of acids, and particularly of hydrochloric aeid,
UwM «olation». Vfhich are yellow, tnkv nii u bright re<i tint. In the «i»e
of Uctlc «<*id. the tint is onuigc red. It HufHceti, then, to compare tho tint
obtained vith thai of Ktundjml Mdutioiie to know thv du|;rou of acidity of
tW^rtric juice. The other portion of tlie liquid serves for practising
■nliciil diguition* with littl» eiibt.-ti of oooki'd alltumen of a given uteight:
«A b»r9, too, it vill be enongh to compare the resnlt gained with that
'liicli ia obtuined by mcuna of a atundaril solntJon of popuin. in order to
iiulge of the di^vi^tivc value of tbu Ut^uidti secreted by the stomach. I
■*«doiily refer thoHo interested in this Bulijeet to the excellent tlimis of
"'T pu^'t ^'- Dej<<-I lamps, in whiub uU the details {wrtaining to theae re*
*wcbea are giren. "

Vhat ia tbo true value of all tluwo new clinical methods? It is Terr

11$

SldEASKS OF THE STOMACH.

difficult ae yet to decide poflitively, the reticarches nre m rcooul, unit their
pnu'tiott] ntilitv is Ktill nndur discniisioii : I have, how«Ter, deemed it
ttocesury to hIIikIr to them that you might 1h> informod as tu «]) the
modem iinprovomcnla iu the diugnoais of thu dyxpepiiiiUi, nnd he read}' lo
aviiil yoiireclt of them when the opportunity proscuts it**olC.

Let u» HOW return to the tn-atnu'rit of putrid dys|iepsja. The iiidiciv-
tioiis to fnllill iirr tii remedy artifiiiiHtly the nou-socrftion of gft«lri(.' juice,
and to iiicrfusu ihu acidity o( this juice. Wu will atudy guccPMiTely tlie
means furnisheil by therapeutics, properly so callud. and tliosu whifh
hygienic therapeutics give us. Lot ue begin with mcdicamciitB.

The firat indic«tioii t« fnllilled hy the employment of [wpgin interimlly.
Tins is a medicament. gi>ntli-ni(^u, whose I'ahie has bwii long under (Ukcus-
sioii, and while certuin physicians extol it without nu-uHure in thv tn-at-
Uciit of dyspopsiiie, oCherti arc utterly eccpticitl as to its utility.

These difTei'oneeB of opinion it'indt from sevoml c«ubc»; und fii-st. he-
cauKe the iiidtvations for the adminiKi ration nf pepsin have not bc'eii tlxcd
with snlllcient cure.* In fact, pupsin ciinuol he pretjcribt'd iudiserimi-
aately in nil awes; it can only give favonihle residtH in one special and
particnlnr form, n-amely in putrid dysipepsiiu You see nowth* importance
of the diviiiiioua of the ilyspnpBiafl whirh I have givpu yon, dtriNionx whieh
may seum to be theoretieal, hut which have the ndvHiitagc of indiuiting
the flpecifd forms in which thia or that medicament may be employed with
«uc«e-8i. The other c«u«c of uncertainty in tho administration of digestive
ferments is that these fpnucnts easily undergo alteration, nnd thus rapidly
I080 their digestive propertiw.

But let U6 return to pepsin. From the time tliat Schwann in 1836,
discovered the |K>88ibility of extracting, by maceration in acidulated water,
from the gastric mucon±( mombnino of animnitt n liquid pomxegiiing the
digestive preiwrtiea of the stomach, and sinee Wasm.^nn and Pii]K*nheim
in \S'Mi were enabled by precipitating this suhstanoe by alcohol Lu obtniu
it in A Btato of purity, thi» modes of fabrication of medicinal i>ei>Bin have
been [>erferteJ, and to-day there am numorous prot^osM* in usage.

I Khali not enter into the detu.i1s of the fabricHtioii of pepsin, I Khnll
mention only tbi; French and English methods. The FrL-nch methotl is
the most complinited. It coiutiets in Udtiug the inner lining membrauu
of n sheep's rennet, thoroughly scraping it, and macerating the detritus
in water; the K«»hitinn in tbon prceipitat<<d with a salt of leivd wliich is
thtMi decomposi'd by sulphuiretted hydrogen^ then the Uauid ia evapurateit
to dryne^ at a tomperaturi: of lean than 113*P. and llio residue coiiBist* of
pepsin morc: or lees pure.

The Knglieh prooeaa is more rapid; the mucous membrane of the
dtotnach of a hog is taken, scroped, and the detritus digested in water
Bfidulated with a little itturiiitiL- acid, stniined and dried on a plate,
yrom thu point of view of tliu antDU»l cho^n it wc-mti t^J mv tlukt we should

ON PCITBID DYaPEPSIA.

117

{ftre prefiBronce to Uie EriKHsU processL The bog in fact u onuiivoiuuH
and itfl stonuich rdsemblea mail in its digOHtive cat)til/ilUies; therefore t)ie
lart French Codojc (that mf 1884) in conformity with this vipw, direct* era-
plojinunt pt httgi:' stflitiactiR in tlin faliricatinn of pepsin

BesidcN tlicae kiu<ls of [leiwiii t- xtructvd trom the Htniiiuchii nf Hhccp and
of hof![8, anotlicr jwpsJn ib in use wiiicli is obtnint-d b_v lYTrL-t from culvcs'
reuiiete.' I>annecy haa even counaelied to make xise of fowls' gizzards,
whieh hare been dried nnd cnt into «nall pieces or pulverizod, nnd whatii
stranger Ktill, the Mtomachs of oslri<:he(i buvo \nmn utilized fnrthii; purpose;
]M.')Min from this source would ! tbink be mlla-r si-un^ and iittbvr cuatly.
The parifiod pepdn obtained from any of tliese eouroes, seems to
preaent the cliamctcrs of nlbuiniuoid substuneus, ultbough its cxnct com-
pontion in unknown, and what ^ows our want of definite know]i>dge, is
to «o phyaiologista like SchifT ili;iiy to tbia product tlit- jiropL-rtics of
aaotixed rabeUDoea. What ib, liowerer, certain is tliat tliifl x>cpsin iict^ tl\e
])OPt of a true femioTit, and in the prwcnce of an acid transforms albumi-
uoid matteni into p(>]>U>ne8.

Iwi not think liuit the peptdn employed in medicine is thut Hubstance
in a state of purity, wtiicb bus Ijocq doacribcd under the uaino of pc|win cx-
ttactive. The naine of medicinal pepstti, or pepsin of Ccrcifietrt has in fact
baen given to a mixture of purL! pepsin and etarcli, in pnlvonilont form,
JB which atarch i< introduced in variable pi-oimrtions, iind h;ia for its
object to giTc to the mixture a certain digestive vidtic so timt lifteeii
grmiwt of thia amylaceous {)ei)«in eball digest ninety grains of tibi-in. It
it this mitturc which is sold under the names of Corvisan'e, BoudaulVs
and IIottnt'8 pepsins. In commerce this amylaceous pe)>iiin is Hold under
time different statee: acid, neutral, and alkaline. I need not tell you
that the last two ought to bo discarded from tbem]>eutics, because ]iep*
totiisatJOQ ia effected only in presence of an acid. It is only the aray-
laceona acid pepsin, which yon Bhould prescribe; this may be given in,
the ilono of from Hcven to fifti-fn grains just before each meal.

If this inixturi- of ])cpfiin and »tureli biut its advantages, it liaa aUo

its dindrantjigea. In the first ))Uco it encourages ao))histicatioru, and

to mioh an extent ta this tlie caw, that cerlarn irmTinfaoturei* Iiiive put on

the market ]ie|win prejianitions consisting entirely of starch; moreover,

(epno tia pmtein aubxtanct' which readily changes when expooed to tlio

vr, Abd thus loses its digetitivu pro|>ertiei:». Attempts have therefore

b"w made to obviate these evils. Ellis ba« ]>roii08cd to use rt*nnot

•iiw, tiWle by macerating in shorrT,' wino the pnlpwl raucous memhnuio

vIkcaU; Perrnt advigea to substitute sugar of milk for starch in tlto

Mnafaottiro of ])cpain, and with thi» combination to make granules,

wfaicli limy bo koirt from the action of the air by a coating of iK'tiBoiu.

Butmui'ii the b«Mt procetM ie that of Wttticb, (adopte<l also by (.'atill»n),

«Inrh mnmis in the uw of glycerine as the solvent of jwjMin. The

I

muooud membimic of a caWa atomach rcdacod to palp is macerated in
glya.'rino whidi diseolvt^s thv pepsin and xlbuiiimoit] matlon; ihe latter
are then uuaguluted by heut ami the ootij^itliini being Hopunited, h liquid
cndowwd with an energetic digt-itivc power is oliUiiiied. Caiiiloii's pre-
paration, made aft«r Uic etmw ]ir(K««s, di^^tit^ its own ircight of tibnne,
nnd a«*ordiijg to comparative expcriraentfi, the glywrite of pepsin would
seem to l« more active than the pepsin modo nfter the fornmlii of tlie
Codfx.*

You know, gcntlcmoii, thnt a-ucordtug to tJio rt»sultH of Berthelotsi'
investigations, glycerine, this sweetish principle of oiU, ought to be ranged
in tho clasB of trintomic alcohols. You know iiXso th:iL Atidi^i^ and I, in
our retwarclien on the alcohols, showpd that thi*? guk)«tunce, taken in largo
quantity and inaoHivi) dosos, possuiBc^ tuxit^ propertiee, corapurubio in a
certain measure to tiiostf of the uk-oholt!, (ilyceniic in small doot-K may,
however, [)0see8H recoiiHtitiieut propvrtiot), und C'uiistiintin Paul )ia» sug-
gested thst thet!e offecte may bo dne to its faculty of diesolving pepsin.
Sidney Kinger and W. Miirrcll hare pretended that glycerine has the
power to ]jrevent undue ooldity of tlii: i^Lomtuli, pyruKiK ami Aatiduncu. by
opposing or retarding tlio gastric fermentations.

Other preparationg of pepsin liaviinlso been rocommGudwl, and 1 oiiplit
to mention two tdixira, which have a grejtt popuhirity, those of tlorvisirt
and Mialhe.' These elixire ahuuld be preaeribt-'d in doses of a tubleispowi!
ful, or dessert spoonful at mcnl time. Alcohol apiienn lo retard the action
of fiepgin, as Vnlpiaii and Mourriit' have shown; this dimJiiiBlicH nome-
wliat the real theni|«eutic value of tliew> elixirs.

By the side of pRp^iu we should place the artificial peptones, whose
tavorable action htw been remnrkud by J'lotii. Muly. (jiergyai> uid Adam-
kcrvicB. Those product? have heretofore beau lilflo known in Franoe,
and Ilollnud, owing to the labors of Sanders, for a time hml tlie mnnofwly
of their fabrication. Si'ice I callerl attention to the utility of these prodncts,
our phftriiiueict* hitve found out how to fabrit-ate [wptone* of oxcellunt
quality which eijual if tliey do not exool thoi* of foreign origin.

These pcptonya are now offered in ('ommerue under two forms, liquid
and Bolid, the latter being preferable. Cnlillou liax etudieil the nutritive
equivalent of tliose dilTei-ent i)eptonea. und hius sliown tliat in the Lasu of
an adult man, nutrition nmy be well maiutiiinud by taking daily, eight
tablosjHioufuU of a sjitumtod solution of poptonea, correejMjnding to three
time* the weight of meat."

You may administer these peptones in the following manner. ' Into a
cup of nicely flavorod broth, jiour a taldes^ionu f ul of liquid ]K-ptonc, or a
toagpooiifnl of solid peptone, and repeat thia nutritive jKftiou thrw
times ft day. lint it muft l«f remenilwrcRl that the aeiditv of these
prod nets and their disagreeable UimIv render them ofti'n poorly aiippoiiMl
by tlie Htumach, and tlie residb is that at the end of a short time one is

ON POTBID DVei-BPaiA,

III)

■£

obliged to ocMC using them. I think tb«Ti that theee peptones oiif;ht not
to bo recommended in the trcataieiit of ufTi'citioiita of tho stomach, nt least
wh*fn it ia necc«8i»ry to iMliiiiriUtor thum by uiouUi. Iml im 1J»> other hand,
they are ailmirabtj adapted for rcctil fepdiiif^. luul ou;;bt U> surve cxclu-
sTolj, 118 I shall hereafter show ytni, for nutritive lovDmunts.

Bt the side of iwpsin and jjoptcnf-s of animal origin, we miiet yhr-a
certain curious prodnetH iiiiite rooontly ittndicd by Wurtx and Bouchut,
■nd which are doacribctl under the name of rtgetal pfptin, "

Tho Carica papaya '\» the principal meinbtsr of this group; it» ^.m,
Iwvc*. and frtut, fnrnifih a juice which hue the curioua proi>orty of tmiiK-
tormiog, with extreme mpidit; and energy, animal Bubetanm>ii into pep-
lotMM. Wnrtx hufi extracted from thin juico a subgtanco whicli poes^iutvi
■11 its digeeliTc projHirticB, and to wlu(!h thu numo papaint hun bet^n given.
With Uits difi^estivu ferment, there have been made elixirs and winca ub»o-
lately like the elixirs and wines of pepsin.

Whni in tho real therapeutic rahie of these popf^ne, whotlier of animal
vegetable origin? It is very mut;h lesi than one might mi ppnse after
wiiBCMtng the uxpt-rimontrt of the lubor»tor>-, wht-ru wo avu tUuiw pepsins
Twdiljr and rapidly transform into peptones the albuminoid subetanova
with whieli Lbev are brought into eoutncL In tho dyspepsiua and in p:ir>
licular ill putrid dyHpepaia. thcsn proporties Hepm rannderably wuakoiRtl,
and for my port I am convinced that the ta;»t moanis of remcidying want
of socnption of gaitrio juice, ia not to introduce soluble digestive femutiiltf
into the Btosnacfa, bnt rather to address one's self directly to the )>ep'<in
glands, in stimnlating anew thoir soeretion by poptogenous eubHtanens;
this end yoa will attain not by m«!if:am(iiit«, but by an alinu-iitJiiT repi-
mm, well nndonituod and well ordcrtil. But U-forc entering upon this
snbjcKt, I must tar a few worda al>out acid medication.

You ktiuw the imiH>rtatit r61o which belotigu to the acidity of the
gacuic juice in the ]X!ptonization of albuminoid snbetancos; you will not
than be asboDiahctl toscvucid medicaments preierilMy! in putrid dyspejteia,
Tbie qncction eo long debated of tJie nature of the neid vt tho gastric jnico
bui a grwt influence on the ac-id medicatioTm prnpooed, and yon will ttso
physicians in accordance with the dominant opinion, prescribe sonietinies
hydrochlnri'-, aometimrs lactic arid. Thus it is that 'rroiii)««n aiKl Ciiron
fc*T« formuLitud antid^^-speptio potions with hydrot^hloric acid for their
Imi, and some physicians have propo^tvl hirtic Icmonailc to eombnt this
wantof acidity of tho gastric juice." You will iUho tind inyourold fnrmii-
larios, under the name of viirioUc dixir of MyHnlcht,'* of Eatt d$ TMden,
(Thad«a water,) and BiUir of Pamcelstu, acid mixturos which Iiure been
nooouMsded in like caaee."

ThuH Car we have been conconiod witli only tbc more tm}H)rtant
tiBtidard prepamtioraL C'ertain pti«uis. and esjiecially thu bitter infuKitmfc,

of oousideruble efficacy in putrid dyspupoia. Although we Av nut

uo

PISKA8ES OF THE STOMACH

exactly knov bow these bitter siilwlaucoB act, they are neverthelaaa re-
garded BS exoitantii of the gustrio juice wcmtion, nnd vf promotive of
digextion. It in true tbnt tlm opiniou doos not rust on any vrry snlid
basis; experieuce, liowever, stH^nu to duciar« tli« utility in some omvs of
Uiow ptisans and infugions, and their adroiniBtration ia att«ndtid with do
QTils. r »\m\\ have more to say of thorn when I como to treat of atonic
dyspepsia.

But by Ibc side of thceo littbor iiifusious ivhoHi intimabo aotion csciiih.^
ns, it is proper to jilaoe other j)r*?parationa wlioe© favorable effect in putrid
dys|»>|)8ia is now porfoctly iindoratfwd 1 nHnde to ptisans containing [»]»-
to^noua HufistjtnDes such as the fi'&iVi? tlecoctwn of SydRntiam" and inf iiHioiiH
of ^raiii in ^'^ pruci^s of gormiiiutiun. Vuii Tiughcm in faot nmiiitainH
tliat at thiij period the cotyledou leares have the pow«r of diasoU-ing th«
Asotized subttaiiccH uoutJi.itLud in tho graiu. Soeda of vetch, of Indian
hemp, of gorminnting barley, hnvc in hiR boljpf. pi'pUinizing propwrtips.

We have JHst jtatscd in review tlic phttrmacootical prcporations uned in
putrid dyspepsia; tiift<c preparations liuvo a ut^rtum vilIuv, but tliuy cluim
tlie Bocond rank iu eftlcieucy us compared with tht* tliototii:' means which
may bo advantag«ou»ily omployod. Jlvre, »b in tho troatnit>Dt of dyspep-
sias gmienilly. ilw first plarti liflongn to hygienlr thiTapeiitic^s.

What iiygicnt.*, wliwt iv;icinn;ii, will you prtiw;ribc for u {labteat suffering
from putrid dyspepsia due to deficiency of gastric juice?

Lot UK begin with diot. Tlicre is a curious fnct wliicli the experiments
made by us in forced feeding (gavagie), Iiaviv lirought to light, namely, that
when you put in direct cuulact with th« mucoun nu'inbnLnL- of the stumiich
albuminoid substances suitably prepared, you see re-appoar tho secretion
of gastric juice; this is what takes place with the nu'iit powdoru, and it
eeoma to be kIiowii by tbeRo expcrimt-nts that the lieHt Ktimulantn of tho
secretion of the p^jpBiii glands are the peptunts wliluU rcttult fron: the
intimate action of the gastric juice upon the azotized molecules of theso
alimcnlnry powders. Tho fact ought to be utilizi'd in tho trcalmfut of
putrid dyspepsia, and you will do well to order meal powder or raw meat
to bo taken in Hmall quantity with each repast, and it is here that we
iritness the tritinipli of thu- method rccoiiununded by Brown-Sequard, who
propoeoa to tri'ut those dyf^iepflias by making tho patient eat a tittle food
every honr. A little malt flour, by reaswn of its poptonising propertifw
may Ik* uKlvantagconsly mlded Ui the moat powder: you ran also add bread
cnist which conti^ins dextrine, the lattvr being, as 8chill hae poiutvd oat,
powerfully pcptogonoua.

Yon will also pnasoribe a small glass of wine at tho end of every meal.
[The Hiinio quantity of old cider may bosnbstitntiid for tho wiuo in CiTtain
cases]. Th«»e fermenfafd liquors augment tK- acidity of the gastric juine,
and you know tliut thin ixirticiilar form of dys()epaia is charHctcriztjd by
ftbacucc of acidity of this eecrotion. Aa for the stronger liquors, you

ON PUTRID DYSPEPSIA.

121

ouiuiiu

ilunild allow only old whiskey or brandy, of good qiuility, niid to loestui

ito local irritaut action, the bervragti sbouUl lie Hwvvli^ned; ougnr in fact

miiuiiuzee tliv irritatiou that results from tlie action of alcoJiol on Uio

tuuoMU m«uil>rftnc.

Finally, do not forgot that milk plays here an ini|iortant rfilo. When
e of the (ligtwlioii of milk. I poinUM] out that thin liquid in a n>Al
tor of tht- acidity of llit: Htomftuli, and that it iim'Js but u little

i(U&atity of gaBtrio juice to frovoko the l^tic fermentation of a great
I ^luntity of milk. The pnwoncc of this Iftctte f<'rment uujnnotits tho nor-
, ml «;idity of the gastric juice, and idso its digestive proportieB.
^m You will order active excrcisi', moriiovcr, in ordt-r to iiiL-rviuiL- the activity
^H (d the general circulation, and you will also advise the jKitient to be much
^Bill tli» <qwn air, and if potMihlo, to live in the c»nntr>-. According to
^■'Charles RiHiet, those rule* find thnir physiftlngical explnnation in thitt fact
^r that tin- acidity of the gastric juice reuiiltH frum ite oxidation; now this

fttidtUion is effected ut the expense of the oiygLm of the blood; therefore
^L tlie more highly charged the blood is with oxygeik, the more is tlie acidity
^B «l tho gastric juice augmented. Finally, you may also derive ndvantitgos
^P from cold haths; hydrotherapy in rendering mure active the gtinoral ciruu>
^ bitiou, enerffizcii also the circulation of the stomach, and has an influence
^^ <n tlu) Be<:rctio« of gastric jiiicw.

^B Oat-door air, hydrotherapy — ^those constitute most powerftd curative
^^ vuans, and you may obtain the advantagea of both at certain thermal

lUitioiu, nich *a Divonne. Sca-luthii liavc also been couuiielled in theso

(asB8, as being stimulanta of the entire organism.

To what spas shall you send yoiir patients affected with putrid dj-e-
pepma?

tTho hydrothermal enre plnys so important ii part in the treatment of
dnpepeia, that in order to give you the most uaufii] indications in this
^*pird, 1 liave drawn from the experieuce of my friend Dr. Durand Fardel,
wtuw wide knowlodgo of alt that pertains to thiH subject is ot'erywbere
Rcognixed.
la gererel, waters charged with carbonic acid seem to exercise a tavor-
>ble stimutatioii on the secretion of gtistnc juice, and are indicated in
tWilyspopaiac; hence it is tliat the table waters St. Galmii?r, Cwidilliie,
tlapetout, etc., give good result*. You may add the waters of St. Albuu,
flwimi. Ilontalade at St. Sjiiiveur; Maliourat at Cautureta. You may also
^F^v alkaline waters, the ivxlic bicarbonatod, such as those of Vichy
"1^ Vsls, but in atnall quantity, a tumblerful at each meal, taking caro
tocfaooBc Ihv Bprings wliich are leaCT alkaline.

1 daill, however, defer till 1 come to H|i<>ak of acid dysjiepBia. the fur<
*•* coaaideration of thesi- alkutiue *aterH. which deaervo particular
^ti<Ki by reason of the imixirtaut part which belongs to tbcni in the
^fwtnifnl of dy»i|K']tsia8,

122 niSKARES OF Tint STOMACH.

TbcMS, gentlemen, are ttie divtvtic and plurniaceutica] rulwi to follow
in the tTOatraoiit of putrid <lT)i[iepBia liy noii>«6cretion of gaetrio juice-
You will pardon me for Imviiig dwdt lit audi gvmi letigtli on this form
of ilvRpppsia, bnt it is one of the most frofjnont, bhiI from the pointof vi«w
of treatment, it deiimiidg tlm greiitf-st attuntion. It rL-maiiiK for me non*
to Kiv a few wortU coiiccniiiig putrid dysjK'paia by Ticioiw fomentation
fjf etibst»nct» introdiiKpd into the stomarh. I shtill ho brief on this point,
for I intend taking it tip more fully when I come to iipcnk of dihitation
of the atonmoh.

It i» in fact in dilatations of the stomach tliat wu And these putrid
dyspepsias especially eommon. ' Resulting from the prolotiged onjonni of
alimentary subi<tauceij lu the diluted stoniuclud cavity. tht«e forme of
putrid dysijepBia require to be trcjited by naahiag out tht- atonueh with
ftiitipiitrefiictivo i^ohitioiis. At the Kitmu time, in some eases, onw miiy
without practising giniige, liave reconrw to certain pharniacentical prepn-
ratioDs, and. in particular to Belloc'e chareoal powder, or to weak aolutions
of bonicio acid (one or two per cent.) or better stiEl to a (Wjlntion whifh
gives mo oxctdlent result* under siieh eiruiimatJini^eK. and which I have
described nnder the designation of carbon bUulphidt toattr. This solu-
tion iuohtuineil, like chloroform vrnter, by agitntingpiirc eulphide of c»rbou
with water, then by cnrefnlly decanting the mixture."

This aqueous aolntioii, as has been shown by ('kiandi-Iley and Pelegot^*
contiini^ frnni thix*e to four granmios of eulpliido of earbon per litre. It
is eminently antifhtptic.

My I'iccUeiit iuternc, I>r. Sapolicr, in hie remarkublo thesis has sliowH
the benefits which may be derived from thia precious medicament which
lias none of the toxic pro|»ertie8 which have been attributed to it by
Delppch. It is enpcriatly in the treatment of gnstrO'inteHtinal affections,
that wo experience the u«efuhieHH of this powerful antieeptie. AVe giro
the carbon biffulphide water in milk, or with wine and water, and thug
administer /tcr diem five ur six lablespoonfuta of the saturated aolutiun.
Uere is a good formiJa for ite preparation:

Take of;

Pure carlxin bisulphide, .... 55 gTEmmea.

Water 600

M. Ksaenco of iieptK-rmint, . . . gtt. xxv. "

Place in a fliwk of the capacity of TOO cubic centimetrps. Agitate
and allow the precipitate to dei«)8it; decant off the clear solution when
needed. When you have pourt^d off neivriy all the clear liquid, luld more
water, and shake oa U'fore. It '\s well always to leave a little uitdii-solved
carlion binnlpbidc in the bottom of the flask. a« the Htpieoiis dilution,

• This B according to Fauttto Ccattni. Remmier aod Livucbe. The proiwi-tion
lolubla In watf>r is niunit IcKt, iici^nliii^ to Ckiond) Etey. (Vide Pelc^t, Acad, ties
Sdoncce, t. xcJx.. p. ^7, 1S81)

J

OW PUTRID DYSPEPSIA.

12S

whan donrnted off from the procijiimto, speeilily w»tki>ns from volatLliza*
tioti of tbr enlphidc which it lioltts in eiupension; tliU i^ pruvental hy
ftlnTt Icanog un txcom of thu uotii^rptic in the flii^k. T ohnll have more
to aay about thie subject wb«n 1 oome to ftpcak of aiitisoptic iiit<:'«tiiial
medication.

In the next lecture I shftll conadsr acid and pituitous d^Tspopcia.

NOTES TO LECTTJliE VIIL

' The tnncoas mombmno of thu etomuch pooeenoe a thickneea nf mx
miltiDiDtreti Hiid a linlf: it is qitiCt- tniii in Uil- hviLlthy nttitc-, but n-iitlily
nndt-rsun softening afti-r dimtfi: it has am iishy white cnlnr win-n tho iii-
diTJdiuil IB fiistiiig, hut is of a iivt'ly red hue Oiiriiiff ilipostion. This color
ie dm; to the nctiTt coiipj»»tioTi which pri'i't-tius thu Hfcri'tiun of (jiutiric
jnict'. On the surfiww of ihu iiim'ous inuiitbrunv of tht- empty Ktuninch
areohwrrcd tiumorous foWitor ruy*. due toahrinkuguot thcitrffuii, which
diapbear when the or^n iAdittbuulml with food; littlo shallow dupreaaious
are alao seen and pointed pro'^i'ssch or ^lupillie ^(tat nmoicloim^), sdio
snail round afwrtorcs, tho oriliot^i' of ^hunU.

The mucous mcmbrano i« compo^ of tlu-ou Uyors: vpitb^lial, glandu-
lar and mn8(!ti1ar. %

The cpithelinm, but slightly ailherent to thn nndorlring layer, is
(onniod of jttztaposited cylindrical collix with rouiu] micloi and granules.
Tks mujicalar ooot thin, mtiftaiil, fonnvd vf bundlfi; of fuH-ncult adiiuros
to the cvUuhir tissue of the KtuiiiH^h and to tliL> glandular Xayer; it is trar>
ened by tlie voaH^s which are distribulfd to the mucous nifmbmne.

The glandular layer, thicker lli;in the two others, ia formed of tn-o
sorts of glands; pepsin glaiidi^ and mucous ^lande^ These glands adhero
lo tho niui^iilnr coat, and aro a niillinu'tru and u half long, uiid am ex-
tremely namtTomi, attaining, according to Siippey, to nearly the figure of
five tnillinna. The mufMiua glands Enmnincl tlio pylornn, anil are also
,(onnd in the cul-de-sac of the l«T>s»pr riin-ature; the pepsin glanils occupy
the rest of tho organ. Tbe latter am rncenioae, prcwiiting thomsclros
UHler Uieaepect of a hair root. Tho niuvous gtaiide, of ulMxit the eame
Itngtb. bare tho apj»nnincu of elusti-ra of gni]>cs; tliry dilTer from the

Cnn glands: 1, by the number of tboir divisions, which is conitiderahly
( 2, by the eitua'tion of the glandular «eoa, which in llie pL'pditk glands
eeen[>y the lermuial Extremity of tht^; gland, whilo in the mucous gtauds
tliif I oeea are irregularly ranged on tli<- i-L'!<[H.>L-tive divisionK.

The pepeiii glands contain jjolyhednil i-clls more or lesi voluminous,
pepain cells, which do not exi^t in the other ^landa, Tlie excretory duct
of thon atomach glands is of variable length, and liiierl on the interior by a
cylindrical opitbelium, wliich is a prolongation of tho epitholiuni of iho

*A]bertini IumI alnwly inhown that on hLiiling f^aMric jui<» to 100" C,
C-12'F,) which destroys the ji^-jisiii. you do notdeprire thejuiwof it* anti-
pntrotaobve propertiea Charleti Hicbet has aliowu that ^e]iHin does not pa»-
MM aoy antisepttc pro[)crty,und that this resides in the acui of that secrutiou.

134

DISEASES OF THK BTOMACH.

He placed some fibrin from fivsli blood in two llasks; to the one lie added
pewiu, to tlif otbiT liylrofhloric iieid. The fiagks wvrv thuii uxposwi to
suitable conditione of hf-Ai nnd inoisturp, and at the end of from I-""! to 20
hourfi it wafl remarkiHl thi»t tin; fibrin which waa not aridified liad Uecome
quit*' iJittrid, while that whicli had been acidified was free from ail odor
or other tmao of putrescence.*

*In ia7G, Solmi, in scarchin^t for arsenic in a corpse which liad been
buried tliirty <iaya. found a crj-statliaed alkaloid to which he gave the
li»nie }if»iiuiing.

Armand ("iantier liad bcforo pointed out the modifioations which albn-
men while piitrefv-ing iindergoeH, Hinoa then he hafl shown that iill wiiinial
wi bBl:m(-ps of Hthuniiiious Hfttiire may biyp origin to alkaloids to which he
han ii|tnlicfl the name of huatmniiips. These idKnloids are precisely similar,
from the ['oiiit of ticw of Ihoir t:hcmicul reiictioiia, to thoiK- produced by
tliL- vegfUiblc world, henf.c (iautiiT thinks tlint the produetion of Icuco-
iitaines in not the oscliisive property of the vepetal eell, hut of every living
tx'tl. nnimjij »3 well as veji^etjil, iiiid that the huniHn orf^nism nmk'e^ idka*
loide jui<l aa the pliMit does. While Selnii coiutidered the ptonmine nlka-
loide as a product of putrefaetion, Gaiitler. on tht* eontmry, genontUzuB
tbe fact, iLud make» them a funetion of the living eell.

Hrouardol luid Ilontinv had pretended thiit Die ferrio ferro-cynnide
enabled them to distinfjuisd tlie cadaveric from tlie vegctiible alkaloids, the
ptomaines niono transforming tlie ferric feri'o-eyanide-s into ferrous ferro-
cyanidc*. Uanticr ha« shown that this reactioii is not as nbuolutc a crite-
rion as hiis been utlirnied, iind lliat the; tsimilurity between thu vegetal and
the animul alknloids is ciomplete.

As for the iietion of these Icnromainr«, it is very flinular to that o(
strychnine, lutrotiuced inUi the eirculalion of ikiniuule. they [>roducu
dilatation, then eontntction uf the pupils, stupor, tetanic eonvukiuiut, ir-
rugulnrilieH in the eardim; pulaiitiuiw, and death by aiTeiit of the lieurl in
ayetolQ,

According to Oautier, the leucomaines hare the same physiological
iw^tion a« mimeorine, and this is confirmed by the retsejirches of Biieger,
vho 1108 tritimformod ncurioo, a substance not to:iic, into mugcarine. a
very toxic anlmtiincG, by leaving the former exposed to the air in aquooua
solution.

Miui» blip, on the oontrarv, luwimilat^il the action of the ptomaincR to
that of atrycliniiie jind morphine, while Tanrut ahowed iu Ititfl, that uuiniol
alkaloids might be obhiiiied by putting alkaline xidUt in contact with jwp-
toneii. Bi'ieger in \)iii'6, obtiuned alkaloids by simply digesting fibrin m
gastric juice, f

* Albertini, Lo Sperimontai*, June, 19T4. Charles Hichet, On the Ouslrii.^ Juioe,
p. \Vi.

fSelmi. On a Virulent Crystallizttble.'VlltaliiidExtpacte.lfTOm the Viaeera of two
Exhumi-il IWii'-s Jour, de Phn.i'm. et de Clin., t. xxix., p. IM, ISil*. Brouardcl
ood Botimi^, On u Bea^iit lap^hli! '>f Diathii,'ui)tl]iiig tlie Ptomaines from Vi'jiro-
tul Alkiiluidx, Bull. AeoJ. de MM.. 2d Herius, t. x.. no. IB. Uuiitier, Can we
Wttingiiish th» Cik'lavei-ic AlLiuluidH from those of Natural ur ArtiKcial Origin?
Bull, Aniil lit: MM., I. xx,, no, 3). BHcipir. On the Vciioinnai Mutters Produced
by Man and the Higher Aaiinal§. ZelUi-lirifT itir pliysiolo^Hc-lie Cliemio, U vii.
p. 274. XiHi. MiUM, On (hv Ilauiau Alkalvids, V^-rlioad. dvr dcut»clii>u Ucaell-

' DiscoTerpd in 18^0 by Rcliwann. idolatetl in 183<) by WaBmann ami by
P!i[)pnhf>im, pi'|win, ciillcd ch if tannin by l>o«champ8, and gruttfrnt^ by
"^ycn. bad biH'ii tbo subject yf nianv lubors, but it did not fuirly cnt<?V
lib tbt! domain o( tlu'inpL-iitica till tliu [lubiiiMition of thn im^iortant
msL'an.-htfti ol L. Corviiarl.

Pepein is an azotized qnatemary snbstancv. lu its greatest 8tutc of
purity it |in*eiit8it-*elf under tlio form of a gniyisU powder. BoliiblL-. tliuueh
wiib tlifliciill}'. in distillvi) witter; lienU'd witb putu^b ur nitric acid it rL-ucts
lik*^- olber prolvinouii iimttors. It Jo preoipituted by the metullic snlpliiit^s,
»c«tjite« and MondcHf by ulrohol atul by tannin.

DiTem proceseeH hiiv© l)een proiioeod for tlie extnic'tion of {wpsiii.
That of Jcunnt-l i» na follows: '* Tnko tho Btomnok of a, nuwly killol nog,
;»p9Q and yrmh m a full strwim of wntcr; spread on a tablej the cimcons
roembrunn heinr upiirrtaost; ()c-ni)w with eomc force tht^ mucons mem-
bnuie with h dnTl knifo. Ton tfaun obtnin iLbnnt iin ounce of a xoini-^olid
T, which is then uritated with live onnoes of distilled water; dici-st
u min«tL-» nt 35 C, udd two drojw of hydroclilorio acid, 1llt*T
Uiroagh a linen atniiimr. and allow thi* tiltnite to setllu; decant and dry
on plates St a t«*mi».'nitiiro of 4^"^." Tha st'iiii-lluiJ subaLarice obtaini<d
br scraping, and taken up by wat«rat 'iO', then acidulated by HCi, &ud
filtered, gives a very nctire solntion.

Tho procuas of tho Freueli rodei is ae followat The rminet Xxgs of
rilMp quite frosh are opctiod, tnrnc<l insido out, and M-iubcd by s Kcntio
BtnsttlD of water; tbo murono nicnnbnuin in [hnn scntprd olf, briiiKen in n
inortar HO as to rapture the crUb and digested for twelvo honrn in pure
w»U»r. Tho infusion tlius obtiiinml is prwi |Htat*d by awtiit* of loul, and
the prt-cipilatf, cuitigBting of iicpxin imd osidc uf leud, in niixtMl with water
and decomposed by Bulphurcttt-d bydmccn, which throws down thu lend,
Imving the ]x>p!dn in solution. The ri<|ni<T having buan dlterwlisovapomted
at about IWF. to a syrupy consiRteiK-e. aft<.T which Putlicieiit perfectly
dr; rtarch is added to absorb the si^nii -liquid matter, and brine ii to u
state of drj* powder. Liiotiu acid is souictiruLV! added to llie li^iuid in
■mall pn>i)ortion before evuiioralion, and doubtless adda to its cflkiency.
An attfinpi to evHponitfl to drynesa might injure the prejiantlinu, and an
oadlr iHitrefiable eubiiUnce would be obtiiinei!. Srandi ig i^IiofM.-n for the
aoUdiflcation of the Rvmpv niiiKS on (n-pnunt of its iilwrtrbent property and
becaiuo it i* not aflc'<;t(.>d W the digoetivo iK>w<;r of the pi']u^in. li pro-
prrly prepared. Tiftn^n gntinn of tbia pepxin (which in tho name ns
H4iii(hLiitt*>>). with the aid of a little lacttic or muriatic acid, will cailKe tlun
0olution in valor of fonr times itst weiglit of fibrin nt the tempeiflturo of
the hnmaii UmIv. Much caro i« requisite to nsc frcali rennet iiacn, and
nut to allow the temperature noed in evaporation to exceed 100 F. It
aaerted of the attove popain, that it baa tho reactions of tho jputric
_aioe and a (ullj capable of replacinjif that liquid forthe purpose of digci»-
UotL It nay he giren with or without luetic or muriatic acid, thu addi-
tion beii^ unneoeaeary whoii there in already aufltoivntoeid iu thu stomach.

'Aooonlinf; to Perpet, ealTes' rennets oonKtitute (next to tho dog's stom-

•ell) tine very bi-«t sounx* of |)e]i8iTi, These are taken in a p<^'i-fectlv freah

carefully wa«bed, then apread out on a chopping block and wiiij^ied

126 D18KASHS OF THE STOMACH.

with BBharp knife till they iirt- rt'iluL-wl lo h jmlji. Tliis pulp is treatod
with four times its rolrnne of distilioii water containinp 4. .'>u parU of citric
Bcifi fur every 1<W partfl hy weight of the jmlp, which is eqinniU>nt to
abuut 10 crammet^ of fitrio aciil for cTerj rt^niiet u«.«l. Tlie mixture
thus obtaiuoci i» iillowwi to slami for twenty four htnir« in thy t'old, tlimi
exprossed through a etntiiicr; what rumiiiiis in the fitter is uguin treiitod
with lU own voluTno of diiitilloil wjit«;r rontainiiig IT) granimes of citric
acid b) tJie qunrl iind iiguin expresiivd. Tht; twu liqindH ui\> then mixed
ftnd allowed to ntnnd for twelve hours in the oold nnd Bcttle; the clwtr
liquid is thuii strainiii off from tb« residno which tonsistB of shreds of
mernhmni^s. fattv matters, etc, Pijrret cliarges thiscluar iitjuid with frwsh

?u»ntitit>ii of pufp, till its tiiiul density marks six to seven defp'ees ItunmA.
r now to tins product a tviitli of its volume of alcohol at 95° be aiJded,
H prtKripitut^ la obtainiiKl which ojtn no longer be diB8olv«<l.

Itv stu'cf-'ieiro muiiipttl:i.tions tho i>(>)ii:in it) conipl(^U-ly freei) of pep-
tones; it is submitted to concentration in l}Oil«re heated Ijy a. sea hatli at
88" or aO'C, and when it has acf|iiired the wiwifttency of syrup, au equal
wt'i^rht of sugar of milk is addoil, ami tlie wliolc iadividoii intoglobnles.
These globule* tiro dried at n low tcmiwraturc »ud coTored with a coating
of benzoin which preserves them. (iVrret, Hulletin dc Ther. L TCiv.* p.
264.)

•According to tho now French Codex, medicinal pepfliD, in powdw,
ought to respond to the following test;

Introdwco into a wide mouthe«t flask* —

MedioiniLJ Pepsin, . . . - RT. vijiw. ((t,50)

DistiUod wflt«r = ij. [«i).00)

Acid Hydrochloric ofiicinalis, . . gtU xv. (0.60)

M. Pork fibrin, wanUed and dried, . . 5 ijw. (10.00).

Pl8<;(! tht> (last insi warm wauV bath, at 50*C. (12i!°F.).and digest for
six injure, taking care to agitiito frequently till all the fibrin is dissolved.
ami the liquid, wiieii ^-ooU'd and filtered, ought not to become tiu'bid hy
tho addition of a few dropR of nitric «cid.

Boudflult*' pciwin. or the itutrwipvtat potivifr of CorvUari has the
following compoHition: noutntl jicpein, 50 contigrun^ lactio acid gtt.
iij., (itarch, ."iu centigrams.

[The following article by tho translfttor is roprodueod from tho Boston
Medical and Surgityi] Jonnial, nnd has a prncticat utility in this con-
nection. ]

The Codex Commission's Keport ok Pepsix. — Prohahly no niwii-
oinal agent in niopB extBUsively presfribed than iwpBin, ami theni ie. per-
haps, non« conooming whose real effic«;y more doubt cxiBte in the profes-
sional mind. The indications for its administnition are not clearly rstab-
lighed, nor is it eortj»in tJint ihia Rihstaneo, even with the addition of a
dilute mineral acid, bus prccieely tho same action in tho human stomach
on the ingredirnta of a men! as it has out ol the body on nlbiimen in a teat
tube, liowever this iniiy l»e. there is a real interest in knowing the best
monne for determining tho purity of this now standard medicament, for
inert pruiHLnitioiiH aiHKiud.

It luis bpcn shown thtii it i» not enough that ttic luiiiiplc- whicb is the
subject "f exjieriment shall dissolve a certain quantity ut eougulated white

OS PUTRID DTSl-KTSIA.

127

of ej^: thia re«alt roay be obtained irith popBins of foebl© digestire pow«r,
anil flimple mlation i^ not iK-ntnnisatinn.

I>r. Picrro Vigier, of Panf. uppointnd rpeontly membor of tho Codox
Commi»«ion to ronw tho i>liarr5ftcoutical raethotU in use for tho aetay of
pipan, hae pablishntl tli» n-ntilU at » loiic sltk-h of *'X|>i-riri]nntjil ro-
•MToheo. Jlo gives the following fonnula, wTiich has Ix-un adopted hx the
C4mI(*x. a pepain vhicfa will ive|K>ud to tiiis test is reganJed as of good
quality.

POBBITILA A.
Take of:

M«lici?»al pepsin in powder, 0.50

Or poywiii extmotiTe, 0.20

liiftillW WBtor. 60.00

Hvdrui-lilorio ncid. 0.60

Fibrin u( sheep, cKlf, liog.. waidii>d atiddriod in tlieair. 10.00

This mixturo ia eubjoctod in a wido-niouthvd fluuk. to a tomitorature
of Vi'i'^ P. for eix hoiirH. .\t thn end of thia timvj the Gltored liquid
oti)i:ht not to show a pret'ipitatc, or hrcame t^londy by the addition of a
few drops of pure nitnc ncid, which is an indication t^at all the fibrin hm
be«n peptonirx^.

\'i(fi«r finds that the grwiter part ot the pupsins of commerce liave ii
il^etttiTe power greatly iiiferi<»r to that required by the alwre standanl.
Tfiey may, indeed, dif«>lvo fibrin in quantity very greatly in excotw of
tbctr weight, but u copious pri^ipibiti^^ will follow the addition of tliu
niiric acid, which Hhowi* that the jjbriii ha« not hnvu pi-ptoiiizud, mid. as
ia well known, the ulbumen its not aiwiinilable uXL-ept under the furni of
peptonos. Tho only re-ageut which enables one to eetiruate the pentoniit-
ing power of a popsjn ia nitric acid, introduced, drop by drop; aim, after
BiilDerotu trials, Vigier has aacortainod that it is i)t}ft to oinploy for this
t«*t • fixed qnintity of toD grammofi ot filtered liquid to which' is elowly
•ddcd. guliatim, nitric acid U]i \a fnrty drop»i abnv<: tliut iiuuntity, the
■old rvdtiaulvm the precipitate fornieil.

The ^me exp«riinenui have rihnwn tlint although the temperature of
122*' F, (•50" C.) \» higher than thiit of the Bt«ina*h, yot tho muintuiianco
of this Urmptraturu is nenL-ssiry for n perfect result.

The CoiiiiniM«iun of the new Codex hae, in aeconiance with those ex-
|«ertm©nts, adopteil the following criteria: " I'eiwin in powder, or medi-
cinal pepsin, obtained from pepairi oxtntctivo by tliitadmixtun! of ii ci-rtiuQ
<)ttaittitT of dextrino, or stan.-)i. ought, in a quantity not uxuuediug lifty
CWDtigntniM, to j>eptoniE« ton grammes of Qbrin.

" Th« pcjjsin extmctJTe (officinal pepsin of the Codex of 18C6), which
ia foand in commerce under the form of a brown extract, ought, in the
dose of twenty centigrams, to i)i^ptonizti ton gmmmoB of Qljrin. '

The report of Vigier adds tliut thentt figures are not nxaggemted;
there arc pupeiiw in the market, and among them tliat of Iloudault. whose
digeatlTe power is twi<!e un groat as thut indicated aliorc. The llbrin em-
ployed ia oblamed br whipping the blood of a sheep, a h(^, or a calf; that
obtiiiDed from the Iilood of tliu ox is found, pructicully, not so good for
theparpose.

Papain acta only in an acid medium; the hydrochloric i^id, which
!• the and of the ^tric juice, u that to which the preferem-u should bv
pren. The quantities of acid and water jjivou iu cbv ubuve formula hare

128

DISEASES OF TIIB STOMACH.

been fixed upon after ntimorous tentativee, as those oertain to give the
best rsBults.

An iutercatJng experiment is pren iUttstniti«) of the pow«r of a limite4
qumitity of pepmn to pflptoiiiise an indoflnito quantity of filirin, [irovidcd
n«w Kiijipliee 01 add areiwlded at the aame time. A complete artificial
digestion hiiviiig bocn obtAined, in iwconlance with the conditions o( tlio
al»\e formula, t«> tho L-ontcnta of tltv llask, etlU lUimotvHtixl. a frenh
quantity nf fibrin vas aAdctl, with u iinitNirtion of acidulated wiitcr equal
to tliftt ubt>ady employed; nt the end of six hount the dipejrtion wa» pttr-
foct. Tliis o'iKnvtiqn wae repoatod three or lour titnc-s with tL« Bsmo
rcRult, only uftt-r the fourth Jitp-'ntion, the filterwi liquid bt'cumc MiiKhtly
cloudy '>n tho addition of a fuw droiJB of nitric with Thin BX|^)eriment
ehows thiit the encnmberiiift action oi Iht' jwfitoneH iti urtiticial digestinna
diminiatR-B m proiiortion a» they are fnrthnr dihitotl, and thiit the diKtJBtivi!
power of the ppsin U^ujnnented in the siine mtio. It hUo uhowx tlnit
pepsin acta afliir tho inmmcr of livinj^ fecmt'iits; "from thta," aaya M.
Vigier, " We obtain a hint aa to the beneficial vflecta of drinking freely
during mcids." •

Tho formnln? for the Wine and Elixir of Pejain adopted by tho Oom-
miBeion of the New Codex are oa followii:

Medieitial jHqtBin,
MuHcadol wine,

WISE OF PKP8IS'.

ELIXIR OP PEI-SIN.

5 part&

100 "

Medicinal pcpain in powdor, .... 1 part.

Alcohol at 80, ;) jMirta.

Syrup, 8 "

nistillwl water 9 '*

Fliivor ad UbUum,

Twenty grammes of the Elixir or Wine of pepsin are equivalent to one
grammn of |H'|j«in in powder, and this quantity le noeessary to digofft ten
grammes nf (ibrin.

As the strong alcnholH precipitate pepsin from its Bolntioim, it is only
in a Torj dilute state that tney can be UBt>fi hi cntijuiiction with this med-
ioinal egcnt; henoe, for the preservation of pepeiu, monHtnia are cho»eii,
as in tlic fbrmulsB above givm. which LunUbin only k-n tij fifteen |»er cent.
of alcohol. The amylafeoiis iR'iJsins (liku Boudauit's), give better prepar-
ations with dilute alcohol than the saccharatod pepsins.

The BlyccTitos of jjeiiein, according to the Codox ComiiiisBion, havp lit-
tle activity, anil it is tliu same with respect to other prpparations whit^li
ooutnin, associated with pepain, other ferments, uueh m pancreatine, or
pharmaceutical products^ mich as Lydrochloric acid, ooca^ quinine, bis-
muth, iron, etc.

Tho Commisgion. in conchiding, emphastzo the importance of the
physician or pbammciet testing every preparation of pepsin of which he
18 the pruGcribcr or vendor, in order that he mav know the quality thereof,
and if it bo a faulty article, avoid itB ubp or delivery. For bupIi* purpose,
the very best criterion is tlio formuki A, given on preceding page.

ON f UTK10 DYSrEPSIA.

13»

* Mialbe'a elixir of pcpan is as follovs:

Take of:

AnivliU'pous [)epsin, . . . , . . 6 parts.

IiUijIUhI n-nter, . . . . . . 24 "

White vim (Lunel), 34 "

Wliiti- sugar 50 '*

M. Alcohol at 80", lit "

' 5IouiTDt, ill a mtmftir on the Artificial Di^Mtlong, and Prof, Vulpian
in hw ronrw*, have ntmlk-d the nrtion nf th« digetttive fprmoiits pmployed
in til** tn«tm«nt of ih-FpfpRJn. Thpy have Rhow-n that thp nruwiio* of an
sciil (*a in the stoimiohjil ilifrofftion) prercnta the action of dia«ta«e and
of pannn-fltinc Thus Mournit liux uaciTtaimni that oncwntigrammf of
dioraue iaccharifiM complet«lv in th hours, at the teiniwratiire of 37* to
40° v., 40 gmmmoa ot a etarcVv suhition (lontjiininp fivn per cent, of its
Trij^ht of etanib; lie remarks that if voii add to t\w tfliiroh wiit(?r twodrnjm
of hydrochloric acid the irai information is not rffected till itt thu end
uf tllirtv hours. Tlie rueult in VL'ry uoarty the eame with both artilioial
aiid tuitaral gastric Juice.

In a second series, Mniirrnt mailo tho aamn expertm pnts willi piiitcrui-
tin«?. putting 20 oentigiiimmett of tliin RiiViHtance in contm-i with 50
gTBTnmc« »f rtarch utitor (v>iit«ini!iij only 'i.T> n{ dturoh. Tho a:ici-h»rine
transformution of all the eturrli water denmnded ei{:lileen hourt. After
the wldittun of tiro dropH of nuiriatie lu-id t^i a similar mixture, tlieii* WM
no tnuisfnrmation «t the end of •iH huure. Rotli urtitloi!)] and imtural
gastric juice b<:havc4l in the eame wa.y; itt the naaiv liniv with natural
gHtrir JQtcc there vats liquefaction of the etorcb psuAo but without sac-
chanlieation.

Moumit diasohed to ceTitignimmcn of puncrcacino in 50 cubic centi-
metrw of vater; then lie put into tliii* i^oUition c«ix gmnimcis of euottod
albumen of egg divided into little cuIk'x; itt the end of eighteen hoiini of
eX[Mimre to the moilenite heBt of an oven there wiuu partial trunRforma'
tiuii of the albumin into peptone.

Thf fwme experiment rrpi«ted after the addition of two droi« of
tnnristic ncid toa mixture in even,- reHin^nt Rimilar, grivo n ru^ult ul^folutvly
nil as Cor as the formation of nlhaminose or peptone vras t'<tucerned,

A» for alcohol, it d<je» not deatruy the iLetion nf |H']>siii on azoti]u>d
nibatatieefl but only ri-tatrdH it; and if the Klixir of Fe|i»in lins no sucb
retarding action on digetrtion it ia he(<iaiin(^ this elixir contains but little
aVxihul. Alcohol rvtarils also the digentivu uction of diantaee and pan*
cnmtino.

Catillon's peptonoB are thus made:

A kilogramme of beef, fre«>l from its fattr and tendinous part?, and
AdpIv hiuibed, in digested at tho tempcniture of 113'^ F. for twelve lioum
in llTf litrtw of water acidulated with twenty grsmiiieH of |iure muriatio
acid (di^nitity I.18J, and with ikepsm in shght ex<x'»«. The proportion of
pepsin oiu only be determiueil liy i1« stanilard of strengtrh. It will take,
for instance, sii gmniniM of the pepsin of tlii> <'o(iex wliieh digests 30 to
40 titnoR its weight of fibrin {I refer to thn prjmn erfntctivf, which comes
in a pasty form, and not to the aiiiyliiceeus |)e))Gin which digetttn only six
ti]m«itM*w«iglltuf fibrin): llie mixtiii-e \* neilat^'d fmm time to time and
kept at a coustaut U'uiperature. Ileiuw 104 i'. the digestion of tb« llbrin
9

liHJ DIHKA8KS OF THK BTOMAOn.

in rvtanlwl; if tho temperature of 123° F. » excwdwl, tlto riak is incurred
of iji'stroyinj; t!i« pqwiii, mid fliiH is Biiru to liap]icn ut I.'jS° F. The
miiturH, at tirKt in a wlato at pulli, bewomeB fluid t>y tlcgreie, am! nftor ii
time, which \asim from two to eix houra or more, aoco'rding to the irtrvugth
of ihf i>eiKiiUt it iittitiiis ii coin|)letti traii8|iareiicy. It t^Diiaists blivu of &^^
niisttii-u of pfjitoiiirs nod 8}'iiloiiin, aud is uot cougulatufl by ht.*i)t and^H
nitric acid. ^^

After twclvo hoiin) of digrHtion, the mixture in iiltciTil to &f>parate tho
insoluble pirl«. nii|iiilitj- of filtration is an indication that the trans-
formation m oompipt«. •

Thtf tiltiTuU liquid uuj^bt urH to become ulwiuly hy hoiljxi^; truatud hy
nitrir iic.id, jis abuvL- auid, it ouehl not t<> give risti Ut uriT pretnpitiifii!.

This liquid is then Matunitm with binirlwiunto nf khiIii, and ('viiponitnd
m n 8cri-biith. When conct-ntnition is a-lv-anct'd, a pellicle forma on the
Kurtaai^; the uolutioii litt.-^ anivud nt tlic nlaUi of siituratioti.

It ia betlt^r for lhi'r)i|»cutic »»i*s lo kwp tin* i>vploii(.* in a tttak' of (tynipy
roiiBiatoncvj, and th«r«foro lUw ovapomlioii 18 uot UKUully piwht-'d to desio-
ttitiorj.

The satumtrd solution of peptones ntijrht to mark li> d'egn>es on the
Hri'oniL*ti?r of ]iaum6, (dontrity l-lf"); it c^ntninB the half of it* weight of
solid peptones; prcpftrcil with Tneai, it has a docp yollow color, « diaa-
grtiuihlc mlor, and a tthghtly wnd tusti?, rcsoinbliiig cuii<:eiitnitvd bmth.

('atiUnn has solvod th« tollowijig problfni: finial is th« quantity of
peptone neooasary U> prodmie the Bamo proitortion of \tr«i us the (luantity
of mcut rHHciitLul for the n>}C>ilar daily nitions. He hiu< seen that in an
adult weighing 144])oniKi8(*tJ kilo«), a ration of SriOgnirimiesof brwul. ;J51
gramniott of i>uluto*.')i. and M graininLw of butter, to vrbiuh arL> iLddud 1I3U
uraiiiiuet} of tno tuiturated solution of ]>eptontJB, sutUi^utt for nutrition, and
induces even an angimmtation nf weight; this is i-quivali-iit to 'i.'iZ
gntinmes of tlii* «o]ntinn. or 1.1! gnimme* of solid pepU»no for each kilo-
gmmme of tho weight of the IxvJy.

In tho c-asi! of tho dog, thu proporlinn of ^wpfconc iniccsBary for niitri-
tion ifi larger. Thnro ia needed, for an animal weighing 1 l.'i kilogrammt^i,
Zli grammeH of aolution of pcptontis f.p., 7 granumw per kilogi-animo of
till' wfi|tbt of the body. I'loU and Maly had pruvioiiely pt^rfonnod similar
cxi>crimcntii. l*lotB fed a dog for ten weeks with a inixtttrL- of libriu pep-
tone, of glucose, of butler and of eslt. Tlw animal eonsumi^t M'l gruuimi's
of peptones, 309 grammes of butter, 42^ grammes of glucow, and gained
601 grammoB. Maly porformod a Uke exix-rimcnt with a pigeon.*

""Wurta luw shown tliat papikinu, the Holublu ferment o( Oanica |iupaya,
diBBoWeH a thouHand tiiiiee lIb weight of niuiat fibrin, the greater part of
wtiich is transformed into peptone not precipitable by nitric acid. The
papainc begins hy attai::hing it»i!lf to the Itbrin, and it givett ri^o to a
uruduct which, under the action of water, brings about a Milntion of the
hbrin, while at th«> ainio time, the fermfiit bwoiniiig frei-, may exert its
action on a new imrtiiin of Hbrin. Aecortling to Wnrtn. [Mijiainc pf)B8es»e8
the rompogitifin of albumin'nd mattj>rs. and rcsBniblea the ]HincreHtic fer-
ment ('iillnd try]isin. t'antr-a pfipiiyu is not the only plant wliieh fnrnisheg
a vegetublv pepsin, and certain apecica of JtcHi uosi^'Sd tho bamu pi'uperty.
Bonehnt gives the name of A'cwi/k! to this Bpuuial furiuunt, f

• f '.itillim. D^-s Pe|jt<>tu-s. BiiLl. Oen. de Tli^raiwiitiqHe. IBHO.t. xevilL. p. IlO-lM,
f WiiriK iinil RiiiKrliiit. iin Pupiunf. (Aaul. iliw Seiumuui. Judc iind Nov., It
batl Bull de Th^i- , t. W {ISS\}). [■. IS3.

ON riTRiD DYarEreiA.

131

" Auiidjf^ieptie ^lion of Trousseau.

Acid muriatic,

Multnra Hc&mA«>, 12A smmmos,
U. Doae. — A UbIcsiiODnftil ivfter each mc-ul.

(hro7{ 'a dyt^jftic potion.

Onvmmes.
Cinchona wi(ic, .... 100
Srrup of poppies, ... 30

llrdroclilonc *ci4, ... 1 (gr. xr.)

H. Sij^. 1 or S tablciipooiifiilH before each meal.

gtt. IT.

j|i^3iy.)

& & S ]iarta

A&

AA

** The (ormuU Tor tliv vitriolic etixir of Mgnaichi its us follows:
Take of:

Sweet fl«^, .

Uaranta p&langal,

Womiwoortf

Pcpptrrmint, . .y, , , . aa

Camomile flovera,

C^incllii, . .

GttiKer,
^H Cloves,

^^1 Chi)j8 of aloes,

^^B LuniDii poi'l,

^H Sogar, 3S "

^P Alcohol <|it (iO") 1!)3 "

f r>ilnU> pulphnric scid, .... 32 "

ifix the sulphuric acid and the alcohol, and pour upon thi> other in*
gredienta pulvBrizeci and placod in b. pptort; macemte a fortnight Bt a
aodcvoto hcnt nml Sltrr.

Daw.— Two to forty Jrops wril diluted.

**^(IN d( Thidtn is made as follows:
Take of:

Pure eulpburic acid, 1 part.

Alcohol ut DO",

C'tirmnt juice, . . . . . . ht M

DistilltKl water, 1

Bopu-. in tinu jtuwder, 24

PlMoke the rajjar in th« water bv the ai<l of heat, adding the ctiTrant
jnire, then mix with the filcoliol and sulphtiric acid in a fl»Hk. (The mix-
tare of alcohol and acid should Iw mmU* with caution.) MneeTnt« eight
dan aod filter. Doeo, 'io to 30 ilroptt in a little peppermint water.

fLsn complicatefl acid mixtiirfis may he rpadily exlrmporized by tiio
pltjaciui Thus the following formuiie will nometimes nerve a good
fnrpow:

B- Acid Rvdrochlorio dilute, m. xi,

Infni^ Aunuitii, f. 3 ix,

Syrup ZiiiiciberiA, ■ f. 3 ]•

Hake u draught to be taken after moala.

I

(I

I

port.

4

M

1

6

1

100

132 I>I6iUS£S OF THE STOMACH.

9. Acid hjrdrochloric dil.,

Add nitric dil. ana., 1 SL

Ext. turnxaci §i.

Iiifiii*. gcititiiin. f, srii.

M. Take two tabltepoonfuls tirice dail; before meals.

Acid hydrochloric dJL, f- 3uJ.

Svrup zhigiberis, I. 5 bs.

l^inct. aumntii corticis, f. 3 ix.

H. Take n u-asixmiitul well diluted after each men).

The dilute IK'I is nftpii given to ad\"iiiiUig« in dosws of ten to fifteen
drops in a mixture with a scriiiilo of Bacclmrftted popsin justnftor meats.]

" Tha " whito decoctiou " is thus made, according to tlio Codei:

Take of:

StUj^e honiB, culciauU and roduoDd to powdor,
Whuaten breiid iTumbs, ....

Gum uraliic,

White BiigW,

Distilled water of oraiiitc flowers,

Pure water q.B. to tnakSr ....

Tritnmtetnpothpr the horn powd&rand the jrf""; (^dd tho bread crniTib«
and the? Biigar; tritnntte anew; boil in waU-r flftcrn minutcH, strain, express
gently ami iwld the orange waUr. fliurnt h«rt.ihorn <!onsists of bone
phosphate of lime, with a little froo liraa Its tuediciual eUvcts are in-
ooiisidurahle.]

" Tliew are Ckiaiifli-Bey*s eoncliisiona:

I. Cnrhou hi-siilpliidt! ia tii stiniB extent Rolnble in water, (thoiiph
oortiiin works on t'ticmiiJrrv h!tv<! (iiiJpiit<'il this), lis. flolnhility varies
iK'tivLt'ii 'i iind :i niilligrume per 1,(K)U gnimmt'a of wntt-r fit tin- tenipora-
tiirr of Ih or '.10° C. In ajritflting the pnri; nirbon bisulphide in a flask
full of water, 1 Imve Been as muiih as .>0 eentigrarns iier litre taken up,

3. Tbi» solution orrttts nil /fnne>itt>tiun^; it kiilt (Jm micr<ibt«; it- w
OTiP oj tlip tiKLit energetic aiUiwpUcs; it l'« beJsiiUn oudvwtid with u consider'
atflf pun'cr of i)viit(ratio)i.

'A. Pure" Bulpbide of carbon in solution in pure alcohol, (at 96°) is
alowlv deromponed and given riw to varioiiB pro<hiPt*i notably to 11^,
(sulpluiretted hydrogen). The ntroholic solution dissolves caoMtcliouc.

4. lontrarily to tho opinion iwlranpt-d by wvi>n»l writort-, I liavo nuvor
for twenty yoars ohficrrod any cose of paralyeii of any of thv limb» aiiiong
wnrkingmeh constantly oxpoiwd to emanations nf sulphide of «i.rl»nii, nor
nnv loss of virility from thi.i cause. (My observation« concern about two
ihcmsand workingmen.)

5. The vajKint of mrbim bi-siiipliidu when n-apircd in u ciTtnin pro-
portion, determine phetioineim renL-iublinn Ltiuse of etherization with no
other discomfort tlmn a lieaviiiet^s of the lieud of Hhort duration.

6. Thu sohiliou has a wai'U] sweetisli t»btc. followL'd by a eunmtion of
lie:it in the stomach, and at the end of three t^uarteni of an hour, prick,
liij^m or tiiigliiiga in tho nuicou» inembrHno of Ibe notie, eiinihtr'to those
produced by sulphurouii acidf with eomo cerebral heavineea or tori>or which
soon passes off.

~. Pure sulphide of carbon upplled to the sktn (ag on a wad of cotton)

I (HW of tbe ntMt enclitic renilsivos; its action is almcvnt iriHtantaiiroitE>,
' the pain is like that, of boiling- wiiter, Init it coases imnu-iJialPlv on
F»ipMar« to B whilT of air whicli vaporizes thp remftining siilpliurct.

It ia bjrcftBon of all thceo facte thiit 1 Iinvc a'lvised "carbon bisulitliifio
to combiit cliolcra uiid tUl tbu itiicruUoUc tltatsuKt^a (lyphuLti ferur, <li{)lithn-
ria, pfaUluis, etc.)- It will be of gruat value givi>» inteniHlly; the Kolution
DI&7 be tued for this purpoao lu mU'aiitage: it miiv lie cm])]oye<I olso lui a
DOtaDiwus revuLstrc, and as a disinfectant for tUu ^cjcctiouij, bed olothus,
garments of cfaolcni [Mtieiit^, etc.

The aqueous solution may be used for watering irtreets and for washing
boitsee, as it may be furnished at an cxiraordinanly cheap rat«.

Sulphide of carhon for medicinal uet- ou^lit tj) m purified by beating
it up with metallic mercury, till there is no longer any black procipitate;
t'> prepare the aqueous solution alt you hav^ to do is to n^itut<> a certain
quantity of the pore btaulphide with water and decant olT the clear »olu-
Cion.

Pure oirbon bisulphide lias an odor regemblin^ that of eliloroform.
The aqueous eolutione constitute the cheapest medicament kuowu; (ono
centime (-j-J-y franc) for K> litres.')

'Ckiaadi Bey, Od the Ani.iHtr]iiiu Properties of Blaulpliido of Carbon. <&iUL
d« I'Acwl. iim Sc, Sept. Ti, lHHi.)

LECTURE XI.

ACID AXB PITUITOirs DYSPEPSIA.

SusiMAKlf. — Acid Djapopsiik — Pitiiitoua Th'spt^ijsiiv — Treatment of Acid
Dyspepsia — Alkiilice — Vichy Water — Viile Wiiter—Iiilliifnao of Sudtk-
Lion on tlie Acidity of tUf Guetric Juiw — ^Kmploy wf Inert Powders —
Piittcreon's Powder — Powdurs and Fills of Troiissoiui, Radius nnd
(tomJrin — Hygienic Trt-atiiicnt — Wiiica — Trentincnt of PituitouK
I>j-81«!paiit — Milk Diot — Koumies — Lavage of th« Stonukch — Tlicnual
Trefttmeirt.

Gextlkukn: I iiitoiid ill thiB luctarotoiricladi; in the samp description
aotd dyspepsia and pitaitous dyspepsia. The one iu fact is ofb>u the con-
sequancB of the other, and it you iiitorrogate piitie^nts affectud willi tho
pitiiitoiis form, you will find that their gastrnrrlnea wafl precedwl for a
perimi of grettiter or less length by iicid dyBpcjisiii.

What iiro tho Bymploaw of these two statos ? At the onset, ucid dys-
pepBiH is phfiracteriKed simply by a feeling of oppreseioii in Uiu atoniach
during digL'sUou; the paLieiit complains of lie:il in that tirg:in whfrww
in dyspepsia from doSciency of giietric juice the stumiich, often fccrlH cold;
the victim of acid dyspepsia cannot aommit fluy exct'ss of diet or imbilxj
freely of wine, withotit rapidly experiencing un aggravation of the usual
symptoms. Tho tmnsutiun of heut in tlio region of thestomaoh iiioreaHos;
during the night there is regurgitation of acid malti^rs which come up
into the throat or mouth, leaving u bnniiiig and smarting impression
along tho ccsophagns: tliia is Pveosib.

If the table eseessea eontinue, to those symptoma is added an ill-doflited
spasmodic pain, seated about the cardiac region; this is Cahjhaloia. In
other tvuK'B a severe pain is felt in tho dorsil nigioii, Biniilar to that
resulting from the ptWMagu down tlte u>gopUagad of too Urge a ntorevl of
food.

Sweet victuals, as well as wines and P|)irits, augment these symptom*,
and the ]}atient has continually a peculiar sour tustu in hie niuuth. At a
more advanced period there eusuo vomitiuge of glairy mucus. Tlioii
thow vomitingR bccomo habitual, and every moraiug the putient throws
up a certain (|uantity of mueus or phlegmy matter; he has now i/i/tiitoits
dijspejixia. (Vll persons a^Idicted to the abuse of alcoholic btimulaiits will
complain (o ynti of this charartoristio Kyni[)toiu,

The diijcasc has now changed iti chiiracter. At the beginning, tbo

OK ACU> AND PITUITOrg DYSPta^IA.

vtomacli irritated bv subelsnccs introducixl into it« inUirior, iHx;ret43a toti
acid n giwtric juic«; then under the mtliience of thin exa^^ratfd Kccro-
tion, tlie popsin eorpusdoB ccost) to lio rt']>roiiuei'«i , iniil tlw griMLUT i«irt
of th(! glands are Imiisformed into I'eritabln miiRon»-gkndK. and no longer
•L-crvtc rtu! K^t^triu juictv but muouH instuiid. in grcut«r or li;s«i quantity.
It 13 till? pspnUion ol tliia macus wbich constitutes the pituitous vomitiiifj
ol drunkards.'

One may also liken putrid clyspepeia by TiciouB fermentation, to
oortain (onnii of iu:id dy»]>a{Mia. In tac-X. ua llunclmnlat Inis aliown,
the prownoo of tliu Inctic. ljiit)Tic, propioitio fomit-nts in tUu Hl^iniM:Ii
Baosee traoBformattott of glyoo^nic alimL^iitH into lactic, butyric, and pro-
pionic acids. This vnrioty of acid dy8pe])8)n should bo combatud b}' uuti-
fermcntalJTe nK<«Hninra.

To return to ordinurv acid d^i's^Kpeia: how nru vo to tn-at it? Here
we mnetwtabliah a distinction between pharmaceii tied and dietetic means.
Pharmacy offers ui<, on thf oiu^ liniifi nIkHlieR, on the othiT inert )x>wd<?rH.

The iwe of alkalies is perfc^'tly indit-atiid, and is in conformity with
the pxperitnenta of (.'harlLMt Kichut. who Hhowcid tlmt alknlioA introduceil
into the etomach in larj^ doseti neutralize the acidity of the f^ric Juicu.*

The inert |>owd«r8 produce anotlior effwl: they ftttenuate thy seerfr-
tioit of gastric juice. By referrinp tn the erjierimentB of Claude Benianl,
of Blondint, and of Schiff. yon will mcc that by their prwieiicc thL-sn pow-
er* priivoke » Bocrution of gaetrio jtii<-e which \a uon-acid, or but dight-
Ij acid, and generally a Bocretion of mu(?u».

Them two means are then logictilly iudicnted. Henco ther are genor-
HallT un<(l in comhiiiatinn, the inert [Kiwdera and alkaline powdera being

DciatfNl in the tumL< furmuta.

Let na commoDOe with tliu alkaline proparationa. It la the bicarljonato
ef aoda whieh tu genorullv cnipluyud; thi>i in };;iv(tn in pulvertdoiit form in
tb(< dnae of fifteen to thirty ;j:i'nin»i a)>nnt mea) time, or the salt is dituuthed
in water in the proportion of one dmrhni to Ihe quiirt, <^onsbitutinKH)l arti-
ficial Vichy water, and K'veu at the proper time. But it must !>e understood
•that such extenj[)orizwl Viehy waterw are far inferior to the natund alka-
line waters, u far us both taste and unality are eoncemerl. With rofsird
to the latter, there are, .-is you are well aware. seTi-ral «>unTH nf the Vichy
water: tlw tlHTnuil waters, pru[>erly M-calkxl, are of high tempemturu,
31'r 35" and 43" (".. these arc the I{o9|>ittt.l Springs, t'homel Well, and
fl«»do Grille; tbeothersani cold, viz, ir. 14% i:.' C. (50' to59*J''.JjBUch
mi9 the Cdevtio, Hauterive and Saint Yorro 8pringn.

All these wat^m contain abnut th« aune <piiuitity of eodic bicarbonate,
that is to ay. from 4 to 5 grams per litre. If you arc far from tho Murco,
ohiKwe always the cold waters, which may be traiiBportiMl to great distuiiees
witboat utidergcnng eluLn^e. You will order them to U> taken at the
UKtUKTit of the re}ui8l, and if the patient supports them well, yon will

instruct him to drink h\» water not with vine, bnt pure, in quantities of
one or two tunibleniful h day »ni even more.'

I( you presorilje Vala whut, there is less didicnlty nf clioice. Vsls
hu a ^rcat DUtnl>cr of spring):, but it is not properly a tlicrnuLl «t^tioD,
for tho watcFR are nil ctold; lliey Imve over Vichy tho odvatiluge tliat they
preeeut a gradation in their ulk»ltiiity; and you will find iimotig tlictw
Vats waters, some vhicli coiit&in only 1 nnil others wliioh have an much
Its 9 grams por litro of bicarbouate uf soda, so tlinl yi>u oan choose among
thcfic 8[)riuj^ those whose wtitors arft tho best (winptod to meet tht^ tndicH-
tious of your case.

In our largit cities tliero have toun cstublinhed driiikiiiK bootlis where
tlie public can obtain tliee*; wntcrtt on dniught; thesvi inin(.'r»l ii'ater
saloons ought to t* encouraged. Thither tli© physician may send his
dye|M'ptie lo obtflin h)» glass of miin'ral wator an Iiour before his uaual
meal; the [tatient thtis gets n certain amount of exerciae iu obtaiuiiig
Ilia ]K>tiou of Vichy or Vols water.'

As for tlie 80-calied inert powders, there are numerous preparations of
tliiii kind which an.' julmiiiiHtered in eoiiiiuetioii with iru-uU, and have for
their basis .snbnitmte of bismutli, phosjiliate or carbonate of Unva. The
latter niuy bu givi-ri si'|»arat<;ly in the dose of from k-n to fifteen grains.

All theiMi powders act us alkiiliea; tlivy are in fact tri-btujic e&Its which
may yield up n part of their base to the acid of the gartrie juice. The
ibnitrato of biamntli is much the niont frequently employed. Odier of
suuva, ami ("arraimiti, then Trousseau in 1S33, wort; thi; iirst to extol
its Lenelits in dyspeiieia.*

Generally the formula for the administration of these inert powders is
somewhat complex, and they an- given in conjnnctinn with alkalies.
There is lirst of all the nombination of sulmitrate of bismuth and mag-
ueaia, known us thu American powdur, or l\itter80]i '» jKiwOer.'

You may employ Patterson's formulaj or the following preparation,
whioh hits given mo good roeulta:

I'abu of:

Bubnitrute of bismuUi,
Carbuimtu uf magnesia,
&I. Bicarbonate of sixla,

Hi

SiJBB.

Hake into thirty pewders. One powder at meul time nmy be takeu
lUBjH'ndLtl in water, oi in (^psulos or wafers.

Trousseau made with these niinerul substances, powders and pills; in
tho latter he combined subnitrate of bismuth with ciialk. in the former
he iiBEociatod magnesia and bicarbotmto of soda. Gendrin prufurrod tlie

"Odk-iiii 17ft8, CiirniinuU in ITS^, iiml TmufWiiau Sa 18U3, pointed out the (rood
wtTfHlji ttr stitiniti-uteuf biKiDUtli in dj'B|)i>pBiiis. Troiissiitii advised it especially
in Hpasmodic vomiUn(|[ i.nd in gtuilnil|,'tii; he gave from 15 Ui 48 ^niius a day.
(Bull, ill) Thfimp., I. v., p. -13.)

OK ACIJJ AND PITUITOUS DYSPEP8IA.

combination of bicarbonate ol soda and bistnuUi; Bsilius a mixture of
magnesin, syrnp of omoge, and p«p{)onn)iit wnlor.*

SdcIi are th*' tne(« of the nicMit of thosp pn>i»initioiiK wliii^h render the
beet BBTvicc in lUcwc formtt of (lya|tepr<iu, You L-iin join to thcsf powdvrs
and potions the nwige o( atitifemientative mod ieumt'nts and audi ae prevent
the tu<j prompt and oiior;gotic action of the gAstric juie^ For instance
lb*' sulphite of soAtL, ronnsclled by Pinalli of Pwloue, han a favorable
action in dyspupeiu. This niv(llca>ini.-nt is given in daily quantitios of
five gittnn« (75 |<raina) in one hundred and fifty gmme ( z v.) of water.

But here too, as in tbti otbt-r fonns of dvsjiL'pBia, th*? first plaoo must
bo given to th« bygienio treatment. Therefore we ought to ineiat on
attention to regimen.

Lot an first eiamine the principlee of the i4in>cntary regimen. The
firTt duty is tho suppression or diminution of alcoholic beverages. The
experiments of Richet on Marcelin, are moRt instmctivc in this re-
spect, and I referred to this point when 1 npnkc of akoholir Htimn-
wine and spirits may ureri increase tvro-fuld Ihu acidity of thu
juice. Bcuommend tlien to ]iativnbi i^uffering from acid d}'a-
psis not to drink wine, and if tliey cannot altogether abittniii from
beverage, to drink only the mildcKt, purest, and least int^Ticaiit kinds.
It ia in thie muludy that tlic Hophi^ticaUoaH, which unfortunately iiru m>
prevalent thut it isadifHcult matter to obtain good table vines, do the
greatest harm. You will in fact soi- pyrsouH who cannot dine at a reatan-
nnt witbmil Huflering imme<liately fioni tlu^ fiyniptom^ of acid dyspepsia.
Cbooee then a native wine weak in utrohol; here certain wines of cen>
tnl Fiance, and some of the Bordeaux wines may be tiacd witli safety.
It neenu to me too, that the light wliite wines are well borne, and as you
vill bo likely to presenile Vichy water with the muil^ the mixture of
Vichjr water and white wine conittitutea an agreeahln drink, anti superior
the mixture of LhcHo watcn* with tho red wiuctt. Permit then a inmler-
qoantity of light wines with Viehy. but proBtribe altogether distilled
njuors whether before, during, or after inenlw, and especially forbid white
vice to be taken on an empty stomach.^

As for the diet, you may allow articles of food which arc largely
and which are «a«!dy digested by tlie abundant secretion of
tp^\\i Juioe. Recommend also to the»te [lutieutu not to take their meatti
ttto highly seasoned: they liad better in fact be very simring in the use
of comliments. for, as you well know, acid dyHpepsia often reaulta from
tho too free tuo of theao relishoL

Bj theaa means you will generally be enabled suooessfnily to combat
tbaadd djspepsias. You should alwars insii^t on out-door exerci^), and
•omctimeji yon may unefully conjoin the U!te of vapor baths, such ae the
Turkifib ti«tlti>, which produce a {H>wt;rful »udation and thus diminish the
addity of the goslriu juioo.

r

138 DISEASE OF Tire STOMACH.

When the dieeane is more ndTancml, am! tho acid dysjieptiia baa given
place to |)itiiitoiH (lyspcpBia. it ie Imporativo thnt tho pationte cxcrciso
exccBBivf rinorousnew with rcgtird to thrir iilimentHr)' livjjit'iit'. «iui cnibniib
to a milk ijiet for a time. This buroio iiiL-dicumiiiit. am v/vW as iiicompttru-
lilo nutnattt, whioli we baro secin ko ust-fnl in putrid cIvHiiviwia, in still
iron* indiwitpri boro. for it modpratoa tlin oxngj^priit^d Jioidity of tbu gn^tric
jiiict', and gives the atdniach »n npportnnity t« rest, while »t tiie f<aino
timo supplying the orgitniu iiueiU This in nn important ]ioiut in the
therapeutic problem under solation, for in this acid dy8j>ep8in arrived at the
state of pitiiitoiis dys|Htpgia, thero is not only fiini'tionHl diwjrrlor, tht're is.
rIbo chronic inil»mniation of the irtomHrh: you witiieBS. in fart, what the
fitTiriMiis «i!l r/iiitrrh of the atomiich. Tbin ehrunic in)!u.iiiiiia.tiuii differs
in many rcspecta (ron» tlie patholoKJcal conception which Broiissai*
vnti-rUiined of gastritis, bnt It ex']^>i iievort heleH»;, uiid to euro this gus-
trorrhfoa reuniting from the inftummiition of the mucosa, yon mnst give
the organ rest-

Tile milk ti-eatment reiidcrB immen«! service, and yon Lave seen in
our wurda with what rapi<Uty by this means our putienbt ubluiii uirieltoru-
tion. I g^y niuedoratwn, beeaUKe nnfortunat^ly the proverb: " \V)m hath
once drunk, phall drink ugiiin " is iipplicjiMe to the majority of our piitirnta,
who, wiieii once Ihey liave left our lioepitfil, prentiy inipruved in health,
il not cnred, sjwedilj revert to their old drinking habits again, and thna
cause n rftturn of all their gnstric ailments.

How arc you to direet tliin milk treatment? \VTien you arc called
utJOii to tr*^Mit theac victims of iiitt^'mijemiice. and iilotig with tliu local
symptoms on tlie part of the stomach, there are general eyniptoms from,
ftk'olioliKni. you should not abruptly enfonv abeliimnrx- from all t^pirittlOua
liquors. In the,ie easefi you may employ konmisK. which along with tha
milk principlen furuiHboa a little alcohol, aud enubleH you without any dis-
advantage to await the peritMl when you can supitress altt>gether the intoxi-
eatiiig elemcjul; when this time eomeM, you will order the milk to Ije taken
for eight days, in the quantity of two or tln-ee (piarta a day. It may be
dilutetl with Vichy water — two tuinbleniful being added to the daily allow
anoe, ^o that the ))atient shall get from tifteen to thirty grains of bi-
carbonate of soda in each quart of milk.

Then, when the nymptomB of gantric irritation arc Bllnriate<l, yon -will
allow the padent to take milk porridge, furitmceoua puddings, eii>ains and
COStartls: in a woni, during nnothcr eight days the diet shall liave for its
baeiti milk and eggs. Then you will begin cautiously to give other kinds
of food, even u little white wine, but rou will take care for a long timo
to exclude distilled Npirits and the hfiavier wines.

Certain persons who are by oct;n[mtioii tjwlein of wine, and wiue mer-
chants, easily contract the habit of tijipling. When you ai-c called to
treat patienti< of this eort, advii^e thorn to flrink ax much milk as poeeiblo.

OK ACID AND PlTDITOCa DYSPEPSIA.

1S9

night and morning, nnil along with their mfsts. 90 as eomewhat to miik»
amcnihs for tia- irritant fiction of the nlt^hol. It iti n fact which ha.-< been
^eUTBiined by oar experiment* on tho nlcohois, that indivitlimU who live
in an atmmpbvra imprognntfrt with tht' vapoi-s of iirdcnt B|>irite, or who
without siniUovin^ the Hk-uhol. keep it coiitlutiutly in ctontafit vith the
baccal mucous mvinhnini\ tin- i>SiKi\ alTcotcd with t^cvere stomach trouhlcE;.'

The gastric caUinh of druiikiirds may often attain a high degrei? of
ieroritr, for the mueoun im-niln-ftno not only 1100011108 thickenml. but it
DMjr ondorgo nlcerntion, mul t^ the glairy pituitons vomiting noon Ritivceis
fa»inal«meiu8; uu<i tlwn you buve before you a Hyinptoiimtif; aggrcgnto
which much reaemblcs cancer of the stoiuacli. Thedc are the false cancers
which are qaito cumbto, both by milk <ii(-t nitil by Invnge of tho fitomach.
Larage of the Ktomarh, eren in rauies of drHiikjird's fjibtrrli, gives eSd'Hoiit
noutta, anil j-ou see here in thcHu.- hospilul wurds fucU which iittcat tht- truth
of wliail my. Under the- iiifTuiiir:e of the o1eAn»ing appliuitiotis which
every day depurate the- i^toinachi; of thc-so paticnte, we see tlie mucus
■ecretion diminish, and the giistrif juico iwrarotioii reappear. I tiiku care
after «ach lavagu to give to the pati<<iit milk in whifli I intrnchii-R ii oortain
quimtity of meat jtovder (WO grammes fnr eMimpif): itii'k [>uwilcr may
alao he added. One tudy alw, wUt-n thf catiirrh of the etoimtch is nuconi-
panied by considprable pain, emplny the milk of bisimith, of which I haro
(poken to yon elfiewhem,

Aa for the thernial tri'atnient, a few suggestions may be approprinte.
In acid dyspepsia, you hod better avoid tlic ferruguious waters and tliose
vhich arc too highly chiirged with rairlHinio acid. Yon will give the
prffnn'nee to ihe Vichy wutent, and if you (U'sire a wat^T Jesw cliargetl
with niineml ingrt-dieiils, you will counsel Dagtioles, .-Viet and Kvian. In
pitnilon«dyspeiM>iH, Vichy, Hoyat. and Saint Kectaire, will reuder you great
Bervice. I may «»y the sirae of the German unters of norabwui^, of
Kiaaingiin. of Carlshiul, of Marienliad: in less aggnivated nuca you can
order Uw Chatci Guyon waters or tho8o of Saint Moritz, of Vio-aur-Cfire,
in Aaveigne, of Brides and of Saint Ciprrais in Savoy.*

Among tbew thitrroal epriuga, two muet be rcgitrded aa unriralM;
Vichy, on the one hand, ('arlshail, on the otlier. I have already spoken
toron of the Vichy waters, aiid sliati not return lo them now, hut [ wUh
lo my ■ word or two about the Carlsljad watem which play 50 important 11
(urt in the tn>atmeiit of atToction^ of the xtomach. Ourlnbad constibutM
the type of wxlic sulphate water, and Hpnuiel is eotifiideml as the moert
importuut as it IB the most famous spring of this station. Caulot has
•hown us moreover liow rigorous is the alimentary hyg:iene nirricd out at
this atation, where one ne^'s (what by the way is quite uuconmion) tho
physicians and faotrl-kvopers work in uoiiton to obtain from these waters
tlio mort nseful rmultK in the trmatment of gnstrie affoctiona Tbi< it is
that ex[>bin« the |K>ptilarity of tli««e springfi.

140 MSEAftlS OF THTC aTOMAOn.

Such aro iKc priiici]>al imlicatiom to bo fiilfilloil in th« trwitment of
ooid unil iiituttouadyspopsitt. In theiioxichaptDr we bUbII ItLigiu the stiiily
of iho thenipeutica of fuuctiorml troubka of the muBcular coat of the
stomach.

IsOTES TO LECTTJRE IX.

' Pitnitoti!* vomiting {ia pituife) coniiifiU in the expulaion in the morning
of « roiiy viMGona niattor eimntitiittHl W true miious, minglixl with au
imipid liquid mid the eikhva «wullowcd bv the patient duriiiit the nif^ht.
Ai^-oonliiiK to FnrrichH. tlit' iiiatU-rs thus i*jecI.o<l bv druiikartli* contiiiu
oompuuuJs of Mulphu-L-yHitiduti. and have ulmoHl ulways hii iiIkHline ruiiotioii.

AcfMnling to Trfvuii, the h'auid thus oxpoUotl by tht- Bttwimch c-oitivM by
exopmosis from the hloml-veaacls of the gastric mucOHi. {IJiill. dt; t'Actuf.
de MM., session of Murch 10. IS74.)

'Churke ItiuliC't iiijVctod iutothoKtomoch of Martitilin during di^i-'stioii.
two honnt aft^T thi- ingwtion of food, aome Vichy wiitur. ami obwrved
tliat. far fmin uuginoiitiiig th« acidity of thi'gusLric juiw. as yomo author-
itiea had cUim(>d, ulkulii-s and Vichy water leasfii this a*;idity.

* Vinhy (Allicr). Alkidino Bpriiigs; tlieir tpuipcratum varins hetween
44 and H^ C. ; their rii,-hiioss iu eodic bicarbount^', is about ti gm*.
[Kir litre. There are U of tlifw,- springs; Ihc four mcutioriod iu the text
ais cold 8pring«. aru aioue fit for exportation.

[The analytical tablu of the urigtiial is omitted ae being of loss Interest
to practitioners in this country than to thow on tin- ctnituient. Wo have
uo alkaline sprinps in tliis country coi[i]Birable with tliei*!* Vichy watt'if,
nniesn wo eicopt the t'oiigrost springfl of California, whiph contain 2 grams
]KT litre of Bodio biearbontitc; tlio Soda springs of Wilhorts, Oregon are
nlfio Htrocigly ullculiiic. Tnin^J

•The Vichv springa helone to AUier, a province in the centre of France.
The Vals station is in Ar<leene. a de|)ftrtnictit of uouthnni France. The
Val« epring* are iiuntyrontf: thi* watoiN uro all eohl. We mny eriitniomto
St. Jean, Rigolotto, IVociousi-, Bi'sin'c, Magde]t>ino. Marquisc/Souvwraine,
Chlni', Sourni- duB Ituine. ('(mvalcaiiiintw, St. I>nnis, Pauline, VivaraifieKand
Dominique, (arxeiucal). Th^'y contain lime, ahim, iron, and esperially
bicarbenfttp of Hoda.

St. Jean cnntaina lAH gin. of biwirbonntct of soda )>er litre; Rigolette
5.80 gm.; IV'cieuiii' 5.94 giu.; Dtnirce li.40gto.; Magdeleijie. T. 28 gni.
There is much free oarbonie acid, and eonsiderable chloride of sodiuni.

' Patterson's powder has the following fortnnla:

Take of:

Subnitrato of bigmutli, 1 part

Hvdra.t.p of uiagncHia. . . . . . I "

■\Vhitv sugar S "

Mix and triturate,

Dose, 10 gruiiui.

ON ACID AND PimTOtrS DYSPEPSIA.

141

Troiiciseau's powder is nmde as follows:

Tuk« of:

Ciiloiiiwl mi^Gsmj 2 parts.

Bicarbonate of eoda, 3 "

Wliice mij^r, 10 "

Min and triliim.te.
Piiec, 30 grain* to ho taken lieffvro mrals.

AnotlK-r formula of Trou3s«aa's in tho following:

Take of:

Bicarbonate of soda,
Pre]mred chalk,

M. Marnana, ft B gr. til.

For one dOM. To be taken tliroo or fonr timos s dft^ two hours
before each meal and buforv bud time; take in a httln plain water, or
sweetened water.

Trauuean's pills aro m followe:
Takfof:

SubuitTftte of bismnth, ■ , , . 1 decigrum.

Carbonate of lini<s ■ ■ ■ . S5 milligmms.

ilonpy, q.B.

"F. 8. A. One pill. 'Vako from two to twenty rach pills n diij.

Oendrin'a antacid powder is thus made:
Take of:

Bicarbonate of sxla. . . ... 3 grama.

Snimilrate of biHmnth, . . . . . 1 "

BL Divide into four powders.

'The antacid potion of Radius is as followg*

Take of:

Calcined rnHgnisiia 4 graou.

Svrii)!, nanmtii oorticis, . . . . 14 "

I*i-I>IK.Tmiiit wat<T. 90 "

H. To bo taken in demtt^rt spoonful doaca

'According to Boochardat'g table.the proportion of alcoliol in the native
wines of France varies from ft to ^3 per cent, 'fhe «tT«ng;c«t t» Marsala,
wliich ooatains *i3.$3 \kt cent. A purl of the table is bore reprodnced:

Ferceriiatfe €f alcohol in certain Fretieh witiex.

Uanala SS.N3

Bed UaiWre 30.:)3

White BIwUfe W.OO

Port. 20.00

Bhsnob 17.00

lUuB If, 43

Koii«llofi 18.S8

<.'viiiti>L>D HaJa^ I&.OO

HMlJursoDOB 13.70

LuB*! 13. TO

Cfaamnwaii,.,,.,., ,,.. 12.77

OriKUk 10. M

WhiTf>winp nrUnutorne 1J.O0

TwiiULTi-p 10.70

Bed wiQDoI QiFOnde R.SI

White •• " 11.67

Cliitfi-itn-Latoiir f.SS

Ri-d Ik-rdtiiHix 10. tO

Wliite wioeof Pouilly %M

LSovillo ».»

Fivuliy winp orriifl.ni|>a^e., . 11.77

Frvmlijrnari 11. K4

Cliiil«au Mar^guux.. 8.79

Certain wine* of cenlml and northern Fnince, like almost all llioee of
the enTirom of Paris, contain not more tlimi ft, 6, 7, per cent of aleohol.

143

DISKAHES OP THE STOMACH.

* In our experimental ri'swirnlit'* on alcohol jioisonilig, ue lound
that the intrwlnctioii of alMiol by tli** skin, dyterminog pravo lesions on
the imrtof tlu^ etotnnch and ttiKHlenum. At the necropsrof nnimals killed
hx hIcoIidI iDjoctetl under tho ekin, we noted hemorrhagic Boftfuiitg of
d'fft-'reul puiato of thv niucotiM mi'inbraiio.

Jaillet hue umU'rtakL>ii t>ii>crin)eiiit« to oacortain the action of alcohol
on the stonmrim! miimns nipmliniiic, nml hv n process which consists in
rniiidly (ulniiriistftring to dojts liir^e dowH of Hlroliol. fnllowpil by ciilplmte
of BttTfhniiic to oppose fntnl nlfoi^ts, ho has dctfTminwl in tho niucOQS
inumlirunu of IIk-m; uimiiuls j(iidtriti8 wilU ulccrutiuii of tlin inuciMiia.*

•A brief reforcnco to thvs*' (foreign) spas ■will bo ap|iropriotc here.

llAiiNm.Kfi. In Omo, I/)wt>r Normnmlv. Thcni are two principal
sprinp*, fwrniginoiis ami ftnlpliTirons. Peome mineralization.

At,KT. [n Anflt>, Kmni'*'. Four prini>i|»il springx, hicartioiiatcd, calcic,
ami umgnc'Siaii : one of thtse in fiTrupiiiuus.

KviAN, In IIiiutL- Siivoy. TIil' [jriTuupiil springs am six in numlier;
mincmlimtion alniuh't iK'jpitivi', Thtw waters are fnebly liirarlioniitpil.

itoYAT. Sodic Ijicarbonated watore. with a little chloride of eodium.

Haist Nbctaike (I'liy (!(.■ i*onie, Fnmce). OtkMHtus, thi.-rmal wnti-rs;
sodic hiearboiiated, with t-qtuil imrt* of bicarbonate of sods aiid chloride
of BoOiiim. and traces of ureeiiiaio of sodji.

TIiJMHiHK<» fp-Mont* (lipase). SfMlinin ohIoridB in large proportion;
carbonic acid in p?(ress and a little iron. The sprinffa am five in nnmher,
tho most important of which are the Kiizabet]i and i>oiiise springR.

Ki»!ii;uEM in ilavaria. Waters atbermul, goeoouft, foebly fcrru^oos,
uiul soilio chloriilic.

CA»rj4H\ii iu Roheraia, Thes^ are the 1yi»o of Boilic sulphate wat«rs;
thoro arc ten principul springs whna? teiii pcnitori" \'arifts liotwoen 40° and
60° C, The most importAut ie Bprudel, vhoae wiitere are alterativu and
Itixativa

Maiuknbad in Bohemia. Sodic siilphatv sprioffs. ittroiif;lv efTervea-
cent, TliesL' apriuga tiro ei):bt in number, of which Lu Croix ia nioet
Bniploj<?d, Iwing mnch songbt after by those saffcring from chronic affec-
tions of the rtijjeRtinii. Tempenitare of tho water S,.v ('.

(,!ii.\TCi, GiyoN" (in Pny do Dome, France). 'I'licsc snringa arc of
rutlmr luw tciniioratiire. {noiy-mitiDralizod, uilervei<uunt. Tlit' springs ut
tliis station are very numerouK,

Saist MoRtTz in Switzerlund. Athermal Hjiringn, motlcrately oaloio,
bimrlioiirtted. fi-t'bly ferruginons. strongly efEerveacent. Tht'ec wat-crs am
cold: are iniicli uhoiI along with whey.

Vic-8UR-C;£he in Canto], France." Cold alltalino waters, etronglj «ffer-
rewent.

Bkides. In Safoy, Prance. HTpertbermat, calcic and Bodic Htdphato,
moderately mcxlic cliloridio, fwhiy snlphurous. Temperature 34" C. ; tonic
in Kinnll ([uantitiei*, while sii ^r ciglit tiiTiihlersful prove laxative.

SaIXT (tKitVAis, In Hautu Ruvov, France. Athermiil or livpother-
mal, mildly sulphiitcd, or Hodic chloridic: feebly calcic siilphatcil, or fer*
rnglnoiiB. I'rinci]ial apringB are sown in number. Temiierature varies
belwe<>ii S*-*" and ^m" C.

* Dujardin Beauruel2 and Audi^c, Bxiwrinientxl H^wiircliest on Aleoliol Foi-
soain^. Farii!, 1!JT9. Juillot, Alcoliol, ila Combuation. itts Ph^-siulogtcal A<4ioa, Its
Anlldol*!. PufiH, 1683.

ON AOID AITD PITlTlTyrS DVSPEPSIA.

US

Of all them springs Sprudol in aiio of thn moBt important; aooording
Bigsky, the compoeition of Sprudel wat«r is as follows:

Sulpliste of potju^i U.IC35

soda S.3;i9

Cvbonstu of boHa 1.3(119

potasw, 1.0307

" linw, a2976

" miigneaium, 1.1239

" Rtronliiiin, O.OOOfi

Ppoloearboiiate of iron, 0.002S

" " magnwia, .... C.0006

PltOfiphaU- of aluminum O.00O4

Flaonde of ciUciuin, 0,0036

Silica, t).073«

Total
Free rarlMJiiic acid,

5.4307
499CC.

The t^m ptrature of this water is 73.05 0., and it miitit be allowed to
cool before Hsing int<>nially. Its tasto is salty and strongly aikalino. It
iasnc* btiSblin;^ m intcrTiiittnil jete, hence the name of Hpni'ld (binUng).
Fnnn two tu thrtw glaiwtM are uifii»lly ilniiik n day. From tlio |)oi)it of
Tiew of etitntiR'h ulToctioim, thu Carirtbod wators nre {uirti>.-ul!Lrly niiplkable
tfj nu<tro-iiitt!4t)iial inilatiuua ao fruqucut boyoitd the Rliine, where the
onhiuu^" diet iw much nmre ricli and sul>fitiuitlal than in our country.

'riie Carlsbad wrftere arc stitJiiglv imrgatire. The nde« laid down for
tl* hm of this water at tlic Spvudcl station (Hecordiug to Caulet) are as
fn[!owB: The water is drank early in the morning (from .1 to 7 o'clock),
Ati liour after the last tumblerful (at 8 A.M.), a modentt^ breakfast hi
koflof broad with milk and coffoe; tho quantity being carefully measured
fon-hitnd. The dinner is at ] i:m., and h more HnWtiiiitial, but t)ie
ti«'nl is allowed bnt one plate of mrat. The snpj»er Is at 8 p.u., and
~inua^» of MHip or broth, a enp of fliwoluto or an pgg. A rule wbicb IB
OOOUdcrcd iuviolftblv by the hotol-kL-inxm, ia to givv only aliments of bi^
(itnlHT, and evury articlu vl food aud driuk must have boou ordered by
coo p^yticiau.

I'll

Si'MM aRY. — Ftinctionul TroublL-s of tho M iiwnlar Cont — Atonic PyBpopBia
— Flfttnlent Dx-Rpopsia — Ditatiition of the Stomach — Civthpterigm of
the Stoitiaeli — PliiirmncfutiL-uI MetiiiB — ^Ti'Uinizirig Mcil irampnts—
BitU?r Dro]i8 of Bauni^' — Bilttrs — QiiAJ«»iiii — Colnmljo — IlitU>r Ptimns
— Abwirhcnt Powders — Mfitrhimirml Mciine — Topical Stomach Medi>
cation — Stoniacli Pump— Electricity — DiotoUo MeauB — IlydrotliorBpy
— GjiniuiHtii^s— Thermal Treatment.

Is tbe previons chaptem we have studivd tl:o treatment of the func-
tional troubli-^ of the mucous membruno of the Btoniuch, wu come nov to
the considemtiou of the modiScations produced in the functions of thu
nmecnlar vna,i, ami I shali first Runi up briefly what wi* know of lUo
anith^my luid phy!iiDh>gy of tbia muscular investment. It is it thin
i&tnttum enveloping tbe »tomacli in its whole extent, uml eonistitntnd hr
fibres disposed in such a manner that they form by their direction several
apcondary layers. This muscle hns for function to agitiittv the alimentary
mass, and impregniitojt with gastric juice.' Brinton bnii weli shown the
course which tlie alimentjiry boIuB pnrsuoii under the influence of these
inoveriieiit«, which are rhythmical, aud are piwUicet] regularly and inji-
Btantly from left to right, that is to say, from the greater cun-ature to tho
pyloric extremity, lioven, who haa studied attentively these perietiillio
movements, utTirmB that they take place even during fasting, but that they
are moi-e active during the digestive process. Accortiing to Uiifiaiitlinrity,
aliments eoiouru, but a very short time in the utomach, which lias for it«
solo function to soak tho alimentary bolus with gastrie juiei.'. and to puas
it rapidly into the intestine by the jiyloric orifice which o]iens for this
purjiOBc. six to eight time* fl minute.

These rhythmical movemeute you have been enabled to observe in a
fomalo ptttient oeenp)-ing No. 12 ward Sninte Marie. This M'oman, still
(piite ynnng, was nffeeted with raneer of tbe pylorus; the thinncrw of tho
abdouiinu) wiills. and the hypertrophie thickening of tho mu»euhir coat
eujibknl us tn ecu tho movenienta of tho stomach, which were effected
under the infiuencc of digestion. M'e could remark that the leiust iiii-
pn^asioTi on the walls of the abdomen, provoked vermicular and rhythmi-
cal movementii, — a true syptnle of the stomach, which, commencing ai tlio

TKEATMKST OF A'W>Nlf DYSPBl'ttlA.

g^WS^CTirvBture, tprmiiiatwl nt the pylnrns. SohifT prptonds that tlio
movemtJiibi may laky pl*a* in a oontrsry direction, but Loven deiiivii this,
mad iiieert« that thtrre are no &nt'i\>en»tahio movements^ «v«n wlien there
ia Tomitiug.*

L'ndop what influenc© arc thcsi? movdmoiits protluood ? This is a vory
iDtemcting qnestton. The mueculur tiinio rnceivfiit certain plexunu of
nama which bavf their scat m tliv guysruor and infcrior Uyurs: thuac aro
Um plexaeeB of Auerbach ami of Mcissner, consisting of very numerotis
nflTTOiifl fllnmont*. ThcBc ploxiisos oomo from two soiireo*: from the
paocuDOgiistric, on the one hand, and tho gri^at nympathetic on thi* other.
Then two nerTC* have n diffcR'nt action, iiiid in this rr^nl tlie crperi-
ments of I*flujrcr and thoee mon? recently ptTformcd hy Bnium-Honrlc-
piM»t, sfxm demonstrative. f Excitation of tlie pneamogaetric has for its
effect to accelerate the movomonts of the mast'uUir coat; it ia the motor
nerre Vt the rtomach and inti'stine, while on the other hand, the great
^TBipattietic moderates these movements, and k coniudererl ur a nfnre of
mhibitioii. Such are in hricf our ]>liy(uol4^ieul and unatomit^l ooc^uiffl-
tiooa rvRfirding the muBcnUr coat.

Let utt now Ktudy the functional troubles of the mueeutar inTeetment.
Ther are of two kinds; either there is atony of the muscular ooat, and
bonce enfcehlcmont of the pi-rishiltie movements — this is atonic dyspepsia,
«r tlse tlie movements are exagRerftted. jxnerted, and the etomaeb rejects
it« eontentfl and we Imve romiting. These two state's mtutt bp examined
•■{Mrmtely: let ns commence by the etudy of the [mrticutur forTii of dys*
pBjM* dependent on atony of the mnsi^iilnr ro«t. Atonic dysi^psia
preecnta scvenil riugee. At the onset, the patient feels while gaebric
di^Mtion is going on, a sensntion of weight imd fnlnew in the stomnch;
he is forced to imbatton Iiih v(%i bceausi' it cfimpri't^NL's his abdomen, aJid
he experiences a general toq^or resulting from a slow and laborious diges*
tiun.

At s more Bdriuiced shige you observe a notable Bwolling of the stom-
ach, and if yon diamine the gimtrie region, yott snn this nrgnn di*tended
b^gsa, well dvliiirated under the aUlominni n-:dl». This distention ir a
ootueqaeDce of the weakncai of tlie muscular rnat, which pasnrely yields
to Uie pnsBuro of the gae which is genemtcd in the flfnmarh; this is what
is ileacribcd under the name of jhhtU7it di/K}ifj>slii. The jiatient bos
frequent einetatioTiB, and if he shakes hiinndf he experiences a peculiar
mmabing teitsation — a sort of yhu-gh>u — iiWuticnl with the HipjKtcratic
aaootuaHn. This noise, due to the shor.k of liquids iind of ga«, and wliich
Cboiiul baa eoiutidcred as ])cculiar to the dy^jupna of liquids, is a char«>&-
tmstic «gn — not as Matioe thuiks of cancer, but of want of cnntiBctitity
Mf the musvutar couL*

' Lcvfo, t)n the Uorenwats of tlie l>tot)ia«l) (Onx. Mod. Doc. ISTS.)

t tlraani-tlfncksmst, rao«:er, Anh.. Hej.u 1M3 and Itns. |>. 108 anil 17.

:

t, pormit me t

atUtntifin t« a sound wliich is not indicaUul by vritcra on diHOUHtii of the
sUimnch; it Ib n iiir>tallic tinkling lioani in certain caaes of extreme distca-
siim of tlio Ktoma(-h, unci whicli, with thu pravioua sjinptoma, loads ono
to think of tJi« possibility of pneiimotlioras. IIow exjiliiiri thin m^tsllic
tinkling, how avoid a miftiiko in diagnosifi? If you vxainint- your patient
AttontiToly, you will notico that this bruit corresponda with tlie heatings
tuf the heart, and thnt it in due to the s<liock of the hoart ngmnst the
diapliragni wliich is forced upward by th« dilatol stomiwih. and to the
tniusmiBeion of this hriiit to the gas-diateniled ventricle of thst orgun.
By noting then the cxccmivo development of the stomach, and the aa-
f-sirfonce of the tinkling imnnd with thr> iionting of the hoftrt, you will not
fuil to rew^ize tlio aiuse of thin symptom.

At the end of & certain time, the atoniftch piiralyKL-d. and performing
its ooiitraotile functions in an incomplete mnmver, bttouios more hi id nioru
distonded, and ono bae then to d«il witli the most rtdvanced period of the
discfue; there in nnw dilatation of the Rtomiieh. Kiiwunnni hna well
studied this form of dy)t{>epeiu with dilatation, mid IVuzoldt ha* written a
icry <-0[ni)leti; monograph on this subject,'

Dihitation of the etomach may bnv« two origins; eometimes it depends,
ax we liiive just Been, on want of eontmetil ity of the muwulnr coftt, which
l>ermitR the ventricle to become distended under the least influences;
(ii iniftimua it is produced by mechanical troubles.

IiL the first civse, tlie pamlysiis of the muscular coat may be due to
general atony of the muMtular sj'stem, or to mncUficjitionB effoctod in the
imuTvation of the stomach. Thus it is tlmt we ubiierve gastrectasia us
the result of atonic dyspciMia or of histeriu.

At other tiiiioB this paresis results from inflammation. You know in
f«ct, that when any pMcgmasin affects tlu- mnMiilar layer, it destroys tho
contractility of the lil^res. This is uliat Impixms in chronic gnatritis, and
invariably you will see catwrrh of tho stomach accomii!init«i by more or
Itysi dilatation of this organ. Brinton, for instance, nttributcs tho dilata-
tion of drunkards to i>araly*i8 of tho muscular ooiit, consecutive to general
infiltration of the conm-ctive tissue.

Other cauRes whii-h produce gastrectasia are of mecliflnical order, and
result cither from the iiitruduction of too great a quantity of fond into the
»tomac)i, oa in the case of excc^ssivo eaters* or, [as is more frof|Ucntly the
case) from the preeonco of an obstacle which prevents tho ftxHl from pass-
uig through tlie pylonia. In tho latter case the muBcuW euat of tlie
Btomnoh undergoes grL-ut dcvclopiiient, and you see along with dilatation
tiu hyjwrlrophy of the gatttriu walls. This is precisely like wimt takes
place in the bladder when thow? is stricture of the urethra.

Whatever may ho tho enuso of the dilatation, the symptomatir aggre-
guti> is the same, at least i\a far as tlie louul sigiw are concernwl. My the

TRKATSiKNl

147

iit and hj percussion, you uoticv it mnrkiHl ili'vi'lopnieiit of Uio stomucli,

rhich 12 oft«n w«ll ilelincutod under tlic alxioniiimi wall^ You notice

1 an MOggerateil «unoroumee« in tlie Mt hypochtiniiriiim over tho coBtol

inritflGK, by roasoii of the iliau-nsioii of Uiu grt"al vul de aiic (if the stonincli

wliicb presses u|> the rliiiphrugm. In order woll to undenituud thvm

tnodificatiotis of th« etnmnch, you should remomber tho relation of tliv

cnUiclcwith th« abfiomiiinl wnlla. which rolations hav« bwQwoll rtudicd

lUily b; Ijesshaft of SU Fetortitiur^.*

Bat the moet chanLct«ri»tii: aigu is that peculiar Kpliixlung ttuund. heard
in well-marked cases, by suddenly shaking the jmtient, hy iiHlpating ovi-r
the greater curvature in a downwurd direction, or by i)rofising quickly and
r«pcatocUyOTer thfliilidoinitiiil wnll^t. Aiithnriticii have laid mu<<hRtn>».ton
this '* bruit de clajtoleiaent," tL6 it in culled, and wliiuh Choinul di-scribed
vttb to much niinutenuss mony yeai's ngo, but this swaahing noi:^- c)kiini>t
ibe rp*rarde<l an a sign of dilatation of the fltomfich, unless it is produced in
tertaiu conditions, Wlion it is waUi-d within the uatural liniitg of th«
ttntnnch, this ttigri i« nf little importiiJice, nnd may liurJiy dtnterre to bo
illeil pitliologicid ; but in order tbiit it may have its full \alue, this bruit
'nuBt 1)6 produced below a Lorieoutal line leading from t1ic umbilicus to
the left border of the costal cartilages. In order to obtain tliis eplashiiig
Dund, it is nccctnary that the Btomiioh shall Hontnin a certnin fpinuttty of
'liqaid, therefore ia the case of pentuus wli» are Coating it will lie a gnod
plan to have them drink a quantity of water before making the exami-
nation. '

In connection with this sign, there is a mistake which mmtt boavoido');

namely, confounding the gurgling nniscii which are prodnceil in tho large

intestine with tlic awashing sounds of giuttriL- origin of which wb have jnsl

qukcn. You know tJio clo^e anatomiud ndations between tho Btonuivh

transverse colon, and you ciuily understand Low guch a mistake might

niade. The utomnchal briiit has however a different tone from the

iteatiual bruit; moreover Die direction of theiu^ annndH is not the same.

ji for thtKie pro«luced in the intei«tinc, they an- pruiHiguted along the

^■eoendjng and descending colon, while those of the stomach are limitvd to

the region of timt orgnn. Moreover, to remove all doubt, rati can judfie

icf the volume of the Blonuu-h, whether augmented or not, by auiioulUiting

. the abdominal region: when yuu make your patient drink in u standing

position) yon henr sometimcH at a point more or Ims remote from the

natural limit* of tlu> goiitrio ventricle, the sound of the collisiou which

nanltii from the fall of the liquid to tlie lower pirt of tho stomiieh.

Bat I Ao not think it of any prarticul utility in order to mi>nKure thf>a>
dilatations, to employ the iirocednrcA counf<c1Ie<l by I^nbo and Peosoldt,
tbeM meaeurements being of no great help to your diagnosis.*

YomitingisnotacnnetnutiiiTOMijianimentof dihitiilion of the stomach.
It h wpFciolly cliaracteriKtic of gostmctaBiaii of mechanical origin, and

14S

DKKASES OP TUE STOMACH.

then it takps on a ponnlinr c]ianw*U>r. It oompe on only nvory wofim
third, fourth, or Gfth duy, wlien it is cxtrnmRly alum dm it and oonKiHU of
all the food tlic- imtient has cittrn during tho preceding (\ay9.

Uouchurd Iia« attributed to thcAc dilatations <iiiite a pothogcnctie rdle,"'
utid tJtking up Eigain under another form tlio views of Iktiii, who, as you i
know, assigned to dyapepsja. i»riniarj-, uecornlary, and tcrll»ry countilu-
tional tronblea. Itouchard thought timt this dilatAtioii vns the expreesioi^^
of an acquired duithcBis, und i^ngcndorod a great number of diseases. ^|

While rcnojrTiizing thnt dilatation is much mnr» frwjncnt than wan
formerly BuppOBvd, for tht- varj' reason it>o that we now look for it with
gr<-ttt*r care, it seems to nie dilBcult Cully to adopt Boncliard's Tiews, for
if dilatation of the stonmch may he the ori^n of general trnuhlrs «f iiutri- i
tiou vfhieh i&yor oortiiiii diathetic affections, ouc is justtfifd in dpinandiny
if tliis dilatation be indee<l ii primitive fact, and if it may not itself refiiilt
from apeneral disorder of th« hittous system reacting on the innervation
of the muaciilnr coat of the stoniarh.'

From a therapeutic etandpoiut wo ought to diiitingtii«h the troatmont
of iit^inie dyapepHiii from that of dilatation of the >(tomiieh merely; in the
furnier ars specially indicated the tetJinizing nieilicauiuntM, bitten* and
antiseptica; in the latter eiioh meohaniud mi-ans &» larogo of the stomacli
hiiTo gn-at imiiortanco. There am »1ao (certain hygienic rules appticftld»^J
to Imth nffoctioiia. ^|

hi atonic dyH])epsi!i you endeavor to act on thw muscular fibre, and
stimulate iUs contrsL'tions. IUtl- wc have an indiaitlon for tlie t<^tanii:iiig
medicaments with elective action npon the striped or tniFtriped muscular
fibre. Tho vegotftl production* cont*iiniLg strychnia attain this end, and
th(>re itt a pro|Nimtion whinh givoR excellent reKults in then> cases, and^^
dewrveM an eajwcisil mention; I allude to the bitter drops of hamnL^^
This tincture is given in the dose of one to five drops before or after "
mm\i, Vou can also employ " Tastour'e powder" which C0Titain» nui
vomioa, fOHrgniinK of which, containing one grain of nux vomica, may
he taken at meal time. '

The bitters accomplish the sime end, and though we have not {nvciaa
tlierapeutic uidicatiouK respecting these mcdionmcnts, 1 am nevcrtlicless
led to bolievo that they act by exciting the muscular eontractione of tho
stomach. The first rank must be aatiigncd to ({uiishlil amara and coiinnhoi
Quassia if nf ancient and elitssie usage. It in lulminiiitered in riasex of
ntoniu dyapep-tiii. csptnzially in the first iK-riod, under the form of macera*
tiontt or infii»ion& You know that quassia givce up its bitter principles
to cold water; you can then ma^-eniLe from one to two drachms of iho
chipB in ft quart of cold water; thie is a handy form for lid minislnttion.
Tho <][uaKtda-wond cupH ai-e much in uw*; there is, however, an inconveni-
ence attending tlic^ir employ, for when they have beenforsomo time made
tho roceptaclv ofmi-ttnrea of wine and water, tliis liquid panotnitce tho

TIIKATAIKNT OF ATONIC DYSVEl'SIA.

149

wood, femjCTite, Hnd ever after Bonrsororything which » ponrwl into thoso
tnpL You rill do better, them, to prviuTilie wi>Hk infusionK, made with
llir rliipe mid cold water. Such iiifiisioua niiiy bu tukcn u short timo
Iwforo meals.'

Some physicians prcKcriljo qunesin. Cnrnparilnn has sliown us the
influence of tins acliv<f principle upon tlie contniction of the smooth fihn^s
m gi-neral. If you t-mploj mtiorphous quikssiu you will order two j^riiinii
daily in gmnalea c«ch containing ont^third of «, gntin; if you niuke use of
<TystiilltK«<i quasein, tho dwo it; only onp-sixth of ii grain.

Colnmbo in given in powder, in the dose of from fire to fifteen grains,
or in the fonn of wine or elixir whieh arc good pn-piiriitioii8 in the traat-
■nrnt of atonic dyspcj^ia. "

Tlicii comes the series of "bitter species;" first germander, the lesser
centBury, and wormwood, which oonntitute the bitter species' proiwrly so-
ciJled; then hops, holly, rhireorr^ hitter orange |>uel, with which you can
make ptinns wliiuli nmy Ix- often taken with benefit.

You are aware that all thettti auh^tnnces enter into the comirasition of
fonnala* raotv or less comidex; efjni{>ound decoctions, elixirs and pills,
are made which all contain for luudK thew rarioue bitter plantm; tho
" Knglish Stomaeluil Decoetion," the " Visceral Klixir of nofTmnn," the
"Tonic Pills of iCoscow." You eiee every country hiia glviii it H]K.t:ial
forninla, and I simply mention these prepamtions without attaching much
importance to them."

By the side of these Babehincea called bitters, ve mnst place two
in«liaimont« which give good n-eiittB in this form of dysiKipsiu; J refer to
rfaubarh oud aloee. I shall hare men- to say about thcee two tlierapentio
agents when I como to the di»iii»es nf the intestines, and the siibjoel uf
j-urgatJTeH is before us. Our interest nt tlie present time in the two
purgaUvee jasl mentioned in due to the fact that they arc often ui»uciat(^'d
in rtomaeliic pre[iarations which are given in the fonu of powder, wine*
orpilla."

Against the occnmulation of gn«, which often results from Ticions fer-
nwntation of tlie food on tho one part, and the weakness of the walls of
tbe etonmch on the other, you may employ certain absorbent and auti-
aeptie powders. As for the first, Belloc's poplar charcoal powder deaenre*
to b» placed at the head. " I do not think that this preiuirol ehnrconl acts
at all ahsorlient of gases, for it is wxdl known thnt this nbtxtrption does not
take place unliiss the charconJ is dry, but I believe timt we eaii explain its
laronible action by its antiseptic effects whioh arc most manifest. It is
'in the fame way tlmt tho inert jmwdcrs act, such as snbnJtrute of bismuth,
whieh also nntagonin^ fermentation.

Iodoform has also been rorommended aabeingantifrrmentnti^-e. While
Tvn^iniiitUK llie aseptic ]iower of tliis mbetanco^ I am not u strong advo-
Oftt«> of its employment, for it lias always occasioned, in caacs where I lak\ q

150

DISEASES OF THE STOMACH.

UBe<L it, more or lo» irritation of the stonuMb, snd I mnch prefer tbo
curbon bUnlphule wuh-r of which I Bpoko in the laftt lecture, nml wtticb
yoM muy admiiiiKter In tbe> done of from four to six takLeejiooiifulH u tiny.

Tbi-n.' remains, Hiinlly, tbe most importaut point to hv cuiisiJurL-tl,
namelv. tb» trcatiu«til ol dilatation of tbu stom&cb by apeuial meuiu. The
thflmpeiitirs of gaHtrootiuiaa, from whatever cnitso, ronsist c-epecially and
ulniuHt pxdaiijrvly in lavage of ttie stomach, and jimt iis. in tlio cnsc of
individuate who are atloctcnl with atrictitrc of t-Itt' uretUni. or who from any
cause are uitablc U> empty their bliulUcr completely, it is tbe duty of tbe
physicittn to withdraw tlie rosiduii by cathctorism, so also it is equally
inipnrtjint in fniAtrei'taxia, by repoutcil wimhings nf the Rtoniach to romovfl
from tiiiit cjivity liquids wliicb sojouni and stagnate ihere.

TUee« liquids, which have recently been well nimlyzud by Vuii dcr
Velden, undergo putri-if active ehangcH by thuir prolonged sojourn in the
utoiniuh, and their presence is a cbukc of con»tunt irritiition to the mucosa.
1)1 order to rid the iitamii«h of these putrid liquidH, it is necesiuiry thor-
oughly to wa»h out and mwlicate that orgnu."

Therefore, gentlemen, tbia operation bocomea obligatory upon you in
such ciifles, and whenever you roaort to it, even when the patient is
affected with cancer nf the pylorun, you will give relief.

As for the tnaniiikl procedure of thi» operation. I niuat refer yon to
what I linve t«id in, a previous lecture, recommending to yon at the uume
time always to hare caro to terminate your Uvago of tlie stomach by a
"gaviigu" with alimentary powders and milk.

ITow long should the tn?atment of dilatation of the stomjieli by titvago
be continued? This depends abeolutely on tbe cuu8u of the gmrtrecUiiiy.
Tbe treatment should often be continued a very long time, even in va^-a
of eimplt! dygpi-pHiii, and 1 hove seen patiente prescntijig no strietm'e of
the pylonis. obliged to pnictice lavage for yesirs; instances of this kind
you will find in tbe theaisof my pupil. Dr. LatagL'.* This long continuanc©
of a remedial procedure must not daunt you, tor the patient derives euch
udrantAge from the liivago thnt he performa it with regulnrity, and you
will Hee a great many penwns who treat their sUimachB with the same
scrupuluuH (iUmiiliiieati as tlicy do their bunds and their fac«,

Apibrt from lavage, tbe ether means are of a aecondary order; I ought,
however, to s&y something to you abont electricity and maaaage.

Furetncr and Ncftel have sliown un that by employing iuduoed and
feebly intermittent currents, one may an)U»e the contractions of the
storaacli. ilacurio and BonneQn have often derived good eiTct;ts from
electricity. I see no harm in the use of this means to provoke the i-untrao- *
tions of the otomach, the nuntcular eeat of which is afleeted with |)amly-
8i», while, at the same time, reeognizing the fact that in most eases the

TEEATMENT OF ATONIC DYSPKFSIA.

151

camnt act« rnthor on the ulKlominnl wiiJIh than fin the etomach itself. It
it DQt the same wbcD the electrical current is applied directly to Uie
ibNiUiCh. Ferli in 1H7!I, uuil Boc<ri in 18SI, ndviecd to rruikc oiio of the
dectrodea ptrnetrate into th« stomach itwlf.'* But it is rktrdet who hji«
rendered the application of electricity eiisy. by coiiBtructiiig the iiistru-
Dkuut which I hero prceont (Figiim V), isiiil which consists, ae you »cc, of
■ Btomach Bvphon diriilwl into two parte, which aro joined by a metaliio
[lortion in tho form of a letter T, which pcrniit*i the introtiwetion of a
rtylct into the interior of the tubn which jwnetrateB the stomach. This
Ftylet is terminated by an oliYe sliaptil carbon point, luicl its inferior ex-
tremity does not extend Iwyond that of the soiind. The stylet is a copjior
wire to the extremity of which one of the clcctrotles may be fixed. The

nil. a

eoand i« first made to penetrate the Ktomach without the e^let, then tha
Inttcr in introduced. Then |«in!( in taken to till thnfitoniach with a certain
f|iuntitj of water by mcanit of thf nyphoii, and it ie by the intermediation
of this water that one is enabled easily to itW-LriiM.- the internal surface
of the stomach. The negative pole is the one that is paesed into tho
fltomaeh, tlio pomtive pole \« applied extornnlly over the ftastrin region.
It ia the eonatant cnrrent of which yon will make use, but yon will have
c»re to interrupt tbia current from time to time. The forct: of the current
anghi not to eiceed twenty-five millianip^ren, and the duration of the
•tence is from five to ten minutes; then you are careful to «y])hon eut
the stomach m as to remove the liquid which yon hnTe introdnred. I
bsTO often made use of thia method in my service, and I have oblained
good rciniltd fnmi it, expLKially in caw« of enoniioum dilatation, onlinarily
M ob«tinate and «o retx>lliou8 to all our modes of treatment.

Dally has alee counselled metltodioal magHi^ of tlie stomach, and
Iland, Inning himself on physiological e\|H'riments, lia» propoisefl to com-

152 DiaKASf» OF TtlU OTOMACU.

proas nrtificiallj the pnpnmoiijAstrio nerre in order to aagmeiit tUc ooittnic-
tiotis of tint iitoDiAcli; thi-su c:ompr(!ti»ions bu pmctico^ oii the left side of
the neck. This completes the theraiwutic means properly wMialled ; let
us insu on to tbu lirgicnii: nioana.

How can jnu, by hygienic moiins, comhet this atony which so paralyzes
the nniticulur coal ot tbt> stomach? Ijst tm bc-giii with alimuutaUoii.

As far as [Kxwible, you will follow the rule laid down by Brown-Si''<)nard
lor tile trcutmunt of the dyepepnias, a. rule wlijcli applies almoBt exclnKivelj
to tliifl variety of ftuictiouul trouble. The number of meals rouat be
multiplied, and the patient muat be made to eat every hour, but very
little at a timo. Vou will choose aliments which htv the most nutritious
and most digestible possible in a small Yohinie, such as julcj un<lenlone
mutts and roaist moats.

To fnror the imbibition of tlie aliments by the ^trio juioo, yon will
n-'couimenil tliat the food bo well jiumtimtcd, and if the patient cannot do
tliis, you will iidvise him to use Snoly Imubed mcatit. taking rare tocxcludo
for the moet part fatA and starchy snbHtAncpn, which oflen sojourn a
long timo in the stomach without undorgoinf; ony modification. You
will ilo well to recommend mich iizntizod subHtancefl ae liave already un-
(lergoue a commencing fermentation, such a« game that is tsoniewliat
high, old cbeoae and sour crout.

Hccotiimend tn tlio patient to be reserved in the matter of drinks.
Schrothand Itartclet go (nrtburand order absolute abstinence from liquids;
tilts it) what Chomel de»rribed many years ago under the name of the dry
diet cure, the advanUkgos of wlueb in the troatmeut of atonic lij-sjjfpsJa
and dilatation of the stomach, Huchard has fiuite recently ehown hs. In
foot in dilatation of tho «toniach, drinks romain a bug timo in the roD-
triculitr cavity, and 'their prewenoo often determines the rbanicteristto
glott-yloH. Put your ptitienls then on u dry diet, enjoining abstiueuce
from liquids."

Uecommcnd ospecially to your patients to avoid at whatever cost that
lethargic torpor which seizes then» after nmtU. Prescribe regular exerciao
after eating, so as to eombit llial pemioiouB tendency, so common in
thfso distfasea, For youngaud old after a hearty meal, walking is Ijetter
than lying down.

Another important point is to excite the genera! circulation in order
to fuvur the gustrie cougcntion which seeom jMUiiea digeetion; for thix con-
gestion, as you know, has much tu do with tb<j coittnictions of the muscu-
lar ClireH; this you will aceompliish by out-tloor air and exoreisc, bucIi as
walking and mcing. To theae meaus you will join the oeogc of hydro-
therapy and gyniTLftstTcs.

Hydrotherapy has nnt only a tonic action on the economy, but it acta
dinrtly on tlic stonuieh by the load effect of cold over the anrface of that
Ti*;up. Remark what takes place in a peraon affected with dilatation of

TREATJIINT OF ATOXIC DYSPEPSIA.

153

tbeetODiAch; the njiplicatinii of ooM over Iho ubdomun provoke* |>vri8taltic
amemcnto of tbo mnecDlAr coat of tbo stomach. Here is an inJioation
ihich ifl well fulCUecl liy hydrotherapy, aud nothing oiiii botUT aouoniplish
Htm euA thuu thu circuUir dout^litis ilirtctod over tliu pit of the stomach. .

Grmuastics may hare a good inflnenco in the treatment of atonic; djB-
p^eia. My friend, Dr. Tomungin, has sbowti mc a number of patients
a iflectod, aud who were, m ha clsimo, cared by a well direuted course
<a gymoBstus slone.

But what Ton ought especially to urge n]>on your patienta Buffering
fron atonic djRpopaia, is to attend carefully to the 6tatc of their bowi'le.
[b htU the muecular lining of the intestinos in a continuation of that )tf
ihertomach, and pamtpieof thoono inducer parulyBJa of the otht>r; hcnco
ilU that almost all penoiui nuffering from atonic dyspopgiii are constipated.
It will bo noceBBKTj then to stimulate the muacular film-e of the inti'stine,
mi not to add paresis of this pail of the ulimontary canal to thnt already
eiirtiiig in tho gastric portion of thn digeRtive tnbe. Thi< patient Bhould
I* enjoined regularly to soUnit a stool, and if habit cannot orercome tho
wmdiMtioii, he should be diru-cted to resort to some of the purgative
minenl watera.

.Vtonic dyepcpna, and ccpccially flatulent dyapcpeio, domaud a quite
ipEtal thermal trcHtmoiit. Here you arc not to solcct those waters which
bare a deri%'atiTe ettvct on the bowels, but rather those which act on tin*
cnlineouB surface; you should, in a word, prefer eAtertud mudicittion with
Mlie, to the internal usage of the watei's, therefore you should avoid the
twjpBCMMiJt wat^'ni which arc more injurious than useful in these c4i8Cfl,
•ndwnd your (wtienta to Plom biere*, to Luxeuil, to Boiirbon-Lancy, to
Unit, to Ba^Qi^nM dt- Bigorrv. to Luninlou, to Saint-Sauveur, or to Aulus.

Wlicu you have to deal with a cum' of dilatation of tUt; »tomuch and
ynt patient ts practicing lavage, you can mud him to those watering
I^liuwi where hivage is conducted systematically, aa to Vichy or to Chatel-
'•nyon. Good effects are derived from tliew water* by bringing tlieni
■lirwUt into contact with the walls of the sU>mach by mean? of the nyplion.
^vh are in brief, the dietetic rules whicli are applicable to the treatment
of •tonio dyspcpeia and of dilatation of tho stomocli.

In Ebc next chapter wc glial) f^tudy the troubles due to perversion o!
the DioTements of the iit^tmueh; I refer to vomiting, which by reason of
itafnqaeDcy deserves to engage our attention for a short time.

154

PI&EAtJE» OF rilK grOMAClf.

p

NOTES TO LEOTIJRE X

' In tha Btomacli tli« mnscular tinue vari<« iu tliiclcrtess: at the fnndiis
it is thin, (i to jt of h lino) : in tho middle it has a thiokii(!«« of about 4 a
line; in tlio pyloric repiou fimillv-, alwut 3 of a line, and even a line. It
cnnnifitR of tHrrp incinnplct* laycni: 1, mont cxtonially, longitudinal fibrr«,
I'sppfiiiilK" at the canlia, where they ariw from tUo pspiniPioii of a part of
thi? loiigitit(1iTi»l tihrt'H of thi' <i>ito|iliafriif<; and nl^^o nt th'i' pyloruR and in
tliu iiiiri' prjiorim, vliciu-o, toneoly i<tri'tchi'il. tht;_v arc continued upon tho
diio(k"Uinn; 'i, circular inuHcli'», m the iniddlii n-gion, from tlie fundus to
till' pylorus, wheru they 'irw itwrumulatcd, <!<)iti4ituting the Kphiiiutvr of the
p^vloriia; 3, most internally, oblif|ue fibres, which, in connection with the
oironlar flbrea, embracp the fnndne as in a elinjir, and run obliquely ni»on
tho anterior an«i posterior walls of the Ktomoch, toward it» greater eurva-
tnrfr, whore tlioy terminato upon the outer sorfflcp of the inucoue mom-
branc, or nnito together.

According to Heven, the stomach in divided into three portionii; the
first, Ritnatt!tl on the left, cardiac portion, nervoR alwayu no a rnwtrvoir for
the food, and tho luovciucut*! in this portion arc little pronounced;
thevL-BMeU and the ^)eptic plands are few in number liere. Tne Bc«(ind or
right portion, constitutes tli(> ustifnt purt of the btomuch; the morementii
there are energetic; the circulation ie active, aa is also the gastric juio©
secretion. Fiimtly, in thi* tliinl {Kirtion, cidled pyloric, the movements
arc still vorv inaiiifcBt. but the ei-cretion of gastric juice ceasL'sal this [wiut.
It is generally three or four honru after a hearty meal that thi^ muvemeuts
of tho istonmch aro must energetic*

#

• Dr. Thwiild has analyzed the gasea of tho stomach in sereral of hia
patients with tho following result:

Carbonic acid, 20.57

Hydrogen, 20.57

Marsh gas, 10.76

Oxyg<>tit 6.53

Nitrogen, 41,38

Snlphiiretttnl hydrogen, Traces

Leven haa found oxygen, nitrogen, and carbonic acid. The two last
may he wauling, but oxygen always ia present.

In a fasting dog he obtained from the stomach 17 cubic centimotrcR
of pu and thorclfttiTeproportioiigworofi.4cnrbonio acid, 12,4 orygen, and
81.2 nitrogen.

Tn bin study of the gases of the digestive tubp, l«ven has, moreoTer,
shiiwii that these gaae^ do not exime from the food, but from the air,
from the bloofl. and from fa;ca] matters.

•Pcnaoldl has given ns a good history of dilatation of the ^mnch.
Thin pathological condition was not noticcKl till the sixteenth centnry»

• Lrvf-n, On the Movwneiitsot theStomuch. Trait 6 Hps Maladies de IBatoniiUv
187fl, p. U. Kolliker's Microwropical Anulomj", Am. EJ. p. 5CH,

TItE-lTlLENT OF ATONIC UTaFEFSlA.

And it wna FiiliiicuB Aqim(ienilens who waa one of the first to point out
the cxtmonliiiiirv «l(iin'iisioii« In which the stoniMrli mav attain. In
1623, Spip?! >:|)o;(kK nf ii r.-t');!!!!!.-!! wliieli AOnlil hold fmir frnlfons of liquid;
in lti«5, Itunni't tlvstribo! thovaecof ii wonmu withujt vnoniiouH dUstutiun
of ttu- stoniach. .VLiactinnl In 1697. ul»o mvaliuns s case ut gustric ditatu-
tion. In the XVIMth century, f»c-tii uf this knid were multiplied, luid
nuDiLToiu authors dti«orib«i), tlioii^h mtlicr iiodcr the title of tuiatomicftl
cuhnsitietf. caaeu ot vxoetsaivv. stomachal diluiiitioi].

In J 74^. Widnianii. Van SwieU-Mi iind Morjpigni. hiid the foundationii
of tlic p»thoji:cny of this affection, and r^mHrkt'd that exceasivu spirit
drinking, c xi)^^Ttttt>i.l contractions of the atomaah, and cancer of the
pj-Iuruv wi'rv the more frwjia'iit cau»L-8.

LivuUiud in 175:2, wag ono of ihu firat to roeord oheorvations of dHata-
tion of the stomach vithont ronHtriction of the mloruo.

In 1833, DupUv pnhliahccl hin work on dilahitiona of the stomach,
in which he reoofj^izml the following imiin'i':

1, St«iio«8 and obliteration of tho pylorus; 2. Abnormal adhesions
of the Ktomach: 3. Uostruiitiou of the mnsculur fibrca; 4. Induration of
thp cellnhir tissue, which liorders on the pyloruB; 5. Atrophy of the
«ACire moBcnlnr roat; 6. Hydatid tumors di'velopcd in Die cavi^ of tli«
■tomsch: 7. Haralvsis of the wullii of the stomach.

Kaumano iu 1834. lulmittoil thri'e8pt;ci<»«of dilatatioiii*: I, by ghittony;
2, by atrophy o( the nmeeular tayvr iu thu cachuetJc; 3, hy stfuosiB of iho
prloroa.*

' I>pee1iaft has Etndied the situation of tho stomach in 1200 nwlavors
prevjuufdy frow-n, and theso are his rcaults: The stom;irh is not horizon-
tall* placed, with tha grtiat cui de urti- on the left, the pylonia on the rieht, •
the ln«(>r curvature above, and thv f^t^ater below. Wlifii it is full, it
dora DOt undL*rgo toreioii arouud itit usih, in suL'h u nimmer that the
ffreatOT oanrature is in front, the leaser boliind, tho anterior wall looking
upward, and the posterior downward.

Normally, five-sixths of tlu* stomach is on tho left of the mediiw line.
and only ono-sixtli on the right. Tliu cardia correajtomU in front to tho
jiUMtion of the sixth and eovonth ooi^ml oartiln^ with the tutoniiim, and
Dehind to the hhro cartilage which unites the ninth donsul rort«bra to the
tenih.

The great cul ti« tae is Rented on the left of the cnrdia. Ita moi«t olo-
T>tcil portion attiuns. on tht* nuimillury line, the huii^'ht of thu tifth rib,
often ttiat of the fourth inl*'rc-o*lttl xpiice.

Leaving the great cul rls Mir, the greater rurvature descends in the
Ittft hypoohondriam, and then turns horizontally to th« right towanl the
median line: ita liorizoutal part is situati-d more or luss low, bui.giMierully
it pfwinT behhid the middle third of the Kps4<u which joins the base uf the
eiunform cartilage to the nmbilteue. The lemser uurvaturo oommenceH at
the lerel of the left border of the base of the xiphoid cartilage, and tukt^
m direction at first a little to the left, luul dowuwanl, then descencU rcrti-
ckIIt U> the left of tho vertebral column. At the lovol of tho extremity
of iho cartilage of the eighth rib, it turns to thv right to terminate at the
pjloras* which corresponds with the right Uirder of the sternum. The
porition of the iiteniaeh is then principiiilv vertical; the great rui ^e mr

* fmixotill, Di« MattwiHrwnil^riititr Er!imi;i'n, IH75.
\\v Bbxtuuli. Ib^ut) (l« MM., Uuy IUI1>, IWM.

Matttlttu on LHlaUUua of

la directed upvar(]> tUc greater curvsCaro to llic \«it, tbe loesor to tho
riglit.

The nnening of the pyloniii looTc« to the right ntici oft«n Rlightlv back-
wnrii, iiiia corTOitpoiKin to tlm ripht tinrdor of tho KUrniim; the anterior
■Willi o[ the ediniat^^h lookn fonvurd, tliu [KiKtcrior biuikivtini.

What jiodiitiun doL-s tbe stuitiiiL-b ocL-upy wlicii it is full? FoMb of
iwri lonciini fix thia viscaa Buperiorly, on tho right, on the Ipft, liehind and
Ixelow. Tliwe folds are tho shorter the nearer you approtwh tlie cnr<iiaand
pylorus, which are nlao the points of the fltnniiK-h which nva ino^ flied;
tiiori'!Ovi>r the fold of peritoneum which extends from this vi»ciit« lo the
6pleen is rory short in it« app«r portion, 6o thnt those two orguna are
intimately connected.

The mOBt mobile part* are in thiit portion of tli« Ptomjirh which is git-
lantod nnder the gastro gplonic lignment, nnd tho inferior mrt of tho
pyloric portion, hut tbuy can only Uko a direction downwitrii. for every
diapiiin-miMit nf tlio greater curvature forward would havn for its result
to make tnn'tinn on the spU'en. which in itaelf lixeil by |H>riton«al foldB.

These Bniitomicftl relutions eufiice lo show that the stonwich can not
move Hrotiiid its own axis in Buch n way that the srcater cnrvnlurc is
plsK'Lil in front: it cjin onlv dilati- rt.'(jularty while its extenial Ijonler
tukL>»< an extension inon* to tW k-ft mul downwurda CuHoe of gOKtrectai^y
ahow tbia in a moHt evident manner.*

• This ia the wiiy Thomel px^ircsses himself with regnrd to this pirticnlar
hriiit: " Tho Rvniptoni pdculiiir to this (ivspepnia i« the proriurtion in the
gaittric region of n xwo-tnitiif tftutid, dne evidently to thf pi-esonce «iin«lta-
neously of h larger quiiutity tbnii tiiiiiini.1 in tbcptumacbiil cavity of jms and

■ liquids. ThiH hruit is himrd during niovemenU, whutlmr thf mti*^nt riswa
or hea down, or auddonly reclinfa on one eido or the other. The medical
attendant rea<lily hears the sound, which is almost oonetantly to be
detected at whatever [wriod of digestion he may examine the [lutient, and
even when the piLticiil is fiisting; all that hu bati to do is to pit-iw enorceti-
caIIJ; or give a few amart taps with the lumd over the left [>art of the
epigaatriiini, in the point cnrrpsponding to the great r«/ He tiar. of the
stomaeh. It in equally well prodneed by placing the two hBudii over tho
loina of the fHitiont and giving to the tnink two or throe latend sthockn.
ThisAr'iiV de cUtpittcvicnl may iMicnnfainubjd with a similar bruit of which
the birgc intestine is sometimes the scat, which is easily pmdne^ctl liv llie
movement of the whole trunk, hut liettcr still by preasiire of tholiand
over the region occupied by the colon. It is met with e!())ecially in
•objects vho have rcoently taken iin cncnm. and with tboac who nn- ufliMited
with scTonK diarrliOMi. Tho knowlodgt* of tbetw eonditiony Lind the special
seat of the stomachal c?(ipoiww7((8UtBce to distinguish it h'om tho intestinal
da^lemerU, t

* These meaenrcmonts are made by moane of on osophajreal sound,
which is iiiitdu to pcnetmtc ua deeply us poesihlo into the stumach; tho
extremity of tho »uuud is felt ihruitnh the alKhiuiinal walla; In>m tins the
distance Ja measured to the part of the sound embraced by the incisor

* Lesahaft, On tlie Situation of the Slomach, its Porm and its Function.
Arcb. dc Vircb.. vvl. 76. fiuK. 1.

\ Cliomel dea DyBpepdiea, 1807. Audli<iiii, Clapotement d« rE»tomac. Coiupl.
K4>n<l, dc I'AmuI. dca Sciences, July, 1$>M.

TItEATMEKT OP AT<iNIC 1>YSPEP8LA-

til. This, in a womun of nvcm^o heiglit (1.53 metres) is (6 oonti-
metrcd, or 59 centimotri's for a man whosu hfif;lit is 1.60 metres.

In mi*!*^ of (lil&uitioii of tbf sltmmch. mtuuuremeiiU bare beeu given,
by Fencoldt of 64, 70, and 73 centimetres.*

' Bouchanl observea tliat dilatation of the stomach is extremely frequent
He has found it in 30 per rent, of his |iati?nt«. and on restricting the
uumber to cJiroiiic liistases, the proimrtion is 6(i per ctmi. Iln considers
SBdilatod, only tboao stomach* where the bruit de chfwtemtiit could be licnrd
— during fasting — below the middle of n line; ilniwii from the iDiibiliriiH
to the bonier nf the left rilnv lie liiiH dt'scribed a very (■orajilex enm of
symptom? resulting from thiet ditntntinn, iind hiiR miiilVze<l two luindrod
and tneiity cxm?, dvM;ribiiig ^everul furiii». Tliuru \», tir^t, a Ltttent form
in wliich the pHtk'nts do not expLTit-iiLV any dyM|H.'ptic troubkv; tlii-n ik
snxind form ai;i;um|iiniiiMl bv HatHlfUl ilyspt'[ifci!i. fisiniralgiu, or intestinal
dv^pepeia; eomctimi'C bepatfc disturbimces prodominato.

r'^nully, IJoudumi iidmitJi livrvntol forms, whicli fimi prebend trpesTerj
nnmeroHs and widely iHlToront. Tboro is the iiuurotic tyiw wttli all tbo
rrtnptoma of ncvrosism, or of hytiochondriaKis: th« ejirdiac type, with
pal i>i tilt ions, inter[nittvn<;eH. and fiilRennginn pectnri»: the aAtlinuitic typo
witli pubnoimry troubles; the ren&l tyi>e in wbieb Rright"!* diatiase niiir
W rpoojiniw^i; the eubineous tj'pe, olisen-eii ehiefly in ehildren. and.
irhn-li 1* atx-ompiinied by f<;Kema; finally tliu rhi-umatio ty|»;, with no-
itodticu of the juiutK. lie conwdera all tlieac trouble* as dL-pcndrnt on
bvntentatiuns taking phiee in the difpwtive tube, am) wliii-h luivu fur their
irritnu unimal alliiiloids, which eiif;;end«r them. Accordinf;to him. dilatit-
tion of tbi' atoiiiiich is the roaliisation of an acquirei) d iath^^tiit^, and ^Ivea
nwe to a great number of diseaaeft.

Ihijonltn Boiiunit'tz. in commenting on this communication, observeil
that Untirhanl in adopting the viewe of Itcuii, attribiibi^d to dyB[>ciiiiia
ali tiio conptimitant symptoms without any more [Tositivf proofs tliiui
tbow adduced by Beau, for in tln'se ouhcs one is always bound t« nsk if
tbo diiatAtion of' the stomocli instead of being the primary origin of cho
trouble, is nut simply a munifeslation. f

•Tastock's Powder,
Take of:

PulTeriiwd nux vomica,
Pulv, iMnella alba.
Carbonate of lime,
M. For oiw powder.
The " Bitter Drops of Runmf " may be oonroniontly replneod by tho
tjnctorc ol nux vomica; dose, from Www to txn drojH Qire*- tiin<« a'dnv.
Bsam/-*! "bitter drops" contiiin iKnalia-ainani. (stryohnoB ignuliij
alcohol, alMinthe, carbonato of [M>taj«!Uk au^l soot.

*<^tutSBia is obtained from the Simaruba excelsior. It is the wood of
qOMBa amam whieh io officinal, this is a native of Surinam, and is a
■mall tre« or shrnb. It im[Mrbi ita bitter qualitiw to w»t«r ami aleohol;

* Prsnx PenzoUlt. Dw Uncinern-piteniRft, Br. Erianiic«fi, 1875, Lt>uli«> Ztir
Diof^BCMM (ler Ua^ndilatalion. (Doutcch, Areli. tOr Klin. Med., Vol. XVI.. p.

f Uouctinnl, On the Palho^notic lUie ot DilaUUoo oT tlie Htuniftcb. unl Uin
i;Ufili»lK<-latlOlliof tbUiDitt«awwlUi Divftrx Morbid Awidonts. (Unx. .

5 oenti^rammee
1 deeignini
Idocignun

158

DISEASES OF TlIB STOMACH.

tlio hittor principle waa firet iaolntotl by Winokler luiii imUcd by bim
ijttnitfiny irfiich is uniorphoua or erj-stMUini-. whit*. opo()uo, modorona, in-
ulti-mblo in i\w uir. iiitt-nsoly bitU-r. BiiUibli- in wiitt-rniid alcohol, innoln-
ble ill etlier. Cmn]iarilun lias showo that miu^Hiii is onu of tbe Iwist stim-
uLanta of tlie rnntmotility of the iiiutripeii mtUKilcR in tbo dotHi of two
graiuB a day, wbcii tlie amorpbou» ia given; iind jlli of » ^raiu, in the
case dF Uii> (.-ryintJilliiKi.

Th*> Jamaica quitflftm ia Huiiilflr in iU iiroporlies to tliat of Surinam,
but liaa u Dioro marked action on the norroita system; aocordiiig to
Oubler. it is tnxic to birds, aiirl resembles nui vomica.

Surinam quai«eia wihhI ooutAiiiA no taiinif] or enliic acid, liotico tbe
iuftwion of thin wood is r prood oxoipieiit for the salts of iroii, (Ciunpa-
don, on Qiiiuxiiiio, its I'hj*Bi(>li>gica! and Theniiioutit! Action.)*

"CoLrMBo(CaUimba) ix the rout of Col-cuIus pHlniatua. nie!iiBjM>rttnmi
jiabtliituin, (ML-niH|KTinaL't'!i>). It in tt niitivi- of Irupifal Atriirii; ih ». dio;-
cioHS creeping plant with cray twining stem, and thick, fleshy roots, which
are cut in slices and dried in the shade. The root as it reaches us, is iu
flat, ciri^'uinr or ovitl pieces, from \,th inch to nearly an inch in lUickaoss,
and from i to :i inches in diameter: chinuer in tbo'coQtor than ut the cir-
cnmference; nf n greeiiisb yellow ador.

Planche in ISII, fonntj in (^olumbo an azotixnd iinbKtaTice. a bitter
yellow milwtanpc, and ono-third of its weiglit of starch ; there was a trace
of volaiiilo oil, mlta of lime and pota««i, oxidu of iron and «ilir». Tn
lrl:tO. Wittstock of liorlin, discjovered u hitter cryaUdliaed i>rinciple which
lie culled iohimhin. Thia eryaUillizes in L>ulorle«ii rbomljoidsl prismit,
Blishtly Holublc in water, alcohol and ether. According to Uodeckcr
(IHDO) the yellow color ia owing to h^-rbprina combined with coltaufiic arid.
Cclnmbo contains no tnnnin. Doubtless both cotmrt^in aud berberina
contribute to tlie remedial effects of oolumbo,

Oolumbo ia & pure bitter tonic, devoid of aetringenoy.

RoL'CIIAKUAT^ Euxm OP COLUUBO.

Take of:

(Oolumbo root, 16 grams.

(Jentian, " 16 "

Uistort, " 16 "

Cinchona lark, 16 '*

Hitter oran;;c peel, 10 "

Juiiiwr berricB, 32 "

Alcohol at 81)-, 40 "

Filtered water, 1,000 "

Hydrochloric, acid, 15 "

Mix and inaccrato a fortnight, filter and preserve for use. Dose — A
tablespoonfiil after ««ch moal.

(hiMMANDKO. By thia the Teucrinm Chamiedrys ia meant, s labiate
perennial Kuropean plant. The leaves and flowering tops are used.

This Buciriofl miiat not be coiifoundefl with tbo tfivcnnm 1llaritl^um, or
the leucnicm smrriiuni, which have somewhat difforont iiro)>ortieK

A " bitter ptiwin," common in France, is made by infusing one lionr
in H quart of boiling water two draohms of a mixture of ef)ual parts of
drienl germander leaves, leaser ccntanry tops, and worm-wood fipa. This

• tBulL de rh*r. Nov., ISth. KftW).

ft

TSKATHKXT 01' ATONIC UXSFEFSIA.

I

formiita may be rariwl ad infinitum. The iufusioiis of ^tiliau, colurnbo,
(|Biisna, aumntii m, cinchona, onecnrilln, cliinite, otc., of the V. S. Ph.
in iloees of u fluid ounce nrc all i^xcdleiit siomachir pminrntionR.

The Ijksskk <!knt*ihy (<i(!iiliuna neiitaiirium), is of tlie gentian
familv, whinb it rosembles in its gciipml [irojiortiHS.

lioPS (lIuHiuIits lupuJus), is too yrvU kiiowu to rwguiro dwBcription.
Thfl stniliilcs aru riK-dioiiiiil. Thu ikIlvu nriiu:ij>lu is nipulin. which is
Terr bitter. M>ntaiiiiiig. accord iiig to Cheviilier ami Pliveu, a vnlntiln oil,
a hitter inattor (Itiputitc), rcmn. friim.an extractive matter, a fatty mattor,
osmazomt^ malic aciti, nmlatt* of limo, and tmlta.

TliH iitit>bile« art usutl iu iiifut^ioti or duouctiou (onu oudch to the quart),
in al«))ioUc tinrturo (douo. a fluid Urachui). Thti dose d lupulin in
IKiwdvr is from 5 to ^0 grains.

C'DiccoBv (Oirhnrium intyhrs), grows in Rnrope anfl America; it ran-
tainaertraetivB matlcrs, r-hlomphyi, snpchnriiio matter, albtimiiii, and sail*.
Is a mild l«nic bitter, whioh nmy be taken in decoction or infusion, (an
OQiic<> flteepod in u pint and n half of wittur down tu a pint, uLd admiiiis-
terof] in liows of one or two iJuid ouncaH).

Iloi.Lv (lies a<(nifolium), containH, nrcording to OeloHchampjt, nn active
principle ilicine. It is used in dwooctioii (an ounce of the frroh Icbtc* to
tliP t|narl).

Ckstias (Oentiuiia lulfii), is an onwlknit popular bitter. The notivo
principle is genti'tiiin. It is ^ven in infusion, tinctun;, extract, wiuv,
etc. The C'oui]xiiind Tincture of the U. S. Pli. is a useful Btomochic in
doava of a t«a«)Hionftd )><.^fore me^ls.

The tooic pilli! of 3Io«cov are as follows:

Take of:

ilxtract of columlw. . . T

:: 5^. : : '^ 5o™«gn>„^

ox jriui, . . .J

Pul. gentian root ti.e.
For on« pill. Do«i! — One or two pilU after mcatft.

" The " Kngliiih Stomachal Decoction " contains bitter orHn|;a peel,
lemon peel, and olore*. The " Visecral Kliiirof IIolEnian" haa hitter
orange peel, cinnamon, curlxiiiate uf ikjIubIi, ^utian, wortnwoixl, bitck-
baan, cucarilla. and Spanixh wine.

Chamomili; which is not muntJoned in the text, is a v.>rvvahiahleniiid
bitter. vrhoM- coUl infusion will reiidi-T kooiI service in koiiiu VEpuj>tiu ciuii'ti.
The (ollowiiift in thu " Stomachic Powder " of th« London lloapitalu:
Take of:

Pul. rbn 1 grain.

" ginpor, 1 "

'* chamomile, 1& grains.

H. Hake one powder; to be tukou an hour before or after the priuci-
pd meaJ.

"Coxporsu Wine op Rhubarb.
Take of:

C'annlla hoirk,

Uhnharb,

Halapi vine,

Maoerato tttfother four dars, express and filter,
Pom— a tubleepoonCiil before each meal.

160

DISKASKS OF TllK tiTUUACU.

"PihVhK JitcTBcivvn; (Fteneh dinner pill).
Take of: ^'

Aloes BOcotrinfi? 3 ri.

Gxtmct i>f ciiicliona, _ . 3 lij.

Puh". (.■hinamoii, , . . . . . . 3 L

Syrup of wormwood q.ii,

M. Make into five (fmiii pills.
8ig. Take oDe pill Iwfcru uiitrh niuil.

'• VEflKTAHI.H ClIABrrOAL..

ThJBUpnjiaredwhh willow, pupiar, or liirph wood. OiTen internnllv,
it aat< according to GubStir. as & elight excitant, and an n merhnnicnl nb-
torbcnt. The carbolieni most employed is the ))opkr clu^rijiml of It^Uoc,
wbich is giTen in the dose of a dc88crt8iH»otifiil in wafwre or caiiHiiloii.

'* Van (lop V«ldfii lius unalyaed the lic|uiJn!moved from Iho stomnch
in ca»'s of pxtrcotitKiii. iiinl Ubk found it alwHrt lU'id and containiag
frot- liydroc-mori)-'. In cjuicnr of the stnrnaoh, livdroclilwrio nrid disipprnni
and doea not appear even aft^r the Inviifi^eH. This permanent dixappi-ur-
nnce of hydrocliloric acid from the ]i(|iiids removed from tlie dtoiiutch. is.
arcordin{! to Van d»'r Vuldmi. a cliuructyriitliL- sigu of L-aiiwr iuaiouijuiiiied
bj dilatjtlion of the Btomaoh.*

" Perli emplovwl fanidiTution of the iitomacli at the same timeaii Uva^
in cases of chronic catarrh and dilatntton of that organ, nsing the Rtomnch
pump for that purpOM.-. Tliv muuiij^ of at)p]icution was u )<uuiid tvrniina-
tiiig at itM distill (^xtriunity in ii. metallii; uidhoiiti tioiiit. wliiolt vthk con-
tituioii») with !* conductor ptuwing through tlxi middlu of tho aound, und
in c-ommuniculioH with tho bnttorv. I't'Hi notwl that he obtained very
cni-r^Hic contraetionH of thy stomach wtn'ii the ext«fnial coiiHui'tor waa
|)liu?i:-d at the h^-ight of the ninth dor»i] vortobni, a little to thu left of tbu
vortobral column.'

Hocci hn^ also made nxperimenta on the dirocb eloctrization of ths
etomach. He mado hkp also of a Tanidir ma^hinp.

Kardot in hia I'Irctrntherapic aerviro iif tho ('whin Hospital, hiui utted
with BiK-cfdH thu upjiurututi di.-6oribed in tliu t«xt in acvuml oueus of dilatu-
tion with vomiting.^

" Against curtuiii dilatations of tho stomach which Chomel dGScribed
nuder tlie name of dyepepeia of liquids, ho rocommendcd a di'T diet, cou-
etBtiii^ in the Hiitipret^iou of drinkn, Iluchani ban adopted ttiese virrws,
and has Khown all tlm a 1 vantHgcB accruing from abntinence from liquids
in ctTtiiin dilatations of tho ttomach.^

• Van der Velden. tiaatrectuajr and its Relation to the Presence op Absence
of Five U^^drochloric Acid In tho GiMtric Juice. Deiibiuti. Arch. fOr Klin. Mi^d.,
XXIII.. 4.

t Bardet, Bull. G«n. de Th6r.. IHiM, t. c\i., p. H30. P*rli, 13 Morgaffni, May,
1879. Bocct, T^n fl|i(>n mental «, June, 1^1.

X Hxxciuird. On the Dry Diet Trmlin^nt nf DiHeases ot tlie Stomach, aud Gnpe-
dally »f the Dy»iw|wiii «f Liquids. (Bull. G*i>, do Th6i-, , Atijr- SUt^ law, p. 145.)

LECTURE XI

TREATMENT OF VOMITING.

Stunmarr — Vomiting — r><'finitioii — CftH0c? — Pictctic TreatmpTi t^fSon-
«i»] Meanii — Potions of Rivit'^ra — Plaster of Diachylon — Of Therijic —
OF Opium — Hydrate of Chloral in Sea-Hickneas, and " Lnnd-SicknoaB"
— Injections of Mnrphine — Vomiting of Pregnancy — Employment of
Aloobol— Of Pcpgin— or Tinrtnrfl of Iodine — Of Creosote — Etlwr
Spr»y — Tobftcco Smokinp — Nt>n'ouB Vomiting — Ilyilrothfinipjf —
Bromide of Putatwliim — Vomiting Diu* to I^sioui of tha Kidney^^—
Of thf Lungs — Vomitings of the Phthisicjil.

Vv DBR tho head of atonic dyapepsin, we have studied the coMcqucncoB
of enf«'bl«m«?nt of the coulmclik* powor of liie muac-ular (loat of the
etomiich; we are now to connider snotlipr mniJifi cation fttTwting thw mu9-
cntar inTestment, att«nd(<»I nith tMTTcr»t()n ami usaj^ralion of it« morn-
nents; phonorucna wbicU nmiiifv^ tla-msvlvce by the rvj\:c'tiou vt uliineu*
t*nf wuitt«ra contjiined in the etomuL-h. And KJnci.' we are f reijuently to
neut Lhis srmptotn in tliu uoud^l' of tli(>8t' Klndit«. permit niu here, in a
gonetml manner, to disoius tho thcrape iitics of vomiting. Do not think,
ronreoTer, that in doing this [ am digrrssing from mv mitijert. I^even
ha" in fact snid tliat vomitinj* never takes pince in a hwilthy 8tonia<rh, hut
that, apart (ram tosin ami other irritanl cmuseH, it i« iilwn\-3 dnc to dyg-
pepsift of more or le»« long (Standing. Although this o]>in{on, tuVen ax a
wbole, may aeem a little exaggerated, it neverthelees applies to a greiit
many caece of vomiting.

Vomiting, you know, is rhameterixfid hy tho sudden expulHion of mth-
■tnMSOB nontainud in the stomaeh. rpsulting not only from the nbnnrmnl
and exaggerated contraetioux of the muscular cout. hut aUo, and espin:!-
ally, from tho eimnltaneouB mntrnciions of the diaphragm and muiwlus
of the abdomen, the whole eon«tituting a true reflox Act, which may have
ita point of do|«irture in variuble rvgion« of thoeeonomy. '

In thin definition of vomiting, I have assigned the important part to

tho atomach and the coiitrnctions of the abdominal muKcle«. This is a

view which I am well aware ia not ado|ited hy all the phytiiologisrta, and

when yon consalt tho writinps of Bayle. J*chwHrt7, llnnter, and oBpociiUly

ihimi nf Ma^>ndi«, you will Hi>e that thoet; authorities a«mbe but a secon-

dary r6le to the idomueh. At tho same time, on reading attentively theM

nentoln, vou will obHerve that the i-X|>eriui(.'UUU rewarclit-e which have
11

162

DISKAglK OF THE STOMACIT.

been muU« ehoyr oiJf this: that wben tlie etomacli U remoyed ixcm tke
iiifiHonp« of tlio iil»ioiiiiiiiil iiiuselejt mid diaj>limgin, vomiting doe» not tak*
pliic!e; hut tliis iu no reanoti fur denpng to the muiitukr coat of the
stomach nil [jurtioiiintioii in thi* ordinary act of vomiting.

SchiS nhowH, on the ooiitmry, that tho etomach takes an ncliT» jHirt
in vomiting, ttiat undor «<rt«in circiimHlAiices tho iionniil moronKints of
the nnisouliir coat of tlie stomacli, wliich imhituftlly take jilace from left
to riglit, that is to suy. from Uif gwitt tnlteroaity towunl tho jtylonis, inaj
l-ako |>1acu in an opiKieitt; diraction, and forc« tho oontfinta of the stomach
from the pylorua touiird tho curdiu.

If we quit tho domain of phyBolngy for that of eliniisd exjiericnoe,
wo Bliall find indubitable evidence th:it tho stomiich by its mucuus and
muscular cuut, plays uu impurtiuit jiurt in tho niuthaniam of vcimiUiig.
and tbnt in this complex act tlio al>dorainsI preasnro is far from being tlio
only factor. Jlcro, for instanw, nro two ])ati(Mii«; tlio oiio has a very
«ovoiv hrouchitiK, witb iiiffi!8»int fit"* of coughing, and ypt, despite nil these
paroxysmal eflfurta of the thoracic and iiixlomiiiul musclwt, hi' does not
vurnit; by bii< side- isii phthiiticul {mtientr who hue but tvw Itttt of uough-
ing, and yet whenever th« cough comes on, ho vomits his food. How do
you explain tliis diffeiM'nee? In tho ease of the one the functions of tlio
niuficular a.nd muixiUH coats of tho Htomach ara intact, while in tlio othttr
the oxiHtiiig djtiiiupeia uxpluius tliu CoviUty of thu vomiting uudt-r Itic luuob
proaturc of the sbdoniinul muaclee.

RcfCttll to your niindii that ourioaa, almost uiiiquo, casts wliiuh you
oliserveil in this hoBpiUil in No. IS, ward St. lAzare. I refer to a certain
pitienL who, with the iiitt-ulion of Knicide. had swallowed a i-Hustic liquid;
you I'cmembcr tliatttie autopsy of tliis patient sltontd uaaltm>et the eutiru
stomach— nnicouB and mu«;u]»r coats — tranaforraod into a vast cechar;
and (or ciglit days lit' lived tlitis, drinking n great quantity of milk, tuid
without once vomiting in all this time, llcre tUf tninsformation of the
walla of the Btomach into a uon-contnictile and inseiiHihlo oschar BufE-
cicntly explained tlie alwence of tho vomiting.'

'WhUe, therefore. I am fn^e to admit in oxplaiiation of the niouhaniam
of vomiting, the preponderant rok assigneil to the contmetiong of the
abdominal muscles. 1 must also insist tluit the muscular ami mucous coats
of the eloniiioli have an important part, and Umt purfect integrity ut the
functions of thfse menibranoa is antiigonijtio to tho act of vomiting.

] have said that the reflex ael, whieti in called vomiting, liaa for its
lK)int of departure variable regions of the eo-ononiy. TVe will now examine
int<j these different sorts of vomiting, and the treatment wliieh shoidd bo
opposed to Ihem. It socnw to me mutt advaiitugeous to give you, tjrst of
all, the genera] therapeuticR of vomiting, applieiihle nn they are to noarly
all c&eee, and to reserve for a apeciul duscripliou thu remedial nu'Hnis
necessitated by the difterent varieties of vomiting.

VOMITTXO.

An important plare must Wrrt lit- giron to dM-trtics. Kxpcrieiitre liaa
dcmoiiBtnitcU the vflicocv of iced driuks, cilervcsctint watcra. and alwti-
nenw from all food, whether ijolid or liquid. Recominttmi the emplny-
menL of a mixture of milk with iL'eaii<lst<ltEL>r-watpr, which may lie sucked
in smaJl quantities through n straw iir pipette. With these means jou
can aBOciaio internikl mul cxtcnial mvdioiitioii.

Among the phnnnaoenti<'al me»iia we hare first the potion of HiTi(>re^
wliieh liearii a markcil rt»L>mb!an(Xi to the minium v^^ertesa^vn of the TTuitwl
Staiw Phamiacojwta. This ]K>tion, hh 3'ou know, eonsisti^ of tu'O pnrt&
There is No. 1, which i» alkaline, and No. ". which is acid. Ton gire
the patient tiret ft toWcBpoonfuI of the lUkaline solution, and immediatoly
follnv it by the nime quantity of tlie acid potion." Then oomn tlie prepn-
rations of opium mid betladonna, and hero you may advaiitjigeouidy avail
Toarselvcs of the hypodeiTnic metho<l for the introduplion of morphine
and atropine. Medicinal lavciueuts have been rcL-otumendcd, hut it must
l>e confCMod that OiU method generally faiU, on account of the effons of
Turniting not permitting tliese lavemyntsto he retained; you tan, however,
Qtilizi* the rectum for todt opium and hella^lonna Biippositories, which are
better retained.

To this treatment, you may odd the nae nf plaJttr'n), »pplio(i to the
ifpttffigtriB r^on. Oneneau de Mn»Hy luia lung insistinl uu the )i:ippy
nMiilts wluch nkuy ho obt-aiued from the employment of thii« means in
obstinate romitings.' You can make use of the diachylon plaster with or
withont belladonna; the cmpUetrum thoriacjc. or the opium plortcr, all
niay render yon Ber^iee. Finally, with Hlill greater proa|>«:t of benefiting
TOOT pBtiMit, TOu may resort to revulsive* applied over the Blomach, Buch
■a nnaptBDiB, resicatoi-ies, and the cautery.

Soch, gentlemen, are the general means to employ in the treatment of
Tonitiag. from wha.tpver cauBK" it may arise. Irft us now take up the
oaaaideration of certain Biweies of voaiiting.

We liave, first of all, dj-sitepniii with vomiting predominant. In tacit

certain iwrmiis vomit with a stmiige racilily; the least error in diet, a

Uttl»t food bmlly borne, too strong a uraell, oxcreiaR a little too energetic,

ftkevn emotion — all this, in these [Hitientj;, manifests ileelf by vomiting.

As tLe n.-j«.Ttiun of food is » corumon symptom in all forms of d^'spepsia,

Joo will have, firat of all. to comlmt, by apprnprinte means, the dysiwiwia;

then roB will bo abb to employ against the vomiting the diffen-ntplurma-

MotiGal means which [ have jitiitonumRrat^v]. R\'pnRnlphit« of wxltuii^

Mil alicylate of widiuni, have also lieen reeomniended to enmlMit certain

^JodaoIaddTomiling.wheru one often mccl« a peculiar alga, which Uoo(U

^*aB the first to find, thu Kiiirintt-ivnfricHfi. These HubatancM have

f* Uioir end to deetroy IIk-ac panuit^e, whoM intimate action in the

i^odnotion of vomiting, despitt> thu researchus of U'indmQIler, in tar from

'■fc'iBK cluirly dofiiitnl.'

164

DISKASSa OF THE STU>L.IC11.

Aa for (lircctious respectiiiK dii't, much judgment \s required in ihv
Bcleotiou of the proper food, and you wilt gften have to be guided ratlivr
by thp caprifw or idiosyncmsk-s of tin* pntioat tli«ti by the most cJirefuUy
fomiulstpd Eetentida coni<tdi>ratinn!i; for nothing ib more strange mkI tin-
accountalle than tSw way difltrent persoiw aw affected by different ali.
mcnta — one who, for instance, vomits eiibstanceB the most digestibk', will
oft«n tolerate without inconrcnionco eubetoncce that are really indigestible;

Then we have n partieuliir condition in which vomiting plays an im-
portant part, a ooadition which is teniponuy, hut which may he the cniiw
of more or lees serious evils — I idlude to w«-«ickucsa. Although wc are
ignorant of tli© primary cause of theae vomitings, a cause which is witli-
ont ilouht ni«Itiiil(^. and in wliieh w« have the iufluonco of eight, etnull,
and m(xlilieatioiiK jirodufFd in the equilthriuni of the nlKloniinal viscera,
it is ncrcrthclcss a form of etckneiw which ia very common, and which
erery physician will be ohligcd to trenc.

It hue been rocommoudcd to eupport tlie abdominal pariotcs by a brood
bandage, whose object ib to prevent the displacement of the intcetinal
mass: 1 tliluk that xmall results must follov Ibis means.

Ajiother mode of treatment lias been scientifically tested; I refer to
the chloral treatment. Oiraldes waa the first to recommend this mode
of managing sca-^ickiioiw: after trying it on himself, ho aiioptert a hint
fltiich he obtained from Pritehard in the liondon Lane*i. Being calleil
to England on business, and having stifftrcd in all bis previoas vayagen
from proti-acted vomiting's, he took a draught of chloral, and hud no
more vomiting. Since then this practico lias become general, and the
pbysic'iuiiB of the Transatlantic Company anti the navy surgi'ons derivw
gi-p;it benefit from the chloral treatment of sea-xicknt^Mi. The ehloral ix
taken at the moment of the departure, the dose, which may b« given in
potion or in eyrup, being from 10 to 45 grains. If the jjatieut Buffers
from ibirst, you eun lulvli^ him to drink iced champagm', which U alxo
indicated to combat the vomiting.*

Dr. (iaripuy has alw employed the some treatment in cases of bind-
sickucus; I refer to that vertigo uilJ those attacks of vomiting which some
persons experience when they are rabjected to any trembling movemout,
whether of onrriagoB or railroad cars.

Yon can al»o use in spa-sicknesH another means which has given gooul
reauUs: ] rt-fcr to injections uf nmrpliine. The IJaron of Thereaopolis is
one of the strongest iKlvociitos of this mode of treatment, and ho cites a
great number of obHervationa where these injection? hare cnn»ed die-
appearance of all the grave incidpntscanRcd hy Ht-a-sickneaa. Dr. Philippe
Vincent also eoinmcnd.t these injections in wa-Bickui'Ss.'

You ehoutd he very Kparing in thu use of theae injections, and watch
attentively their effects. Morphine, in fact, delerminoa of itself in ar»im>
purtious fiyvero and prolonged vomiting. In those caara where the injeo-

rBEATME>T OF VOMtTINO.

165

tions of tnoq>hine itro badly supported, you cuii Eomotimi^s lulvanLKgcoiuly
nuko UM of the mixture oi vhicU I liaT« spoken to you bpforo, and in
which atropinf ifi combmoil willi tlie morphiuo. It is eajjecUlly in Ibuse
roDuliiigu wliicli huve for jioint of (lepartiin? nn inteiiiw paiu, whether ia
Uie stooiach or in some other orga,n nf tlic abdominal cavity, that you irill
dcrirc benefit fmm tbc-^ iujoctiona of morpluuu uud utropiiia

Atnoi)^ the orgiina which hiive a dirwrt iufluetice in (iiiusing vomiting,
the TttoruR is pre-wmiiieut, ami wo si-o cui-taiu piL'triltw, cwrlain uterine
oougvrations aiid ulceratione, ncconiiianicd by this symptom; but it is
(mncipally in pregnancy that theao vomitings iiro, bo to s^teak, the rule.

TiiiB \oiniting ia more likoly to sntK-rvoiie duriiifj tbo first four montlia
of gvstation. It is an inconvenient and painful sj'inptoni for which Iho
{Ayrician is often consulted^ but which hnx ordinarily littlo gnirity.
Botnetimtai, howcvor. this morning sickncia wquircit a formidnblt; intensity
and persisttfucy. ftnd one fitide him^'lf iu pi-vsoiice of incot'ivible vomitiugSi
which if not cotnbat«d in time t>y an ener^tic raedioation, and oven by
the intorvi-riEion of tho ftocom-lienr, may oiid in dontli.

It in d<>sirab1«, thtm. that tho phyKitrian nhall harp at hand powerful
tbentpeutio mt»ns to combat these vomitiiig»; and, without going further
into the aabject, whioh would require for ita complete treatment detAils
vhich you will find in the »]H>cial trcatiAos and t«xt-books of obstotno;, I
ahall set fortli the different measnires to which yon may advantjigeuusly
nwort. Heru cverj'thing baa been tried, everything luu su'x-eedvd. and
evafythinf; baa failed; huneu tlie list of n^medice id a lour; one.

In the first rank, we liitve the alcohols, wliich Ilonchardnt hivs vanntod,
and which are in common use in the troiitment of the vomitings of prof^-
naney. I haT» uren seen pregnant women whfi Iwfore hiul a grwit repug-
nnnee to spiritnous Iif|uoi-8, not only bear them well during thi^ [leriiKl,
but creQ long for them. And here, gentiemcu, it is jost tliose aloohoU
which are tho strongest whicli give the be«t rtwults. You will thou pro-
Berilw whisky, rum, cognac, and especially the elixir of Grande Thar-
tmiflu,* vhich may bo taken in the dose of a few drops on a lump of
sugar.

By thfi nde of thcso remclial meamrvs yott have a modloinient whioh
alao gives good resiilta, and wliLeb our regretted friend, Dr. Oroe, loujf
■go rooommMidcd: pepsin given in the dotie of from & to 10 gmins haa
Bomctimva aireetod the mnet otjstiniite vomitingH.

You may aUo niuko triaU of Liuwgue'e reim-ily, who was in the Imliit
nf ordering in thfloo ouaa tinetnm nf iodine in the dooe of from five to ten
drops in a little twoetoned M-atur. In a recent iliesis. Dr. Olli Itiu shown
that this remedy may be Iienefieially tried in all forma of dvitpeKpia with
vomiting. In England they employ cmoHote, vhich, since the labora of

DI8EASKS OF THE STOMACH.

Bouehnid nntl Gimbord, hiifl boeii very mucji given in pulmonary com-
jilaiiitSj lutil niiiy IjeailminisUired in wine or capetiles mixecl with oiL It
is a mudiuiuu wiiiub mu}' hv Bonictiintw mlrantiig:(K)U»lj trict].

You may also liare recouree to a moa^ure which luu! j^i?Dn me some
sucMH'SB, und whiuh has bi^nm rGcummeiuled by Lubloskj, of VarsMnna,
Thin physician, who bad previously published suvfni] momoira on pulvcri-
zatioiiB of uUior, aiiJ abown thtt adYnntagcs which might lie derived there-
frcini iu clirouic ufTiTclions, lius cuuL-hiBivdy showa tJuit tho aiiuiL- method
may jfire good evrvico in Tomiting from whati-ver cause.' With a hand
atouiizcr, Uko that of KiebawliKMi, for iiistaucu, you ww spray the region
of the stoninch with ether for three or four minutes, and then make Uio
patient cut a little food..

In tho case- of otic of my patients who had almost inccsautt vmoiaa, I
obtained by tlue meaiii; a iiuLabk' lUmiuution in the number of vomiting?.
TliL-M' piilvuriziktioiui aro altoiidiMl with no iiicunYvuivnce. Cvrtuhi
Spimiwli physicians, aiid in partirtilur Giilccran and Rodrignes Mondez,
liavc luiiployud theuf tq)ru>^ with BiidscBa.

There is another simple exp^xlient ailviaod by Gro«, namely, tobacco
uinoking. Huviiig runiarkvd that ouu of liis lady [Mitieiits, who waa preg-
nant and suftered from hicnercibh> vomitings, experienced marked relief
whv-ii in a room tliat waa full of tobi^co smoko, tho k\^}a EUggeeted it«*e]f
to him of reoommeiidijig tlu« pftUuut to smokv; Bho did no, and her
vomiting entirely ceased.

Mak« utie, then, of all tho moans that I have indicated; add injections
of morphine, lavement** of chloml, inhalations of oxygen, whicli Ilayem
tonsidenj as unc of the best niDiedifs in dyspupHia with vomiting, and
which ]*inard liaa ajipliod to the treatment of the vomiting of pregnancy;
resort also tu " gavage," Soraetimea you will attain your end, at others
you will fail, and yon will then be obliged to have recourse to diklatiouB
of the nock of the womb, (m^ested recently, or to promature delivery,
which oh^tctriciaiu liavo uQaiumously ccnaenteii to employ if medicinal
means fail.

By the «ide of llieso vomitings of prugiiauey, 1 must plaiw tlio«« which
hysteria determinee, and which, like the proc^iing, arc Rbaraot«ri8ed by
H perifititenry which often deftee all therapeutic meaus.

A}ir»pm of tbcse hyRtcrioal vomitings, I must make a diatinclinn. Id
certain neuro]>athii: patientH you will «».■« supL-rvone voritabtu oriKcs of
vomiting and gastralgia, and for months the jKitient will tolerate hardly
any food; then the ga«tric form dimppoars, to f^ve place to othi-r nurvoiis
troubles. Notliing in the examination of the patient will rev«il to you
the cause of these vomitings. Tho nterin© functions are well perforroodj
the urine i« ftl)un<iant and voided witliont diffienlty. and one rein invoke
in explanation of these disonlers only tlu; nervims xtittL- lo whose influence
the piiticnt is subjected; thia Ib the so-calted nervous vomiting, to which

I shall hATo occwion ognin to return when I coiiio to the treatment of
hjsU'riu.*

AgBiniit tlipue voniitinfre.wliich Iwlong to the groups of afFcctious wbidi
Hucliajil liaa very hapjnlj rhiinMiterbeiJ bj the tiatnu of gastric hysteria,
yoD can employ tvo orders of nmodicB which have given mc exocUont
remits, namoty " Ranigu " (or furcwl ftM'iHii;f) and oltM-tru-ity.

It is Mpecially ui hyatt<rkiil {luLiunls u1Tih;U>(1 wilb HpuKtucxlic troiihleu
of the pharynx and oesophagus, tliut the method of "gai^ttfEe" succcods;
and & pati<>nt «ho is in the habit of vomiting idl her food immediately
afUr its inpjfrtion. finde thiU these vomitings cease whtm the food is iii-
troducud by the Rtomach-tnhc. You inay i>iii|]loy as it imtrifTit tho meat-
powder and milk before epoken nf; you ran also jiroctsdc earh " gavage "
by a lanigo. 1 have by this method obtuinod irsulta whicti wore truly
narrcllone, racb oa Charcot liiid (.^ootfroy hiive also obtiilncd. itut in
other iwaos this metliod becomtw iuauflic-ient, and nolwithstuiidiiig the
garage the patient vomits Htill; it ib then that recouree should be ttad to
dectricity.

It is tc ApoetoU that wo ore indcbt«d for tho nil«« of the oloctrical troat-
mcnt of vomiting, ami yon atten have eeen him in my hospital apply his
methtNl with iuwoiw. TliiK method (-onsixtH in the [)ogitive polar gutvani-
iBtion of tlie right pneumogaefric. The positive eleotrode is placed just
outside of the inner extremity of the clavicle, in the point marked by llie
deprewioa caawd by the interval between t.)ie two inferior fcutcJouUited
origins of the Ktemo-mastoid muiwte; this electrode, wliich is moiiitened,
Bbould be of nnall dimension; the negative electrode it) held in the hand
of tlie patient. The battery which iti tisod is that of naifFo, with "col-
l«rtor,'' and the quantity of electricity employetl vnrieB between ten and
twenty miltiamp/Teo.' As for the dumlion of the sf'anue, it is very varia-
ble, and one ought not to t-wAge thu iipplieation of the electricity till tlie
patienit« find their senaations of si»sni and vomiting gone."

You may aleo employ dii-cct elccttiKation of the Btonmch with the
mppamtuii of Rnnlct. You will follnw hfre the ennm proeetlure as tlwt
whieh I described to you in a preTioMKclmplur under ihe head of dilatation
of the nomach; only it '\» the positive pole whii^h nuist be placed inside
of the eiomach, tho negative electrode being applied over the walls of the
abdomen. Moreovor, it is tho conRtnnt cnrrcnt which you will nw>, and
not the iutemipted.

To fon-*<l feeding and to electricity yon may join the use of prolonged

bs, which aometimea enrceed, m Ferrand and Panehex hare shnwn.f —

I duration of these baths isfrom throe to eight lioiirs, and tho tumpcm-
tore from 68 to 8:2 F. In other casoH, vomiting in tho hystorical is Hymji-

'ClininJ T>icr)(m.-.ilic7.. O. S. Davis, Eil. pugw )(M.

tIkUK-lK!Z. I'rtilonk'iMl ItiLtlis in (iustric Uyrteria. Bull, de Tli^r t. rvi., p. SS9.

ItiH

DISBASES or THE STOMACH.

tomiitk; r>f another patbolr^iml condition; the nrine is not sc-cretiH], anil
tliis liyatvrioal anuria, wtiicli Cbareot Ims mentioned, and of which Foniet,
.luvontin, and Socoaot hiive giron examples, is aoeompanicil with more or
li'H!4 nltunrlMit vomitings, in which iircm in vitriable (jnantity is found.
'I'hfM; vomitings resemble thoia* of urinoua dyapcpsiu. The lattcT is, in
fiiict, abiiosl alwars a dyspepsia with romitiii^. and it rceulta from a dam-
aged stAt«of the kidneys. As soon, as these glands cetidc to perform their
fuiictiang,tiic urcA mut oxcromentitiooe nmtleni of the urine, rotninod in
tlie bloocl, seek eliiinnation by the intestinefi or hy the Ktoinach. The
patient urinates, aa it is said, by his gtoinueh. aud this it la which explikins
the frequency of the vomitings wliich accompany the nephrites, and in
jiarticular intoratitiiil nephritis. The treatment ought here, of course, to
be cljfferent; ws are not wi much concerned with corabatiiig the Tomitiiig
us in restoring the sterotion of tho kiJnoya by the exhibition of ^uitablo
diuretics, and when medical moans fail, you will find yourselves powcrleas
to arrert these Tomitings, which eapply the place of a function which is
no longer performed.

In patientH affected with nrinnry eomplainta, who incompletely empty
th«ir bladder, you will often Becattaekti of vomiting supervene, and it is
one of the nioat common signs of the digestive trouble wMch, afflict* thi»
class of invftlide." TLomi vomitings areof a very ]>emi»tont idiamcter, are
oiU-n even provoke<l and iiugmented by all attempts to interfere with or
control them, becoming alwohitely inroercible.

In pulmoiuiry sfTectioiis, vuiuitiiig is un incident which in sonietimes
fellewed by grave conaoquencoe by preventing alimentation. This is what
hapi^enii in vuuiig cbUdruii, in whom tliu mecbanicnl ttet of vomiting ix so
easy. The convulsive cotiph of pertmuis provokcR vomiting, which if the
paroxj-smH are often repeivtetl, may be bo frwjueut that ulimciitalion can no
longer go on: tlie patient wastes away, and may succumb to an intercurrent
diHeiiBo, fB<rilitattid by the gradually Increiuiing debility. This condition in
j>erlus8oiil [Wtiout* demands carefnl attention. The little patient must lie
fed froci«entily, in small fiuantitics, and is MimetimcH beneflted by wpB of
strong eolTee, cognac, or Eome Dthvr alcoholic titimtitant which promotee
digestion; foods should be given which an- rapidly and easily digoetod,

Fhlbisis in the first sttige give* rise to vomitings which are more or
leas fre^juent.. In lii» theaiit, Pr. Vnrda, of Smyrna, one of my piipila.
has Mhown that thcac voiiiitingB are due to Bcvernl causfs, the princijHkl
of wliich are the dyspepeias, the intensity of the cough, comproasion of
the pnaiinidgastric nerve, etc."

But whatever may be the instigating cause of gnstrir treublea in
thv pUthisi<:al, they iirc IribuUry to one uud the sitnie medication,
namely, to "gavage." In fact, by a circumstance the physiological ex-
jilaiiiition of which i» lacking, while fooil« intrnduecd by the month ure
vomited, those which are ronreyed to the otomach by the ilexible tube are

well tolmitwl; and when I come to speak of the treatmont of pbtliifiuj, I
will show jrou nil tho honeflts which yon may derivo from TVlwve'n method.

Ai to vomitings due to norpbral affrctions, if from ii clinira.1 point of
Tiewth(»y pruwrit * great importiiiice, tbuy have littlu int-iTest tbun»|)euti-
colly. onlesB from the fact thut then is so little that cun ht> done to
feiioire them.

Finally, gentlemen, do not forget that there are certain obrtltmte
vomitings which may be cared by tho simplt' U'pplt'tMtioii of n trim; this
is the CMC with Tomitinfts caused by certain hernias, either of the etomoch
or omentum, ami which aometimeB protrudi' through Um liuwi alba over
the gastric region, and may become irreducible.

Socb, gentlemen, arc thf uousidiimtitmB which I di-aire to preaent
respecting the therapeutics of roniiting. I have dwelt e«[])(;cially oti
certain aapecta which you will bo moat oftou culled upon U) treat In th«
next chapter we Hball etndy tho neuroses of tho stomach.

NOTES TO LECTURE XL

' Blany eontrudietory opinions have been put forth concerning vomit-
ing, and QUoy tboories' have been proposed to explain tlie niechaiti^iii of
tbui phvriomenon.

\ limiting was first ntl.nbiitj«l tn gptwrnodic eontnictioiis of tho eloiiiacb,
then Baylc (in lfiSI)nii(i CMm<? (in HI.si>) referred it to contrnctioiia of
muscles of tlin atidumi^ii. Hchwitrtz ailvunvcd tho NimB vii>vr, and Hlinwed
that if tW stomarb liim coMtnicttiMin tht-w arc not ncci-iwary for vomiting,
wbirh, nionvivpr, never taki-a pluco when the Htomwh is M'purated from
itA rvlatiom* to its abdominal walls. Hnllor also iidmits tho r61# of tlio
alMlominul intiscloB and of the diiiphnif^iii, but thinks lluit the aiiti-
peristaltic movumenta of tho stcnitich may iionii-tiiiR's snllice tu (•ITet't
tomiting. According to Hunter, the act of vomiting is accomplished
«ntin.dyl)y the diaphrag'm and nbfiomimil miiaclw, and it is not oeceasaiy
that llip irtomach «honld nartimiata in the a<'t.

In 1813. Magendie nndcrtnoK a wriPR of experimentfl, and showwl that
Tomitine in due, not to the b-toninch, but to the action of the diaphragm
and alxiominnl miiHcIci. When, in fact, the diaphragm H paralyzed, the
Tomiting in fiwhly perforniiHl, but hIlII taket> plm'o, owing to comprvniou
of tho nbdominni mnsclee; it doe? not. however. lftkt> plane vruvn tlie
nlidoniinal walla are remOTcd. Kv|ttueiii;; i!ib ^Irlnlnch of- a dng by a bog's
hlodiler adapted t« tho lower imrt of the cHOuidiagus. MageniTie injected
into the veins of tho animal tjiilar emetio. ami the coiittniU of this new
stomnrh were abortly es]Hdled hv I'oiitniction of the ab>loniinul walls.

'Ilie eiporimeata of Magcndie. c-onfiniied by tliosc of LegHttoia and
Ueolnrd. were attaol(«>d by Muitigault and Courdoii, who asiigned the
irihcipal rdle to the stomach.

iwitini repenting these cxperimcnt«, has shown that if inntcad of

lulajitinf; the Yiog'st bladder to the tlif;;e«tire tubo abow the canlia, it U
a.(liiptc<.l below, vomiting tloM not tnkeplu««; it isinconsoquunce nocK^esorr
to luiiiiit It cnrtuiii uctiifii due to tliid portion of thu etonutcb.

Acmniiiij^ t(> Builgu (li^4U) it b tliu routraction of thi< dmuhnigm and
abdoniiniU musL-k-a tlmt pmvoktw voinitiiii;. But tills uc>t isBUletl hy the
sutiden contraction of the iivhirnH; tho pyloric rthoclc being commnnicated
from riglit to left to th« coiitcnts of the Btomnch.

Itnhlo HI IX&T animiK ilinC at the moiiiont of TOmiting there is nu
jiscfiit of tho cardiac i>ortioii ol tht; rtoroiK^h; tht> movcinenUi of the
sloinnrh lire KXrciitiitual!, and the |hh«suit exerted !iy the iibduminal mus-
tlnji imd t\\e diiiphnigm lit xuflieieiit to ovemnme the rc«ist&nce of the
ciirdin. Accordinp to SeldfT, tlie cnrdiii opvn^ hy the active contrftction
of tliu longitudiiiul tibnrii jirocct^tdiii^r fnjiii tlir ()'HU|di:i^iiK. uiid whiidi
dihito thut orllicQ even before the HlHlomiiiHl |>res)(uro comeit into ]ilHy. at
the moment of nant!i.'a. ilr, I'atry of St. Mauritiua, on exuTiiiniiig n young
mini who had bei-n (.-Tieccnited by a bull, obecn'wl tiiat during vomiting
tbu stomach contracti-d vinlbU'. but uot enough to exjiel ite contents: tlic
u«o{iliau;uH i>tiiitnict4<d inoii* utrongly, inid at tti« momont of vomiting,
th(> (Ariiia opened to lot the vomitivl matti^rs o^cape. Vulpian liae hIm
oba«rv«iI in a Btomach remored Ernm tJip abdomen, and n-parutod from
the inflnpnce nf the diapbraBm and alidnminni miini'les, qnite i>trong con-
tntctifiiw, going from thu nyiome tii tho ciirdia.

.-VrnuziiH uud Fnmck liuvv studied the Blato of tho thoracic ttnd ab-
dominal prL'sHuro during vomiting; tliev Imvc pointwl mit two diiituK-t
phiiHGS in vomiting; in the first tliere i» a eories of njBpiratioiiB, whinh
tend to equal the a-bdomitiftl prcesiire without exceeding it; in the «econd
tlui thoracic prot<8un' uqiials the abdominal; it is to ttiis \Aiajn- tiint thu
iixpulaivn fflorts fiirrnMiioiKL Aocording to tbesn experimuntur*. tbo
vumitod inattiTs I'wiipo the oardiii during the period of tlioiucic tmpirution.

According to these Tariona osperinients, one may jmlgp what is the in-
fliiencfl re-Rpet^ lively of the stomwrh, of tho (eflonhagus, of tho diaphragm,
and tho abnominai' mnaclefi, in tho act of vomiting.*

' Tho case was reported to the Medical Society of the Hospitals, Nov.
9, 1877, by tho int*^r]le of St. Antoine Uoi^fiitiil. The |«iti<^'iit was a man
forty-Huvun y<^*ara of ago, who, with tliti intvut to commit suicide, dnink
the cuutenta of li vial full of !l cfl.ut(tic litjuld; (naturo of the caustii.- not
determined), Fie eutt^rud Oct. lU. ISTti, and died euddtmly the -itb.,
supporting without vomiting the daily large rftinntitics of milk which were
given him for bin nourishment. At tbn jnitn[isy tho stomach was found
in nimost ite entirety transformed into mi fafbar, bo that Bcarccly any
wall of setKimtion could be mid to uxiat butwuen thu etotntich and the
viscera in itK immediate vicinity.

• Bayle. nitwiTtjitioDK. Tmilimse. IBSl, Cliirat-, An AaatiiuUtuI Hx|ii^i itirnl Con-
<.-<eminff Uil- Niiliiro of Vomiting. ICWJ. Sehwartz, Inaiig. Dioirrtations Contuinini;
Oljeer^'nllotiBonVomilinK, J. nimttr, Reriiurlis on DigmUun. Mn^piiiJii^ Mvmuir
on Vumltin^, IStS. Legnlloisonil Beclani, Ex|>ei'iineiite on Vutuiting. noiirduii.
Memoir on Voniilinff, IHI9, lioslan. Memoir on Vomitiug. Budge, On U.»j
Met^banhmol Voinitinp. Bonn. I8*a Putry (Dull, dc I'Aciwl. ile iUti.. IfitW-lHtttJ).
Si'JiilT, [.i-KMiitisc on tin- i'liyitiiilitny of Di^t^iiUon. IHGt. Longet, PI ijsiology. VuU
\Aatx, Lectunw on Vimiitin*;. Eculf dp MW«diw», IHli. Ln^udcr Bmuluii, Ou tiio
PbynioluK.v i>f Vuiigiiin^' < Pi-waiiioaer, 1ST4). Arnoziui and Pranck. Ou Voniitin^.
<Soc d» Bio3, S>i-»uc«, April 9, mitt.)

TKKAT.MKNT OF VOMHINO.

171

* Potion of Bivii-re (FroDch codex.)

No. 1. Alkallsb Potion.
Tdt«of:
Bic«rbonat« of potaeeiuDij .... 2 gmmmcc.
Common vaUir, . . . . . .50 "

Syrup 15 •*

Mix.

No. 3. Acid ronOM,
Tokf of:

Citrif-- or (tartaric) acid, .... 3 grammee:

Common water, 60 "

Synip limoiium 50 *'

Mix.' A uililf-;j»ooiiful of Na 1, mav be taken br the patient &nA thi«
followed imm«lial4>ly by n tablcBpoonfiil of \o. 2; ilio liqiiidn combining
in th« Htomacli. Or tliiey nmy \)e first mixed in a cup uiiu druuk during
ffPeirescence.

■ Qneneftu do Muiuy^'H pluatur oonsists of two f»rt« eaeli of diaohylon and
UieriACA (a French prepamtion containing opium), and one of extract of
Iwlludouna. Clin. JIM., t. I.. 1874, p. 'iao, [The emplafltnim bella-
doiitue. or till) «inpliuilrum opii of the V. S. P}i. in which the ertractft
are inciorporated with Burgundy pitch, lire proWbly eqimlly efficacious.]

•The swrcina rentrif^nli is an lilm of ihu gfuui^ murismopffidja; it
prf^aentft itootf nnilcr the iispe<rt of httlo cubes, having a regul»r form,
vhich is very cliaracti-ristic. Besiflee the atomac)!, whore it ie frequentW
mt't with, it luu been found in the urine, or even in gangrcnons focf.
Aceoniiof^ to Windmuller, tliis iwrcinit ia tho cause of tae acidity of th©
vODtiting in certain castas of dyspepsia.

• Id 1871, Dr. IVit^iinrd in the I^iincot, pointed out tho good cffocts of
chloniJ 08 u mcaiu! of prcmrvution from Ben-mcknceB.

Oinildcn liad bcon always seasick when he croasod the Channel with
the M91 s little rough, bo oti the lulvice of a phvHician of Donloffne, ho
took, on the departure of tiie bout, a quantity of syrnp contiumug 6to
grains of chloral. On im return from England, lio Look a |X)tiou con-
tuQiDg eight grains: both trips were made without any Kicknetas.
In Miotbor trip from Cftluiti to Dover, the sea bcin^ excessively rough,
Qinldofl on emlurking. Kwatlowod a potion containing twenty graiuH of
cfaloiwl in syrup and iM'pi)erniint water; he had no Ht^a-^icknegs on thia
woMton nor on the return Toyi»ge, whea he rt^ptnited the dose.*

*The Baron of ThcredopoUii employv the following injection:
Take of:

Muriate of morphine 30 centtgrammM.

Uiirtilled water, 20 grammoi.

M. Inject ten drops of this eolation into the epjgartric region.
Philippe Vincent, phynacian to the Cunard Company, also oouuders
•w injecuoiu of morphine as the best medicAment to onpofle to eea-
•^WM. He UBUB two to three centigrammes a diiv. The following
"««ion i!oiitiiini! morpbEne and atropine in n iinitiLbV' form for hypo-
"'^no'c injoctionB:

* t»««l(]«», On Ihe Trattmeat of Sea Sickue&a. (BulL (]£d. tl« Th4r., L 87, \i.
** OM. AiT*i. de Med. Navale. Jun*. 1873.

172

Ul!S£A6£a OF TILE STOUACQ.

^akeof:

Murinte of morphine, . . .10 RentlgTammfla.

Nciitnil culptiiit<> n( atropino, . . I " "
Clu'rry liiarcl Trotvr, . . . . SU Krammea.
M. Otiu jj^rammu of thin eolutiua uoutiutis onu-lmlf ct-utigrammo of
morphine mid u]iQ-luilf lulllogTuinnii! of acropme.*'

* Lnl)l»«lcy ftdminisU'rsdouohoanf other RprayoVipr the RpijijuHtric ropon,
und nvrr thu cuiTi')(]H>iidiit); it'poii uf tia' VL-rtobrai coluiim: he Hdvixufi to
proloiitf thJB douchi-' two txi llvu miiiutus, mid uvuii lonjjor, iC tbe ptiticnt
finds that il dot's jjood, and to ropyat it yv«ry tUroo houra In mhtfliioua
ciues. Dr. Lubleeky altematos the douchos of other with douches oi
chloroform, f

' In his work, Apostoli inviets ou tbu time ifUen tho otcotricity should
bo applitKl for the n-Iii-f of romitiiig. This is his mode of proocdun;:

1st Ktapc. — Alwut tlireu minutes of poritivw [loliu- gulvuiiiiation, thp
stomarh ho'mg empty; this is a preparatopy sf-ancc.

2(1 i^tAgo. — Witliout ioten-iiptiiig the eh^ctrimtion. tlie ])atipnt is made
to swallow little by liltle. and in small i*ortions, ihu food or drink which
is " autiiiatliic" to him, aud wliicli lie kuows would bo iikoly to provoke
vomiting.

3d stapp. — The sf-aricP tumiitinufd till the patient no longer experien-
ces any Kenttation of epamn or vomiting, and till he foelR a Kensn of fnfn
^ire. AjiOBtoli ro-eomtnenda, nioreovor, to nmko two applications a-rtay,
and in ui;;lit vnscs of hvstiTicul r»mitiu>ri of <n-liieh four wiiru incourciblc,
cure was obtainud at tlie end of from one to eight Mt'aiicos, (Apusto)i, On
a Xew Klectrieal Treatment of the Epigtietric Putmi aud Qaatnc Troubles
of Uystoria.)!

'* Gubler and Parct have rcpommended vnlcrianate of paffein fnp hys-
tvrioil vomiting; it may be given iu piU form; dose a couple of grume
before meals, g

"This ie what Prof. Gnyon iwys apropos of vomiting in urinary
patients:

The Tomitinga in urinary patients are of grave import -when they lagt
long, and art- frequently renewed. They often complioate buccal dysphn-
^a, and then the nutrition of the patient, uln-aiiy ('(tmprommid. bwiomco
no longer possible. It is Ruch patients iih thcKo that die without fever
with a progrcseire lowering of the tomporature, and who iire at once the
victima of blood poisoning (un^a, ete.), and of inanition.

W« have followed the history of niaiiv of thi-m- paLient«<. ana have
Witneasod their attat^ka of vomilblg, iiol only as the result of the iii^stioa
of food, even in email quantity, but have seen their painful retellings ae
they heard in the adjoining room the mttlin^ of dinner diehes, or smelt
the food that was cooking; this was the result nf a curious sort of reflex

•Oiu-ipuy. Rev\iB MMicnle do Toiilotwc, 1879, p. 284. Bdron Jo Thcmopolis,
M«n>hia.^ in Sea RkVm'jts, BuIl.d.'Tli^r-. 1888, t 105. p. 4*2. I'liilippe Vincent. Hy.
po<i«rinic Inject iudh of Morpliiiie in Hihl Sii;kn<!»t. Brit. Mtul. Jimi.. Aug. im, USSS.

t Bull, de Tli4r., t. x«V,, p. 333.

t BnU. (icThfr. Nr»v,, ISSa.

^ Juk's Papel, Qn tlw Employ of Valerianate of CalTein, Paris, 1878.

TKSATHEHT OF VOMITOrO.

action, aiul one which tnilicHten that in those conditions of toss of fnTictton
tbe Tomiting i? dne qiiito as much to tho thnupht of food, r» to functioniil
proTocataOR ol the stomach, which rofumrs to act und ti^'rtttics tliis in
idTanoe. In theee puUeuts, iu f»ct, vumitiug foltown itiimudiutL-]y uftcr
ingestion of fooJ.*

" ThesR are Vardft's conohisinra (Thf-aei do Phris, IfiTfi).

"Vomiting in the phtliisieal ir, in the great niajoritv of casea, »'
>rbid phwiomenon of reUvx nntwrc'. TKo vomitiiigs which wv call
licul I.e., those which arc proLtnioJ hy fits of cimghiug, Iiavc not
thiH oriciii. and take plac-E- hy a mHliaiiisni purely pliysinil.

" ThiB plicnomenon m«y appear quite nt the onset of the dtBC'ime, and
eDQKtitut<-« titt-ii an initial fvitijiloni (diimlultir en^rj^omtrtit); sonietimt^.
ami more frvqueutlv, a w|jil« afU-T tW iiivasiou (gastric It^siuns), or evfti
al au ad^'auced |>i>riod, and us a precursury sigu of death (gaatriu liMtious,
tohercalous menrngitii!).

" It is !wB frequent than one would suppoftc.

" ItB etiolopy may be reforrpd to four hmda. which «to in order of fro-
quency: I. losiona of the gastric^ mncosa; '2, comprciuion or U>eion of the
pneamofiiiuitrics, by raatimi of elniidnliir ongargnmanta of tho mediastiniiin
and of thu nwk; :t, effnrtH nncT ttts of coughing; 4, neoplaiinm of the basis
crunii. or of the meninges.

" In fine, from a propuostic point of -new. the appoaranoc of thin sj-rop-
tom ou^hl njways to bt.- conaiduri^d w of eril )m{H)rtr and it ought to ho
«D«mrbcal)? combated, for iU pvmistoucu coiuiderably a^nvateti thu
condition of th« patient."

• Guyon, A Clinical Study ot ihe Dlgi-stivc Troubles of UriniaTy Palieuts, (Rev.
Mens, de U£d. et de Cbir., Jan. lOLh, ISiS.)

LECTUBE Xn.

THEATJfENT OF NEUItOSES OF "niE ST05IACH.

Summary. — flanJialgin — C^iistralgic riyHpepsin and Giwtralgia — Treatment
by !*r(t|jumtioii8 of Opimii — Morphiin*, Cliloral— Trwitmetit of Pis-
orders of the Sense of llungfr ami Tliinrt. — IhTMire^tiii— Anoreiiii —
Boulimia — Eisential Ampinia — Hyjrionio Tpcatmont — Phanrnweiiti-
cal Trealmeat — Artificial Aliniieutatiou — Gavage — Arsenical Prepn-
ratioiia — Thermal Treatineut.

In the preceding leotaroa we liavc been occupied with fuuctional di»-
orderH of iha niiisL'ular ami muooim uoata of the ittumuch; l«-day we eoia-
mono*' the study of the perturbation); affecting tho nervous system of
this organ, and yon alremly know that I include in thin group of neurotics
tho modifinitioiin which com;i;rn tho bciibc of hungor »ud lliirat.

In the nornml state tlic digestive ant is unoouscione, and is porformiil
without diHcomfort or [witi: but iu th9 jiathologioil stAto. tho muscular
coninM-tioiiH of the stomach lire accompanied by a seiisatinn of dlKtretM
wliiiiU HtimotinicfiocquiresH great intciwity. The jvatieut thenoxnenciicuis
severe onuiips aitd nu achiug [)aiu iu the etomnohal or dorsal region, and
ill othf^r cusi<«. 8 v<>ry dimigriMiiiblt* ueruuitioti which mjomit to bi> u(-itt4>d at
tlif inferior extremity of the cesophagne, and which has rccpived the
imme of mrdial'jia. All these Bymptomn charactttriKc giwtnilgia; and we
iiuiet now sUitc the dlffercnci' between gaetralgie dyspciieia and gastralgiA
]>roperly nd-f^jiUwl.

The diffuruiiee liingeg on tho following fact: while in gustralgia tho
)min is rhiefly felt during fa«ting, and apart from the digcativi' periods,
and aeemn to Kubmde on tho intrwlutition of alimuiitury nittttora iuto the
sLoniflcli. in gastnilgic dysixjpaia, on tlie contrary, tho jwm is exporioncod
whik' digBHtiun is giHng on.

I shall not dwell longeron tho Rufferings exporiencod by the giiatralgic,
and nuist refer you for more lengthy detaJlii to the Bpocial troatiseB ou di»-
wiSDB of the Htomach, remarking only that this neuralgia of tho stomach
him, with some authoritieB. a predomiimnt role in dyM|)e]«iii, and accord-
ing to T-juu'giie, tile dysjK'psian aru nothing but neiirosea of the stomach.

Do not think, gentlemen, that this so common affection. gastrulKia is
alivays benign. I am now attending a man forty-five years of age, who
ix taken every two or three nionths with formidable ga«trdgie atljieks;
the pain at the pit of the Btomach is iitrociouii, aud fur the fortnight

KEUROSIS OF THE HTOSIACU.

17»

ilnniig which the crisia la^ts. ail food is rejected. Tben all ccu£>ca as by
magio, and from thie stiito of snfforing no symptom n-mains, till n nov
xttaick 8ct« in. &[orRovor, lbi^rL> mv no bilinrv, or ronal calculi, nor are
tbore any other orgnnic IfHtonn tluit \ cun dlacorcr.

Here aim, ait I havu done iu tliv au»e of vomiting and pituitonii dj»-
peiwia, 1 ehatl include nndor the »tit)i> head the general treatment of gaa>
tnUgtc dyspi'psLA and gnstmlgtii. If from tho point of view of internal
pathology and of clinical mettictno, yon must Iceep these two affectionK
diMinnt, it ia not so fmm the |Kiiut of view of clinical thfrapenticH.

What is the treatment of gastralgic dj'Si)C])8iu? This 'n an iini>ortn»t
point in the etady of dyspopaia, (or tho painful afToctiono of the stomach
w ray frequently mot with and oitn may tnily my tliat in it large i-ity
tbere is not a woman or a young girl who lias not cx])erieiiced at times
paint) of greater or h-as severity in the region of tlie Htoniach. It iii one
«f the most habitual manifestations of chlorosis and autetnia, and one of
the most eommon of the neurnlgiaa.

Bere yoa will resort, not to pepsin, nor to rtrychttine. nor to the
luttrrs; it ia opium whitdi, in thi.'»L^ paiufiil forms of dyspepsia, giroa the
raotft 5atiefaotory results, but it is nec«s(«rr to et^lect jour preiurution of
opinm, and I cuuiiot too much iiitiist on thiu point It is not enough to
■s.y tluit opium >« indicated iu gastralgia, we muKt also know the prepara-
tion which agrees the bcttt with tht> iiarticular trouble, and here is one of
titL- grvat advmilagce of polY|iliurniiu;y.

Altbongh I am In general, btit little favorable to complex fonnolse, I
reeogniae iterertheiu^B that for Bome inedicauumtH, and for opium in par-
ticular, medicinal comhinationii often modify very happily the H<>tiv»
ejement which enters into tbc pn^pnmtionD. and certaitily the pills oCeyno-
lloaaua (extract of opium), thvriacu (au electuary of opium), and diascor-
dtuiu (another opium compound), the wines and Tinegartt of opinm, the
fyru]K of opium, luive u dillerenl action from tliat of morphine, and each
of tlicse prepeirations has a different indiaition.*

Iu the form of dii'spepaia under coneiderationi the preferable opiate,
u Monncrct haa shown, is the Vinoj^ir of opinm (acctum opii), or the
English " Black Drops;" I know of nothing U'ttur to ijomhat diitta wing
(uiric BenaationH. At tlie moment of tlit< painful crisis, you will gire to
tbc jntient from od« to three dropn of this vinegar on eugar or in u little
VHer, bnt remi-mber that thin acetic prajiarution iis very rich iu opium,
•■4 tot that reason you should he very eiirefnl in its administratioD.'
Gillard haa modified this preparation, and hiu made a solution of

*Tha eambinatlon of opium with powerful stimulants mich as cupsiciim. with
'NgiiwcB «uch MS clJorofortu. «Ui<T, boUoidonna. sometimes gtve^i li^ttvr rMulbt
"Ui**!!'-!! tliL' u|>jaif in ^iveo sing-l.v. An exoclli.'ul prepatatioa of lliv kind is
™»|»I|HM' iCoIlM Bruwne). or cltlimiiiwxtgM- (Pai-k<«. Davis A Co.). — Traiuk.

1?6

DISXAfiK OF TUK STOMACH.

mumte of morphi*. called in contra-dUtinctioiit nkife drops, and whio^_
t8 given in tliu eatnu dose ns tho proctxling.' ^|

There nre also powdcrR, piHs, ami iiyrups, ooiitiiiiiing morpliine.
ThoBo you nan luw, but jou ishuuld, liowovor, alwayti give the prafurciico
to powders orer synxxa, whioh nre generally bud prepamtions in dyBpcpsb,
sixvx in the greater nurnljur ol imsi-s, tliw ujiiuto must be taken just before
meals, and syrups disturb the gastric ilig««tion.

\n some cbbos joa ma; haro to reeort to Bubcataneona injections of
iiiorphJno, but you must alirays remember that if tliu^u iiijoctiouB aro
among tho meet powerful of therapeutio agents to empluv in jiaiaful affeo-
tioiiB of the stomach, tliL-y nre novurtlielees attended with this aerioua
drawback, that the patient soon becoiTifj* dependent upon Uiem and find*
liimautf, bt'fon- bo ie uwaro of it, u niorphion^anioc.

By the aide of morphine we murt place chloroform water, a new mcdi-
camoitt iiitrciduci^ Into thcrapeutica by KatbaUe G-uillot and thoroughly
stiKHi;d by Tjiisdgne and Regmiolt It frfvea excellent resiilta in gastTalgia
with dilatation of the Ktomuch, oaeuugiiig the dietrcbK and untagoiiiaing
putrid fermcDtntions, chloroform being, as you know, not only an aoica-
tht'tto agent, but also a powerful antisL'ptic. Nothing is easier than the
preparation nf this chloroform water; it consists simply in shaking to-
gether chloroform and nnitor, then decanting the htiuid.'

Tiie uame of mturaUd chlcroform water ia givuu to this solution, which
coutaine a little loaa than one i>orc.'enL of yliloroform. You ranat not use
tills chloroform water in a state of pnrity, and it should he diluted with
an pqiiiil quantitj- of water, constituting what ia callwl dilate ehloroform
water, wliioh is given in doses of from one tea^jjoonful to a tablcKitoonful.
Ordinarily, in owes of jrastralgia, you will proscribe this dilute chloroform
n'ater in dessert spoonful doses every quarter of an hour, til! the jmin dis-
appe-iint. Moreover, there is an infinite number of ennihimitioue made
with thits prupamtiou, us Beummim lius tdiuwu, and you cuii select from
the divcra formnlse which he has given.

By the side of chloroform water, we may place the solution of hhnil-
phide of carbon, of which I hare spoken to yon before, and which is pre-
[aired exiw;tiy jn the siiiie way n* chloroform water. This licinor carbon
bittoipiiido is lees calmative than the chloroform water, but its anti-
putrefactive power is ji;reater, bo it is rather in dilatations of the stomach
accom]ianied by pntrid fermentation and more or less discomfort, that
yon should titiliee this liquor, reserving the chloroform water for casus
whore the pains aro much more seven!. The inert iiowdcra give excellent
results in the treatment of ga^trulgia, a^ Trouseeuu has already ehowik;
in these aieea it is the eubnitrate of bismuth which you should employ,
lUid you may if you wish, moke use of the following mixtare.

KEUBOS£$ or Tim STOUACU.

177

a a

SijBH.

Take of:

Subuitratc of bismuth,
Iflagnosi&curb., ....
Prepared chiillc, ....

Pbodphale of lime,
M. Divide into forty powders which may bo giren in vafera or cap-
nles; one to be tnlten witli ench tnenl.

When I come to speak of the trraitmerit of the neuralgias, I will sboiTi
^a thjit&nM»ig the thcmpeutic uiuaiim applicable to this condition, e1«o
tridty deaerrea tho first place. The nenropathic. states of the stomarh are
also tributary to this kind of trcatmoTit, nnd in tlie^ic co^cs you will employ
positive polar eteetrieity, iK-cordiiig tu the method of ApueluU, slid to
v-hich I have referrwl in the previous chapter.'

But electricity la not the only remedy applicable to neiimlgia of tho
atoniAch; all the other moaits adrieed for the relic! of ]>ain, which 1 liavo
mentioneil in the chapter on tho treatment of neiinilffia,* and in fact all
the talmstivu prepHmtiunii have been rw«ommeiidt>d in gastnilgia.

You, of couree, underetaml thata» gat^tiiilgia ie but a «ymiitom, you
abouM ae far OS poBsible direct your tnnitmont to thi> cause of the gastric
pttin. and thia eanw you will be nblo to find, it mny lio in an ahcration
of the blood, as in the giistnilgia nf the ;ii»emic. it may bo in hepatic din-
orders, as in the [uiiuful crises of individuals ulTucted with gall »tone«, or
it may be in altorationa of the mucous membrane of the stomach, lU) in
oaacer or simple ulcer of the stomach. Having then found tho caww,
yan vill endeavor wliile trisiCing the pain to tiombat the morbid state of
^^bich it is tlie cxpressioci.

^Bt Such, gi3)itIomen, are the special indications in the treatment of gas-
^^■dnL 1 will now iiulicato the treatment of raodificationi! affecting the
■Hra^ of hunger and tliiivt Thia sonne may be ivn^ented, diminished,
or perverted.

I ithnll take up the mbjects of dvitorcsta and nnorcsia. hut shall pass
npidly over tluit of iiervereioii or heterophiigiii, berausn thiH aHoction
dOM not present any marked im],»orwnoo from a therapeutic point of
riew. In fact, heteropliagia is observed diielly as an accidental and
Moondary symptom which munifests itself at the begiuniug of pregnancy,
or it mnv be under the influence of a profound perturbation of tho in-
h^octoal bctiltiea.

Thoae diwnlers deacnbed under the name of jiina and malacia, present
Httle gravity, and the physician luis generally only to yield to the long-
ings of bia patient, especially if X\wsv t>ertaiii to alimentary nuhfrtances
norB Or Icsa indigestible, but which may iiererthelcas. in tho {)iu'ti(rular
inatance, 1>e well digested by the patient. .\6 for the nirHliticiittniia in tho
fancttons of the stomach which :in> under the influence of mental aliena-

' Vol. Ul. CUoieal TlieruixnttiuK, O. S. Duvj*^ DuLtoit 1W.1.
12

178 mSEASKS OF THE STOMACH.

tioii, tliP troatmpnt ninet bo directed to tlve cci-obnU or m«nUl state,
nilUor tlinii to the etoinucli. There remnins the diaeaaa deecribGcl by
Jleusinger umler the titk' of geop?uii/ia; t\m I Iiave nevi^r otwerred, and
aa it is not likely that you will ever witness it, I do not think it neccBBary
to ^ro you a complete description of itA trcatmont, and ehall have to tqSpt
you t» wnrk» siicU aa thiit. of Leliert, which give a full account of this
Ktningu perversion ol the fuiiL'tioiiB u( the fitoniaeh.

Dysorexia, like the foregoing diseuse, is eoinetimes met with in prrg-
nancjf or in certain states of cliloro-aruemia, or neuropathy, where thv
8un«D of hanger i» nuver iiatis^fied/ You should know iilso that thi^ in-
fiutiable desire to eat ia habitual in dia1>eteSj therefore I recoiuniend you
wliciioTcr you observe snch cau'S carefully to examine the urine before
deciding your diagiiOEio and treatment.

Whenever tliia morbid hunger is depoadont solely on nervoug dt»-
ordiirH, and when it is but an epiphinionmnon oT ii gmve affection, you
may combat tlie ajTiiptonis by opiaU-^ Opium, you knuw, hint for one of
ita etTccts to diminish thp dcsircr for food, to ap]x-aftC' or citingnish the
appetite, and the old saying "Qui dart dine" (he who sleeps dinea), \t
eepeciully applicable to those who miikc use of opinte (jropumtioniL

You must not, however, think this an invariabU' rule; I have in luiiui
one of my confreres who for more than thirty ycure baa been taking «ich
day from half an ounce to an ounce of laudimuni, and whenever he tries
to leave off this medicine, ho invariably lofi'>e his appctitoand digestion,
and feels weak and pi-uiitratecl. For this pjitieni. whuae lUKinraey of judg-
ment cunuot be called in queetJou. opium is the best stimulant of the
digestive function». This is Init an isolated cane, but do not forget that
thin admimble medicament po^wwes tonic properties; by reason of tho
»tiinulalion whiL'h it gives to the brain, it arouses all the physical forooB,
and morphioniaiiines, as a rule. Meek to obtaiu from opium, uot m much
aiim and repose, i\» the ner^essary ntimulation for tlieir enfeebled organ-
ism. Tliis reservation being innde, opium may bo used to diminish the
houliniia; to '\Vi empHoy you will Join in the ease of nervous pntienta,
hydrotherapy and bromide of ijotassitim, and above all, you will endeavor
to re^ilate the meals so that the patient shall eat frequently a small
quautity of nutritious food.

Of all the perturbations alFcrting tho siense of hunger and thirst, tho
most common and the most dimoidt to overeome is eertaiiilv anorexia.

There arc very manycanst'swhiph produce this state, ami it would not'd
an entire chapter to set forth in its entirely the etiology and aemeiology
of anorftxia. Ulood diseases, febrile alTeetions, profound perturbations of
the ecodoniy, inniiifeKt LhenMelves by a dliuinuliun ot the appetite. Tbia
diminution is often due to a lessened secretion of gastric juicy; you know
in fact, that l>r. lieaumont in his obwTvations of Alexis St. Martin.
noticed that during fever the mucous mcmbruuu u( the stomach ceitsed to

rBFBOSBS

TltK 8TOHAOIL

seerctf pwtrir jnicn. In other nisL-s thi* real cause ««caiie« us, an«J ■ne do
not know li«w moral itiflut^uci-a, mental distress, nnd tli« emotions, siispeiu!
the a[>i>etite. Hovever thiei may be, it b <iuito a ccttunO'il ejinptoiii,
which yoa will often be calk'd ui>oti to combat.

WhfttiSTor m»j bo tho tn'titment chosien, ilo not fopgat that thwB will
be caaes in which rou will fnil comi)lotpiT. Wlien tlie lost of appetite
Rally exiaU, and is abcolnte, the patient, ilcBpite all your Koliritntions,
and despite tbu danger which be iucura from iuanitiou. will reeolutdy
Ti!fnn to take food, and ho will die rather tlutii Hubmit to the painful task
of eating.

Do not think, gentlemen, that this pictnre ia ovenlrawn. BeoaU to
mind those two wnmen, the one otcupying a bed in our fctnulo w;m], the
other in tho foundling hos]>ital, whom wo hod so recently under our ob-
servation. Both were anEeniit', atilTering from that aiiiHmia culled eMjtentin]
and pernicious, words which indicate our i^iomnce of the primary CHum>
of the diseaee, hut which denote that despite an attentive examination,
DO pathological condition was foand in the organs explaining the cnchotio
state of the patients; thesto two women could not eiit, and notwithstand-
ing our endeavor* to vary their diet, notwithstanding otir daily exhorta-
tionSr these anhappy beings assured us that they could not swallow iiour-
Mhiaent} although there wad no ohatacle on the part of the cesophugus or
■tomaoh.

These two patienta men fueenmbed, and, as already the clinieal
enuniuatiqn had xhown, ai the autopsy no lesion was found capable of es-
pfatining the death. We noted fatty degenenition of the organs, and in
particular of the pancrvae, but was this degoncratiou primary or second-
ary? Thia it is impownble tn suy.

It in not alone in thuae caaus that you will meet with obstinate ano-
ITiia; you will observe it also after convalescence from typlmiil fever, and
other grave affections. Ilt-re, as in many other disorders of the elom-
adi, hygiene plays the chief rAlo. The patient must change his scene,
he must live in the oi>i>n air, in the mountains, at the seaiude; he must
be made to jouniey. and his dietary must be constantly varied.

It is in these cases that the physician ought to be both good conk and
derer prnetitioner. You will perhaps be ttble to stimulate an nppetito
by ni(«ns of ajipetizing sauces and eondimeuts. You will not forget
too, that often cold meats please the nio«t; this is tlio case with ba(!(>n,
nMat pie, game, salads, etc.; in a wonl, study the gustatory whims and
dMtm of the patient.

A» for medicaments properly so-oaJled. the nrs<?nic»l treatment' may
Ksndcryou service; I know of no liettiT. Arsenic exercises a real stiuni<
bnt action on the digestive functions, and if 1 do not fuUy aidopt tlie
Tftivhanical explanation of tbt CJermaria, who pretend that arsenic acts
(linx-tly on the capUlariea of the stomach and intestine, and that in

180

D18KABE9 OP TIIE STOMACH.

dilating these remeli, it causes an nctivo congestion of tlie organe, I do
not to&T to afHrm nDverthcltia)!, from u. clitiiail HtaiiiljKjint, tliiit there
in no botter BtimuUiil of tlif (UgcBlion ttian the araenicail prt'imrations.
Uae then Fowler's solution, the granules ol IMoseorides, or the ar»cnic«I
pills, or tho flolntion of firwnifito of Roda. Whatovor may be the form
URcd, tho rcjnilt will he the fame; the appetite will return, the functioiui
of the «kin will he pruinotod, and the iraticnt will get wuU.

With thcae prejHiratioiis f associate, but on & subordinate scoilu, tlio
bitters and certain tonic* which etimulato the organiBm, such as cAnella,
gingiT, oardamom, nutmeg, etc., of nhirh more or loss complex comliiiiu-
tioiiH linre Seen made, such ats the oroinntlo powder of the Unitetl SlaU-s
pluinnacopiuiu. '

But it is necessary to bear in mind that these hygienic and pharma-
coutical mcaiia will fail in casoa of etuMioni anorexia, which you will then
h«TO to comhiit by artificial alimentation. In fact, nothing ig moru iinli-
catod in such cBse» than ga>-iig(\ In instjinces of anorexia due to cerebral
dnriingcn)iMit«. wfhavoi!ot!ii tlmt tliv dtnui^iitL-d ami insane have beon able
bytliis meane to live for moiitluaiid years, although absolutely refusing to
Dutauil drink. To-day, thanks to tlie Kyplion, and especially to thu alimen-
tary powders, this method Ima Wmne much more practiL-ahle. and wo
are enabled, in {Nttiuntji aiTec;tt.'d with mental alienation, and those that
arc the subjool* of anorexia, from wliatcver cause, to employ tubos of Hmall
dimensions through wbieh our liomogeneuns mi-vturw made with the aU-
mantary jjowdor* may iniw without any obstoeli'. In th« insane patient
you can pass the tube by the nurus; in sane indiridnals on the contiaiy,
you wilt introduce it by the mouth, and you will make uae of tlie ordinary
i^'phon nr the " gaveuso " such sm I employ. By the oagy poptonisatloQ
of the* molycules of intmt (>owdor, wo oiteu see the putientR under its in-
flueiu'L- recover tlieir appetite and call for food. It is then a kind of
trciitment wliioh is obligatory in such uihob.

Ihit I cflnuot liniBli what pertains to the treatment of the neuTOsce of
the HtomiU'h without pointing out tu you hure the really iiwftil appHcji-
tiouB of a new alkaloid, cocaine. Since K»>llor showed that coHiine antes-
tliftizes by its local action the mni^us inenibi-ane of the eonjtiucliva, tliere
hiw been a dispofiition to apply th^c name remedy to the relief of jNiiu duo
to affections of the mucous memhmneB, and to the sjmemodic trouble
which have their source in modifiLiitious of theet* momhranoa, I was one
of the first to show the mlvantiigefl that miglit be derived from cocjiino,
not only in the treatment of giuttralgiu, but also in that of otlier neuroses
«i tho stomach,*

You should make use of two per aent. eolutionii, and direct this solu-
tion to be taken in drop doses, or what is lM>tler still, apply it directly to
the mucous membrane of the Btomarh by means of the iL<suphageaI souod.
I have thus caiiuod diiuppuaruucc of the svvi-re diatrede of

NEtJHOSES or THE STOMACH.

181

»en of Touiiting und boulimia. It U in fact, prolukbk^ that tiiu tt7u<te
tfestrailiing qnalities which wo havo attrtbtitefl to cooa leavea KSiilt from
their ftiueRlln'tic action on the pharynx and etomjipli, tiii* action dtstroy-
ing momenturilj' the scnsitiuu of tiutigcr uiiil thinst

The hydrothermul treatment of gustralgic ily(SiH;i)ida is vcrj-JmiiortBnt
Hydrotfaerapj pla3rB also a dommant r6U'. Vou can liere employ ihu
wktun of Bngnoloe, Alet, Krian, an^l ospeciallj i'ou(;iio». Vou ought to
avoid wutera which itn* too minRralizei] and too gaseous; you caa also
praecribe the Spiuiisti wubent of Ubiirvuga of Alzatu, of Solari of C'fthroa

Bach, gentlemen, are tho therapeutic riilee applicable to iieiinM(is of
t.i$oatteb. In tbe next chapter we shall study buccal aud iutoetJual

KOTES TO LECTXTRE XI.

' Here are the differt^nt fonnnlie of the opiate ])repftration8:

WiSKS (IF Ol'lL'M.

A. Laudakl'M 07 SxOKKUAU. (French cocIol)

Take of:

Crude Smyrna opium in slice*, ... 40 porta

Saffron (crocua eutivus) 20 "

Brui)^ cinnamon (lanms cinnamnmnm'), . 3 "

" cloves (I'^rvoplivlIUK iiromRticuB), . 3 "

Ifalaga wine, . ' . ' 330 '*

Maocmte a fortnight; agitjit<> from time to time, exprem and filter,
eventj-fire oontigrauames rt;pre««ut tivo ceutigtftmmes of extract of
■opinm.

B. RrjaBBeau's laudanum, which is ni»de with onium, honey, brewers
TCHti alooh'il iinrl Kittor (ii proL-i_>^ of fcnnvntntion Ving institutod dur-
^IS^^ prepamtiun) is twicv uh titrong tva 8ydcn)uitn'ii.

^^^^B 0. $YRi:ra OF Opidv.

' Sybop of Tueeaica, (Froncli codox.)

1^ Take of:

^B Extract npii, I part.

^H UisLillod water, 4 parts.

^P Simple syrup, 495 "

niiwiilvo the extraet in thv distitlod vatrr. fllttn-. and add the syrup;
20 gramnifs represent 4 et^ritij^nuiimt^ extract opii.

SYRtP OF Yellow Amhkk. (French codex.)

Take of:

HvTup of opium, 200 porta.

Spirit of vi-llow aniU-r 1 "

D(M._lll lo'^ll ^mintneH (3 ft to 3 x).

Id2

DISEASES OF TUX STU.VACU.

pAKKtiORK: KuxiK. (The fonnnlu ol the Fronch codox U the aame
flBthatof thoU.S.l'b.)

D. AcBTUM Oph. (B. Ph.)
Take of:

Cniflp opium, 1 part.

UiKtillctl Tincgikr, 4 "

l>igc»t eight liays and filter. Dose — H to 10 drops.

E. Black Dsors. (French codex.)
Take of:

Bruisfd Smynm opium, 100 parta

Vinogur, GOO "

Btiffnm 8 "

Nutmeg, ill coftTiie powder, . . , . 24 '*

White HHgar, 60 "

Maconito t)io opium, the enffron. and the nntnicg, vith 450 of rin^ar
for tea d&p; sliakc from time to time;* heat over ueca-bath half iiti honr,
strain, expivas: add the rtst of th« viuL'gfir to iho dreps, let itmcorato
twenty-four hours, and exprcBB and strain; mix tho two tiqiiida, filter ftud
add the sugar; evaporate ov<;r a sea-liath till the weight is reduced to 200.

The black drop represents a quarter of its weiclit of ext. opii; I port
= 3 parts of ItouseoAu'e and 4 pari« of Sydenham^ laadanum,

'GxLLARD's "White Dsopa"

Take of:

Muriate of morphia, I gramme.

Cherry laurel water, 50 "

Doeo — Olio or two drop* on n lump of sugar before moals.

[In this country. Miigeadie'e solution of morphia is more genemlly in
use. It coiitaiiiB Iti graum of morpbuiu murintu to a fluid ounce of water
or cherry laurel water. Dose — 5 to 10 drops. The officinal solutions are:
1. tliLi Liquor Mor^ih. Acebitin — 4 gru. to the fluid ounce; 2, Liquor
Morph. Hydroohlomtis— aime strength as the above, the Aom of both
being 15 to 'M drops; '3, Liquor Morph. Sulphutis, i grain to tho fluid
oiiiipe. Dose — u teaepoonf h 1, containing ith grain.

The HOKPiiLSK P1I.L of the Codes contains 1 cantigmmme (^th grain)
to each pill.

HoNNKr's powder conaists of bismuth, ! gramme, morphine muriate,
2 to 4 milligrammes. To be btken ln-'fiire catdi umal.

Thn SymuI' nf Moiti'HiSK of the Frentih oodex eontatna 5 eenti-
grauimcs hydrochlorate morphia dissolved by the help of a gramme of
dilute: acid in 98 grammes of Byrup. -D grammes contain 1 centigrurame
of morphia, Iiose — on« or two tablespoonfuls.

Of the ETHEH PRP.PARATI0K9 for interna! nee; 1, IIoffnian''s anodyn*
(apts, eth. sulphuric oo., done 20 to £0 drofw) \b thn most in utw. 2, A
Byrup of ether directed by the French coties. Hegnault and Adrian giv«
the following formula: Take of Bugiir 440 piirts, diatilleil water, -IflO pirts,
aienhol at UO", 50 parte, ether 20 parts. Put in a bottle, shake and pro-
serve. The whole «f this might bo given as u doee if the parta takun are
made tO' mean grains.*

* Jour, do Phwrn., Jaauury, ltf6d

WECROSES OF THE STOMACH.

183

•A New Mode op Using an Old Remedv.— Chwirofobm TCater.

ChlorofoniL, fto old remedy in thu pructico of tlw majorilr of procti-
tionen, though doubtlosa u new ntiscuy in thu cxjurioncc ot th<* octo-
genaritui, miij be utilized for oth(>r piir{ioM<a than aiiffifitheflia, and the
mtarated chloroform w«ter, linrt formiitariKed by fJnillot in is4i, and
which WM uftcrwiinl moAv- thu subjui;t of n »ar\ee ot trithls by Lnt^-^iit; niid
Be^iHiilt,* luid Ktill niuru recently by B«.-iirniaini,t ix not utily un L-X4;elkinb
»iid handy eici^ieut for nmiiy mt-diciiiiw, hut poBseaBua valuidilu lumlgtwic
prop«rtice. It is a stable preparation, luid the eaTor is «spi'ciully agree-
able, aweetidh, and when diluted one half, devoid of all piqiianpy and
acridi^: it makes a good comhinatinn with nearly all medicines which it
i> d«airftblo to adjniniet«r in a liquid munittruum, ^egoinng the ineipid or
anpleaauit taste of many of them; it miirkerlly enhances tnu scdativv uiid
anodyne propertioii of analgoKic and najc»tic rometlieR. I.jaHeffue eGpecially
rivommeiidii chloroform water m ii Hiiitable vehicle for the iidmintHtratinn
of morphia, in union with which it fortiit! one of the best palliative coagh
nudicinee, as i» generally uclcnuwlfdged. in lulvmicej phthisis.

Probably no better exeipient for the Baits of iron can be found. The
mode of preparation is very eimple. Into a Htink two thiT<U full of pare
waU-r, |Kiur an excess of chloroform, agitate well the mixttii'e several times
for the Kjiace of an honr. and allow the chloroform to deposit it»?lf on the
bottom of the flask. Decant or eyphon off tho clear BupernatAnt liquid,
Tho Bolntion shoidd he perfectly tninsimrent, contninin^ a. little Icfui than
one per c*nL of chloroform. For internal administration it is genendly
duirablo to dilnte this aaturatcd Eohition with an equal quantity of wnti.-r;
Um doM of the dilute aqua obloroformi boiuc about a dessert spoonful.

lAB^gno had ahown thu unreliability of alcohol as a solvent for chloro-
form, and the difficulty of making a good preparation of nhloroform
water from the officinal spirit solutions. Nor arc the omnlsione free from
a <_vrtain irntant effect and even causticity, felt for some time in tho
stomach after tlw iugeMion; sometimes manifesting itself asacuU) pain.t

Among tho therapeutic advantages of chloroform water is one on
which I^asi^c and neurmann much insist, namely, it£ ii»e an an annlgenc
in painful stomach affections, whether these proceed from indigestion or
^m organic difloase. In the ]itiiiii^ of indigeelion it is almost without a
ri™j, B^edily mitw?iting the functional diatrces by its man'oloxis topioil
aedatire action. Iii the painful intestinal disonler often nccompanying
the completion of digestion, it is of no utility. Heurmann has had favora-
ble experience with ita employ in allaying the acute suffering and nausea
which attend dilatation of the stomach, cHpcctatly during the digestion of
food. He alao strongly recommends it in cases of gastmlgta. and hure ho
is seconded by Dujiirdin-Beaumetz, who introduces the diluted chloroform
water by the stomach-tube, performing "lavage" with the solution, hia
fbrmals being two t4?«uipoonfiilii of siitunited aqttachiorofanm to the quart
of U<]tud. 'Iiiis preparation he re>;aril)i iis both caLmativo and antii^eptie,

* Archives gen. de UMecJae. 1879 ood IS83.

t Bulletin geii. d>! ThJiitpi-utiqun, t. cv., p. V7.

t Laa^e, loa dt. and tladt^n M^icaim. t il.. p. 1147. AlmlW at M> per
wot dtasolTca uurijr Iwitv iU wi-iglit «f rhlorofomi. At 80 per cent. I ^uiinitf
of rtilororom is «olubl« ia 1 trr- 1& uf itlculiul. At 00 per i-viit. 1 ^nuuiiie rr^iuirvs
• ITT. ID for JtH solution. Al 20 per cent; 1 gremmc nquirca AS p«mmc» for its
•otuUuu. «u-.

164 DISEASE OP Tmt STOJIACH.

iinil tho vraflhitig ]Hv>r«>t3i is, kbora all, imiirmtwl in oastrio (Hlatatio^^
Ijia^fnic also finds iitlrautage from chloroform water in the paiiu a^:^
luiuiUi wliiL'h iMxiomiMiiiv tniioor of Uii' eloniacli.

From t)i« list of lonimlte given hy Beunitaim vre select tliu (ollowiug:- =;

H. Sut.. chloroform water L3 parts, fl|

Pepporinitit water, 3 *^ ^H

WaUT, 13 " ^

M. Iin^e — n tablpanoonful for n onlmativo Ktomach potion. Good ^j
norrouB vomiting and toe vomiting of prt^naoey. ^^

B RatuniU:il chloroform water, .... 3 parts ^^

Synijj of onifigw. 3 " ^|

Liquid niorpli. sulph,, I part _

M. Dose— one or two twtfpoonfola., Tho al>ovo is a ubmuI form ^^
the admin irtiiition nf morpbia. ^H

If. Ilvdratn of chloml, 1 part. ^^

8ynipnHriLntii cort., 35 pnrta. ^H

silt, chloroform water, 50 '*

M. I>08u — a tal)li>>tpuouful. The acrid taste of chloral is much moi3x--r
fied when ailminiiiterud aa above. ^H

B Silt, cliloroforni water, peppermint water, && 30 parts. ^M

SjTijp of ()oppies, 30 " ^H

Bromide of |K>ta88inm, 1 part. ^^

M. This preparation in teaspoonful doees ii exceedingly valuable in
the th>i<ni pniitins of infancj. ^m

Thu folluwiiiji ij! called by Dr. Benrmann the " salicylic potion ">—^|

B Salicylate of eoda, tj parta ^H

Syrup 30 " H

Pep|K-rmint water, 30 " ^H

Ihmto chloroform water, .... 100 '* ^^
The liisa^feable tiwte of xilioylflto of soda is almost compl«
giiised in thin mixture.

The following, callocl " hemostatic potion," contains iron: —
Q Dilute chloroform wator, .... 1!30 gnimmoa. ,
Syrup aunmtii cort., .... 20 "

L'iquor ferri [KTtihloridi, .... gtt. xx.
M. iW^ — u tubii'spooiiful. The styptie taste of the ferric clilc
altnost complvtclj ruiiiuvcd in thiH comUiiutioa.

Lnef-giio recommended a now somewhat famous hydfgogue cathartic
potion, which ie made by nibbing up one gramme of' gamboge with fifty
«if synjp (if orange and one hundred of natnratei) chloroform water. The
doste is a tnlilHspoonfnl evwrv morning or every Bcmiid morning.

The almvo formula' are «Knnipl(>3 of tlio thernpeulic mngo of lhi«
iniilit'iimctit. Thfv cuu bu varied ut pleasure by thu practitioner to meet
MIMjcia! indications.*

' Acconliiig to Semmola, the most mlient })haso» of gaetralgic dyspepsia
are a groat intolerance of fond, with epigastric pain and gastrslgia, often

* »om an u-ttclo by tli(! Iraniilutor in tim Boston lt«<iii>al itnil SurgK«l
JuurnaJ.

Ni!l'K<*81S3 OF THE STOMACH.

leo

folJoirfld by romitinfr, with other B^mptonia wliieh accompAoy ererr Roit
of ifloir or aiiticult iligeiftion.

The aiufles which ronstHJitly produce these kind of iiervoas »iy«|)p|)8iH8
KretJNwe which pxImiiiiI Iho nei-vons »jgtem in Reneml, but priiiciiwUy
dftntDd mental wottt, ilisippointmonts, the tjoKm^I emotions, uml sexual'
excenes, niwciully wfum Ibvfiv cuusua havi^ opcmtt^il during the ])rocee8l
ot dij»«Uon ami n-jiwitwllv.

liief« may e\\st in the long run in these raara or nen'oiis dy8po]>sia a
true oatarrb of i\\v atoiuach, but it ia lUmiys socondarr, and uneueB oe the
r^^Mtnlt of three iofluencc^g:

1. TbM wme vice of imioniition nffoctnig tlie capilkrj circulation of
t>»«§i<)macb, (raeo-motor pariLlTsi^);

i, Thi* proiongf!'! presence of aliments which very slowly Oipest:
3. The irritant iiction of all the ]>ro«lucts of ii defective digeution.

' Boulijiufi ia a morbid symptom oharaeterized hr an bisa liable hunj^i
^^•t't i.roi>ortion»l to the loeaea of the organism. 1*lie old writers diric
^xwaniia into bonlimia w-calleri, into ryanorexia, or canine hunger, and"
xnio lyeort>xtn, or wolfish hnngor. The vorj- definition of boulimm uhows
"*->ut one cannot include under t!ii» Dumo the hunger which supen-enes ii
tlicwnvuleecencc from curtain luutu difleusus, or that which follows ex«
o«MVe bodily exertion.

DtlTercnt ejinses hnve \wen ateiigned: Itnulimift may depend on certain
''onveniUil midformaliun^ or aiiomitl iit< of the digeKtive tithe, on rlirmiin
' '*;iMw of the tihdonien: it often iipjx-iira in prej^iutney. in nienUd ntieiui-
''••n, m general jiHralysiB, m hyHtena, in exophtliulmio goitre (Trouaseaii),
■""1 effpccinliy in iliabet«e.

It soinetJnieii occiirs tr(in«ieiilly after tlie ingention of certain inedicii>^
'"••ni« (iwllde of iron, Xat. Onillol), or after eating food too highly w»a-
^Jiiwl; it hiw been eoJd too. that imticnts affefitcd with tnnia, are somc-
"fiira boulimic. ^

IndiTiduaU itnfTering from Iviulimia cat a great deid. and a KhofAimo

After their meals they are Riiddenlv taken with ad irTcsistible dcsiretD eat

"•Oft.; if ibcy cannot sitiefy thw waat. they uxperienoe ]KUm ii| thai

**^iniich and mnluiae, rinking 8en«ttioii)i and even Bvncope; after having

^rgwl tlienist>lvi>ti, they are overeomL' with tur|H3r whilu diguKtion its going

*'i ; digeetion ia, moreover, alow and diflicult. Sometimes the enormouB

*,' inientary mase which the toulimic c<>npume8 is totally dig(«tcd. eome-

*•>»»»!« it 18 rejected immediately aftorwanl by vomiting (cj-anoiW-iia), or,

f*'»»«ing rapidly into the inte^tiiu-, it produciw energetic fK-mlaltic move-

'T'c-ntu, and is K^^t rid of by diarrhira, whieh ntpidly enfoe^loH the )«>tieiit,

v^>Torexia). The stonln are onlniarily fetid, as are also the swrait »Tid the

***dora] «*oretionit. When tlm cli.'u'Hf^> has not nrnnired a very pronoiince<l

*^'-**' of acnt*uc«8, ft fair state of gejieral hcalia may bo mainlniued for

'me time; but in other OMfcj!, luitwillistaiiditi}; the abundance of (oodi

.ten theri) in a progrewdve emaciation, a dinuTitition of the foreea and

^)k' intelhgenee, and the jxitient siicenmlKi, either to the progroea of the

^iseuM?. or to H>m« intercurn-tit diseiise.

There are degr«>«8 in bouliniia; the patients are not all equally rora-

t^iouD, but ihero are somo thtit euntunie incredible (|u«ntitie« m the

Wvuty-four boure, Percy, for instance, citos the case of a man named

TSimre, eeveniy years of ago, weighing ll»0 pounds, who wontd eat in

twenty-four lionn id omonnt of beef equal to hU own weight; thiH num

OHO 6ay eat a monl prcpttred for ftorentcen porgans, ho vas even on ono
occaaon uceiuod of uaniig devoured a child lour ycArs of aga.

"Arsenical rREPARAxioss is Commos Use.

Ibtpler't 9ol«fio*u—Thli solution i« officinal in tli& U. S. Pb. where
the formula for its preparation i« given. Dose — 5 to 10 drops three or
four times a d»y.

pN\rmfi'K nohUion. — The formnln for this preparation in found in tho
Prvn(ih Cndux. fitid in the U. S, l*)i. It ie an iiquL-oiiH wilution of iinwniiito
of Boda, contHiniiiR one gmin of the salt in a nui<I uunw. The done is
about twi<.'t> that of Fowler's tuilutioii.

ffr(i!tn/ftto^/>io#fwr(We«.— Each granule has I milligramme dijthffraiu)
of ar^pnlnue acid, combined with mannite and honey. Doee— 4 to 10 a
diiy, before meals.

" Granuhs of arufnwte nf soda. — Th© quantity of arsenic and tho doso
an* the name ne in the aboTc.

fji/twr xoda ar*f.niath. — Talce of arwniate of Koda, 5 to 10 centi-
gmmme», dirtiUod water, 250 gronimoa; Mix. Dose—ono or two dessert-
ppoonf Ills n day.

[American phnrmocists have put in tho market pills of arsenious wad,
8H(iur-c'0uted or gelatine eoatiHl. A, aV* «*«' """^ rii! grain. A pill oon-
^^'^S i^ grain le a very handy pill; one of these may be taken fer dit,
after iiiealerj

Tulv. CnneUai Oi. — This powder is ofRcinal in tho Pli. Br. Thepulvis
arovmtieua of the XT. S. Ph. which miiy be feund deaeribeii in tho U. S.
IJispenMitory, is similar in composition and in properties to the above.
Dos*' — 10 to 30 grains.

Pvlr. rrettie urofnaticus, — Tliis iftmado with 3 partaof aromatio powder
and 1 part of chalk. The puhiji erfUtt aromatif^uii cum ajjii m the same,
with the addition of a little opium; every 3ii hiia 1 gmin opium.

'Op^- Ertflkri>xylum tnea, (ervthrosylacoie), is a ehnib which is a
nuttm (tf Peru. 'Hie leaves are medicinal, and have lung Imeix noted f<^
tjii^^ntimulant and tonic prti[>ertieK. Niemann in I860. Kstract^d front
eoea an alkaloid eoeaine; formula; C"H"NO*. Tho muriate (in i-sidwl
prisms) is alone used in mi^dictiie.

To Koller, in 1834, we arc indebted for our knowledge of the local
anaesthetic proportiea of cocaine. It bne of late been found aiw) that a.
general nnteethctic action may bo obtiinod by suiwnt^ireons injections of
this alkaloid. [Thua a hypordcrmie, injeetion of a Pravuz sj-ringcful of &
four per cent solution of cocaine mnriate is found to possess analgeRiD

Croperties in neuniigia aimilar to, and atnioEt e'jUitl to those obtained from
he suheutaneouB uRige of an ordinary dose of morphia, only tho effect is
not so lasting. At leust this bos been my eiperieucc. — Tmas.]

SumUBT. — Snliva — Stfl rcliy Dyapupsia — Dietetic Trpntmont — Pharina-
oeatical Trwitment — IMa«tiL«» — Kxtract of Malt—Inteatiiiai Djuiwp-
eia — Inteatiiiai Juice — Bile — Piiiicreatic Juiw. — PaucreaLin — Hbo-
Cucai pyepepsja — Preparation of Paucreatin — Enpcptic Prepara-
tions.

Tecs far I bare been occnpicd with disorders pertainicj^ to tlie
ttotiuKhal Uigeatiou; but if tlio utuciuich pluyu a pr(>puiidenuit rOle in the
cougeri€8 of tliu digestive acttt, t1k<*n.* ari^ olhi?r fH<'-t«n< as well, and no
coTuadBration of dyspepEi!! wonid "be rompli>tv that shanld omit to take
into account tbv porturbutioiie ailcotiii^ the proccttavs of buccal and iu-
testinal dij^tion. Therefore in this chapter I ohall take up the buccal
and int««tinal dv8]>t'p«ia8.

Starchy foods, ft« yon know, nudergo the action of the Kalira,' and it
iiby ruason of the diitetasv which tliu latter coiitftinB that fdm-crh iBconvcrt«d
into dextrine, then into iuwimi1uhk> migar. Minlhe tuia furnished in thja
regard the moHt preeiae and esaot data. I Lwmot hero «nt«r niittiitA>ly
into the mibject of the com^neitiori and 8ecretion of tlie saliva. \\'luit I
doaire to remark is that the Balimry ferment, the pii/alin of nerzeliuet
the diastatc of Mialho, is only foutid in mixed ulira; wo arc atUl ignorant
where this BpeciEl ferment in dcvelupiCHl, whieh, as Mulder \vm shown,
■faarm with all albuniiuoid subiitunceK in ptxx%88 of decomjioiiiition, ths
proprrty of snochBrifyrng starrh.

But if thu Hiliva be in&utTirient. or if the impregnation of the aliments
therewith be incomplete, the di^ordoni which re#ult will make thcmselrea
felt only on the part of the Btomach and inteslinp. In fact, us Olmrles
Bicbot ha« nhown, if the acid luodiiim of the stouiachal digestion cannot
of iteclf tranfiformamylaccoiiB mntter» into sngHr, it nevcrthek-M favors the
action of the snlira, on these sutstancce. So, when starchy matters are
not infialivated, Ihey remain in thn Ktomach ai* fureigu IkkIiuh till ei^Millcd
by th« contTwtioux of tlie Htonmch; they tlu>n paiw into the intestine and
an; atibjucted to the action of the jjancreos, which digests tlieeo sub'stAUcus,
tfs Uouctuirdut and Sandniti have shown.

Therefore tndiriduiL]« Btfwted with buccal dj-apepsia, or aa it has boen
rightly called, dynpepsia of Btan^hes or ainyliicwoiiii dyspepsia, experi-
euc« as tho result of an exclasively Tillable diet, disortiors which are

188 DI8SA8B8 OF THR BTOMAOH.

clutractRristic especially of ntoiiic dyspcpt^ui: they luivc a feeling of weight
ami prt's-ture nnd twinging paiiia in the region of the stomach; 8yn){>t4)m8
whir.:li inilirnt*' that the gnstric digestion is ilNpcrformcO.

What rvniwiice vill you prcBcribe for those paticuts ? Iloro too wo
muirt give the first ]>bu;e to dietetics. To pentons guffprijig from these
disorders you should riM^ommeiid aljslinencfi fn>m stiirohy iirlifl<->a of diet,
and if th«y c»n not submit to this FL-^iniL-ii. yun eliould limit, as fariut
possible, the quantity of farinsceoua fonds, and cause euuh uliinotitary
SHh»tancof« in be taken in n ftoft Ijoilcd i»tate. n^ as to destroy th« protect-
ing envelope of tlie starch granules, whirh oppnafs tho Ka.li%'[iry impregna.
tioii. Iti-oonimfnd thorn to eat alowly. to maBtiwite irith curt-, i-Bpt-cmlly
when eating encb articles as bi'cad or fried polato&».

Already in a provioua loctnw I haTo insiiirtod on thi;? point, bnt I think
it liest to return to it now; this dywpepsiii of stiirches is in fiw^t a fretjnent
dtM>aM> in persoiiH who hy their prufesBion are obliged to eat rapidly,
phyMciaiiii for instance. Hence it iB that it is not adxiaable to include in
the dietary of such perfioiw, and purticiilarly in that of the principal meal,
which 18 gcnemlly (iHvmirfd witli gn'ntest ha«tt\. niorp than n limited tjuan-
tity of bread and of uniylaL-eoufi HulMtuiiceit. Their n![ia(%t shuuUl he meat
tu]d bread, rather than breail and mait.

.\a you see, we can eumuianise aii Miaihe liaa done, the dteteliu rules
in these two sentenee^; relative abstinence from starches on the one
hand, and eomplete and prolongnd niiuttirntion on tho other.

A« for the iihurmaceulii'iil tn-ulnieiil, il runfiiiitji in the employment
of dia8taa:i, the use of which ie bat<ed on the wundest principles of phyu-
o'ogy- We have seen that when the ^mach does not secrete cnongli
gastric juiee, it ie none^Mirj to give po|)wii and a miiiend acid: tho em-
ployment of liiaalnse is just HB much indicatt«l in amylaceous dyKpepiiia.
In fact, the identity of the diitsta«e discovered by Lhibniiifiuit, and isolated
by Tavern and Persoz in the grains of cereals in the process of germuia-
tiou, with the animal diastase of Minllie, is complete, and botli poseen
the property of transforming starch into sugar.

Coutaret luis done much to promote the proper application of this
diastaM to tliemi)^utic«i, and it is in folloiving his precepts und those of
DaquMncl, who has given a very interesting study on these diastaso
produetSj that wo to-day know the mont favorable indie-ations for thoM
substaneoi, whieh are diastjMC or nialtiuc, the vxtxacts and the elixira of
malt.

XHostau is obtained by making an infusion at 'M'C, of groand tnalt«d
barley, then by coiigulnting the albnmen at 70^ C, und preeipitating the
diastasu by nb-folule alcohol. This is tho proceas of I'liyem and PersoB.
It i;ivi*sau impure product. The i)rocfa8ea of llerthulot and of Schiltwsu-
berger, fumiah much purer diastases.'

'J'liia diii^taw or inaitine, when it is drie<l, conetitutes a white aaotiwd

BUOCAl. AlfD LSTB6TIKAI. DVSrEPSIA.

189

powder, ajuorphous, without aavor. soluble ;u water and in weak alcohoUo
Bolntiom, insoliitltt in ulcohol, tmi) whioli, ne BouchanUt hu^ sliown. lu^oa
its [iroportit-s whcu it is mixed witli uortaiu Rabstancca, Huoh as. alksliat
aul Btron^ ucidtL

You cou make use of this maltJLe iii the dose of from 10 to 20 conti-
^rammce; and horo you bav« two forms wliicli arc in common ut<i.-; tbo
mult |>owder, wlilcli is givvu in tbi> doiio of 50 c-untignmunea to a gmmmc,
aud the «itr»ct of malt the dose of which it from one to two grnmniee.'

There is a «yrnp of fxtmct of malt (oiip jHirt of malt extract to ten of
Hiaiplf syrup), but the best proiHinitioii in my opinion, is Uuqut^nci's
elixir, the doee of which is a tabloapoonfiil at the cummencemenl; of eaoh
med. {DuquosnoI'B elixir ie maiU>ii« followe: Mult oxtract. 1 part: 8implo
i^p 10 parts; Miiluga wino 10 piirts.] Yoii may alfto make iixe of the
liquid Fxtrw^ of iniilt, Imt at thu tnma time with ii good daH of reser-
ntioD, for inanr of tliceo preparations contain but litUc diastase, uiid
eome none at uU.

The subject of intestinftl dygpepsia is more complicated than tlie pre-
ceding, and this is due to the fiiet that the intcrstinc in ita participiitton in
tbs digMtive process has miiltipk' futictious. TIitijl- «k'mctit« concur in
the perfommace of ctiyliforouH dj^'e^iou; the int«etiual juice, the hUv,
■nd the psncrmtic jui<-«.

X^et Qs anm np the physiological notions which we possess relative to
the action of these three jirtnluot* of a-crction. Phyfiiologiata are not
tgre«d in ascribing to inteatitiikl juice a dij^ootiTe action of its own. Ae-
widing to 8omo, tliig julci-, which is elightly alkaline and albuminouB,
•mateifiefi fatji, tratiKformH jtlarrh into Riigxr after the manner of pan-
creatic juice, and has an action un the digiwtion of albuminoid matten;.
Aooordioff to other physiologista, this jutc« has no digestive property.'

You «>mpr4jhond how diflk-ult must ho tho solution of the problem,
by rcowon of the impossibility of isolating each of the secretions of the
difTvrcnt ghinds of the int«>Btine, and tlint arcwrdin^ to the part fmm
which the intertiikil juice is collected, diflvrciit resulto have heca
obtained. But if iih\viology ia itnabl<> to solve the problt-m, from a
elinivul )<oint of view we have iiii|>ortHMt data funiiehod by expt>ri-
meniation in cases of artificial anus, and the experimpnts of niiarli of
Bonn, and of DilTeitbuch of Berlin, seem to us in this re^nl demonstm-
tire.

These hatl to do with certain patients the subjects of un artiQcial anns
bigh ap in the intestine; little suckti containing alhiimiuous snbstaiioes,
were introduecd iiitu the false annc. and were found in the fiPi;at mattcns
completely emptied, the contents luiving appiiri'utly bci'n digi-«tvd. It is
not then doubtful tliat llie iiiti-etinal juiot^ ]k)^<ii'»«c$ a digestivs jMwer of
its own. and this is a fact of oonnd(<rabl« im|j<irt;inee and which wrvec as
Iha toria of the operation propoted by Surniay of Ilnm for atses of

obliteration of the pylorus, an operation which coDBisU in opeuiug the
iliiodcnvm imd prnctieiTiji» niiU?ro«wmy.

As tor the bile, plipiolugiHti UTu Htill in diaugrueiiaml; some tliinking
that this liquid is purely excreoientitious, others making it plaj an im-
portant and notable part in digestion. Here, too, clinical experience
Khov-D «8 on what ado tbo tnith i«; in fnol, in owok of biliarv flRtiiln
where thn bile esonpos hy an exterior opening insteail of flowing into the
intustiw'. there eujjcrvenc profound dietnrbancoa of the nutrition; the
unfortunate subjects pine Bway and Hnccnmb to tho disorder which affects
tUo intestinal digestion-

It is evident then that this liquid boa a real action in the inteictinni
digBition. an action whieh vie may thus eum up: th« bile by ite prwieiu-o
excites tlio contractioDi* of the intestine while Inbricatiiig ita walls, niid so
true is thie, that in individuals aOocted with obiitcration of the bile
duct*, ponrtipation i« &lmo«t alwavB the rule. The presence of thin alka-
line hqiitd also facililatus the passage of the chyle into the lacteals, and it
would seem also that the bile by it« alkaline properties aide the emuUify-
ing of fats, and completes the action of the paiierciia; finally, by its anti-
septic properties, it serve* to eheok pntrid fomientation of tho ulimcntnTy
Iiohis, a fcrmentftlion. whieh, as liotiolianl lias shown, p!aj"B a pre|H»nd('r-
ant jjart in the produetion of certain morbid xymptonis of the economy.
I shall return to thia point vhen I come to speak of the treatment of the
intestinal dieoases.

If there ia still a dispute as to the real digp»t.iTe action of intesitintti
juice and bile, all phywologinta are agreed in admitting the predouiiimnt
aw^tion of the pancreatii? jniiie in the intestinal digeertion. This juice pr»»-
EdiMCB the three following properties: first as Bouchardat and Sandras and
Valentin have shown, of Baechiirifyiiig starchy miLttcrB; nocond, of trana-
forming albuminoid mattem into peptoutw, and tliia fact, foreseen by
Eberle, Purkinje, and Papenheini, liaa been definitely demonstrated by
the experiments of Claude fiemuhl and Corrieart; lastly, it posaoBses tho
cnrioUB property of emulsifying fatty matters, by causing them to break
lip into glycerine and fatty ai'lds. T)o not think that theite effects are but
little marked: the following statement shows you the digiwtive jxiwer of
pmcj'catic juice. It has been proved that imncreaUin, an aetive product
which Oufresn© has obtained by acting upon the pancreaR with other,
will <ionvert nine times its weight of utan-h into sugar, emulsify twenty-
five tiuies its weight of fat. ftuA jwptonizu thirty times its weight of cooked
albainen. The pancreas ia then, you see, one of tlie most at^bivv and
powerful glari.le concenicd in iiiteetinal digt>8tion, and you wo the impor-
tant part which it muat pprform in completing the digestive action of
the buccal and stoiruichal eavities.'

This i«incrpatic digestion has, moreover, been the subj^et of n-rent
very imporhmt tabors; Heidonham, Kuhnc, I'odulinsky, llurzen, hare

BirOCAI. ASD INTESTINAL DYflPEPSIA.

191

shown that in the pancrons tlicm oxirU no ferment, "but a eubstanco
called tfftnogens whioh muy pruiUu'u one.*

All tht? digestive proce-ssea which wc have just enumpnitod takp place
altnost exdusivcly in the small intc-stinc, un<1 socm to cctuw in the lurgo
intectiiie. II«iico it 13, tliat phyuologist^ who urc diapowd ^ oecrilw
sti important r6Ic to the cfecum in t!iu intestinal dipwitioii. sre pum-
pplled to take tlivir facts., not from inHUincoe ol»«*rviH:l in niun, but in
oortain berbivora which have this portion of the intestine verr much
deTe!oix-().'

In mnn the «pcutn is only rttditneiitary, and tho rdlo whicli it \g callcfl
to play in i utcHtiiizil digt-^tion its verv iiiuignilicant. if indeed it Itas any
pnri at all: hence we are led to believe that thnt variety of dx'spepsia
deeoribcd by Bachdct of Lyone under thr luime of )lG»-r»«il dyepejitua
hM no leptimate riglit in the jfroup of fiinctiona) tronbles ol the diges-
tion, and doee nut merit u spei-'iul description.

\4TieD I spoke of bnccal or ftniylat.'t'oiw dj-spepaia, I told you that tbia
form of dyspepsia mitnifrsts it*telf bysymptonis whose scat is the stomaeh;
Ukeviw Btomocbjil dyspcpeiA may be Attended with intestinal firm^itoroe.
[showed you that in putrid dyspepKia in wliich the socTotion of ga*tric
juice is not sufBeient, tin? albiiniinoid niallerK pasa into the inteBtinal tutw
nithout being peptoniitcd, nnd if the secn-tion uf jiancreatie jtiJce ia not
cnfiicientty abuiiduit to complete this dlgcetion, tbeee nndtgeeted sub*
FtoncM, it is ciuj to undemtiind, act a» foreign bodies in th« intcetinc and
determine colic of a more or less Bever<> nuture. Yon liare the ty[)e of
ilib in crapulons indigestion, in which th» indiridualH not only romit
their surfeit, but also Buffer from co1io and ()iarrli(ea.

But th<^rc in a rery interesting point to consider, namely, what be-
eonica of the [H-'ptoniwd HubatiinfBH when they rennh the firat portion of
the duodenam. We know tliiil gRatric jieptoniiatioii lakes ]>la<!0 only in
an acid mrdinm; arrived at tho ampulla of Vater, where the bite duet
and pancreatic ducts meet, tlic ohyme finds an alkaline medium, and
tlw work of peptonir.stimi by tlie giutLrie jiiiee muRt eo-nRe; nothing now
rrniaiiis but the panipi'plonen of MeiBaner, timt is to say, thnt precipita-
tion which takes place in the acid |)eptone-8 when neutralized by an
ftlkali.

This phenomenon is plain beyonddiFputt; it shows that Loven's theory
tliat tho alimentary ^tibxtaiicetJ i<imply {uuffi through the stomach to un-
der:go the chemical profeciMy <if digcetioTi in tlie intestine, is not quite in
•ooordftDOO with physiological facts, since we see peptonization eonie to a
atop in tlie duodenum. We must then admit with Itichet that tho ali-
nwntfl remain in the stoimieh n siifticient time for the |H-ptoni«ttion of
nlbuminoid matters to Ix- effected, and that it ia not till after the aocom-
plit^hment of this act that the peptones jsiss into the inti'stine and uro
ttlt»orb^i in u ucutml or alkalino state bv tho vcsmIs of Uiu iututtiue.

n

192

DI8EASKS OP THE ST03IACII.

Tbm fact in important; It tihaurB uh Ibat the too rnpid pagsagQ of tili-
nivntii from Uieatum&ch into the intestiDo by reason of inordinstu Brtirity
of the muscular coat miLy bo a canHo of mtcetiriftl dyspepeia, resultiu^
from Uie preeonco in the intcKtinn of a fjunntity of food aubsUuicee too
great for the pancreas to digest.

At otlicr tiratw it is the pyloros which by il! performance of its rAle aa
porter of the stomach, (tuAv port, ovpoe keeper) leta non-pcptoiiijMrd
liubaULni;!^ {xuat out of the stomnch. This inoontinoucv of the pyloruB,
which LoniK de Serf waa one of tho first to point ont, ha« always iu-
tcDtiiiul (lyspepititt for ita iionsequcncc,'

I iitfittiaul dysi»cp!<la, wliutliei- resulting from incomplete digestion of
albuminoid and amylaceous mnttors. whether from too great an abun-
diuico of fatty RiibstancPB, whether from inwifflcient soerotion of paucreatio
jnice or of hile, always muniicwta itself hy the following Kymptoms: Tlie
patient exiHTieiic-ea some coiisiderablu time after eatiug, uhdomitutl pains
ol greater or lees severity, horborygmi, colic, uncomfortable distension
of the intestinal coils; finally, there ib a mnrv or leiw ahuiulaut diarrhcea.*
What treatment will you oppcwe to tluH order of symptoms?

Just uH we atlviaud pi'pwii in the fuiictioiml troubles of gtwtrtc dige»*
tioii, and diastiine in buccal dyspepsia, wo here employ puncreatiti, and
Defresne hits rendered a real service to ihcmpoulice in iiitrudneing this
KUbaULiic^ into the materia mediea.

Pancreatin, obtained by the action of ether on tlie panerean, presents
ita^lf at Qrst in n TittuouEt KUte, itftor which il is eva|)omted to dr^'noEs; it
is precipitated fi'om its soUitions l>y atcoliol; at the tem|KTatur« of TU° C,
(15S' F,), paiicrwilin is rendered inert; acidg ami jwwerful alkalies
destroy its digestive pro[>ertiBii, wliich neverthelesii manifest thenrndves iu
a feeVily iilkaliiic: or ucid medium.

]Jefre«ie has devised many preparations of pancrefltin; he has mado
powders, pills, and an elixir. Tlio jxiwder if given ihesolvcd in water, or
in t'ai»siile-R, dose. .1 to 10 graina The pills, each containing :i grains, are
given licCure meals; doso, 3 to S. The elixir |h n good prcpuratjon; each
tc-iispeoiifu] contains 4 grains of the active substance.

Ail iheae preparations are administered either at the beginning: or
middle of a meal, for pnncreatin ought to be Uiken along witli foo«i_, of
which it aids the digestion. In fine, the use of tliis medicinal agent mnst
bo eoutinuiMl a loQp time; tills is a point on which our colleague Ilucluird
luis iiistly insisted, in showing ue all the advantages wliich may be derived
from ^laiiereHtin in gsietro- iiitestiniil dyspepsia.''

At tlie isame time, do not forget iliat paucreatin, like pejviin, i« a
ferment, that is to say, a eubstance that easily «poiK and that often its
tiientpeutio effects are rendered nil by reason of the profound moditica-
tioiis which this ferment iindergoea in its pre[mnition. You so© then
that hero too, the most imjxirtunt r6le still belongs to hygiene.

BUCCAL AKD INT£9TIDrAL DTSPKPBIA.

193

BeooDimettd tbcn to yanr putietits affecteil with intestinal <1;spepiiia
ta paj eepect&l atteiitiou to their food, uiid ti> takv uiily thode alimvnts
Thich, in little Tolum«, are the most nourishing, in ord^r not to impoae
too much vork on thie part of th« nlimontary canal. Order a diet largely
aiotizod, und livoiil as munh an poKKible tttts, whain digpittion in performed
exclaiiiTcly by thu iinnLTc-Ms. Butaliovu all. proseribu, abeolutcly, from the
dietary of your putiviLt cuiie tjugur; you know in fuct, aiuce thv tuburs of
Claade Bernard, that the tran^forniatiou of cuni.> stigur into glucotae takes
piscv excludvoly in the intt>stine.

We have now to ransidor tint tn^tmt^nt of the colic and flatulent
divtc^aion of the iube«liiKu« which oliaracturixu tliuuu etutcB. Wo have,
ill fact, wliilo OQ the subject of giistrio dyeptpsia, seen perturbations
in the functions of the inutuiilar eout produce Njieuiul dyspeptic dis-
orders; likewiae if you analyze the disturbances eneuiiig in intestinal dyt-
]K-pe>tii. you will sec that y«u miiBt iiscrribe » considenible share in their
production to troublfs affeetiiifj thu mu»rulur inveetnient, and that, iio-
cording as the peristaltic reovetiiente are exaggei'nt4M] or abolinhed, there
cuporruue more or le^ i;(^riou8 demngoDients in the digestivo act; this is
what Svi ha» deacrilH'd under thr name of intestinal atony, and which he
ootlBidvni ae j»Ktudo-<ly8]J0i)«ta. Hut an I proiwHu to devote u wrieB of
lectures to the treatment of intestinal affections, I shall return to tbcec
points when I come to »puuk of the therapeutics of diiirrhoia and eun-
stipatioo.

We have seen that in the treatment of stomach dyspopsijui there are
uoUiplo prepiiratton« applicable to oeveral forma of dyspepsia; tlio eamo
Btay be mid of dyapcpoia in genemi, owing to the ingenuity of pliarma*
eistx, who have endeavored to associate in complex formulae the principal
fermcota ot digestion; thns we have comixinnds of diastase, pepsin, and
psnomttn. Hnch are the eiipeptir pre]mnitioni< of Tiey, the " Pepsin
and INutaeo Wine " of Chiusainj;, the " Klitir of <Jre>[," ete. I am inclined
ki tliink that thene eumbinations do more harm tlian good, and tluit in
Boat f niirwi the attentive study of thu different symptoms presentv<l by the
I»tient, will enable you to decide to wliut purticular ferment yon should
give the preference. "

In the next chapti'r [ Bhall eonxider thu therapeatica of the Bccondarj

I

NOTES TO LECTUKE XTTI.

"The saliva, product of seeretiou of the different mliTary glanda, m a
liqnid which is ordinarily alkidine. and only eTcvplionally aeid. The
oom]>o«tion of mliva, iiecording to Jacubowitccb, is aa follows:
13

194

DL6KAdKQ QF TUK BTu^IAOU.

•

Water, 905.16

Epithelium, 1.63

Ptyalin l.'M

I'h'oHrihuUf of Bodium, 0.9-1

Alknlitiu cliloriddS, V.8-1

Sulptio c^r^nitiie j^otasHinm O.06

Limu, eombini?'! witli oraiinifi mnttcr, . . . 0.03

Ma^OBia, oooibtQuil witu orguoic mutter, , , 0.01

100.00

Aocortling to aome physiologisls, Htitpho pjanide of |>nUu»iuTn doeit not
CKist ill huiiiftii Buiivu; acROrduig to [joii^t, it lb constant in tlie saliva
from all thi- gtainlct. i)urotid, fni1>mftxillnry, mihliiignat anrl buccal; iU pru»-
I'lRv in L'lmnu'U'risliir of 8u,livn. thoiish tho fjiiaiitity iw but inci^iilluiiit.
Klct»in^ki 18 of opinion tlutt tliie mlt Hog for iltteiiil to prcyrent the deTelop-
merit of fiTnu'iiUitioii in the Buliiik

PasUmr h;is found in human «a!iva a mirrolio of figure of 8 aspect,
uiiti v..>ry ininutL', (^MioTorocciia I*isti»iiri, Stornliorg). ThiB microbe
<^anrtcH ilfiitb VLTV mpidly in tiit* Uiin^. by producing un intvnso congestion
of thH hingH. Arnumit Oiiuticr in liitt burn. h:i« »}iqwii th»t the italiTa of
mnn fonuiiiiB in the iiurmal sta,l« ulkuloiiU hnving n toxic action for
cvrt«in uuimalu, nod in imrticulai', birda. Thee-? iilkiiloids oro MuUogoas
tu tht auitnut ulkuloidB wliicb be baa deaci'ibL*d uiidi:r the iiame leuco-
muinuH.

' I>iiLstnM> is prepared in tlio following manner:

Malt, dried iit ;t tenijwnitnre of !)9° ('., {122* F.), U rodllcod to ooetw
]>owdor and jnit to macerat* for an hour or two in twice it« voliimo of
watttr at '-id" (!, (86" l*',). When tliu niaccmtion is tcrtiiiiutt<Hl, tho ■whole
nuuis {k Btruined tlirongh a Koarse linen cluth and fxprKsswl.

Tim liquid obtained is heuted to 10" C. (tsu*^ K.), in a Hon-bath main-
tained at 75° C, (1G7° F.). As eoon as tin- albuiiion is coat^ulntud, it in
Btruineil auL-w through linen, or belter, filU'rwl through jjapor, if thy
volame of the liquid bo not too jjrent. It is tlifu allowed to cool, aiid
aWhttc alcohol or alcohol vcrj- concentrated is turned into the liquid,
vhit'li is kept o^itnted. It is necessary to nso a considerable quantity of
uli;ubol. at Ivnst seven or eight tiine^ the amount of the liquid employed.
The difietiiap, insoluhlc in tho nloohol, ie prc^ipitatM under tho form of
white llakra, which are eolhtctud on a filter, and then spread in their
moistened Ktate and dried on gliuu plates heated jn a stOTe &t the tem-
jicrnture of 40" 0., (10-;° P.).

The product obtuiuvd is pulvcriaed, and kept in dry flaake. Ouo kilo-

Sranimc {'i Uw.) of ninlt uives about 15 pnimnics <2'.J5 grains) of dried
iust:L'4e. This niaj Ix? htilT further purilietl by rediiatolviiij; in water and
ri'-preeipitatinK by alcohol. J)uquo8ner8 methoil k still more complicated;
tile iliaBUiM) in urvcipitated by tn-bwio phoephate of lime.

Diastase, which jmjimwmos thu propt-rty oi traniiforming into Bugar two
thou.<tand times its weight of stjirt'li, comiiienL-es its action on hydruted
Btarch at 15" C (h'J" )•.), attains iU) maximum of intensity at 70° C.
(15t»° F.), but loses its properties at fi5° C. (187" F.). This, saye l>nqne»-
uel, explititi» the inurtuoatof agn^t many of the diostaee prepanitions
which are made ut too liigh a temperature.

Diiqucsnel'a mode uf testing diaKtofie:

BUCCAL AND IirTEBTINAI. UYSFEFSEA. 195

'luku n wi(k' luoutlKnl ttuifk; ]nit iiilo it 10 pummcB of ti 10 per r^t^ni.
tulatioii oi ittitrch; af1<l A CfiitJgniiiiiiiL'it of thu (]ia»tjuti.' Lo •-xiiiniiie: Htir
logethur villi a ro>l iiiul h^it in :i si-ii-lmtli ut Lhu tumpLimturi' ot W C,
(140* F.)> At the ciul uf a cc-rtiiiii time, if the diiietoaL- ia goo4, tho
•tarchT j>ult«ceonFi mass will tin hwti to iiiii(lei;gro tlimg^regation, Uqiiiry
an<l i»iee liltie bv littio its prupt'i-ty of timiiiig blue by iodiuo, a propertjr
which ends br dmippitaring nltngciluir, iiiiil oftiit in li«i than nn hour, if
the quantitr ib not iuc gruiit for the diostjiso in thu fliistc. At this mom<.-ut
the transfonnation is coinplftt;, Ijut if niio wmild mtjisurp llie saccharity-
in;; iwrcr of the diastaae bv must have »H.ro to employ lui excess of the
riunh wtutJou.

VThvii the reaction iit c^tniplfli'd. tlmt ia to siy. afbvr wwrul hours
(l^nerally about8ix)> in ordur to bo hutv yon have not :imi8t(.>d tho oi)em-
n'on too quickly, yon add dirtille«i water enough to make a volume oi lOO
cubic cpntimi?trea: you agitate imrefiilly and tilti'r. atid in thit^ cb'ar liquid
TOn detect tbf? prespure of phiws^t by F^liMng's tdandard pobition, wliiHi
» without effeot on a Rimilur c/tfci- mhition of Btareli which has Iwen
heafcod i» the eumv coiiditiouii, but without the jirodt-nw of thu diaetaw.*

'Thore aro scTeral Kxtmcts of Malt and tilmilar prejmmtions which
goby the name of Maltin<T. maimfanltirL'd in thitt country, and in cminral
ate. Of them-, I may »mt:if y Tmniraer's, miuh; in Fremont (Ibio; Keaiibv
and Mattisoii's of Stw York: — tliese estnu^tw are some of them meilieated
with iron, trtrychnine, quinine, pepBin and panpreatine, bi-pophoi^hites,
ftf.

Reed and Carnrick make a very fine " Malline" plain or mwliaited.
The well known linii of Tildyii and fo. maniifuL-ture various forms of
nalt extractii. The dose of all these preparations is fi-om a twwpoonfiil
tos lablesjioonrul, after meiLla; }iatient« generally prefer t« take tlieir
malt UDdilute<). Amend of New York miikes an excelleiit Malt |M>wder,
the doee of wliich i* a teasyKyinfui . MaBee'* Malt with Uod liver oil and
Srrup of llyiiojihoHphites [g a very pluafiant mixture, in which tlie taste
of ooa liver oil u almost completely disguised. Traiia.

*

*Thero is found in iho iutratine, lin^ides the mixture formed by the
alira and gastrit; juice, the bite, ami [lanrreatie juif«, a liqnid eomposed
of infwtiiutl jtiiee, and mueuH, and tus^retecl by tli't' tnhnlar glands ot
Lieberkubu and the folliclee and ^laiidn of Brunner.

The function of the intestinal juioe bus loiijj bi-eu misunderstood, btit
ttMlar it is pretty woll known, owiiii;: to the lilbors of Uallerj Ijuuret, and
Imm^c. Frerichs, Itidder, and i:>cnmidt, etc.

Thu intestinal juice i^ a colorloss visi^niiH liquid, of ncid reootion, un-
coigntabltf by h«at, and giving an abundant preeipitjitu with alcohol and
the metallic twits. Its density at 13** U., is 1.010.

CoMPoamos op tiik Intestin-ai. JncB of a Doo.

(Itidderaiid Schmidt.)

Vater 98.

Ornnic matter 0.5

ai&a, 1.5

196

DISU&SICS OF TUB 8T031ACIL

CoKPOftiTioN OK Iktkstikal Jl'ick of a HoR8&

(Colin and Laasaigtie.)

Water 98.1

Oreanic matter, 0.45

Snltft. 1.45

Acfionling to the labors of 0*Fimk, who G^jwrimcnUftl on luireii, and
tljose of Kolfiker iind Mfillcr, whose oxpLTimBiits were ncrrarineJ on oita,
tlie iiitostinul juice id different In hcrbivoiu mid. cariiivora; Unit of tliv
herbivorn ]m» no effect on albumen, while that of the caniivora dtgMts
albumen woll.

* PfttiereRtic jnice ia ponred into the dtiodoniim by two distinct dncte;
that of WirBun^i uud the acccseory duel. The Bccrctiou h intermittent and
like th(^ bite ih itiual nbundaut at tUa time of meals. Claude Beniurd hiut
aluo shown timt wheu you (.'XjR'rimont with jtancrL-iiticj flittulafi in animals,
the iiqiiid collected at the bc^inuinj' of the ex{ierinu<nt in viscouti (tliJs is
nonnul pancreatic juic? ), whdc at. the end of the cxperlmvut it btx.-oni««
watery. The notion of this juice liii« heeu stndiwl by miiur phyetolouititH
(Tiedcmannand Gmelin, l'urki:ij«-c and rapouhcini, IJut cepeoiwllv l>y Val-
entine of Itonie, and Bouphanliitaiiil 8andras of I^l^is in 1844). 'fhe latter
miwU' uw for their exjionmoiits of ni-tifieial juice obtained by ntaeenitiTig

Sortions of paiu-i-wis in water, liberlo in iH'Si, wits t!io first to point out
le at'.tiun of piuK^i'ditic juicu on fntK. ftnncdiardiit and Samlrua have in-
KJiited more particularly on the Ku^i-harifjing pmrnTtiea of thin jaiw, anil
Dondors, hy his o<cpenmonta on animals on whicli ho hail produced a
ponoreatic Htttula, iios put this matter beyond doubt.

In 184C. Claude Beniuitl showed tho jiroperty which pancreMic juice
po««e(%L'£ of tiiuulsifyijig fatly bodies b^ dvoompo&ing them into ^tty aoida
and clycerine.

The proi>erty of digeating albumintiid matters has been contested bv
Keferstem and Uullwachs, and ailniitted by Corviaart. Urinton, iu»\
Mei»int)r.

The eompoffitioD of |)unercatic juice, according to Ticdomann and
Gmelin, and Itidder and tSchmidt, id an follows:

fAXCIiEATIC JUICE OP A DOG.

(Tiedemann and Gmelin.)

I'AIfCttEATIC JUICE OF A DOO.
(Bidder and Sclimidt,)

Water,

Organic muttt-r, analogous
to albunii'ti, and iuaoh\-
ble salt*, .

Matter aolubln in alcohol,
(atul aitts eoluble in alco-
hol).

Matter iinlnble in water (and
salts soluble in water).

91.72 Water, .... 90.08
Orf^nic matter (pancrco-

tiii and muvue), . . 9.04

3.55 Salts, .... O.M

3.86

1.63

100.00

100.00

*ZyirLOgcne 19 transformed into pancreatiii after death, Hurzcn prc-
t^mds that under thu intluenco of tho paneretito^enouK niatteni contained

in tho blood, tho pancreas chaiges itaelf with zjmogene, but that th&

ItnOOAL AND INT>STINAL DTaPKPSlA.

197

I

»

Inttvr dooR not becomu poiicruulirL till tL« sutceii has fitmUhcd it a i<i)erial
fornii>iit. Tliw iHJiIw) in accoriiuinjB with the fmU silTiuioed In* Schifl.

Albertoiu Itas shown that the iHgestix-e power of the |«uicrctt« on
abuminoid niftttvre niauifests itself in the fi?tiia »t tho com mitn (foment of
Xhe hut third of intrauterine life; later in fact tliAU that of the stomach.*

' It M cfiperiftUy in th« hurbivoni tliat wc finil the rjpcum vohiniinoas.
[n tlwt home it forma a jxmch with a oajnicity of 35 qimrtii. It in also wry
IftTffr in the rwlentia, »nnh iia the hurc and iwrcupincL In the carniTom
it iiiK»roo]y more than nidi men lun'.

TfaH-'belet of Lyonx, hiis laid f.'reat 8treB§ on th9 anatomiosl relations of
tlie hurge intestine, which almost eovent the etoniach, and andording to
him, the pretended f^stric paiiie of which a great number of dyspepticti
coniitlain, Iiave th(.-ir Beat in the trannrerHe colon, f He attributes to the
large i»tviitini> and to the cfBonm the di^extion of noii-iizutizi^il foude, and
ia oertaiu cases of dyepepin with non-aiwimilfttion of fats and etarch, with
groat emaciation, he lirlievon ttiu fault to ho with the alwre mentioned
portion of the digestive tube.

•"nw pylonw uiiiy commit many iiegligoncee; it mav CTon lone tta
property of contnietioii and n-iimin relaxed: tliia incontinence has for
effect to prevent the sojottrn of ulimentM in the Ktomach, mid tliua to bud-
UUH the stoma-'^hal diptwtion." Lunin de Srre, '*(}h ihe IWt of the
Btmnach and of tUt Pylorus in Di'/tvUoji,'' Paris, 1874. He add* that in
other CMaea tlwro are painful spiuimK of the pylonis, and tliiit ihJH state.
Irhidi is generally dua to on irritation of the solar plexus, ^.tfually stops
gwtric digestion, by arresting the aeci-etion of gaatrii; juice.

•Cniilet ia of opinion tlmt the Utc appearance of the dyspeptic pha-
nomeiia is not sutlicient. to compel the anniiKsion of inteKtiiiiil dyHj>epsiii.
Up thinks that digestion goes on at the aimo time throughout the n-hole
fxtcnt of the active portions of the digoslive tube. The mtestiiial diges-
tion, aet'ordiuK to him, hf^na at tlto same time an the Hlomach digestion.
In fine, he aflirmn tliat iho tardy appearance of the tlppeptic maitifeista-
tion* IK ehanictorlHtia of ga»ti-ie di,-FjK>}isin, and e^poctatly of atouic dys-

"I)efiT«no pre|)are8 jmnorratin in the following miinner. The fre^h
pmerciM of a ueg is trilnrated and reducetl to a pulp, and placed with
ether in a recipient; the whole ia Bubmitteit to a temperature of 112' F.,
for twentT-foiir honrs. At the end of this ]«!riod tlie f^landuliir [lart-t are
rQCnpletefy remlreil into jwiicreatie jiiire, while llie fibrous titu^iie llonts
en tM Boffiico of the liquid. Tliiii ethert^al solution of p«Qcrvat(c jnico
Ik then oraporated down to a dry etate under the influence of a strong
cnrTfnt of air. at a t«mpera,tHrB of 104° F. Obtaineti by thia procoea,
panemitin preaenta itwlf nnder the form of n pale yellow powder, rerr
wlublo in water, of a fnsh. animalizLsI saror; its solution iRTiieonaag
pKUcreatic juice itaulf ; it ooaguhttcH en numw by heat, like the wliit« of

* Bersen. LesBona on Digestion. Pireiuse, 1977. PotlotiDnky. Arrli de PQug^r.
t. xili. p. 432. Weim. Virrliow's Archiv., Ixviij.. p. 413. KuIiimi and Lea, H«i-
rdoih., Nat. Hist Med.Vertli., L ii., 1879. Albeiioni. On the D)gcetiv« Power of ttio
HiGRfia in Fo-tnl Life. Lo Spei-imeitlule. foac. 7, iSi^
I Bkulielct. Nniiveau Ouldo dii 0,vsp«pUque, Pari*, 188S.
t8o«. tic Hjdrol.. t. aviii.. «, iy73-I97i

_^

198

DISEASES OF Tire STOMACR.

ogg. Alcohol precipitAtes it from solntion; tlio procipitoto, Boliible m
wnter, ia the punrrnitio ferment, ivhilu thti liquid jmrt is incTt.

Accortlinp to I)efr«-aiH*. l.'i pniins of piiiK-ri'atiii liigput 4 OTince« of
flbriti, an mjnon' iiikI ii iinlf of frcsli mmil, or 1 oiinnn of cooked ullninii'ii.

Tht! i»incrx»ttn pills iiro mmlt an follows: Tako of [mriicrditiii, 3 i.
hoiu-y gr. vijub, tnugricsiu rj.s. F. S, A. pil. No. xx, (which Bhoiilti be sil-
venKl). >ji(3h pill amtsina a littlo muru lluui 3 gmiim ^jaiicrcutiri.

Kmxik or Pancbkatin.

Tnk.- of:

I'nticrcntiii, -1 |)art&

l)r>- whJU' wiiH', T?0 *'

Crvstiillizci) fiiisir IT5 "

Tiiietiiw of poKGL., 10 "

M.

I

"Moumit and Vulpian Iiavn 4lncl]HTd thRmscIviw upposod to the
anocifttion of difforfiit fomionts. Porti'B Iulr slmwii that, poptcin and
diaBtaM &ra not iiicompatiMu; bat, occorditig to bini, pcpein imd pan-
creatJti caunot be uosoelatcd.*

BIBLIOUKAPUY.

PurklBje et Pfrppeah«lm, Zur Kcntnisa der Tordmning im R^iindon und
ktmolicii ZiiMwnd, lS3ft. MajTpnilk' rt RnyiT, 0<>nij>, n-ml. dt- I'AiyuJ. it<^ w, CI,
Benard, Rccheivh^s sur los lutagfn du giic imncr^ittiqiie dnnn la digostjon (Ann.
dodiiniie, XXV.. 1!4«). Bouchurdulvt Huinlms, Ana. dcTL^mp.. 1843. i.l., 1845.
CI. Bernaitl. Annales de chitiiie. XXV. , 8" partic, l&4fl, ol coiire ilii |ih ysiologip pro-
fi)ss£ uu Colleyi! d>' Fmnw. lAW-IBSB. Lcnx, IK? odipM i-«)iii'oetlonii. clc. Mltuvui-,
145U. Uiddcr ot K(;Umidt, Tmito des msJiwIics (Ju tc>iv, titul. fiitu,^-. juu- Diiiiii>uil
el Pe.llnj^iL, Ittns. CurvlHurl, Hiir urn; roiiirtion (leu (.-unnue du |)an<T/^a.t (iUa.
Iipbil., IR57). Function ^n>.>i-gi(i«iadit puiiir^uN Kiirk'KiilJiii(>iilK ii.zot«j« {Gax. liebd.,
1660). Briutua. Ol>scn'. uu tliu AcliouuCUie Putii^i-eatiu Jiiii.-(ioaAlbunK:n (Dublin
QuurUrrly Juiii-uiiL of Mpdicwl Scirmc. HW6). Vun ili*n Coi-|mt, Union phamiaccii-
Uque, I", 1 yoar. IWM, l*| Union ni^rfimlo. a«B*Hf. L VJU... 18S9. Chunvm. .Votft
sur 1b sue panci'&itiquelHidi. Jo rAi^ad. de niW., I. XVUl., 188B. ct Union midl-
cale. Hosirii', t,.\T^Ii.. lB.m. Liili<)rUf, TrilmiiH iiiWR-alf. Diivmljfr. 1H74. p. 118.
HiiclianI, Union mt'(U«ilr, 3"s^i-ie.l. XVII,. IWW. 7'<6pt 779. tx-frpsn*. Rpcherchfe
exp^ritnentwlw siir Ic nMe phy«iwlosicnn' i:t lli^nipimtiituc iltr la [NinciYtiliHi;, 1875.
HaUcr. Clotn. physioL. VH Tii^lem&tLn de Gnielin, Kevherch^ cxp.. physiol. i.'t
chimu)iii>£ sur la di]?e»tlan, titid. do Jourduu, 1HI8. l.i^urot i^L LfutAui^ni--. lii^cJir-j'-
chfes pour servir i I'liistoire de In digration. Fi-eric.hs, Die Vei-dauiiug' (Wagiier's
Hundwortcrbiich dcr pliysiologio, t. ID.). L(>l)miian, Lehrbiich iler phy^iiiila-
^'iacliuu Cltcnuc, I. II, Bidder «t Scliiiudt. Die Venliwiung^Baftc. Ctdlin, Trnitf
de phy.^iokipi? L'oiiipar6c d«t Bnimniix domeftiqiies, 1^54. Hiim'Ji, Ht^itrtJj^r xiir
Phytiiologio dor Vf-rdnuungaor^ne (Arch. fQr pii.thi>lo^ai-he Annlomiv iiiid
Physiologic, 1858). Fiinkc, Lshiburti dcr Physiologiti. KOlliki-r ft MflUw,
Ueber daft p!iy§iol. InsUtiitzu WarzlmrK<I. Bcrldit, |». 221; Ii niTicbl. p. 77).

* Jour, des Connala 11^., Augunt, 1870,

LECTURE XIV.

SECONDAItY DYSPEPSIAS.

SuvuARV. — Secomlftn,' Dyapopwas — C'lmliiic, Ilopatic, Tabotio Dyapcpaias
— C^hlorotic Dyspepsia — Kvils u( Ui« Furrugiiinus Mfldicjitioii —
Dintlietic, Scrofnlons, Mer|>etic, Aniiritii; Dyitpvptiiiui — DisorOeni
Cona&cotire to the TJysp^psias— NcrvonaTrouWeisof Oiuftric f Wgin —
Stoniaclial Vertigo — Aklomiiml Angimi — Multiple Forma ot Dyspop-
fiia — (.'ontliisioiiR.

Qbntlbxbn: Whcu I was cngagiKl in tracing tho plan of the djra-
pepedae, and the dil'ieionu which 1 proposed to moke in tliia group of
hinetioiul disonlorji of tlip trtomncJi, I told you that thcro wore secondary
dyspepMan wliich u«i.'i.'f«iUtLL>d h spt^cia] treutment addrt!ttt<e<l nii>ro pnr-
tioularly lo the cause of the functional trouble tlmii to the diiaonlcr of the
Momach. Without here attempting to treat this suhjcct ci^iiipli^tvly^
which would rt-quiro Bcvcral loctures, a subject, moreover, for which I must
refFf you to M[)L>riul treaUsos luid whioh you will find wpII handled in tho
Kniarkablostudvof mycolleagiio lUymoud " Ontlie nyitpepiiiiAii,'** Idmiire
nerertheleaa to call your attention to two or three varietifs of this )(roup
of dytpopsiu.

Here we Rhall havn to conaiiior tho dyspcpgiao from two principal pointa
of view: SrsL in their relation to the aftectionH of which they an? a mani-
fi:«tatioD: second in their relutiun todiseattea which may in their turn Iiuto
(or origin Ute functional trouble^) of the stomach.

Tho local afTectionsvhicli may manifest themBolvM by Ktomoch troubles
■re nuuieruiiH, and we liavo slrwitlyj while on tht' subject of vomiting,
Epoken of the dysix'ifflias wliicli have for their point of departure tho
ntcnu and kidneys. I ftliall not thon retuni to this point, and ahall only
gl&ncw ut tho fuacUonnl ^mtrie di^rdors which accompany diecuwM of
the hi-iirt, lirer, and nt'r^oiis xy^tuiii.

ItariiHud, Slid inoru n-cently Prof, (lermain Sc^- have shown titat cur-
tain affections of tlio heart, of lurt-atcd form, may nuuiLfcet themselves by
dirtnrlmnccB of the digestion; thoJ>a are the tmo cardiac dyspopsiafi. Ab
for the liver, Scnac Iuir pointed out th« unportanoe of functional trouble*
of the rtomach in the diagnosiH of gall stonea. In patients affwted
with biliary calculi, apatrt from the [lainfiil cria(>4, yon in fact, neca more
or loK obatitaate dyspepoia almoet oonstamfly pn^aont, Uygpcpein of n dis-

• Ka,\-nioD(l. Dw Dysp^psiM. TW*n d*Agr6gatioB. Parw, 1878.

■

r

msKASKB OF THE 8TOMACI[.

treoning form, returning vrory duy in puroxysnu, apptmring cepeciibllj
about ui^btfall; tliese symptoms of hcpatio dyspepsia do not disappear
till tti« iwtiuDt is frotHl forni liis gall etouiw.

In regard to the nerrouK xystem, you all know thv voinitinga which
Accompuny cerebral ulToctionH, uiiti m particiibir, ttioHn of the meninges;
loeionH of the H)>iaa] cord ha\<i also a lourkcd. action on the dorclopmcnt
of dyHpeptii! disorders, and wo hiivo here one of the must diffipult forma
tfl trout. When \ come to speak of the truatmont of tliovhrotiiuniyelitiK.*
t iftiall dwell mcM'e iHirticularly on thwio tronblfid of the ftomach, which
Charcot vtwb ouc of the ^t to doscriUi miuutvly. But what I can ueaure
you is thnt thoso disorderg arfl esporiullychara^tmstod by crisoB of piiinfwl
dyapeiwia, which of ton niaui/est tlicnisfhcs years hofori.' tlio appearance of
tliiO mednllary pymptoms. Therefore, whenever you obBerre in a patient
thow) painful paroxyeniB, repenting thomselvi-H at intervals more or leas wide
ai'itrt, and rebellious to all ni«tnt! of treatment, examine attentively tbc
Btttto of the lower enlromitics (whieli mu-yalrwidY show syinptoma of com-
ing )uiraly8iii) ; examine aJMicavt'fiilly theot-iilar phenomena, and you will
often find thnre prmoiiHindicationsr(!»pix;ting tbc origin (if this djB|>Bpflia.

Alleralione u( tbu blood also fci^'e rise to dyspcpeiiui, and one of tho
moitt frcqiiont al tlieaeis tbat fortnwbtuh it: witnessed iaaosmia. Almost
all chlurotieti ure dysjiepticH, and this i6 a fact which, hy \t» frequency
forces itaolf on the observation. I have not time here to Hiiidy in detail
the treatmentnf atiatmiu and chlorosis, and must rt^fer you to the cliaptors
devoted to the subject in my third voinmo.* I muet, however, put you
on youi' guard againut thu evils whiub may result from fiirruginoua medi-
cation in ttiese cases.

Iron, in tstct, in many canes, instead of «nnferring bnnefit on patients
suffering from chlorotio dyspepsia, only auRmonts tlic paBtralgic state,
whatever the form of iron wbiL-h you adminisU<r. So in this painful
dy»|iepsia of theaua-mic, I muuli pr»ffer arsenic to iron, and I join to lh«
amenieiil medication, the appi-opruil*t dietetic means, that Is tn say, the
uttiigv of Dudcrdonu or raw nieuh<, and meat powduni, iiydrotherapy, oxer-
ciee in the open air, gymnastics, etc.

A8 fop tb»i diatlieaes, they have a vory marked inflmtnoo on the dyspep-
»ia«L This subject ha.* ln?en tlioroiigbly studied of hito by PJdoux,
Bourduii. I)urand, Fard'i'l, and still more recently by Comillon and
Scmw; r^rango,* We shidl have to consider suoceastvcly tlio inflncnce
of ucrofuln, of her[H>tiHm, and of that of guut and rlicnmatijon on the
development of the dyspapsias.

• Clinical Themi»cutie«, <i. S. Da\-i*, Part a

t Ih.. DetHiit, !S8B, page IM.

I Svum; Lngruiij,'!-. On tho Natun> ii( Uio DyMptiiMiuK anil tlii'ir Vitiil Ceiiditioru
as Bi'uugbt l(> Liyhl by th« Uso o( the Sul pburous Watom, nutably those of Cau-
teivU. Bull, dfi Tli^raii.. t cvi., [i. 187.

BKCOKDAJtV i>YSPKP8IAa

Of all theae diatheses, scrofula is that which hiw the least ti-ndrncy to
det«nniiuttions toward the stomach; it is not so vithherpetiam, and
TOD know that Pidoox who hna greatly vxtoinlod tlio domain of this dia-
thcKii^ ooRfiidem tlw must of thv dyHpejHiijis, and «ti]H<oiallyt)io«ti which UK
of a [Kiinful ord«r. as due to lierpetisni.'

If nil are not yet agreed in recogiiiaing the existence of lierpetio dys-
]>epdia, there is no dispute ae to the iniluenco on dyspe)>8ia of urtliritism,
thi> wlo sonrce, according to Bazin nnd Pidoiii of gout and rhininiatimn.
Just OS It in the rule to see the he»rt alTertoil in ucnte articular rhou-
0, 80 it itt rare to dnil a gouty puti«ut without Btonmch troublea. So
rluiurTer in your patieuta you nK>et a dyspepsia which ia oUtinatu, pro-
itind, resistiDg tbc means habitunlly cm]>Ioy«d, be persuaded that you
h»TP tn do either with gont, or the prmlnct of gout, and in your practic*,
gmntliiRii-ii. you will oontinmilly find confirmiition f>f this fact.

luthcM.* cascH tlu'tn-atiiiontHhould bethri-cUsl not only t^> tbc stomBch,
Vat also to the gouty element, and the uric diathesis which cxieta in thin
nort of dyspopgiu. Employ the alkaline preparations, and eKpe^ciallv those
of lithia: suixrvineat the name time the dietary, so that the azotixed inatt^
rials may ho in direct proportion to tho utuscuhvr labor and the exercj«e
the {wtiuut. As fur the- ro^imen, follow as a ^uiUu Liiu excellent iiidi-
itaoiiB formulated by Ituuchanhit, recoiu mending at the eumc time excr-
■ and functional activity.'

Constipation han a marked influence on dj-Bpep«ia. In th»t gouty, of

wfeom I liare jurt spoken, you almfwt inmriubly ohaen-e an atonic dy8|)ej)-

complicat«d with obstiiiuU.' coustipatiou. and as the muscular coat of

fiho stomach and intostine is eonttnuouii, it seems that pnroitiit of the one

i1i«dB to [nrens of the other.

Exaniii. then the stools, and provoke intestinal movements by light
mliiie pur^tivcs, or hy some bitter luxatiw: cuevam, aloos, rhubarb, in
ttpler to keep npthc freedom of the bowels. In th4>8e gouty dyspcpeiae
with constipation the whey ciirn and the grape cure, certain purgative
w»ten». and in particular, those of Aulus, give good rt-sulUt.'

Aa lor the inflnenoc of dyapeiMia on the dcrelopraont of d jalhetic alloc*

^IJOU, the qncBtioD is not yet decideil, and dexpite the affirmation of lleau

,in advanced periods of dy«jK.'p«iii gttnend disorders of tbo eoonomy

may arise from the functional troubles of the digt-ation, I am &r from

ittiog thia view, which suirtK from the hy no means certain postulate

f\balt dy^iepna alwap ontaiU blood^corpuscnlar deficiency.

If, in fact, in many caws dyappiwia may bring in ita train profonnd

dvtiirbauoM of nutrition, weniuxt rememtfcratso that in many others tbo

I of the digestion doeanot hinder complete a«imilation of the food,

md that in thcao cuaos nutrition is in no eense compromised. Moreover

it it T«ry diflknilt to know If tho dy»p«ptic manifestations are not ntther

ktba •fffwta of the commencement of diathetic affections than tbo caii»< of

the Utter.

tm

DISKASEfl OF THK fiTOMAOH.

But thppp ia ft point to which I desiro to call your ntteiition,
of some deliaicj'; which pprtaiiia to the ncrrons diMrdere whieh have their"^
aonrce in djH|>u[»iiiu A)reudy TrouNti-aii, uitder thu itumu of gaetrii: ^
vertigo hue deacribed certain rery interustiiig phenomena which remit i
from (iigefitive trouhlcw: but thoroare othors wlUch are much morecnri- J
ous, 1111(1 u'hiL-li you will not find ^leHcriljtfil in many of your tvit^booka.'

I refer to those Btmnge nerroiis Bjinptoma which certain riyuppptij
expcrieiirf, ami which aru a rcvcrbrration from tho stomach upon
hcurt or abdominal viscura; EnTaploms whi(!h rome on in criae^, and to^
which I hav<-> given tht< iiainv of ulidomiual augiua.

TVlien I 8{>okc to yon of diwasefl of tlie aortro orifice, I told jon
they are often accompanied by u pc-caliar nervons irritability which tt^
beratee to points more or Ipbb remote from the heart, and which line foF
it« origin modiBculiont) uffeoted in the nervous eleraeute of the numerotu-^
ganglia of the pulmonary and cardiac plexuses which exist in this r^on. J
Tho samo anatomical rondil ions iire met with in rr«pnct to the Btonuich, ^
which is in rt'latioii with the numerous ganglia of the solar plosue (rent— J
able abdominal iwrchmm); and onn can t>nHily nndemtand that tho modifi— 4
cations taking plai'w in the constituent partM of tin* Btomacli may re-act^
upon tliL- ganglia, and determino there alteratiouit wliicli may in
cases manifest themflplrcfl by symptoms of great gnivity.

This is what Levcn hiu* descrilxKi under the name of ccrobro-(
digoftflo, an aJTe^tion which in (^IiaructeristKl.aH I hare juBt said, by visiocTal
and nerrono troiiblt^M irhioh affitct imrticulady the functions of the lungaM
and lu'jtrt and those of the cerebro- spinal avis; let us nsamine each o^S
these iMjinla. * '

A« forthocnrdific tronblen, they have been cBpeciRlly well Btndicd bjr-
Potain, Bari^, and nui-hard, and cuuHtitute a group of ph-eudo-angina pec-
toris coutweutivo to affections of the stomuclL and particularly dyspepsia,*
Thei-e are, in fact, a certain number of jiatifnta whose paroxysnu of
angina norcr apjicar except under the influence of the digestive i
who would oxift comfortably if they oould live without eating.

Am for tilt! niTvmis di»unlerH, apeirt from the rertigo df-s^i
Trousseau and Bloiidi-au, there e.\ist certnin modifications of the intelli-
gence; the patient pecs bis memory fail; lie becomes gloomy, taeituni,
and OBpociall J, liypcohondrinoal. 'nieerFliiir plexntt playn in man the mme
part as predisposing cause of )iy|H>L'houdriusis tbnt the goiiital orgaiu do
iu the development of hysteria in the woman, and many faypoohondriacsl
patients are simply dyspeptics.

Finally, tho tronhloi^ of respiration arc chiinictcriwd by veritAble criwa
of mITocation, a tnie gastrie luthma which tx dejtvndent on the perturba-
tions afFacting tho gastric digestion.

What gives eepi^cial intt-rcst to these nervous phenomena, or to speak
more correctly, to these raso motor phenomena determined by the modi-

■t.yinna ut

?rib^^^^

SKOONDARY DY8PBP8IA8.

203

fioAint t^ffccted in the px-at «rmpathi-tic uiiil in the pneumogastrie, U
thil tboy aro trjbiitarr to a treatment ininicdiatelv directed to the tlyspep-
8in Yon ought th«ii in preK-ribing for these jiaticnte t« give your jirin-
cipal aUentioD to tli6 ^toniuoli, Ibitn ^on should rcgulute the functidiis
of the nervous syBtetn b; hy(1rothcr»|iy. Moreover the tn-atmout of tliis
gBBtric neurosis has namy points ut contuct with that of neurogiathjf n»il
I shall return to it agaiu vhcn I como to the treatment of dis^a^eti of the
nervous sj-st^m.*

Such, gentlemen, iiru tho particulars which I dosired to present respect*
lag Hue dj^wpsias; the dcacription whii^h I hurv giTcn m»y posiuhly t<cum
niLhor theoretically thuii cliniaiUy i-xiict, hut it has thia great advautago
U»at it eoabloi yon to aeiw the thera[>eutic indications which you ought
to fulfill in Che treatmoul of the dyfi]>ei)Biflfi.

All these forms, i» fact, are more or less correhited and intermingletl,
^tis constituting tvrn great divisions of dyspepsias: those with atonic ten*
^eiicT, villi torpi^l form, and comprisiDg eapeeiAlly pittiitous, atonic and
flatulent dyspopajaa: the other diTieion, on the contrary, being charactcr-
*K^Hi by iU irritiLlivo leiHii'ncy, and here you will find grouped together
tl»e acid and painful dyspepsias and romiting.

I b»Te now finished my task in the cxiiovition of the dys[H?)isiiiK of
^'Inlt life, and yours now comment.'eii: — I mean to Kjy, that now that
3ron know the principal mulhode of treating these dii^eatfu's. It will bu your
Oftn?. by the attentive interrogation of your jmtient's dj'mptomg, to detex-t
tlic predominance of thin or that form of dy6)i(>psia; it will Ixi inciim)x>nt
<^ Tou to cumbinc and vary your medications so as to respond to cikIi of
^llo symptoms, also to ascertain what \nrt must be aaai^icd to diathefis
in these dyspeptic raamfestations; in a word, you will have to imitituio
S^ur treatment, and all yonr skill will be exercised in snbordinating, each
'to tMch, the princiiMtl therapeutic imlicationa which I have fomiulutcd.

I cannot in concluding do better, m order to show you the diflieulties
of your task than to quote the words of Trousseau in their upplicution to
thia very subject: " It is here more than anywhere else that the physician
under the guidance of his inspirations is obliged to fuel hia way along in
the search for indications, which vary according to ctuee, according t*
individuals, and whii'h iu the same individual are susceptible of variation
from one miunte to anotlior."t

I shall now comjdete tho study of the dyspepsias in Ooqaainting yon vith.
an interesting finictioiial malady which you will oft«n ohecrvc, and con-
ceming which familicfl will often clairu of you the most minute dircctiona.
1 refer to the dyspepsia of young infanta.

* See Clinknl Thi^rapetitics, Am. Ed., port I.
^ ainictti Mwlicino, t. U., i>. 341-1882.

•

' Soc the work of Comillonon tbe relations of the dyspepcias tooonsti-
tntional di»2iui(«.

I^ilom JH i«cIinoil to think vyvry chroiuL* iuid«tormincd diacuM which
ratinot be inHmlttl in arthritism, scrofula, or Bj-philiM. im hurijotio. This
hBrpelii? diutheHis, according to him, is the caiiseof (lft*"eiL dvspiipHias out
of every twenty. Ho gives tiieee aa the princiwal cignaof this airithesia: " If
thvTV hv no crusti-d tetter, there will at least ito likely to Ije a ftirfiiritceoiia
di<»qiuinutio]i of the luiiry ecalp, look for a eehzu'^'ous oozing from the
HolciiH hiddon behind tho rim of the ear; the freo Jvorder of the eye-
Hds ifl the color of leun biicon; the flkin is irritahlc, dry, harsh, easily
bpconies jHiriginoiis; there are (in females) habitually itehin^ii ahnut tlie
vitiva; tlirre is ii pnu-if/Q jtodiri^ and an niopeeia wliich urt^ fnrei^ii to
oihur dieciuti-f of lua^ stutidiiig. <tivc AtUiiliun to thv frequent colds, tho
dry and hubitiULl cough; exuinitie the throat cajieriHlly."*

*ThiHisth« hygieuie treatment reeommended by Bouclmrdat in [jolyu-
ria duo to uric iicia, gravel, and gout. For diet, be advises to abstain from
substanoett likt^ garden rhubarb (cnntaining oxalic acid) and tomatoes; to
use meat sjiaringly. and to choose fish and *hol! fitth. T1il» vogetaWiw of
^B season may make :i pari of the daiiv fare. Ordiimry r&di»lie)!, the
black mdifth, water creH»tiH and »^^ladfl are iuilimtcd. lie forbids the uaage
of alcohols, and recommends to ilrink every day ii qnart of water in which
is dissolved a teaspoonful or two of Kochelle salts. Ajb for the eseretioiis,
ho rccommonds ti»o patient to go regularly every dny to the *tocd, and
empty the bladder every six honrfi ut IciiBt. Finally, he recommends ex-
ercise, and attention to the nkin; every week a Imth eomjiosed of the fol-
lowing ingredients should betaken; carbonate of potasKi 10« grammes,
Kptx. lavender 'i gmnimes, benzoiited tincture of vanillu 5 grammes; — to
tw added to the water of a hatli. Frictions and ma«wg« should he prac-
ticed after Ihi" batli-t

'According to Alriq, the waters of Aulue, besides their laxative action,
have an excitant elTect on the ganglionic nervoiis Rvstem; they also rwii*
late the circulation of the vena porue, aud surprisingly benefit atonic uya-
popsia with constipation. (

* Writers have long given attention to the nervoue troiihlca of gastric
origin. Ciillen was oiie of th» first to mention the " vaijors" which so fre-
quentlvacnomiKUiy dy8|>i!|>Hia. BarnisalsoiiiaiHted on the Bympathy which
exists ht-tween the ^tamach and the bntin, and on the bond which unites
hyiHwhondriasis to gastric disorders, f'homel |)ut in clear light the fact
that in certain eases of dy)^))ep»ia tho sym))atlietic affections assume such a
propondorance that the patient dwells on them oxclusiroly, leaving one
» de the digestive diaorders.

Trousseau dwelt ]>anicnlar)yon the vertigo of d3rBpeptie8, to which he

• Soc. i]. Hydrologi*. t. xii., p. 342.

t Bull. <U> Th«r.. t xcL. p. 488.

t Aonales de Id Soc, d'liydiMlojfift Mfedicule, 1, xxW., 1878.

SBCONDAKV DYSPBPSIAB.

205

W

pno the name of vertigo a tttoniam iipw, a vertigo which Wepfnr hud
m«utionc(l under the iiamc of ttrfigo per comremurn nnfricuU.

Ueau hii8 givvii u rury iwiuvk-tu d<iHcri|}ti'>[] of till Ihueo nurvuua
troableB. He ^le^K.•ribt^s b gastric iIvKpiiuui, and n austrio rough. Uo coii-
giders iateroostal tieumlgia irnd Aorso-iiitcrcostal iieiirulj^Ja as u rt-tlex
pain, banng its starting jyomi in t)ie ncrveo of a dieonlered etomach.
Firmlly. he iuh given the pietiin? of tt fomi of dv^ficpsia with iieuropulhic
priNloMiinanooj and which produces hypochondriaais, hysteria, aud ovon
inauiitT.

Lasefiie hns nim dwelt on the neuroNeH of ilyspeptics. Levon also u
described all thiH pnthological a^fr^at<- under tho name of corobro-gn«-
tiic disoMo. KuctI hjusitmincd opnll thc8cfact«in his inaugural thesis.*

'The nprvoiiBsyniptoniswhidi-origiiiate in dvepepsia are tniiltiple. and
pertain raccetwrely to aensibllity, motility, the cerehral faoiilticB, and the
xunctious of tho otiior visoertv.

The trouble* of wiiisibility are very complex; thero have bc«n noted
int^rc^sta! ncuralfiu, jmiiiM of ^eatcr or leas severity running up or down
tht; Kpine, C4>phulal^a, uni) hy[H>n[>athema uC the nkin and musdefi.

Tho iliiMinlprs of motility are miii^h more nire. nevflrtheloas thorfl
huTc Iwvn iiotiovd rvul coiiviiUioiiK, and foniiivatioii? in tlju uxtruiiiiticH.

Ho not forgut. howi'vur. u projjax of all tlu'su pht'iionicua, that oflt-n
it i« the communwnR'ut uf ilititiiiXL- of tho ttpiiial cord, and lliat in these
nwex th*! dysiwptiia, intttead of bting piiinary isoiily B«i:«adary.

Tlw ftirooral troubles are characUTized by vertiginous attacks of
syratury form, and which ItlondL'im bus dividi^a into eevornl clatwei;. and
m (Birticahir into vortieo from want of food {tvrti^ififs at iiwrfwi), and
vertigo from eoo muoli fnnil {vfrfttjinfH a rritpula). Tlie otiinr cerebral
troublei pertain to intellpctiwl modifirstions of which hTpochondrianiii in
the most perfect type. On the part, of the viBeom. there have been noted
pfttpitations of thu t:nirt. and a retanlation in the cncrgv of tho hoart'tt
cuntrai.-tiona. Potain hji>. mnniiver. dwelt rccenlly on tfuiw; carditis dis.
turlimeeti of gtiKlric origin. iJyspnd'a and eough have also been mentinniNl.
Lt-^eJi lias endeavored to prove a constant relation betwen the cerebnim
and wUir plexus. He inairitain» Lhiit the impresisioiis of the brain are all
Bcnl to the Holar plexus and reeipnx-nlly. lliiit the nervous imprussiunsof
the TJeccra, aunt t» the ple.TU)3, are trunhniLlled to the brain. The iiitet-
Iciotual life and the vegolAtivo life iaberjiunetratfl each otherj and cannot
bo wparalcd ae Bicbat thought.!

'Hcl«>rden, Wiebmann. Bnttor, Macfjueen, liavo jwintod otit the rola-
ticns between angina pectririRnnd etomoch disorders. I'otain and Bariv liavo
also dwelt on ihe elianietcrK of ttu-(^<> anginas of gastric origin. These,
aooordii^ to Huehard. are the KvinjiU^im^ propter to thewaiiginas:

1. Tnia angina pertnini-- 1'» nil iiifc^iand all eexea.

S. The parosysma art) less violt-nt than in true angina poctorta; their

* Roftl. tiiwW ot NervoiM Tmiible t>r Ciastric Origto, Paria 1880. Li>vi>ii. on
C«MbroRa*lr»c'Diiigai»ft,8w. do Biol, OcL 1881. Bean. Tr««tiM on I)>-«p.T*ii»,
ia». Trauaseau. Clin. Me<l., t. ill, |>. H.

f Bloiuhnu, Ob Stoinaelial vertigo, INiS. Luboullieno, OnViscsnilNvumlKiiM,
IMO. L-'vi-n, Stomach «n<I Brain,. 1884. Barms, Treatin on Oaatraljias u»J
EntemlciuH. 1827. Cliomcl. on t>>-npe|iNiiu>, l^.l?, etc

DI8KA8B8 OP TH£ STOMACH.

duration is longer: tlio;r )>uTst forth often altvr a full meal, or even sim-
|)ly »rU'r tho iiig4>atioii of a tew moiitlifula

'i. TUv putn is just iu front of the heart, and not in tbv Bttirnuin;
it couKtBtft iu aacu&utioti of di^lvutiiou of Die thorns mtbur Itmii om- uf
constriction uiiU cwmpression; it« Juration is longurby aquiirturof uii liaur
or half an hour, or ©ren more.

4. When th« paroxYHtn comes on after a mftal, which i^ the mlu. the
putieuU exi>erience a ififflcoltir in breathing, thoj ha.ve nnhvlatioii rulht-r
Uiiiu ttytrpnoja. (Bant'-). Tiii-y fool a jminful goiisation in tho «i>ig!uitr)-
uin, Lhnii the oppri^selou augtnoiitd, the ptiW ii; small, the extrpmitie» are
cold, antl an agonizing jmiii rets in, iiccomjianied hj a nuirked ayncopul
»la.io. This form of angina i» then ehanictcriaeil hy the jiroductioii of
pulraonarr a-nd cardiftc aistrcis*, by tb< oxiet^nco of o. son of <lys]ma3a or
anhelation whinh often arconijianit-s the painful rrises.

."i. One of tpn oliserves sigiiR of reverbenition of the gartrie affection upon
tlio heart (palpitutionn. Tnt-?rniittenws, lipothymiiw, iwyrtolic symptoms,
etc.). with or iiritUuut uuc^itiL-iiUitiuii of the preoonlial uulnees, especially
in a trantivente direcrlioii, exiHtenee of u ri^ht-«iidod bruit rf« (Ki/f^ and of
a tricnspid inHuffioicncy more or less enduring, aueuutualiou ol the Becunl
pulmonary brnit. etc.

G. In ]tsendo anginal attacks, even those of tlie greatest Boverity, recoT-
cry h tho iiile, unil fhiilli is the exception.

The mechanism of those uuginaa cf ga«tric origin according to I'otain,
isns follows:

The reflex excitation, which may havB its point of departnrp in tli©
liver, in tho intestino, oftonor in the atoinaoh, uetfrmincR lUi exngs'^rated
(xmtniction of the pulmonary vei««;lH, and an elevation of tenBion in Iheao
vesHelii, from wlienu; pruL-i!<;dH iv certuiii uKstiiele in the uireuhLtloii uf tlio
right heart and u consevutive dilatation uf the right cavitivH of the heart.*

^

*

" Biii'i^ On the Cai-dio Pulmonary AecicicDts CorBecutive lo Gastiv Hepatic
Disondci-N, (Iti'V. d« MM., p. 1 aud IIT, 1SS3|. Uiiehuiil, Ou An^riua Pectoris and
the False Anffina. (Rc%-ue de M^dtcine, 1883).

SisiMARY. — Dyspepsia i>f tho Nowly Bom — Atlirupsin — TIip Milk of the
Human Komalo— Its Composition— It» Variation*— Means of Deter-
mining tho Value of Milk^ — Lactomett-r^Kxaminiitiou oftlieXurBing
AVomsti — ^Stule of Itvslth or [>i3wiseof ttiu NursiiigWoman — Influonue
on llie ililk— How Oftpn Shoiili! a IJabylK* Nunwd— Artificial l^actH-
tion — Gont'aanti Cow's Milk— Tbu Numng Bottle — Oatiuwvl — Woiiii-
ing— llT^cnip RiilcH oC thf Newly Itoni — CoiiBti[)iiti(tn — Dian-hwa —
Eraploymeut of Phospliatc of Lima

Tbe dyspepaiaof new Imminfiiuts, irhicli is thoBubjoct of thin chapter,
in a snbjoct of great iinportunce, and deeerves to hv treated with contiidiT-
kblf detail. Every day you w-'c in tho infant dopartiiK'iit of our houpitalj
(Wan! Sainto Jilniie) ririod examples of the functional disorders of tho
stomach in young infantM.

Tho infant at ita birth and during a few follovriug uioiitha nuiy l>u rO'
jrarded as a digestive tuW served by organs, and yet thii) digeetire tube is
imperfect and in proci'ss of forination. Fitt«d to itasiniilate only one kind
of food, milk, the alimentitrj' canal Is complcteil as the infant grnwii, and
in proportion also a nion- Hubatimtiid notiriuhmont becomes nuwasitatCTi
lor thf development of the young being.

Milk then ii the exclusiro food of the babe; it meets all tho rei^uire-
menu of its orjranisni, and promotes the normal development. In onlor,
howerer, that this evolution eluill go on regularly, it i» nccesitary tliat all
tbehygtunicnileeeliaji U- rigorously observed, foraay dc|iurtur(tfrom tlii'iu
laws entails not only funetioiml troubles, ax in tho adult, but also gnre
diBorden. To dyspepsia. Kinipte moditicAtion of the functions of tUu digus-
tive tube, mieneed altt^mtions of the tissues, at fii-st cnnible, then liecom*
ing incnrablc; it is then that you sue unfolded tluitKym])tumatie aggregate
of which Parrot haa tnK^ the description with tlie hand of a master; I
refer to athropsia. Wo shall concern ouraelvcB lierL- with only tho first
p(>riod of this state, vitb the prologue so to speak, of that pathological
drama which w> fatally entaila tlie death of the little Wing.

W« abaU, then, study tlieiH! functioiml troubles of the etomuch from
a tbenpeutic stand-^Miut, while fully rucogniiing the fart tlial it in often
difflcatt to distinguish the simple functional disturbances from thi> more
advanced lesions of the gastric and intestinal mucosa, and to seiHirate, for

M

208

I>ISKASt« OF THK »TO»ACH.

example, dyxpf^psiA properly fioca]tcd, from the cularrhal gastritis deGcribed
by Parrot. 'Vhv one. in fact, entails tin* otlii^r, ftiid it ia sumetittivd iiii-
pvtsiblv to eay vli«n tlie dysp«^sia ceas&e, and at what time comtnoncea
the iilterutiou of tho muoosn-

How do the dj'epcptic troTilcles of the new bom infiint miinifeKt thnm-
bpItw? First Iiy BympUiniB riiort* inarki-<l on tlio purl of tUu iiitt-stiniM
thuti of thu Htoiiiuvlit and ttiis in readily und(;retood when you think how
rapidly tlic milk iKiaww from tb« stomiK-h into llio inwstiiio, and of its
more prolongwl ^Jonrn in the liitter; «'<■ shnll then have to note the sif^ns
which clinmcterizc iiiteittinal dyspuiuiit. Our colluigue Julca Ijiniuii iuu
given a goml desL-ription of this syniptonmtia ng^^'iJKatu,*

The infant, after taking the breast, sutfera colicky pains in ita Ixuvele,
it cries, it* feattave are wnnklccl_, the belly !« slightly diBtendod, and iwiu-
ful to presmre; there are borlwrygmi, jind the i»erii»taltic movements of
the intestines iin: exajyTemtcd. If ut this moment yon L-xumiuu the juis-
Mj^s, you will »eo that they liare lot^ tluit gqlden yellow color, and thut
conctisteney which chikracterizc the tteai] di^c-liarges of infants In good
health; they »re gmmousand prejcont white massenof nndigeatod ejiseine,
which gives them the iisjnictof Bt;rumhi(;d "-'ggs: elightly fetid giwes also
eacapo.

At a more a<lv»nced rtage the infant t;ecomes fretful, no longer sleeps
finietly, Btarling out from its distnrbod uliimbers with onteriiw; it eon-
Btantly Beek» the breafit; then ensue vomilings of ennHed milk and ernc-
biitionKof wind. This uoiiditionnuiylust for t*omc time, and if not rcliev^^l
by Huitftble treatment, another orderof symptoms api>ear8. There is now
fever, thu BtooltJ bwxime abundant and green, the inluut emaciates, and
yon now obs«irve the characterii'tie i>igii8 of inflnmniation of the digestive
tube; you have before yon the beginning of itthn^pKiu.

"With what remedial itgents arc you to oppose those morbid Bymp-
tomH? It \b to hygiene that you are to look for reme^iiea. There are
hardly any medicines for the now bom infant, and apart from » few
mild revulmTes, and inert powders, dnigs have an action rather Inju-
rieus than uMrful in the an'ei;tions of tuirly in&iney. Rt; then reserved in
the employment of pliarmacen tical means in the treatment of these infan-
tile di^ensen; fwlilres? yoursolvesto hygiene, and aliitndon almost altogether
the iM:tive metlirationK, which often have a, disastrouB effect in tlie-af eiutett.
Let UK now take up the hygiene of the new boni infant, and particularly
alimentary hygiene.

Milk here plays the principal and I may say the only part, as wc havo
alre:uly «een, and almont all the fuuctioiint troubles of digestion in infimta
result from the fact that milk is cither Insufficiently or with dllUculty

• Jiil«s Simon. Dyr^peptiiii of tliu Now-born Itifant, Union M4d., 1878. PiLirot,
Atlire|»iu, of Uie Nuwiy Bvrn, I'arii, IV'H.

1

Tint DTSPZPStA OF rnCW-BftRtT irTFANTB,

Bppropnated. Henoe vc will ilret take up tlie stmly of milk, and I need
hurdly toll rou tliut with respect to Us tnodo of nntrition. tlu^ itifiuit
appcnrs before you under ono of throe coiuiuion*; either it is iHirwl by
ita mother, or by a wi't nursy. or it in bottle led. The first two states
may W coasidercd together umltT tlit.* head of iiutural lactation.

Woman's milk in the iinrma) ntato presents thfl following chikraRtore:
it is blniflh, slightly' o^mlino; mixvd with a unaU quantity of wat«r it
iWDmes a peoiiliar tnint blue tint; it is inoiloroun, of slightly swwitiah
tstfte; itji reaction i» alkaline. H«at (lot's not ooagalate uilk. and if you
aitii rpnnrt, yon obtain n very incomplete coagulation of cjuiein. If yon
luialysu tilts liqui<]. &^ many cliumii-ti; liavn donB (particularly Himon,
ifc(w]iierel, Vornoiti, Kilhol, Joly, and Henri Ki^ry) you will find tliat it
contains butter, sugar of milk, casoin, water and salts.

Aoc«irding to the recent analyses of Hynri F^ry made at the Experi-
lavntal Nanwry of the Hupitul ICnfnnte Atviatre, tlio compoEition of onv
tbousnnd p«rts of milk, dennty 1,U32&0, is as followe:

Water, 873.02

Ciwpin, 17.05

KuLter, 36.79

Sugar of milk, 71.10

SalU. . 1!.0-I

1,000,00
Bnt, as Chnrles Sfarchand has remarked, numerous varintioits may
arise, coustitutwl by n diminution in tlit" quantity of twmo one of ihe prin-
cipal elempnt* of the milk, and we may say with refweuce to this |>oint
that when, with all this elements of the milk rcmiiiiiinp Ihe Mme, tlier©
ia ieen to be an increase in the qiiaiility of thv hnttur, or the t^iigar, thv
milk Btill preserves it^ nourishing (jtmlltiea, and children reared on it arc
getK'mlly hejdthy.'

It i« not the aaiuf when thora is angmentotJon of oosein; in this caiso
the increuKc of th« casi'in loa^is to a fuiliirt^ of aliHorptiou hy the digestive
tube, which generally ri>iidern the milk liadly supported. One cjin readily
understand that rirw fvrsa, milks with a dufH-ioiR-v tif butler or of lartoso
are nutritively insuflicicnt, while those which contain casein in moderation
mrv well tolerated.

On what do thceo modiflt^tions in tlio natnre of the lacteal secretion
depend ? Tliey renult from wveral circumslanL'es, which wo ithall take up
when we come to ctm«tdcr the condition of tht'inotlieror wet nur»e. But
flnt wo should in«]uiru by what signs rou arc tn determine the goodnesa
of a nursing woman's milk? You can teal thv milk by the dcnsimct^-r of
Bonchardat and Quevenne, or with the lacto-butyro meter of .^Urchand,
or tlic ]act«Mco[io of Donn/*, or by Adam's or Eebach's proceaa, Yuu can

abo adopt the means recommended by Bouchnt; wo refer to the eiia-
14

tneration of the f>t gloliuI«i which the butter contains. All thflen memiH
Kro inferior, howi'Tor, to that unique tost of the nutritlvu riUou of tiie
milk uixUt coiisicteration, wlijch test is tho iu^it itM-lf.*

But in order to jmlgt' wbetliL-r the iufiuit ih thriving or not, it will not
do to dc>}wiid on the eye aloae, you mnst refer to a more impirti&l crite-
rion, tn th(! 5CJil(M^ which hettt indicutc the daily gain or luiw.. unJ the
sunitary etulti of ihv htlh- being. Nutttlis Uuillot ("On Nursing Women
and XurelingB,'' Union Med., lt<5*^) luu rendered a signal servico to the
study of tlK> dovolopnii'nt of the infant, in rccoHiMiomiing daily weighing
a» a jiart of the mctlirjil RmierviBion nf the newly born. Iknii^hiiiid,
Ijouiii Odiur (>f (ivnuvnund livni- Itliichc liuvu al&u ehcm-n all LUl- udvau-
tages wliich may W derived from this method of weighings.'

Thi'rofore, gontlomou, do not forgi-t to atlojil this practice; require
that the infant shiill be weighed every week, and let thii! Iw done by Home
uncwhoin you c-an Lnist; insist that tlio weight sluill be carefully nxiortiod,
and whenever the child ceoaesto gain from twenty to twenty-five grammoB
a day, bo jwrauaiU'd that some distwrbiiig tjleniMil h!i« inlt'rferwl with the
natural rate of growth; jtlj then your inttTrogaiorieK and ymir endraToi's
till you have found the cuuhu of tliis loss, whether it bo in the infant or
iiL the wet nuTBe, or in some eitraneons eireunistiuice.

BiMideH thi> condition of tbo infant, wliJidi U the bo»t meant! of judging
respecting the initritive value of tbe milk, tbere are several external signs
nbich may guidL- in choice of u wet nursf. It is said that the wet nunto
should be of dai'k complexion, twenty to thirty yimn; of age, and tluit her
teetlishotdd 1>p sound; theee arc conditiona more theoretical thjin practical,
and Coudcrejiu* has shomi that if one were to judge by the t*'-Bt of the nurs-
ling iilone, tbe iiueat »jM*iincnB belong to women thirty to forty yuuni old,
who are blonde, and liave carionH toetli. or none at all. 't'lierufore, gentle-
men. while giving duo weight to circumstances coimectod with the general
bcallb of ilie wot nurse, your criterion of ber qnalitieution luust bo the
8lat4.' of the infant reared on her milTc.

The condition of the mamnue, moreover, Ims xume imiiorlaucu; it it
eSKntial that tbe nipplos shall be well formed, that the akin shall be Sne
iind iniirked nut with numeronB veins, and that the development of the
iiianinw shall be eonfttituted by the gland alonie. Fiiudly, there in a last
queetion deserving of runsideration, namely, the ri-lation between the age
of the infant and the age of the milk. It is best to Itave the two us near
logether as poaaible; at the wimo timp, it will not do ta attach too much
importance to this matter, for nonietinifK very young infants will thrive
well on the milk of a nLinu^i whose ]H.Tiod of parturition ih long past.

And jtLst here it is well to remark, that at the commencement of lacta-
tion the milk containit oolostmm and albumen, &ud thut these elements

I

I

I

I

rnidcr the milk purgative, a cotulitiOQ which hrora dcaiUDco of
J^^HEtive talM' in the nov born babe.

The food of tlin W€t nnrsc hiut a marked importancL- on t\w coinposi-
Uon of the milk, und juat an wc sec dowis produce butter of dilTorcnt i)uaI-
itice ncconling to tlio pwjtnree where they ffi«d> IJkowiao nursiug women
give milk of rarinbio qiitility noooniiiig to their food. When the diet is
tooaxotized, the milk in rliarged with raseiii and tiocomoa iudigestiblo; if
tbv alimentation kv iiutuflicicut, the milk diminiahee iti quftutitv and the
infant pines away.

Ilui uiiother ]ioi»t to vhich I wish )mrtieulftrly to call your ntteution,
i» the deplorable effect prodnc*^! on the infiiiit by alrohnl when l^iken by
tlic wet nursi-: muny caws of coitrtiUioiu, wboai- cxplurmtion wu^ a miiD-
tury, have rvtmlted from the iiiteint>erato use of alcoholic stimalante by
wet nniees. Diaeftee, like diet, infiuenwt^theqitulity of ilieniitk: Beoquerel
nnd Vemoia on analyzing the milk nf wnmon Buffering from fever, have
shown that there in a. full in the pn)portioii of tlio butter, and a diminu-
tion in th« quantity of liquid, and tliis cvuu to the poiut of a drying up
of the lacteal secretion. '

There is a QiulI circnmstAiioo of a phygiologiMil chftrActior which ought
attract your att^-ntion, I nlUute to menstrual jtm and prcgimnry. A
ng wonuinoft^'U turns Hlt nii^U!<L's return, and minie Imw Lbougbt that
in each c*tos she ought to cease nursing her child; I do not think »o, for
with the exception of iriOing colicky {lains in tho infant iLt the appearance
of the meDWfi, generally this change pusses un iHTceived, and I have »een
fine nurslingB reurod by women tluit wltc regular iu tlit-ir monthly periods.

Pregiumcy aliM modifies theqiiality and diminiehee the nutritive \-aliio
of tlie milk, and without nayiiig absolutely that the milk of a preg:TUUt
woman ia baneful to the infant, it should l«? borne in mind that it no
longer Rafliccd for nutrition, atid for tUia very reJU!on n vonuin who finds
bvTBclf with child should li'ave off nuit<in|c her babe.

Frequency of lactation, also modifies the luiture of the milk, hence it
liofi long been the custom to n>gu!at« and limit the periods of HUfkling;
it haa been laid that during the day the lialie should be suckled every two
houn. while during tliu night the intervals should Ijo longer. [ think,
however, that it is not wcU to bo too rigorous on this |ioiut, for the infant
itaelf indicates by itn crie« tlie need wlueh it has of taking QOurishmenL*

It murt, hnwerer, be rememlien-d ttiiit i^omn infants maiiifest great
ttitmoity. Oltd aru subject to indigestion by miRon of the too great quantity
of milk whioli they ingest; tliis would ncccesituto u careful regulation of
Uie perimlii of lactation.

But, gentlemen, the infant ie not ftlways fortunate enough to have a
wot nurse, or the milk of it« mother.or wet nurse may bo insufficient, and
one is obliged to Imvo recourse tu artificial hkctution. It ia here that we
ooDW to the uwtt fruitful caiues of lufautUe d>ipcpsia, oud the majority

212

DIB1A8KS OF TllE STOMACH.

of iiifnntd with large bolties, rmuctiitod limbs, pinched fcatnros, whom
^ou we in our iiunlinp; Itospitels are bottlc-fcd bubica. Their dieeaeo,
(iind very cift^n their (k-ath) results from the ignorani'u auil infiltration of
tlioir niotliLTm, who jx-mst in giving tliem too highly asotiE4.'(l iui*l rich
food — food not sntcoil lo the nndovclopi-il staU; of thcJr dlgeetire tabe.
WiiiD ic! ofton ^iven to balx-a in tbu early luoutbs. und no practice' can bo
moro baneful or more eontnii-y tytwuml hygiene. Honoe there is no Buh-
ject more worthy of uftreftil attention and study thim this of artificial
tantution.

What niilk ought to bo chosen? This question iwonu to-day pretty
well Bolved, thnnka to the exporinients tmule l)y Parrot at the espprimcn-
tal uursttry f^stflblislit-'d at the llii|tital Des Eiifaul« Assisti-R. Atti-r hav-
ing made H comjiarativo trial of the milk of the cow, the goat, the bitch,
uml thii aEH. it w;i5 foutul tliut tli<^ liitttT if thu hci-t lulajitod to thcalimen-
tationof the young infimt. and Tarnler basgiven the weight of bis author-
ity aud pnivtico to tliis doctrine.

Rut it nimt hv admitted that this result is rather theoreticul Duiu
prwtira), for l^irrot injrietfi that the infant ^hall obtain its milk directly
from the teat of the uik, wUiob cnn only be n-ulisud in exceptional causes.
I know thiit Tarnier pmpost'StomJministpr this milk from a cup or Ppnon,
bill evL'H in ibis ctuse \vv ihnl oiirwlves in prettttuce of anothur difliwully
which in the high price of the milk (it or t francs per cptart), which miutc
greatly restrict its uaigo. We arc then obliged to fall back on tht^ milk
wliieh is the mnsit arailaWo, nnil the most in use, that of the eow. Goat's
milk luis indt'txl been rocommendcil, but we have no very aeeunile data
rcpjiecting the employ of this milk in rearing chikbtn, and while recog-
nizing that the goat aci>mmodatt!SLLi9(df Ix^tter than thcik<»to the eonditions
of living in our citie?. iis milk is 113 rich, in ctiBein as Chat of the «>w. oiid
for tliflt reason jiresimtH the amio disiuhTiiitiigea. We arc then obliged in
nioac mm» to use cow's milk and to render it as digestible as pos^iible far
tlic young infant; this end is in a measure attaineii by diluting it with
uati-r and itwc*et«umg it. To fiillUl the Uitter indiuitioit, you ean uaa
tirOinary !Uigar. or what is belter, sugar of milk, whieh can now be bought
at a sufficiently cheap rat«/

As for the amount of the dilntion rwjuired, all dejiends on the rich-
ness of thi^ milk. If you have a roilk tlwt is quite pure, yon ought to
diluto it with twice as mueh water; if, on the contrary, you hare a milk
of which thi! eouree and quality are doubtful, and which may have aJrumiy
undergone more than a sufficient watering, you can give it pure; aud this
is what. I recommend to |)oor women who fflmo to consult me at the hos-
pital with their nuntiug bottles Qllod with a bluish white, dirty liquid,
looking wholly uidike milk, and the result of a mixture of eow's milk
with wat«rgrucl, toast water, or some other vil« slop, aud the cousequeuco
of which, on the infant is deplorable euougli.'

TliK DVSI>£P81A OF KKW>BOBK IKFANIS.

313

Bnt do not forgot, while constdflring this giv^at »|Tie«tion of the artifi-
cu) utimiMitutioi) of iiifiuiUt. tiiul it. is nut ciiuuffh tu say tliiit onn kind nf
milk i««a)>vrior to anot-lier kind, bnt it is e'|UfiUyira)>oitmit tbnt thu food
of tlie aiiimiile that fiiniitdi t)it> nulk slmll not Imvo iiiidergotm tiw ^roat
niodiHeutinn. and it is tliis ditTerpticu in tlio feed of uiiimjik wliicL i-xpluiiiti
tlicr dilTrrfncv in Uiu rcaults obtuincd. und in tliv HouljrBuii nmde bjr dilter*
ept rbuinixte,

"Wiiat quantity of milk ought the infant to take? This is on important
point u'bii-h lias Ik-oii inadu eli>ap by Parrot's inv«8tigAtiou& Tho ImIw
should take during tlie lirnt nuiiitli, :(U0 gmmmcH (10 ounces) of milk jwr
day; darin;; ihv iwcoiid. third, fourth, und fifth munthe, 600 gramme!)
(SO oniices) por day, and dnriniz the oth^r montha BOO pmmincB (2C^
oniic«s); and to tbJK milk tlio following <iu»ntttira of stigsu- uhotild he
added: for the first month 3HgninimRa (1 ouiiop) per day; for tho seooiid,
tliirtl. fourth, mid iirih, -lO ^rumm(» (Ij oumxis) uid for the others 50
gnuniUL'd {\'i oaucva.)

The milk is gonomlly (fiven from tho nursing bottle, and there has
bran 3 groiil deiil of discussion tiK lo tho beet kind. Thv beet, b<^causn>thM
viniploil. and the rhoii)icKt. is tlmt sold under the numr of tho EniflUh
Hurtiwj boifle. It voiiBi^te of ii flik»k-aluk)}t-d bottU; tvitli a stopper
throagb whicdi a glass tultupii»ic>i!. dipping into the milk at one end. vhilc
U» lIiH olluT is tilttil a rubber tiibo terminated by s nipplo.'

With rc'ganl to the mlviwdiility of n»ing this little utensil, everything
dejiends on th« can; whitdi is taken tu kwp it cK-nii. It is of eonrse un-
dervtoud that the milk must hv of an even teiupentturc. but tkia point
does not prewnt muoh diflienlty. So bard is it to unBurt^ perfi-ct eleanli-
DCn and an Aseptic condition of tho niimiig bottle, tliut Taniter discarda
it aItog«lh«r, ordering that iuf«nt*i under hia charge slmll Iw fed with cup
and spoon. If it wore a nmtlfr which oontx-rni-<l solely our niirHling hiw-
pitala, I should I>c> fully in sympathy with my colleagne of t)ie Maternity,
for as you may aw every day by the eareful insix-otion which I ninko of
tho " biborons " in our wanis, I am unabJe, especially in the summer timp,
to euforoe tho deslnid uUruidim-ss of tlifw buttlctf. But this is not the
caae in manv fiROiilivs whvrc due att«nbiou can bt; paid to mattvra of this
kfoid.

All important point in the ntirturo of the young child is to know just
when to mollify the milk diet by the addition of otiier articles of food.
Hvrv you faavc for guide the ap|>rtimnce of the teeth,* a» their evolution
fnilows the dcTclopmont of the digestive tube, and in proportion, uo the
toeth ap{M.iar. the functions of the <ligmtive tulM> are oomptcted. It i»
gmerally at the end of the sixth month that you eaii bi'glii to introduee
into the dii'L-iry of tho infant mirh Btundiy aulffltancea tw arrowroot. bi»-
miu, bread oru«i> op giiigt-rbrotid, which yon ran give in water or milk
slightly salted urswcotoncd. Vou can also uutke use uf the malt flour

314

DISHASKS OF TIUB STOatAOlL

pre]ianitioii8 of Jlinhlo and Lieb^, as well as a Sariiiaoeons combiuatioD
whicb ima been proposwl br Iliiiwon."

In ft work iimlprtakon in conjnnptian with K. Harily, i have shown
tbo iu] Tnntiif^BS of o«tmviil oh uii iirtio]i! nf \V\et, a tfureal Tery inuuh vm-
plojwl ill lhi> slimcntatioiiof infants and ndiilbt in Scntlantl, nnd of whicb
the UBage is general in England. The mode of pivpnrtition is very eira-
pie; a couple of toMpo(>nfnle of oatmcnl is allowed to «oak »n honr or tvo
in linlf li pintof viiter; it is tliencuoketl after being ewet^tencd ami Kilted;
jou obtain thui a mther thin gruul which may be lod to the baby witli a
spoon. ' '

You can also make nwof Fnielmndo from any other meal, tflkiufi cnro
icy ♦■inplov 118 littlp ax poKsible of fatty BtilwrtanfMiB in its pr('])iinition. It
nmy in fnct Iw said thai in Uiv infant tbi^' fniit^liun of the |Hincn.iuf, at fur
as conccnie the abonrption of fnbs is not derelojied till a later period.
Finally rotncs the eporh of wcjuiiiip. fixi-d C8|wi'ia]|y by tlio appraranoe
of llip other U«tli, and in particular, by the amines; an ejiocb at which
the <liet may I** more varieil.

Do not foi-got, moreover, that it diet plays a eoneidorablo part in the
development and I'liro of the dyH|)e]ieiaB of the yming child, the other
hypienic nilw have ai«> their importance. Thecaro of tli« skin, in n-gard
to elvantimta;, and above all, atniospheric condltiona have a dominant
influence on the lieaTth of the little one,"

Obaervo what laki^ff place in nur infant depjirtment when nocessily
compel* 08 to increase the nnml'or of beds in those unfortmiatiOy. too in-
salnbrious wards. We see the littte fnnndlingB at once attjieked with
colicky j>ain* and prtwonting intui^tiaal Ironbloo. the rusult of ovur crowd-
ing; vitintpfl anil unwholesome air lias in fact a predominant notion in
t}ko production of dyspt^psia. The young infimt ncodii the open air, sun*
shine, a larpe ami well vrntilat^^l apartment, in a word, the main ad-
vantages of fmiiiiry residence. This ia what cxplairm llic ditTorence Ix'-
tween the country and city iiuraliug; the one has a good npufunuice, roBV
complexion, firni and rosinting mn&clcfl: the other is stunted, Iran, and
delicate. You should thc-n insist on great [uiinB being taken to renew the
air in apartnienta wbinh are orotipiod by hifants in thu cradle.

If I bave dwtdt at soinu length on this xubJL'ct of tht- alimentation of
the yonng child, it is becaiiee it is necessary in comliatiiig thd dyspepsia
of early life to understand well the hygiene of infancy, and if yon are calletA
apon to treat the functional troubloR of the digiistion of a babe at Mie
breast, your first (;are will be to patts in rt'viww all tlie dietetic circum-
stances which have an influence on the development nf theae affertionp,
and in »nch minnto interrogation you will find the vause of the evil and
ila remedy.

I ought, however, to indicate to yon (wrtaiii minor i)harmaceiitical
meoaa. First of all I would njcommend the iij« of magnesia, which is

•mE nysPHPfiix of nkw-born infants.

215

'

comlKit the constiiwition of (lyBj)L>|)tic infanta, uiul yon know that
nt who \u\» hnt one atofil a i\ay is constipated: two or three stoola
[ai leant) in thn lwonty-(uur hours is thii re^iliir rale. Ilcnry'a mu^csiu
U n good prppnmtion and tnny ho gircn in tho doae of n dessert i»poonf«l.

If thvre ia diarrh(i?a, you euii give liim lime wa.l«r with milk, inurt
powders sach as subniirnlc of tiisDiutli and cliatk, or you may try to ad-
vantage the preparation of Renf' Bladic, wbich coiim'ste in giving to tho
itttsuit a CoaEpoonful of cnetor oil witlt a littlo eyrup of gamarnbic

When thore is vomiting vAtU too sppedy pofipilation of the milk, give
a taUo«]ioonfu1 at Viwhy water every time the child w fed. Sutih is th«
trMiment of dyspepsia from a pharmsvceutical jfoint of view; it is of very
littJc importance aBeomimrci] with the hygienic treatnifliit.

I mxxsft not finish this topic of tho modicntion of oarly infancy withont
spying to you a few wohIe ROnGeming the pre]taration!i of phoBptiate of
lime, preparations which are manifold; the lacto-i>hoBphat«, tho acid-phoe-
phat^, the r-hlnr- hydro-phosphate, etc. All have for their basis, as you
know, ft solnblo mlt of time, and which is soluble ouly od condition of
being udd.

Thew phosphstea liave been much vaunted, and they are of ertenwve
usage. It hne been believed, especially siuoc the labors of Dusart, that
they might be beneficial by supplying to the growing organism phosphate
el lime, HO nocoBcary to the bony tiastie of tho young child.

I am vom]H>lted to boHcre that this \a a mistake; thn experiment*! made
m Germany, and more recently in France, by Chery-Leatagf, and thi- obser-
vations of Sanson and Caulet, enable us to affirm tliat pliosphate of lime,
whether introdaccd in an insohiljle state, a« the tribasic phoepliate, or in
a soluble state, as the acid phosphate, does not lix itself in the economy,
and panes off in tho f«>cu) matt«r8 or iu the ai'ine. In this regard thu
expefimenteof Iteiden of Pommeritiare decisive, despite tlie more recent
obserrationK of Dumrt, which id my judgment, bare not itivoUdatod those
of the German savanL

If you wish to introduce phosphate of lime into the economy of the
yonng chiki, it will not do to rely on tho phurmuceutioiil proparatioiiK.
but yon should select that form which iiatnif has already assimilated, in
making it a component of tho vegotohlo kingdom, llencu the ocrcitls
whioh uontain the phosplmte in gn-nter or lena r|nimtity, bran bread, cer-
tain h-gumi'H, have a fitvorable influencu on the duvulupment of the young
infutit"

Bat, you will eay, tho acid phosphates have often a happy action, and
we continually see benelicial rLwiilt* from their ueo. Thc«o beta, gentle-
men, are not due to the penetration of phosphate of lime into tho econ-
omy, but to the fact that then- acid phosphates on the one hand may haTS
introduced into the stomach an element useful for digestion, liydrorhlnric
or lactic aciti, acd on tho othvr, to the circanutoncc that when once tbow

DISBA61S OF TlIK STOMACH.

uuitl prepiirations bto ii<>utnilis<>t] in the intestine, tliore is a. ]irecipitttte of
iiieoliiblo calcic pliosplmte. wliidi in itx turn leudi to diminiHli int«}(tiiisl
iirilMtioii.

Sucii, goDtlcmen, an the brief obeorvatioiio which I wishctl to make rclii-
tlTfl to the d}Tipe|iBiii of new bom infinite; and with thi« 1 eoncludu what I
Imvi' lo say respecting the functional trnnhW of the RtnmHPli. In the
next chapter I shall treat of tbt- therapeutics of ulc«r and cancer of the
stomach.

r

KOTES TO LECTCTiE XV.

' ChariM Murchand, a pbarmacist of Ffeamp, has published a very in-
teroHting memoir aptm the iibnormulitit's cf milk ami their influence on
the nursing child. lie divides the milks M'liiih he cjdU nlmormal into
two rloieeii; tliosG abnarmal by exeeas, and tlioae abnnrniiil by inferiority
of one of tliti locteiil principk-A, all the others buhig in {iropur pro)K:)rtioii.

(1.) Milks ttbiiomtaf ftyexce/tK — A milk which bus a proi»rtioii of butter
higher timii 3<j per lODO, ordinarily gives good rLJUultx. und oughl to be
recommended; but it is not so tf the quantity of butt(«r be croatlT in ex-
cees of that figure, CRpocially when the lactoHo dws not fnilow the same
rate cf increase. Marcliana has in fact Been children pine away otia milk
presenting all the ehamcteri* of a good aniclo efi\e in respect to the but-
ter, the |iropurtiou of which was uXove b'i per 1000.

An excess of lactone docjf not seem to have an injurinni- influence,
but this IK not the case with the protein mutters, an exwRji of wliit^h may
cmiae gaatro-intcstiaal troubk-s; hcucu one ehould supiTvise and regulate
the itliniuntutinn of the wet ntirw, whiidi ehould he Euflkieutly ubundant
and eomposed of » proper admixUiru uf aaotized and elarohy KubstatieeK.
In fact an idim(Mitution very rich in protein matters furniuhea u mitk like-
wise rich ill plastic element*, while a regimen in which etaiches pre-
dominate, furiiislies a milk riclier in butter and in lactose.

Slureliaiid alHo notes the influence of tlie age of the milk ; the albumi-
noid matters augmenting according to the needs of the nursling, lie
thinks that for an infant just boni, u milk several monthK old is an indi-
gestible aliment, provolciiig vomiting and greenish stoiils; these ill eflects
may bo obviated by giving one or two teaspoonitfula of pure water with a
little hit:urboiiute of ftodu, which the infant m uiudo to take after oach
meal.

(2.) MUL'iithniir'maJ by inferior il)f. — A milk wliiuh contains leas than 30

Iiart*i pLT 1000 of butter ought to he mjected. In a ca»e where the
lutWr did not attain thu figun? of iA. 12 ]>er 1000. Marchand w.\tt able to
supply Um delicicney iLud keep the eblla in goed condition by giving it
daily a doBsertspoonfal of cream in a little sweetened water. A diminu-
tion of lactose, which iei met most frcciuently dnrinij gestation, or in the
course of utt'ririe diseancH. ia a htui dcfieienoy, winch can, however, bo
remedied by giTing the infant after each meal a ti'a8|>oonfid of sweotenod
water. The Tack of mita, and esijeiiially phoi^pliatc of time, may be rcme-
dieil by giving the hitler tudt in eubstuiiee, which is i-aaily aasimilablo and
dtK's not fatigue the etomucb.

TUB DYSPKl'SIA OF NKW-BORN mTANTS. 21*

Tinalljr Uwre &re milkx »o ubiiormal that they muiit be nttorlr iliit*
cardtsi, and reconnse (in dclmilt of « soitablo wet Durso) must U- liii'l W
artificial liictatioii. 8ucl) itt tliurniik of which Maixrlmiiii (^irinttliv follow-
ing Hiiiilysut; it WM taken from a wunian 33 yesirt of ngp. bloiidv, of short
fftjttnre, of firm health, but who had never b(-(>n able to rear on her own
milk mir of Iilt eight children. IJti(l«r A we givu tl)« tinalvai^ vrliicb
ttuir bi' contniDtod with Che Dormal constitution of human milk asgivvo
uudiT K.

A B

Butter, 12.73 36.79

Irtctoae 7ti.'J7 71.10

Protein mattcre 3.S2 17.05

Salts. 2.22 2.04

Water, 904.06 873.03

1,CX)0 1,000

WcBTi's Table. Coju-obitios or 100 Parts of Womas'a Milk.

I
I

I

£. UarcbaDd....

Bertiuprel I

Vpntobi r

iKn-fTM

Ibid

Filhol 1

J*'y. i

Slid.

Ibid.
Ibtd.

lUd.
lud.

lliU.

lUd.

1.0836

1.080

.081

.089

U.S^*

13. 8B
11.44

I.OV

in.en
19. -it

12.06

3.1
O.fiS

s

9

1.5

8.14

iM
8.74

».«

S.4
A. 4

».381

7.(rt

t.m

T.B

la. 24^.897. 33

4.1

ft.o

4.75

9.15

18. 4S
14.44

11.88
18.8

o.ea

0.85
».0

lo.soini

is.sa

3.1)6

ill

OlnerrBtlanK

7.«
3.«

8.T

8.8

5.S
5.78

5.3

S.93

3.8$

4.54
5.3

.35

4.ao

n.ft

7.5
Q.06

7.15

6.8

8.8

4.85

1.27

6.0

S.d9

0.18

0.ie«WomanA. One moatb &[t«r

O.IISTliP aam""', 43 days alter do.

Ilv.-i;v.
0.287 Till* Niuiiv. H monHut siflw d<»-

lii'cry.
0.114 Tlw- samp. B daj-s aft«?r — isuf-

fei-iii|i; fram iuiuiitiuu.}
O.Sn TlieMiriK-. ufl^reOuyn.
O.aaSiTlie tiontt-. aft<>r8 day«.
D.ISSUixiKl (tieL

0.1S8

0.18
0.16

Q.tfS

0.05

O.H

0.7»

0.84

1.8S

0.8

0.78

MeiLO of B Qumberof iumU*»m.

Wet imnw thirty your* of
afo. Milk uf ll)<> S4th (1»>.
HM^rro DoiinBliiTi«nu

Tlic Kaiuo. Milk at 'il monlliit.

t)>i<l.

Iliiil. Mi1k of fourth month.

Ibid llilk of l«nil) nioatli.

WomaD having milk, Imt not
auraing; SS yvara uUi bru-
nette.

Lympliatic MWfniiiM' t«mp^ni-
ment Millt of Um Mvond
nioiiUi.

Brunettt). Milk <tt tb« second
year.

*Tbc densimeter, or lacto-dcimi meter of llnuchanJat and Quevennc, is
ail arcom«tor which Ims threu scalra oti its stem: one niwlian. on wliiuh
arv insorilxxl the donsilifa fompriaed betwwm lOlC and 1045; two lau-nil,

'

the one ooloretl yellow for pure milk, tli«> otlior blue for Bkimmi'd milk.
The instrument "being gpwluattii (or tiw tt'nn)i>rutiire of -f-lS"! K> uniploy
it vou nuist bitlier recinco the t«mponitiirc of the milk to 4-15° or con-
Bult for lli« oorrectiona of fempetatur«, tbti tublca of corrections given by
Bouclianiut and Qucvouiio.

You titt thifl instninu-nt lu you wouUl on oniinaryflcromoter; dipping
it into thi' limiid to be rxjuiiiiioJ. von olisi-rvf the luvul of the liquiti on
thi! ftfi'tn, ant! read otT the figures thiit f:orre«p()iiil, hy this you jnUge of
its SMOcirtc gravity as compjired with pure milk.

It iit neccHsiry to beur in miiid that the ilmBilr of pure ntilk oseillulvs
between lOtJ!) and 1033, iui<l tliut uvtery twnth part of wat«r added, dSmin-
iahL'a the density of the fluid hy 3'.

The following; table, according to Bonchiintiit and Queronne, giv««
the iiroiiortioiiBof liiitl«r ami crram in niilki* of different density, as tested
by tlio scale of the Iaotpgcoi>p.

Brgnw* oil tliB

Appfoilni»U>

wriKlit or biittcr

IVpranUi:*

actdf (iT Itir.

or

UuAo-ixife.

IKT litre.

CPPJUU.

u

40

13

27

39

13

28

38

12

99

37

11

30

36

11

31

35

11

3'3

34

10

33

33

10

34

32

10

3fi

30

36

29

9

37

28

9

38

27

8

[)agn*ii on Uiiii

Arprviilmul*
wi-liTliI of <>ui.t«r

Penxta4imB

■■ale of tlu.-

at

taijlont'ope'.

IK-rlllrv.

creMD.

3!)

S6

8

40

S5.&0

8

41

25

7

4-J

■«.50

7

43

34

ft
4

44

23.50

7

45

6

4C

22.50

6

4?

21.50

6

4B

2L

6

4n

20.50

G

50

30

G

Woman's milk, if it is vory rich, marks 20 to 25 degrees; cow's milk,
if it 13 good, 30 to 35 degrees; if it in bwl 40 degrees and more.

The Jacto-^Hti/romffer of Miirclian<l consists of a cylindrical tube di-
vided by three lines into threo ]>ait« of Umi cubic contimetreH of espaeilv;
tliO |wt nearest the o(x'ning is divided into ten iwrts, representing tfio
degr<H.'a of tlie jipiHtmtufi.

To use the iinpiiratuH, yon fill the tube of the InRtnimeiit ono third
fnll with the milk to be examined; yuu theniidd two ilrorwof Uquop aodfe;
tbc-n after Iiaviiig iigiluli,il it. you pour in etlier up to tltc second tUirtl,
then alcohol at 8ii° to fill Lht? reiimining third. You then agitate the
mixture and let it rest in a vassel fidl of water at 40° C. ; the bntter then
forma an oleaginous layer on the upper part and ot^upiee a certain num-
ber of dcgreea markt-d on the tube. In oriier to ascerUiin the quantity of
butter (I'j eontiiined in a litre of milkj yon employ the formula given liy
Marclianu; t*= IS.liO grammM -f "X 2-33 granimep. 12.G0 represent*
the ijutintity of Uitfcercorri«pon<ling to that which diiwolves in Ihealcohal
and ether employed; ;* in the nnmlner of division.^ whicli tlio fat globules
occupy: '-.H3 represetilii the qnantity in grammes of butter t'xieting in
each uegrce of the jjrail uiited tube.

The lactcjBcoiK.' of hoinu' isa little instrument resembling Romewliat
an o|M'ra glass, (The working of thin apiiaratus is not easy of explanation
without suitable cuta, and aa it is notuecu in this country, thu dcifcriptiuu

TllK DysPKI-SlA OF NKW-BOBN INFANTS.

219

of the oriyinal ia omitted. For n Rimilnr rt^ason, Afbm'x nicUioil is aIm
Oinitt«<l. The priiicipaJ methods in ubo in this country may bo found
dracribod in ZierniM(*ira C'y[:lu[Kt.-i]]ii, vol. xix., p. 366. An urdiriurr
hy*1rom«t*r uii8Wi>nt n wry f;tio*I puriJose. Tha liydroniet*?!!* in iwa
art' enuluak-d aci'onling to vnrioufl jjlana. The ono wKieh hiifl boon
founu moftt conveiiieiit jfl a t<iiii|ilit epimlle, ftbout fiftofii ci-iitimflrwa
long. Thp stom of tliit* is {^ra<liiaUMl from to 40'. 0° ropri^i'iiiitig
pure WBter, nnd 40° ru-in'i'M-iiting tho Biwciflc gnivity, 10. 10. Thii*
nuise » wifHci(!iit for all usvs, and tlio mstrumcnt is readily carried
in too porkct. nnd its ho Hlinrt tlmt. it flctatA in an nnlimiry qniirt intsasnrp.
This iiuttrunient is of eFi]iecial iihi^ in tr»tlng caw's tntllc. Any milk tiiiit
stands utmre ^3° is pri>tty siirR to lx> Bkimtnod, wliiln ihiit wliich falls
below 29° is nqtittllv sun' tu U: vriilvnil. Tlic iTfAtiiuEnuti:r is ii Diuch
more complicatwl in mm men U]

Bouchut'ti mode of eiiimii-nttioii of ^lolmUt) ie qiiiti< prat'tii'ulilo whera
one has a good mtcroaco)H-. Th« description le condensed from tlid
aothor's not*-. "M. Naeln't," Buys M. Boiiphiit, "hiia made for mo on
a glatw slide nomc («tl«, a tenth of a ni illiniptrc in di^pth. I tiiko np a
drop of milk with tho (ip-aduiitod dropping tiil>c of Linion»iin and dilute it
with 100 drojie of distifUHl witor. '1 hia pivtw mu n liiiiiid with a donaity
of 1030; Ui« milk globulps reailily rise to the top. A drop of tbla 1 j>er
cent, lactvnl Sfilntinn is put, im tlu> gliiH^ elide in thn wUs.

" Thu eye-piece micryinctvrt:ontiiini< on it« distal lens a tnMiing similar
to that tiW-'d in lliu iMitiinrnitioti nf lilouil glohnle!': itprojVctH on tliL- <;]»)«
slidu th« iinn^'Of a quadrilutenil with F^idc« ^ niiDimutru; lliiiit|iindrilatHr!il
is diridwl into foor Ei(|iiarcs. The number of globules in each sfjiiMrf ia
easily counted, an avenge 18 taken, and tlilH is multiplied by IIKNJ ^thu
cahe of lU, the cells being ^ mitUmutre in depth) then by 100, since tli«
liquid is a I per cent, dilution.

"Therefore, if 92 bo the nnmlwr of globules found in ii nquarn. tho
calculation such as 1 have indicate«l, gives ^i. 437,000 for the number of
^obnlestrf milk in 1 euhio millimotro nf milk. Ity this process ( liaTo
counted the milk globnU^ in IM ret nuiws.

" In my obeorvations 1 have made account of the ago of the wi-t nurso
and of her milk; I have eMtjLbIi«hed ccrtaiu categories for milk tjiken
beforu uuniing. These are the prineip-nl rL>8ult«:

Five times the globules hare lieen from

FourU'eii " "

Twenty

Twcntv-four "

Siity-als " "

Twe'nty-soTeu " "

Twice " "

It

(4
t(

il

200,000 to 40O.tK)0
41K),000 to (>()0,(K)0
GOO.tKK) to SOO.WIO
800.000 to 1,000,000

1,000,000 to a.ooo.tioo

3,000,000 to 1,000,000
4,000,000 to 5,000,000

158

"Tho«c numbers comprise tho large and middling eizcd as well as thn
■ntall glubules, all tliat it is noxKibln to count by adjusting the tuliR of the
microH!0|»e so as to vary the field of vision and bring into view all that are
in the stmtum of milk.

'* lH-«tiib(i thii divoreiiy in tho comjiOBition of the milk, aud the rarim-
liona in tlie (luantitv of its elements in the mmo nursing woman, at ditTer-
ant epochs of the day, the numemtion of the globules, mulv with care,

and floveral limrs in tlio tweiitj-foar lionni, (n*'pi» ii modium which woll
reproscute tho quality of tho milk.

" MorcHriT. if uiu- irouM iiivL-slipttu dti-plv Mit-rjnctttion. and iia I hare
donp, proneptl from tht- miiiibor of ^lobuli'x to tliu ujiproxitniitive weight
of thft qimntitT of ImtU-r piT litre, or ovtii dtilerminc the approximate
tli^iiffity, this 18 easy hv voiiiiMiriiig tlie milk of the cow witli wonuiii's niitk.
TU« (ollowhig ixiiupri*-.< my oliseiTHtions (»ii cow's mitk:

" Tiiku ft uvrliiiii t|UtiiititT of cow'tt milk, »\y ir> gnimmto; I, ntAko the
exact miui«ration of tin: globules; and ^, dctcriuim- tin* com-apoiiding
dfiiaity of the milk; then ;i- ih'tertiiinf; lijf chumiciil analysis llin t|iiiintity in
weiphtof imttiT eontiiiiiwl in the milk Hulimitteil to aimlysiK.

" In com])ii.riiii» ihrnw. tlin-i^ kiiida of resulta, I liavc dmwn np ft tabic
indicatiiif; with whul ihmily and wttli M'liut weight of butter per litru
enrrewpond tlie f|ii!intitie8 of glohnles appreciubW uy the iniiTOsoo|)«'. In
this way, kniminfi the nninbLT of glolmk's in u eubic niillinifctrL' of milk.
i uin able to tell with cousidcnible exactness its weight m butter, And its
apjiroxiniiitu dciiRtty."

{{oiiehiit thus filioAn tliat hy a oarofiil etndj of tlio clohiiles in ouo
drop of milk yow e«n com© t*i know it« dontiity ami it*j i-iomieee in butter.
The mean of Ht^renil niiaU'nni lUionld be titkun iiH the Htandard.

"The medium f|U!ititity of KloUnliw, valued iirronHnjj to calr:u1ations
Tnudft on l.'ii* wet nnines. is ),U'^().lHJ() jxT enhm millimi>ti'o, and
H>2.(;tW.000.i.iU0per lilro. but betwoL-ii'HW.WO and l.OW.OOli per cubic
millimetre, the iititk is of good utiulity. There n'nniins hut to deter-
mine the t[uuntily. iind this is easily a»u-ituinud hy weighing ttiu infant
before and after nnraing.

* Aeeording to Kouelmud. the infant if weighed immediately after its
birth and a few davs later, is fonml to luive lost weight, but at the end
of live or eix duve he be^'in^ to piin, and epoedilY regains what he boa lost.
The iiifnnt ougfit to have gained:

At the end of the Hrst month, .

second

third

fourth

fifth

raxth

seven til

eighth
mnth

tenth

el e%'enth

twelfth

^.M) grammes.

7W

650

600

550

500

450

400

350

300

ZSO

SOO"

"Tlie following aeeordhig to Simon. Becquerel and Vernoisf is the
comnoftition of a hundred -pMU of woman's milk examined during die-
cased states:

* Bouchaud. Th6s6 de Paris, 1841. ReD4 Btache and Odier, Some Cooaidem-
tionxuii tile MorUUit.v of New-born InfanlA. 1967.

^ Bocv]ucrel and Vemois. Milk nf 'SxmingWomta in H»i1th and Siclcneaa,
Piu-J!.. 1853.

•It hiw been Wfniarked that tho milk first dtttvni ie the iKiorePt: thut
of llif miiMIe of tlic inilkinir offrrsj an iiverage coni]>osition, and iliat of
the iii»i is more crwuiiv. If tlicn tbt* iiitorvuls oi Eiu-kliiig nro too wide
apart, the ninmmii U^riJicd with milk, mid tve the infnnt (loen not oinpty
the ItreAHt onmitlt^tf^lv. it mar only rnmrtvo the nqiicoiiH jiurt, and thus
hafe inmfficieiit nourinHment,*

' CoH i^wiTiov op 100 Parts OP Cow's Mii,K.

1.^

^"1

ObaemUoM.

O.-i
a A

2.8
0.6

o.a

0.5

0.7
0.

0.144

0.78
O.W

0.M^

Milk of amth <U>% 5 quarts a claj.

Fo'l rtn hav.
Same cnv. 'Milk of 3imh tUiy.

S quarta a duv. Beet*.
Sani^ i^w. Mfllc et 803d dity. »

iliiiirtn iiday. Hay atiil oil cjikc.
A cuw |iii:<ti]n-il ill a ricli lU^ld.

Milki-d ill UicNlttbluurtiir Ivnif

Jrivinp,
Same I'litr. Milk of th<t (ifxt

morainf;. No exerciM*. No

r«M>ilinf;.
Simii: (-OIV. F«d in Uie stobte.

Mitk of lhi> rvcDJuic.

Aveni^ of sercinl aiuUyKC*.
Mi^aa of t»a unaly***.

Spver years old f*»w. Kiitin'
mdkiag. Milk of sixth niuiitb.

Cow f*>d oa carrolH.

The Ntma fed on beitfl.

HcAB of ft*VttRil nnali'Mo.

0.7% Avarn^GompoaltioDoI the milk
of a eow tram Caux.

* Kobeyner, ConaldemtJoas on tli« Suckling of Nevr-bom Infaats. (Bull, ile
ni4i»p., Jim., IKTD.) Onuig^ On tli» K«;nilfttion of the Pnioda of Lactatkin
CJoDT. dca ConnniHsaiiow M^lk-alcA. Fcli, f^TA]

Same ivnimal and Ranw
fiwd. EiitiiH' milking, 2 ^ti*.
in 34 hull Hi.

The general ftvcrngi^ of K'f^tB milk, iiccordinji to Olievsli^r and Henry,
jfl as follows: iJeiiKitv. 1,30'J; i>rv ri-swliif, ViA; Oaaeiil, 3.7; Butter,
4.3; Hugar, 4.U; Kxt. limtter aiid Ki{t«, O.bG.

' AiwoHiiig to I'rof. Pflrrot, SOO grammes (10 ouiKvea) nf milk ppr day
for till* finst ntontli; fiUO gnimmtis (-f ninirefl) for tlic 'id. 'M, ■Jth imd 5tti
muntlui; SOU (2<iS minci's) for the lith and following monlliB. represont
ill h3! oiiseB n qunntity of milk which suRlf;i'i« fnr iiifBnta brou(;ht up on n
l^ottlo. it being uiiilfrstouil tliut tin; milk hv \nm: uml of i^ood quali^, and
tliiil. if it betlilutcil. iM many pnirtitioiuTs mlvisf. « iptiintity of nii^r i«liikll
IiimiiUIliI in tin; follnwing proportion: 30 gninini^K (1 ouikt) for tlio Ist
tnoiith; 40 gnimmoa ( ^ j ami 3 ij**) for tho lour following monlli.!, ami 50
^mmnii's ( z j and 3 v) after tliL' Glli. At tliis [icriod of thi? rhild's life
It wil) do to fiL'giii to ai:cu«tom it to otlitT kiniU «if fowl, mn^h hh gni^l
mode witli milk ami flour, liriwid mii, mt'Ml brollie oi' ntftws mtiiic with Itmn
niciit, etc. These articles, it fidied to the infaat'B doily rfttions. should
Uik(> thn place of a portion of the milk, ami tlti? fNiro nf thv infant will
then l»e conipoiseil of: milk, Trtiigrammos {2:!J onncps), stiirch, farina, or
brciiii, 107 ^Tnnimce pJJ i>unoe«). sujsir, 50 (Ij onntrs). Aoiiordinp to
(inmgi^-, sugar should not hv luldnl tu tlio /iiilk of ihv infant. H« IrneibH
liiinKidf uii the experiments of r.nssjinji, who haa shown that in tlu' infant
the bhUvu is deprived of ferment. If HUgiir is tim-d at all, proforoneo
lihould be ^iven to tiugiir of tnilk, wliioh cun be absorbed without under-
going tranrfornmtiou.*

* Objiwtiona Imvo boon made to thoso ruhbi-r nip)>los; IXKidM tbo 111-
eonveiiiciiec that they soon become snftenod. nnd (roiiwqiiently must bo
often ehanged, it bus been Khnwn tliiit the mode of iBbriL-Htion of vuleun-
ized mbber may cause harm to tbu infant. In Oormany, m hue boon
remarked. «iiii« kiiula of riiblHir mutunnl (^outidn as much ae 50 per cent,
of a iiiixturp of oxiile of ■ivur. othem If* [mr wnt. of carbonate of le«d;
and 38 iter (Wiit. of ehiilk. In still other pre[>ariition8. the prcswnco of
itr^uic liAB been detoctod. Fauvel Iiiih also detecttn) by frequent anulysea
impurities in the rubber need for niirang bottlee.

* Pamtl, lleport on the ArtitVioJ ADmontntion, of Infants <TJnion MeH., 1S74K
Or&ng^, On Artiftcial Luctation (Jour, des CouiiAisBuaoas M£di<»lv», I87SV

THE DySPKPSrA OF NEW-BORN INFAhTS.

223

111 a report to tlie Frenrb Society of Ilygifuo on NuwUip Botilrs,
Ifrni' lilaelic ronsidiTB an priifurable the buttlo witlioiit nuetion tulm. The
fclasf mouthpiucc may be replaL-ed by one of pui-c caoutchouc. The bottlo
i«boTild Ixt bt'ld in the hand while tlie baby is sncking.*

* Th« evolution of the first twcntv tnctli (milk Utfth) which fall iiboiit
the eoTenth yciir and iirc ri-pljici-i! In- tlio iKirinanciit t«>th, onliiiiiriiy
takes pUoLt in gnmpe. vith iH.-riuilii of lull, uiiJ in tUu folluvring: onk-i" 1.
thf twoccntnil inciHorHof thi? lower jaw; 2. the two uppt-r miHliau iiicisurei:
3, the two Hnpor iRtcnil iiiciiiors; 4, the two Inwer lat«>riiJ im'is*)rs mid the
four tint uiouirs; 5, the four ainhive: 4, thu foitr postt-rioi* molars.

Thefiret tooth gt.'ni'nillyuiiiH.'Mn^ itt UK'ni^uf six iuid oiil- hiilf tiioiitliK.

According to TroiiBsi-iiu. ihv cvohition of lUu Iowit modiun incisors u
■ccomplishnr in a sfwu-e of lime i;ompriaod bL>tw»cn 1 and 10 days; tlie
fonr upi«r incisors take from 4 to fi weeks; the lower lateral inciaora and
th« four first inolara re<mire one or two months more. The ratiiines are
two or tliroL- months in making their aii[waraiic«, luid the Inst molars
require an equal time.f

"Tliia is Iiicbip's formula: Miiko a mitturv of 16 ^rummee of wheat
Sour, 16 gTBmmu'H of malt Hour, and (>.:i75 grammes of Bodio bieurboiuitt*.
Add, Btirring, 32 pnimmos of water, ihon 16K frmmme^ of cow's milk.
Hoot at motlerate tem[M;rature, stirring eont^Untty, till the mixture
Iwgins to thicken: removo from the fire mid uoiitiime to stir for fire miii-
utvo. Finidly liriuj^ the whole to the boiling iKtint, thou strain throtigli
' a tin<> sieve, You thuH obtain a ^niel twice as coucentratcd ae woman's
milk, which can well he given in the nursing Ixittlc. After being Ixtilecl,
it keeps well for twenty- four hniin«. The «ivor is largely that of flour
imd malt; •.■liildren very rt-n^lilv take to it. an^l concrally thrive on it.
[Mellins' Konil. the Imperial <'ininum, l.iebig's, Kidge'a. and llorlick'a
rood, an! ma1t«il prepamtions much in use in this country. Trims.]

Hrneon Haims wonderful ru^ultH in the alimentation of infants from
the following |(re]iamlitin: Oatmeal and arrowroot, of each 5<)0; sago,
400: coooii. 50: augnr. uDO; pn-cipitaUtl pliwiipljute of linie, oV: vanilla.
1. A ta.li](-»poonf nl of this pre))amtion [whiidi must flr»t undergo thorough
cooking] in a cup of milk, umkua a very subetantitd meal (or a twclvo
niontlis' old baby.

I " In their rewarches on oatmeal, rhijardin-TIenumetzand Emeatllardy

L sbowod that this eeroal liaa the following tioni|HMitiou:

H Water, . 8.7

^H Fattv mattere, 7.5

^M Starch . Gi.W

^H Azotixed matters, gluten, U,7

^H HinenU malten, 1,5

^H Celluloec, otc., (mfttters not dosoO) . . . . T.6

100

Aooording to Liebig'a method of Judgiugthe nutritive Talue of a food.

by dlTkting it into pinatic and reepinitory vlomentfl, it ia found that oat-

tiHal contaiiu:

Plib^ie oloments, 10

Iteejiiratory '* 35

* R«n^ Bluche, Elude aur Im Bibvroiw. 1970.

♦ Trouasriiii. Clin MM., Vol. JIL

SS4

DISEASBS OF VllK STOiiACH.

Tliis proportion is nearly the same ae that of woman's mitk, where Uii-
two elements art* n-preseiiled by the following Dgurw:

Mastic elements, 10

Uespiraitory " 38

Ontmv-iil has more iron limn any other oerortl. In their experimeiite
nuulu in Foundling HottpitalH, Piijariiin-lioaumetz ami Hiiniy, »ii(l «till
more rocentlT. Murip of VerRailles. have obtained moat eatisfactory i-wjhIU
with Oiltmeaf as a iintpifiit for young infanta.

"The followinciitstritctioiwtomothcraand nur«-6. prfipareclliy ftcom-
mii«ioii of wliicli iTic iiiithur wii« a nictijlicr. hine lu-cn issued Uv tlir heaii
of the llepiirtmeiitof Public Cluiriti^K (udiiiiiUKiration general de TAssiKU
anco I*uhhr|iip).

1. Till iLe »p|iL>uniuco of the first teeth (between the 6th and ?th
months). th« only I'urid of the iTifant t<houId 1«_' milk; that of the mother
espeeiiilly, wliiL'h is iilwajs jirefunihlu if mIiu be in t;iiod eeiiditiuii, or eoii-
troriwieo, that of a wet nnr»e. It is in fact very dungei-ouB to give an in-
fant (luring the first moiitlis solid food, (bread, cakes, meat, legumes and
fill its).

2. The child should be givon tThoXrcwrt oroiy two hour* (or tbcrcobout)
and Iut« often in the night.

3. 111 the erent of inability to provide woman's milk, the milk of thv
■oow or goat nmy be Kiilwlitutwl; this should be given warm, diluted with
one fourth [mrt {inn: water, and ttti^hlly tswuutened. Al the hegiindn^
of tin- fifth month the milk may W t.iken pure. All other licjiiiilseinployeil '
to diiutH the milk (tliin gruel, hrcwl water, barloy water, etc.), are in-
JTirioue.

4. In feeding tho infant, ghi-ss nnrviing bottles slinuld be employed;
these, espedally the tubing iind tho nioniiij'iet'e «bonkl be elcaned OTerv
time rlu'v nre I'twil. Xevor allow nurses to ri>i^<ipt to tlie "Bugsir tout**'
with wlu'oh snnic mothera seek to npiieane the criea of the infiint, and
which arc sure to prodnrp r:inkcr and dinorder tlio digestinn.

!>. It is not till the lx>ginning of the sixth or fteventb nmntli. thnt ono
ehoiild begin to give &triuaceous eubslanccs witJi milk: eiieh as briMid and
milk, hiikod flour gniel, riie. arrowroot, etc.; towunl the end of the
first year it is always a good pliin to give thuse Eupplenientsry articleR in
order little bv little to acoUHtom th© ehild to weaning. AVeaiiiug ought
not to laike pW« till after the firel twelve or sixteen teeth have jiierced
the gnnis. while llio infant is in n goo«l Mute of health, and during the
hill whieh fi>llowrf tho eruption of a crtmp of teeth.

(i. Every morning tlie t«iilet of tlio little ono should be made befon* it
is siickird or fed; Ihie toilet eoniiista: ]. in wasliing the ehild's hoily and
espeei.illy the gonitals, whieh ought eoustjintlv to be kept clean; 'i, in
ftcrnbhing llio head on whieh it will not do to lot dandruff or scurf aecn-
mulate: :i. ni eliiinging tho linen at leiieL even' Bueond day; 4. in giving
a wiiriii hath in whieh the infant should be held fivt- or six miuntas. Tlie
bellyhand ought to he kept on during tho first month.

7. Swuddiing etothvs which cause compression of the bmty, should be
absolutely rejectiil; the more freedom the infant liiu* in it« movements,
tile more robust it beoonieB, and tho batter ita development. All swath-
ing which compresses tlie nock and heud should be diBcarded, as being
likely to cause disnnlera in tho health or the intell igenoe.

if. Tho child should ho protected against the injurious effects of cxcees

OP OTIW-BOaN IMFAXIS.

of ooM nnd heat, whether out of doon or in the house; within door? tho
air Kliotiid be reno^'ed eevernl tmvs a diiy.

9. It M not {inulfiit to o^iirrv tlit< infiLnt into the open air before the
fifteenth day- iiiilo«ui th» k'uiiiumtiint ho very mild.

10. It iB very dtuigorous to allow the iulant to sleop In the bed of its

t mother or niirsp.
1 1. The bed of tho infant nhoiild ho composed of fresh oa.t«n etnw,
soft tbiitch or hiigka; tho cnullo ehoiild hiivo ctirtnini; during tho first
months of infancy, oud especially during tliu cold ec^ostint! to avoid niir-
renlH of air, but these cur&inB shoujd never be completely uloaed. The
babe onght not to 1w ronkeil.

1'2. Thertf should not be undue hoate in teaching the infant to vulk;
it «houUl be alloweil to creep oti the tloonuid get up alone: vralkiiig cart^
und busketK idiould Ihj dieennled.

IS. The leiiat indis^xiaJtioii on the pdrt of the young bal>o, (oolio,
diarrlicpa, frequent vnniitiiig, cough), ahmild lie at once attended to.

14. A." pregiuiiH^y has for effect to render the milk lees nonriidiiDg,
in ejiitc ef pregnancy every nundrig woman bIiouM cejt^e to give the breast
to her child.

tl5. It is a good pliin to vaccrinaJe tho infimt in the first three moncbs
which follow birth, or even in the first few weekn if an epidemic prevails.
Vftccimition is the only prophylaxis against omall-po.'c.

"Heidoii made an oxperiniont on twelve little guinea pip«, all ef the
(»toe litter; four wore Tijtorone. four less strong and four wci-e very
feeble. They were divided inl<i series, feu r in each; two ntrong guinea pigs
Iwing Htw^eiated with two weak ones. To one (-tmng and one weak one
wiu( given phoBphato of lime mixed with the or<iiuan,' food; to the two

• other pigK of tlie K-ric8 only food was given. The es|)erinientAtion lasted
4'i dayH. and the Hide rL>i4u1t obUincd apiR'ariil lo hv Kiiginentutioii of the
phofphiite of lime in the exereuiviit*i. Heiden eeucludeo from thwe ex>
pcriments that phosphate of lime la not at^imttutcd,

• Tlie atme conchtsions may be dniwn from the expcrimenta of other

Germnn obeorveni, Weigke, for instance, who ha« nhown that phospluile
of lime abided to the feed of milch cows not only te not assimilatea, but
IB not even cliniinuted in the milk, Nan»on. professor of tho srhool of
(trignon, has rcpeat<'d these experiment* and arrived at the (mine eoncin*
ainnit: vix., phoapbate of lime addetl to the daily mtiona of animalK ii< not
lhMrlJL^l. and piu«4e^ out in it«t entirety in the fiecal matters and urine.
Ilenee Sanson lldTi)«L^tt to give to anintala instead a mon* abundant food,
ami feed of better i]iiulitv, tneb an the young Hhuol^ of gnuwea or grains,
the leguminous and eleaginoiis cereals ete. Chery- Ijostage shows also by
hi« exjierimenta on guinea pigs, that the l)efit means of introducing phos-
phates into the eeonomv U to make use of plnnta which contain llivBe
Mlis in notable oimntity, and the following tJiblv representing the
different weights obtuinc<l, Hhewe that the odvautugu in m luvor of thu
guinea pig that takea only it« bmii.

May 27. Jidy 15. RilTciTnce.

Olvfcro phosphate of lime, 'JOT

Nicto " '* 248

fhlorbydro " *' lUl

rhoBplmte of lime, . . 176

I'urebmn, . . . 'il3

U

315

108 graminec

260

Vi

308

109 "

380

105 ••

U&O

1C7 "

226

DC9£AS^ OP THE STOMACIL

Accordinz 1o T)r, Canlct. the binhoHphsto of Hme (soluble phofl-
plmte), is mstticr dt'comiiowd nor ttlworU«l in tlio Ktniiiach ; it arrives lui-
L'haiigttl ill the iuteittine wIiitc, in iin »ci<i moilinn!, it i« <IecoDij»ow(.I jiud
pr(iei|jitaU^(l iiiulor tlio form of onliiiar)' phogplmto of limo; it )i(!tj< Ui^n
tui a mechanical fib»orbc)it.

The insoluble phttsphafi! of lime does not behiivo in the nnine way.
Ill eontnot with gimtric init^e it in dpeompnecd into a rniliihlo mlt of lin'io
(]ikAtiLt« or chloride), nnd mphosphatc of lime; now tho Ifictatc und chloriie
uro Eolublo, uiid iiluorbuhtiT; liuiice, acoording to (Jauli^t, tliu liisulublo
pliOBpImte of lime yields tu tliu organism a part of it« lime.*

* H>'iilen, Fnli!in°:'s Lnntln-ii-Lhu^h. Zriliinf;, xxiiL, J»lirg. 1 Il(^ft, Jan., 1874.
Ruiiaon, Mi-«i«ir do ilu' TlitMtry of the Pi-w^icioiia Developnient of I>rinie6tic Ani-
niulsOcz- lielnl.. 1H74. DiiiuirU Miticnil iiiuniliuii in OUMknw, 1874. Caulot, Oil the
TliurApotulicRilleof Bi|>lui8|)lin1<-or Lim(*<ProKi'"nMM,l878). Ctterj- Lc«ta|fe, Ex-
pi'iiiiieDluluikil Clinical RiT«?mvlii^und-rliuiiPi'i-|iii.nitiiinr4 ot Pli<r>|ituiU- of Liniu
(Tli^ac de Paris, 1674). Dii}ttnlin-DQU.uiueU, Sue ilu Xb4nip., ."itwsiou Muruli 14th,

LECTURE XVT.

TBKATMEXT OF ULCER AND CAXCEU OF THE STOMACH.

SusM^R'Y. — Clcer of the Stomach— Symjrtoms — I'lmrmiM-futical Treat-
menl — Sitrato of Silver — PtTchlorklL- of Iruri^MUimitli — t.'h]on»l —
0]>i!iU>« — L^viige — Dietetic Treatment — Milk Jiiei — Cancer of the
Swmaoh-^DiflicnUii's of I>jagni>si!« — Trciitmerit — Hy I>an^T(> — Them-
pt-utic Indifutioiis According to .Sent of thv Ctiiicer— Surgical Int^r-
TcTition in Cancer of the Stoinacli — Gantrotoray — Oastrectomj" —
Oaatroetomy.

TliK lengthy developments into whicli I liavc cuteretl in the prt^rioDi
part of my work v*rtoui'*'K tt> tlio dvejicpsiaa will oblige nm to be
mocb tnoro brief in tlio thontjHiutic conBifWrntion^ which I am aliout
to proeent relative to ximplo nicer mill oiLiioer of tlie stociRch. You knov
that thesf affections arc charafU-'rizcd by symploiimtic dyspeptic tmiibles,
and that tliu tn-Atnieiit of these symptonia it> the euiiiv uh that of the
difierent dyspepsias studied in tlic foregoing chapters, llenco J eliall
Iwre aet forth only the more im[H>rtaiit points in the thenipealiL'H of these
two ■(Tertiunx.

Let UK bfgin irith ulcer of the atunuicli. Notwitluitanding the numer-
oos works oil the duUjvct of nlupie ulcer of this organ ainee tlio^kv of
CrOTeilhier, we an.' slill ignorant of the oxaet pathogeny of this nfllctioa;
aoall onr treatment is directed, nut to the first cause, wbieh b8c«|w« uh,
but to tile symiilouis dettTiliiued by the loss of substance of the walb of
thf i<toiuach.

The symptome wliieh ro«u't from the pi-cwonoc of the ulcer aro oh
followa: Tomiting. and often X'omiting of blood, duo to the opening of
more or leas importaut blood- veaicls: attacks of [Uin, sometimwi very
aeTL-re: lastly, perforation of tlie vralls of the i^toniach. tuid the fatal con>
•(.•quencee that result therefrom. Such are the three principal pointa in
tlie pathological hii>tory of uleer. Add to thi^ brief description, that the
ulcer, if it may cauiu> death, in Ukewiw susceptible of cure, and this in
one half the (UKtt.*

What can tlie physician do to alleviate thcM.' n'm^itoms and biuit«n
cieatrixation of the Dlc«rf 1I« can employ both a pliarmacentical and a
di«totio treatment; and although tha latter confititutoa the boat and

* In Dnntun'* 100 ciwe)^ tln-rw wiw tirntrixiifum in M, perfnnUioD ia IS. 4 died
Im^, 8 ol i»iMumpti«n, and S-'t ml imtktei-miDMl causes.

DlSE.VSra OF THK STOMACH.

perhaps th« only mwinfi of (-nro, permit mo &T»t ol all rapidly to set forth
the* pliamiucetitina) mfAOH of which vuu may amko use. Two rndit aro
to be ac-omplisht^l: onv set of remptlica acts locully on the uU'vi- tu bring
about its cicntrization; another sftt is given principally to comhat tht- puin
which is BO «hanictoriBtio « lymptom.

Thi- ItKal iiiuilifiera nru tht- moat immcrons, miil tho firrt place most
be ussigiipJ tu ihu Kills of silvLT, aiul purtluukrlji' iho nitrate. Struck by
thi> good effects pro<luced by cnuberixations effected with luii&r mualic on
cutaneous ulcers, omio medical authorities have ouppoeed that this salt
might modify BilnintiipoouRly the surfaw of the f^wtric iiloor and bring
abiint cieatriKatioii: hence it Jx that we see Troui»eBu, nroH, Nchiitzen-
barjer and others, reoommend tho Uf»ge of pille of nitrate of silver of one
centigram, the dost- of u-lucli iti progreeeively raised till ten pilln a day are
taken. Fleminj; has even gone farther and adrisod to inject A solution
of nitrate of silver directly into tho stomaeb by nieaoH of the (esophageal
aonnd.*

I am f|uite of Brint^m's opinion with n-gard to this treatment by the
silver iM!t«i. lirinton treliovea tkis medication to bo quite inefficaeioufl,
and affirms thiit if he has obaerved p:itipTita to get well while taking
nitniti' of Kilvor. il was simply beeanse they were on the milk diet at the
Buim- time, which is known to be of itself ciirativo. Mon-over, it i« diffi-
cdU to limit tho action of nttruto of silTcr to the BurfiKO of the uloer,

Luten, baling himnolf on the good rc'siilti nbtainod in tho trwitment
of ulcere of batl nature by the pnifouiulJy mwiifying a«!tion of |K>rnhloriilo
of iron, has connselied thix medicament in round nicer of the stoiouch.
He atlministen) three or four timi-x ii day t-t^n drops of the tincture of per*
chloride of iron in a little Hwetrtoned irat«r.

For tho mme reason Ikmnemaison nf Tonlonae has rec!onimcnded the
«ubnitrat» of bismuth in largC! do»es. Ilr Ihih himself been in the habit
of giving two to thr™ oiinraai of this medicament during the twenty-four
hours. \

I shall only mention Bulpbato of iron, proposed by A lierprombio. and
the strong sci-iiMl lettuce (lactiica rirosa), which Caziu of Boutogno luie
adminisli'ivd in tlie,w rasea, and I come now to the trestmout of ulcer ol
the stomach by cblond.

Hcrtzka of Rudu-Pcsth wa« the drst to advise tlie emplovmont of

* Tnussonu Cliak-al Medicine. Vol. II. tiroK. Union M^d., 1857. S<?l>Qtz»a)>er-
KQr,aaa.316d.du&trai(bourR. IS^O- Fleming, ANewMo(leorTix-uti»Kiieven>I>ra-
IMtpKliUf and Chronic Infliunmntion of Uic Sloiiiiwrh, (Med. Times and Oaz, ItiOB).

t Thin wiiK in m-fordaiK^t' witii Uio liiiportunt loliors o( Monn<-n>L Vide BonnA-
maison.OuiiioTriutmentof Simple Ulcer ol tlM-yUMuwcli, Toulimse, 1871.— I.ulon.
NotivMiii Diet, ilti Mt-J, ft ("liir. Ait, EAtomnc — I.utcm. Ou UImt of tlie Stomach.
(Hull. d« laSoc M6U, il'UbHon-ation, 1858, Uertzko, Bull, do Tli^rap., t. xdv., p.

I'LCKK AKD CANCER OF THK STOSIACH.

chloral in tho treatment nt iilceroua gaKtritiK, taking ns hw basin tlio
rcanlta whwrli I \unl obtaiui'd by tho extcnuil aiipHcution of chloral in tho
trpntmmtt nt iilc^'nitioiis of bail iiJiturL*.

Untwrt unatt'ly L-liloml is itself mii irritimt. ami I have itlnwiy tohl you
tliat its proloii^d u^n i.s a ouii^ of ratnrrhul inflttmniatioTi nf thr Hlomat^h;
for this reason this mcdicution iti uuiny outt-s uinuot hv cuuntTcllvd. Aiul
what I Bay of chloral nliw applios to nil tho irritant \nct%\ mo<lilier8 which
liare bwti a4lvifii>d in the truatmeiit of simplu uloer of the stoniacli.

Be then very resvired in the emjiloy of the«e topion.1 moiliflerB; you
can he lesa so in tiw usage of opiate preitrtratiniiB, whii:]i uttuJii a triplo
end; they combat tho painful paroxysms which are often bo violent in tho
onanin of thfi iliwaiic, thev aiiay vomiting, ivnd they siitMlut* tlie Bensation
of hunger, ami thns enable uh to keep the patient fasting for sume lime.

firiDtoD, and more recently Oallard,* hai-c shown the good effect;* of
opiatCH. Yon can prearrilie tlie Ktiglieh " bhiek ilrops." or the French
*' white drops." or pulverulent mitturon of mnrphine with inert pow.lere,
of whiph I Hpnke to you when on the neuroees of the HtonuuTh. But the
hypodermic method U assuredly the best meaiw of introduction of mor-
phine, being the least irritating to the stomach. We liave also seen a<l-
Tjaed, in order to comhAt tiie pain and vomiting, tho employment of
energetic reviilwvea: v<sie(itnries, iamica, the uctual canterr, etc. 1 tliitik
that one ought to be very chary in the employ ot these meiins, the farora-
We action of which, moreover, is not aljsohilely liemonslrati'd, For tho
Tomiting and the hfematemesis, make use of ice, and the difleicnt nienna
which 1 mentioned nndor the head of romiting. I ciinnot too mnch
iiuiHt on tho henefiia of ice usetl intemnlty and applied in the form of ico-
h^ to titv epigastrium.

Quite different ia the end propose*! hy Dohoirc in the tn«tmetit of
IjVIddt of the stomaclu Baling himself on the fact that ulcerations of the
'h nre nggmmted by the secrctimi of gastric juiw, it occurred la
I^bore to employ iu the trmtment of ulriui rvhindum the Alkalies in
Urjga doeea, aa theee eubetancea have for tlicir end to ncutmlize completely
the acidity of the gastric juice, and thu3coni|«el the alimentary bolus to
be dtge8t«d in the inteRtinc«. Ciwes of ctire hy this therapeutic method
mr» an yet too few Xo enable uii to jmlge of it« value, bni one may well ask
if the introduction of a gniit quantity nf alkaline Hilt« into the economy
(au ounce or more a day) may not do et-rioua Iinrni ''

Bot before- touching upon the dietetic regimen, which constitutca the

mofit Active mode of tmumeut of simple nicer of the stomaeh, wo muH

idiacuM the ^Tilno of lavage of the stomarh in the lher«(«eiiti«i of thlH

raflbotion. lion] wu meet with two quita oppoutu opinioiu; some authori-

* Qallnnl. Du Trait<rii>>iit ilw I'Uluura Simple de TE^rtomac, (BulJ. du Th4m[i.,
i, ik-ii.. 19T?)^

230 DJ8BA8IS Of THK STOMACH.

ties thinking that tlio i»ractice of lavage in rimplc uloiT of Uie stomach ie
highly hencRciiil, aflirmiiig that bv this inBiius i:ieatfi)uilion of the nlcorated
muoouB mornbraiHi is ftiT-Jrvd, others nhsolntcly conik-mning thia pnictiro
beoflniw that, in their view, it escit*"* coutnictionB of the stomjich. iinil
Cavers h«niorrliHg«3 by the movements which it imjxMtesoii tbc ulcerated
Hurfncc.

I IhiI iovc, for my [wrt, that the trntli lies between these extreme opinioiie,
and tluit Iitviipe iit cLTtnin iMTiniia of uk^»r of tliu ettjniiurli iiiny piv«? good
resutta. while at otiitr tiint's it nrny he iiijiiriomt. I will es[ilHin — whi-ii
tho ulceration in jnst beginning, uiiil n» beninrrliiigc liiw im yet tukoii
ptitcre, ami thrre only exiaUt tht- L-xtn*mL- yiiin uompiiratc^ with voiuiting,
onu inuy List-luliy iicrform lavajft), and especially iJ u«e in made of the milk
of bicniuth of whivh I biLve bofort' f)iok(m.

It i8 wppcittlly in the tenninal perinils of thu nleer, when cicutrimtlon
is going on, utid tlio hemorrhagca have caiseU, that Uviigu (nay rfndtT
great sorviw. Uy such clcwiniug of tli* mufous membrane and tho anr-
fado of tbe nicer, you previ-iit tho sojourn of alimentary pnrciclce, which
by their preisence hinder cicalriaalion. imd irritate the siirfaoc of the ulcer.
And just as we xon nh^rous wounds of the skin gut wfU uuil}<r the iufla-
envv of lava^'s or dreE»iiij;8 ofbuii re^K-jitod, M> alao tho ulceratioiiaof the
mucous ineinbraiiB of tho Htoiuiwh undergo favorable modifleatioiis by tho
eame UKtiiis.

Hut tnii-age iKMTomHS daiigerouB when performetl immediately after
bffimikU-inci'it^; it is to bi: fvim'd tliat by thiB meiuiH uiKr iii:iy proruko
new vomitingp of bionxl, whether by detiwliing too promptly tiie oo-
clnding clots, or by provoking new contractions of tho Ktnmach. For
auvfral yean; I hiivu rcpuiit^dly pnu^tited luvagxi of the sitoniiwii in niKen of
nicer, and I luivc iUwnys derivnl odvtmtugo from it whon 1 have foUowud
the rules hi'i-e laid down.

I might iNirticutiiriKecnsce whore theroHult has been truly marvellous;
instimneH, in iill prnbiibility, of the nature of those iileerous gimtritoB
wliith lire still poorly unJer»tood from the point of view of llieir jiatho-
logical anatomy, and clinraoterized by iibHciteti of those deo{i ulcent which
cut UiLf dilTorftit liiyL-rs of the Hloniaoh like a punch; ciwob, in fact, where
the lesion emiMiKts in simple eroHions of the mnoous mi'mbnuio, luwora-
]iuiiiL-<.l with but little lutniettimesiH, and where the presence of blood h
indicat^'d only by a slightly darkish discoloration of the vomited mutters.

Lavage of the stomach has also another ;ulvAntUKe, in Uml it enables
118 to feed the imtiunt In fact by mwuis of the syphon, after having
elcansed »ud drensed the mueons membrane of the stomach, you can in-
troduce ft certain unuiunt of milk, and if you fciir the injurioHH effects of
too largo a quantity, you can make use of a mixture of milk and milk
powtler, sueh an Dobove usl'h, for by ho doing you conBiderably augment
the uutritivo value of the milk, and nroid tho incouvMuienw of too groat
a bulk.

ULCKK AND CANCER OF TUB STOMACH,

231

Bat lot nil return to the hypicnic Irwitmunt. As I have alreiwly said,
tii« diototic regimea dt-scrvee the first pliKo, an<l Cniv«illiierr mado n good
completion of his diBoovery. when, after having xliown the «vil nnd ita
DtHTch, he pointed out tlie mtnetlj with which to int«t it. Tiiis rumeiiy
is milk; it ia nea-eniry to support the piitifitt whilv K>^i"K tln.^ 8ton»u;h
the luut pocsiblo work to do, ftnd milk well ftiKillB this indication. Tho
milk diet tlieri iH ahBoUiU-ly iiidiepvnHibk-, and nil aiithoritiex, Schutzcn-
U-Tger. Brinton, Wade, I*u1>b, etc, arc imaniiiions nn this point.*

It IB here thiit the milk trcutmunt might to bi- moet rigoroualy followed
out, and you luu^^t Uikc the utmost pains m your directions; Karell of
St. PeterBburg has juBtty maintaini'd, that thi' phyMciiin ought not to 8»y
to his patient dmply: " Drink milk, ae much o» you <?an," bat he ought
to indicste and limit the quantity, th« kind of milk and thu hours at
which it ehould bu ingi-sti-Hl. Yuu will tlivii ordc-r your patient to ttiko,
lour timt'8 a day, at carefully pre«;ribed pt-rio<l8, from two to eight ount-w
of miUc If he csuuot taJto tliis c|Uttntity all at once, follow tho advioo of
Gallartt, and give it to him in Rrtuill ([Ui>ntiti«n at a time, even if he luw to
gpt hia cupful down by slow aips, Kiircll f wmuimjIs ekira milk; for my
jiftrt I profer the milk freeli from the cow. You can add ILme water to
it, or alkalies: Luca of Naples prt'tends tliat lime wnler is thf unique
remwly in ulcer of the stomach. Thoee subfrtancwi have no great efficacy;
tbcy simply favor the- regular and Kpeedy digcHtion of the milk.

It ia n«CB««iry to L« very careful in th« rwturn to Bolid food, uud this
tranaition will be facilitatetl by the mm of the alimentary powden). What
ve muet avoid, I have said, i« to imjKNW- too arduous a ta«k on the stora-
acii, and we can accomplich our end by employing the meat powders, by
rouon of their rapid pcptuniaution. Then when, iw a ri*Hult of yotir
,eiHlcevors, the mucous membrane of the stomach shall have sncccodcil in
oaily digmtiiig thexo aliinunUiry {mwdors incorjHtnitetl in beef tea, you
will be able to return gradually to ordinary fare, beginning of courtie,
witit articles of food mo^t otiey of digestion, and ynn will do well to take
w your guide the dirvctions which I have givun you m prtvioua chapters
on tlie diet in dyspe}HiiaM, having due regard to the likes and tlislikef! of
yonr patient.

There is a la»t point on which Brinton innate, which is to recommend
rest and to forbid violent exerciee. You understjiml well the valne of
this prohibition; tta object ia to avoid perforation n[ tho stomach, and to
favor the protecting adhouuns which prevent such perforation from n|ien«
ing into (hu peritoneal cavity. The same nittitoti should make ux careful
abont examining tho region of the Htomach in perwna affpd«<l with ulcer;

•Wadi!. On Oir TrMitcnent «f Simjilf tTlwT of tin- Stomach, (Bril. Mrtl. Jour.
ISW). Lmibi>. in Ziemnen: Ilrinton, Un the PaUioloey, 8}nn|>toms. atul TreatmeuL
«(8irapl« Uloer of tli« Stoma^li. I^odon. 1M>7.

t KorclU on the Milk Tretttnient (Arch. gva. de Mid., 1806).

tra

232 nSBABBS OF THK STOMAril.

for under the infinence of jiroBetirp tti^ adhoeioiu may giro way luid gravo
iRiTiiwrrlwge or faUl peritonitiH reHiilt.

Th<uie luematfinviscfi, wbich urc among thc< rharacterutticti of simpio
ulcur of thu BbomAch, iiiorit u particular trcatmoiit. WhoD thoy are uot
TPry nhnndnnt, ice, pert'hioritio of Iruti, and ottpL-cially aubcutaneoufi mjec-
lons itf erguliiiu. (or oi-gotiTiiiio in t])« dose of Tiatli to ^tli of a ^^in) sut-
flco to arrest, tliem. In otlier 0*011 on the contrary, thn hemorrIi]^t-> tAkcjt on
an alarming istiuruutvr; Komi^tinK'S it is »> cupiouH iia to oiusc the dimth of
the patient; eonu'timcs it is bo often i-epcated that d«atli supervenes us tlio
renult of gradual and incrensing cxhaurtion. In the event of profiitia
heinorrhages, wp run do little; the ulcer, in fart, has invaded one of tlie
import^biit branuhuii of the ctcliuo asiM, and thu loss of blootl ia onormonn
In tho due of more moderate repeated hemorrliafz^s cntailiuK ciEliaus-
tiuD, we eau iuturfum advantageously with transfusion, which fulfills
SMveruI iudiattions. acting a» a lia'tmwt.atic and KiiHtnining the patient tit
the liuinie time that it sparue the Btouiuch; it ulw ruittoe the puW and the
untioii of thi! hwirt.

In a (uiae of ulcer of the stoinach where by reason of repeated and
abundiuU hemorrhagua, tho patient then ]Mdp. cold, with impereoptiblu
puW, was brought to ilejithV il«K)r, I hare been able by meant) of a
tninf^fiiiiion of five ouul-us of blood. elTui^ted with thu up]»Lratiis of Ituusitol
,d with his aid. to bring l>ack the jwtient to life and (what is better
ill) to health, hia humorthagas ctiasing from tlmt moinunt."

TraiiKfusion then is a means which it will not do to neglect tn emh
cases, u»d you shmild alwavn rL-aurt to it. taking can; not to inject too great
u quantity, not more, fer iiisbmoe. than IM gma. (live ounces), for whvu
yon exceed tfaiii amount, you produce a plethora of the art«rial syBtem
whieh muy lend to u giving way of the arterial clot, or even to nipture
of other blood-vesselB in the vicinity, and a return of tho hemorrhage.
It IB well nndcnstotid tluit while the hiematemesis i<» going on, you ahuuld
avoid the introdnetion of food into t)u> xtomach. ami lu ordor to suBtAtn
your piitienta, you will have to make usio exchiaively of the rectum aud
employ iieptoniaed lavements.

•Such, gentlemen, arc the theni]K!utic nilea which should preside over
the treatment of ulcer of the stomach; let na now take up the study of
caueer of the stomauh.'

Caiieer of the stomach, despite its incumbtlity. should be made the
aiibjuct of aiJi^ciul therapoutic indicatious. and thia for many reaeoas: first,
becnnsc we ought to treat incurable diseaseB like those that ui-e curable,
and if the physLoian can not enre in all ciisea. ho is always in duty hound
to do his utmcet to alleviate the painti of the patient. The other domi-
nant reason is that the diaguoais of eanrer of the stomach is one of tho
nio&t difficult pndilemH of irliul<»l medicine, and one nmy atfirm that if

ULCER AND CANOKB OF TUB STOMaC]!.

233

,0Q be made of the presence of an appreciable tumor of tbiti oi^n,
llivro exist no ])o«it!Vc eigiis of cancer of tho stomacli.

Thiit woiild be » ciiriDiiit chapter oj intemd pathoiop- which would
fcivi- till' liiistor}- of IuIk- cancers uf the sUtmach. In u cumminiicntion to
the Medical Society of the Hospitals, I have ahowa all the difficiiitiee of
titie clinical problem, and you will fiitd in the th^i» of my pupil [>r.
DeschuJiiiw, a complete Htudy uf this au much controverted question of
gwrtric cancer.

There i», in fact, a diswisc. the recent knowledge of which, ha* pro-
fonndly modified the rery basis of this dtagnoeis. I allude to chronic
jf»strititi with dHatatioii of the Rtomaoh. This nffpction, in which wo find
the Btotnach dilated with not^ilile thickening of itj< nalU. in lUH^onipanied
with Bymptonu almoat idcntioal with caucvr; the h^ of the putioiit. his
cuchetir state, the vomitings, tlie ha*matemoHi», the puin in the region of
tbv stomach, — all, unices it )m< the iibBcneo of th« liinioi*, suggest eaucor
of the rtomaoh, and even the tumor itself may not l)e wanting. The
thickening of the walla of the- stomat^h, or even the ]H?rtstaltic tiontrac-
tkiUH which this organ undergoes, give to the hand of thu explorer a
sensation of well define*! hardncee, eurpriaingly like* tliat of a roal tumor.
In presence of such difficnlticK of diagiioaiH, several moans of extrication
from this embaniisKmont Imvi! been pruiwHcd. and I winh to call your
attention to two of them.

Rommclaere of Brussels lias maintained tliat the diagnosis of cancer
of tho etomnch may bo mado certain by the examination of the quantity
of nr« excreted in the twenty-four lnmrn. Whenever the figure is lielow
tvngrammcii (l-W gruins) uud tlii« lasta for scvi'ral coneecutiTo days, you
may ufiirm that you have to do with a malignant iiffeotioiL of tlie etotnach.
Kommelaere afRrnis, in fact, thiit maligtiant tiimora in general, are
charaotorixcd by a iriciation of tlw> intimate nutrition, and that this ncia-
tion ia not met with in benign tunion.

I bftTu |)ut in pnictiri! Ihv nivtliod of RomnicIiUTi'' in my Bt-rvico, and
the nealte to whi^-h I have arrived justify in pitrt the affirmation of the
fielpian physician, in oo far that in ctuK« of cnncer of the tttomuch. or
pTMamably mich, we have always found tlif proportion of urea excreted
in t»X'nty-four hnura leas than ten gmmmt.-fl. while on the eonlmry. in
«MM of ulcer of the stunmch, or of dyaiieiraia with dilatation, thiti ttgurv
of ten gramnies haa always l>e#n i-xeeedtxi.

At the same timo it will not do to oonchido that tho t««t of itommeliK'n?
k infallible; in one cane in fwt where we found all the 8\-raptnma of
cancer of the liver and etoinach, and where tlit- fijruro of urcu luwl nut ex-
ceeded three or four grammes a day, which enabled us to affirm the diag-
ibMie fif canoiir. tho autopsy rovonletl a liydatid cj'vt of the liver with
groatly thickt'nod walla.

I think then that RommvlucrL-'i) metiiod, while Bomutlincs furnishing

4

lis Biij^«rtivo information, ean not jjire ua dftfinitp indications, lor, aa onr
cn]U*u{Tiu- Albert Rubin lias wult xhuuii, tlb> Il^iir«> uf iireti muy viirv in a
c«]»oeroilit indiriclHiil anrordin^ to the period of the difliiasr ulicn ho is
uxftmincd. At the outfit whnn Dm iliagiiotiiti Ik ofton most difficult, if
alimontHtinn ia Htill well pprformod, the tipiirc of uroa may bt- rt'lutively
Kiuixidi'mblv, wliilo in tht? »irlK>tic [leriotU it itt vitruuiiOy smo]!.* Use
then tike t««t hot do not placv too high a value on it.

In flBrnmiiy it hiis hteii proi«igrd to biujc the ditigiitiRiH an kI^is ilmwn
tUrectly from tbi- utonmcbnl digcittion, and two onlvra of ingiiH hinv been
espoeially iiivoki'iJ : the prewnoi! or nbaunee of acidity of tlio gMtric juioo,
and the di{!i*Mtibility of certain aliiiivrits.

As for thi* dtagnoatic value of tbe acidity of the gastric jnicc, fjcubot
iKwinj; himBclf on thu rosulU obtuinud by Vun dcr Vclduii, who pretends
that aa iuxm an a noopliuim in devoloped in thr walls uf tbo atoniaub, the
hvdrochloric iK?i(l of tliL* gaslriL- juicp diHLppcuni from that aecretion,
Ijenbf, I say, haa snufrht by the mme methmla wliirh I havf already
dt-M-ribcd to yoii niidor the hiavil of pituitoiu dyepvimiu. to awjurtaiti the
degrw of th« acidity of the giiBtric juice.

At) coneeniiiig tlm diagnostic value of tli» digoHtibility of nliniont^, this
name pbyBioIogiat, in comparing the rate of digentinn in ciisesunder con-
Kiduration, with artificial digoEtinns nuulc cuncurrently, lian drawn np »
liet of foods whose rate of digt-Btibility omiMea one to determine the diag-
no8JB of the aJItwtion of the stoiimeli which one lias before him; you will
find, moreover, in the t3ie8i8 which I have juet cited, that of niy pupil.
Dr. IVachiim|w of Riom, all the dctinils jiertnining to this method of diag-
lioeiif. t buve repititt^'d these experiments, uiid 1 reeo^iiize tlie fact that
in certain oircumstaneenthoaoroethodit may add conBrumtion to other sif^s,
while having only a reliitive value hy theiUMflvex: hence it in that w« ww
lii'uhe aflKociate them with other clinical data, and hnna hit) diagnoais solely
oti the emu of signs ubMin'cd.'

I have elsewhere miule a fyimmuiiieatinn to the Medical Society of tho
Uotpitaltt cuneeriuiig tlii» subjeet. and luLve shown all the nncertnintk'H of
tho prooes* recommend eri by l^iilx*. *

l^rdon me this long digreasJon on tho diagnoMiB of oujuer iwid other
affections "f the etoniach. but it had become iieoei*«Biy that I should enter
thus minutLdy into these clinii^al details, in order that you might be able
intellig<*nlly to treat eaiir^<r of the stomach when yoa meet it, lu well a&
all doubtful eaM's that niniulate cancer.

Admitting that yen inay arrive at a preci«o diagnosis of cancer of thi;
stomach, the prognoHia is differnnt according an the eaneer ig seated in
this or in that part of the frt^niach. One patient, for instance, shall havo

• DiijiLrdin Beautneti;, On the Dtagaostic Vs-Im* of tii* CUniwil Pr<H!«ssee Em-
ployed lo Tej«t the Acidity ol iJu> Gastric J uirv, Oax. hebd., Dec. Oth. 1684.

TILCER AND CANCER OF T1IK STOMACH.

235

A mulij^nant grovili of trifling extent which is ntunbcd &bont tlio p^lorua
or canlia, am) life is soon compromiaml, ovnnf^ to tlie interraption of aIj-
mentAlion; uuotbur oti tiiv contrary, iimy llvu u long liiDv with i»ii(!«roim
lesioriH of much gitmter ext^'Ht. wliii.li invnile jHirtioiiB of tlie stomach lft«
neceenry fur ilignstiun. This 'us not all; thu rarJrty of canrfr ha^ »lm lui
inSuencv; cortaiu nc-opolusms <k-vc-lop with cxtmonliiiiiry rapiilitvr i^ixl I
bare wwu [mCiciits go through nil L)ip ;iliases of their (list-asc? luiit sncciimb
ill » space of from oii« to two nioiiths. whilu othi'ri;. on \\iv> e»iitniry> live
for years with canoeronii lesions of the stomiich whose i>rogre88 is very
tlow.

Thww, yon sep, nre ctiiiinil tioints of thp ntmosrt importanco, iind which
you shouhl always ImvB in iiiiuii when you an- in prwsuiioeof a nuuiuSecled
or rappowitl to be affected witli cancer of the stoTniich.

Yonr thi!ni|)pntic imth, thim, is plain. Are there only vngne 8iimiiM«
of cancer? You ought t-oemploy rcmetliea aildrcBScd to the diseaac which
has the gn>ateet rcnif iiiblaiiee to euiicLT: I refer to ehroniu uIcmtouh gastri-
ttK. Ilorv. nil thu riilcx which I huve laid down tinder tht> hi>ii() of dilatii-
tion of the stomik^h are iipplicfthle; lavage ajid meclinition of the gastric
mncoM, lUimvntatioit by milk and meat powdere; such will bo the bauos
of your thennvntici*. But, yon may say, in tho event of the eniw being
one of genuine caiiwr instt-ad of ehroiiie uleerous giistntis. nuiy not your
treatment do harm? None at all. and the lavage and dn^Uj^K of the
stomach cannot hot he beneRcial. Acconling to the real nature of the
lesioTi, you will eo<:* gradnol and stire amc'lioration under the influenco of
yonr trwitnient — impposing the patient to lie alTeetiKi with lumplo u)ti«rons
gMtritis, and tluit he rigomuely follows your directions. If the dist-ast^
be canoeroos, yoii will ofU-n have the good fortnne to note an improve-
ment which will kut a eortain time, but it will be bat temporary, Nnd
d<?apit« nil your efforta, the individnnl will =iiieriinih.

We will now vxamino what are the thL>rsiM>utJe means to bo employed
when ihe ouioer is ititiiAtetl at the pylorus, then when it is seated at the
cardiu, ami Isuitly, at nome part of tlie walla of thu stonUiOb, oocupyiog a
gn«tor or lew oxtont of sarfaco.

Cunecr of the pyionis is mueh the most frequenL' By reason of the
ohstarie whit^h it prenents to ihe jntMsigu of ullinentary !inl>9tlQCM from
the stomach into the intestine, it i» certain to caii!^ dilatation of tho
stomach and rapid emaciation. The diUtation, dt-^tpite the prcscnee of
eancor, i« tributary to InvR^, which eniibjo*! us to cleanAe the mueoua
membrone, and frnn it from nournes of irrlUitioii which reaiilt from tho
(irotunged Kojouni of aluneata: liivuge. then-fore, shontd bo practiced in
moKt ca»es of cancer of the pylorna. As (or the troubloB of nutrition, you
0U1 in a ctTtaiii mca»are rcm«dT them by alimotilary lavemontfl. and the
only lavementa which can wrre for nutrition are, an I oliall ahov you
farther on, poptonitml lavements; it is then to theau ttiatyou should havit

f

OF THK STOMACH.

recourse, and by their mi-aiu, nnJ (r«immt lavagt-a, you will be able to
prolong the lifo of your iMtienta.

Tim cancer may l» ecatcxi at tlio cimlin, anrl hcrt- tlio coikditions aro
dilTcrt-nt. Tho iitotniu!li, insh'iut of hiding diintfHl, hit» ibt wulU in olnm.!
contact and it is the inferior part of the iiwupliugus which is dilated. Wo
have at oor dispnoil in order to overeoine this Imrrier which opposes the
ilosceiit of the uUmcoturj" bohis into the stomach only two thonipeutic
mt'aiis: first, thn lui ministration of liquid food, «nd here tJie raent powdnra
render us grwit service, owing to the homogeniKius niixturu which thfy
make with hquids, and aeoondty the peptonized lavements of which I
liavc- just spoken.

(.'ntherizationnnd dilatation of thestrictaro hy boiigiosof progromiroly
inurpjising size have alw) liopn iidviti(>d. It 'm ncjcvwairy to b»> very prudoiit
ill the t-ni|>loruient uf ihcsL- munceuvrcs; it Iium often happened thnt in
the attempt to force the ofsophageal sound through the stricture, tho
oeeophague, tliinned at its lower extremity hy tho dilatation of which it
18 the Beat, ns well us by tho oarcinomatouK loaioiiR ntTneting its Hubstanco,
haa been (K-rforatcd. At the same time I make esetptlou of the method
recommeuded by Rriehabor. who has proposed to employ in mioh c aa w ,
and especially wheu the eancer is seated at the ujipor part of the cDwpha-
gusi, a ]»ommni'nt sound, and who by tLie nieJiiiB was iiblo for a year to
kt^p alive several [lalieuts who, without tliis imtru mentality, woiUd have
infalMbly succuniljeil.

I^hia cesophagcal sound wliicb is introduced by the nares, mxty he of a
rolntively Rmali caliljre. since by menns of these handy ahnientary mix.
tures of meat and milk powder* we can feed the jtatient through quite
narrow tubes.*

When tho cfliioer is seated in other parts of the stomach, our thera-
pculie indieiitionfl will depend on the phenomena wliioh art^ presented.
When the vomiting i» lacking (and hero you Hhnuld not forget the tact
that there are great many cases of cancer of the st^vinach. even with the
presence of tumor which have never been attended with vomiting, even
at the most advanced periods of the diseoec), you ought to employ arttclcss
of food whit-li demand the loiist digestive action on the ]«art of the
8(omac;h. First mirk, then certain fariiinrcons powders, such :ui the ilour
of lentils, cooked or nmlted, mixed with an equal quantity of mt-iktymwder.
When the attficks of jjain are very severe, use injmtiona of morphine, and
if the abiise of tlie»e injections ib to he feared in iwrnona who do not
present any grave lesion of the organiam. I do not sen that it is any great
harm if a cuncvntus patient liecomes a morphiimianiiu;. Tlianks to this
incomparable anodjiie, life is lenowcd. tlm pains disap))oar. and you boo
after eneh injection a eort of re«arrectiou effected in those oachetio
suhjeets.

Recall to mind that patient who renuined so long in our hospital.

rjLCER AND CANCKR OF THB STOMACH.

237

occupying; No. Z\ Wan! St. Clutrles. This man had nrrived at the liwt
degruH uf cacbuxia due to cancer vt thu tttotnach: ha was T«rikib1y dvin^
of sUmttOD, — the anitiul heat failing littl« by little.— nnd tinding uo
relief cxc(>pt in injcctione of nitirphinc, which ho said, rt-^tored Im tcm-
peruture niid his pnlae, and ^V(- him evury day a new luaaa uf life. Ynu
myt in thin caeu a cloar «iarii]ik> of tho tonifying action of hy]X)denuio
morrihia; do not hesitate then to privrtici! these injections, nnd niakoltioni
often nnoiigh to allay the ptuus, and do not U&r to employ pretty largo
dowfc

Other modes of treatment liare been propoHL'tl for KBtmer of the gtom-
•cb. The ]»-e|iamtion8 of conliim have Ix^en pftrticularly vtnintoti, cata-
plofimH of the leaTcs hciri|; ujipUtHi over th(> epigastric region, and pille of
the extract given internally. All these meflns have been tried, and they
have never to my kiiowlalge cured, or even amelior&'tcd a single eaw, and
therefore are liar<lly worth trjtng. I may say &a much of other pretended
B{)ecifiG8, fltich as cinidurango, and Chian-turpentjne.

It remains for mo to ay a few wordft about surgical intervention in
tlie treatment of canecr of the stoniaclj.

EmboMeiied by the nnlooktxl for snccees which modern mirgery Iisk
obtninni in aWnmiiial afTcctions, certain Rurgicat authorities liiive pro-
posed to intorforo in malignant disctue of th« stomach, and bavo practiced
flaccceaiTvly, gniitre<itomy, gastrutumy, and giUttroRtomy.

Oastrutumy conBixtH, tu yon know, in opening t)ie otonmch, and thia
operation has been jkerformed of late, eAperialiy in order to remove from
the cavity of thie organ forcigu bodies, and you arc faniiliAr with tlie
intercgting ttutca at Ijibbe and Fclizet. It han h1w> been luMv proposed
to practicti thin oiK'mtion iti order to peneLnitv the stomach and gain
occeM to the pylorus for the puqxtee of dilating it with the fingers, and
thus overcoming libroid UuokeniiigH of thia orifice, or cicatricial biinda
csueing idrtrture. This digital dilntntion hiis never been performed in
France, aud the nioet serious objection which can bo madu against it in
the difficulty of accurately diogiintiticating tlio pathological condition ro*
quiring the oiMrratiun.

l*ractio«l for tlic tir^t time in France by IVan,* then in (lormuny by
Billroth, Uydygiir, KkiiiuH'I), Kitujewaki, etc.; in ItJiIy byTorclli, Ouvaa*
lini, and in Braxil by Port, rejection of tumors of the atomach, or
(iASTKK'TOMY, detqutc Bpvenil cnccL-Hiful tMees, seema to me tn l>e a
baxardooii and \cr\ qnestionablv oiHinition in eancera of the etoniach, and
tlii*, for a number of reasons. Without ex{Mitinting on the difflcnltiea of
the operation, I will mention the two pntminent cauw!S of buliire: the
iUUe of pliyiiiologic-at d<.-pnivcnient in which patients alFcctod with cancer
of the 8t4Hnacb necessarily are, and which militates against their rallying
veil after aowiVtfre and prolonged an o]K'ration, and secondly, the impofu
flibtli^ of sffinuing that there do nut exist other tumors of a like kind m

p

DIS£ABKS OP THE STOMACH.

tliu (loop psrts of l1u< iilxlomiiii. Tbotu* uru. T n'jKmt, corvlitiniis whioh
oii^lit lo render us little «-niliiifliastie in nclyocating the eitension of ga»>
trectomy.

It is not BO with oastkostomt, tlint iw to my, tho wtnhiighmont of a
}H>riiiauiiiit optiiiiii}; in ihc walU of Uio «totiUR>li. Tllitt is :l iiiucli mora
feasible njieratinii, and one wliicli ha« gircii niimeroits ituccvsaes. Ga»-
troKt«)my iiiny bt- jHirformcil for two conditions — the operation heiiig aome*
-v\v\t different in tbe two casee: when there is a etrictore of the owopha-
gtiB iiiid curdiii. auiJ ngutn wht-n th*'r« h an oWta'-ilt* ui tha pylorus.

In rtrintnreB of the oosopliagu^, and when thi» tnl)« is innjcnfiou*,
>rii»ttioBtoiny in impnmtivo, and yon well undrrataind how life may ite pro-
loiigeJ thcTL'by thruu^h the eetublisluiicat of a ^atitrJC tii<tulu. Tht- (;uri-
OUH olsK-rvutiun of W'nuTtiil who |)(>r[(>rm(M! tJiis oporatinii on Mnrptflin,
sliou'S xus uU lli(!> advaiitUfii'M wlii«h may be d«riv«l from ;;utttro6t«}niy, and
if in flhroHH constrictionn it doi?9 not always give good results, it is bi«ciuiBe
tho opi-nitioii wiiM i>frfe»rnit'd at too lali) a perioil. and the patient, ex-
haurtod hr prolonf^ absttinence, conid not rally from tho effects of tho
inirgit'jtl traumatism.

1 "believe this opemtion perfectly indicated in cases of cancor of tho
CAnlia and n^mfptui^fl. 'ITiirso aro in fact i-jinccrouH ufTfctions which be-
conio praTc. not by reaaou of cstcnsion of the lesion, but Ix^cftuao they
constitute an innsurmoun table olmtjiple to pL-rfonnaiujn of function in
on^ans indii^poDHtblu to Hfy. A caiici'i" of very trifling exlviit «ituaU'ii at
tlip pylorns or cardia will cause death by inanition, and you niulerstiind
how oajsy it munt be, by cro&ting a nt-w pawjigc for tin- introduction of
food, to prolong for spveral yenrs tho life of the patient.

WhoH ihu obstaoli' is seated at the pylorus. surgiuU intervention of a
different ohamcter is require<l. and gastrostijiny contnista in eslahlisliiug im
new outlet for the stomaoli which ehall oiten not oxtomally, but into an-
other part of the intestine.

Siimmy of Mam luismlviaed to mako the o{>oning into the duodenum,
and he has jicrfonned this o]«n>tion in my wrvice on a young woman
Iwrnty-four ycaraof age affected with cancer of tho pylorna.' Theopcra-
liou proposed by Billroth evvme to mo to constitute u uotaUu udronuc on
the preceding,

Tliin o|>eration coneistit in attaching a loop of intAstino noareHt the
duodnnum to tho wall of the stomach, and in estaWishing there » com*
municution between thv two caritiea, m> th;it thv HtouiiK:h elluill opon into
the iutoBtine by a new pylorne. This op^tratinn doea not involve the risk
of loss of those fluids so neK'eswirv tn jntestiiiHl digestioUp the bite and
pAncreatJc juice, which continue lo (low into the upper part of the intes-
tino. This u the operation wliich you ought to jicrform wlicncvor there
exi»t« an obntucle at the pylorus oflc-cting or nearly ctTccting closure, and
for my part I havu very much regretted that I did not resort to it in two

UI^SK AND CANCBK OF TKK ST03IACI1.

239

C88M whom t hail dingnntitinntnd lion -mill ignnnt Rtrictiiri* of tho pvloriis;
the mtopoy haTing 8|k>wu my (liagiiosis to bo triio. 1 believK, mtweorer,
that ID certain forms of cancer of the pylorus, without any cHclitictic8>'Dip*
tonia, tikis opvrfttion U indi<:AtC(l: for leaving intact tlte tumor, it doee cot
intoh-e tli« gmvo riHkB of gnatrt>otoniy. Unfortuimtyly, ii8 in stricture of
tli« (rsoplingi)R, wo do not jirnjioiit! thiR mirgiciU prr)Ri»liire except in the
lutb etag€(i of the Jiscasc, whuti tht- vitjil jiovrfnt urv low uiid the patient is
ill able to withstand ttic eoquel^ of the o|)enitiou.

There remains, in oni«r to complete my subject only the consiiiero-
tion of the trefttmont of a "hilioua" condition cuIIimI " efnbtirtdit ^u-
tri^m," hnt Ihia whirh Ik a sort of acute ind igeirtion is vommonh atv(^
ciaUid with u general fubrilc condition, uud properly belong* to thu thera-
pculicK of fevers.*

As YOU sec*, the treatment of gtomoch affections in genoml makes
hoavy ilcmnndn on th<> phiiiiirinn: it rtaimM of him pmrmind nliiticnl
k^awletlg(^ in onlur thut Iil- may bv jiblu to apprL-oiulv und to group the
difft'oiut symptoms presented by the patient, and to understand thejr
origin and their march: it requires also an oxU-nsive iipqimintance with
pluirmacology, in ordfi' tlmt hf may be nbtp to vnryand clmn^o the differ-
ent medicttmentH and itpprDpriutt! thL-ni to tuch stutc-; li dcnmndii, finally,
H complete and tlioroiijzli etmly of hyj^ienc in order that he may uBtablish
in tt acientific and rationed manner the bEiees of a rcjiim^n suiteil to each
of the forms of dyspepsia. Add to all thi?. the perBeveniuo»% the enoi^,
and patience indittpenjinhle for carrying out tlie preac-rilteil trentment,
and you nill understand how uiK'v»atiry in ttio tht^rapeulic mmia^munfc
of affections of the stomach are the knowledge, talent, and art of th«
phyuician.

In another series of leetareit I propose to complete the study of the
troatment of atTcrtions of the stomach by tlmt of the thenipeiitics of dis-
i of the intetttiue.

4

KOTES TO LECTUTtE XVI.

' Cancer of the sloiniicli ia the mo«t freqtieiit of cancer*. Acoordtng
Irt Virchow the ratio of canwr of the stomach tu cancer elsewlwre, is aa
34.9 to 100. According to Wyas, it is rery nearlv the aime, 35.6 per IW.

Acconling u> Eepinc ami Lflwrt. cancer of tlie stomV:h is rare before
tbo ue of thirty (1 jier cent.), lu* al>u) after the ageof serentv (4 per ol.);
itii&Mnent from the age of 31 to 70 (114.6 jwr IW>). "fliis fn-quency
attainfl its maximam from 41 to CU (flO.7 per 100).

Ilerwlitv aeemd ests^ptionnl. iici-imling to Ijrbert, in cancer of the
stomach; aiid women are more lial>!v to thin diseusc than men.

240 DISEASES OF TIIK flTllUAOU.

Chcsnel hasstntlied the clinical fortn» of cancer of tlic tstumiviti:
has xhowii that truly Intviit cauovr is mm, us bu was able to colliLt« utily
MX casoe. Tlic dvfipeptic form ix mueh thv moi%L fnvjuent, and the dya-
pDpUB prcsonta only giwtric troubles. In fine, in otlier cases, caiioer of
the f^tttmunh tiikcH ihfT«reiit tnrmn; it may simiilaU' Bright's diiteaset
(dramir'iit form), tuborculoslii (thoracic form), a diuuauu of thu Uoart
(ranliai! form).*

' Bomin«laere "haa examined the cta&ntity of nrea vliminated i^lbe
twenty-four hour;* in cases of cancer, of Himplc uIoer«, and of dyspepeias
of the rtoniaolL Th«s* iir« hi« rcBiilt*: In eight cneiw of tmiicer of the
etomach the quantity of urwt vuriod iK'twucn six ami eloveu grammes,
with Jin iivt-nipe of nnm jtnimmoB. [n tlm oietis whcrp thp oanopr hafl in-
viidwl at the toime time the liver and tlin Ktomnfih, chi're wns an averau;<i
of ten gramineB; in eiise* of caneer of th« liver, tlio nveniffc was eight
fpainnKvt; whilo in tiiiiCfr of tht; uteniB the iivonmf wsib 9,29 ^^THmme^
In vimm.ii)ing companitivoly jmtiont^ uffcL-ttt) with dyspepsia and with
simple nicer iif the Htoinuch, lie found on the ooatrary', a ligure varying
between 11 and '-i^t {frantofkee.

Dujanlin-BeaunjetK in hi» Mirvico, arrived at the following rcsulta:

Nnmes of patient. Duration or Matn of uiDk

ctigtcrviitioiiH.

AiignHte !>., . . . .0 d«vK 6 gtHmmeB.

Pierre I) 10 •' 7 "

Uniw Cw., .... 10 " 4 "

MacellinT., .... 5 " 5 "

PLCKBOrS OASTRITES.

Jowph B., .... I9davt(. S5 gmmtnea.

Emik-I) 5 *^ 80 "

A B., . . . . 5 " S3 "

laidore-r., .... IB " 24 "

XellioT. 7 " 36 "

But one obaerVBtion of nicer of the stoniiwrh vna t»ken; in this gam
the average c|iiantjty per diem for five days was twenty prammes.

Albert t^ibin oppom-s this way of Inokiiip iit the subjeet, Aooonlinjj

to liini. the figUHi of urcii ie in direct n-lntioii witii the Ktitte of nutrition,

and when the latter is enfeeblud. fruni wluilevei- ciiuse. the prowirtiHiiof

the tirea diniiniahei«. Thuti it ia thai he has found in tndiviauala who

take very little uourishinent. a very small projiortion of Hre«, while ou

the contmry the amount iseouaiderable in (i&tionta affeeled with uiuIik-

nant tninor, but able to take food. All depends Hum ou thu period when

one aualyjsce the nrine.t

t ,

* Diijanliii Beuiiiuctz. On the Diovcnosi* ot CRncri' of tlie StoiuaL-b, (Soc.
MM. iIqs lii^p., July '£iU\, 18HI1. l^uU DescliampH. Un the Diagnosis of Caocwr of
the Stonoacli. (IM-»^ de Paris, IWMt. L-^bcrt, Arch. t. KJiii. Med.. WT7. Ferd.
Cheinel. Clinfca.1Stiiil.v <m Cancer ul itiR Sliimtuh. Iniui^urel Th^ia. Porla, 1S77.

f L«ub0, Od GaMtreetuftiK. and iu Ib-iiitionK witli tli<> I'rHien«A or AlMMic« of
pre-Bydroclitoric Acid iu Uic U»Btnc Jiiicv, (Dijlscli. Arcb., t. KUu. Mwl.. xxiit., 4},
Kommelaere, On Uie Diajcoosim of UiLnewr. 1883. in Ann. de rUuivontilA Itbre d«

ULCER AND CANCER OF TltB ffTOMACK.

241

' liQubc employs till- stoiTuich miiikI for tbt> dioffiions of ^^tric afft^R-
tions, nnd he «tuiii>L'« bv tliis motiiis two [foiittt!: 1. tlit> ilunition of th«
ilif^tion: '2, lilt) iutvusttv of the M'cri-tion of ^ii&tnu juio4^.

1. To aeccrtuin the liurution of the digcEtion, he porfomied lavwfo
Bpicii lioiira after tlie meal; in il person who digesis w«ll, the inytter of tuu
bva^ ought to return clear, witliout ndniixtiire of mucue.

-', To judgp of tho iiiltL-nsity of tho secretion of g«>Jtrio juim, ho detor-
ntitii<«t thfl Bridity of the Eastrin jiiire luid its dici'stiro nnwcr.

To ohtain giiHtric; juice, he intrmlnrrwi a litrp of Jitiiiid at the nrdi-
nnry t^'mponrtiirp into tlio stomiwh, tlinu he removes it t<>n minntes after;
this is the liquid with whioh hu OKpcrimt-iiti),.

To judge of tile lU-'idity of the jpwtriL- juicw. ho jnskea iiso of the imt
of troptwiliiie; to tt-st digestion, liw injinersoB littlt- portione of atbuint-ii in
tlie liquid, and the complete tK<iution of this albumen is regarded &s
determining the duration of tlie digestion.

All grave drBpe^jsiiui are chaructvrJxed liy «lowrio88 of digestion.

'OuRwnhtiner and Winiwarter have sliown t Imt on t of 903 canc«T« of
the fitoniitch, 042 wvre timitfd to the pylorus. Of this number, 'H^ were
without gluiidnlnr engorge mtu Is, and 1',''? witliout adhauoiM to nfiijihlwir-
ing parts. Ijetlderhoitse hjw givim similar wtatistiea. Out of liO Qost^, :!9
were of the pyloms, aud in Sit there were caDoerom nodules iu otbcr
oi:g»na,*

'Kruhabvr introduce Sy the nareH a nibhpr or gum cothpter. Whon
llie Btricture is very close, he bi'gins by piuMiiigu lirm gnm Hontid, which
he replaeea in a few days by one of caouteimiic-. SIoreu\'er. he »how« tliHt
the oenophagus toleratea well the presenee of a jiernianent cuthck-r, and
hiiB piiblishod il >terie« of obscrvatioiiB of eii^'u of eanwr of the ussophiigua
where this wuad has remaiued Wh, H55, and !ijl dayf^t

■Beseotiou of the HtunuK-d) wns Qn^t att«rmptcd in atiimali*. Mern^m in
1610, Oiitt conceived the idea of extirjtBting the pyloms, and (innthnr
prBeticed it on two dogs.

Iu ISiti (>usM.>nbauer and Winiwarter took upanew these experiments,
and rew-cted the pylorus in S dogs. Kay)<*^r repviiUni llietuj i-xiH<rim(<nt«
■nd proved that one ean in the dog rewet the jtvloriis witliout clfath fol-
lowing the opemtion. Siuee then the 0[)ei-atioa h&s been IH timee per-
fonneal in man.

A/Jtr I. — Tnrelli, Doologne, 1876. Man aged 42; hornis of tUo etom>
■fih; refection, euro.

Ca«v 2.— (De* tumcnrs d« raWomcn, 183(>, p. 79). Han affected with
QUMXT of th« pylonix: deiilh the fifth day.

Omb 3, — Hydygier, IHbl, Man set 03; oanoer of pylonw; death 12
hours after.

Otue 4. — Billroth. 18fil. Woman of 43; cureiiioraia of pylonis; fimt
enn:>, then return of diiMMUuf after 4 tnunihs and death

Bnuwtlis, ct&t «tc. Dujsnlin-Dcaumvtx, On th(< DinjR^nosin of the Cancer of tlie
Stomach. Oul hebd., July. 1884. A. Roliin, On the Dinitnutlitn in iim Figun^ uf
UK«aa Dlii^tuxiK- Si^u oT Mnliji^nnnt TumomtMoc. Ued. <!«• Uop., Aug., 1884,
I>«Mtaun(H>, loc t-iH.

*fliiM(iitMiinii An.-ti, <le [.aiij^i.-nljif'k. Ril. xix.. p. 347.

t Krialuilwr, On Ui« C&ophageal Sound Permanently Left in Place (AnnaleB
dm utuludiw dv rurcUlc et du Umyx, 1SH3>
16

I

242

DISEASES OV TI[K Bl'OMACU.

OtM 5. — Billroth. Woman of 46; canoer of pylonu; death after 3fi
lioiirs.

CfMt 6. — ^Hillrotli. WomaD of 38; cvitxir of pjlorus; denbh at the
end of 10 hour&

Qise 7. — Billroth, 1881. Woman of 25; cnncer of pyloniB; reooT«rf.

Que S — GavKsxini. Woman of JT; choudrufibronut of sUiniuob; re-
covery.

Que 9, — Esumrcli. Uloer of mtomjich and gautrie fistula; peoovery.

Oate XO,— Bopdonheuer, t8<Jl. Cancer of pylorus; denth the MooDd
(lajr,

Oau II. — Kiteienski, [SSl. Woman let 52; cwuwr of pylorus and
lenor carotid; deatn iit the t'lul of 6 hours.

f,i(« 12. — [jtUiierhotw, IS^iJ. Woitiau of 33 years; canoer of pylnms;
death at end of 10 hours.

f'ltw 13. — CztTiiy, 1W8','. Mail of 27 years; conyer of pjinrus; euro.

C'lite H.^Uvdygier lb«'^. Woman of au years; chrtmic lUocx with
dilataltoii; n-covcry.

Oiae Ij. — Ilalui, 1SS3. DUatiition of stomach, rosection; death at
end of 8 days,

(\w \Ci. — Langcnbecb 18S9. Cancer of pyloros, wbicli was adherent
to iHinvreiiit; death ufter the opcnttion.

(Vw( 17. — frUjswiilMinpr. Ciinccr of pylonis; d«ith.

Ouie 18. — Fort. I8S2. rcmal«: <^in-(.'r of stomach; fintt laparotontjt
then eix monlhA after ablation of t^aiiccr: death a fow houn after.

'Surniar lia^ indicated the opemtire nianoenvres whicli enable ouo to
mac)) the thii-d jiarl of the dnock-Tium. to open this portion and Ax it to
the wallti of the tttonioeh. By thii- inle»>tiniu oril1e4> |M.'{)U)n)xwl aliments
may ho intnxluc^'d into the intostino. Tliis op«mtioQ whs performed
June 19lh. I.STK, <in a young womMn of iH. wlio prpsMiteil a mobilv can*
oemiis tnmor of thn pylorus. The mtient supciimlx^il the nost day, and
the autopsy shnwed tlint tlio BoutuI wnieli had been intro«iiicod by Surmay
vriut veil pliiCLi) ill tliv lirst portiirn of the einall iiitvstint.%*

PART II.

Treatment of Diseases of the
Intestine.

LEGTITKE XYH.

The IKTESTLNK FltOM A THEIUPEUTIC STANDPOINT.

tVMHAHV. — Aiiatomy and Pliyeiolojty ol tlit- InU'stinal Mul-osi— Tlie In-
testinal Glands — Fuuctioufl of the Inteetiiml Mueoai — Abeorption.
Swrccion, Eliminatiou — Functions of tlio Muctiwi of tho IjirjTi- In-
testine — Ex|)eriniental Itese*rch«ii — Ijiiveinents of Meat Ilrotlis mid
Milk — Their IncfBciencj — Peptonized l^vemeuts — Their NatritiTe
Power — Their IVeiwiratioii — Adminiatration of Meilioiimcnls by tlio
K«ctum— Modiciiuil Lavcmcnle — Suppositorice — Muscular (.'oat of
the Intestine — Movement« of the Intestine — Influence of tho Ner-
Tuiit System.

Obkixemkn: Tbu therapeutic studr of diBcaaes nf the intostine is
^« Wictmarj oomplement of thu i^tiuly of t)ic tr(>ittmont of dlMUM of thd
^oiawli. From tho point of view of anatomy and physiology, aa from
^"at of clinical medicine and thtirajientit.;!, we cannot Heparate the etnmach
^>*cim tlic intviitinu. lUid tho huiid tliut unites tiinni h ro close that to Iw
■t»icUy lOKtcftl we ought to compreh..>nd their affoctioiu! in the same dc-
^Cjiption, rather tluyi to Ipaat them under geiNimte categoriea.

Before entering upon the suhjectof the treatment of uiteetisial diseases,
^*^liieh hy their frequency, and especially by the therajieutic considera-
^iona uonnocted therewith, pri.-Ei*nt the grcntcst interest. I dceire first
^ mm tip in a few words the anatomical and ptiysiological ilatn which
^* pOBBesB eoneorning the inLuetiiio, in order tlmt rtitr therapeutics may
1m abreast of wen the most recent physiological oajiiisltiona.

t shall bo brief on the anatomy of the intentinc. anil eliall refer yoQ
tinder this hcAd to your text books.* You know all the divisions, the
telationjtand thei'ontiguratinu whH?h eliaracterize the small and the i»r^
inteatijxoi yon know also tho cnnKiderahle extent of the mueoia of tliis
organ, and the multitudinous folds which increase almost two fold ita
length; you know also those numerous villi which cover the mucous
membrane of the small intostmos, and their ^-ariablc forms.' As for tho
glands vhich tine the miienna, they belong, as you are aware, to three
group*: the tubular or Idoherkuhulaii glands, thf nicoiuow or Bruniier'H
glanda> and the closed or aginiiiated follicles which cenfltitute Peyor's

See especially Uie rftocnt work ol Hertwrt Watuey oa the Minute Anat-
fot thf> AJinientaiy Uuual. Lnndun. ltR~.

34(i

ULSKASKS OF TIIE STOMACH.

jmU-hts; you will Sntl inoreorer in n reociit work t>T Dr. (!uret of
acbool of Lvoiia (ovan new vievta respecting these glan<la.*

But while lilstnlogiail progrew ennbU-tt u» to explore thia mncool
iiietuljniiii- L'Veu in ilu moat minutu rrypU iind foldi:, pliVKiolog)-, it tnuri
))e lulmitteit, has not marclied with rqanl paou, and dtupjlc the ardor (A
raeetirchvf in thi» tlirer-tioii, all the points of this piiyeiolt^cal study art' iaP
from being fhici'Uitoil. To tliow who pMomI tlmt thorapoutJca cannot
nmko uiiy udvance exwpt wi far as (U'(Mniding c?!tuhisivf'ly on cxperimcmA-:
tion Hiid [diysiology, the «tiidy of thv truitniviit of iiitextiiuil ajfectvont
gWc6 a formal contmOiction. Taki', for instance, the case of purgaliTe^
for iigcjj they huw boeii of daily adniiiiislratioii, and yet, ua yon will fiinT
in tlie floiirsc of thune U'otnrGS, ve do iu>t even yot know exactly tho inti-
matH action of th»w simplt>, nseful meilieiinientti. fto. ha ve piireue this
atiiily, you will he continually realizing that cliiiicnl ohaer^'atioo and vreo.
etupiriciHin have gone ahead of phyaiologirnl experitnentation. '

The tnncous mi'mbrano of th« small intestino diwfaargm three great'
functione; it in a medium of ubttorptinii, sec'retioii, and eliminntioiu
these fiiiiotions are utilised by the tlnTiipcutist.

' Abfiorption ia one of the mot^t imjiortant fiinctione; it is dcsti
Diako the products of digestion entc-r the economy, ond while the pep-
tones imd the (>mulKilio<l fatty matterEi penetrate liy the liurti'iilx, tlie water
and nalu are rapidly ahsorliLil hy the venous syntem. It U by tho latter
By3tt.'m of vesiM-ls that we cause blie moot of our medicaments to eutcr tha
blood.

.18 n soTTcting organ, the small iiit^-rtine hna tjfon loss rtadie^, and
much diKoiistiiou i» still going on relative to the pro|x?rties of the intostina]
juici^ 1 hiive already nlludod to this suljjt-ct while upeakiug of inte*
tinal dy»}H-psia, and despite tho recent affirmationa of lAtvoii.t who a««.'rl<
that the intestinal juioc is acid, I otfirm thtit in man thio jnico is neutral,
and (!Tnn genemlly alkaline. What Bingnlarlv complicates thi« question
ia the difKrulty which we find in »e|)anitiiig Ihe pccretionH of the divera
intfutiiiul gliindi< fruui thu liquids funiittlied directly by the capillary net-
work. However tbis may be, yon will eee that it is by augmenting tliia
iiiteetiniil sucretioii that most of our piirgiitivra act. This intestinal
muoosa, by r(>rL«in of its extent of surface and its abundant Koeretki&g,
crLublcji therupL'utica thereby to practiee revulsions of eoiisidemblo im-
l>ortance, n.*vulsitiu8 moreover, whlth, by the euonnous flow of serosily
which they entail, produce a most intense iiiitiphiogistic effect, and too

lu AU
tiood tdl

* J. Gare], Kc»eaKli»t on tht< (lenei-al Compamtlve Anatotuj' and the MoriAfr-
logical Signifloution of thn t}liin<l»i oT the (rastrio anil Intestinal Uuooea of Tert«-
brotc AnicuidK, Purm, 1879.

\ Leven a&serts that hia rc»«aivhe.i burr; »Huwn the inleslinal juice alwnj^
to lioii^ii). and t hut what luu li<>i>a eonaldeFed us iateslinol juice Is not such. See
Slaladiea de rt^toniu>;, lti'9, p. 52.

THK nrrtBTINK FROM A THERAPEUTIC STANDPOtrfT. 247

will MT Itow in <%rtnin iuUmiiiiistory ullactiorut thus revulsive action may
render signal serrice.

Tli« office of the iiitoethu* &s au eliminating urgun is une of great itig-
nificanci^. MptlicamentA intr<xluc*<l into the economj hy thv skin, or bjr
luty othvr ctiauucl, lux' vlimina.tA'd chieflv hy the kitlucp itti.i by tlie in-
t«?tiQtf. Tbe experiments on the alwliulis wbioh 1 haw nuulc with Dr.
Audigi- liavu given ux u good itluBtnttion of this elimination; in fact in
aninuts which »uccnnib to the coiiiH>i|ueni.ii(i of the iiitmluotion of alitohol
under the pttin, one iilways witiiewes disorders constitiitefl hy liemorrhagio
softening of tlie nirn'oiu membnine of the Juodennm, and we have
abown that thiii lesion iadue to the elimination of alcohol on the ?«rfiie«
of the iuLeatine. You are not ignorant, moreover, that when the funo-
tions of the kidnev or nf the skin are «n|i])rtia8ec1. there \* an elimitiattoii
of exarementitjons prodiirts frnm ttie surfure of the intestinal mncoRa>
which provokes dturrhuca aud often ulcerations, u« u the caeo in unemta
or PStenaiTe hiirnsL

Tilts <|iie«tion of abMirption, of (tecn-tion. and elimination, which aeenis
flo plain with reference in the small intestine, deservra a tlmraugh investi-
gatiun in it^s rulation to the (unctions of tho large intestine, and this
capecially from a therapontie stand |v>int, for the rectal miicoen is often
ntUiwjd for the introduction of nifdicament*.

Ttiia mucous momhmne, as yon know, is clearly differentiated from
that of the small intestine hy the following points: it hit« neither villnni-
tiea nor valmUa conniventcs.' As for it« physiological r6lo from the
point of view of digeiition, thiti has been well Htudted the past few yean
by Albertoni of Padonii, Garland ' of Boston, Slarckwald of Heidelbei;g>
(.'zomyand latachcnliergerof Fribourg.' These rsperimenters, who hare
all arrived nt the same reunite. Iiave studied the digestion of the largA
intedtine Ivoth on individualj) the subjecta of artitlcial anus practiaed on
the (swii\ ostrvmity of the largo intestine, and on animals, and it nwolt*
from their exjierimentj!, that the seoretion* of the large inlentine are in-
capaHo of thomselves of modifying aliments, of pvptonixing albuminoii)
mhrtaiieesi, or emulsifying fats, and acnrcely nt all aot on atarrhy mattt'ra.
The muL-uus membnino of tlu" large intestine, then, from the [voint of
view of digestion, hatt but the one function of absorption, and tbia pertaina
almost exclusively to water and mlts.

Tlic hirgc int«tino. then. hiM no din'ct digestive office, and it is a
mistake to Ruppme that jinLtienta eim Ih< fed and sufflsiocd by hivemcnta
of meat hrotlis or uf milk, this water and hlIui of these tmhstanceit bnng
alont- ahmrl>ed: and notwithstanding tho recent facta cited by Fort,
IHimas of Cette, TbermeB, el*v, I am permaded of tlic utter iliBOfficiency
nf these lavements for purposes of nutrition, and hero I bun my opinion
on tlw t>X[iL*rimenta of Oarville and lloeln-fontaine.*

Noti; tluit among the oUtervHtions related by Kort and otheris one per-

taiiie^ to a cliiki recatted to life hj a laremenl of broth conulniiig a Urge
(liiiinlity of Itotirgogiic wine ami extract of cinclioim; bU the others con*
ounied liyetoricdl juticuts the Bubjects oE iucocTciblo Tonittiuj;, but caaet
of tliia b-ort are wortU nothing as demoDBtrating thu imtritiv-e valu« of
HHnieiitary lavemeiits, for we can matcli them with a considerable uum-
bnr of in!iUincc!i (if liytttericul |HTsanx who. mitwitbBttiiuIing nn almost
totiil ahstiiiriK'i; from ull food fur RL-vt-nil moiilh», havr bcuii able to main-
Uiiii liftf without seriouB impainnent of the fon!!*, iilthoiigh no nutritive
1nv(itiu-i>u wort' t'MH»loyi<d. Biiqiivl, Cliari^ot., 31*Kii<tl, Brummlel, Joseph
Mirhol, and oarBolvps havp nfl«n nlisorvpJ such cases, wliich show by daily
aimiyttifi of the urine, thul under un iuQuvuut) not veil understood, liya-
terical patients do not ditt^^simiktc.

Tlie esperinietits whieh I buve made in examining, as Boulounii6
rw«nimt*Ti(i8, the teni]>fni.ture and the <)iwntity of nreii exereti'd uach
diiv, have conviiiemi mo t!i!it the only way of using the rectum for pur-
(jMrt(_'» of alimciitatiou u to employ pcptoiiized hivcmunt«:* my pupil Dr.
Chevalier has emljo<!ietl most of theao facts m hia inaugural tli^siu.*

Tbc large iiitextinti being incaiiable of itKclf of m'xtifyiiig futty or
albuminoid miLttefH, it is reailily understood tliat larements of hvut tea,
uiilk, or even bluutl acrum or deiibritiated blood (atvording to the recom-
nieiidutiun of Dr. A. II. Smith) cannot sprve for nutrition.

It is not eo, howyver, with peptoiiized lavements, and Daremherg by
hifcreRiiItx in linman Bubjects, and Catillon by hi^ exiHtrinieiits ou animals,
have shown that niitritiiin may lie maintained by larnmenta of jK-ptones.
At the same time, lavements of meat broths and of milk gi\c eoiLBiderahlo
relief to jiutieiitB, but this remUU from the fact tlmt the water and the
salts, in ponetniting the euunomy. allay to ii certain extent the intense
tbirnt which certain patients exjH'rienee. Tlio objection bae bfou nmde
that theae tults and other HubHtanceti nwociatetl with them, may be |)epto>
genons. luid the ftxperimonta of Schiff allndcd to in LcctnTc III. (page 40),
have beenailegeii in ]>roof. I am free to admit that the jKiptnpeiis and
ditxi.rine may be absorbed Ijv lliu rectum, but it is a sorry advantage to
tiiTitaliKe the atomach by making it secrete ga^ric juice when it is no
l^ger a receptacto at food.

It in nnder»tniiii that 1 make hew no refcroneeto spiritnous luvomonta;
the latter in (act, are mpidly abfwrbod by the int«fittne and by their stim-
ulating and waste- restniiniug action may play a cansidorable rfile in the
caw of enfeebled patients wlio cannot tolerate fond by the stoiuacb.

Kencc then, alimentation by the rectum, aside from the use of pep-
toueo. in a theraiwutie deineion, niid a« long as it cannot \ie shown thut by
lavements of hroUi or milk the temjieraturo can be nused or the daily

•Che^-allH- (in .Vlimontfition by thf? Rectum (Th<H*e de dorlomt. 18791, Du-
JurJin-Beaumel^ on Aliiik<*ntiition by lli.- K.n-tiitii, (lidll. do Th6i-a|i.. Jan. IHTlij.

TlIE INTESntTK FKOM A TirKRArEt'TlC STANDPOINT. 249

amount of urea augmuntM. I tbiuk inyseli warraiiUnl in dviiying kH
nittritire value to theiK) Iftveraents. In a word, lavements of broth or
milk rclioro jmtiviiU but du not nourish them.

Moreover this view of tho Rnbjoot wad long ago defended by a phjsi-
c-ian who nmdo u xpeciul Kliidy of alitnuntiiry luvemenbi. I Tvter to
Rejcnier Av Oraaf. wlio in l&fiH, publwhed a Ijatin treatUe railing in ques-
tion the Rtility of iiiitriunt clystcres.*

But it is not DQOu}i;h to know tliat only ])e]jtonized lavenientit can survo
for nutrition, you mii«t know how to pr^'pfirf tli^m, anil how to make
the mucous membrane of the rnotnni with iilkalinp wcrction tnlemte poiv
tonc« whose rwKHiou h decidotlly acid. This ia how I ]iri>ci!i«d in «u*!li
01008: 1 precede each pejitoniiied lavement by a coyious iiijeetioii of warm
water to elcmr the rectum, then I throw np the following ch'stei, which
the patient in to retain:

Into a tnmblerfiil of millt to whioh is Hflded the yolk of an vgg, I in-
trotluee two dt:aM.Ttspounfui» of solid ]ieptone«. or two tubteapuuiifula of
liquid iK-plonee, then Jive drops of Iniulanum, and lastly a pinch (7 or 8
grains) of biearlionate of sodu if the pojitones are «eid. Y«ii know, in
fact, that there an* to-diiy nctd peptoneH anil nantral peptones, and as the
secretion uf the large ititetttiiie i» iilkaliiie, it i» important that the nutri-
tive lavemeutei be either neutral or alkaline to counteract irritation of
the intosttnn] muooai.. an irritation whioh it is v(*ry difficult to avoid,
despite all the precnntiontt which one may takn for thit purpoice wlien
foreud to cuiitinuu for a long timt* the udniiniKtnttioii of thi.«e nutrient
injectjoiut.

Hut there is another condition which it lb neccesiu'y to fulfill in order
to render tho nutritive Invemenu abiiorbiilile. namely to r»rry thorn up aa
tir u« poiwible in the inte.>!tine, and this you can iLttJiin by making um> of
the |irocL-i« by CDteroelit<iii, Wheu I come to H)HMd( of rectul irrigatioiia,
] win describe at length this method which is counedled by Cantani. It
» BulBcient for mo to lelt you now that the Iiesi wuy to «irri|' these nntri-
tivw mixture* well up into the colon, is to make use of the Dvbove tube,
which thia time you will introduct', not by Ihc mouth, but by the anus.
By the rigidity and the tmpplenees which it« extremity prosenta, yon can
make this tube penetrate very high into the inttwtine, and aoconiing to
the height which you give to the funnel, you can angment the Jnttindty
and force of the ciinvnt,

I>i-9]iite nil the improveuientx which liavu been made in feeding by the
rectum, it mu8t be admitted that it is an exceptional proc*«liiro, and tliat
it is difficult to oontiniio it for a long time.

■ R de Onuif. Tractus de ClyMerfbua. La Hayc. 1«88. [He exptewM himaalf
Afubtrolly i»n tiiH sulijocl of Un-jw tlyntrni. whkli lie thiaks cannot bi" al»«rbod.
Wkilv lftvt>m<>ntii of spirit!!, may, lii>lliinks, do good.]

250

niSKASES OF TIIK STOMAGH.

Hut if the largo iiitcetim- cnnimt Hiinioc for pruioiigcd ulini(mtatton, it
must be iulmitt«d, on th« other hum), that it is a nscfol cbaiiu(>) for the
mlniitiistniUoii of meilicinee. B^t Brifjuoi/ tli«n Domarquay' in Prance,
aiiJ Savorv in Kiigland, have nhown us tliP rapidity of absorption for ctr-
tain inihHtanree which thr rectal mutxiHu proKtnte, and which muy oTcn
in w>me ciui-s Durpius tluit of medicine's given bj (be mouth.

Cliiiimiis liiive uveii goiia farther, mid luivc propocied to maku ub« nf
the rMtttitn, huA of the facility of abmrpcioii of its mucous tnembraDe, for
the practici* of anipHthesia.

Kwomiuuudod for the firet time by Piropoff in 1847,oiia»tbcaa by the
rwtiim has hevn studiyd aii«w by MoIIt^To of Lyons, who has shown all
tlie uiivantagoe pertaining to this new Hiijtsthotic mrthod, wbieh prt-sunts.
however, a serious incoiivcnivnco in not otukbling iim to test the quantity
of i-iluT iitiMirbi'd. Despite this drawback, the gntttvr \nurl of Frcncb
and foreij^i phyBicianH who have ex|H>riinenled with rectal Hiuesthcsiai,
are unanimous in admitting; themlvantngei! which it jtresenttt when opvm-
tions are to b<> jwrfommd on tin; h»'ad or tnichea.

It ie on Uiis pro[»crl:y of ubBorptioii by tiif roeUil mucosa that an* baaed
two modes of adminietration of medicines; medieimil lavements and thoito
pscellentftiid of ten emp]oyc*l therapeutic iigents. »n]i|iodLorii>fi. Alreadvi
while speaking of rliloral, I have told you of the ad^-antages presented by
thi^ n-wUd adminiKtmtiun of thie hypnotic, uud yon will see a« we go on
tliat other meiUcaments are advantageously adminiatered the aamw way.
Aii for );uppoBitorie8, they daily render us great eervice, OHpecially thoec
lliat hav« ojiium or Iwllailonna for their basis.'

Thus far we havr; utudivd only the intcKtinul mucOMi. IJo not fot;get
that this is only one of tlic component structures of the intestino; there
in alttrj a iniisculur luyer which plays an important i»irt in the intestinal
functions, and which is the peat of the iKTistitUic movements with which
the intt-Ktinal miuis in animated, inovemonts whinh in the normal state are
uiicoii^iouf, but which in [tathologiijul states become pnuiful, itiid tlius
oomtitiite what is known a* colic. Legroa and Onimue have giren m a
goofi study of this intestinal peristalsis."

The intestimtl movements are under the dependence of the nnrvoua
Hy8tL-m, but the t^'imiK-nitnre and eB]R'ei«Ily the circubilion have a marketl
inltaence. IIoiTath of Kiew, has shown that in animals a low teniijera-
ture ))amly:c<^>!4 tli« iiitoatitinl movL<meiitu, and Llmt the latter are tlie more
intense the more active the intestinal circulation is. The intestinal
nprroiiB B)-stom is quite complex. The intestine nrreivoa not only filn-
niuiiUt from the pneumogatitriL', but aliw iicrvcH from the great 8ym|ni-
thetic and lumbar coni. These nerves ate first distributed to two plex-
uses; the one is situated under the uiibmnuous coat, this is the plcxux of
Meii<s:ner; the other is situated between the muscular planes, this is the
plexus of Auerbach; thencu branchea are supplied to tlie inuisclve, glands
and t)lood -vessels.

THE nrrKSTtXE from a TnKn.vricrTTc standpoint.

Some of thcsu hnuictic^ prceidu dvct tlic pL'rii^lttc movnineiite; others
haTo under their dopeirience the intestinttl secretions. AJrcady Moronu
faiwl ihovn that il siifficus to out all Lho lierveu n-hieh b-iipply an tnteatiiial
loop to sev » iiotnlilip i^uant-itv of liquid accumiUato tWro, but it '\u to
VutpiAii that wo tiwf the most complete Ktndy of tho jurtion of the nervons
Ej-Htcm on the eeoivtioii* of tlie iiiteetiin,-: br lute put in clenr li^lit not
only the imjHirbiiiC fact timt llm inU<aliiml M'cr*>tion ami <!intubti()n hiv
ondcr the control of thi' j^aiiglionic ;uii.l medullary «yKtt>ni«. tint lUsu Ihut
certain {larts of the encrphalic nervooH f entres hare a marked influenco
on the fnnctione of Ibe inteslinc.

The intertine, moreover, is the sejit of very important phenomena to ■
which numerous pliyuiulogioiil treatijWK bave recvully called attention; I
rafor to intestinal pntrefaction and the absorption of toxic siibsbincea
resulting thi>rnfmin.

It i^ to-diiy proved that beoal matter? contain toxic substances which
Bouchard m 18S3 waa one of thu first to iHolute. ' ' These toxic Hub«tiincea
haxv thi' reaction of alkalotdH, and belong to the great group of plointuiios
and Icuconaaines of 8olmi and <iaiitii?r.

I r»ail mutters, mort'ovcr, conbun producttt dnidi sm indol, phenol, and
ricato], wbirh originate in the putrefaction of animal Rubatanr«t. They
oontaiu. iHwidLis, lotiein and tyroi^iii. wldcb n>i;ult from llie itctloii of thu
]iancre«« on pepsin, and Rmilly nil the dcrivatires, such tui stercorine, es*
cretinei etc, wbit^h arv due to snccesiivo decomponitionii of the hile. Hiit
of thcao rabstunceii the mort important by far aro the first, by rea«on of
their eilrenie toxicity. Tbosu alkaloids hare a triple origin; they arise
from the putrefaction of aninial suWtitncos, whether fn>m inodiflcation»
effected in the conutitution of the iH!}>tone8, or from the prtwenee of hac-
tvria, vhicb are tlio mora nnmeroue the nearer you approttch the unaa,
lithe cnriona experimonts ofMiqiiid and Vliiri^' IHvy have sliowti. I>>t
OS examine each of these points. I shall not devote) any moru time to
the firftt (alkaloidH of ])utrefiiction), for I huvi' uln-iuly under the head of
" I'titnd ]>yspep0ia" given suthoient attention to this snhjet^t

Alkaloids arieing from inodilication« effected in the peptones prewnt
the greatest interest, and it is to Tiinret that the merit belongR of Imvitig^
flnt sbovn us, in lf>Hl. that it KUtHc^e-v to place an alkaline xulwtaiice in
the pnwciKse of tlii; |H.-ptoni*8 to obtain a body having the reaction of an
alkaloid. Since then Dricger hae obtained toxic alkaloids by the netion
of fpMtrie jiiice on fibrin. Hence then, in the phy«ologtcal riato, lu Mion
as the pi^ptnnes pass from tlie stomiieh into the inteirtino, they fhura
nndcrgo mmliflfratioii-i which trunsfuru certain of their (dements into
iHomaines or IcHcornaincn."

In fine, the miero-orgimisnia contained in sneh great numbers in &Enil
matters ])Uiy a not donhtful port hi the production of them alkaloids. To
I the axiom formulated by Donley: " Every vimlent disease In the function

(ue iiiii<n.iwi) .

252 DisKASss or the stomach.

of a mtcrolw/' the fullowiiig Lintt Item wldfd: " the oi^aoic iilkuloids i
fnnctions of niicn)bM;"arid jMitliologists lia^e preWuduJ that it is by tho
prraliK^tiuu of tlii!«c tilknIoifU vimt the niicrolx-i) ]io«Re8B toxic properties.

In KUpiKirt of tliiH iiflirmiLtioii cniiipleto srientilic proof in linking, but
wliat 1 can ossuro vou iit thiit tlu-sc micro-orguiiisniB cxiA iu great nuui-
bun; in our dij^tive tulje«, and that thev arc derived from eeveral sources.
Tbey may L-omp from tliu food wlucb wo cat, and from (ht> air which wo
brL^lliK, ai)d which conlaids lacU'rin in prodigiciiiii nnndxTS. or from tlio
water which wr drink, which in by no muiuui frtHj from Uiom ua the ro«
ecarclics of IViiist show."

ITenoLi then, iw yoii aee, in th*? phyBittlogical and normal atjite the in-
t4.-6tiu4i coniiLing a cfrtuiu iiuutitity of toxic produce, bui tbo»i> &ub«taiicea
have ni> injnrions effect on the economy, owing to their daily elimination
by lhi> st()»i]B, or by tb« different t-mtnictorics, iiml in particuiar by the
iiriDC. But let wme untowarJ circumi^taQce intorrupt the luirmony of
these fi)»ctioii», and wo ^e tliuu supon'ooe a series of Bymptomtt wfaich
roRnIt from ^tniHoning by theRe tosic Atkatoids. Those untoward ciircuni-
fltanrri! iiriHc cithiir from diHtarbiinrett produced in the fimotionating of
the dijtestive tube, or from thu [juiftnition in osrass of intoctioua micro-
orgnnitttnB, or from tbo non^climinuti'on of tho ptnmainea."

Ar you see, gentlemen, verj' important c-btiiejil doduotions follow all
tbuKt- fiicts. ihrihictions to which I cannot too much call your attention,
bnt tiicro aru also thiTuiHiutio conscqui-'nct!* wliicOi pertain to the necessity
of regulating or of arrt-fAing thoae pntrid intestinal phenomena. Snch
indication*! we can fulllH by llit- diro-L introtUu-lion of niedicaments by
tlic inteHtint^ or by their aibniniRtration by tho mouth.

Thtf fir«t mode of untiHcptic modicatiaii coiiaiirtci nf dimnfectant Iftve-
riionts, and when wc eome to speak of the trcatraent of tj-piioid fover, we
»biill eoo bow useful Ihuy uix'.* It Iihh bpL-n attem]>te<l to accomplish
tbo mme object indirectly by antiseptic mediciiios giwu by inont1i>
and here good results arc attributed to llie aiilttf of bitnnutb. given
in large iIospb, <?harc>0!il powdeT. phenic acid, especially iodoform, of
which IV>nclianl ha« vnunted tho nntiaoptic projiertica. and finally
the biHulphidi; of carlxjii. whjeh I have rocomniended. This latter
medicninent td'enis to nic much BiLperior to iodoform, which determines
iilways, even in feeble doses, a marked irritation of thw digcetive tube I
upo ftlwaya, he it iiiiderstood, water uharged with fliilphido of carbon to
which. »s I have already told you, I have givyii the luime ot carbon bi-
Hulpliide water. This anlphido of carbon solution Itas no tosic property.
and in the doee of from fonr to c-igbt BiHmiifuls a day, it protluoes alma!<L
complete diginfection of the stoola I ehall have more to say about luiti-
«eptic intestinal mi-diealioTi when I eonit- Lo tho treatment of infcctiaus
diseases in genenil and lyplioid fever especially.

1US lyi'hSTlKJi FKOM A T1I£KAP£1*TI0 STA N'1>1'0INT. 2b'6

Hdvinji^ Bniahed tliose brief ouatomical, phyaiolo^cal, and clinicul con-
ndemtioniiT I oonw lo tlio lhcmpoutic8 of diseases of Che intoBtinog. aiid
1 propoBC to limit iiiTself ahnost RXcliiBiri'Iy to thp study of the trpatm<?nt
of two chief EnrmptoniK which you will ofU;ii hjivu to coDibut; constiinition
and dituThoA. The next lecture will be deroted tu ih& coiisidcnition of
the first of Uiese symptoms.

U

KOTES TO LECTURE STIL

'The valnil* conniventcs art foniicd by a fold of the mucous mem-
brane, and contain a greiit iiumbt-r of arteriiil mmusntili, veins, lym-
phatics, and \noac ctclhiliir tintna ThoiUi foUU nnprtir lir»t lit tlii? »>coiiil
portion of thi- duodenum; nt tliia point tht-y an- but pli^-hlly L'oii8|ii»;uoui?,
and ncqnirt- their largt'st dimt-risioua in tht- third [wrtion of the diiodc-
nom, to disapgwar in the Itwt c-onvolutions of the ileum. Prof. KapiH^y
vae able, in a female, to count 55(i m the first half of the small intv«itiTie,
and acporrliiifT to this able anatomiet, the total number of thcee folds is
from S<Xi to 9110.
H Tho length of the smiill int«tino TOrio« from S to 9 tnetres; that of
^r tlip mnroiis mi-mbraiip (owing to folds iiist mentioned) from V-i to U
Bietrm, and the sHj>prficiiiI ii)[t«iit of thU membrane i« about. !0, 125
square ccntiniotres, rcpretieiitiiig two thirds of the total iJurfaee of tho
body, which In a man of iLverage size, in equivulcnt to 13,350 square cvnti-
nietres. (Sappey. )

The intefttiiiFt] villot^itioa prcoent tJiemKelvoR under two pnnripal t>'pes.
ITm provalcQt form of the villi is that of minute flattened trianjrulnr
prooetBoa; otbern are conical or cyliiulrical. or ctch clubbed at their free
extremity. The niiniljer of tlitw villi in eonsUlentble, Hiid aewmling to
Sappt-y, there are I'-i to 14 villi to every Bqiuire millimetre, whifih would
Uiuke. for the wlitik' extent of the intestine, a numLerc'iuHl to lOl.l-.'i.lWHt.

A cylindrictd epithelium covt-ra tb4«e viltositicit. BrmtUiuer and St«*in-
aeh in 1867, Were llie first to jMtint out Ihe ciliary proloiigiiliuiDi whiuli
Uie epitbeliu! ccllti of tho villi present. Ileidenliaiu, Krdmaiiii, Italovh,
Eimer, and Ituiv^h, are also agreed on this point, and Tlianholfer luia
glTcoagooil dewriplion of the*e cilta. Tho bile accelerates the move-
ments ot th<«e %-ibr.ttilc cilia, Miuch play a very important p&it iu tho
absorption of fattv hiiliMbiniieH.

Many hiftnloguts maintain that theoe vibmtile cilia do not oxiitt, m-
peciaily in man.

Mon-oYcr. the villoBitic* are tiio aubjoct of moYomcnts which are (wo-
duced by a double uiusculur layer, the one longituJiiml. the otimr tnino-
renaL Prof. Kubiu tiai; given a very oompleto deiuTiplion. whieh ia
worthy of consultation, respecting; the question of the lermnmtion of Uie
lymphatics in the intesunnl villn^ities,

Bninner'rt frhiiuls are ao calleil from the Swiat auKUimist who (ticcord-
iiig to ftVpfer)' tirxt doecrilMxl them, and whose name was not Jirumxtr,
bat Brun Von Jlammemtein,*

* J. Oarvh Reacarchea on Uic Otmpral CompantlTa AiMloiDy knd the Uor-
il SleniOcatioii of llw (ilnnilo uf lite Gaatrlo and Inteallnal Hiiuoaa of

I

:254

PI8EAJSfiS OP THE STOMACH.

'Th^ mtiooue mombrnne of tho lar)*e intaRtine is thicker, flniipr, anil
ieai cotomcl than that of the sniitll iiit^tttino. It hiu) neither valvuliv ooti-
niTentcfl nor villi, but piKSitcKsi-n vmlcithir glands ur nhut follicles, and
tnhulnr glnndK. Th<«« txihiilnr glnnd.>i nro longer than those of thp small
int«"ti!ie, iind iiro often hifurcaUHl at tlioir de«*ii extromity, whi«h rcrf*
nn the nmnrubr Uvi^r to ii'litL*li it 'w ndlivn-tit. The oIom^ follicluH are
Heated t-'hiuflv in the folou; in (Iw rt-Bl of the intext'me tliey are few in
tminliur, uiul of variable diim-neionB.

Albertoni had niider ob^'rvntioi) a tronutn nitli faiM> anus Kituat<^l in
thv i)n]}er |»n of the a^eiidiii)^ colon, ami thi« it vrhut hn noticH^: Tlio
ei-cn'lion of ttiu liir^ intostinv u a iiiiiooik; lii|tii<l. uf a white t^'olor. i1e>-
cidcdly alkrtiino for 48 hours or moro; iu tUgcetive |»ropertics arc of jittlo
inipnrrjiiirt^ H^b, ranked albumon, mrait, introduced liy the falsi* aim.-',
wpre not, nindifi«1, ©tpu after a long wj/ourn. As for milk, thf iiiiU(>o(t8
[mrt wiw ubAnrltod, the ca«con« part oitjwMwl, tho mg&r ■was abwrlxKt.

Tlin mine nrritor Iioa inadc- a gnmt nambi-'r of exncriments witli nutri-
tive ]aTtimrnt« on iinimaU. and tlirse are his conchi.monit:

1. Solid altmminoid Ku)i6tAnouHdo not nndorgo in the large JntcBtin«
Any difc«eti>'e modilic>atiou.

2, The li(|nid iilbumiiioida of millt. of pjjjp!. etc. are not modified in
the large iiili'i<tini'. Jf ll«*y ary ali^urW-d tUfj' jmujs wholly ur in great
pftrt into the ni'inc, and cott»e()ucntly are not ntiliKed by th« OTy;ani«in.

.'t. Tho jiiirofi of the liirge intoetino may emnlsily fatty bodit-K, ut tin:
8itme linit! oil intitMliiced into the last portion of tht) intestinal canal is iu
jMirt ("xjioili'd.

4. t'rvHta1li7!ab1e etlgar disippL-arif in tho lar^ intestine after liaring
U-t-n tninK formed into g]un()H(>. luui then {tcrlinps into lactic and butyric
aeida.

5. .Starch iinderffoos no modification thcro.

fi. Uiiiligi'«U'd alinii.'»l» which Biijoum in the larjfe intestine, tak« on
there thy character of fajL-ul nuUler. miininthL- color.

7. Tlio juice of tho hirj^e intestine does not ch!mp> tho color of tinc-
ture of iodine, a9 does tlK- alkulintr eaiiva, the m.'niiii, and othur alkuline
hiimorfi.

' Garland ctf Hoatnn has Btiidied the iiitedtinal juice in dogs by the
method of Thiry: these are his n-sulrH:

" 1. The intestinal juice tmiii^forma starch into augnr.

2. It a(rl« in a doubtful nianner ou the albnmen of eongnlatod pf^,
but it diseolveB fibrin, and lliia aolveut iLcUon ia morcactivi; when hydr;^
chloric acid w a<ld«l,

3. Tho action of hrdroclilorlc acid alone also produces, but mora
feebly, the tTuusfcrmation of Qbrin into peptouo.

' Max Marckwald alw utilized a patient with artiticial nuns at the junc-
tion of the cteoiim with the amending cohm. (an o|M.'mtion which had
Iioen performed by Simon of Heidelberg). His expurinieuta have ahowu

V#rr«brate AninmlA, Paris, 1879. S&jip^y. Traitfi d'Anatomie, t, iv., p. 230. Ocrois.
Aiuiliini»-Pliyt(iuli)^'iu(l Btudii.'H of tlir HIhihI Vi-ssi'tB uf tlic.Stnull Intestines, Tk
(ill I*ans 1^74. Charles Rohin, nrtirle I.yinpluitiqiii? In Diclionuaipe deu ScrienoOK
Mwik-aies. Thanhoff.>r tn PtlQs«-r"« Awliiv.. Bd. viil., 197M, p. 381-448. Milae EJ-
wai'dx, Lcvona de Pli.v-siologic. t- vi., p. 104,

THE IKTtKTiNE FBOM A TaERAPBCTlC 6TASDP01NT. 255

*

that tliL- juk-e ol ihe larcp iateflttnG contains no elycogeiiie ft-rmoiit, sml
tliat it digcHta noithur titiriii nor allmmcn. Aa for alwor|iti<in, tho Inrge
inltrctinc tiljsorlw WRlor largely, an<l peptones in small qimntitr. and e*-
|M^nal)y whon tlio latt«r iiro fonned in tli« inl*«tine; but nuuWRs of oon-
wiitratftl |>«ptont<* irrilnto tlu* inte«ino; albumen, introduood into the
lurgB intestine do«5 nut cnU-r llm blood. whutUi-T oliloridu of ttodium be
«4)tT«d to it or not. Miiifikwaid (■imclodea from tlieiw L-xiienniKnlii that,
wc* ill tin* «we of pcptonizod Invorannla. wtitcli i^nnot nowevi-r miflice
for nntritiun. uliiuuiitiLry liivcintMitii ari'^ a Llii.>ru|ietitic inic'takc

Tht'sean* the conclusion* of Czi-ruy. Uitxchuii Ijerjrcr and il« Fribourg:

1. Th(! Eargi' intwtini! of muti. and tlie liipiidd wliioli it si<>i>rt.>tA.<*>. Iiiivv
no di^o^tivc o^jtion, eithtii- ou coa^ntiitcd ulbumon, on soluble ulbumvn,
or ou fat.

'2. Jn ills iiornml statfl. eolublu albumen (dissolvod in water) is rosorU'd
by tho largo inteBtino without being modiflod (digmtcd). Tin" longrr the
sojoom in the intestine of the albuminous fint^tunRo. the hir^r the quan-
tity absorbed, and any irrilntion of the intnsttno either husUins al»turp-
tion, or suppresMi-K it Hito^>thi>r.

Chloridu of eodium uUo dintinielK-s alMorptio». but is itself nbeorhed,
ercn when th« intt-sliiio ia irritiit*.-d, and tliu absorption of albumen i»
BusiK-nded. It h known that in the huu'si.>g^, ulbnnR>n t*xit;ie in i form
littje fuTvrable for alworplion.

3. Tho hvrp.- iiitti^tiuf aboorba fat in emulsion; the alieohite quantity
which piia^'s into thi' or^inii<m i* [irujiortioiial to ihe degrw of concentn*.
tion, and to tho ttmu during' wliiLdi tliu li([uid U in eontutrt with tho ub>
wirlwnl Biirfooe.

•4. Somntimw cooked utarch Is ahaorhoil, but it ia not known whether
it in nlworboil lu Rtarcii, or ufttT trsnxformAtion into Hugar.

' Oarville and IVx'hi-fontainu took two dogs and ^ubjct^tetl tliem to rigor-
oao sbetini'uou from all food; to the ona the'y garo onlv wahir, to tho
otber two lavoment» of meut broth, — 5<X> gramme — per <ffty. Tho dog»
both died at lUu Annie time.*

• Ilere are the difff-rffnt moiles of pn-iwration of iM'ptoniiwKl lavement*:
[jeiibe iiiwii tho frcah ]ittn(ireas (aWTOt broa*!) ol a hog; tTuil that of

an oi. Th«ir diroctions aiv im follows: Minci' finoly eight omiOM of frveli
meat, mix witli ono third part lu* much of fresh lean miiieed pancroaji,
poor on th« n'holi' aight fluid ounces of warm water, bniiwi the whole in
a mortar to a soupy coneiatcncD, and injoct in thv rvctum. To avoid any
irritant elTect on the lower Iwwel of eub«tanci:« nut ubM>rl>t*d, I'roi,
Meyer proponed the following method: Oniiih the fresh lumRreos of an ox
in a mortar with warm walor at ys'' R, then wjueeae the jmlp tlirough a
liuun Hlmincr. Tho li«tuid thuH obtaim-d ia tntunkt<-<l in a mortar with
hunhiMl lean meat and the yolk of an egg: all tlbrous imrUi are rejoctrd.
The prudui-t is kept at a blood Jurat for two houru. and ie then injoetod
mto the rectum which if* pruviously emptied by a clyster of sweet oil.
This ix HeiiiiigerV pn.'|ijiration fnipfoyvd by Daremberg:
Put one pound (3UU gmmmua) of Uiiely hashed Imui meal into a glaiu

* AlberUmi. in Lo Spcrimentale. I8T4 : Ooxlaod, Iot«»itiiuil Digestion. IVwL
Mod. and Sunt. Jour., 1874; Max Marektrulil. Aivh. fllr paid, aDat.-phy«o)., L
xllv., |>. 805. 1873. Citfniy anti J. IjitaclienWrger. Ardi. fOr pulb. utat.-pbys..

■ Utf. U. l'-ttr\ill« unil B<wlti>tonlam<<, Huv. do. biulogte. W74.

256

mSEASKB OP TU£ STOMACH.

ater

rt ut I

m

on ft^n

I 1 • I

fliisk Bml pour on :t qiuvrts (litrpu) o( wnter. Add 30 cnbio oeiitimeti
of hT<lroclUoric leid, density 1.15. Tiimod receptacles, or eoch u
liiicil viitU copptT or uEIict metal must uot lie ubpiI. Add 2.5 jrni*. pm
jwpein of full Mtren^h, i.f., capable of i]igt>Kting 'ZOU timeK il» weignt ol
moiHt fibrin. Diffeiit 34 hours nt a tcinjwniture of Ii:i° F. liriny to
e-bullition, then add of a solution of souitiiii ciirlwnaUi (coiitniiiiriK -SO
pn». \tcT litri.- of tb« crystal liEtjd wH) enough to glvv ths wholv » (<wb)e
ftllciiliiHi reaction. To iittiiiii thin rvsnH il is necfiasary lu add from' I5.i to
ITU cubic centimetres of the eolution of carbonate oif aodium. Pass tbe
boilini; Itrjuid thronj^li n Guv. Iinni strainer and express. Tb*» li<|iiid
Blinuln then bt; (•onccntnttod in n ii«a-liath to 1.100 — 18(X> cubic Pentimv(rt«r
of which one half should b« injecti'd per diem. If yon make list* of pop-
bmcs ulreiwly pntpiiriHl, yim *linul(l difsclvi! in a cupful of wiirm •vater
two or tliroe taiHimonfnls of those pi-]itonea, inid add five drops of lauc
num in favor thoir rotJiniinn by tho rot'tum.

Darembvrg in a cuttc of tstricture of the «esoph&^us kept n pntinnt ali4
fourti-n-Ti niuiillis by jieptunizcd l»vemciits: tht- figure of un-u yras kept i
15 lu 'iO ginK. p(-r dtiy. In t> cast' of ulcerous pharvugitiu hi- ubUiineu Ik
eamo roBult; the figure of ur«a before using the Wements was 10
rieing to IT pms. after the lavements were eniplnyert.

(^tillon takes a dog vroighing 10 kilugrammce, and feeds it on
larementu a. day, <aioh conipo<cd of S ^ggs iieptonizoil by tho mblition
6 gms. pi){uin dineolTod in elYcorine. At the end of ^f davfi it had kept
it* tempenitnm and itJi weiglit; (9.250 kilogrammes). The pepxin wu I
then nmitted (mm the lavementji, and at the end nf a fnrtniplit tho dng j
had lort ".tbO kiiogramnios, with iv full of 3 di-gruee iu tho tvni piraturc '
TUbu thrtie luvcmi-ntsa day of biuod (100 gina. euch) were givi>n. Tin: '
effect van di-jilorablw; the unimiil kept un loniiig waight, the tempuratuK I
fell, and death t'UBued from starvation.* |

' Briquet in a memoir to tho Academy hw Ktnclied the absorption of,
mtlpluite of fjniniiie by the rectum. Theite arc Im conclusion*: ^H

1. Ttiv lupiid whi(;li <:out<litutt!i< the liiviMiifrnts mar nvaW Iw rmide V^^
pass as far iMt the eiveuni. and cons«(iueutty be brought in contact with a
very u.xt«nsivL' ubsorbtMit surface.

'■i. Tlie muvona nientbraue of tho large into^tinc, mid the liquids which
bathe its eurfucv liave no eheniical actiun ujiou tliv Hub^Uinu-s introdut^
into the large intestine, ivhoro nothing it! absorbed but what is firtit in
solution.

S. When soluble saite of quinine are adminiBtered in laremcnt* in
dofien l>r>low l.*^ griiinit, a little mor« than a third of the quaotitj adminin^
tered is alutorbod. ^^1

4. When dows of more than 15 grains are administered, they are baJt]^^
supported, and only ii fifth or si^th of th<i mnintity is absorbed.

!>. It is only after an huur that tmeses of ehmination in the urtno (and
conaequentlv of absorption) are noted.

fi. Tht! (Inratioii of eliniinntion is in ^'oneral quite short, and ordi-
narily two to three days at iha most.

7. The greater or lees dilution (within oertain limits), th« more or 1

*' Brovm>f}6luHn] tin Alimenlitlion bjr the Rectum (Gax. hebd., ISTVh Dan4t>
bsrVt Alimentutiuii by P<>ptoTl«fl, [Gaz. hebd.l. Mayet, Ahninnlnry IjivotncBtM.
(OiiJt. h«bd., D«c, 1S79>, C(ttUlon,CVni{>lvs UviiU. da lu Soc. du Tli6n>|>. 1379.

THEltAPKimO STA!fDPOINT.

lew viwoiii^ lUituit! of tlif liquid, and Gimllv. tlio addition of atlbt nf mor-
phine to Ihe alkuloida of the cinchonM. do not sensibly modify the ab-
sorption.

t>. Youitf; t>eople nl^sor!) I^otlcr timii adults; old people absorb bitdly.

5. TLc cincboiu* alkaloids iwlmiiui4tor(.<d in laremuiit in doses lielow 15
grains may roiidor ull the scrricv whii^'b i^nit bir lookvd for from tht«u
alkaloids when jrivon in emnll dosos by month.

10, It ifl not so, howovcr, in the niee of mamivc rioBea; theeo arc never
rbed in suffioiftntJy liirge quantity to produce rtupefying or energetic

iffoctL

11. Tla- larRO intvatinu «in not p;nemlly bo m«do to tok'rat« more
Uuin To gniiiiK of ()uinii)i' ut oncu.

' • Demai-qiiar p»ve Uvements of 200 gms. rontnining one gnimine of
indtde of ]mtiui>inini, nnd tlipn HOii^lit for iodine in tli« h'qiiida of the
economy. Abiiorj>tion wax iilwavK niori* spM»dy by thft Urgi? intestine
Omn by thv rtomftoh. and »t tbo ond of ultniit lil^o minul«» the iochne ap-
peurvd in th« siU^'h after an iodide liiTemi-nt.

Savorv rtndied in unimalH the adsorption of Ktryehnine. KCy. IlCy,
>nd niootmc, adoiinifttored both by the mouth and by the rectum. TboBu
uo his conclusions:

1. Stryclmiiu; in solution has a more rapid action by the rectnm than
br tho stomach: Kl'y and HCy act with the same aetirity by both wuy«;
nicotine U more active by tlie Ptomacli.

2. The preopnoe of food in iIip ntnmach does not in any thing modify
the energj- or mpidilv of netioti of strvehnine.

3. if Btrwhnint^ lie Riven in iwiwdtT it i» nbsorlwd better and morv
quickly by the etooiach than hy the rcxitum.*

• A good BupiWBitory is niado uo follows:

Take of:

Opium }nl grain.

Ext. belhulonnn |itli "

Cacao butter 75 grains.

Mit, for one HUpiwaltorr. (Th*.' supporatorios of morphia and tannic
aoid (U. S. P.)> "f* amoHK ilio*.; Mio*t iu ui*o in this countr>*. — Traua]

"The muscular coat of the intestine in composed of two plnnee; tbo
one, niperli(-iul, is conrtitnted of hmgitndinal fibre*, the other, dtvp. is
formed of circular 1ibre«; tho latter is two or thrw limes liie thiokesL

In the largi; intestine, the Uyer of longitudinal fibre* does not fonn a
eompletv lining lu the inlextine, and constitutes thrri- longitudinal banda
wbicu all start from the appundix vermiformis, and here form the tbiekert

* Briquet, Btilletin.<lcrAen(l. deM&l.. t. xii., p. a?. Dcmarquaj-, llwH.-otvtc-*
CM tlM AlMori>tion of Metlk-Hnicnla by llw Rwton) (Union MmL, MsenM, tSTTV
Savory. £aMeff, Uaiwh, IB84- (With r«(-nrd loan»sHM«ia by the rpetiim. lo whidi
the miUior Hcrotea a dwrt footnote, tltis piwrPM, for a whiU- lr(.il in lliUconn-
Inr, ha» complHelyirnB* out nf tojtu"', lu-iim found to tur not ii mitt •■nil ihI with
dollar, wlii1>> Wirif; n-Hainly in<iiDv<>nii-n1. Tho n(li<^ iu lulro<lucerl into tJti-
tum tbn>ii)tli nntiiall Uihf which ix iit mnioumii-ulioti with a flunk <:«>ntMininK
tlw eUinr, iinti wliich U kt?jil in wsrni wal*r at a temppmlore (nboiit 180" K.) suf-
(WmiI to Bet (nj« Uk aniKatlictic.— Trana.)

ir

2f)S

DIHE.\8EK OF TUK STUUdOU.

bvvr, wliilu, ou the othvr lund, tiia circular Qbree are m tliia tluit tli(
exiittouco is denied by sodic aiitlioritio«.*

" Bouchan) in Ififi'Z, found certnin alkatoidK in fwral mattt-rK: tli'
alkaloidB iire nnmeroue; some arv Holublo in titli(>r, domo m^oluLle, ai
all arv emiiiciitW toxic.

In lt>H3. Arnold also oxtractixl toxic alkaloids frnm fiecal mnttera.

Ill fieaii iiiHltt^TK iiru found tiiibHtunueH wUicli rceult from putrofactioii;
these arc indol, pbvnol, and skatnl.

Indol is » ^ii^stance wliicli, under the inflvtcnoe of chlorine takes on a
TOKC color. Tiodmaiinaud GnuilindiKCOTonx] it in 1)^26 in mattere contained
in Uio duodoiinm. CUudo Bi''rruird notiuod it in the pancmift. Kahnc
ahowEMl that it is a proihict of putrefaction, and in 1ST8 ItadziejcwHlii
I>niii1«d ont that inaol in a rnnHtnnt conHtitnrnt of the stootit. Two
oniTiionR liavo hoen put fnrtii a» tn the origin uf indul in the intmtine.
lIopi»e Soylcr tiiid Kaikowski maintaiu that it is due to the action of pur»
paiicrwitit; juice. Kuhni'. N"ciiL-ki. Jlrit-^iir. Uufiior, claim that iudol ia
the rwult of the action of biK!U>n:i in the intivtine. Indol paiaies out ii]
tho urine under the form of indioflti. ]n (act, Jafft- in IS^'J showed that
iiidiciMi 18 au^ineiiti'd in tlio urine mulor the in3nonc« of Huhcuianoons
hijnctioiiB of indol. and it t^wms clear tlint this indicaTi in the urinu n'pn?
8011 1« the indul abaorhed from the iuteutiuu, uud oxidizod iu iu yasmgo in
tha hlood.

Ak for pheno), DaTimann was the fintt to find it in the skioU; it ob'
also be dotcctod in tho nrino, as the investigutionK of Stoedeler show.

Miquol and Mari^ Davy have sought for micro- orjziamsmB in different
parin of the or^nigoi, hut have found IwH-tcriu only in the hingn and in-
tentine. In the intcotine, miL-rubeii aix) the more abundant uie uoarer
the anus they are sought for. f

" 'I'anrat hue ehown tiiat the peptones are tranrfonned into alkaloids;
it Huflic^t'H for this to treat priitoue by iionfcnil rarlioJiates, or hjr caustic
]>otii!«a and t« add ether. Kther dispiolve« a Rmall tjuantity of a volatile
lifjnid with alkaline rttiotion, which preeents all the i-cactions of the alka-
loids. If tht'ei; {lujtioiioK iirti left to putrefy, there h formed beridee a
nolable ()uautity of a nnn-vulatitu alkaloid, l^nret think? tiiat ifaeee
alkiiloidy do not exist readv formed in the peptones, but are p»>dQ(%d
there by the action of alkalies.

In ly8;3, liriygiT oxinictud oertain alkaloids from these peptones. Qm-
trie jiiico in made to autou 20U gma of librin, and the whole evaponted
to a syrupy consietence and subjected to amylic and hutylic aleohol; an
amorphouti lx>dy is tlius obtained which htia the reactions of alkaloids,

« Sappey, Traits i1'nnatomi« il«i»-riptjw ; Legros and Oniraus, Expeiiinon-
tttl Keaearchea on tlia SlorenmnUi of tlic InU'-sliaes (JourniU dc Robin. 1866, p.
18").

t RducJianj, 8oc, tie biol., August 3, 1883, Arnold on Ptomninon, in Arch.
PlianiiiM:it!, 1683. TicdmuBti und Oiiicltn, Re»carchcH on Dit^Htioa, 18W.
Cluudtj Bcmanl. Memoir on Uie Patiore:is. 18.16. elc. Rulint). iCrfalirungeu und
Benierkun^n Qb«r Eujtynn! und Fermente, 1ST7, HMJEiejewKki (in Aiv-b. t. AimU
omic, 1870). Hopjie BeylerduZeit (Qr PhyaiolaEn»'bi;Cbemii;). Stucdcler. An-
oalcr tier Chenii« iind t'liitiiiiHciif. xc. Uari£ Davy, Aaauairv de TObservatolre de
MontBOiiris, iwa, p. 401, oU^. etc.

1

THK ISmSTlNE FROM A TUKKAPEI'TIC BTANDPOiyX. 2'>9

And kilU froj^ in tlw dose of from 5 to, ID ccntigrBmmw, and hares in
Lhi! doec of oiu- gramme.*

" PronKt and Kiiuvl-I, bytlieir procosa «f j;i!Uilinc uulturc, Iibtp 8tuill6d
the develo{]iimut of lliy pruto-orguTiisinii in iH)Uble wuli-nt. aiid in partirn-
lor, tbose of tlie Soii]<>. By nimiis of gliu« s\ii\m with cut wjuaros hnvine
sidiw of 2 niinim('tre«*, they lisve Weu able to nuoisni'e the numlior oi
cultiirt' colonit-a anil linve foniid from 8.(HK) to 243,iKK) bftctorin to each
culiic etntimt-lrt'. A n-i-iilt'iil of I'siris driiikiii? Si'inw wiilcr from tho
Vanne, trill swallow in v»c]\ tumlilerfiil (the tumbler Wing of tho capacitor '
of 2M) centimotree) 2,;.'iC,000 microbes-f

" nuiiilN->rl ill 1873, ciiU(*(l ittl<^ntioii Lu tlic ime«tiiia] sviptii'a^mitis, but
at Otin time nothing ww kiiuwri i>r tho I'slxtuucu of iiiicrobi-a or of'
ptonuimea in the intiifltine. Iluinbert diviilw them septiciemias into two

Cp«, aoconling an there \» or is not retention o.f misters in Llie itite»-
{HwHinrt, J)ea Snptiarmw* iutfslinalfn, Th. ilf Paris, 1ST3). In
tbc first group ho plac^e coii«tiiiation, «truugu1utiaii of the tMirel, and
acute iiidiKL-Biion; in the secund, typhoid fever, and suppumtiooB of tlie
mouth mid pharynx.

BouehanI coiiBidera tlio int^'fltinal poisons as the principal cntiso of
ummic* uecideiitH. The iK^tcuiiitilation of ii coniiidenihle qnantitv of
ptoniainex in the blood ix dui* to tlit- four followinjr coniJitionK: 1, \Vant
of uliniination by the kidnt-vs; ■,', Want of deatrnetion by the liver; 3,
£xoe«8 of absorption by tlie intestine; -1, Excem of pruductiun of tliu
ptoraainea in the intestine. {

•

• Tann-l, Peptones and Akiduidx. ComptM Rend, dc t'Acad. dea St. 1881.
Briegpr, Zur Kentuisa der aroinaliiichon substauzL'ii. IStlS.

\ TrouKt, Atrodvmic dv MHcdnc.Si:«iou of Oct, 21, It^i.

t Proust. Acad^niJe de MWedne, Stance liu 31 OcIhIm- r. IH84. Humbert, Oes
wplii-^nittii intpKlinAlm, Th. dePuriK. 1878. Bouchnnl. Dii rftle p«tho(ri^nAtta)iift
de kttlilalwliun do IVtttoiuac (8oc in6d, dci hAp.. June. 1484). Cutnby, Uu rAle
puti)iiK^i>liie dt^ ali.vliilitc« qui se fomivnt d^iin le tube dig«irti/ (Prugi^ KMii-ul,
81 May. \SM). Ncttor, I)^ poitons chlmiqite^ qui apixki'aiaaeul dans Im njutifircs
or^niques en d^coni|xiHili(iii t^t dt-.t iiinWIii-squ'iln p«^i]vi;nt pro voquer (Arch, g^n.
de niM., S«|>ienilH>r ft Octnbpr, 1SS4, p. 477), Ckiandi-Bey. Sur l.'n proprifl^w anti-
WptuiUM *i Aiilfure lie «ii-hitrn' (Conijiti-n ix-iid, Amd. tU-s Sc., t. xcix.. o'lS, lfl84,
p. BOBV Sii|>p1tMr. Sur Ir* iiropri^t** physlulc^quea. thirapeuUquvs et toxittiiw
AiwO I- d«carb„ TIl de Paris, lOM.

LECTURE XVin.

THE IIYGISN'IC TREATMENT OF CONSTIPATION.

SuMMABT. — Doflnition of Gonrtipation— Coum" of tho Alimpntary Bolus
■ — Intestinal ('i^culi — DefiiciLtion — Frecal Mattetfi, ('omposition —
Daii^ni of Coiistipation — Uygionic Trcutmeut of Cormtipatiou — In-
fluence of Alimpntation — VegetaWo Diet — Frnits — Bevcngos —
Water — tMimaU'— Kxercaws — GvmnastiiiB — liifluouce oC Habit — Moral
Influences — II yii rotherapy — Applications of Cold "W«t«r — Dondie*—
Ijiivrnicnts. their Itietory and Origin — ModiiicationH in the Instm-
jn«nt— 'l"he Age of [^vementft— Actiou of I^vemeiits, thyir Advaii-
tageij and DiaodTivntagos. ■

GossTiPATiON 18 clmniffcrised by the abaolate scaniiiieiB or iiuaffi-
riency nf {*<■**, and the dryncfin and hardiuws of the nistters expelled. In
the prwmt »Uviy I nhnll Ioavo one mlo the symptomatology and diaffno&i»
of coniiti [lation, tint I Hhall dwell uu the pathogeny n-iid otiolflg;y, and this
beoaiise Lhew? two divigioiie of our suhjeet hohmg eRpecially to thitrapentios,
for tho old adage: nulflaia cntisn, inf/i/ur e/fir/H^, is here eBpuciully appli-
cable. Hnt in order wuLl to know the pathogeny and etiology, we must
hflvc recourse to phyBiology, and ohtiiin iin exact notion of the coaree of
the alinienlary bolua. and of the uiodiGciitions wliieh it tindi-rgoett in lb9
intestine: ttiis will enable ine alw lo apply cercaiu practical data which 1
gave you in the foregoing chapter.

The alimentary holns, after having bc«n in tho Rtomach subjocted to
impi'f>iii]iLti<in by the guslrie juiiie, and after the conversion of tho ailiu-
minoid inatteni into peptones, pasRos into the duodonuiii. There tlie
medium clianges; it wan ncid in the etoinach, it becomes alkaline at tho
amptdla of Vator. and this alkalinity is duo to the action of bile, which
at thi« jtoirit in ponreil into the dnndonnm; tlipu (he iilimentnry bolna by
reason of the luhrifuetion of the intestinal wallB, and tho incetiKitnt move-
mentM of the intestine, descends little by little to tho tleo-c»?(-u] ralve
(Buuhin's valve), through which it iHinses, and penetrates the largo inti's*
tine.

It is there, a« Spring has remarked, that f-ajiropoiesis oommoiicea, that
is to say, the formation of (leeal matlora properly ao called, which become
moulded to the walls of the intestine, so as to reproduce in cerbiin ani-
mals the exact form of tlie iutcstinci).'

A-n soon as tho alimentary boln^ has eleurod the iloo-c»cal Talre, it

UVOUMTIC TRKATMEUTT OF 00X8TIPAT10N.

2fil

eDters a diT«rticuluin of the laj^ in.to8tiuei which, tl it does not ])laj an
important part in cljgoetion, nt Ituut iu man, offers ner4*rtlieletw, from tho
point of view of coiiKtipatioii, a great ititBrest; I iillude to tho oeRum.
Fax»l matters may in fact uucumulati- tlivrc, and if the niuacular coiitmo
tility of this reiwrvoir is eiifi<ebleil, tht^ir prva«nc« iiiay deterinine graru
inflammations, which havo been dc«cribo(l under tho name of typblitia
aod perityphlitis.

Tliiii accamnlation of fsecal niattcni in the camum is attended with
onothur fv^uttiri; uf iiiturc-t<t, TiuiiK«]y, llint owing to thu dvolivuus jioaititin
of this reservoir, which ia placed bolow the mouth of the amaJl inteetinc,
the pTolouged eojourn of tlieev matters docs not noooHmrily ontail consti-
pation, nnm the liquids constantlr secreted by the anuill intostiiie find
a free Tent in the lar^c inteetinc.

It is also cliicfly in Ute \ATge intestine tliat intestinal calculi are found;
thMc are rare indeed in man. whcro LaLoulhi-no hiis neverthelen discov-
erwl tlieni, but fnxjucnt in aniniiilK, the honte for iiifitaiK>4>.*

Impelled onwaMs then by lliu {wrlsUiltic movements of the large in-
testine, thi! fa-vnl umtttint travt'nw tiic largo iuttviUnu. becoming drier iu
thttir transit, sojourn eomo time in the eigmoid flexure, then dcaoend to
the rectum. By their presonco here tli«y dotorniine at thu lower outlet
u special sensation wliich reflexly «ilU into play that nomplei niKchanism
in which the alHUiminnt muscles cioncur with tho Jntustinul musclca in
fort'ins the HpbinukT aui, and in the expulsion of the fuoos by tho act
of deft-'cation.

O. Betnie, uf Thiblin, has maintained that the ftixe» always stop at the
iigmoid flexure, and dc> not sojouni in the nnstum; this view ia also belli
by Johnston." 1 bcliuve, howuvvr. thutit is a mistake, and thu gynawo-
logicul touQh suffices to show how often fiecal matters aocumnlato in tho
rectum, pneaeiiig forward more or U-«s thu posterior wall of thu vaf^iia.

Wlwt du these fieinl mattcrH couHist of? They are the residue of nli>
menls; they are composed in gjvut part of BuheUtnces which are not
nliluivd iu nutrition; cellulose of vegetables, and cartilaginous substuncv.
epidermic tiasue, and animal Fats. Thofo was a time when one of these
prodocts wa»! employed in therajteutics; I allude to album ffraeumf m
Tsritablo fs^cal residuum.'

The quantity of these matters is vuiable. and is bkrgoly dtqwiulMit dn
tbo fooil tluit is eaten. They have an aJkalimt reaction, and their color
M well aa their odor dopends, in groat jwrt, on modilieatioiis uud«i;gonu
by the bile which is jioured into the intestine; you will find, in fact, in
the fa?ra1 Ruiitunull thu ]irincipleii which aru derivud from tlic bdiikry elo-
mente, cholinic, fellinic acids, dyslysine, vxcretin^, etc.' They coutaiu
also, as we have swu iu the hut chapter, curtain products uf putrefaction.

262

PISP.ARKA OF Tll£ STOMACH.

such M tndol, «kntot, phenol, etc., then microoi^nisnift, and lasUy^ij
{itomainm Kml IpiioomaineeL*

ICow tluit wi- \u\\v i.-<)iiai(lere(l the <*qui;^ and natiiro of the uliment
Iwliis in itfl transit to the lon-pr extrcmitj- ol tlic~iCgi!etiTo tube, let
study the fAthogcnj of constipation.

SoantiiKsw "f tho iftmAa owns diffprent raiiaos : •

1. It may n-suU from u inivhiiiiH-ul oljKtui.-k- to the passageof tlio
nuus: this lb ooustipation b; obstruction, to which [ shall dornte a speciiil
chapter.

S. lu other owes, cotistipation is of alimentair origin. Almtdr tn
thv chuptara on Aliments and Kegitnen.. I havo given due coosiderutiou
to the t»ctM adduced by Voit whicli ahow tliat the quantity of fiecal
nattera Tsriee anconling to tiw diet, and time thi; more rabstanoee tueleu
for nntrition prtMlominata, tho tnnr«> ntmndnnt are the tmpee, and that,
mnveraely, the more asmmitable tho food, tho lee« in quantity aru tbe
stools.

3. In a thin! jrroup enter the conMipationB whirh depend on want of
Mcrction of tbe iiitc«tiiuU juices. The bile on the one hand, the intcAinal
jiiioes on the other, aid the paseage of tbe alimentary bolne; if tlte odb
or the other is de6cient» tbe march of tJie former ig stayed, aod there ig
constipation.

4. Lifttly. tbe muscalar coat plays a considerable pert in the ]) ro g T t< B
of the atimetilury maas; the perisrtnltie morementa favor the tmnsit of tbe
(ijH'jil bolus, hut let anylbing diiuiui^h tbe ctmlruclility of tbi* iiiujtriped
muK-te, and there ia arrest of the deect- nt of the excreta, and conrtiputjon.

b. In a la«t group there is no ottstacle to tho course of tbe fvcal
matters, but at tbe moment when defco'Ution ought to be oeeompliitbod,
one of two tilings may take plaoe: either the patient, as frotjuently hap-
pens in persons afft-cteii with medullary spinal disease, fail;) to experience
that peculiar M-uAition which is tlie starting p(»nt of the reflex action
which brings abont expnlsion of the excreta, or else he mffers at tho
moment of defecation tio severe a jain that he makes an unooDBctoua
effort to avoid dilatation of tho anus, and thas preronta ex{)uleion of tbe
bnx«: tills is wliat happens, as yon are aware, in flasare of tbe anna.

Such, gentlemen, are tbe eauec* which produce !<cantiD09« of tbe stoola;
yon aee that Mu^h group claims a special mention, and that each requires
a jnrtieidar treatment. But befon> entering upon tbe study of oach of
tbcM! diviainn5. 1 desire to present certain hygienic cannderationa upon tbe
ireattnent of coiutipatioiu Hj^ne. in bet, pbys an important r61e,
and I shall sum up tor ytm the principal preoepts applicable to such

The first pUce should be assigned to diet. Wben I spoke to you of
the regimen applicablr to di»asp«o( tlie Btomach (Lecture IV. >, I alluilcd
to the 0O{nQUM)c(» of stoola which rcault from rabetanoeB not abeorbedt

lIYttlENIC TUEATSIENT OF CONSTIPATION.

2(;3

■*nd I meniioned the facte reUt«d by Voit, t shall not speiul any moro
time on thorn now, only rpcnliing to yonr mind that tho moro nn iii-
dintlnal sulisitilit on nlbtiininnuN iitul t-usily itrwlmitnble f(KH], th« riinro
ocuitty become the istoojs, wliilu, on tbu other Imiid tho mure i-cgctablc
tho (liot. tho more abundant are the feces.

Hence when cn\M to pr«ecribo for pcrsonB that nre oonptij>at*Ml, yon
t<hnnl<l innst on the tino nf h vegetal dint, and siiroly i,ho rojtiito vbich
ench sutiitanoea aa spiiuich hare in coctircncas reiiults from tht- fact that
tln-y contain a prwit dwil of wlliilope, which siiKniciits tlie fitcal residno.
Thus it in that the employmont of bran bread, Ciniliam bread, or rye
brond oftoutimoB rc^ilatoa tho hnwula in pormns that mako uso of it-

Von BOB that some aUmeiit'i more than othon* prrHlispose to stools, and
may thtiB combat c.onsti|iatii)n. In this group yoii will plauL- rJiii> fruits,
aiid ill particular prunes, which often ecrve for the preparation of purga-
tivw ptisans and (•loctnarieR. t?rftp«H have the mmc yff*ct. a« I hav«i told
yon in a previous ohapter. In the satm- group oerlain fatty tioilifs enter,
winch being jioorly or incompletely iilworlx-d by thf Htomach, dftt-rmine
a purj^tivti action, I 8hall return to thi« wubjoet umlcr the hwnl of oily-
purgativoa; UiKtly cortjiiii «w;eharin« mBttore, stieh as honey and molaewi^l
have, a« you know, u bixuiive action. Hut the hho of {Mitnhle water tuiR
not a lietlu to do wich the sukntinL'tat or abundance of the stools. In thin
rcspvct the drinking watom onght to be coneidorwl from thv tbroi; follow*
hit' i>ointa of view: temperature, quantity and quality.* The tempera-
tun- of the watt^T has in far.t, a groat influenno on iiit4^«tinal troubles, and
in the ohaptore on diaea«ea of tliR Btomarh I aliowml yon that the xtfv of
ice wator often Bi)t-«li]y cuumm diarrhuia. Ab for the quantity, tho l««i
oitedjinks. the mort; acaiity are the stooU, and vi<v wrtid. A« regards
quality, thoee drinking waters that are hard, i.e., impregnate<l with cal-
cnrPOUB principW aro apt to cauw olwciuato oonntipation; if. on the othur
hand, they contain conHiderable az«iti»'d inpri-dicnt* they pro<lnce diar-
rhcL'a. and we liml lierc an explanation of how it m that {h.thod)4 cliangin)^
locality or climate are often subject to diarrhfwi or cwnatijiation. People
from tint pro\iiiee« wlio oomo to reside in Piin« almoKt alwa^-s ex|>eTience
pargatire effeLrts from the usitjip of the waters of tho Seine, which iiro
rii-'h in orfjniiif mjittcn*. while the Purifiian espcricuccB the contrary- effect
when hogoc« to the country and drinktt tho hard wat«r of the wella or
spritipi.

Other drinks may also cause diarrluea, and without spenkinfr of swmi
wine, I may mention jjcrry and cider, which act in this way in punsonii not
babituted to their use: the came may be said of beer. >[ilk hH:< btwii
also aocuaod of provoking laxative offocta; this can only he exceptionally

"fW-iTtbf miiurkHtile theaJa orAnnoai] Ouutier oa Potable Wotenw Tlijae»
inU. [m-i.

DIBKABKB OV THR BTOMACII.

I

thu ciiMs uitil thcru arv sliuntlunt otMcrrationH vhicli prove that properly
carriii] out, ii milk diet do«e not produco dJairhcce, but coniitipetioii.
Nitvi-rth«Iiwa coffon in irbtcli niltk Iiirjit'Iy oriters ia iipt t/> (sTor free actiun
of tlii> l)OWL<U. and MuiDV inTMiiiK ikfi' iv^iilurly piir^l Lboroby.

1 will join to tlie alimoiiUirj' liygicne the uw of tobacco, which U laxa-
liro it) minie iudirUluule. Miuty 6inoki.Ta will MHurc you tluit when tli<>y
Icnvt' olT Kiiiukiiijf, tbcy Imk'oiik' conutiimtnl, amt thut Kiiiokiug otter meals
pnimtiUfi p-'fiulurity of tlia boweU.

Hxorcbtu iti Ihr njtoii itir Iuls ttlso wi iiioout«8tablo influance on ootuiti-
(mlioii, and it inuy truly hv mid thxt it sbAiids next to diet aa a remedy
for thin morbid stuto. Iiit«stinAl inActirity, nnd torpor of the tnuscl«8 of
dt-'fwatiun attend general iniuciilur eiifet>blonu>ut, and the leis exercise
ono talcoK. ttia moru bu is diapoeod to constipation. Hetiou it ia that we
idmtvit Hlwayaaoroonittipalioii in pereona of sedentary habits, and it may be
itlllrnuKl that tbv hAbitval oonstipation from which bo tomuj women 6DfIer
ia thu nvnlt of tlui inaotit-e life which they Uwl. 0((U>r eiercim than,
ifiiich lu niill^iii^ and ^ii'niii;kstics. Wliilu hanlly ^om<j ao tar as to ailTiiie
alHlmniiul (tjiiiiuiBtics (to which I have previously »llnd«l}, tJiere is cer-
tainly mnch Uittt TOU nut do to furor tbv regular nraromtrnts of the dia-
phra)^ and iilMloiiiinnt mu8cU«, and yon cannot too much insist on the
t»rjKin<iil fxervioiti which inorvwse the fon?u of ibe miucular group which
OBtera into play in the act of defecation.

Then* an* certain E])ecial moTDiuents which favor diarrluEA, such as
the trwnblinjc motion of milroad cars and carria^t^; honoback riding and
yachting', howov-vr, piWiEpoee to eonstipation. Theee are I know iiv-
dividual prculiarities, but tlwy descrre to be noted.

lUbit playv alao a irrrai part in the patbogeajF of constipation. There
«n penona— «nd females mpecmiXf — who «aa nnuai whhoiat iaoonmii-
taum ttom a w«ek to a fortniglil without faaring a stooL These are, I
know. once|)l>aiial ombs, but it m^ be stated that ordinarily women do
not go ftoalnal oABOer tlian cmy- two tlays* while OMft* oa the oUter huid,
find theasrtres «owti|)At«d if they do mi hwe ode or two skoeb a day.

The penod of iteinaliea ia aMthcr iMpettuii pomt; seme penons
bnvv the habit of jeoiag to stool at a ngebr hottr eracj day. rtili» tfaie
tmet, and if yoa kaiv U* do with pelientt that «n ooMlipBted, weommend
UwMl to !*• to aioal at a ftxc^l hour crvrr day, and the eariy aornii^ is
the batter tims^ the; should culieit an t>««cnatMii, erm thoi^ tot » i
the; may not sneoe«4 M thaa* daihr s

U»talaMlemati|palals^hi*eamarfeed waiMiiiaai— ii[«n

tifiwt^hwr rfniiaii—i wrhMhjtiim_iii rf mwilil |iiii
. tnck as iMuity. w^cb are •• flIlMii
ImtaeUy— r ito n iin e ipthenM if gDCBii

8l91 hnity tutdcntood. bat whach »

KYOmmC TKKATlltiJIT OF COMSTIPATIO.V.

265

Voltaire hfts vritt«n about it iti and ulvrays will bu true.' ^toreover,
Vulpiaii, by tliu i>iperiin«iiU wliich he has mode, one] tn whicli 1 alluili-d
ill Lhu for«<^>inf; cliaptorr liae jmiiitfitl out tliuiuttioii of rurtain pitftii of tliu
oiiccphiiloii on the ilitwtlnftl c-irculirtion, and put in cU-Ar light the elooe
bond which uiiitflfi the (icrobnil funatioiia to tbtHsu of tbi- int^sUne.

Tbti iiiflutiiiced of oxtenial i;ircuiiuUkii<;»4 Ijolli in Uie development and
cure of conHtipation is rjuite an uiifiiioaiiniiable, and it is a trit* oljscrvii-
tioii that cbangofl of oliraato produce either ooastipntion or diurrhcra,
oftcnor tliu lattvr. I>iarrl»i?a i.i ii frc>(;u4>tit aooumiuuiinicut of acelinuiti-
j zation ill wanti countrioB.

^K Tin influence of cold nioLstum on tli<> nbdomen Iwiiig oiio of the miwt
^^^vdinary causes of diarrliota, you well uiideret^ind whr thte muuiH Iul»
^frnm sdviflod in the treatment of con8tJi)atioii; wot clothR, or ouUl water
' in the form of douches tipitig uppIitMl over the ub(loni«n of consliputeil

kpfiTiioiut. Hydroth«ra]iy in of undoubted utility in consciiiatiou. liiitnTRges
ill his Ucdical Noeolog^' montionB canea of obstinate von(iti)Hition tliua
treated by Chaptul; Schcdel rotates also a case of euro which once niaili!
oonsidcrablo noise, and contributoil not a. little to the reputntiiHi or
Prieatnitx; it waa that of thv only son of a prince of Lichtf^nsteiu. wlio,
afTtKited with a €on:«tii>ation rcljullious to tiJl kinds of treatment, wbs cured
by the application of gold water.*

How dow cold act in combating constipation? It is by mciwnng the

perijitaltic moromentA of the intestino, and this increwie is not due di-

rectly to the fall of the tt-nipt-niture. which, on the contrury, would have

h an opposite cfTi-ct, a8 we liave seen, but to the fuct that tliie chilling of

I ; the periphery entails without doubt a greater circulatory activity of tiic

intestine, and thereby »n nu^ciitutiou in tho inle»tii>nl contnictions.

Every va«>-motor c:aiiBe, morenrer, which can bring about thin nctire
int««tinal eoiigoBtion, will produci- tliis L-ffi'ct> and it in thuB tliat wo can
explain certain curious facts like, for iii!>taiice, that of tho Duko of
Furrare, who could iiuver have u Btool uiilest! lio went to the wator-elosol

* walking with hin tiare feet on the cold flagstone floor.
Beaidea the ajiplication of oold and cold water, I will mention another
meaos wliicb may render good aenrico. I allude to {)L-rittt?ul, aiiul. luid
rectal doucheo, which act directly, not only on the muscular wall of the
rectum, but also on the congeries of iniiBcleH wbiuh take part in the act
of defecation, and thiR leails ine to n[x.«k of laveiiii'nta which play bo grnut
a i«arl in the treatment of twiistipntinn. Permit me to sum up in a few
words the history of this ueeful tlivropoutic agent.

Tho origin of th« clyster lian biHtn c-tirriwl far bock into antiquity, and
. if we may Iwliorti the fable, it is u> the b1ork ur the ibiH that we mn the
A __^^_

■ AuiTs^oA. Nosologic MWt«ik>, t iii. Schcdel, Examen CHtli}»c dc THrdro-
JbMWiie. |k S4.

I

2tia

D»BAaB8 OF TirS STOMACTII.

inruntion of thia therapeutic meuns. 0ns o{ tlMM biida, bo aaya tbo
«toTT, mfforing from oonstipution. vrn« seen to take up ui it« beak a qua
titv i>f truU>r mid ejiurt it in tht> uiiuk, Uiub n>Hoving iteplf of its dJstrees.
in{i[»ocnit4>-K> CeUu^, OoJen, Oribiwus and AKlepbu without heHitatV
adopt this legend m of historicnl mliditr. These ancient phvaicijine we
m:ioh in tbo habit of pn-flcribiug Uvcmcntti. which tUuy ailmiiiutorod b
tiK'niu of a bog's bladdf-r QIWI jrilh n-BU<r and mlspled to a lubu mud
from a twig of «ldor; thw 1ntt«r wait intRKlunud into ths aon.*, and b
prewiires more or less energetic on the bladder, tlw liquid was made Uf
pcnctnitc the iiitvfitint.s this wait the cl^tcT bug so lotig in fiwhion.

Even in onr day, in name partu nf tho world yet little abreast of the p»"g-
ress of civiUzalion, the inliabitantii make uw of mi apparatne »u)l more
primittre, namely, the liorn of a mminant, the little ostromity of which
pierced with a hole: and the liquid to lit- injfctfd is turneil it\U> theoivityof
thu horn ami ma^le to penetrate the ns:tnin by ^ntrity. The nutivcs of Sooth
Afriea use a large hollow gourd for this purpose; the little extremity is
inlroduoed into the ann^, the gourd iti lilk'il with WHtur, and an assistant,
applying hin mouth over the large extrtmitr. forcibly blows the liqnid
into the intestine, ^H

The elvBter bag has nndergone a notable evolution in modem timee; ^^
ulrendy in l4!>r> the$<yniige, which may be called cliusie, wa« iii ii«e. and iha
invention Ih u(u;rilH.-cI tn (iuatinariu, whoHc instnimcnt was, however. Ewon
))t^rFi!cte<l. One of the most im{)Ortiuit mudiHiutiuiis ie that which or^-
Tiitte<l with Do Graff, and in the LranaLution of the Trentiae on C'lyBtern, a
tninalntion whieh is the production, we are told, of one of eur most learned
and brillJnnt eoUeagned, we sec the immenfle importance which De Oraff
attiK'hod to the improvement which be introtluctKl.nnd whif:li eonsisteal in
adapting to the Hyringir, instead of the rigid tnbe in use, a ftexiblo tuba
of (wnftiderflble length. Then it occurred to aomy elever eontriver to give
a right angidar enrve to the extremity of the loii^ delivery canula, so as
to enable the patient to give himfielf the injection.* T-i«tly a mintion and
force-pump wild made; this wm the cli^»ti-pump; and eince then all iIk-w
instmmc-Qts have dimippeared to give place to the irrigator of Egulsier,,
who h»8 iiiventeii]. it must be acknowledged, one of the most handy ap-
pamtndcn for the adminifltnition of Invemcnts.'"

The oommiinicatioii of Ifciii' \\v. (JnilT to Plempius, prof(«aor of tho
Academy of Louvuin, m which ho announces hiii invention of the Ruxible
tube, and the diQlcultiet; wbieli he Mm) overcome in bringing abuut tliis
improvement, Itrnrs date March 11, HiO!).

All |)liT«icians from the most remote agei? Iiave connselled the em-
plo>Tnent of clysters, and ust-cl this remcdiiil agency, In the Middle Age*
the lavement wan in vogue, imd (ruy de DinuliHc never went out without
his clyrter bag under bis arm. But the epoL-b in which the clyster reach«l
ibi maximum of popularity was the reign of f^uift XIV., which may truly_
bo called the ivge of cJystera.

IIVCIKNIC TKEATMKNT OF CONSTIPATION.

2(jr

difficult to imngiiR- tlie 0TU>nt to which thv iiifutiiatton (or Ufe-
tneiits vim rurrini at tliiR ppo^h. To got nn idea of it. you miiA rrnd the
primtc joiirnalH of tli« fiiiiiw, ami yoii will fiiui riwonlwl tht? fiu-.t, wliidi
SL-i-niK to>(luy BO im]irolmble, tliat on the occiuion of n royal rc(X'|)tioii, tliu
I»a»phmcjes can8(>d aii eueina to be adminietered HurrcptitiouBly to herself
by » ebftmlwr-innJd. Morrnvpr thit pliysicinns of tlio prmvl kinp h»vo
cairofiilly rBgistered iiU tht" i-lystcrs givL-n tc their augiiiit client, and the
Qtimbur of them m conitideniblv."

Thero has come dovn to ub, relative to this jimnia for clysters, & rery
curious docamout; it is » Miilt brought a^nsi-n eiinou of Troviv;. l-Van^oie
Bout^geoiB, by a miTw KtiRtinefte Iloyrau, who having' admniistt-prd liyo
rlystcra to thiti canon in th*.- taJiirse of two yeaw. dL-maiulvd of Iut jiatroii
the sum of two sous m\ deniers per laTemont"

Molit^ro hae, moreovtir, given ne a very correct i»i(!turf of tlii« iiifattia-
tion for lavomonts id his immortal comedy the " Malade Imajipniiin' " and
the uc;eount of tht- ajmthenary Flcnraiit i« in perfect oonforraity with what
vc liiiiL in the tn.-iitiiM-s of nit^iioiriu of tlutt ]ieriod."

What does jihysiology tt-uch ub altout tlin iMlmitiiBtrution of elvBtere?
Notwithstanding their aversion te lnvt>meutii, it Ik to English aiithoro tlint
we are ind«l)teil for tht; mniit lomjilete iiiFonnation on tliis snhjWt.
Chriiituion, Anthony TlioniMdu. DcnruiLii. (rraV).-«, ami Mantliull Hull have
given as very interefittng facta in this connection, which show that dur-
ing lifo lavenioiitx eannot go beyond the ilixi-ciecn.1 valvu; the nnme nf
"ai>othecar>"'K harrier " is then applirahje to this tTilTe. m* XternO De Gnuif
long igo maintuinvd. Tlieiw experiments show ux tliat with the onliuiiry
neons of injection, lavetnenta penetrating the rectum liardly reach the
ogmoid flexure of thooolon. and the quantity tliat eaii be thrown up does
not habitnslly esewd from oiip to two pint*."

Rear in mind that I am not fl{)e»1cing of injtTctions forced into the
lai^' tnteitlinu uihUt j;n-i)t |)n»«iirL*. When I come to »iiuak of the truuL-
ment of intcetiiud obatruetion. [ dhall ohow yott that the laTpmeiii may
br appropriate nienuii bo eurriLi) inufli further, and made to {x-nettute a
conxiderable extent of the large int4.-iitine. and ponrihly, lut ('antaiii !)»•
lievue. the HRiall inleetilic.

('antaai, in fw:t, by the motho<l eallod cnteroclimt, WlieTcs that ho
hat mode fatty imbfrtanooe, m oil, pww the iloo-oecal >-alvc. lie pretends
that in three ewws he hiu sv«>ii lavcmeiilfi of oil. introduced by hi>« method,
can«o vomiting of the oily Tnatt«:ir« which were introduced by the anuK.
Boopile the ficiontifie rigor with which his obHprvationx have 1>een bilten,
, J Wlievc nevertheless that thew facts are eTeeptionnl, and that the mlt>
■p'nt'rally holdti gtioil tliat the ileo-ciecal valve couHtitutefi an ini[MU«iblo
Imrricr to liquids introduced by the reetum.

What are the a«lvantagee of simple lavements I' What are the diand-
I? Tlivru luu been much oiid about the abuse tt ulyrtcnt. and

I

2(ift

DIBKASBB OF TJIK STOMACH.

it h»» l)eon aascru-tl tliat LIil-j raiuBR innctiritT nr piritiia of t\w amsculur
ftbros of tho rt-ctum, iui<l Llmt LliL-ir [inilongi^ urn: is luniiriil.

I iim of opinion that these erila have Iwen greatiy eraj^omwd; job
<uin («fiitr Hvniil this muscular vnfovbtmnimt no oftou roferr«d to aa &
ooiiK'^nuitcu of too fmqtient lnvcmeiite br iiiung the irater cnid iiusteail
of w«rm. Colli vrutur. in fact. b_v tht- rcautiou which it (iroducv*, cxcitea
■eoittnction of the rauaeular fibres, breaks up the facal iiiattors, and favor*
tlidir vxpnlaion.

It a then H piiod niHtuis Ui i^omlnt Ronxtipntion, hiit do nut forget this
important {toint. Umt if thi- constiiution huK toug liwtLi), the laTement
alone cannot overconiL> it, for it doea not i)en«trate tliL> rectum; tbo c&nala
intitxlncod by thountw Iodgv« in the fgcoat niutt«r8 wliicb cloHi the oriGee
and thus prevent the water from pumng inbi the intestine. In th««e
CHwa you will hnvc to tavdA ilinrctly by thi; aiil of a spoon handle or the
finger in breaking up the fitcal moDs and rontoving it piecemuftl. Tbea9
are prrMN>4liirc« tn which it in often neoeeairy to renort in old peoplei

Sneh. gi>ntlunieii. are the differunt hypivnic iiu<«ns »t our disposal
the onro of (-onHtipation. In the next chapter I shall take uji tlio Hobject
I of the phurtiuu.'uutiod trvutrnvnt.

^^m ' Ib England in juniwio Btnkta at Lymc-it«gi8 have boon found the

^^B ooprultt^'s of the ichthyoAiini:t: thrae coproUtM pn>«L-nt npirul iioprt.'»>

^^P aoiu which hare eiuibUil iiaturult«u to twtabliab thu lAructure and the

1^^ form of the digwliw tubo of this antodiluTi«n animal.*

I rai

■ t»

!^ thi

*7^he intestinal calriili which have b«en found in animak, clueBy
raminants and soli^Kils. hitvv been called bosoarda.

Bezoarda naed to be consideni] aa poWDinng gnat medioitial virtuca;
twoapwieaof them w-ere di^w-riln-il ; (be ftnit called on>N/dJa csanti- from
the nontach of the }fwil or guzvlk*: thoM called »tridwnlaU were brought
from Amoriea. and w<>n' fotim) in (ho stomarh of Ihunaa. FiniUly, under
the name of (It-nnan lH>*o«inliv worv disijiiiiited thoee that were met with
in the Kloma^-h nf jrwrt* and of cattle.

In aniouklx there is odvn found witbm Lheae oaletUi a central nuoleuv
formed of haira. All ihtiM' bo>hi<^ ha\ o lN.vn aaalyaed and arv couatitutetl
almost exclusively »f L-arl<oiiatt>« an^l phtwpluile^ of linir. Ambei^s i«
an hitfwtinal ixmonnion found in the stiwiarb of the n^wmMccii whale.
In the hom\ theA> ixtncn'tions sometimm attain to a large mxr^ so as to
weieh as much a» H ]>iM)itt)^

Bouley \m» reorntly prnacutrtl to the Academy an inti-^nal calonlns
found iit a hwse. and weighing kMucwhat more Uuw An puonda. Aooord-

KOTES TO LECTUKE XVIII.

•VtMldaftd, Oa the
and oUMrFomattoaa.

Diw w wy of Oo|ii«Il*«B oa FomU Ftaen ia Um Lyme-Rcsda

HYuiRNio trf:atment of constipation.

'2«9

I

Wg to Colin those I'wlculi arc drvalopcd in only oiio rt-pion of thp int**-
tiiiw, nailed diaplingmatin or gaiitro-i] inphragouitic, and niay sojourn in
these pouches without prtxliicinjij litirm.

In man tlic- inteetitial coDcrctiotis Iiavc often for their {wint of dvpor-
turi! n foK-J^i body, such an ii fruit stcwif, u swd or n urail bIouc: they ure
ouii»itilut(Kl Ijy atlcic c:Lrboiuit(.>i« or phoupliiiti-H. or liy futtv ttubauiiu^tu.
Sometimes these foreign iKnliea are of a ifrittT nature called intcirtiniil
gravel, vfhich is (Xinstitutod by silica, itiid ttmroimded by itmuioiiiiioo-
magi)«>«ian ithosph&teK, Tliie intestinal giiivol results froui u dii.'tary al-
Riodt fxoUteivoly I't'gotiil; Hues itnd Mossomlcr found a humiin «tlc'uln«
with u diiimctor ol 10 rcntimotron (about GJ inches). Piniilly in the
humnn inteotinu have been foniiil magnenan calculi; inittanceft hare boen
ohscrvixl by Illondeiiu ami otherK.*

*\ stercoract-oiis matUr from dop« fwl pxclunivcly on tho hon«a of
b]ien>p, aiid ik<iirive><i uf drtuk. A ntiHliciiMit^iit long gone out of iiaO)
thongb sanctionotl by the ancient Codex.

" Wchnarg, who hn-i miulft n piirliciilnr study of tho firres. has .ihovn
tlut in iimn ttii; total cjiiantity uf cwrfUR-nt^ %'oided daily yarien Imtwccn t>7
and 3l>6 gramnicH (2 and lU uuri«'i-H). with at) aveni;;e of 1i!l j^niiiiiiiuH {i-^
Oanow); the solid iiiiitters coutiiuicd in tlii- f-^vw vary bt'twwii l(i and 57
grammea (4 ounce to 2 (^atlcee), with an average of SUgmmmes (1 ouiiw).
Ab for the quantity of alimentary t^ub»tan<;es not (lig«at«<d. the extri'inea
wore 8 grainmoii ( ^ii) u day. and (the minimuni) U.8 ems. (\'2 grains.)

Valentin hax shown tlmt tht< prmpitAte fnrnisho^i by Inimnn bi1« in
deonnipoiution given olT the odor of txcai matlvrs; ul thu isamv time tho
kind of food has an inHuence on thin odor.

Oholoic or tanrocholic neid given rino in dt'compofrition to tanriii and
cholftlic will, which itw^If forms a neutral nibstnuc*'. di/gfi/siiif. which
traH di»-overed by Ilt-rielius, Xun-ttt hue futind in the fu-cul matters of
miui It sneciftl Mibstjinee whiirh be litw dcirribed under the nnnie of e^cre*
tiar. 'I hi» xnbfitanco, which ha^ fur formula: C,,E1„S,0, comes from tlie
dDcoinpcMiliou of taurin.f

'Accohling to Xetter, TrfUwwihMck noted miproargHnwnw in tho
fu-cnl inatton^: h*- nlisiTV«>d tliem under two stntci', cormiw-ii lar and eel-
•liapod, Frerinhs desrnfMvI five forms of fungi fonmi in llic digestive
tnbc: 1, Tho bueenl alga; 2, Tho vejiat fungus; 'A. A fungiut with rav*v-
liura; 4. 'Vho cryptuooa--u« guttulatus (whioli canses pustules); b. 'rite
Miri^iiue.

I N'oUin^^l dfiCtnrilH'fl tlve Bperies: 1, Round arm rod-itha{M>d Imcterin.
"Krerv stool contains miliiou!* of them. Tlu- rods are mort abnndant in
1ic|nid stools, the cocci in thick fieces: the latter may be armn^d in nnek-
laoes, or agglutinated into u g«latinoiu stroma; ■£. bacillna eubtilifi of

'Blomleou. On an lotinlinul Culciibr<, Soc. do Tli^r., 1979. Laboiilb^np, On
Intcsllnul tiravel. Arch. (•£ii. ik> U^d.. 1878. V)U|udiii. On the Form»lion of
B«K»nrtls, Am. d»' CbMn., 1*12, ole., «U:

\ Wflisarg, Mikroflkopische und Cli«fnischc Unt<^r*uchungen der FVcw KMun-
dcrr «rwarhi>«<iHT MenMclim. CHi'mm-ii. \**SA. Vnli^iiin. Lehriiuih A»t Pbynlnlngfie
dw HeiwohM, 1847, t. ■., pL 800. Mare^l. An A<T-()iitil of (ht> Otvnnii- Ctwiiikul
ConAlJtuentB or ImntirdiAtv PriDcii^lcii tit (liv Ext.-re*acnt« vf 3Iaa aod Aaunala.
Fhilo. Tnuutac. 1»4. \). Xik

2iU

DISSASeS OF Tinc STOMACH.

Oohn; 3. The itaccliftromycw, or ynast plant- 4. Cloatridinm, or elliptical
or^riuiisni, rod or lownKe-BlmpeJ, colorol blue by iwliiie, anJ rosembUnff
thr biitvric ferment of PniBnou-slsi; 5. A BnuiIIcr ui^nitan, »l«o ii;auiva
by iodine, and wIikJi is. pc>rhit[)ii, ihe iiiycodttrnm Pa«touri.

ynit<.' rooontiv M. 8tu)i] biw iiiiii'miicod lo tlw Congresa of Oi'rman
|)hy»iciatia tbat lie hoH noted timl cultivatetl 26 upecieB of luotenu nor-
oiaily prt'smtt iii thi> digestive tube.*

'Thcfie lire the difft-runt divisions vihkii havi' bwn propowd for con-
«ti]]atinn: PJorrv ndrniiM thnw kinds, — one. due to ulimentation: Kterro-
rentfri'Hanis ; tlio apcoiid due to a mmhaniL-al obtrtacle to dpfecatioti:
dn>fc«jftoti»; a third, ariainfj from intestinal mralysis, rectomrvia.

Coloiiib tias ulso three ^oiipa: in the nnti arc rniifrcd tliOM cauaes
which htivi:) tlittir point of dt-jmrtiire in tho int««tiriu itwlf: in the ai>poiid,
the alterations of the intestinal wallt; in the third all causes which are
Apart from the intpfltine.

Spring's diviiitoiiK oi const! iiiitinn »rw as follown: 1, Saburral eoustips>
tion, dufl to alimentation; "J. Toxii" ponsti]iiiitioii, cansod br mi-diciiici^ or
poisons; 3. Cholcetiitic fonbtijiiition, due to abscnrc of biliary secretion.
4. (Jawtrio roantipatioii, wliich ac(^«mi>ji.ni<'K affet^tionB of the utoniach: 5.
SpiiBmodit! constipation, obaervud in thf proat neiiposos; ij, Pamlytie
constipation, from puralyHis of tlio intratine or abdominal walls:' 7.
llypcni'mic constipation, from chronic liypcnemia of tiic iiituKtinut; 8,
Hyiiocriiiic coiiBtiimtion, duo to dryness of the intwstine; 9. Cerebral
conatipatioii, ohaerred in affections of the brain; 10, Stenotic conxtipa*
tion, tht! result of mechanical o'bstacle.f

'Voltaire, " Rcvianx, J^s OrcUles dit Oimtf rf? (.liesterficlH et it
chttjielain tioutiman," ('Imp. VII. "ThoBu jtcrwjnK who arc in er>od
crjiidition. • * • whose bowtds arc freed by an oiwy. repular periKtaN
tie movement every moriiiuB an soon as they have brx'sik fasted, * • •
** thoee who are thiia favored by nature, are meek, affable, gracious, kind,
A wo from their mouth comes with more grace tluin a ifes from tliu nioath
of one that is (.'oiwlipatnl."

'Guy dc Chuultuc: '"Ilie enema or clynter dates fmm the nlork, whicli
once on a time having pains tn ite belly, took up sea water io its bill and
squirted it into tho rectum, as Galen relates in the introduction to his
work on Medicine.

According to Mondiere, the Inluiliitanta of the (told IlemonB of
Africa uao for syringe a dried hollow gdiird, havinp the form of A flosk
with lontf curved tube; they intnHlHce the small extremity into the
snuB anil cause the liquid with whicli the gounl \» tilled Ut jienelniU
tho intestine, either by pressure of tiie hand, or by tlK> help uf an assist-
ant, wbo, applying hie'mouth to the loi^ uxtronuty, forces the liquid into
tho roctnm by the blast ut his breath.

' It 18 in Ambroi«e Parf- that we lind the first description of tliia niwli-

•Nell'»n. On Clii*ttii»'«l Poisona which Appear in Orcunic M&t1«^ra in Pnx«u o(
Deeomposilion. Aivliiv. Oen. do M*i3,, Sept. and OeU, 18H4. Li^iiwenhoock, Let-
■Um- to Hook, Leyclvn, ITfT. Frericli^, in Wagnoi's Ilaiidwcrlcrbucb dea Pli.VW-
ologle. Nothiiiu^l. ZeitKclirirt tflr KllnUHw Medizfn, 1891. ill.

jSpinn^, Syi!i|itoiuiiliilojfic, t. I., p, 1T7.

HYGIKNIC TKKATHKXT Of COSSTIPATtON. 271

fication in llw olv-ster syriojfB : these are \m words: " Now there are certain
woiik'H wIio Irom » aotiix of ulianiu and nioiK'sty voulil on no accviiiit fie

IKTsdudeil to receive » clysttT from tbc haittU of a mBii; (or tiiifi reason I
iiivo fleviseil this infttninn-nt liy which th^v can administer to them^lves
a uU'ster, placing tho a])])nnLttiii in fmiit nf them, with the hine a little
eli-vatod, and tUo cnnula in the anus: then titc Hiiuid is pourca into the
liag (which is miuiipuUtt<:ii by lliu hanil].*

** Acoording to Colfon, it is not to Ouatinaria, who (litMi in I-IUC, but
to Aficonna (!IG0) thivt wr owe t\w diBcnvory of tho clastic ij-rinjfi-. of
which the latt^jr has given a oompleto ilwcriptinn in lun worka.

" Here are a few of tliy formula' of lavemonta oriiereil for King Loim
XIV., by tUo [ihjm-iaus in urdimiry, Fagon, Viillot and Aquin:

Calmativk Lavkmkst for the Kiko, A.D. 1652 (Vallot).

Oil of ewvct iUmond« 30 granimes.

Ilonrjr, . .' 45 "

Lenitive elpctnarj', 15 '*

Dissolve in a ilecoctiou of barley, and make a clyster, to be ta-lcen in
the morning.

I'nitiATiVE Latement fou mis Majesty, a.i>. 1653 (Vallot).

Muiiiiu 30 gnunmeA.

Boil eliglitly in a suflletuiit (juautity of decoction u( lurley and linsocd
nieiil. Aild, alter Btruiiiiuj^;

1 [onoy. 4^ graiumos.

Ixtnitiro olccHmry 15 "

Oil of Rwuet uliriuiidfi, 90 *'

Muko H clyHter to bi< tukc-n iii the moniiug.

Laxative LAVKMl■:^T roii Tim Kisu. a.i>. HJ73 (Aquin.)

Manna, 60 grammas.

lenitive elcctnarv, SO **

Konvv, . .' 120 "

Oil of HwcL't iilmuiids, . . . . (iO "

Mix. and ilissulTe in u decoction of barley and lintMx'd mmLf

'* Writ in favor of fitiennette IJoycau. nnrw, against Master Fnm(;oia
Bourgeois, canon of the mighty collcpHte and papal I'hurch of St. Urh«iu
of Troyc§: Seignoor Bonrgooia wna for a long time miffering from a
warm intern penitrnew of tnu viwei-a. and that kind of arnmony of the
blood which oan«'« the red j»irt to HXtmramte. Having ron»ult<il mom-
liem of the faeultv about hin diswaa-, he was ordareil thp frequent usage
of tt kind of Ictiitivu nitn]ication known, commonly under tlio name of
cU'stvr. The Faculty baring 8|)oken, there was nothing to do but And

*H. Oiialiiiariii, De CurU -EfitTstMiUniim Partk-uiariuni, oK,, I.yoiu, I8S3, L'in-
atnuitenl ila Molierc tniil., ilu Ti-»il4 dc (*ly%tcnl>un, par Kvgnlrr ilo Gnuif, rariii,
1879. Coluo. De la Methwk InUittinale. Tli. dc Purin. iwn. R. do Graaf,
TnwIb^onClystere. L»!U>-"'. IWN. A. Vnr*. Work*, I. iii.. p. 557.

t Journal de lit Rante t\e Loiii* XIV.. 1W7 to 1711. hv ViUrtU (TAquln and
Fn^n, PhysidanA in Onlintu-y. wiU) Intrudivltou. Notes aad Critical R(>a«vtiuoa
V J. A. LeKol

I

272

DIBKASXS OP THK BTOkCAOII.

some one prorided with the neeewiry ability to carry out the onion-
nance. Thif party might imv*- applicll to Scijrueiir Oontil, the rt'tfran
ttiHitbi-can' of lite" citj^ t>iit tlie afoTVHud QentU vaa doing a lucratiTo
btivinoKx ill hh shop, which h<s coiild not leave to mccommcxinto Sei^rnfur
B— — . Etifrnnctto enjoyed thou a moot bTilliant reputirtion; nhe hit<t
tht- honor of ecrving persons uf quality in tiie city, who pmiMtd irqiiallr
lior kchI and Irt dexterity. Morwivpr. although «he was not rich, yut br
H nirp sptmies of s«lf-dciiiaJ she demimdud only - boob 6 deniera lor t'ac'ii
service |HTforniwl.

Seigiicttr KmirgcuiH xiipliud to thiti lady; ho pmyed hor to come and
sou liim; he LUiilIuiid to Iter litii nmliuly. Ihu advice of llu- phyfticutnR )in<[
the serricfii of wliirh lie liud m-od. KticnnL>tt*> having given him a Biunpli?
of hrr skill, he ovrrwhelraed her with pniiaCH, and ucaou^ht her to toko
cliaT^o of ht» naM>.

Twu eutii'vycum piissed in this way, that \e to eny. Seigneur Bourgeois
ulwuyii tt little bmt«;d in hxs bowt-ls, and alwftytt bcoomirig refreshed:
Ktieiinctto always obliging and always rixidy to refresh him; and tlias she
kfipt on, onco a day. and HOmetinuu; six timt:v«.

At the nune time she h«d nmsd of money, and Seigneur Bourgeois wan
not willing to Jiemdo to her demands. Three hundred times, in momenta
the mo^ in tir fitting, and in a |>oxtiiro th<^^ mo«<t suppliant, sho liceought
him to huve regard to tier iievessitii'^ am! he hitii no pity upon her.

Finally after all iH-rsuaaion hwl provetl umivniliiig, ahtf brought a 8uit
against hiin and the writ waa isHued on the 5th of Mav 177li.

"She asks for tlio modest sum of l.'tO pounds Wtfi for having put in
place 130(1 tavcnK-nt^, and for having funiixlied the syringe and contenlK"

After having eliown by tlio lughest authorities what a mon^trons wrong
it is to defraud the hireling of hiu or her wage*", thy advocnlo continuo*:

" If ordinary fiervint's (Might to be followed by ii prompt recompense,
how nnieh more prnmptly should be tlie reeommnwe of WM^ret Bpn'iew,
of those w.^n-ices w-hioli nre repugnant to people m general, those serviow
in £aet whiL-h nro not rL-mlorotl fiw.o to face?

" Wlmt will 8eigm-ur llourgeoiM say in defenso of himuolf ? Will b»
deny the servicos of EtiennPtte ? All his neighbors and frionda are ready
to lestify to their prrfnrmanee. Will he nay that Rtiennette aeqnitrrd
lierwif malB<lroitIy of her duty 1' The voire of all deeent ]»eople will tie
raised against him.

" Will hu preaumt! to my that the sum of l.'JOnonndH i« exorbitant; tlrnt
lavenien U, us well us other things, ought to be less dear in grotM timn in
detail, and that he who takes tliem evei-v day, and oftener six than one.
ought to have them at a choaper rate tLan it person who only asua one
occaaionnllyP It i* loisy to show the fulbury of tliis view of the caw.

" Etiennette ha* served -Seigneur Uourgtwifl for two couaocntiw yeare;
the futt is undeniable: each year is numiKwwil of 3G.^ dnvs, making T.t()
days fur two yearK; now jMnnsigneur was in the liahit of taking one inj<T-
tion a day. and often Kix: henne if we make an averagR valuation nf thrm
laveiiiciitt^ u day (which t» nut exceBEive), we »hall have a tot^U sum of
2,100 lavements for I'-iO duys. which at '- sous 6 deniers a piece, which is
the liuiTi'iil priee. will give a total of '^73 pounds Ki sous,

"fctiennettedoesnut. however, ask fortius sum; she id willing bo redtioo
the 2,11)0 lavements to l.'^uu, and instead of 2*!:) iK>nnds 1.^ bous, which
alie might justly have asketl, she nHlueen her demand to IfiO ponndB.
How then <loe» .SeiKueur Bourgeois darv to complain, and c-an Rtiennette
carrv her disintorestidnes.^ and modenitiou farther?

IIVOIENIO TRKATMKNT OF CONSTIPATION.

27S

" The proper int«rc«t of Seigncar Bnnrgeois ought to cngago him to
do juHlice to P.tieimutte, for he is not yet perfectly well of his diacosr, and
if lie dwB not Bitisfy l5tieiinctte, who honcoforth will be willing to vender
liim sorvicoa which he is known ro (jiuilr to rocoinpense? Who will
reader Ihcm with ua much zi-iil itntl (lL-\ti;nl_v?

" I>>t him rGjK'iil tif hia wrong, ami Eli«iini'tt« will forgtt the past
One is ittbu-liod to people by Iwito-tits; who is attocheil to himljy the bvi\^
titrt she hart n'liderwi him. Let him do jiiBtice iiuil ho will see her return
to his liediiide with more »*al than ever."

This writ was compottrd hy the odvocAte Groalcy, lu n p^rt of that
tnomoniblv suiL

" This tH the pswage in thn immortnl coniody of HoHt-re relatirn In lare*
menta. "Next, a small oJyetur, insiniiiitivo. iiro[wn»tive. vmollieiit. lo
soothe, moiatcn, and rffrran the enimilK uf Moitsii'iir — Next, a giiud
detersive clyster, eom]>oi«>d of double fjithnlifioii, rliulKirh, honoy of Piwi-^,
»nd other thin^, acoording to th*- onlonnanoe, to ele«r, wfish. unA clcun^o
tlw entrails of Monsieur-— 30 auus — Next, u utrmiuatire clyster to cxpcd
tlie flatQB of MoiiBiear — 30 uoua."

" Some anthoritipH have, hownror, maintninrd that lavpmr-nfc* and even
RuppoeitorieR may bp rpiidt^rw! by month. Korkrinf^iiis fkim* that the
valTo nittv be clnirt'd; kegiiier d« (iruikf iissprtrf that thin fannot be. and ,
he citt-s the obsuniLtionj! of Galen, Suimert, I'urc, liartholjii, aud Colsoii,
in Bupport of this beliuf.

ifull Iiaij imuie a >ferieii of experiments to ascertain what quantity of
liqnid the Urge intestine may hold, »ud to whAt height injections may be
made to aocend. In the cadaver he hiut been able lo throw iip from 4 to 8
pini« of liquid and flit the entire cavitv of the t&rge intestine, and even
get past the ik'o-ejeeA) valve. Un the living subject he has thrown n[> 5
pint« of ati oily IJt^uid, and percussion liiu= eiuibled him to rocogiiiKc the
j>re»eiice of tlie liquid in the entire extent of the inlejitine.

In another experiment nuule on a younjj man who wan n]a<^ hoH*
2ontally on the left side, he guccccdetl iii (retting -S pints to bo retained;
then not inii.'oeediiit; in throwing tlie iiijectiuti iiiiy futtier. he found that
the liquid had penetmteil to tlie junction of the tmiiiiTenae ami ascending
ooloo. The Kubjec-t was Iheu pluceil on the right side, and it was found
by percussion that the liiiiiid fmd {nisscd into thr it;4ueiiding colon, and
liie WM then able to iiiject three pint« mure o£ liquiU.

This bool is the proprriy oj

COOPER ilEDIC.VL COUEGJi.

S*N FaANCISCO, CAL
flflrf M nut to ihf r^mnr*-d fnmt the
labni, .t i: ,t.;.i i,<f ouif prrnon or
under ui.y ^I'tivxi tvfmtt^vcr.

LECTURE XIX.

ox SALINE PTKOATIVKS.

SmntARV. — Pnrgative* — Clnwifiaition of l^l^glltiT«^ — By their 'Effect —
By their I'hysiologicyil Aftion — I'Jij-sioiogiail KxiM-TinivtiU w Uh I'urgu-
tivua — ProcvstM*^ uf Kxpuri mentation — fi«e«arc]iea OQ SaUoe Piu^ga-
tivee— Esperimofits ol Colin, Morcaa, and Vnlpiati — Inttfrjirolation
of tliB Fiiuis — AeliiHi on the Muscular Ctiat^-I'livBioIogica! I(i\ii»iim
of Pargatives — Sniine Purgatireii — Diffeivnt Toxic Actions of the
Riiltti of RoJtt. Miigitosia mtxd PoiukU — Hiilts of Socia — SulpliiUo of
Sod»— Salts of Ma^fida— Salplmte and Citrate of Magneeia — S*hs
of Putafua — Fu rgutivu Wut«rs — Sodic Chlorido Waton, and Magneoaa
Sulphate ■MTftterR.

In' tlie pn>vioii» chapter I have ahovn the hygienic means at tbo
dispoMil of th>' physiciftn to combat constipiUion; 1 rihall now pan in
ruviow tho pliormaceutica) tif^cnts in uae for tlie s&ni« objoot.

Tho»i«) mt.-jui8 urn di'HvMl from an oidor of invdiouuvnts which form a
iuiliirn.1 groiiji in thorapi'uticti — \ir,., purgatives. And sincf tliis intorfid-
ing quoHtioii of ptirgstivce is now iH'fore its, allow me to tn»t it somcvhat
at length, and toll you 07i whnt tjatios we i^hould found the tstady and
cla«!iru3ition of those prwiouH medii'inal itgeiiUi.

I'urgativu!^ liiive nlwayr' littd uu imjiortiint offiL-e in therapeuticg, and
anthoriticn, in onJer to study thcin more completely, have cudwivortil to
group aii'l claesifj thom iiflt-r a methodica) niuimer. There are two
grtmt liaiM's to t\wso cIiiKHirieations: the one. iilrendy nnciont, Jb oetnblishod
ou the ditTervHt piirgalivu eSvctn oblaiju'd by Lhese medicaments; the
oUier, more modern and more nclentillc, takea for its jiointof deptirtnrc
tho physiological action of tUe«e sub^tanccB. Alibert, ITnrtmann, Tomusi.
Tronaaeau nnd Pidour, Bonehnrdnt ami otIn>r luithoritioa hare chwsed
purgutivM aoiwnling to their effects afttir a munner almnst identical, imd
yon will find u cluir unrl methoi^lical resuuii- of tlietso clui<eii!catioius jn the
tiiistaa of Keqnin pub1ii<]ied in ISli'i. '

I*urgBfiveH, necordiiig to llic*?c authorities, lu* divided into thrco
classed. In the lirtit ure reukonetl Uxotiveii. tlint in to fax, the mild
purgatiTex, (.-ultud ali-o l^uitiveii; this class iiicludea munna, ea^sia pulp,
tuiuirinds, and pnmcK. The i^ccond claes compriscx the mild cathartics,
represented by rakincd magnesia; the moderate rallmrtics, of which
rhnbarb and itonna are gooJ cxniiipk-.*; iinallv the quiiBi-dnistic cathorticts

ON &ALI.VI-: Pl'KaATIVBJ.

275

nicli tw jtdHp uid «<9iniinony. In & Ini^t tlivi«ioa aro miiged the irritnnt
purgattres, the dnutics propcrlv so ciOled, such iw oolocynth uiid crotoii
oil.

The other buflis of close ifii'utioii ia eetabiiiihiMl ufKiu the phjeiulo^t^l
action of ihem pui^tivcB, whi'^]i I must first explain to you, rcmindiDg
TOM of tlift rxjterimcntH wliieh Imvo oii»l>tf<i »« to mitko tliia etiidy — experi-
im-iitul rt-wjirc-hea which have Ix-eiviwrfonitPil in rniiim by Colin (1^4),
by Morwiu (1S68-1870), imd ljy Prof. Vulpwn, in Kiiglaml by lAitiler
Bmnton (IS7J), in Germany by Thiry (ISOJ), by Katlzeijowgki, unil by
Brigier (lS7t<). But bufon- tootling fortli tbt- rt«ult* to which thta^mnxp^'h-
mrnt#T8 have arrivtwi, I must describe the prooesaea oniployml.

TliHW pro<fssf* an- of two kiniLH: thiit of Tiiiry, cailcrl Thiry'n fletula.
and tliat of Colin. Thirj's prodihii-e is very coinplicutcd; it conBistH in
se|arating by two perptimUcnlar sootions n |>orti<m of tho intestine, whily
leaving it ndhtTont to thu mL<6uutt?ry, thuii in elosiiig one* of the exLremi-
t\v9 of this i.<iolatc(l Inoji, and in a]»plying t)ic other to an opening made
in the aKIomiual wnll. Ymi hiivc thuB a blind pfiiich or r,triim opening
extemnlly, ami obtitiiiing the ainic %'itai nippir as the rest of the intestine,
by r«i»ou of the purlion of iht? meeentery to wliich it is Httat-hod; thun
the two cut endu of the iutestintt are cai-efully stitched together, «o as to
cuuiitaiii thi! continuity of tht? tiilie. In intnKlutriiig into thin rut de mc
irritant medicameuls, or iu uduiiui!tU.Tiiig thu same by the stonuch, joa
olMM>rvo wliat takoB plaee in the portion of inti>»tine under experimonL

Colin'i) method in much simpler and greatly to be preferred: it ii* tliat
which is employed by V'ulpian, Morenn. lAndcr Ilnuiton and Ilreigav
It con^iete in pliicing on & loop of iiitestinu two spring force]N<, whieh pre-
vent this portion from (■ommimicating with the r^t of the digentive talie;
care ift taken before applying thu foreupe to pri>)«s out all Che eontenUi of
the portion isolntwl. Into this intestinal loop a purgative lif^nid U now
iujccteil, and the whole i« retunnd to the abdomen; the aiiinud in Hhorily
afterwanl killcl, and an cxaminutiou mmle of what bus taken place in the
loop under experimentation.

Do not forgot also tliat iu order to judge of the intestinal morementtj
and their intensity, yon run make nsie of the graphii: method (which luw
gireQ BO gtent preeision to our cxiierimcntatious) by introducing into tho
intestine, aa Xjegros and OnimuR hare done, a rubber bag QUed with air,
commn ideating with the registering ap^mrattlB of Marey.

It in by thew^ procedures that the action of certain saline and dniatic
pUTgatiTGC, a« n-elt ae tliat of certain of the solaiiacoas has beeu studied;
the reseamhea an the aalino purgatives hav« been mnch the most numor*
OI18. and tbiH ia what luui been obiu-rTed. If, after Ihe example of Moreau,
you inject from twenty to twenty-five cubic centimetres of a 20 per cenL
Mlnlioit of sulphate of luagneeia into a loop of int<wtinu separated by
CoUn'a procoa*, you will obsorrA that, at Iho end of from C to 54 lioura^

276

DISEASKS OF THK STOMACH.

al- it"

UuB loop will oontaJD (ucconling to tlii.' tiniL' tbut luu clnpaed),

Ui 33G cubic oeiitimotrva of » liquid oontuiaing mucus, leutxicytee, uul

iiitvstinnl jnii'e.'

Tliitt i^xjR'rimvnt you will find nlwavB to mirroed, nnd thigjirst taat of
an angmentRiI secretion ot liquid under tlio influvnce oF nJiiie purgativM
compels as to rejt^t thu I'^xcluaivu rivvr of Tliiry and Iladzivjvwski, w
think that the aotion of purgatives ie,cxplained solely by the exujr^eratu
of thi> iritf-'stiuul iiiovL'iiK-'iite. This iitereaso of inte«tinHl movrmonts dooc
not vxiBt, Bn iASf^ronand Onitnnii huTe shown in their experimentA, vlivn
Hilinc purgatives iirc lulmiiUKtun-d. uiid wc arc oblifi-d to tittributc tlio
purgutivv eSvct to the grout ttbundaucc; of liquid w:i;reUHi by tJie intvctiuid
mucosa.

But whiit 18 the mcelinniftni of this eocrotion ? There vag at first t<
an rxpljmation whirh w-Knu-d to Ije the most imtural and ph VBi«l(igi<'al ; it
vra» luiii utaiucd thut tht^rv takvn placu bi-twueii Lht- wiiine ^ubnluuce intro-
duced into tb« loop of intestine, and the intestinal glands aud nuin«n>as
blood- vl'BhoIw diiclribi)t«'d to this jiorlioti of thw (iigogtivp tubi', a (loublo
axniotir exchiLiij^. TIiIh vit^w wtut the more probable Innn tlie fact thattho
very exaot expcrimouUi of liabutvuu, of Jolyct, of Fruoiy ftid Vulpitui, bad
shown this imjtorULnL prindple.tbat whtri you iujocrta pur^tiwHulutionin
tiie vcinB of u dog, instead of thin hnvingn purgative effect in the intestine,
aoC.'laudv BtTiiBrd maintained, eoritstiiiatjon, on the L'ontnry, reeulta. jU
jou we. the explanation was, wj to Hpeak, complete, and phyeio]o)*i«t« aaiil:
" Whrn you intrixUiKu <;ci-tuiti siltti into the inteetine, yon dcUmnine the
osmotic jwuseage into the iuleistiue of tUu w.Tum of ihu blood- veewls,
whence rewults the pnrgutive ellec-l; white on the other Imnd, when yon
inject the tiohition inin the foiiiii., thu ottmot^is takiw pkee in the coutrarr
direction, whence rcsnlts diminution of tlie «*cretion and constiiBition."*

Permit me to vtop u momt:iit at this point of the action of purgative
fmbntitncefiintroduoeil hyiheTeinR or by tlioekin. They give in hirge doses
nepntiVB reynlt*. but Ibis is siid not to bo the euBc- with small dows. Ac-
cording to Vii1pi:tLn, in the dog little doM's of sulphate of magnesia injectod
under the skiu produce diarrhti-ic etoola. Luton has already timiiitaine*!
the purgative effect in man of euboutanconB injertionB of enlplmto of
maguoeiiu' Despite the concordance of those rc^Archcs, I avow that I

"Tj-ynwaiid Oniimw. ExpMitnpntal Research e« oh the Movements nf Uie In-
t*«line. Jiiiirtml of Koliin. 11309, |>. Is7. Kjibutcwi, Soc. dc Biol.. ISflfl. Julj-vt
Hill] Freni,v, ,\nh. ik- Pliyt*. ilc Rrowji S^iiard. 11*60. Clamle Bi-nmiil. LfwunMon
Tusicanci Medicinal Substances. lS."i". Colin, Pliyxiolngrie Conipar.!-*, I, i,, p.646t
18.'5I. Morwiu, M«?m«iii!» ilc Vhysicjlotiii-, 1847-lHW, p. 120. Viilpimi, App^refl
Viiso-Motour, t. f., p. 483. Bninloo. On tin- Artion of Puivatlve MeilkiDott. f nbv
Iltjooer. 1H74. Tliiry. Uf'ber eiiie nniwi Methode dep Diinmliirm zu i«oltr«n, Feb.
2^, 1W4. Ra()siejewi»ki, Zur PIi.vsiu[oj;iiKli«ai Wirkung'der AbftUirmittd, IG
BriPKer. Ziir PliysioluglsfliL'ii, i-(c. . 1878.

ox SALLNK rURUATIVHS.

277

I

ive often employed th««e means aii<l li:ivo never obtaiiiticl cerUiin nvulu.
anil 1 bcHpvfi llmt till nome iiqw tlisrovcry w mwlf, wr citiiiiot be aawl to
pOsetNH tt siugle tb«rB)>eutic ^^-iit wliich, iutxatiuwd under the skin,
atn uomUtt couHttpatioii und protluce pnrpition.

Itiit lot lie rctiini to tijc ijUcsLioii of tlie osiDOtio exclutnge of salinv
oolations inlrodiiccHl into the intei>tin<*. Alrwuly Vulpiaii, wliilo alioiriiig
that tbu units of mii^ii'sui uru iilKorlnnl anil piiKS out in thn urine. )iii;l
insiHtiNl on the state of tltu mncous membraiio ua being always one of
oougmtion. and h»il iirgi^ lliut tho i>xamiimtLun of llm liqiiid SL>(<rutL>i)
Mhovrit tliat saline purgative!^ act jinn('ip:Uly in dctvniiiiilng a tumponiry
ciitarrli of tlio iiit(.-»tinal mncoiu. Tbc recent experiments of Morenu'
have ebon'n tlmt Uie Oimotic action is but trun8it:ni. uiul ^-lui only t-xiiit ut
th(* oiui't af tLv actioii of aatine eubHtaiKL'u. We huvu thon to lulinit thiit
mline pargntiTes determine a veritable )iitostii»L catarrli. and it la thus
that we arc to RXplnin tlieir action, tbe intimate mechaninin of which
Valpian ban «u wdl iltwvrilmd. *

With aaline sohitiona we have seen that the mucous mombrano alon«
is aftocted, vhUf thi* mii»;ciiliir coiit presents uo mutlUiuationa in iU tunv-
tiona. tt is nitt so wlien the dniKtri^ purgntivea ure given, Thcw; purga-
tivctt, whose lucnl action is much more intenito. and whiHi produce a reri-
table inUummatioii of the inteatinal inucuea, detcrmiHo also, as Vulpian
baa abowii, exuggeruli^ (.routnu^tioiis of the miieoulur ctmt, und thus aug-
ment the iiioTemeiits of the inteatino.

Lastly, ixTtain modiciunvnts rightly ninged in the group of jnirgativcs
limit tlieir action to Uiia coat alone, and without B|>e»king of the »trycfa-
niasand other tetinizin^ inm1i(».munt)), ))vrmit me to point out ootno vrary
interesting factti about the action of the »Qlani.

Oulmcnt and lAuretit have alrawn tlmt hyoseyamln and ihiturine in
email dost-x enorgizu the conLnu'tionn of thi- int^'HtiucH; Lcgron and Oni-
mus liare obtainetl the Etame effects with iitrupine, which acts directly on
Qm ptrcat aympathetic. and augments the intestinal coutrautility, which
oaablea n» to esplain clearty the pargatire action of the memberv of the
aoUuium family.*

Such, gentlemen, arc the physiological experiments aixroitling lo which
we are enabled to estnblinh a oc-ieutiflc ehwsificatiou of tlie different pufga-
tives,' and thin ia the tdtuaillontion which I propoKe:

In a flrst group I i>haJl examine purgativtw, which tu-l by angmenting
itputinal wcretion without increasing the peristaltic m<>vcnit>nta
the second group (intcpniodiuto grouji) 1 nhail pluoe purgative i>ub-
■tanoM, which both augment the intcatinul Berrrtion ami the jwristaltic
moreounts. Uerv bv shall tiava two subdiTiajons to consider, the one acting

''Oulmant and Laun'nU A Study of Hyoscryiuiiin auj pHturino, Arch, da
Pl»y«., i>m. LtOKM and Oaimw. Jour. d'Aaatoiule tA dv Pliys., de Ch. Rabin,

i9m.

jUteiiit

S78

DISEABEa OF TUK STOMACn.

especially on the intwtinal Bccretion proi>er, vie., th<> dnwtics, the other
liarjng a epooial action on tlio liver, vik. , the chologognfis.

The thini group is conRtituUul by in wl icemen U, whioh produce a piirga-
tivu effect bv ac-tiiig cxclusivuly uii tbu muscular coat: Hwj maj bo called '
maBCiilar purj^tivue, anil include atropine nnt! Btrj-chniA.

There is, finally, a Inst prouji, in whioh entor Riihslanpee whiuh act by
n mochanieal effort; tlip.'to nre tncchnnicul purgutivos.

I shall begin with the Mrst group, i.e,, purgutivwi which augment th«
intcstiiml accretion without increasing the peristaltic cxtntracttonB. Tfaoro
are in this group thre« orders of pur^tiree: 1, the ailine purgatives; 3,
the Bacalmrine purgntivog; 3, tho vegetal, non-dnistic purgatirea.

Th« aalino purgatives have (kkU, maguL-iua, or potaeh. for their hmt.
Befon- gluncinj; at tho variolic nn-nibrraof tliis group, permit me to ro-
nuu'k that from the point of view of dt'let«riou«ic»* of action, there iit a
great diffcronoc botween tlie ealtj* of those three nietale, b» the experiments
of (irandeaii, Joivet, Cahours, Habuteati and Moreau go to hIiow. Tlie
KnItM of Buda hitroiluccd into tbe blood aix- not toxic. One ma; inject as
much lie five drachiiut of sulphate of soda into tho veins of a dog withoat
producing any toxic rc«ultj!, while one tenth to one third that ((uantity of
HulpliHtn of magiiefiit nr of Riilpliate of p()lafih uiuses fatal efleet* in the
auiniai; ami if we wi;re to cluait these uiltfi in tUe order of their toxicitv,
vti ahonld assign the first )>laoo to the salts of potush, thv aoxt to tho Balte
of nmguesia, and the laut to the salts of »<x\a.

The Balls «f sodium furnish n great number of purgntivwi; we have
the RKlphute, tartrate, citrate, and phobphatu, which mny be utilized. Rut
that which i» the most employed and the Un^t is tbe milphatn of soda, called
Glnttber'a «aU. It is an excellent purgative, which in the dose of half
an ounce to two ounces gives imurellouB resulta vithout jirovokiug too
intense coHc'

Oft«n when makiTig onr morning visita you have heard me order s
purgative draught wliich I call tbe fiurgalive water o/St. AntoiHe Nofpital,
and wliioh lias the follnwing cemjioKition:

Take of:

Hulplutt*! of wAa, . . \

Rochclle salts, . . ■ f ■ • •of each 3 v.

Cream of tartar, . , . )

M. Tliasulvt' iti H i]uart of water. Tlosie — oue or two tumhierfula every
morning. This in n cheap and useful laxative which you may often hare
occoeiou topresprilie.

Poton and tJuichon have vanntod tlie citrate of »oda,' but this
salt is little given on account of ita slowness of action. Didiuui of
Savignac has adviiied tbe tartrate of soda, but thiii salt has itlso gone
out of vogite," Tlie name may be said of phosphate of soda, which
used to he given in doKB uf one or two uuncee, and is u mild oud excellent

ON SALixB PiraoATrvHa.

271)

luxativc" The siilplioriimtc of Huda, intrwluci^ into tlieniiwuttcs in 1870
W ltabut«oa, ia now itl>ancl4iicd on uccoiint of itit iiiertAbiliCy. This (ult
undergoes tm]i8forma.lioii into tho bisulpliate, a Uig3dy ncid and irritant
mXu

Chloride of sodiam " ought to hv ranged in tliift group, for xolntionft of
^fiOQtmou «alt, awl i-vi-n sea vt'-Ator arc- recoiiijuvudcd ua purgatives. Ilayvr
eren weiil farthor, and Iwliyved that Hea water, beaidoB ita purgative action,
vas curatJTe in cancer, and to render thi« water more impportable, hii
proixjBcd to c;Iu)rgv it with rartxinir arid. Ijcljert hiu also rcc<imin«ndwl
mm water reudi'rctl |>iu<vous 1)^' charging it with uarbouiu ac-id,as u laxative.
Uowerer this may be, in ottr neajKtrts it b quite common to see the suiloDi
retwrt to sea water for a prompt luirgativu effeet.

Magnesia," hke soda, fiirnishps to theraiwiiticg nuraerouB purgiitirea
First of all, vc have the railcimid magnma, wliirh Fomawgrivce hu« no
tliorouglily titudiod, and which, from n pluiritiHcvutical point of view,
prL>8(<ntH itself under two Btates: either its a light powder deprivwl oi water
and called French niagnetciH, or an a ht-arier gahstnnce which goes bj the
name of Henry'it or Howard'o magneaia.

3Iaguesiu is an excclk-nt purgativi.-, <;«pecially for young children, and
may be given in the dose of one or two teaspoonfaln; it may be also lul-
ouniKtvreil to adultii, hut itx effect soon weurs out, and you »ometin)uH sea
'tis free uiw us a purgative followed by a more or less obfltiuate conirtipa-
tion, and oven in ecitain nwea the ahii»e of tliiH mngneaia muy niiiae
'fntP*tinat calcnii. In pharmacy there an* two popular preparations of
magnetaa, Miulhe's magneBia and the milk of magnma."

By the side of these prv|»Lrationsyoii will plaee the carbonate, or better
still the fiubnirhonate of niitgiH-sin deBcribed under tho name of white
OMffkOM', it ii», ItowcrcT, little u^-d us a purgative, but ia often rvnort^d
to to eomtiat acidity of the stomaeh."

Magucssia (umi«he8 the Kilt* which is most employed as a purgatifB; I
refer to the i(ulphat4; of nmgivesia, known att KpHom salt». It is with this
Mill diwolveil in water and cliurged with itixbonic acid that the artificial
Seidlitx water is made, whieh eontains Mi grammes (one oimoe) of sulphate
of magneBia Ui 050 granimeB (or about uii imperial jiiiit) of water. The
quantity of lalt in this preparation can l)C angmented at pleasure; tlio
LdoM must, however, Ihi made to eurrue^Kind with eueh increosa'*

Sulphoto of magnoeia was long the mlt most in uec, but in 1817 citnto
of iiuigneaia '* wan intruductnl into pharmacy by Roge of Aituil', who has
Iberely acquired quiu* ft renown, and since then tU« citrate, being
pleaaanter^ baa tended to Biipentede the sulphate.

Tbofe are Mvrml prciMnttinns of this salt, wliich ia employed in the
doae as tiilptiatc of nwgnetiia, and serrea as the baaia of a very
plmsant putgattve lemonadv. This mlt, when it is jHwrly prt>[Hin<d, ia
VW in iuactioii. wj itmt ofU^n thopatletiU iiutobtuitung thedexirtHl elfeet.

cuts shortlr ufu>r taking tii« jmrge, uu] kuITmv in cotueijtKtnno it reritable
hypcrpTirgatioQ. It han heen proptiMd to ftulMtituts the tartmtn for tlin
uitr&tt!. und CbcriUiur han Iiighlv vuuntiMl tliu lulmiitagea ot Uu8 salt* but
it hiiK not comn into general iifte."

Dorrault hiu: tuulerbikeii sume intctvKting «xp<n*iin«ni8 doroonvtimting
the different purgative remlu <^tiuii«d. compiirHtivulr with thv aaltR of
niafifneAia. and han shown that, »ll tliinga Iteiiig I'^jiia), it is the cuLphatc
of mag;n<'ma which proiincuB tho nion iiitcnBo purgative Action.'*

Kiniilly, arconlin^ to the RXjwrimeiitH of ljilmril(!, thn chloride of
nii^rneaiuni, like the chloride of Kuiliitin, ought to lie L-twmed among Uio
inirpktiveit, with this dUTiTence, howvTer, that tho chlomlu ot magnriuum
hitfl u msrlind action in ext^iting and otwrgirang intestinal coiitnictioiiA,
luid thia givfn it n plaoo hy itwlf in th« group of saline pnrgmtiTiM.

The »alta of pnUiMUiim are very toxic aa I toM tou, which eTplnins tho
fiiL'L tluLt thev are kj little used lu purgativuM. Tho eulpbate of potash or
naf-th-duobir^, vnm former! j prcscril)ed in the dose of oti« to twodruubma,"
the tartr»to ia tbo doife of five drachmii; but they lutve been abandoned,
and the oidyaalt (with the otwption perhajw of the lii (art rate)' ° which luw
kept its pUce, and deserves to remain in general uaa, it a doubUt Hilt of
potckBBa and soda, which goes hy the luunu of Hochelle Hult. which wns very
nincfa vaunted by Tronaaeau, and iaan agruetible and exeellviil pur^tivu
in the ilono of from hnlf an onnco to an oanoe-*'

The Kn^lish, who, hr yon know, arn not mueh in favor of clysters, have
(M-Tfetrtc'd the iiHSge i>f siliiie ]uirgiitivfK, inid we owe to them the popuhir
purgative prciMimtion known us the SeidHtz jMu-derg, with whooo oom-
poiiition and mode of administration yon aro well a<;<iuainteiU

Such, gentlemen, aro the wiiine piirgiitiveji in eonimon ntmge, purga-
Uvea of a high utility, and on whieh you will h;ivo eontinuuHy to tpIj to
coiiiljtit i;unsti|uitioii, and obtain derivative cfleeta hy the digonti^'e tube.
In the courM! of these lectures I slmU lmvv~to return to these aalt«, whidi
liiive the ndvant^ig(.> of Iwiug well toleniUMl by the utmnueh und of deter-
mining u diarrhwio flux without too mueh irritntiou of tho iutesttnal
mueoKH, and the prodnrtion of too iwTere griping pains.

Of all the sttlta wliirh I have en unierateil, tho most employed are the
sulphate of eedu, the uul{)hate and the citrate of magti'esia, and the double
tartrate of jjoIjihhu and smbi. But the«e pharruaceutiaLl preparatiouB hare
been of late yean* fnnu-what left in the slia^le by their formidable nTalH,
tho purgative minend waten*^ natural waU-rs which offer nil the advan*
tagua which the fori'goiiig purgatives prei^-iit, and which nmy be given in
nirnimum doae. and at a relatively low coat, by reason of the ready railroad
eomniuuit'jitiong to all ])art8 of Enro|R',

I must give ynn a curaory view of thette pnrgative waters, and if, eon*
trurr to my ukuuI liuhlt, I luive not apjwnded this duecription to the end
of the dukptcr on hygiene, it is because I thought it more ratioitul to tuko

ON SALINK mtCATIVKS.

•2HI

up the connderation of these waton ftfttr th« «xammation of tlio action
of Miliiict purgatlTcti, from which tbuy kiorraw thnir tnodiriruil olomentA.**

Tlio purgative wal*niiirBarniiig<Hl iii tlirvu principal groupe: 1, walvra
vliich borrow their active principle from the chlorides; 'i, thoee wliioh
owu th«ir properties to salphato of soda — thone arc tho eodio snlphato
vateni; 3, tbOM whoso active ingrtxlient ih t(iilphat« of miigiin^ia, th«
mognostan salphate watem. If I wen? aillod n[M]n to clufia thvse
waters acoMxUng to their purgative activity, Uic first placw would belong
to th« ma^eMiin t<iili)hate waters, tho aeoond to the sodio Rulpbato, and
the tliird to the chlorido waters.

I will begin with the latter. Thn mmHc chlondn wntorB aro qatte
Tiumpmiia in Pranoe; moli aru the watent of Balaruc. Bourljou-Laiicy,
BmirlKintiv kre Bains, Salies-de-Bearn, 8aliii8 (Juni), Llniirlioii'rArchain-
hault, SalinailoutiereandNiedorbroutiin Alaaco. Ail thew mirn,Tal waC*r*,
cold or WAmi, contain from two to tliroft up to twenty gramm^^a per litre
uf chloride of sodium.

The sodic chloriilL- wut«;n< of (JiTiiianj', if not more nctire, arc at least
bctU-r knowu, such are KrtMiBnjM-h, Niiiiheim, Kiaftingeii, Wioabadoii.

The sodic eulphato wator* nrc low* nnmorous in Franco. I will oite hut
two: Miera, which contain» two grummet of Hulpbitc of soda to the [{uarl.
and of which Hcrcml tumblcrfuia a day may be dntiilc. aud the waters of
Bridcs-eii Savoirc. which Philbcrt has ao much vaunted ia the treutmvnt
of obeatj; they are similar to the foregoing and contaiii one gramme of
sulphate of smla to the quart. Visitors to these Rpati lire in tlie habit of
drinking five or six glasaea a day. By the side uf these watent we must
plaoe two FrtfiK-h apun, tlint of Auius ami that of Ghdtel-Guyon, which
liare a nianifeet purgativo action. The first, probably owca its laiativo
effect to th« mlphato of lime which it contains; the M>caTtil, orcortling tn
labonle, to the nhlnridoof niHgnesinm which cntem into its compontion.

.Austria, however, ieaheud uf France in the [HMtsL'tMion of two nnrivnlcil
Bprings, Carl!*l»ad aud Marienbad. The Sprudel Spring at CorUbad it
one of the most priwd; it contains sulpliatM of potash and wida. It Ih a
thermal g[)ring of high tcmpomturo. It muft l* homo in mind that the
great reputation of theae wati-Ts is due Ixith U} their purgulivc artion and
thu aoveru regimen to which the putienta arc subjecbed at the springs.
Marienbad and Franaenabad are epringa containing sulphate of soda in
Inrgii quantity, three to four gnimim's \wr litre, and a little aulphme of
potasU, The purgative wiitoni of 'I'nnuip-Schnli nlao belong to tliitt grou]ii

Uut all ilieae aodic aulphattf waters aru aurpiwaed by a new spa dia-
«0Tered in 8i»flin neiir the Fn^neh fironticrj I allude to tho Kubinat wator,
vhich containn almost lOU gnmmcfl sulphate of •Kwlinm per litre.

llio magiHwiaii unljihiitit waters are the true purgative waten; they
(arc rarely drunk at the eprings, but are nuieh exported. These cold npaa
i &re found chiefly in Ilungiiry and Bohemia. There is near Buda-i'eath a

282

DISEASES OF TtlE STOMXCU.

Bubterratieau stroain of piirgativo water of 8 very actiTe nature, whicb owes
its properticH to the clayey magnesian ntrala through which it paawA, and
nil that ii tioovMor; it) to uiuk woile to the level of tliis uodcrf^ouDd Btreom
to obtain thifi n-ator, which ia here so abnndant.

TlK-eo bitter w»t*re have lor tli«ir type: PuUiia, Seidlita, Saidscliiitr
in Bohrmia, llmiyndi .Tanoe, Rakooty of Buda-Pestli, Roj-ale llongroise in
Ihiiigary, FricditrichahiUI in (Jermany, Birmomstorll in Kwitsurlaod. In
Fraiiee wo hiivc l>ut on* ftolitary specimen of th««o bitter wBtere in the
(rrti'ii water of Monuniruil>V»]gueyraa {which lias gms. is. of magneeiuui
aiilplwlc. and gms. v. Hadiiim sulphate per litre.) All these watcnt hare
us tliuir Kctivu ingruLlienta more or Iccut of milphntc of enda mid mt^^iesin,
ami one of the most purgubivu is the ilunyadi Janos of UunKar>'. which
c^uiitiiiiii^ in (.•ul'Ii litre '2'Z. 55 gmtt. Kulphutu of Bodu and 'i'i.Z5 giiis. tiulpluita
of mapnettia.*

These waters nrc conveniwit and easily taken, are well supported by
the ^tuucli. and roudur, it must b« confosaed, real fiurrico in thonipuutica.
When imbibed in funall doaea, their pnrpitive notion ia soon ov«r, and they
ooriBtitutt' on« of thw Itwl meaiiM unipioyed to combat raniitipHtion.

The bitter waters in moderate doses cause a Btool in about an hour
aftiT b(;!ng tukcn: tluiy do nut produno oonfitipation wlion their adminis-
tration U dismntinued, and acting ftlwnjg in rolativuly feeble dOBM thoy
f ullill all the oon<1itiona which one could wish for in an habitual purgattvtit.
In their enploynienl you will \)v govanHjd, on the onu band by the degree
of oonstipftticm. and th*- greater or lew resistance of tlie patient to the
ikction of tUvK: wnttTs, and on the other hand by the purgatiro power
thereof. You will give, for inKta,nce, a hirjje tnmblerfnl of FuUna on an
empty stomach while yoii will not prescribe but half a gla»( uf Uiemvn-
storfF, and if you use the Ei]nyadi-iraiio«. a Bonleaux wine gobl«tful is
sufficii-nt, whilv of thu stronger liabinnt a lens quantity Btlll fiuRicca. But
do not forget that you must persevore in the administration of these bitter

* We give below a table which shows the com|)OHitloii ot tlie ilifTerent luognmian
ttii][ihat« tuiiLenU wntwnt (aoi.'erUtnK to (iiumt.)

Sru.

Dalwocy

HuitytulJ-JsuioK.

BirnieDStorfT

SeidlltR

Piillna

8uiiLM-Jttilr.

V'li l^(?_v i'(u»- Montm i rnil

Fr'ftdrji.'behiill

EpBom

25. oa

22, 3.1
23.91

12.01

10. M

9.81

6,14

2. (18

ON BAUirK PUBOATirXS.

TftW-re, repeating tlie aperient draaKht erery noomiiig for a fortnight or a
month. If, «n the other liniul. yon wnnt « purgative nvthor than nn
aperient offect, ynii murt order sc-voral tumbk'rfuk to tw ilruiik.

But, ! repL-ut, in the trt'aunent of conxtipation, it in rather in the
number of the dowa* and in their rciiotition tlian in the qunntity thut you
will find the romwly of the evil to combat. When I cannot aviul myaclf
of A nacnml pnrg»tivo watur, as at the hotjpiul, I employ an artificial
water which re(»mble» tlie natnral, Rach .i« the solution of Bulphate of
BOda in carljoniu acid %vuter, of which 1 bnvp before Npoken.

I have now finished the purgative waters, and in the next chapter 1
shall toko up Che eocchariuu, drastic, and chologoguc purgativiiia.

NOTES TO LECTTJRE XIX.

'Giacomini ckesee purgatives in the group of enteric hypoAhonisants,

Trousseau nnd Pidotiicliavo itividcd piirgativee into two gnwl clat^es:
thoae which are derived from the vvgotiLl kingdom, and those wliich are
derivod from the mineral kingdom. '

Boucbardat in hie Formulary adopti) the claasi&cation into drastio
cathartics and laxa.tiT<»i. In hin Materia Medica he divided them into
pargativQR of vogeUible origin, into saline puigative«, into emo]li«nt and
into chemical purgatirce.

FonasBgrirmi admits th<; following clivraification of pargntircs: 1,
Alkalino-aalines; 2, SaHnes: 3. Antimonialx: 4. Mercurialii: U, Beainous
purgativea; 7, Saccharine inirgatircs; S, Ai^ixUiIated pnrgatiTes; 9, t'on-
vuluvant purgatives; 10, MtKihrnucal purgativus; 11, Composite purga-
tivee.

* Wo givo bidovr Kfor«Ln'H table, nhowing the nnantities of liquid found
liHnm wiltii. \\<>givc also the time that luu) elapucd

had administered ii 20

by him in th« inteHtiiml loop of a dog to whi<;h
pJrcent. solution of K|iiinm wiltii, \V<>e\
between the iiijt.'ctioQ and thu ejutmmation.

t^iiftiitity ofcotutiOD
tnject«dL

SOcc .
80 "
80 "
SO "
20 "
SO-"
85 «
SO "

' Luton has observed on himiiutf . then on jiatients in tli« Hdt«] Pien
of Rheimis, tluit a subcutiuieniis injection of 10 c(<ntigT»mm«8 of Ei«oiii
aalts proTokea diarrhoeic Htooln.

Xuadgft Vulpian injected 10 centigntmnie^ of Epoon) aalta in 2 or 3 gnuna

iriie « lapsed.

(^aatitv of Ii>]tud
found.

G houni.

7 C.C.

6 "

70 "

31 "

7» ^f

• i ^

fi "

. 12i "

83 «

. 130 "

S3 "

. 196 "

1« "

. 875 "

24 "

. _ _. _ *

. 336 "

I

I

S84

DISEASES OP TlIK STOMACH.

of iltdtilloil ■wBtor; the dr^ htvA ilinrrhrtMi durinfi the night which followed
the injection. Th« cxperimcut rct>eBtpd twice gave the same r««alteL
When muL'h \iiT^vr «)iu«ititiiM! of siilpiiaU; of niagii«*ia are injected (10
gnmirtK*!!, for iiiMtaiiL-i'). no purgtitiTv vftvcl is noticL'd.*

* Into a Inop of int«citinp (irfipan'tl as indicAbril iibore, Moresa inJBcted
sulphate of ii»igne«i», then thi; vollnw f<«rro-rjiuiide of [Kitamum. aaalt
tho trftCPi! of whi(>h mny lx> found in thi> iii'iiie. Thn pmanncN' of thiscalt
ii) th»t ojcretion (kmonstmtctl thu lavi timt if thure in n double vxatisti£Q,
it takeff piano at t)w liemniiiiig of th«> L-xpi'riiiiL-ut. aiu) Mion t' Cim c fc

Cutin replifH th»t litis faoi ia nut a puaitiVL' iletiiotuitrul-iuti, becattaeat
the cud of a little time tli« int<«etinal mucosa beoomee inflsmed, and no
]oiij;lt jireiK-iiU( tht^ iioniml comlitinns for at)(v)rpuon. (Monisu, Bull.
de i'Awui. du M«'d., 1879. Colin, lot. cit.,lHT«.)

*Vnlpiiin in his work on the Vuso-Motoru thus suinu up the rvsults of
hiiiohs(>rvittionH:

*' i^irgiitivea introiJuced into tho digestivo poBaagoa, art as irritant« to
the inueouit nKmibniiiLi>:

"Tliia irritaliosi dfltTmiiiei mfjdifi cations in tlie intffltinal epithelium
and an oxeitstion of tin- periphoral extremities of tho ctintripetal inteatinal
neiTee. This exoitatiou ia ciuriixl to the inferior tlioracic nervous ganglia,
and tlie intrH-abdntninai gaiifrlin (^iiiglia of thn solar and mewnleric
plexufM"*, giumiia of the plexnsiw or Mi>is»iier and .\nerbRrh); then it i*
rcrtoeted by trie vuso-inotorH upon tho vossoU of tiw intortinal walU, and
by the Mimitory nervea ui»oti the aniit(»ini(!al elements of thn niuroufl
membnuic, iimmig olhurs thnw at the glands of Liulterkahn. There
l^>Aultii a cnng<-titiou more or h'Hs intetiRe nf tlu> intestinal mucon^ mem-
brane (relies viuso-d ilutiur iK^tiun). an epithelial dcxquaniation. with rapid
and abumltiut production of mueuH. diapcdusi«. or not. of leucocytes, and
an uctivu wjeretion of inteatinal juieo, with which ttro mingled, withnnt
doabt, in certain rases, the products of a nrofuao transndation, formed
espooiaily of wat«'r and of certain salta of tne blood, and due to an ex-
a£gerate<l and vicioue procus^ij of which the elements of the membrauo um
the scat.

" Here we have, it Hepma to nip. what Ihore is that is nsHentJal in tlie
DiechaniHni of the iirtion nf purgative snbstaneea.

" In a certain immtier of fonfft, the redox action, due to the irritatinn
dDtenniiiod by purgiiiivL'«, is not elloited itolely by followinK tho diuvtaltio
arts wUirli 1 have iiidicated. The cxciLntion niity he sumcientlv stning
ti) b« tninsmitttHl to the Hpiiial cord, and to provoke pain, Suoh is tho
mode of production of colics: it is known that they are manifeated with
fruater fretpienoy and intensity when cerkiin purgatives arc used, auchae
orostics, than when other i)uri*)itive« 8iich &j( eatines are used.''

'(rernmiii SiV has propoised to divide purgatives into two great clasaes:
1, e%'B4-uuiit purgatives: ■^'. true purgatives.

Tho tivaeuiuits are subdivided into two kinib:: thorn? which act mochani-
eallv and tlioee wlitch act by cansiii}; contraction of tho intestinal muHclcs.

'rhe purgatives, properly xo-called, are suUliviflwl into five genera: 1,
tho neutral i»It«: 'i, substances containing tW/Mr/tc oocf (Buuua, rhubarb);

"Liiloii, Oil 11it> pMrh'iLltve VtTm-t a( Siibt^iitiinoous Injevtwo* of Su][ri]Bb>ol
Magnesia, Bull, dv luSoc- M6il. de Rh^iim. 18T&

ON SALINE PUKGATIVE6.

285

3, the anhTdrous giycosides (rolocyntk anA aloes); 4. fatty subHtuncaft
'(coetor oil);".*), the mannitefl (sugars and es|>dci)Uly ongar of inilk].*

'Siilphatft of bocIb (Olnnhor'a aaJt) rrystulliifw m wliitp ofSnrnscont

[priwirw whicti urt* very itoIubK' in wnter, iiiwoliiblt- iii akohol; the Uinto ia

■Ditter and disigrwable. It t>xi8ti iw & groat rniiiiy iiiirivml waters inul in

' certain nwriiie plants; is obtamctl by eva^nitioii u[ tUe aaline waters of

Lorraine.

In BRiall dotwfl of 1 to 3 gms. eoilic sniphate acts as a diarvUc. In
larger do>>i» of 30 gms. (1 ounce) it acts us h puigative^ and caaaaa seruiu
fftook Constipation sometimes follows a prolongod ttaage of this purg%>
tire.

Sodir salphate enters into the rompnsition of maiiv preparations *uch
as the rof/al pHtau niifi filurk ithi/n-'f of tlio (.'odes, l*»rgst.iv»» luv*«Tn«iit8
are ooiutitutcd by diwolviug from half «u ounce lo two ounou m a pint
of water.

'Netitr&l citrate of soda is eolorleoe, inodorous, of salty taate; cn's-
tallies ill 8ix*8i[l«l pymmicU; iin?lllftr«»t'«iit; viTytioliihlf in water. Do»e
— one to two ouncRB. The sniiiller tlow is }>ur(!;iitivo to young suhjo-^t*).

"TariXtttBof Boda i« iti tnuwpan-iit iKTmanwii i;ry«tu]« and is vcrysoln-
hlc in vratBr, iiisolublu in alLHihul. The niMitml Uirtratt? has little Xa&lc, and
a aolntion svreetoned with l«inon syrup niakea an agreeable latativo.
The do»e i» about an ounco.

" PhoBptuLto of soda cr^rstallizce in rhomboidal pnsms, tcrmiiuitctl by
afour-«idiHl pymmirl; it w quite an ugrtx-ubti; purj^ativi-. acting without
naUHra or oolic, and provokiiif; M-rum. and btliuus evaouationa liku mdphato
of sodiL. Dodu — from i to :; uuqcl<s.

"Chloride of Kodhttn or nommnn lailt is ohtainwl from itx solution in
■en wntor, from tnintw, where it (joca under tlie name of rock salt, and
from ult aprin;^ It crvBlulliiK^s in cubes. i« solublu iu water; iufiOtublo in
abaolutc ali:oliul.

Couuiion salt is a stimulant diun-tjo in small dooeB, and purgativo in
large doses; is oft«n employed aa lavements in the qtiantity of 1 teasimon-
ful to a pint Jilany miueml waU^rs {notably that of St. Leon, Canada)
owe their efficacy to thi^> oomniou salt they coutatu.

"Magiicnia, or the oside of mttgncsinm, is obtained hy calcining tl»
OarliOnate; it is to<j wull knixm to recjuire dcMrriptiun; when rjuito eaU
cined, it is wholly ineoluble in water.

Twokindearein use: the heavy or whitL>imignusii>(Engliiih mngniwa);
Henry's magnesia, whicli pri.'!(ent8 itwlf as little bard grains: and the
light or French magnesia, tho ordinnrj- ralcinod magnesia, which may Vw

flTcn to children in the doec of & to 15 grains, to aditltK in the doee of a
raohm or two.
It may be given in tablets, in chocolate, in syrup, or in potion, or
grnnulatcil, nudcr tho form of the grunalar eflorvescent maguc^a, pre-
pared chiefly in ICtigland. There art^ nnmhcrs of these nn^jnmtions in
the nuuket, which constitute agreeable laxatJveK in doaot of about a table-

* Volpiui. Appnn^il VftM-MutMur, t. i., |>. 516. G. 8^ Dea [^w|>i.-^Qgt <]utft>-
Intoatinahx, I'artn, \m\, p. 812,

28G

DISUAHBJ OF TUK BTOirAOII.

Bpoonfiil. Th» prwipitat«(I hy<lnt« of inngnceu boa been ofton oxhibited
OS un antidoto iii ursciiioiu mcvX poisoning.

" Mialliu'bj magueHia is iiuhIu iiti foUovs:

Take of :

('iilciiuiJ mugtioaiii, ....

Water

Boii 22 minutes and add:

Siigur,

OningH flower water

This merliciiie ttcttt o or C liuitrs uFtvr liuviiig
given in Ibu morning on an empty stonutcli, uud
cold water.

Milk of niugiiuHia U miuic as follomt:
Take of:

Calciittid iiia^nvBia, , . . .

Pure watLT .

Ortiiigo llowor water. ....
M. For one du»e.

Aftor thu lulminlKlmtion of tliifl Itixative a
should bu ilrtuik.

8 enimmea.
. 40

. 50 [nvranie&

. 20 " •

bet-u takvii; it idiould bo
h& fulbwud b; ii ghuss of

lOtfKtainai.
80 "

10 "

cup of BWoctenod water

" Carboimtes of magnosia. Tlwro are tliree carbonates in uae, a
neutral, a bicarbonate and a Hul>carbonatc, called alao wUito maffnema.
Tbc most of the carbonate of magnottin in n»e is mailf from the bittern
of silt workR. ami il is munnfaetnrt^i in lialtimore from tho salphatu.
TJio British I'h. dirocta it to bo made from the solphflto W in-ucipitation
with cvirlxinutfi nf noda. It is Tory inaolublu in water, but somrwhat xoluble
in 4'arbonif? acid wattT: ninncfonrs magni-sia iH a solution of this natara
I iii-lmiiiit^ n{ niii^iiMJa iK givf'ii in doccR of from 10 grainit to a drachm atkd
a hair. It iit a miid Uxutivuand antacid.

"E]wom nn\U, so wi'll known a« a |>opnlar cathartic, crystalliswa In
qnadriuifriilrtr priflma, trrmiiuited by a fnur-sidtwl uyniniid. It ia effloree-
Rent in aii-, is Vfry »ohihl« in water and inwohible m alcohol. The done »
linlfiui onnoo to two oiinws, diKBf)lv»>d in a larj»e miuutity of wnter. The
natural niineml watora (Froidfriohahall, i'lillna, Soidlitsi, liirmenst<^rff),
contain il. 'I'ho most ugiti-abln form for its miministmtirin in a lu^lntinn in
airboninirid water witli lemon iivrnp. Dr. Henry o( I>nbUn n3(M>mmendg
it with dilute? milphnnc a^^id. 'Yo nevon ouno^a of ii. satunit^Kl anneoiu
aohition uf this ealt ho uddit an ouuuu of diluted 8Lilphurii; &cid, nnu giree
a tAbleHiHiunful of the mixture for a dona in a wineglasaful of cold irat«r.
It is aaia that an onnee of this salt in a pint of water hoilod for two or
three minutea with u couple drachma of roaated ooHee in entirely deprired
of bittenH'sa.

An aqiK-ont) solution of 100 grsin« of thitt nidt should yiold, whvn com-
pletely docoTiiposed by a boiling solution of carb'>nAto of eoda, ^4 grains
of dry rttrlxmiitfl nf niikgnesia. (U. S. DiBponsiitory.)

" This e>alt id destitute of the bitter, disagreeable tAsto of Ep«om ealt^,
and 18 a very gentle and at the siiue tiuiu (|uiLi^ efficient |Hirf^tive. The
doHo is the Kaiue il» Chat of the Kulphatu. There are several granular
ellervoecont preparations in the market which are called citrate of mag-

ON 8ALCNK PCIMATTVKe, 287

'nvam', the most of tliom, howi^rer, an oompoMxl of a tittlo citnte mixed
vith tttrtrnte and snlpbutc.

[Tb« offerTceccnt citrate of mttfneeia is nmdrt according to tlie German
Ph. as (oilows:

Take of;

Curbonntn of magnosiiini 'ib parta.

t'itrie iicid, To "

"Mis. form iutu h thick puate vith distilled water and dry at or below
S6" C.

Tttki' of:

This aiaxs. 14 psrtx.

Birairboimte of mMliuni, . , . . 13 '*

Citric aoia 6 "

Pr'liiU' Hiigar 3 "

Mis, nioi^trii with sufficiont ulcnhol, ijaas through a sieve to fonn a
coarse, gninular |Kiwder mid drr.]

" Tho tartintf^ of niagiiceiii i^ (.TVi^llini; and little aolubk'. Tho hitur-
tniti.' u uiot-t employed; l\i\>i is iiioit- s'lluble. »riil Hiiten into the r<>ni|K)!ii-
lioii ol Turioaa lomoiiad«s. Ganiitr Ima projjosed the following prepara-
tions:

T»ko nf : •

(^trlioiiato of magnosia, 15 parts.

Tartaric iicid, 22 "

Wiiter, 600 "

Di«olrc, tutor, and awtt-leu with (it) parts of »>-nip. Flavor with

OIBQgU |H!l-|.

'* I>orvaiilf6 oxp«riment« were niade on Berea young men of tho saino
age, and in a good stato of lienlth.

Each OTIC of them toolc wiih intorrals of ton days, a doso of c-aleined
ma^oeia (about two dnvclinu), a doso of citrate of tnogneaia (^ ounce), and
a doM of Bulpliatu of inagnma (im onni^c and a half), These pnrgAtivtti
wnre administered iu 6\-e outioes of wa,tt<r. and the pnrtio) were pUiood in
the tume ifonditionB of prpparHtion mid uf regimen.

Thi^ rcBullB notcti wure as follows:

1. ItviutivuW to tlio iininbcr of stools, tlwif was im avprage of 2,ft3
with thecaldned inagnesiii; 3.','i< with the fitnitc anil 4 with the Jiiii|ihiitc.

'i. Relativetr to tlie duration of the pur^tivt' at-tion, this wiut Lti.83
hours for the oalcincd magnesia, II houn for the eitniu-. and 8.60 fur thu
sulphut(>.

X Itelatively to tho weight of the evacuations, this was 1.UI7 kilo-
gnimmea for tho calcined, 1, .71 for tho ritrate, ii.iOO for the siiipliaie,

4. It^latively to the nature of tho st^olfl, these were feculent with tlie
magnosiA, somi-«eroug with the eitmt<;>, serous wicli tlie KftMni.

5. Relatively to the clfuct« produced, thu nauMii was verv markol with
tho sulphate, leiw with thn mugni-aiu. iu>ne ut nil with the citrate, and the
inlphute pra<lii<!<>d coiisiderahle ti-n<>Hmuii. There wna burning thirst with
the sulphate, leas with the colciueil, aud none with the citnitt*.

*'Sulphat« of Potaah (sal-de-iluobus) is white, inodorous, of hitter
teirte. crystallites in short hexagonal priRnu, is soluble in water, insoluble
llu alcohol.

288

DmEASK8 UF TUB STUHAOU.

The dose as n laxative is from ] to 2 t^^aspoonfulB in a pint or more of
water. It gripoa considorablv. Thyro have t-vcii bt'«n fatal casos of
]>oiaoniiifi; from the (roe uw of this ailt. It formerljr went by the
of ml pojffcivjiliis Giaseri,

" [The liitttrtrutv of pntawn. or rream of tartar, is tl»n only tar>'
tmt^ of that base uscmI in the Utiit«Hl Ktat«K It is too well Iciinwi) to tiecd
dtMcription. It is soluble ;n IS4 fiftrtt cold and 1^ of l^oilin^ wati-r. It
is u fniixl oooliiig aperient in doees of a tlrachm or ttro. uraducin;r cupious
watiTV Mt<jole. Thi? Oiu/erth Suijifiiiri;*. mid llii- /•«/»•. Jalau Co, con.
tnin ttiia ealt. It mav be givc-n stirreil iw ewoetonwl wat^r, and forms au
ttgi'ewible pai^tive <frink. Tho beverage cftllml Jmjierial is made by rlLs-
solviii^ liaif au ooiK^e of tliis salt in ^ parts of boiling water, and adding 4
otinn« of white sti^iir and tialf an ounce of froRh lemon ]icol. Cr»am of
tartar is much given as u doim-etic laxative mixud with an cnxaX quaiiti
of sulphur and takun in moludfiu&J

" Thf- tKrtmlc of sodii iiiul potaslt or Rot-btOle Halt* (Seignotte «tlt)
was discoverwl byJ^igiiPtto, a pliarniacist of Rix-lmlks in \*u'-i. Itorvstfll-
]izus in priwnrt which are offloreecent when exjxtiH-d to tin? air. It \e vorv
Bolublu in wtLtor, and is an adinirabli>, excellent purgative in doses of from
half an ounco to tin ounce. The Seidlitz powders so well known in the
lTnit«Hl 8tatcB and England contain Itochollo «ilts u« their baeia.

" The priii<:i™il purgative wak-rs of th« old world aru mentioned in the
text; the lengthy nctt's jwrtaining to them in tho Fri'nch edition are
omitted, hh b*Mng itndBsiniblo in the Americnn tmnslation.

Among ibL> purgative iniiiLRil waters of tliie country wc may spi^cify:

1, Tlitf Irvine Spring of Ettlt-ll Springs, E*lell Co., Ky. This water i»
highly inipri'giiulcMl with inirgiiig uulphiitt'S, and is taken in doevA of one
or two tumblf rfuls in the eiu-ly raornmg.

2. The t'rab Orchard Springs: Imaition Cnd) Ornhard, Lincoln Co.,
Kt. — 7 gru. sulphate of sodn and 'iTt of fnilphnte of magnoKin to each pint.
TEiese wator* are largely nnftd for tho niftnufactiir(> of tho Crab Orchard
mltti, which are obtained by Iwi ling down the wiiU;r. ThL-scBaltK are mai.-b
uwmI in the WeKtcrti States: whuii taken in small and repeated dutiea tbey
give rise to copimiB aeroim and biharv evacnationa

'■i. iiarrodaburg Siirings. In iJarrodwburg Springs, Mercer Co., Ky.
These waters utv mildly magiiOKian Milplmle.

4. The Bedford Spfiuga. hi BuiIfonlCo., Pa. Th«8« waters are mildly
purgative chali/^ale. Every pint contains 10 grs. eulphatu nuufTW*!*.
and traces of carlional*' of iron. These snringR, wliich are quite a mvorite
rcHort, are bwiuLifiilly situated in a valley of the east'Cru rango of the
Allfgbanv Mounfeiiiis,

5. Tli'e Midland Well. In Midland. Midland t^o.. Mirb. This water
is potaKsic sulph:i<t« (K^ gmimt to the pint), and is of conHiderable local
repute as a laxative.

ti. Elgin Spring. In Adduon Co., Vt. TMe water containe sulphate*
of magnexin and Hoda. and is a good cuibartic.

Among other springK. much reported to for laxative effect are the St.
Leon, near Montreal (eodio cliloride); Coopers Well in llinde Co., Mi».;
the SjUt Sulpluir Springs of Monroe (Jo.. W. Vh. (purging; tnilpimtes and
free snlpliurotted hydrugen); the Oreenbrier White Snlpbnr Springs, of
OreenbrjLT Co., \V. Va., an exoellent ajwrient and ailemtivo snl[ilinr
water. — " UiL^e springs are the Mecca of eoutlioni touriate, thu ruo'jrt of

OK SALINS PUROATirBS.

the cay and fARhinna'hlc. u plucre wltcru piciuiuro secting reigns nupreme "
(WRlton); the Yeiliiw Sulphur Spriuga in Mont^mpn'(^.,Vii, — finoraloic
8iil[>har waters, with an acti veproportion of purgmg aulphat«e; T
Wliite Sulphur Springs, in Freilerick Oo..Vft.; tlic Avon Hp:

) raloic

liivingstoti Co., N. Y.; the Dryden Springs in Drydwi. X. Y,. which an*
nagnwian sulplutto and sodic chlorido; the Bc4fora Springs in a town of

Inilian Spriiige in Indiana; the- French Lick Spriiiirs in tlic mmc statu;
lastly, the Snnttogu wub^rs ivrc for tho most piirt laxative siUine watom.*

LECTURE XX.

ON SACCHAIUXK, DltAH-I'IC AND MKCHANICAL PURGA-
TIVES.

SvMKAHV. — Succhtti-inc rnrgativi's — Manna — Honey — Vegetal Non-
Draatii! Ihirgntives — ('iiwna I'lilp — Tamarinds — Prunce — Cbolagogaee
— C'tlom«l — Kfaulnrb — I'tHlgjihyllin — Aloes — Drmtic I'urgativ** —
Setina — Jnlap — Sciunniony — IikHuii JaUp (Turp^Ui) — Crotou Oil —
Munrular I'urgiitivns — IWIiMinniia— Atropmo — HyoBcyamin — Klee-
tricity — Purfratives with Tiocal Action — \N'Lit<t Mustaixl Seed— Oily
Purgfttives— (.'astor Oil — Thernpfutic AiijiliL-utioiiB— Purgativts Ap-
plied to the Treatment of OonHti]iiition — nesiini^ oJ TreatnienL

You romeiiilKtr, gentlemen, tliat ia tlie (livision of purgatives, I mngud
in Ihp flret group of these medicaments thoeo wluch increase the secretion
without auf^metitiiij; thi> inteistinnl eoiitrnctinnR, and 1 tfild yon that there
oxiat in this group two Kub-variiiliea: iKo saline purgatives which we liavu
Hbiidied in the foregoing chapter, and the eacrharine purgatives of wliich I
am now to epoak.

Ortain siignrR have thu property of proihicinp n dialytic ©ffoet on tho
inteHtines similar to tlial of tcsline purg-ativeM, and Medicine utilizer two
of tlie«e Bubstanceu, manna and iioney. Murmii htus been employed for
children: it is an u^'ee&ble {lurgativ^i, contnining a particular prinoiple,
mannite, Yoti know tliat mminn ie oTtrat-ttd from the trunk of an ash
(fraxiniig onuia, fraxinns excelsior) which grows in Italy, and that thia
tsubtttance odzck fnim truns>'enie iiidHions nuule during tlie (lowering Reason,
and according to iU shupe, manna ia rwid to be in tt^rx or llukra luid in
lumpa Tho sweetish otlor and i^avor of numna rapidly fatigue tho
Btomoeh, and it is iliffleult to oontiiiuo ita uwige long, hence as a mc&us
for comlKLting luibiLu»I (-oniiti [uition, it hits l)een almost almmlcmiHl. '

Common lionvy is a mild laxative and is much iitilimxl for thin pmr^
poae; the same may be said of moIai*dca, which conetitatee the laxative
principle of American girgorbteiul, and of the brown bread, so much in
usR in Now Kngiand.*

By Uie aide of tbeae Hiinelmrine pnrgativnB, yon will place certain sul)-
stances which belong to the vegetal kingdom, and couBtitutc tlie mild
aperient medicines of the nncient» — purgativee which Imd ii great rogue
under Lonix .XIV., but which are tibaiidoiied tu-duy; I allude to caasia
pulp and tamarinds.

CaeKia has srircd lui thi- \waa uf a multituilo of apozcms or dL-CDctioiia
(ormbrly very mucli Tuuiih.-tl, such m thv nuiniialiKle of Tronchin,* the
confi<ctioii uf lIuiiicK^h. the LsniCivg, and i>K|>i>L>ial)y lhi< «i3lebnitt.Kl (JatbitU-
cum; pre{wrnl.ioii)i which arn tf>-il«y forgotUiti, but whoie hiatory \Ktkn
tvstimoiiy to tho popiiluritr in whinh aasia wns once hold, n sari of cnuo,
in fact, to vrliich MolJvir din-'cts thi- shttfls of bi» ridiotile — which die] not,
hDwi>v«r, pri>vent UdiUu from uffiriiiiii;^ that it mm to caoaia that Voltairo
owed his gnuiL ag«.*

Thn tflinnriTid * in also much nwd as a taxatirp; ihf fruit, «"hieh likr
tlutt of ciui^m iA a \K)i, Ib tht- pitrt uslhI in niciiicinu. A ptisan and a
jmrgntivu olectuarr were forno«rly prescribed: thuBe are not now in use;
Uw last few yctuv, liowi>Yt>r, Grilluu bau takon u|) itgniri thiij propnmtion,
and ban nuide iwutille^ nf tamikriiiil pulp witli extract of bcnna, the whole
being covered with chocolate ('[\itnar Indicn).

Lastly, primes may be montiouvd in thia f^onp. ALl those Babsbmces
(xmuiin a«;L'hiirmB priiiciplys, t^j wUi(?h ihfyowi- thoir inirgBtivL' action. I
will iuld to thesu (twoot pui*jr»tiv(*8, in littlp iiw at thi' prpsont day, two
widl known STniiw, much employed in infaiitJIi; niodidnc. ifie sifrup of
jieacfi Jtotrers, and the i^yrup of jmle routs, which ure jfivvn in thvdoseof ouo
or two deBsert-8poon(nl.i for a laicntivi? cffm^t. f

Sncli is tliu firet group of piirgativwi wliicli you may utiliae in Llit-
tr«itmpiit of constijKition, wliether liabitiial or accidental. Yoii can not
help noting tho minor importaiKH- «'hich is aceigncd to-<lay to this sah-
diviaion. While tho fwcphurinc pnrffativca and the QOn-drwtic vcgetaJs RTol
now virtually abundoncKl, the saline purguliveii, on the other hand, oniu
the purgiiti re uatore iiidi8])ittably and (U-)i«rvi>(1lr occupy the flr»t place.

I come now to the si'tnnd or intermeflisito group of pnrgativefi, thoae
vbjdi both augment thu inhMitinul Bucretioua mid tho musoalar contrao-
tionHL We shall have to make here two Eml>di visions, oomprisinf; the
choU gogu pe and tho dnucic purgittivett pro])er. J fihall begin by Kiyiu^ a
tew words about cliolagogue^, and I shall mention only the principal
modicamentti which act by augmenting the secretion of bile, reserving tho
Cotisiderotion of their phyeioli^icAl action till we come to «)>cak of tho
treatment of diM>axeii of the livflr.I Tho tlrrt nink is tmsigiuHl to the
pTDto-cbloride of meruury or calomel, which det^nnines thotte greenish

*lfarnwla<lc of TVoDohin. A kind of thick tooch. of »d iif^reenble taste, pt»-
pored with two ounixv o( oil ofHWti-t alniuniJ», iw uiiich ;>ynip of violetn, nunn*
in tous. vor}- fre«h |ni!p uf L'a'Uilu. sixteen ^mloft of pum tni^iacanlb. and two
dndims of onkn^-llowcr witti-r. It ih ukii) as. ih iMxtilivi". ilumulnMit und pei^lonJ.
Tfie Cof^fce^io ttumrr. tli>r LrnUim; iiriij Ihi; (.'iiHu'lii-iitn. wen v<^y (.■ompllcaLed
prvpumtJonB: tlic fomim.-initniiw lK-><iily-(ivi-. tin- lutlm-lirtwii tnf;n<dU'«t«.

f Pcadi Aonem tu»l \m\v rwi«« urv cniditi-d with liixutive {>r^poi-tiei», and iiyru[xi
miMie fn>m them are much in use on t))u Continent uf Eiirapc.— {Tr.

292 D1SKASE8 or THE STOMACH.

tlischftifies to which tho Knglish giro the name of ciilome] stooU. This
prconiiib truittcr, coaoerniD^ vbicb there hts beca m much dispuU), ta to-
dajr nioogniaod aa being of the tuitiiru i>f bilo. W1i«n mlonicl ia given ni
the doM of from 5 to li> grains, a purgiitivL' eSi^ct ix nipidl^ pnxluced.
Thi« mpii icament la much giren to childrpti and it is vised more in Eng-
Uiid Rud thu I'niti-d Stuh-s Uum unywbcro else. If th<; adminietrBtioo
of this mcr(!iiriiLl initisyoii attrontit of iU stiuiU rolntno and aUjinrice of
ta^to, vou Hhoiilil rcjiiionilior nt Ihu Katiii* time that you aru doaliDg viMi n
proto-ralt of merciirv. and that you are to uToid in its adminisitutioit
vvurythiiig vrhi(;h might trutisfonn it into tho bichloride, a substance
which ia ominontly toxio. Yon will thpn avoid the minorni and vcg<.>tal
ocida fttid the ttfid j»?llii'a. and you will take care not to prescribe with your
calomel the soluble HlksloiiU. «alt«, hromidcti, and iodides wliich may de-
ctimiKjee tliie protor.hloridp, and tnuiflform it into the bichloride. You
should oleo avoid sub8tanc«8 containing Uydrocipunis acid, and not admiti-
iBter calomel with cherry-laurel water. It will not do, however, to oter^
iit)il« tb« dnngur ut tlic tniiiiitfornialion of calomel iuto corrodvu tsnblimatc^
and ^'empfi Una rencntly shown that tho mcrcurioua chloride is more stable
thnu bus bvvn gciicruliy bvlic%'od, uiid thut it it with ditlicuUy tTHiiMforrned
into the bicibloniio.

By tho Kidti of tulomel there ia also a purgative very widely used,
namely rhnbarlt, the dose of rthicli is fi-oiii oul- to two Bcrnplcs. Kbtibarb
has niutiy mlvaiitugL'ti in it» favor; it acts uaa tonic Btomarliic, and i»gou-
emliy well borno by tho utomaoh; hcnt^o it iftgoiiemlly taken about Difial-
tinu'.

KhiilMrh is given in powder, m ]iotion, or in ayrup. There are two
sTTups in ccMnmon vse, especially in infantile tlierapeutics, ibc eimpto
sjTUp of rhubarb, and the aromatio syrup; tho doBc of both is one or two
t«afi[iooiifula for young children. The simple ayrup in a mild cathartic,
whilu th» arumaliu syrup ia Imth laxative and astringent, and is much
used in the bowe! complaints of children. As on habitual lajcativo for
iufui)t« I much prefer mtignesia, espcnrially calcined magnesia,*

PodophyJIin is also classed among tho cholagogne miKlic*m«nt«, and I
shall return tu ila uses when 1 come to speak of the trentment of cnlculous
alTectioiiH of the livur: I hIuiII only ibltude to ibts mudicumvut to-day in
its applirution to the treatment of constijiatioii.

Eniployod first in America, where the plant podophyllum pelfatum,
from which poduphyllin is extracted, origiiiatwl, this nmnoiia matter has
hei'ii highly praised in Fmnce by Trousseau, and recently by Conatantin
I^lul, who hns shown its advunULgLitJ. According to [*nul, ]H3{lopliyUiu u
the regulator ;wir ejcellencp of ftoole. and the hi-at nietlicament for constipa-
tion. It lui«, moreover, the a<lvantago over other pnrgativos of not loMng
its power by liahitunl use; it pixMluces it» laxative etTects in small doseii of
even one third of a gralji, while in large dieses of two graiuH or mure it U
a true dm«tic purgative.

SACCIIAHIXK, DRA9TIO AHD MK01IAN1CA1. PURGATIVES.

Notwitliiitaticling UiD oom[>ct4>ticp of 1h« mptHml aiitlioritiefr who Iiavo
extollvd jwilophytliii. iiiid notwitlistumliiig the puinstalciiig ami uxnct n>-
Bcarcl)<-8 of Jfiircliami,' tliia rmn has uot tho Tt-jmlL- which wiis prr^licted
for it by th« phj-siciiuis who have studied it, and this resulle. 1 think,
from this tart, that in most cnsog podophyllin dotormiucs quite sevcro
colicky ]iains. and (or my imrt, whonevpr I harp prpseribed it. fsiJtvinllv
to fpnialea, I liave t»een obhgud toiibwidon tt tor thix ruanon, even when
tbv minimtun doso of one third or half a grain vas not vxcvedcd.*

The formnlnof the pilU of podophylltn Tariw little. Constantln Paul
adda tho [lowder of ginger: the Knglish eiidtaTor to dinniuieh the excitant
uction uf pcxlophyllin hy utwociuttiig with it hyoBcyaniiiB; as for TroiiSJieau
and RIondt.-»u, they obtain the eamc rusiiH with pniiMirationB of boIUvlonna.

rf podophylliii 1ms boon to o certain extent abandoned, there is another
medicament wliii-h hu8 bi>tt«r withstood ibc aiissults which haw been
made ujjun it, and which n>m»inH one of the bext remedies to combitt con-
8tip«tioD; — I refer to qIuvk, wbi<^:h Udon^fs alw to the choliigogae medicines,
and merits a pla«o by ih^lf in tlie study of purgatives.

Alom hoa an oloctiro iiciiou on tho lower |>art of tho largo uiteatinc, of
vhieh iteicitea the mu«cul»r dbresand augments the citxinlation. This
tK pvCTi one of the mnat wrious disadrnntnge^i in the Hdmini^tration of
idoiM when you ha»v t« do with hemorrhoidal ]iattnnta whosp rectal varicea
it inritates and inllamw!. Thia very property i», however, an udvaiiti^To
when it ia deHiruble to ])rovoke physiologicjil eongwtions of the utenm or
other or<r]ini< of the pelviit. or uveii create hemorrhoidx for derivative ulTect.
However this may l>e, aloes Is a medicament very much emj loyed, which
■orvcK for baxiM to all the stomachic or other pills whieh havo the projierty
of determining regular tttools. It ii slow in its action, and ix admini^>reil
U the time of tho evening meat when given>to priMlnuo otools the fuUow-
tug morning. It is a good niedieamunt, of which I have spoken under the
bead of affections of the stomafrh, and which is giren in the dose of one
to two graiiu in pill or powder.'

I luiTe now flniiihftd the consideration of the purgativi's which aro
pompreliended in the eliuts of eholagogiiex, and I shall now take a brief
glaiwo at the medioimentit of the eecond Bubdiv iaion. which net, as too
know, both by augmenting tho secretions and muB^:ular contractions of
the intestine, or, iu other words, which pnrge in producing more or \tm
griping. This is the group of drastic imrgiitives. whieb aro very numer-
ons, and of which I can only mention in thiit rliapter the principal agent*.
At the head of the group, aud in a mrt of intermediate poaitioD between
tho members of this and the pr««din^ group, Ix-longa a siK-cies of cassui,
which wrveA as Ijanin to thv greater [Kirt of purgative det^octiuns. I refer
toBBirXA.*

Seoiui in the state of leaTea or pod ia an excellent purgative; if we

294 DisKASKs nr thk ttTouACir.

may tnut tlio cxperimttntii of RritiKh aulhoritiiMi, it if to k combination at
ammonia with cHtliariic uciit. uitluirtJitL' uf nnimoiiiik. that iVs purgative
action i» duo. Soiiiin is the bafiis of all tlic puT]gAtive fitiinns or tt«((, such
as the biact draught, the IHiwD Bovalo or Imporiul, th« Purgative tea
of St. fJermnin. end othcre.

One of ihp best purgativ4< ptisiiu is tliat bnown undor i\w Ramo of
parijutliv ylisnn of Ike Saint I^uis Jioepiial, which I'rof. Uurtly formu-
lates thus:

Take of:

Henna loavM, . ■ . . . .1 .^

\\ iM yHKiwy, . f . . . . )
M. SLcup oiK< hour in a quart of builiug water, utnun aad sweeten
with boiiL-y. Dose — a tumblerful eveiy mortung on rising.

You can mlfnnlujrpoHaly combine senna with prunes in infuirion, or
add pngiT, cnrtlamomg. coriander or anise. Tht- '* Imperial ptiaiu''
wlijch rorviiwrt pre|)urfil for Xnpolinm I., who fmnglit lijfi wiricv ilurin^
the CiernitLU cumpaign for an eczema of the nock which tronblcd him
about woikriuj; lii« unifonn, lind wnna for its bnsiH. If I allude to this
fact) it ia liecanne there ia a cnriouH liivtoiy connected vith it. The
(tt-riimii phj-sician whom KaiKiU^on «t Srst conxnlted wuh op]io«i(!<1 to the
rapid cure of this ecxoma, affirming that ita eupprcsion might have furore
(y>neoc|i]enci38. Thn ctnpcror, pressod bj the military campaign whic>) he
wnR conducting with liiH nsual vigor, did not follow the a<]vien of Uie
(iiTimin ph'i'Hic-inn. but tluit of CorvJHurt. whom he had summoned from
PariK.* The triumph of ('orYisart waa romplcte, and tlic emperor's raisk
disappeared: but after Xapolcon'a death, which was ctmsed, as you are
awiiix), by cancer of the Htomach, the (iermaii physician sH>nght to have hta
revenj^e by insiBtiiig that if Ilia aihice hiul been followed this disease would
uevur liuvu deelurinl itself. Unhappily for this affirmation, the ante-
oedetits of the family ohow that the father and unole of Xaiwleon died of
cancer, and it would Hcom thiit hcrtidity pliiynd the principal |mrl,

llowever thia may be, senna deserves to retain its pliu;e in therapentica
Hs an excellent purgative, and on the onu of all the dnutics which giros
rise to the least pripinfi:. Nercrl.hclesB wme griping does accomjiany ita
action, and this is an inconvonienco which can bo partly obriftt«d bj
mactratinp tiio l«iv{>8 and pods in ulcohnl before using thorn.

The nthor driuttic purgutivea belong chiefly to two families: the con-
rolvulacfa; mid the cucurbitace». To tlie first Ijflong tnriicth," jalap."
and Bcammony; '* to tlio eeoond, colocynth," otaterinm>" and cayajuna."

Of all thc«e cathartieR, jalnp and acammony are the most employed.
Seammony enters into the composition of certain iKLliurtLc cukes and
chocolates and the anisette purgnti?eB. Of an agreodib taste, it is taken
without difficulty, but it has the dlaadvantage of griping eovervly. The
dose is seven grains in a little gweetciiod milk.

SACCBAIUXX, DBASnC AND MECHANICAL PUROATIVIM. 295

If ynn prwcrilw jalap, yon wnnld do well to employ the comjjonnd
tincture of the (Jcrrruin ]t]iiirnuM»p(ria (tlw eau de vtf AUnttnnde), of
which the doAo itt hiitf u flini) nuiimi. ThiR in an <>sc«?1k'nt livdnigr^ne
o«th«rtio in mitml hfart tliwiu*. Tlie eompounil jpUap powtipr in
drachm doses is altn h grHxI piirgiitivc in flropsical affLtctioiu.

I^istl;, nt the XkoA of the gronp of draeticB is a member of the
KaphorbincG*. croton oil, which \% ocowionaJl; given in the do«o of one
or two drop* in pill with liruiul uniinh. It is a dangemuB medic-inn, which
acts by (1et4^-rmti]ing in the intootine an irritation aimilar to that which it
prodnwB on the nkin."

A The third group of purgative mcdicflwicnt* comprehends thoee that act
'^dnb-rmining inteatinal oontmctiotiB, In it iirnini-huled tho (rtrvtlinina,
»ud ]utrticuiurly tincture of iitts vomica »»d tlit- bitter tin<?tiirc of ll&tim^,
which have conHi*lnnibU> pffiraiTrin theccmstipatjon arising from intratinal
parMS. It is in this way lliut certitin of the ttolani act, mich att bella-
donntiT which I'rouKBGiiu luu nitufli vuunt«tl; Iio usihI to prcttcribc it in
pills of one eentigramim* of eitraet of beiludoniia, and one centigmmmo
of tho i»oii'der. This medication meritB |)orpetuitj, and will render jcm
wrvipc in combating constipation.

Electricity may vXm Iw reparoled not eiactlj m o miiKular purgative,
but ait a tburap<!Utic agent which combatH oonAipation by increniiing in-
tertinal contraction. Althans, Ehichenne, and ospooiallj Onimus and
Icgroe, have well Btndieil the artinn of electricity on the inteirtiruil mov«-
in*Dt«, and the two latter experimenters have shown ua that we may both
employ constant curruntH and faradization. When galvanism ie ns^l tho
curront abonld be appHwI to the «piual conl or splanchnic nerrea.

If yon nf<e faradization,, which is motit en))»]oye(] and is really tho
mo«t efficacious, yon introduce one of the polva into the anuH, and pam
the other hack and forth over the alKlominnl walK 1 sliall have more to
any on this cnhject in anothur clmptor."

Tliere are, lastl;::. purgative i«ul>>itanceB which aci by a n)qphaQi<3il
ejact, and to this group U'lung the nils and white mnrtnnt neede.
'l^'hite mortard seed woh formerly rerr mnch in TOgiie in the treatment
of eonstipution. It was highly vaunted by Cullen and Marmtan, and in
18'iti a fanatic by the name of John Taylor travelled extenoively over tho
worW, proclaiming the nnti-cottive virtne of this seed. I*tterly. how-
vrer, the reputation of this orucifcr has materially Mlon. White mustard
■M»d, which may luire a real purgutivc a(--tion, has also its inconvenienooa;
it sometimes accnmulatvH in tliu (]ig««tlve tube, and has men formed com-
plct m»ann in the lower part of the »niall inlestiiieis oausing occluition.

Beptldiate tlien tho usu of iheM; gmiiis, as Well as the employ of all
Omno foreign bodies which the lower claaws mmetiraea swallow in order
in obtain purgative effects. Keiriembi'r tlie fact wliii'h took plaoe in the
lerviuu of Potain: a man died in couMequence of saturnine eucvpbaloputliy

oHiiaed by ImlUr of lettd wliicli lie bad Bv&lk>wud from time to time under
prL'U'Xt of cWring lii* digi-Atire tub& Ho preunidwl Uiat lie kept exaci
iw.nauni of t\w entmiioe luid exit of these IiiiIIh, and oonsMinently not oiie
ixjuld lavo WMnaincd in his intwitinc. 'I'ho flutopey «howe<l th»t hi»
reckuiiing wiks nt fault Tlioru were, in fact, found in the stomach seven-
Uwn of iheite halltt whotK! prt'jt(.'ut.i' Iisd di-teriniiied lead puiKuniiig. Tim
caw reminds me of the famous " per|>etuul pills" formerly employed, and
which when awallowod produced a pargative effect leading to the oxpul-
sion of the pill which srted «imply mcwhaninal ly ; the liirter, when r&-
covLTL-d, might nerve i^niiu tlif aamu jiurjKisu,, and waa often handed down
Ijy inheritance in certain families.

Of much moro importance are the fatty purgativea. Oil, whatryer
may ho itn origin and ita natiiro, if taken in great nluindnnee is not eom-
pk-loly tniiitiformud by the jtancrtsitio juioe, but intts a& a foreign body,
^anitiiig & \<K-a\ disturbance, which c:(cite8 tho inti^-stiiial accretion and leads
to u purgiitive effet^t,

(Wtnv oil is the tj-pe of purgntivc oils. It ia a mild laxative cathartic,
M-ldum griping, luid one that renders gr«at Hervitip. Yon know what a
marked diifarenf^ there is between the fruit of tho ricinusaud the oil
which i» extracted from it. Tempted by the enticing ssjwci of theae secdR
(wliich roaonihlo certain bootk-e), and supiMjMiitg that the seeds would have
the mme mild purgative effect as the oil, jiefHunR luivo now and then euten
tliese seedB, only to suffer grave disorders and even jwisoning therefrom.
Th« seeds, in (not, contain a very energetic and very acrid drastic prin*
eiple."

The castor oil obtained nt the prewnl day in of excellent fjiiality, and
thanks to the iiiiprovenw'iiU niudu in its faliriealian, is not dilli<'ult U* take;
it is ill fact fai- different from tlie oiix of a former (hiy whose taste aiid
whose odor were so repugnant. Add, nioreover, that its mode of ailmin-
istraticn hue been improved and tliat tlic combination ol the oil with
strong coffee or with onion wmp* renders it mnro |utiiLtubte and moreensily
borne, even by deheatti KloinocliH. You can alao completely mask th«
tiu4e of castor oil by giving it tn emulsion; the following is a good formula:

Take of:

CuRtor oil, ....
I'ulv. ueitciat,
lV*P|K'rmint water,

•V"'!'

M. Do»e — one to four ounces.

While the nrdinary do«e is alwnit an ounce, it seems to be a fact that
even in a smaller dose (two to four teasjxionfuls) it purges relatively an
much »a in the larger doses.

Si-

(grammcH

XXX.)

3n.

(

It

viii.)

3ij»3

\

It

lUT.)

:'■

tt

XXX.)

gACCHAKINK, DKABTIO AND STEOHANICAL PURGATIVES.

I Itftve Dou- finbhofl tliin long und pt^rliaps tiresome enurm^ration of
pur;gntiTei>, imd the dc^taiU into which I hnvn ent«ri><l will j^wrmit me to
\k brief ill the iitat4.-meiit uf thu In-utmuiit of voiiiiti|mtion. Voii iiotv now
tli« rich arwnal of i-cmoclius whwh tliompnutioa rnrnixlu'H, aiiJ from vrliirh
yoa. o&n draw- wcnpoiu to comhat coimtip&tioii ; I bIihU uow compbto this
r lecture with eoine hints as to thi^ trnatnieiit of this affection.
^ From 11 thumin-iitic point uf vir-w, i^onstiiiatioii not only authorizes tho
tiiTiHionR which we hav« cjtmbliahccl, but it also preaenbt itself niidor two
quite ditfurciitaisiwctB: Boniotiiiu'B tho coiititijiutiuii is only a |Jttaaiiig inei-
(lent, (niised, it may be, hy a cliange of diet, by c^i'tairi medicinal or toxic
eiilMitancett, as in Iriul^poiisoikJiig. or hy tiuitioroiiH othnr circittnstiitictia —

EUu8 is a( yidt?ot»l cfta atiiJotioii; titirnvtimcsitisapurtof Ihu individual tcm-
ppr8mi>nt, boin^ n constitutional peculiarity, and utiU^bs remedied Iii:^u for
months and yeans, or even a. wFole lifetimp; this in lutbitii ul coiistijm itm.
— Ill accideiita] uonutipatiou, you can draw freely froui tlie whole group
of purgativet^ The sahnes, oily purgatives, and even the drastics inay Im
nsed, care being always Uilscn to grade the intensity of the remedy to the
obstinacy of the conBtipution. You can vary the In^atnient by iavemente,
firat einiple, then purgative. These latter, when the iiieL-hanicsl action of
the water ia asaoclated with tlie local irritant effect of certain purgativu
nibstances, is an oxcolleiit thoi-apuutic means, but it often fails.
Then oome tlio mild purgntivoe, saline and oily and Baccharino, utd
hwtly the draxtjcs; the hitter are rcHcrved for certain toxic constipations,
_ much as are due to leml |ioisoning. where, in order to overcome the con-
etipfttion, yon will be obliged to rewrt to the most violent drastics, eiich
•8 croion oil, which you will administor in doeo of one drop, cither iu pill
or with castor oil. When the leml conRtipation iii ovenriime, you can, us
you often see me do, nmke use of a prei>aration wiiitrU rwidily pn>riot«i
Cn^om of tlio IkiwcIs, in thei*e cases of lead colic — I refer to the /lonei/ a/
euiphur (intl iulphurU), a mixture of c<^iiAt )}artd of flowers of tnilphur
and of houoy. Thin mixtnre, which may bo given in greiit-s[»oonf«l dogwB,
u jHilatahle and constitutes a well tolerated and admirable laxative.

To these purgatives I may add a drug very much employed in tho
U&itod Stat«B, the (hmcam Kmjrada, or. In give the Imtanical term, the
Jthatii9uii Purnhiniitt, the family of which already fumislu'* to thent[M>n t ics
the hucitlhorn (JihajTin 119 Caihnrliruii), a dniatie purgative. This pnrgu-
tivo is gireu in the form of jjuwder of the hark in the dose of six giuiiu
in capaales, or in that of the cxtracL My pupil. Dr. Eymeri, has devoted
to tho study of this plant a rcrj- interesting thesis.'*

In liafaitual oonicti|)ntion, attention In hygiene olaimx the tint place.
You should, moreover, endeavor, tiefore dec-idlng upon your treatment, to
fathom the [tnthogeny of the const i|itttion. If it be due to want of mus-
cular contractility, as in the cu»f of artliritio dyspepsia, or even of certain
ikcuropnthitii which are attended with a jiarcn^ alTocting not oul.v tiii*

29R

DISEASES OF THE STOMACH.

mnscnlftr coat of the Rtomnch liiic hIw that of the ontin digortivo tabe,
vou will vmplojr the muacnlar purgHtives, or oven certain of the- dntstic
Ymi muT pTeii adviwila^ously ivsiiTt in theae oum t<p electricity.

V^Hien, on the other band, the constipation is due to a want of iDte»>?
tinnl wcTPtion, yon will omplov the apjiropristc purgstJTee, nnnoniliering
tliiit it is often by minute tlow-s frwjnently repeated that yon will rucc
iti triiimphiii^ orvr th« mriittiptition. Rtit nhiit it is neoMmn* t« uvoiii
thv |iroloiij^ tiw of drastics, which arc only Vaofioiid in preparing the
vay for other nipalieations.

In fact, in tnany caami. in order to obtain tho first catharsis and get
the bowcb to act at all. wl> are obliged to employ th« most violent pnrga^
tiTco, bat when oni*e we ban- attained onr end. wc mart retnrn to the
milder laiatit-e*, from fear of irritating the intoitiiies and determining^
emeriti B.

Thus far I have consideml only tbom* forms of eomtipation whieh,,
arr dctrnnincd by want of Bccprtion cir by want of mracnlar oontmctilitf,!
leaving one eide that which is due to mecfauiical obstrncttou.

I pmpoM> in Uie nest chapter to rtody this fgtn of ootietipation, vliic)
requirm a special tnatmenL

NOTES TO LECTURE XX.

'MuilM istfaeconerete jaieoof twocpveiataf (lsximi^both1
Mntbem Kirope. Whon the rouiu; tree as it0] a aipltag of
•ad ite stMO has a thickaesB of ai nst three indiGar tnuHra
M* nade in the bark, and a jske ooaea, which, being oollBeted and driid
Ml lAiba, coBrtitPlw taar m ibto aamia. The manna which fi»w« fn>m
tBCMtoaaanHrlUaftritgilUMriBecoiiereieeiii kttio fn^rawnuoo ibetm.
eoBstitatniR what hat bna ealkd liUb nauu^ (p**itB nanne.)

MiiiiM niwiliia at ocdiBarr Ui m p t n t a n i> *a puts at wasor.

The MTMt is that luad Ifafce BuiH. vfaie^ ii Qw «■• w Uw
in tear* before spoken ef : cm — M Wl —una (mtmm tm mrti^ nl the
pkanaaer is next in quality, bat is bhw or hm mkad wiA tan
anl ia lwB(n-. Fat manna, eoUacUd lattria tWaaiaas. iaai
■Mi; Terr artire, bat very iliaaniriMn to t^ taata. Tfaa b«k
mmnwRv cootaina frDm aervntr to eigfatr per rmL of Manatte (C
sngar, a iMmons aad aeid matter, an axoiinid Bnb6tance^. and aa ~

m«tt«r, wsler aad asbca. Mannit* is locnd, not mir m . _

whieh it was RSCtHslMl far tha fii^ ti— W P l uii a * m \9m, bt afannia
hi]ge nnaiber of v«gcta)iiM: ce fa cy,^ "gp^ « iTe» | i im i gr— at i tnrk.<
fiwa roM^ etc. SUanita ia a b e n ftwa i c aloohol, as BestMot has i

* n g— T iai w w .ll dbeflrsf duirugviuaa gfaeoaa, a( aM»
«| iavarteil svar: it ponHHa. btmAm. amnl tnt

pi iw iiihs TiTTinf -iTti T*" 1 '*-' * ' " Smmtkimtt^

annka airi mme an af a ilu|i hta'WB c«iar.

IK MB far j ii a aliiii jmrfoam. mad mmm m tka laM af

SACCIIAJtIXK, DHASTIO AND JIKCM AK^ICAL PfBOATIVBJ. 20^

mMlipnmcntf^ tlie mvh nnil oxymelfi. Tho prepnraLiona in whioli lioiK'y'
and viin^r arc combined arecalM oxymel^ The moU uri> (r.S.l*U.)
tho mei depuniltiin. or cliiritltni liont-j, met rosa.-, or olic lioucy of mux,
mel boraciK, or the hiinty vS borux; thw oxyuiols ure couunoQ oxymel and
the oxymol ei^ills.

' Cejma fistiiln is » in«iobor of the leguminoiae. It in a natiro of Upper
E^pi>t ftfid Indiiu Thcrausift trw* atttiim to InrgoNzoiind tlio hciight or -10
or 50 focL T1j» fruit. wUu-li cuiiUuiis tlit- offiuinul {urt. Ganiastsot long
cylindrical, diirk brown ix:iuliiIou« i)odM; thcet- ari* u foot or more in
Icnffth, 1«GU thun tin inch thi<!k, witli b wtiody ahell. Internally the ^kmI
is tuvided into numerous CC'IU by thin trAQsverae M-pta, n-Liicli arc covered
witli a Koft blot^'k |)ulp. £ach cell coiititine a 3in;;le ovul ifliliiiiif; m-w1,
Tilt' pul[i is ej:lruL-tud from tin* potls by tlret bruising thi'iil. tltun boiling
them in water, and aft^rwiirds oraporating the docootion. or, when tho
pods arc fmiih, by opening them at the Autnrce and renKiving the pulp by
» spatula. (U. S. I>i9j>en8atnry.)

('omia pulp hiu a sicklv mlor nnd a awootJsh mucilaginous taote- Ac-
cording to Viu|uelin and llcnry, it troittains eugar, gum. b Riibstanco anol-
(^iis to tannin, glntim, water, nnd a coloring matter notnblc in. i>the-r.

[In thiR conntry caiciia is iM>]itom prcwritMx) oxcrpt nn an ingrtHlient in
the coiifoction of ecnna. which wc give in place of the compTex forcipn
prti(juruti«nB mi-'rittonttl in the author's notes, many of the corn}iuuoi)tit
of which could not eawly be obtaiiiwl in the Unitwd Statwu.]

CoKFECTio Senk-e, U.S., Br. — LtnitUv Electuartf,

" Take of sennft in Hue jwwder. eight troy ouiiocb: tamariiiJ. ten troy
oanoM; ooriandwr. in fiuu |KJwdt'r. four troy ouhom; purging nutsia, fiiielv
faniaed, sixteen troyouncen; pninoH, elicod, sevon troy ouiicm: ligii, brniEUif,
twelve troyonnoes; eiigar in cotinte jwwder, thirty troy ouiiceit; water a suf-
ficient quantity. Digest in a rlose ve»K*l, by meiinx of a water liath. tli^
E urging easHiH, tamiinnd, ^iriincr and Hg in ttiree piuu of uat^^r for three
our«. Separate tlie courser portions with tho liund and luss the pulpy nia^,
by nibbing, Hrat through a coarjar hiiir sieve, and then tlirnuKh a fine one ar
a miiHlin cinth. Mi it the reHiduo witha. pint of vnlei'. and htiriTi|rdigivt«<d
tlie mixture for a Bhort time, treat it as before, and add thf- product to tho
pulpy h<|uid llntt obtikinetl. EYa|K>rAtc the whole until it wuiglie uinety-
■tx troy ouucea or until it has lieeu brought to the ooii(ii»(*iu*y of honey.
Ijtatly. add the Eenua and coriander and iurorporatu them tlioroughlv with
tJ»e other ingredient* while yet warm." Under tho name of meificatisl
pruDcv » confection is prepared by mixing pruncft with a strong infunioii
of senna, adding cugar and ovapornting to tho consiatenou oi a [Ufite.
^nna jwste <-onfiista of ^^ and i>ofracrod Mnua beaten together und
ciirercd with granulateil wi^ar.

Tlie following prescription from Beamier contain)^ camia: Take of cueaia
pulp, one troyoancc; hitartrat^t of ]w>l;ui)i. two draohnid; cinnamon water.
ihrco flaid ouncv»: mannu. one and one half druckma; mix, and give a
I b^Mpoonful ever)* two hours till it opemtea.

^H 'The tAmarind m the pretvrved fruit of Tamarindus Indica. This is
^^ B tree of the k-guriiinoKe. grooving in the tndias. It ia a tree which risea
L to a gnmt height (i^ to :ij niutivd): Ihu fniit \» a yoA frora two to aix
^K ibrlitM long, and about as thick as the fin^r, a»h colorvtl, much curved,
^H witt) uumeroua quadrongnhir weds, contained iu uulla fonncil by a tough

N

DISKAgEB OF THK STOMACIf.

niL-mbrauo. Exterior to thia mcmbmric is s lixht^colorwl anJ polpr
uialtw, which is tl»* mrt ymploywi in iiu'dieiiie- Anconling to Vaii(|iu*liii"s
aniUj^is, LUU parts of the pnip contain 9.W of citric a^iA, 1.55 of tartaric
acid, 0.45 of mnlic: ociii, '•i.'i!> of cream of tartar, 4.71] of gum, G.35 of jelly,
34. 3i of pareiirliTmatoim R»ttt«r, and 27.5.^ of water.

Then* tiro iu comiiiorco two kinds of tamariuds: tlib one, prcsorviMl in
Bne&r or molnssi-s. is tin.' brown or red bimiiritKi of the VTc!)^ Indies; the
othor, prcwried witiioiit migar, is t\w Mark tamarind of tlie Eiwt ludit-s;
it is tlio pulp of thi* Itittei- wliioli ig chieflv iined in mMicin*".

In the Unitwl Stntcs tamarinda arc wldoni prescrilxKl except in the
form of tuiniiritid water (wliieli in an infusion of the tuiimrtnd nnd is an
acrreeiibin !U)id diinli in feviTs) and the c-onloL-tion of iwnna. alxjve given.
Tiio au(ht>r jfivt'ii in tlio notoa of the Freuub udition a purgative electoarr
of tiiumriud prufiurcd as follows:

l^ke of:

Tamnrind pulp, 10 parts.

Crwvm «f tartar, I }>art.

Ilorhi-llt' flultA. 'i parts.

Manna in tetxiv^ 4 *'

8ynip i>f judo tojwr 8 **

Mix. l>osL' — Half tin ounce to an ounce.

' In a work on the altvmtionH of niioimd, VeniRti (Oomptea Rond. d*> la
Soa, MC'd. dc I'lsi-re. lb'7U) lias aliowii lliat »ii^r in contact with this mdt
does not undergo d(-(-oni|toiiition. It is tlic same with acids; citric acid
after tlfU'cn rlavs of contact with calomel did not nioilify it, nor did
chloride of eodiuin liavo tlio k>a«t action upon it, oven in tho presence of
albtinien. Anivirding to this anthoritj. proto-chioridc of mercury ie more
titabte than is mmally miii|K»ied. luid tlie tiirhtoridu more easily btrooniee
ohlorido than the chloriuc undcrgoon trnnsformiktion into corrouve Kubli-
niut4-,

Ithuharb (for dracription of which aoo U. B. I>is[R'nffltorv) contains
rlnil)!irliiiriracid, tannic and gillie acidii. extraetive inattRT, nnciystalli»ii)I«<
^uf^r, Htaruh and jinmniy extractive, nialate and o^ialatc of lime, a yellow
cryutal iixabtu Htib»ttiiii'c. rL-!<iii, oxide of iran, and other tMibstances,

Accortline to IIil- roKearcht'xof Kublv. rhnbarb conliiirw rheotanic and
rheutnic aci«Ve, u ooIorlcHs snlistance plieoretino, chry^ophaiiic acid, and
a pectic matter. The Chinese and IVrsian rhub&rhe are the beat; the
EiirojH^aii rluiljurbs not Ix-infc balf a« active,

Uiinbarb wlien rousted loses itgcathartie property, but bocomes more
Bfitriiigent. Tlitt pill, syru]), llncturcK, comi^ound powder, i))Tup8 and
wini's of rhnbarb are all officinal and unoful prcparntions. Tho infnEfion,
especiallv when iniulo with tho addition of cardamoniH, in a very excellent
vtomachlc laxative.

'Podophyllum poltalum ia a perennial plant of tbefiimny BorberidaCMP,
which grows in North .\merica The parts employed are the rhizomes
and roots; a resin i« I'vtraetecl called podcplivlbn, which pi-escnts itacif
under tho juii)wt of u biillinnt'powilcr ticprived of cryRtallino appearnneo,
of a yelliiwiBn brown color and acrid and tiitter taste.

According to Mujur of New York. U'aides thie rutiin, puduphyllin coo-
minH berberine a colorless alkaloid, u Bpeeiul acid, an odoroua matter imd
RHponiiie.

SACCIIABIKK, DKAHTIO AND JIKCllAKICAL rKROATIVMiJ. iWl

The n>gin in mluMe in alcnliol, etlior, tlio cas«ntuiJ oils, bisulphide of
II. mid in part in tlio nDciilifH,

In ttw <lot« uf from i to 1 gniiii podopliylliu prorok«a rogular stooU
10 to 12 bourn after its aJmiimlmtimi,

[Tbe larger doses of I to *J graiua are Ukely t« produce nnusea aud
Tomitiiig, 08 well as colii;.]

TrotiB4«»u*8 and Blondcau's iiillB conciKt piicIi of potiopliyllin gr. i;
extract of belliuionnn gr. } ; powaor of Ix'lliwlonnn root, gr. J; 'o)io or two
eiiph i)illH to Ih-' gisi;n pcT djiy. Van-dr-Corput's [nlU consist of jMHio-
pliylliti, ^t^ J, Cnxtile tmitp, gr. ^, in eiinh }>i]l: thoiw uf UonsUintiu 1*11111
contain niich ^ gr. of podupbytlin, with as much powdenKl gtiigvr and a
little Uou«y.*

* Aloes iR a bitter jnice fiimialtt-^ll liy niinierotisifpccicBof o/us (liliaoete),
originating for tlie nifwt part in Rontheni and wyKtern Africa.

w hen it i» dwirtni to obtain this prwdiRt, the \va\ea are plaokod near
tlicKtcrnuiid plan-d in {;uut t>kiiis. into wliiuh the juice isallowo) to vxudi';
it is thmi in8j)is»it4j<1 by iirtillcial lieat in iron caiildrou& Th« follow-
ing liiNM'ieu ruriiiub thu hUk-'D of t.'omiui<rL'Li:

1. Su(;otrinc aloes (from Bombay, KfuA ludicii, or Zanzibar.) Deep
brownish rcti color and disagreeable odor,

2. Common aloos (Dnrbmlocs, Curacao). A dry, hard, cliooolato-hroWD
sulwtoileo witli clean, waxy fmctnpc

a. AlocB fenix, wlii»-h lurniahL-s t!io Capo aloi'«. I )ark olive or jrrecnish
color, approaching bo black; prnsitntH a smooth, bright, ulniuiit glum^* sur-
face; nowder is oi a line greenish yellow oulor; its odor ia atroug and dia<
agrecttutc

4. African aloes, wliicli is of littlo activity.

5, Artioruscont aloes.
Tlie juice of aloes, of a disagroeable saTor and odor, owes ita o<lor to

a volatile oil. Aloea is soluble iu alrnhol, insoluble in chlontform ; pnt in
warm water it diiMoh-es, but there aeparates from the solution a browiiiith
mat)8 fonned of rennong drops conotituting wlwt ha^i \iwn enlleil the trsin
ofalitea; theaolnble portion has bct-n culled the bitfrr t>f afoea, or alotiittc.

The bitter prinHplo of aloes in a cryslallino substance, iiioine, fnjm
which liave bfcu extraoLed bnlxiinin, iiatdhin, and maihin.

Aloes i6 proeoribed M an aperient and purgative. In the doio of 7 to
t5 grains it acts gently in Sto or six hours, (:au)*iii<^ dinrrbtoio atOoU with
ovacnation of bile; it at the same time n>t8 up an irritation and congos-
tJon in the lower part of the rectum, and in the fenuilo a eongMtioii of
tlio nti.-ruN. In larj^^r doe(e» aloes may prwluce, Ixodes abnndimt stoola,
general enfe«bleniunt with a fall in the pulw and tempera tiim.

Aloea is given along with pinitogt', (tn»mmoiiy, oolomol, myrrh, otfl.
To render it leso irritant, it may be associatoii with extract of hyWyamas
(24 gr^ to 13 of aloes), with rhubarb or with sulphatu of iron.

RnrbndfK'H alnp« \^ given in one fifth the done of ('a[x> aSoes. Tho
ofBcinal preiBirationB of aloes are numt^ronii. (Si>e U. S. IW-iiwHratorv.)
A iisi-ful InTemeiii is made by steeping 3 i»ii aloes with a half impenai

^Constaatla PnuL Od the TraaUtiiml ot Huliltiui] CinwUpatiuii bj I'odoptijrl-
lin, Boo. da Thfp, A;>ril, 1^3. Marvliiud. Now R«*ciiurh4<s on Fo<lopli,vllia,
Bull. d« Tlier.. t. Ixxsvii.. 1874, p. lU.

3U;.' DIBKAS^ OF niX 8TOMA0n.

pint of decocttou of oats; &u|>poiii lories wilh I gramino aIoc< to 10 of cacao
miltor luit aim mmotimoa tiaii) to combat conallpftiion.

DiS'KKK PlLLB. {Pitulif ante vibiim.) (Lady WebsU-r.)
Tukv of:

Soootrino hIoob 48 gnina,

Miietic 12 "

R«l POBB . . . . . . . 12 "

Ik<nt tlu'm iiilo & nuut witb water, and diride into 24 pills, lloa?—
1 h) I) pillti.

Scotch Pills. (AHJermm's PUls.)
Take of:

Harbadoes aloea, H oentigmnis.

(lamlxiec a

Kmm-iico of Hiitae. 4 luUligranw.

lloiioy, 4 ovnUgnuns.

Mix (i>r onw pill. Dose — 3 to 6.

TliK Pit. Ilhm Vet. mid tlio I*iL Aloes et Myirhtiv ore old srtd famom
cntluirti<> iMinUiiAtiutiK.

Till' Comp. tlHoture of aloes or linfture ef long lif* of the Codex b
nuwU* by imux'ratiue togothvr Cape aloe», gentiao rtrnt. rhubarb mot,
udoary. unfTron. whjto agaric (polnwriis officinalis), tht-riac and aluoliol.
Tli« vnrioiu) pilU of aloiM of X\\e Ir^nch Codox do not matorialW dtffor
from those ol tho V, S. Ph. The CoiiPorsD Dkooctios of tho U. fe. Ph.,
whioh is not pTcn in tho ('ndoi. is a very usrful laLative pn*paration in
tbi' itnM' (tf « (>oi)pit> of tJibleK]K»nfuls at lied titnp. In thin decoction the
itotivfv prinoipU^ of the alooa are kept sotabl« by tn«a]» of an alkaline car-
buimt*-. and tlir Unotnro of cardamoms pvve it a cordial propertT. 'Vhv
ViM'M AiA»K8 i»H «-arm stomxrhic lasativi'. and thi- tiiictnrva are erametia-
^•^to as vpI) as ptiryntivi-: tbv tiiicturo of aloee and myrrli ia a deservedly
|to|mUr (Mvjwratiou.

* Sontta tor ratlKT i%t wnmm) ramea from a pmak nnmber ol species,
(caaua anilifoUa. ultot-ala. an^stifnliaV. vhxmf Inflate an? mixed with the
h«n» of a i^Hnt of Uu> tamily of apoi'ynaew, amol, (cjnancham aiipicl);
tb)» mi\tut\- is mM ttodcr lliv uahw ot Wnc Jr t» jmUtm, a tauiM denrinl
fron au impiul formertj kud apon it br the OUooun iWic. Pfaannacy
dietnt^ishoa atso wnvtiea «l amaa bj tlMir nun-H>: (the Snian^ lodiaii,
Italam, ^twyat aix) Tripoli aetUMS, Mc). Tbe laaves oC ttua kguttiaous
pkuif are fonxtA in nmnKTv-v' mixed vilh the potb.

Srcina n<«itiuiis an acti^v [vinnple, ttUmrlimt, vliicfa Ins bam giraii
In the tl«to«< itf 10 tu )^ <vtiUj:Tum3i aa a panatink

cim w >be fiuailiar lufttttOB of «mibb and fiafrr to wkielk E|ao«i nlta ia
aiiiM a^cr tlte iiifnMa ia AnuMmL Tbe folk»«in|[ {tram tW V. & !>ia-
pMMtttvMrrk w a ]e»*l tonwita ft>r m«m tea: lUc* o( mam, ImU an oasae*
auhiiatoof ■HKikraia a»d OHuanai, <)f ewr^ aa owkt; fcHHlandadiadiB;
baiway iniM-. half a pint. ^KViktv ia a contvd rttauk tS tha Ii(|nid
tm\l l.^vM' tbtivl uny Iw fpvi-a tat m ^nw^ aod tvMMfd evtrr (mbt or fiw
Iravn lAl it «H<vinMc«. TKe I-YmkIi l\>dM sababbitrB tilaafacr aalta tor
llwKM«,aBaW»«dwr^ttbw«^ TV^Tinaa llMal»*of ttaCo^MM
M«w&U;th*aMa»aatk» laitataaaC Shm^ tW C. & Pb., with th»
«Uitia» il «lK(ii WaMK. (usiagr. Milifc aiHl Mi^lMto «f aftia:

8iilpliatc nT soda, . . . . [■ . .of eaoli,

pRrslev lenvim, . . . . )

AnUo and Coriander seode, , , o( each, gr. Iixv.

Water, Oil.

Sliced lemon, "So. 1.
MaiM*raU* 'i4 lioiirs, atirring from tirro to tira«, oxpreao and filter.
Doat^— a wiiif^lassful."

'I'Le " MHeciue do Xajralpoti," imjierial uttMn, oontnins infusion of
SL'nna with i;n>am of tai-lar, turtar ^inctio ami HUgru*, (eooli quart of tlu*
iufiisioii would contain about i grain of tartar emetic iiiiii uii outici- 'of
en-am (if tartar; to ^H^. twkiMi honrlv in tuiriblt-rfiiU till trw purgation.)
Tlie MiHtiim St'iniiv Co. of thi> B. Tli., liiu^ Kpaum lOilis. (txtnurt of
I iiquoriw, tinntnn' nf wiiiin, lyvmn. tin^turo of cardamoms, and infusion of
i wuua, and in a popului' and cxculk-nt preparation.

I "nie origiiiat fornmlu of the " imporial ptiaiii," preawihed by Cor-

I rimrt, is aa roilowB (cr(»iti of turtar being ruplaood bv thr> ncutml tartrate):
l^ "ftike of:
^^H Noutrn! turlmto of ]>otaH«i. 30 grummcR

^H Tartar emetic, '.'.1 miligrainDic-^

^^m Siuor, TiO ^rnimmei*.

^^ Infnsion of (u-nna, . ItMHt "

PibroItp and filter. Dow — a ftmall glawrfnl every half hour or hour
till purging «nsuw.

"Turpi'ili I* tb« root of Ipoma-a Turpotbnm, an Indian plant. It li»«
an enorpiaio purgative action, du« to tbo reMinoun juice which it oontaing;
tUia rc^iu contains an active principle tttrpethine. The do&e is about tho
fismo as that of jalap.

" Jalap i^ the tutwrous nxtt of thpIi>omKa Pui^,a Moxican plant. It
nontatns a [tertiliar renin wliii'h n its iictivo principle. Jalap w an actir&
dra8tic cathartic, nmilucing oopiourt walvrv stools BiMng hjtlnijjojn"'. it
'» much ii) use in (iro^mifM. Th<* do^ h from 1^ to '.iO grainit: of the n^'iit
from 4 to 8 grains. A good old-fiuliioiii'd purgu oonsiiits of valomul &
gnun?, jidap 15 graitiB.

Tlie officinal pr«pamtion» are tho rxirarl, the com/wwm/ fjicii^r, the
jtuh'iit M-Jimmiinii fh., thy rrxin, and thi' linfSurt, Tli« cotttjioinid /M/te-
4«r ontains I part jaliin to 2 of orcain of tartar, and i& much used in
dro{Hd<ml rumplaints. Tbi; rmupuuMii tincture of tbo (jemian 111. ia olw
a jxipiilnr hvdraguguu purgative. It is uiiide at< follows;
Take of:

Jalap root, 8 |Brta.

Turpetb root I part.

Scaounony, 3 [xirtM.

Alcoliol 96 "

Mix, macentto for 10 dayti and Alter. Doeo — ono or two tabl(Ht|H>onfnl>i,

**8camiiiODy is th« concrete juicv of the root of CoavolvnlDs Scam-

monia, a Syrian plant. It i^ a |K>vcrfnl dnutic purguliTt*: is mort! artire
and ItMt uiiploasint ttmn jiikp. 'Dil- duw is j to lU graimL The ofllcinal
I'r.'ioiraiioiiK are the Ont/ectiau, tlio Fii, (Mocya/h Ca. the I'uleu Hcattt-
timiiii (At, uiid llio rcain.

304

UlBKASm or THE 8T0MACU.

" Colocyntli in tho dcoorlicttt^fl fruit of ciiciimis colocynthis. nii Orien-
tal |ilHnt. Coti>o\iithin is the active urinciplu. Colooynth U h ilntstic
pur^ttro, in Urge (loet-* ptwlufing vLolont irritation, )mrginy, romiting,
cramps und colic. The (^nnpouud eztrarl is a fuvonte proparation: it
contains rolocytitli, oloos, Kcanitnony, ran)amom><, and goap; it is lui eoer-
gftio find «afi> mthartio in tlw dn*? from .'■ to 30 pminB,

The ooini)uum] cutbsrtio pills contain tbi» extract combined with
oatoincl, piiiiiiogi% and jjilup, i'ho compumui cdocynih pit! of thu K. I'Il
oontainK cMlocyiitli. alovs, Hr&mmony, sulphtite potanh, and oil of cloves.
Tlw ftiJl iff cofurifnth and hyoacyamm contoins the above, with thu addition
af_oxt. hyoec>-Hinufl to provont griping.

" FUt^'riiim is the concretf jnicp of the fmit of thn MoinordicB elat«-
rium (wild nu-iimlier), a pliiiit of tjonthi'm P'ninrn. The active principle
in flalfrinr- Elattfrium is a v^ry poweiful drastic cathartic, aoldom prv
ecritx-d except hi dro]isical alFootionB, I'ho dose is from ^t Ut \ nvin.
A gooil u'liv to administer iilHtoHiim is to onK-r 1 j;nLiii to be tliTidou into
Hi pillif! gfvf Olio pill vwry hour till active purgaliuii ri-eults.

'* CaTAponA, tliv linuilian pur^, though nkuch u»ed in South America,
U not given in thu United Statea.

"Crotrtii tigliiim is a tnt- 5 or 6 motnw in height which grows in the
I-^ifit Indies, C'cyioii, and MolIueoL It funiislics seeds [tirana .\foiftutr4i,
gmna tiffUi) coiitaimtl in a cH|Miule the size of a hazel nuL Thn npcds
contain i» liswl nil imd crotunic acid, a volatile oil. a yollow-brown rc*in,
wax. elf. The oil is obtained by criiisbirif; ami exprct<aion. or by ether,
IiigMUtl it causes an acrid sensttion in tht: (K'ajpluucuH and a kcom! of beat
in th« fltonuLch, then follow nuuwu. mmetimes vomiting, then griping
miue and nuiurroua c^-acuutiont. in largo doeee it is powerfully toxic.
Tho dose \» one or two dropa.

"Induction etirtviitu apptietl tlinx'tly to thu intetttitut! caiuK.' a contrac-
tion in tho inimetltatv ncighlwrbooil of the cluctrwdes; between the cUt-
trodcK tliero ts relaxattOQ ot the waUe.

The ^xinriant cnrreiits abolish tho i^riotaltic morementa and cauM a
dimintitiiMi of teiii^ion. The current follows the normal direction of tho
ino^cnH<tit«. or, it it be rcvenied, caOKw aiigmvittaticm of the eontractiotUL

KKvtrixation of tlic Rpinal cord by constant ciirrvnts aofnieats notably
Ui« iM-ristaltio eontnu^tioiu at the montcnt of tUetr application.

Imliiction eum'iitsappliwl over the splanchnica augmeDt the t«n«oa
without determining jvnstaltie moTvnenta.

t'on.4taul eurrv-nt» evfr tho spLaaehnios gire rtee to perurtaltio contnc-
tkituk KlivtrtMUon of tho nemHU lUexusee and mnoitenc nesres pn>-
dncec ainular eff«ots.

Inierrupti.\l onnvttt« in thf direction of tlte paenntogagtrics catue a
dilatation of the intcvtiiMw ami «rr«4 of Uteir DtovMnents; this pbeaonw-
nou takm place hy nAex actM*. They pndDcv dinrOyp on the otlicr
hand, connartiou of the tixaatA,

Coni*aut Btodfint^ currvati vnr tfat ■■■■—■■liiiiii ^v« littla «ffeat
on tbo intnanw; they acroA th* mtnml «r patnokifioal ooatncliaiiB of
tWitonack.*

SAUCUAKINK, DUA6TIC AUD M£CIlA2fICAL PCBeATIVJ

30r>

Tlio

"CtLBtor oil 18 obtAinetl from tV seoils of Q\e ricf nn* eomtnunu, »
memlwr of the E«nhorbict*re, u niitivo nf Intliaiind Africa. The rtuinns
liafl lj«vn <:u]tiTatca in France, wh<n-o it ia a shrub attaining tlie height of
abont ax tet't. tn India the ricinuH or jmlma Cfirin/t tsa trt)e, sotnetinKM
rising to the height of :iO ur 40 fni>t. \'\w fniit ir » three-ceUed capsule,
cOTorvd with tspiuus; cucli li-II coiituius u biuuU oval cumprue«cil Wan, tlio
analyniM of which givw; rcaiii. ostnictivc malu-r. gum. (in llic inte^-^
mpnts), a fatty mutter (oil). 4'u»L'in. atbuuicn, ligntiOUK niiitt^-r, and atoroh
(in the kcmol). Aocoming to Peroiru, tlicre U also a bitter aand prinoi-
plc The 8l-»;iJb iiru not employed in nieJiciue, as tliey jwsscaa too encr-
gutic draKtic projH^rlti'K,

111© oil ia obtained by enpreBsion or by exhansting the accda with boil-
ing water. Tiisson, in 18(il. extracted from the seeds by boiling water a
cryetJilline alkaloid which he caHcd riciniae.

Tho ordinary do^ of uietor oil i*; iLcouplu of lableepoonfuls. Tho un-
pl«a«aiit tuEbe o^ this ]>urgativc may bo [>artly diu^'uiseii by adminit^turing
it with nrungo or lemon jiiirB, in hot hroth, in oofTef?, or pi*i>prTiiiint
water. The fiancel givns tin* following piiliitable method: Tiiki; an oruiigi*,
divide into two rqniil parts, Rrpicrze the jnirn of one half into a cap, and
uoiir thu oil over it, Llirii lmvct it wiUi thu juice of the otlicr lialf. "^'"^
loltuwing \a a guud catUartic ilnLiijjbt.

Take of:

Castor oil, 3 vi.

Pcpperiniiil water, 3 X.

Vit*lli ori, Xo, L

Mil — one do»e.

''[Among the nargutive laveincntii given in the author'a' notcit, tliu
following is selected:

Take of:

Sulphate of mtU, 1 ounce.

Honpv (or mnlnnws), I "

Inftuion of scnan ) pjut.

H. For a cuthurliK hivement]

The {\UKara Sat/mda (rliuMiius piirshiana. ^o-called aftitr Frudoriok
Pnreb, the (it-mian t)otanist who fintt di-i^oribiHi it in 1B14] lieloiigs to tho
family of Rliauiiiut-'oa' uhiL'li gives us tlie bii(;kt)iorn. It is ii uhrult which
is a native of tho Paoific coai^t of North .\moriciL It ontaiiui, according
to Preecott's analyHiB. brown, rr^l, mid vpIIow nwins, tiinnio, malic ami
oxalic ncidB. Tlio imiwiUt of thu loirk i« iiwd in medicine: it is gr^nerally
given in <'U[i€ul«« of m\ gniiiiii, 'I'ho rtuid «'Ttnict, fintt introducod into
tberani-utica bv Purkc DitviB aiid ('ii. nf Ih-troit. m chiitHy need in
Amenoa, and ill given in dones of from Mi dmpK to a tftasjMXUifiil. The
ta^te i^Tftthcr nnplenmnt. h<*nco mpanB have l)peii tJikon to render it moru
palatai»le: the cai*mra cvrtiial Mi-mn vt-ry well to fillHIl tllis euJ. Sonio
physicians pn-fi-r to administer the caMcara in the form of pilla of tho solid
oxtnct, of wliii'Ji tlu> do«j in a grain or two.

It is to Bundy tliat we owe onr first acqaaintance with this new caUmr-
tic. In France, liandowttki wairitlie lirsLtoexjieriment with it. l>iijanlin-
Resumets liaa made trial)* with it in his service, and his pu]iil Kymt-ri haa
(■mbodied the rvsulta in his thesis (Et/meirif 1m Crutfnra Sagnida, Thim
iaParu, IS84).

LECTURE XXI.

p

ON- THE TU1:aTMBNT OF INTESTINAL OCCHJSION.

SuuMAltY. — InUwtiiuil Ooclauion — I*iitbogcny — Sjmptoma — IHa^osis of
I'^ODo: (Certain, l*rol»blp, Uiieertaiii — Dm^osJB of the Rest of tli©
Oct'luxioii — Treatment — I'lirgnlives — Mm-luiiiR-al ik-aiw— Mercury —
lATomcrils — Forced Irrigation — Injcctionn of Air. of ('arbonic Acid
— Lftremtint« oi S«1tz«r WnU-r— lAv*'m«iit« of Toboeco — I'niictorc*
of the Intestines — Coffw! — Bi-llnilontiB — Miuwifie^ — Klectri*^ity — Snr.
gical Tnmtmwnt — Terniinalion of StrangaUtion*— Choice of th«
Opuiuliou — Lainrotomy — Eatcfontomy — Moment for Uie Operation.

Okntlkmks*: When in the last lecture I wu speaking ot tbe treat*
ntent of cDiiiitipaUon, I tohl you that I should n.«iM*ve for a special ohaptur
that form whicli nmalts from nwrluuiival obstnintiotiH opponing tbe ooniM
of fnval iiuttuK. and thus prodnriu^ occlusiun. It is this sccidont. un-
hap[^ly too fiwjuont, which I wieh to fltadv t<Mlar, while Mttiii^ forth
tb« thaiapontio rraounwR which enable ua to combat iL

I shall bo hrief on the srmptomatology, for I cannot hen> trace the
{laUiolo^cal hifltory of inteetiiial oodnnon, aitd ehall bare to rrfer yon for
fuller details to your treatises on Practice, aud in particular to n n-niurk-
abh) memoir on " Internal Strangulations ot the Intestine " liT my bieml
and oolkagu*) Eru««t Beenier.

Ab for the oaoara whirh an- oapaUe af obstraotikg the conraa of tho
boal mattim. yon know tlut th^y may be Mated vtUun tbe infeovtine. in
tbe walls of the inteettne. anti ontade of tbe tateetinB. A0kib|; tho«e
banng tbeir origin in tlie intencr ot tba iateMinal canal, are foietgn
bodies^ faatdeued beral nattank iatealinal oslcaU. etc Tbow wbidi Iwve
th e ir amuoe in tbe walls are niorr beqamt. and pneent theraaelvee mndcr
two carronstaacee; either the inteatiae is in a bealtby itale or it is
diseased. In the latter pvt-nt, it is a eaaoer or ctrairieei i^Mi diminish
tbo calibre of tbe inteatiBea, this is intestinal iteKss: in tba jonuar
evoKl -we baT* to do witb iaTagiaaCio* «r tvirting ef tbe in^eitine; Ibit ia
il«w or TolrahM.

Aa for dM eaaaee wbiob art omtmAt «( tfca iaMainal «a2k^ ther aro
VCTT BOMerMM, and are dne^ aowtiMca to flbraai bands er^giiaUing in a
fanner i a a a—ti i m o( tbe ateMAtMy et peiftumaM, cr fen rtniyilittiiM
by an tafrinal diiaitiestaa, W M iiw i ; tb«5 an e«MafMnt «■ an ab-
opning tt tbe i bdwia al aalk or db | i b ii n ». as in benuab

THE TRKATMKNT OF IXTISTINAL CMXJLITSION.

lAStly, there is tlie eiitiro group of slMlomlnal tumors which oicrctse
more or lem comprcasioti on the iutestlne,

Wlmt it is imix>rtunl ta know is the relatlrn frequencT of theee cauwHi
and llt-tnton tius );iven ti» h\ thi^ rcgnnl inu-i-csting dnto. lu an^^zing
6iXI caaee of occlusion, he has found that in nigi nation titk«4 th« lewl in
cauMkkm, heinjf accountable for 49 per cvnt. ; tht-ii coium fihrouB hamla
and adhesions: 31.5 per oont. ; then strictiires and compreesiour^ of tliu
intoBtinal w&jlt: 17.5 per oont.; and lastly twiittiug or volmlns: IJ per
oohL'

The srmptonu of occlusion ought to be wdl understoixl; thuy vill
enable jou U> eetahlish the tlia^osU of the canst-, itud »s you nil) sw. this
nuttor of diugiiCDie \uus a grout importaiico tlicru|>cuiically. I<et uti then
briefly sum up tht> princi^ial Kymptomg, which nro: vomiting, oonstipation
and tympiiuitw.'

Consliijntion plays si dominant part; it Uthf abeoluleabiwiK-'e of sUwIh,
and the re^ii^tanre of thi» constipation to purgutiven wliir-li constituti^ the
important vlcment in tin.' t'yni|il>-.iniitoiog_v of ot-oliuion. l>o not tor^l,
ranreoTer, that if tKe rtrangnlittiou he neat«l at the np|K'r part of the in-
testine the patient may )mv« stixds. despite theohstniction, from emptying
of (ho bowel below the tteiit of tht- »ti-nngulation.

Another important phemunenou, the vonnting, preuente a special
characteristic to wliioh reference ha^ often bt>«n made, namely, the ap-
poumuoe of fiecal niattem in lh« voinituH. Tliis is in fact one of the
pathognomonic ingiui of thi» ulTei-tion.

I^sUy, the arcnnuilation of 0tn above the obntniction doterniineti more
or less meteorism, which Bomotinice indicates the seat of the strangula-
tion. The gniver incidentu of the affection wimetimen rtp]>enr (juite »nd-
deitly, sometimes on the uontrary. tliey supervene in a xluw and prugrBsnre
tnamicr.

TIte diagnosis is a ntatter of the utmost importance, and involTos
two i»oint». finit, the determination of the cnnw of the oliatrnction, next
the pliwv where it is seatetl. Tn at«!ertain the cause you niUHt rely on the
apjieaniiii-e of certain syniptom*. on the march of the oonaccmiTc phonom-
sna, on tliu a^e of the [wtieiit, etc. ; but, considered in a general wuvt it
may be wiid that the diagno^A of occlui*ion prtisenta itwlf nnder tbroe
nspecfai: tm certain, an prohiihle, nnd nx micertain.

I. Thediagnotua i» certjiin when there extrtaa tnmw ]x-roeptibIe to
{latpalion or the n«tul touch: it iKeertuin when by the finger introduced
fatto tfa« rectnm the obstacle can lie felt; ccrtam also when there existaaD
engorged and irreduirible herniub. Moreover in moat of those eases the
morbid nianif(«tJitinn-'< are develo|te<l flowly.

II. The diugnosis is i)robabIe. when one ia obliged to infer it from
certain ti[K.-«-ial ininptoms. For instance, if you Itare to do with a sudden
COM of obstruction, if the stooU contain bhwd, if t)K> ptktjent ex{>erieDce6

SOS

OISKASIS OF TU£ STOMACH.

R Tory acuU- biiaI tvnosmiis, if pii][niion of i\ie abdomen vaabloe jou to
fool ail elongated fl&uEn^'-^uipod tumor which follows tfao pcristaUic
movenifltitci of the itiU>atin(>, it iti IiIcpIt thxt the caueo is int uegusL-eptimi.

Ill atiuthtT pulieiiL the uM-hiKiuii it) ulniust iti8UiTitaiK>oiiR, ami at tlifl
moment of its occurrence the [mtient fwla an excruciating pain in the
iilxlomen; them in abundant foxuil Tumiting, iind wlici) you inquiro into
tltv kistorVt you iiscortain tluit tliorc wiu tm old iittai^k of ptiritanitiii; it in
[iruliable iJmt von hiivo here >i caw of xtriiiigulatiitii bv |H.>riLoiii>al bauds.

l-juittly. we win ^ujipOHo tliat it ih in an old {juthou ilmt the ohstrnction
ha? tjiken pluc«; thitt it Itao been preceded byiilternationfi of diarrha?a aitd
oonetipation; tbo piUimt, mori>orer, is cuchotic; ho hu for A lonj; timo
hBil pHins in the iilxlumeTi; bix belly in voliiniinouti; his foKws sru in flat-
teiiod ribbon-like niasKcx: it ie jiroltable that in this cage it is canccroiM
att^nosid of tiie intestiiiu wLicli is t]i« raiiw.- of tilt- ocolusion.

Ill, liifitly, c-aflea are unhappily too :iumeroufl whvrc the symptoma
arc obticiire, rendering tbo diiigiiu»M of tlie oocliifiion very difficult, ami
notwithiitumUiig' the reninrkahle rppnrt miule by Hutirhinsoii at tliw Mtnli-
cal Congress at Unlb, tbc axvu^t diiignosia of iutvritul atraitgiilation is still
one of the moBt difficult problems of clinical medicine.'

Ae for tbo ecM of tbc obsUclo, w« must base our judgment not only
on what we c-nn diBt!over concerning the cauiw, bnt aluo on the informa-
tion fumitdied by the ructul touch; but Jt is chiefly the form of the ab-
domen which can and ouglit to giiide ns. Langier has, in fact, shown that
when the obstacle is s<«t«d in tlii.'> email inte«tin« it is the ccntnd part of
the Jibdninen wbinh is limiofled; when, on the eoutniry, the obstruction
is in the large inteHtine, the swelling is in the culua, which forms a salient
peripheru) border leaving the central pirl sunken.

Aftoi* tlieae short explanatioiitt. the iinimrtance of which you now un-
derRtantl, let us takn up that ^wrtion of our subject which Iuik tlio moet
pnu-tioal interest, namely, the treatment of oeelusion.

Yoii have before you a case of inteotinHl ohHtnirtion: you begin by a
careful examitialion of the [ttkiieitt, you uHcertain llie march of the dint-
orders, the circumstancea which liave preceded them; you palpate ttie
abdomen and ex]dnre the reetum; then, wlieii onco your diagnowB i« nindo
as iM'cuntUfly as possible, you iniititute your treatment. Wiat sliall be
your fii-at step?

In most ciujea you will begin by giving a pwrgatiro; this is as much to
aid iliftgnnsis as for thempctitii> intent; you must, however, he nttr<*fiil and
not have rBcourse to ton energetic dnistieK. I nhnll never forget a {uitient
whom 1 olitterred when 1 wiutdiniciil chief to Ilehier; it wujta man ufTuctod
with internal strangulation; the diagnoeie of the oauee was uncertain, and
mild iiurgfttivoB liMil been given without any effect on the obstruction; &
pill of eroton oil was ordered wliiffli caused cscrucintirig colicky pains,
and the patient died with rupture of the bowel. At tlie post mortem we

TILK TRKATMKNT OF IKl-KfrtXAI. OCCLUSION.

' founJ tli6 Cftum of tlio obstrnetion iti a pcritoiiMil Imiid onnittricting the
intestine. So then be cluiry of jMiwcvfiil oivtliartirs; give oily or Mililie
pur^tivvCj und do not pniscribu aiiytlihig niurv ilruatiL- tluin jiiluji.

Yimr purpitives. wn will fiiipiwiBe, \mvo iironseil intestinal »(!tiuii, your
[utient h»6 Uiid i;tui>I>j. tiii_> obi^t^'lu is miiovixl, juilI R-cuvi.^ry i>; ii»Kiiro(l:
everything lias goiir well in tins owe, tiut it is nnhiippily not alway:^ po.
aiui ofton«r tlmn otlierwiBP yonr pnipitive ri'niiiiiis without elT«Tt. Wlmt
moBt now bo dono? Certain meclianieal moaiw have now be«n recom-
mi-nded; Burli as metallii! moroiiry l)y niouth, ami freo lnveirwiils by tlie
riJL>tum. TUu adi»iiii;«triitioii of tuutalliu nwix-ury by Dioutk U un old
meihod, once much in vogue for overcoming intcittinnl strtm^ilntion; it
wna suppoM^d thai ihu mercury uvuld dn this by it^ wuighL Mt^dioul
writers of II fomitT d;iy Auoh tw Ambroiee Furf'*, KolloniU »'id liplluci, have
reported numuruns cukuh in whi:?h metiilUc meroury ovon-aniEi thv intes-
tinal obibiido. A pound Aiid oven h puuiid ttnd n half of this nietXl would
be given in 0110 doao; the piitinnt vna put into :i lutth: and while tlioro
two vigorous ftuist»nt« kopt siiaking hint iu order to niako the mercury
fall into tliu ititvctine, and causa tli« »l>«tTuctiuii to disapptsar.

Gentlemen, this i« u. inviL«ui-u wliioh iiboiild bu nivntiunt^d oidv to b«

•

coadeniited. Uiuiiii» has shown by ("arefiil esiwrimenta that mercury
vhcn iutroduccd in hirgc quantity doce not dctscend in bulk into tlid hirgo
intOMtine, but pcnetratoa slnwly, globule after glohuio, and thi« U an true
tliat if tlio obslHcle hv ri'iiioviid you du nut svi* thi> iiuTcury voided in
gross tnaBWit, but hbtle by little, in piirticU^ or glohiilee, in the tttiKtlB, and
for weeks afterwurd thix metal is foniid in the dejecta. Moreover tlio
horizontal jw^ition mnintaiiuHl by the pntient is n hindranco to the diwot
artion of mercun,' on the ol)Btni(?tioiL So, deHpite tho ronent fuTor-
ablo facts re^Kirtetl by Temier, Teit«o)L. Iloudulx^hie. FoilK>, Poumtoau. and
Matignon.' [ am of opinion that niernnry cdiould 1m3 ntterly iliscanlcd
firom the treatment of intestinal occlusion.

Tile mochanical meiuift employtn] per rectum are an fnllows: tinit lav<s-
nenUr which miiy coiimin purgative HulwhuiL-ea to promotu intestinal oon.
tractions, but you van aUn nte water alone; mid it is not now a oiniple
enema which you mu«t udiitiniater, but u |)ow«rful injection thrown into
the hirge iriteatinn. Two meuiiB niuy be utilizetl to make Uie water ponc-
tratu an high up im itotwiblo in the intestine; uitluir you luay make ubo of
(^ntwrocliMn or fom^l irrigation.

I Itave already told you in former ]ct:turvH what Cuntatii meana by thin
woM eutor(>cli«tn, and liow he fiiiploys this mctho<l; I have told you that
the beat ontenM'lint iu the long flfxible IX'bave tube. This proooM will
give Tou excellixtit results when you liuvu to do with compremdon of th»
inferior extremity of the large intestine by abdominal tumor, or stenosis
by cnncoroaii degoncration; in penetrating nbore the obstacle, the long
(»h« enabli-K von Ut throw rnrren(.i of water into tho midst of fiPcal

810

DISEASES OF THE ST<>MACIL

mntteni iic«amulat«<l in this point, and may determine iheir t>xit in a
1i(iu)(l HtaU-.

The otlier nn«nH (xmsiiita in the am of [lowprfnl forre pump syringe*
which onahb as to throw a very energetic etream at waUr into the intes-
tine. This is a prooodure not always without dariRor, ao I grwtlr prefer
euteraptiem to lliis pnieliw of forcuil injwtiana Itu^ wht-tber you malii-
nw of aim or thv utln-r proct-iw, it is otiW addri^Mxl to obstuult*^ i<mtv<l in
the Urge int«Htint-, fnr drspjto the fnrts n.iporti?4l Ijy lanartl nnd those still
more rwi-ntly by C'uiitiiiii. 1 belioTc it is rcrr wldom indeed that nauhio's
teIto (ileiviauoiil) (-an bu fonwd liy injiwlionn.

At cithL-r timeis it u not vMot tb»t ix injei;U>d but air. Ilippooratea
adviMd l« pmploy fnr this piiqxjw n hla4"k«iniiilli'?< ht'llowe. of whieh th«
noiszlo WBN intniducW iulo lite niuii!. L'oilhiti Aiirclianus and Wood luive
nsod this menus nnd viimit<?d its rftKiilta,

It I11& been prtt|HJBLil U) eubatiluU.' for air earboiiic luiid ga«, which yon
know hii« :i rc«! action on miiwiilar contractility; anil in tliia comuftion
yon rpmenil>er the utory of the negro whn wi« eiiffnrJng from strangula*
tion. Tho American phmoian who hod tlic cure of this patient intro-
duced into hie roctum a tripk> chai)^ of SeidlitK powders; two uwiKtimtt
stoppL>d tilt! iiniis. ihf patient folt hiintttlf on thi< jioitit of bursting, some-
thing gi»vp way, thii ohstnelo waa r«iiiovod and tli© negro r«ei>V(!ivtl.

Without recommvndtni; eo Uanili a measure aa this, and which might
be danppronF. I can heartily piulorw a more iiimplo inetho>l, and one
whieli in many ausvn give« guud n«ultfi; I refer to the injection of aeltzcr
water into tlie rectum. The 0]KTation is very easy; vou introduce as high
ap aa poauble a 4»miU furnished with a lon^ Tubber tulm, which yoti tlien
ftdllpt to a euitablo Byringc and a ncltw^r fountain; you press upon U»e
pixton and the Bcltzi>r wat«r {wneLmteti with violence into tho intcRtiuo.
There are nnmeroui* oases of cur*! hy tliis method.

I wlvipi' you tn repudiate tha employment of tobacco injvotions, recom-
mended by (fome authoritiee. and in particular by Ronnicr Joly, whether
in the form of Nmoke or of decoction. For if it in not deinnn«tratcd that
tvliacco in lavement im ttujwrior to oUier injeotioiiB, it bus been proved that
these lavomrnta may be toxic, and detertninc sj-mjitomBof fatal poiKoning.

Pargutives, lavemctite of wattir, of ^H-ltiier water, huva failed, wiiat will
yon do next? You can try by punctures to diminisli tho extreme disten-
sion of the iiile^tiiie by gH«, for the miucular libres of tlie Riit if nndnlv
stretched lose their con tntctil ity. Yoh can uso for tbi« purposa one of
the fimall needlcB of your aHptratnr, or a fine capillary troear, puuctnring
the intortiuc in plncoa whero it in niort distended, but this ojwration miut
be done with great jirudetn'e. beeansi' these pimctnn-*, niatb- with o\'er
w> fine a needle, may determiiu* ijeritonitis. They are. in fact, the more
likely to do thin for the reason that they are jrenoralty ineffiL-acious: for it
is much more diHicult tbuu ouc- would imagine to witlnlraw gus from tlie

TllB TRKATMKNT OV ISTKai'INAL OCCLUBHm.

311

int«etine by this me&na. I have often puncturvtl looiw of inU«titii-, «nil
dcei>iu< nuiiiBroiis iwiiimtioiw, 1 havo liardly «ver obtained in this wny
much retlnctioii of th<? tympimitii! Bwelliiig. Itowrvc then tliesp jiric'kiiipa
fur cufics in wtiiL-li tliu mulL-uriniDi is so {jrrL-ut tbtt llio diaphnigm iRcrnndtK)
upvnrd into the tUorax, and circoIatioQ and respiration nru BorioiiEly
impt-doJ.

Aiiotlier means miperior to the pDucture is the employ of ico, vEiitited
byGrisolle and Miuisoii. Ynii should nlways rewrt to thiiti)iinpl«>rem<Hly;
tliu application oi ouKl to tin; iibdoiiiL-ii diniini«lic« tli« quantity of giw,
cxcitce inteetinal contraction, and ojiposes the peritonitis which &o fn-
(juently coriiplicntofl the Btraiigahition.

By the i«ide of ire we may pliice the use of belladonna, raiiiited by
IlaniuH, Chrc-«tiuu, Uimud tuid othvrxi aa posaeeeiiij; curatire rirtiies in
i<truiipiliLtioii. Coffee in large doflen has been advincd by Dumnd. (rn>-ot
and Lanuirre Hc^uot an botiig t^'speeiully pfflcacioiis in hornial stranf^ula-
tiou. Coffee has for its efTect U> liugment the intestinal coiitmctioim;
rtrvchiiin*", which at^ts in tin- same way. nmy also d«) good, ax'fttTiWna to
Homolle; ilwrieux hiw rwomnK-iidi-'l ihiyor's tianinKT: (*ojrie. Ititrhnnl
Ncale, and BoDnenmiston of Tonlonw have cmirwlled euspendiiiji the
jwtient by liis feat with the head downwanl; iniuwigu niid wet cups over
the wlwle nbdomi^n are nieiitiiires which have long been in use among llie
Itussian iieiiannlB, but all thcHC iitt-unH lu^' Tcry uncertain. Therofom after
having utnploycd puri^tivci<, ascending douches, itpplied ice bo the ahdn-
nicn, if yon arc not able to overcome the obstitele, there remaiiiB, before
lufiortiug to Burgical niOiiii8 a la«t rewjiiroe, electririty.

I^roy of ktiollefi (I82tt) «-as the tiri<t to H{)ply electricity to the treat*
mont of stnuignlation; he was followed by Duchenncof Boulo^v (ltJ51),
t'Urcrtein, Stokes (ItsliS-lsUT), Kpyhol (]*n>T), Maeario (187u). Dutcuil
(1S72), Flouriot, Bftlmonte. M«rin (liommi (181.'^). all of whom claim
fligiiml succeAtes. In 1876, Hmtcjuui reported thru.' cumm of inta<tinal oc-
ihision eared by itiniiigulation. How ie electricity to be applied ? Till
ijuite reciMitly the only form used ha« been htrndization. A bent rhco-
phore was introducoil into the n-ettiin, t-he other eloetRXle whh placed over
Uic abiloininal iralls. Kiit IWudet * of I'aris haa laid down the rules which
oaglit to Ix" followwl in such ciiKej?, imd wliirh arouit followc

, You will make use, not of fanidic but of galvanic currenh!. and intro-
by the nniia a Hpecml electriMlu contititutod by a rublter KOUtKl in
U plaeed a nietjkllic xtylet which doe« not quite rench the o.ttremity
of the aouml, so that the miiiHius mcmbninc in never in direct contact
with Uie etylet. The stylet is in comniunicatioii witli the negative poto
of the buttvry while the positive olectrodo is applied over the abdomen.
Tbt' force of the current must not exceed 10 to l.'i millian){>('ret(. lunl i«ch
''anco ouj^ht to liwt about '^0 miiint«iL Vou will have care to iuturrupt

CDm>nt from time to time.

oagtit

i

318

DISKASHS OF TUX STOMACH

Bardet has ingeniously modiried the rochtl uxoitator; he emplora nn
iiititriimuiit quit« like timt whicli li« ueea in dirucl «]ectmfitiou of llie
sluniucli. ThiH uppurutUE mnea not only for Intvfltinal galnuiuatioD, be
eJso for tho practice of entvroclimi.

FinuUy, when you bave quieted thi' vomiting by ioed drinlcR, wlipn
you tiAvi> ntlicvtid tl)f piiin by i^ubcuUnt'Oux iiijiiutiousof morphine, wliich
liy thrniM^lvcs, iwrording to Jameg Martini may combtit 8trangolatii>u,you
Imvtt uxhiiUPtrd all the roswurcfa of mc-ilical thi;nij>_r. anJ tho interferenro
of thv surgeon is demaudecL And although thi? subject ia foruign to the
province of those leoturus, pennit mi' in a few words to state what kind of
aid we arc to exficct from the surgeon when fT<^rylhin^ i«1»e hut failwil.

This is on» of the grarrsEtt and mwit dithciilt pn)bU'mH of therapeutics,
and OQu wltich you may often bo called upon to cucouutor. You ought
tlivii In bo familiar with every step in the op«nition contemplated, and
wilb it(t possible luid ]irob:iblo re«ull«. iu order to give mund udvioo when
tiiv Hubject matter of diwrusnon in wluU to do In a case of interna) strango-
laLioii that n-KistK all mudical nt(.-aHurL-f(.

Untler what circunuitanuoa and at what stage in the diiieaitc ought
surgii-al iiiterferene* to be sought, and wlml should be tlie operation
cbo«en? In reply tu thew qumtione I shall draw largely from the in-
toreeting monograph of my collnigue l« IK-ntu,* and from a diacitflBion
which took pbco at Uic Socit'ly of Surgi-ry, in which Lo Fort, Tc
LucsB t'hiunpoiuiiere, etc. , took part.

ITnder what circumstances u «irgical interferoncv demanded ? As in-
testinal occJusion IB an affection incomjMtibh- with life, unless the obstacle
to ibo coune of fkc«l matton ia n-inoviHl, Ihv ]>utivut t» doomed to di«.
Then is but one condition in which nature unaided can bring about .
onrtf naniuly. when Um obstruction U due to iiivagiuatioii: here eoine~'
timas the invngitiated, aauBge-«haped tumor has sloughed away and beeJi
Toided in th« atoola.* ^H

Ar<oording to l^inhtenstein'a statistics which oompriae 593 cum of^^
intuEKUscvption , Uu> geii<<nkl mortality iii t3 per cent, aiid the cbanceB of
Mpuation and elimination incrpnsp with age, that is to ny, below flve
jean the chances are 6 jkt cent., while at 60 yrttns they an 60 per cent,,
but on the other hand, the obanow of dtwth increaae with ag«, Moroorer,
if we refer to tbo rwulte of gaetrolomy as f.ir as known, we find a mor-
tality of tiO per cent, which gees to sliow that in (lermns of a certaiu age
■Ifoeled with ileus, there atv as many chaiiovA of rvcorery without opera-
tion as with 006.

Save in eases of iatusniflooption, where the prebabHitim of reooverf*
with or without sur^rioal interference, must always be a nibjert of

THE TREATMENT OF INTESTINAL OCOLTTaiON.

each intm-foreuoo U Always nvceasary, and hero 5^11 moKt taki> TOur cboice
hetnrrvn two opemtioiis. vnteru^Loiity, or tlic opening of the intestine and
t1i<: furmation of a fiilso tttiiit>, aud liipuratoiny. or the a{H^!iitig of the ab>
dorncn Iiy a flimpk inoUioii of the itbdoniinal wall*.

Tliia ]utt«>rap(>nitioii, altbotiffh counsiilled as rarly lut ITiT'J ))y linrlietto,
hivt been lierelofoi'e iiegk-L-UxI. but iiow, tliaiika to the aiitiiMtpLio metliods,
tlio jiwritoiioHni is a new lidmain conquered by nicKlem aiirgpry, and to-ilay

[ laparotomy ig an opcmtion which may bo eontompJattsi without the horror
•with which it was formerly rt^nled. 'i"he operation for artitii-ial riiub
pn>8ent« serioiw diffieultifw; on thi* one hand there is the uncertainty

ist what jwint to make the opt^nin}; into the intestine, and on the other,
the impoHiibility of maintaining existence if the false outlet ia made at
too high a jKiintof the intestine. And then, to bring Imck n poor wivt^h
to life to doom liira hencjoforth to Us the viiitim of a reputnive and niorti-
fj'iug iuHrmity, does not seem U> be a very deitirable result.

Hence it is that the medical profeesiou hae come hack to laparotomy
being the prefomhlc opyration, which ie always advised as a lii*t poj*ort

rin caAeR of Htran^ilntion, whether by a Innd, by inniHiudeoption or l>y
toniou of tha intestine. Eutenijttoniy should be rwserved for ouws of
imor of the intestine, and when the olxitacle ia seated in the lai^ inte.f-
); tho false anua should tklways \ig made above the o1>ftruction> and it
will ulwaj-B b© a matter of dolilieration wiiore to perform the operation.
In regard to this, however, you should remember that, iiwording to the
£nglidh autliori ticH. Amuasat'i! niolhoi], in which lumbar colotomy is

rpmctised on the right side and on tlie level of tho i:«cum, gives better

'Ksults thitn tho method employed in Franco, which coawBtii in making the
nnnutunki anus in front, in the left Elank, on the level of the sigmoid
Bxure. In a recent discussion before the Society of Surgery. Trelat

^showed all the wlvantagcfl of the method of Amuasat, advantages which
pertain, not only to the opowtivo procedure, but also to the fmbeeqtient
ennrenience of the situation for the miii,|)lntion nf uppamttiE)i<fi designed
to remedy u far as |xi8sible tliu serious iiioonrenieuceis of the artificial
UII8.

Ab for the period when thiff operation ought to l>e performed, there \a
fgenvnl i^roement that tho earlier is the bettor time; the longer the in-
terval that has elapsed since the date of the titningulation, the fewer are
the chuncL'M of n.-cov«rr. idtliough life imir [lossihly be compatible with m
strangulation existing for woekt<.

I mj'self atw, in fact, a patient who for three weeks hiul intetttinal oo-
(dnaion with fn>eal vomiting, and who (hiring that timt> suffered but little
poin. But at these rulvanced periixlM the pulse become* fitifonn. the
temperature falls, and the wononiy IxTomes so enfeebUnl that but little
can be expected from an operation, and when one is »ttvinpt«tl and the
obitHla removed, tho patient guecunibe from the Rhock.

314

DtSKASRS or TIIE HTOMAOn.

So, tlinit. sftcr hnTin^ trieil all mcnlicinal uioune without effect, if yc
(l<«ide to rusort to a nu^cal operation, do h> at on early (litt«, t>cfoT« your
pKtivnt ii oxbnuRtMl by the HKjuelie of tlic occluaiou.

KOTES TO LECTUKE XXT.
' ClaHnfication of tliu C'auH» of Intestmnl Oucluition (after Doliger)

I. By oTftatiio alTuctiotis
of the inteHtiiul wulis.

TI. By lesion of nonitioii
or the iiitUtitml whIIk.

III. By Ktiangulation,
l)ro|MTly iiOK»IIc«l.

1. In&anuiia.U>ry sU-tiwia.

2. Cicatriciul eteiiusix.
'X ilyuprtroiiliic; »'ti.'iiosiii,

4. ■N'ifnilar Btcnosis.

5. HtcttioeiH by polypi.
_ 6. Ciuiix^rouit rtenoM.

1. IiiviL^iiiaLloii.
■i. Torsion.

3. Stiddun noxioii,

'1. Internal hornias through the diaphmgmj
nbnornial openings of tho tnowatcry^
etc.

2. Slixn^liiUoii bv lliu ilao-c*cjil appendix,,

or an inttwiiiuil diverticulum,
o. Strangulation bv peritoneal bands.

4. Strangulation oi intestine by intcetine.

IV. By foreign boi1ie&

1. Calculi.

S biliar}-,

i intestinal.
2. Fon>i^i Ixwlitw, pntperly Eo-oalled.
a. Intvrtmal worme.

4. Ilanlencd itl^rvoral matters.
1. Kidney. ut^ruK. or oLht^r organ com-'

pressing tlw iuuwtine.

5. Abdominal tunion; CHtmpretning the

tatesttne.

' ThcMi> aooDrding to ErnMt Bonier, mv tho principal cymptomi vhid
enable ub to ertabtiali the ilinguo^is uf thenatutv uf the inteetLnal stranguJ
lation.

/miiti/tNdfioM. Vomiting, ordioarily bilious, rarvly sterooraoeoos, wo-
Btipation, nuvly abeolatc: bloo^ly fetxt diarrlKeic 8tot.)U: vtniining and
violent uxn\ toncemos: belly at Aret n-tnicted nfterwanU trmjmutir; ab-
dominal tunor cylindrioal. kne» or vlbow Kba|Mxl. length greats than
width, morv atlicnt during tho erieis uf i-olic than in the rtate of Kytm.

Siricimrr. .\nU^'<xU>nt signs of imjiortance: diiiwtfivsof the inteetuwK
cabeetic ctate of Uie jntient: frequent aliernatioDs of dimrrhoia and of
OMUtipation: abdomen iiabitnally diiitended and voluminous; ftorcora-

■a TOBuUaCi tym^mnitva much deretopcJ.

StrmmftJimmt fnfrriy j»>nt/W. AntMniont signs: antcoior penUmaal

THB TRKATHKNT OF* INTESTINAL OCCLC8ION.

315

*

inflftmrruition; it(!liml ingna, pahiit vxcoraiTo at the momont ftf stmnsula-
tion: olminatc prvcocioiu vomitings; absolute constiputiou: no blootly
«vaciiaUoiL». no tumor.*

' ThcRK are Jonathan Hntchiti«on*8 obs«>*rvfttion8 concerning the differ-
ential (lia^ositi of tlH> vnrioiiM kinds of stmngitlution :

_ 1. When u cliild euddcnly prvwntH tymptoins of iiiU'stiiml olwtruotioD,
it is probabk- tliut it w a oiee of inTugirmtJon or perit«nitiB.

*2. WUi'n tliu [mttunt is iiged. thi- dingnoaiH will l«! uittier obWruction
by fcwal nittttt'nt, or wiucerouB affection.

3. In adult life tlic okiieos of iiitx-tttiniLl olietruotioii may be moittple,
bat inii~agiun.tion and cauwr are mt-t with very niR'Iy.

4. Invnginatioii ia rt'oog^iiixed by 8L>vt<rt> Htraining eflortfi in dofemtion,
the presence of blond or mucu)^ in tlie excnita, tbo iu(N]mt>lc'to constipa-
tion, and the iircwnce of a e<nni-9otid swelling felt by palpation of the
abdominiii wails, or by tbe rfnul touob.

5. In invi^natioii, tijc ftbdoniiiial walls remain gcnprallv n-laxed,
and UK thvTv is but LitUs mt>tcoriEim, it in always powililu witb tuv help of
•CUBtithL'sia to detLTt tii« int«'Rtinn) tumor.

6. You wilt KUKpect a cnneerons Urgion whon nn old patiotit liaa for
some time had abdoiniiiul mini^. or period? of U^tnporary coiiHtipution,
In Uieflo cases atiu tin- conxtipution u often incumplvt^'.

7. If then- bo a tunitir whiuh coiniirysat-s the inu-stinv, if von ethi'riza
the pAtiont vou will gi«m.'rallv find it by palpation or by the ivctal or
viigirial toncli. Yon must take care not to by lt«i fistray by tliu prt-si-nct!
of iscylnLi.

S. If, between grave attiMiki of obetnietion, tho tmtipnt has enjoyed
perfect boullh during long int<;rvala, one may Ru»piH-t the prusencw of an
abnormal iliTcrticnlum, nr of a bund fornic'd by old udbesions. or of a
portion of llu- inU-stino dtKl^'iided in (be form of a pouch, or of a volvulus.

9. If from the U-giiininn of the inttwtiinil obstruction the abdomen
bpcome** hard anddistentltHl. it Is iilmnst cortuin to In- a emt' of pnritonitis.

10. When you can sea the movuiiienta wf th« iiili*liiio through the ab*
domiiial walln, it ie almost c«rtain there is no peritonitis. This symptom
ie chiefly obanrved in leau subjects, with an olu obetracUon hjiviiig ibs M»b
in iho colon.

11. The tt*ndonc>' to vomiting will be iu proportional relation with tho
three following conditions: first, the proximity of the scat of the obstrnc-
tioo to the stomanh; second, ihii closencNs of the raiiiHtriction. and lastly,
the poraisten(!i> with wliiidi ioifd or m«itieint> is given by tho month.

1^, Wlicn the obstruction has its Mat in the colon or rectum, iiansoa
is completely absuiit

13. Violent straininji and bilious vomitings are oftf« mors iniinfnl in
bcpatic or iiephritii; coliea than in int^'stinal oUitrnction.

14. Vomiting of fiecal nuitlere is observed only iu caws where the o\>-
stmctinn is relativclv high ii|i. If these vomitings appear early, it in a
grnvo symptom, iiidiciiling verv close eoiin-'tation.

15. 'The introdiirtion of the liaml into the rectom, aftor tho method
of Simon of neidclbcrg. may oft«n give valuable information.

The following table by tiniest Besiiier, givtw the frwjnenoy of tho seat
of the strangulation in th'e different varieties :

:n6

DISEAS>S OF TIIM STOMACH.

KUUTB of Lhe SlnutculU lOD.

Invsfnnation

BtpnciHb

RtraiiKiiIution bv tonioa

Flexion

Snlid bcLiiilx ;bridf;eii or aroulm)

A|ipliriiliJ>ii of itiociecuin.

Divpi'lit-uli

Intestinal bands

AltDomuil onenim?* of the perito- i

iwaX Tulila \

I>m))lini;,'ii>utJo upi^riiiti^

IVi-iU'ii'-.il |n>ui'ln.T*

By ci>uipi>o^ion (tunion) •>...

Total

NuuiliH- ef

II

183

8««l In tbP anan
inlRMlne.

8«M ■■ Um lH|e
IMflMtne.

84

17

8

' MatifH"))) exntnined the ftction of mctnllic tnercurr iti ten caaes of in-
tomiil irtranjTiiIntioii. His ooni-IiiaioiiB »T«: 1, Given in doaee of from {
lb. to 1 lb. it 18 iH.-rfi-(!tlr inert, as fur ax any mcilicinal action is concvriitKl:
2, It acta both by it« wtiijilit iinii by liividiiig tUu istercontecoua matters;
if llwintMtine is sound ittIo«s not cansv latvratioiiB! 3, Mercury tbtu given
is veil tolfi-atort; it »t<.jw ri>niitii4t ami allovintea the pain; 4, In obetnio-
tion due to fi^iU i in imctioti its lioiioficial i-flLi^ti« are alniort certajn. It t8
thv Niniu in i'ASt'i of (^omprtitsioi) aii<1 Klunosit^. wli<-re the oalibro of tbe
inl<«tino is not ntt^rly eii]>prea8P(l; 5. in other (onns of occluaou it H
wry unciTtain, and i:* iiot to be rea>nimcniUMl. •

' Bondct's lUkhoTf ii»U- from 1880. Uc showB thnt constant cttrronti set
moro imrtifularly on tlit- smoutli tibri-« of the intt-stiae. iiromoiine ooo*
tmotion. wbilo interni|>t*'d currents act cbiellv on tbe mu»;!w* of lite ab*
doniinal walla. He i'it«-H uiwa of reoorerj- nmler galvaniiim. Boudot hafl
til:<u ubtainotl guod mtulto from tliv Buin« imiui&t

•Tliii* elimination gonnmlly takes place from the llth to tlie SOtli day.
Kren in cawa wrlif-Tu fliinination takes place lh<; mortality, according to
Ijo Dentu, is oousidomblt;, — from iS to S3 per cent.

BIBLIOGKAPHY.

E. Bmaior. I>m flrangli<(iii>iil* InU-ntM ili* ritiUtttin, PftriA. ISOIX Luton, tati-
de Oct'li»ioi> )nt<wtin«lv fNuuvvAii l>i<,-ltMiiuur(' il< mid, «l do chinii^;. pmti-
(1i)iT». (. XIX, p. Sift). NM Gii^iifiui lilt Mussy, ClirnqHi? ui^dii'aUe, I. IL |>. 15T.
Liu^tfr Aes Baawls, Etiuk- siir le HingD(^>>4)i' «•( 1» tntitvtneiit ili<« vtnuigliiqtiviiU
internee, Pw, ISTO. FIcunot, Du Inulvnivnl ile rocvtuoiou int«etiiiale int«rfi«

* Mnti^on. On tlw Tivatm«nt of InlmtiDA) Ocrliciion by Metallic HervurTi- in
Lni^ DiNoft. Tb^Mi dv I'nrkK, 1879.

t Boud«1 ot Pano, Noto on Two Cm«« of IntMtinnl Ovluxioa TrcaUsl and Cured
bjr Bcctiicity. ProKrfe U€A., ISW, RanU-t. Tnuifi Or EUtnclt^ MMk-al^. Paris.

isat.

THE TREATMENT OP tNTFSTnfAI. OCCLljeiON.

31

i do Paris, n' S, 187B>. Do1)l:^r, De rinterveolion clilrurglcale dujis l» «•-
ANons intMlinolc* (Tlt^ de Purin, l^T'J, n' 41Tr. Koiuicr, Dm divcis mod«» dti
■itcnipot dp roccluaion interne da rint«sUn <These de Paris. 1873, d' SOJ. Bul-
(mu, De t'ocduslon lutustinti)^ iiii jiuiiit do viio dii diu^noKiio vl du traiU'nn^nt
{Tli^ <Io Pari*, WiS.) FftjnLt, IV rtnt'«rvi?nlion cliintr^«nl« da&s roc(:liiSLi>a in-
leMlJiiulH (Til. d'aKr^if., l&Wj. Williiun BrlnUm. laUwiitud ohHlructioii. lyondnn.
188". O. Lf-idiU'nsU'Mii. Wi?irU?ljaJiredirirt IRrilio pniktisclie Meilkiinde. 18T8 et
1S74. Jocuitliuii liulchiiuou, Asuccvn»ItU oui- oE ul>dumiiiul »<»:Uon lov inlumiw-
itTiKou, wilh reiiiaiks on tliin and other mpthocl»o( treiiiiin^ut (M«ll<K>iCliiriirgical
Trftuwu^liotifi, vol. LVIL, p.^Sl., London, ISTll. LkUiuu-is^PioquoL, Dp i'm-linn dy-
niLiit)i|ue du cafi «t dB&oavni[doi duos \vs lierni«8 Mmngl6>»(BulL de TUAm{*.*
18«1. t, LXT). M*|il;uH. Lh ea.f^ (Eliidr di- liiimp. pliyatol.. P»ri^ 1888).
Loj^«, Th« British Med. Joum,, 1881. Kichard NeoJe, London M^ Uncord,
1879, Christiswn. Eniiiloi dii KuI^'anUnif conlr? rolKlrm-tion intvMinnle
()[(tiilhly Journul. 1854). Stoker. Il6iu s'accorapagitant de voniiiweiiientB til«r-
conuix. tniitt^K avi^' kik^^i^ ttii moyen du gnlvunMrnc apptiqu^ A lu niviiibranc
ini>q»ftUAt> d(- rinu-sliti iHidl. di- Tlifr.ip . IflfUi. LXVIIl. p. -Wii Keyliet. Ob-
stivction inteeliDale ^lerie par la TanuliKttioiKAiinak'K do la MiM-i<-14 d<- iiiAdMiiiM
de UiUid, 1667*. Macnrio, ObsM-rviition d'itiua jfueri (Mir Vilccl rich* (uiwlique
(LyoD medical. 1874). Deitriol, Dit traitemeDt de roc<.-hiMi>a inturtinnic intcnw
par l'4twtric-it^. Tli. di- PiiriK, 187Q. D»li(iiin1«, IkL-liuioii iiitcfitinoie gii^rii! |inr
1'6k>clndl£ (Moviiiienlii ini^dico, ISTS, ii" 1). Mano Uionimi, Utii'rWD d'lin uia
d'obelriic'tiun iDtijKtiniJ*' ^Lr r)ip|di(-jilii>n df^arniirantii iudireL-tn (KucoglitiiH meiU
ico, 1875, 4" 6eri«, 4" voluiuo, p. 401), Curci, Indfcntinn dn r$l««lr)cit4 diinit Ift
patslysie inttsttinali! (Rticv^litori iiitHlica. Juillt-1. 1877, p. Kl). But.'quoy, C'on-
*id4ratJotui pratiques sur le tmitement de rinvn^nnalion Jntvstinale (Jinirn, d«i
Th^mp., n" 4 i-t 5, ISTH), Balbt^idicy. Di' I'^leclrii-it* appliiiii^e an Irailt'mcnt d«
rtxrliislon intftttlimle. Th. dc Pai-Ih, 1980. Boiidetfdc Parin), Note sur di>tix «-iui
(r(Mx-liitti(in iiitfstliial"-. iniil/'s I'l nii/'ii-- par i'/-l>-i U'ititfi iProgrte mWicaJ, 18S0X
BorOetf Tr»il« d'^kutricili luidiculc, Puru, ltM»i>, p. £7(t.

LECTURE XXII,

THE TUEATMKXT OF DIARKHCEA.

ScMMARY. — THarrhcea — CatuKs and Pathogeny — Alimentan', V'aao-Motor
DiaiTht»a — Diarrha'u (mm Esccsb »f foiil-rttCtiUty — Diatlivlic ])««■-
rhfTrt — 'I'liprapt'iitic Indiraitions — Not nil lHarrlnPiia Ut be Cured —
Ilygit?iiii' Trt'atwwiit — Milk and Eaw Moat — Iiilluuuc* of Cold —
Pliarmflceutical Treatment — Inert Powder* — Aatringcnta — Bismuth,
C'lmlk, Tannin, and Uliiituny — Oxido of Zinc — An-oxoaraotic Sub-
stances — Opium — Morphine — Asfiooiatioa of thew Different Kub-
Bt»n(-4>8 — -Ijivomvntit of Ipocuc — The Diarrhcw* of Cliildreii — Cholera
InfuntiHii — Tri'iitmynt of Infantile Diarrho-HB — Malarial Diarrhwa —
The PiarrhiMi of Wann Countriee — Diurrhoaa of Cothiii Ckinu — Ther-
mal WutorH in DiurrhcBO.

Qentlemen: 'niarrlia?a, tlio treatmrnt of vhiob I desire to oonaider
to-day, iH a symptom whieh is the opposite of coustipjition, for while the
luttor IK diiiliiig\iiah(>(l by thf> iiunlni'HH iitid H(>iintinei» of fupcal inatlnrti, it
is their abandiLii(!u and tlu'lr li<]uidity whiHi L^haniciuriKu diiiiTbu'a.

Dewpite this opposition, the causes wliicJi tietemiine these sym]>toms
aro iilentiml whilw heing (loiitrary, and juat a* wc haTO econ couHtiputitm
prnduofid by alimentari' suljstdHCOS, by modiliciitions efTectod in the intes-
tinal seurutiotiH. and by [Hjrtiirtmtionfi wIiom* seat is the musctiliu' eoat of
the intestirtes. so we see the same causi-s produce dinrrhu^

Wc have then a diarrhoa of alimentary origin, rrnpuhmt diarrhrea,
duo to the insertion of fooil in too p'eat quantity, or Nidly prei«ired, or
badly tolerated by the iiitvBtinal muwJHa. When I was on the subji-cL of
aliment^ition. I had oomiidei-able to nay comx-rning the influence of the
({nuiitity and tguulity of fooJtf in causing diarrhoea, and I shall not rvpcat
what J then said.

In other uisuti it is to tmubles alTucting the function of the intestinal
miicowi that we are to attiibiite the flnx. It in a vaflo-mntor disturbance,
iLM Vulpian Iiuh well Rhown, which is tlie iiiiUul iinisu uf tliiu intevtirml
hyi)ercrini%* and tlii» diKturbauoe jc^'ueratly has it« startiu); point in a
reflux act: it is thno that diarrhoea mav be jiroduced by cold; it io thus
that dentition may originate intestinal troubles: it is thna that nervouu
diarrha'a may bo explained; even inflaniniation ads in the samti manner,
and it is the irritation of the mucosa which by reflex action, determines

■

TH£ TREATltENT OF D1ARAH<£A.

MR incrouiod Tawntttrity of the iittestine and thereby an exuggemtioti nf
ttie iiiti'tttiiiiil HL'L-rt^iuii. Liietly, uit^clmiiioiU troublt^s of Die tklxlutjiimil
cLKnliition may give rise to diarrlioM, of which we see an oxumple in the
8crou)« clinrrhtMi pmdiiciMl by gUsin of the vona porUe.

In other viuffs. Uie dJiLrrhoMi rRRiiltx from climiimtion of toxic principles
by tho iiittwtiaal iiiucuku. And just us wo Mt- uiu'inic »nd eudurul diur-
rliuKw produt'fU by the iiinctivity of certain emunctorioit of tlie eooiiomy
(iiiu'Diic poisoning, siuUlen sweut-Biipprwwioti), ho also certain poiiKHix stick
as the mnkritil, and thst oiigoiiderw! in tlic vitist«d air of ampliitliontrwi
nuty produce the Hinie effect. There is in fKt^t. a malariiiJ diiirrhu*a
whkli is Iributury tu quinine, anil YOU ttro all uequaiuted with tlie diar-
rh(Hk due to prolonged Bojouni in diiwectiiig- rooms, where tho air of
nwpiiution ]» rendorMi foul by umunatioMS from HubjecU itt nn tulvuuced
Btage of decompoailion. But thia ia not all, — I have previouiily nhnwn you
the im)iort]uit r61u plnyed hy mirrolii-H and ptomuince in intt-stinul digo«-
tiou, in provoking vcrituble iiifiH^liouK diarrhtme. wliicli eliould be coin-
tntod, as we BlmJI soon me, hy a sjhhsiuI medieatiuUr to wbioh la j;iven the
name of antisi'^ptic intogtinal mt^licution.

Hnt it will not do to at^uin* the notion that tho mucoun membrane Ls
olottu cmiciiruttl in the jvutiiogenr of diurrhnii. and 'l'rouc«t:iiu baa doao
well in tailing attention to the inteetinal fluxes produced by mi exaggera-
tion of the jierislaltie niovenieiits, and which lie calls diarrliaa by exag-
geruttnl tonicity.

Such are. briefly stated, the prtnoipal i-raiii^^ of diurrhan. and if i hare
■i^Altied them, it is Uiat 1 may make etiology do wrvice in therapeutics.
Von will then take ^Tvut care, whenever you are cuUimI to a ca^' of int«fl-
tinal flnx, to awertain the cause, in order, if {X)e8ible to remove it, and
thus cure your initient.'

From a therapeutic ))oint of view diarrhoM prowDte il«c1f under threa
prtnoipal nxpects: Bumetimea it ia hut a tconpiHttry phenomenon, dia*
appearing with the cause wliieh produced it: eometimea it is porsLstent,
chronic, due to profound leatonR of xhi' intestinal mucom; lastly, under
other eirciiuiKtaJieett, the ahdoiuinal flux is one uf the mniiifetttationK of a
general diathetic state, ench w* arthritiam, herpetism, cooBtituting the
gonty or dartronx diarrhoea to which (fuenuau do Ulugay has callwi atleu-
tioiu

The tbcntjicuue inilicutiunH in the latter eluai of diarrhoiut arc quite
different, and while we ought very encrgetioally to combat certain diar-
rhceaa, we must on tho other liand turvfully resjiect certain abdominal
fluxtTs, and tlits ix, it must bo cnnfeKKud, one of the most delicate points
ill the treatiuent of diurrhu^L

Aaftfreneral rule, when the diarrhov ia not rory abundant, when it
haa tast^l but a few duyi<, and espoeially, when it liaa not wemod to en-
loeble the patient, it in not bust tu be in too grvut baate to suppreee it.

»

320 nisKASEs OF THU srroMAcn.

On Llie oontnr^', when thu iiitestinul tlux uhows a tenilencj to beoome
ehronic, and thus be a drain on Uie vital fortwa i^ tbo oconomy, joa
ou.^lit tij liilior for ite sappreeBioi), und the more eamoxDyi ihv mure pro-
fuse and tstubbora tho diarrhoea. It i« to be takvn tor grantod that

I lonve one fide the (ebrilo dtarrhcpjui, duo to iducouh etateti; Uichc aro
ppijthMiomeriH whii^h ouglit utways to \t*! Te«pectod. These rHimrvationB
bi^iii^' iiiaik-, I prori'i'ii to the treatment of diarrliocas, and eejiecialty of
olironic diurrhteuo, and I will begin br by^eiio, whiuh her«, as always,
play* thi* predomiiiiiiit •pan.

A grpat nntnbpr nf diHrrhn^tis uriw> from alimeiitanr i»iuii?8, whotlior
becuuMO the jiutictit cats too much or not eiiouj{Ii. or di^eatH poorly. ITare
care ilit-ii alwiiyx to cxiimine attentively into the diet of penninB sufferiiiR
from chronic di(irr)i<pn, iind yon will And in the majority of cosoi the caaee
of the alTefitioTi nnil it« n'mody. Am ! hiivo Wforr dwelt Kuffiiiipfitly on
thin BtibjWt under the head of isUimiieh diseiues. J xhull iiobs on without
further prctiminiiry remarks to two aliments which occupy tho first plaoo
in the trcatmenl of dironie diarrho?a«; I refor to milk and rair mout.

Milk is the best medicament for ehroiiJc dinrrhoNi, somotimett, in tact,
it is thu only mwiicument, and you must not forg«t to t'ombat that fonhHh
prejudice which imputes to niiik the am nation of abdominal fiuxe«. Tbii
is a grtjttt mistake, for a milk diet ulwaye produee« constipation.

X» for rtkw meat, of which I have before xpokcn at some length, this ia
the way that Weiwi of St. Petenibiirg Himt' tn employ it. ITo wad trcftling

II youiij; child alTcrted with clinjtiie iliurrhu'ii of u most rebellions kind;
one <ltiy the c:hild eagerly tsnatched a piece of raw me^it and eat a portion
of it; eoiitnirily to what was fearetl. there woe immcdiatB amelioration
and a diminution in the unmber of titnols. Strm^k by this result, Wetra
mjuie furlher iriflls of niw meat in miiiilar cuxvn, wliich led to ita introdno
tion into l)iem]K!Utir^.

I cannot here state the rules which icgulato tho milk or raw meat diet
in dinrrhn'ii, unci mnnt refer ymi to whnt 1 hnve previously 8t»id under tho
head of difteiiBca of the Btomach. I must, htiwevor, give my iku^'ided
opinion that the meat powders arc mipcrior to raw meat in the tmatment
of chronie dinrrhci'a, and coupled with milk diet. I have aiwuyx fouitd
these powders to bring about a oure whon there did not otist, be it auder-
stuud, on tho part of the intestine diranlera of too grent gravity.

This is my manner of treating chronit- diiirrho>ii. I keep the patient
a week on a diet of pure milk, then I begin to admiilieter in increasing
doHes the meat powder, whether in milk or in broth {which must be frco
from (at): and wht'n I have obl;uned well formed st^ol*!, I combine with
till' powder of meal lentil flour, and i( this mixture is well KUpiwrUHl. I
add corn mod, then 1 return g^i-ailnally according to the Htateof the inte»*
tine to the ordinnry ri-pmen.

I much prefer Ihesf powders of moat to tlio peptones which have r»*

TriK TKKATMENT OP DlARKWKA.

321

oentiv been rpeoinmoadeil l>y Baeile Fcrie iu the trpatmeiit of tUo iliirrhu-a.
of Ccwiiiii China.*

• MoreOTer villi ivgapJ to the divtetii; trfjitment of (liarrhcpa. there in a
gfreat difference l)otwei!ii the nWlominnl fluxes which tmvu the iiinull in-
t««tiDO for their ecat, and those which arc 'duo to iliBOrdera of ih» larve
intcittin4>. It in in the 6-ntt o>iIy thiit tin- iitMit ^wwdor or milk diet h:is
any tnirutivo hIIipju*)-: Kuuh h rL-gimun is of much lew acoount whon tbu
iliiirrha-a origiimtc» in th« Xarge Intcittine.

In oonticctioti with thct» alimonl^f 1 rnust mention certain mibabuices,
us <)iiinc¥?, which ])o»i«h» iintrin^'ent ]iropcrtic% just lui do all vegetable
mlMtanocB whioh contain tannin, and thurcbj are tliompoutif-al in diar«
rhoea. [Th«ro i« a. syrup of qninces whicli is ollk'inul ia Prance and is
I^Tcn in dow« of aroiiplo of ntiiircH or more; t lie weirds are nerer prescribed
for internal nso though employed exl#mal]y in mjiccration. J

Kice, aa well im whonbrn ntan-h, ia espocJally npplirablf* to the dietetic*
of diarrhoHL, und tlit* huitiv may Iw luiid of white- of f^gg: albumen water
liAS in fai-l Ijeen greatly extnlled, ami iti* efficacy doubtless conitists in that
it domandfl no lulior on the {Rirt of the inti^eiincd, but allows this portion
of ttio nl imon tarr <>iLnal to roRt; whib> of pgf^, by the viiy, if ntfiidly pvp-
touijcol in thi' nitutmudi. nnd absorbed.

Next io the alimentary rt-gimen, and of almost equal importmice from
an etiological point of view, w the influt-ncfl ol cold and wet. ('old air
MtUTutod with moiftiirp in one of the mo«t frw|ucnt cauet* of that diar-
rhiBB whiuh may iw calk-d ocuHotial. and you shniild not forjpst to trnjoin
Upon per«uTi8 who with difficulty adjuH thenisulvea oven to slight atmo»*
ptienc chatigen, tn w»tr a wdl-pndded flannel waiBthaml. In countries
like Aigicr« where tlift tTansit from the hwit of day to the cold of night is
BO mdden, the military unlinance makc» this flannel wnitilliand obliga-
tory, aud thix dimple hygienic ineasuri! presen't-s the Ho]di«rM from the
diarrbfraa so rife in tk-it c^nntry. lA»tly. ur^e your iliarrhueic (mticnta
to guard against yielding to emotions, which often no aggravate diarrhu-al
tendonchw. 1 hn«l4>n now t*' lh<» pharmat'eutinftl meanit in our p^Mweivion
for the trt'Hlmc'nt of diarrhcra.

Phamiitcy furnishes us inert powders, tuttringentx, and mediainK'nta
which oppoee the ottmotii; movements which lake plaoo in the intcstinvB,
And Uatly, there are local meant) which we can jnit in lutagc. Tbeao

rrMnii wi! will now coiiBJdyr in llieir nrdrr:
Thi' inert |)iiwcWk dewrve the first mention; they do good by a local
ikction. and perhaps by a special action which they derivo from the clumU-
eaU of which they are coni{>oeed. We have tirst nubnitrato of biitniuth,
which is more uee^l than aiiv other medicine. The «ubcArbonat«, lactalu

' Etaxil'- P^H^ On ths Treatmeal of the Dintrhoca of Cochin China by Peptonoi.
c. lb t1i»m|>^ 0(^L SS, IWXy.

■n

323 DISRAHiS or TIIK HTOMAOn.

and tunnuU! Iiuvc aIemj Iwnii proposed, bntRll them prep«rstion8 are now
uImiikIoiiihI. At tbu miiiu time I mutit make rctwrvutionif in fuvor of ntli-
cylato of bismuth, which \oii Uavc tftxrn me ex)K-nniei)l -n-itli in mv ItOApita]
Borvi<H>, hihI which 8f(>ni» thiiH fur tu glvo oxoi'llent ruoulta.

Subnitratfl of bUtniith U a<lni>niKtere(l in powder, in potion, id postillee
and cvuii in luiKlicins] t^riatniK. It iti u tafttolcHi inwlicameiit, cuily odntin-
tstored, cvon to infants; an it ia not toxic, it may Itv givun in tari;^ doiK«,
uiiil you know 0ml Monneret, who bius dont> bo much to poptilarixe aab*
nitraUi of bismuth, omjiloys it in (•scefsivo dottus, twenty to thirty ^ranimce
( 3 ' to I j) u diiy. Oniiimrily one to three g^nunua (fifteen to forty-five
graino) ttullii^i.-. but kr^vr diwtu! iiru (|uitu taSv,

Uittorly, C'artiot has rniaodan interesting question apropos of mbnitrate
of hiRmuth; lio hns shown that this t»lt ordinarily contains loail,and lieiiue
Doucbtit haji uiiiintHined that the presence of li'WiI if not an evil, and that
it iti owing to this impurity that oubuitrutc of bismuth is eudi aguud uuti-
diarrhoeic medicina

HtiwL-vt-r tlii« may be. whether pure or impure (and the phamiaoopceiaa
now j;ivf nit^aits for obtaining Hibi)itriit« of hidninth in it« purity) it acta
both OM an inert [mwdor and as lui antacid and abaorlient. Hianixith is a
VKry biisie niilt. whiub n^iulily n^iutrahitve thi^ e\eeH»truaeidity of ihc-giuttric
and intetttinal jniot'S, moreover it abmirbs the giuiuu geiienited in the intea'
tinv, mid which Itiivo a I'rrlaiii Hhant in tho production of th<^) diarrhoea,
aini the siilphiirett«l hydrogen thus abdorttcd tranHforniii the hiuniith into
bismuth eulphidu, culuring the fii-eiia black; a very cuniinon uvcurronce,
by the way.

Kut bisDiuth iu HumuwhiiL ex|ioneivo, and oalcic projuinitiontt may often
he a'^lvanlagcouiiily tiiibRtitiite«I. Lime wat«*r iH an exet^llent medicament
in diarrhtea, and Ib esiK-^iially valuable in infautilv tht.-ni[>i-utica, being
gcneniiiy uddod to milk in the ordinary diet of infants Buffering front
looneiieiis of the howel»!.

Tlit'ii L'omu the pri'jianitionB of rhalk, whicTli are niore or less numerous
anil (complex. Latiitly, thorn \» the (uilcru! pliimphatc, (tlie triliaaie and in*
soluble, or thi; acid uud isolublv,) whic-h aai& ehielly by dupoaitiuf: on the
mirfiicoof the intewtine a stratum of inHuhihU- powder. I have already re-
fvrriHl to th«ee diiTLTmil ijlio»;pbate». niider the heat] of dyspepsia of uuw
bom iufnnta, and dmply add in thix eonnertion that the utility of these
phoHplmtea in the tteatmcnt of diarrha-n is umj ucatioued. '

In the old pharnmco[Xpinfl we find niinierotw substancea Ijorrowwl from
the fliiiiunl kingdom, and liaving crhalk for their H\»\&. The jiowder of
cnili (tliulU, the eyes of tlie cray fieh," egg and oyrter hIiuIIb, have in tnrns
hi'eii pmiMiHcd in the trtaitment of abdomlual (luxea, TheoLt pre' jui nit ions
are tu-day abandoned, with the exception of one which merita some atten-
tion, namely, calcined hartHlioni. which st-rvea an the linsis of ono of ths
niort UKeful doeoL'lionB in ihu therapy of diarrhcea, namely, the White
Decoction of Svdenhani.'

Finally, Onliler, taking up again the prHCtico of Adair and flenly, liM
brought iLUPW into rc|)uto tho oxido of xinc. vbioh given i^xci-11l>iiI riutiilta
in from twelve to fiftpoii-gnurt dojwH, asNuaiiitrd with eight praiiiH nf car-
bonati- of }>otaBb foui' lniu;» a duy. Uuiiuiiiy of Nutito^, I'lijo^itiur and
Jaoqtuor, have shotrn by numerous reported cases the good effects of tlits
oxide uf zinc iti diuirhiHi.*

'riierefore, to mini up tho foregoing olservations respecting inert
povileni, wo liuvi* first, tbu subititi'uttf of hiamuth, tlioii the osido of xinc,
Olid IiiKtIy thi- i!ulto of lime, of which one of tlio bwt prciiarutious i^ Sydi-u-
hutn's whitf* doL-octiou.

The axtri ii}^iit)4. &ik1 especially thosu wliiofa aro dd>rivc<l from thu vog»>
tah]e kingtloni, have n prL-duminant action in tho treatment of [liarrlia>a.
Tbua buiniii ia a ffiod remedy lu throiiif diurrhnaii!: it is given in pillu in
tile dose of two to eight gruins iiiul even more.' KhiLtany fnmishea alao
a ptisau and an extmcL' Ciitochu is Ic^k uniployed, yvt hus tiutiiy advo-
catBS.* The aime may l«^ mid of eolumho, and of giurunn, which Ilerve
of Iwivaur and Dcmucf luive rccouuneiidcd. tlm first ill |>otion, the second
in pilU, to combat dianha-a. IjOftly, the plants oontaitiing tannin, such
a^ Htrawberry vine, tormantillo, biBlort, rose U>avoa. wabiut lenviM, liave
bwn rocomnien<led as anti-diarrhff-ic mediciiwii, though little ii»mI.' Siirh
are in brief the pnnci|ml luitringnnts employi^d In diiirrhtea. Let us jiueh
now to tliv Ofiittte mediuuiit^uto.

Th«re are, you know, mt'difaments which augrneut or diminigh the

' osmotic ezchaiigwi wliicli takv jtW-u throiigli the intt<«tinal walU; the name

tttt'^xomnotic han been given to preparationR which prevent this dialytic

, action, and such mcdicnmcnte have butii utilisud for the euro of duurlia'n.

Opium is tho an-exoamotie stilwtunce pur exwIlenL-B, and if to this you
add it» [»awer of eiifoobling the iK>niilMlti<; umveireiiU, you iiiiderKtand the
great utility of thin mctUcane in the tiTatm«nt of alKlominul fliixea. Rut
I liere isan importuiil jx>int in L-oniifction with tho action of opium. — the
mode of prepuratioii ami combinutiou is not a matter of iudifieroace:
while ooniB of the opiaW prejiaratious have* but a limited action, others ore
rem&rkablj' etHcncious in the treatment of diarrhoea.

By far tlie two bent prL'[»initiuiuf are diuKcortlium and hiudanuin. "* This
old prvpunition diatfcordium, which origiiwt^-^l with Tmco^tor, and which
take* itti name from one of its ingredients, Uuerittm Mvrdium, oontaimi a

>t number of vegetjd snbAtanoes all of wbioli are (.•ffleocioue in diurrlmia
niach a« bistort, tormentilla, etc. ; and it is proliibly to tho aasociattnn of
lUueo taonin principleti witli tJic ulkaloitbt of opium that thi« el«:tiv€

' Ailair et J. Hniily, LiipiK nittiniinarm (Liki-iiilu nativa) in aM lluxibiia cwihse-

Uoonim (Om^-tin, App, mM.. 309J, Bonumy, lie roxT<l«de xino riiitut In Dlnrrh^

(Bill). tli< ThAru|i.. May. 1877, [v ffll). Puyt^iitirr. Do I'Enitilui de )*Ox/de de kiiic

tarn In Dfairrhfe. ThL«e de Paris, 197J. n' 2S0. Ja«|utcr. Ih* I'Oxjih* «l« xiwr

ii$at la Diarrii^c, TU^e (1« Piui», 1878, n* tSO.

324 DUKASSS OF THE BTO.^IACH.

Bctioii of (liajK^ordinm in the treuLmuul uf ititu»tiual Auxue U due. You
am then lum di»f»aoniiuin or Uouuliardat's gu)j6tituW> hiii) iwliniiiister this
mulicument in the dose of from otiu to fight gmnini<w (fifu-t-ii gnuue
to ~ ii) without iiicoiivi>oieii(--4t, rvrncm lj<.-rii>g that <liiuurorditim eoiituiiis
fwr gntnitne six millignuQntiv of extract of opium, und tbut Bouchunlat's
formula rontuiiis iwr gruiiiuiL' two uiilligmu)tiic6 of luorphiut^

bimlunuin isiiiso itii exL-uUiMit forui of opium for diurrh<ea. Tb« best
prcpArution in usv in thu Utittvd States U the deodorizoU Uitcturo of
ojiiuni. a iww and wscpllciit ofBciual lately iiitroduocd iiito tho pharmaco-
po-ia. Tlie ('onfoction of Opium is the hfst modem Hulntitute for tbo«e
complex uiid tiiisdvntiliti pri:pamtioii8 formerly knovn as Ihertaca and
mithridnU; it is a combinatiou of opium with sptcvs -which iiivr«Me the
Btiuiulaut and lutringi'iit action of the opium, niid may be f^von in doses
of from tun to thirty grains. For the Ltiu/ianum of Sydenham, so murh
iu vogue in Frniic^t?, iha .Ainvricun pnuditinncr vill substitute the Vinum
Opii of tho V. S, ptuiriuacopceia, of which the cotupoiutiou and doee an
essentudly tlie Rame.*

It hiLK biH-ri pro]K«ecl to utihxe tho alkaloids of opium, and Kabntcaa
has evpii clus^ thom according U> their ancxosmotic action. Of all the
alkaloids of opium two ouir an^ available for thij! purpose, opposing as
they do itit«8tiiial cxoamosis, viz., narcuino and njorpbino, and tho action
of morphiuo is superior to tlmt of uarcvino. Till quite recently it hm
been tho ca»tom to give thtt; alkidnid by the mouth, hat Behi«raiid Btill
more lately* Vulpiuu. havu (ihi>wu that in liyiKMk-rmic in jeotions the aotioD
w much more marked, and l..egagnear in his thv«ts hw brought together
numeroui; ubeunntions which «efm in tliis rvgard concluBivct

But what givpH the ht'St results in the treatment of diarriicEa is the
association of opiHt*» with a:<lriiigi'iitji and inert powders One of the
be«t known of thc^ prcpamtionB is the combination of diascordium t with
Bubnitrate of btgmuUi, under tho form of leu-gtmm boluses administorod
in nriablo numWis three or fnur times a day.

I advice you ulttu to employ au antiitiarrlHric potion which I often
preacribe in my hospital service, the fcomula of which i» m follows:

8 Vini opit gtt. x.

Siibni(ntt«o( bismnth) gma. x.

IVjimTmint water. ....,.*' j.

DistJilwi h'ttucu wati-r " In.

Svrup of rhAbniv *' xxi.

IL ~DoM — one taUospounful when reqitind.

* U. 8. DtopMkMktoiy. Tb9 iloNO of vinum upit is the same as tbat oJ tlw tiaet-
ur*.— Ttvas.

t LcwneuTt On Hypudcrtuic Injvctionn o( Morphia in tbe Tinaiiiiiiil of On^
rtuM. TMm d9 PttriK, IMI.

tlti« confvoUon of opium ma^y i«k« the p)*o« of th« di«M<M>iliuai.— Tr.

TUK TK>LiTMENT OF DIABRHCSA.

325

Tiocsl ap]>licatioiiii hnrv iin imi>ortaiit iwrt in ttie treatment of dtar*
rbtLik Tlii-M- uif imiiiUinl uinl otlii-r cittiifilBsmE, ur men a simpio layvr of
batting applictl ovpr thu nlMlonioii and covcriMl witli oil silk, which nets
by iDBintBtiiiiif^ thi> Titiil ti<>at. It hoa bceii prnpoBcnl also to covet thn
belly witli u coating of roliodton, and it has even boeii clHinieJ tliat there-
by the Diost obeliiiatL- diarrhoas can be curetl. Thiti is a nicani^ tlial is
certaiuly saSe enough, und which you can tr)' if you like, without, how-
ever, expecting the iD»rvpllo»s renults which have Ix-en fittribiit«<l to it.

I jivpmt'nts have ii bfnrlicial (-iTert in the treatment of diarrhcm. You
niay employ, according to the L-aae. Kimplc fmoLliunt l!ivciii<.>nlB of starch,
or Htarch and Uudanuin. You may aleo medicate these lavements with
eome astringent subBtancc. Buch iw rhatany or tannin, and even Riigur of
Ii>ad," BtirthOK and (tut-nitui hare ralhMl uttentiun to the gnml elTectn of
injectionii of Goulard's extract and wuter (a tcaspoonfu I of liuuor plumbi
to eight otiiiccK of water).

Within a brief time Bourdon aud C'honppo* havt» strongly recom-
mended to llip profcftiioii powdered ijM-me in Ittvenipnt. Choupi»c, htw
givcti a complex formula for these lavement* which I propoee thus to
simplify :

Into L-ight fluid ounces of warm water, stir loO grains of powdcrutt
ipecac, steep one minute, add a few drol^^l of hmdaniim and admiiilsler uti
a lavomont.

ThiH i»an ftxci»llent pn^panitioii which pivt-a good rcaulb in thv diar-
rhfFu of uhildrun, and ct<i)ccially iu that moet duugL-raua fomi, cholera
ilifaiitnm. I have often had recourse to it, and have always derived
iMnefit from it.

And Hince I am now on the euhject of iitfantile diarrhu-a, do not forgot
that this is one of tlio gnivest and moet f reqticut incideiita in the pathology
of infants, and there is not a day but you will see obstinato cases of it in
onr foundling liot^jiiLal. If yon will i-i'call to miud how sensitive young
children are to cold, and how liable, on the other hand, they are to dJ«r>
rhfra from the least change in diet, yon will readily understand tfae fr©*
(piency of this irj*ni|tt«m in the lirst id-riods of life.

The stoote arc at tiret lacking in conflist«iicy and roacmble maiihvd qtgs,
thwi they become green; colicky jwiiiB of greali'r or lens severity make
their Bp{H>anuK'<', fetid gitses are voided, tho infant bwKimeti vmacialed,
and if the diarrluni is not arrested, it ]ttuees to the chronic stage and the
child dies.

In Rome caso«i these morldd phenomena have an exceedingly rapid char-
tctwr: the Ktools h^comt' Kerou^ thevaru constituted by a greeniF^h s)>rcHtity
in which float mnttera rewmbling chopped Hplnach; tlio child'a fealures are
(ancbcd, hit) cycv arc sunken, biis voice becomes ostinct, his akin is cold

S26

DISSASKa OF TlIK STOMACH.

and deuth oft«n eupcrvouos m the courw of a few h«ura; thie is cholraa
infimtuni, so oftnn nhst-rvutl at tlie time of wuuiiing aud of which you ne
BQ maiiv iiurLHiiOM in my imrHling bo8)iiUl.

As Toii observe, tho diarrhtra of iiifancj' is often a t«mi)onin' trivial
affair, duo to exijoenro to cold or to eomo indJBPretion or modificntion iu
diet; POinctimi's on tlio rontnirr, it i« ti. ijeraistc'Rt i^mptom, umi of the
preL-urxors of thiit syiii}itoiii)itiL- uggrugHtv which ix described under the
munc of afkrejiaiii,' lastly. It ia sometimen mi event of cxtromo giftrity,
conetJtating cbolum infnnhim.

In all thei«c otmfl yoii ought to interfere energt'ticiilly, and jon should
nndenvor to iniNlenite and arrcuit tlio diarrha>a froiri in very onsut. It H
HlwH.ys dttngurouK to h<t &i) iiiU^stinal flux in young infants 1)ccom« e*-
tiiblinhtd, fttid while in the athilt you pan and ought to retsiwct diarrHcwe,
it IB not 80 with tho diarrho'as of infiincy which should npvcr bo allowed
to contmno, no mattt-r whtit amy hv th<.- uaueh.'. Some have, bowevor^tuc-
oepted from the gen&ruJ rule the abdominal fluxes of dentition, and basing
themueivcfi on tho aphorism of Ilippocnttce, have afiirmud that it will not
do to sto[i tliie diai-rhu'a.* 1 oiiunot gnuit thut tUiis objection it wull
founded, and it liiu always bevn my pnictit^e when a teething infant has
too profuee h diarrhtPR, and ee{]i*cially when th» diHcbargtiti becomo gre«n,
to interfere with ac^tlvo treatment.

It IB udviisublc then to ouinlju^t theee fliuee early, and I believe tliut
from mmple diurrhiiu to the mont advanced p^-rioils of cholcm infnntnm
tbt'TO arw only iuBenBibln tmiuitiuim. To attain your end, employ snb-
nitmte of bismuth and lime water, but be exc^MMlingly chary of htudanum;
l*arrot rujeets it altogether, and if yon give it at all, do not exceed -s drop
or two. Children in fact, In-ar opiat<-« biidly."

You eau alao tn,- Iteiu'* HIache'it method whicdi givea good retmlts, and
OOnuets in till* adniixtnrtLi of equal partu of eut^tor oil and eyrup acaoia,
which may bu liiiv^red with ciiinnmeii or nnine. A tcaspoonfuJ of tluB
mixture may be given after each diiKlmrge.f

Do not iioiiiit too much en lavements, iind in thiw regard I nharc tlie
opuiion of I'arrat, who gliowa their complete ineflicacy in the diiirrhtoa
of infanto — a diarrhci-a whicli dc^teudx on fiinctionut troubles of tho small
intefltine, und not of tho colon; hut almve nil havo a mirreillance of Iho
diet. TKie ia a capital point in the trefttnivnt of thcee intestinal fluxw of
etirly life, und one which I have fully conHidered in the ehapteron thedti^
pcpsia of ncw-l«»rn infants.

Ah for choleni infantun^ anti-dtarrhoeic medicaments are not sufliuient,

*]nTanlB willi ubdonilDul flux«« during dentitton very Midont liavc convu^
flionK. Ilippocnites, Liber dt^ DeiitiltiiK,

|1 liavc i>m>Q added lo each doae ot tliM eastor oil emtilsjon liatf a di<(^or
JiiudAniiiii. -Tr.

TllK TKKATMENT Ol'^ DIAKIUHKA.

327

yon must raiiw Lho vitAl foiv«« of your littlfi pHttontti. Give tliem swt-cteneil
wine potioiiK with old rum or 'bnunly, rouse the flugging strength by brisk
trictioiu of tho whole body: (?vi!U nituH to the pructice of TrouHaeau, who
advised full mustard batlis in tb«se cases."

And siiicv ] hare tiikcn on myself to tmco oa rapidly as possible t)ie
thontpoutic iiKlJuitioiis portaining to ci*rtiiin forms of diarrlitBa, »IJow mu
to compietti the Kutiject in reminding you that there are dijurhcHns tribu-
Ijuy to n tipvciul truitmcut, diurrhixuH of an tiifvctJotu) kind, rvsulthi^, us
i IttT© BhowD you, not only from the proeeiioo of s^wcinl micro-orgHuisina
in the fipcal nrntteni, but alao from ptoitiHin«)!. The {leiietrutiou of thu
organism by tliue*} infectious 8ubetaiice8 detemiiiic-s liyntptoms very simi-
lar to those of uraemia, and it is to thin symptomatic aggregate that
IJouchurtl huH giTcn the uumu of attrewarmia. Wo i?ari offoctivcly trait
thorn- infootioua diBrrh(i>u3 by introducing into the dign^stivi} tube mb*
stano«6 tt'hiuli detitroy the agents or products of putrofitction.

Bouchanl luia liigldy rccommendod iodoform and charcronl |>owder; I
munli prcfiir the solution of biRiilphidc of airbun. In order to prepare
thu M>lation> you havo tho following formuU;

•Pake of:

Pure bieulphide of carbon, ... 26 grammea.

Wator, ....... 500 "

Kweiico of poppprmiiit, .... gtt. X3ti.

3L Pour into a diwk of the capacity of 750 cubic cootimotres, ehake
and allow the mixture to euttlc; the clmr Kolution 'w to be employed.

You must take care to advise the patient to uae only tlie super-
natant lifiitid, and not to dietnrb the bintilphide of caHmn that •'emaiiiu in
the bottom of tho flask, Kecominpnd also to roptac* with fresh w*tor any
portion of tlie iH)nteutti of the Ha^ik which ahull be derantcl uway. Yon
have thus a constant supply of (.-arljon bt)<ul|)liid^ water, which you ran
administer both by mouth, — giving a tjible»tK»onful in a glaas of wuh:r or
milk — or ill luyenient. diluting tho noiution one luilf. By thie niuaii« you
destroy the fetidity of the Htuolt:, and, as \ have often asRiirtt) myttclf, you
annihilate all odor.

By the aide of thew infectious diarrhfi'as, we should place the malnriHl
diarrlufttt. Jules Siiuou. tiuvot, and I'oUiin, luive nhown timt in certiuu
coseB aalphata of quinine cures m by enchantment diarrha-as rvlK-llioiie to
ever%* otlier medication. Thei-efore, wheuever yoii di«et>Ter in the etiolngv
or in the conrve of the s\inptnms, tniceo of a malarial uilluence, do not'
hesitate to rcaort ob speedily as possible to (juinine.

Tliia leads me to sj^^k to yon about the chronic diarrhons of warm
DonntriHi, bo frequent in thi> colouicx. Here the only offlcicious treat-
ment, at loust when yon meiH chsck of this kind in Francw, is milk and
^Vichy water. Aprtrpoti of milk, Talmy Iia« shown that when this is laek-
M ut iKa voyiigcs, one may employ eondenhcd milk, and hi> hiui even

32K

SBBASSS OF THB STOHAUU.

iwiviMxl tho rxclusivo tuuigo of Riiptr of milk, ua being cumtire of tJii
4!liroiiic <iiarr)ta<a. Liully, mure reeuutly stitl, Fvrw liae poiatwl out the
groal HilvuiiUgtw of (hv peptonii8 in tlie r|iarrlur>a of hot oouiilriet*.*

I shnll not take up th(:Gu))jn[:t of tliudiuirliaiiof Cochin (JhJiia, which
fltiti iiii'lcr inrestigfttioii, some nftirmind that it is parasitic, and thai treat
mont ought to Ik> aiUireesed tu the anguillula whicii ia fuuml in the int
tiiiR, ot)K>n« ntnrmiiig thiit thiH iieniatoid plays only a oecondary r61e an
tliat uU untliclinintit: mt:iJii.-uti<Mi fails.

It n?in»iiiB for mu dimply Lo ineutlon ihe minora] waters whicti are'
beneficial in tliarrhtfas. Plontifiil ae are the ptirgatire vaters, it must be
coiifi-«dU(L that Riincml watcm which nrc ciirntivo in elironic diarriiowa are
fnw. The first and in fact thw only one h Vichy, and yet TOU know well
that thin water is only to hu aeud vxtcniatly in hatbH. being rather hnrm>j
fill when drunk; then we have Plonihierea, and waters which uro iippUcik-
ble, not 80 much to tho abdoniinal fluxes, as to the dialbe».?8 of which the
diarrhoea j« an opiphonomminn; and Recording; as the individual is horpetioj
or arthritic, yon Mbould select different spafl.

Such are, in bt-i^f, the me«nii at your diH^WKiil for combating diarrho'«.
In tho next chapter I eliall study a apecial flax, dyaont^ry, the trtutmeat]
of which claims partioular indicationti.

NOTES TO LECTTTRE XXTT.

r ' Thc«e aro the principal divisionH adopted by anthoritieg in the ■

1 flottion ef diarrba'ii:

If 1. Infianiniiilory diurrhtua;

^^m 2. ItiliouK diarrlu»a;

^^P 3. Diarrbiiu by action of the miiwiular ooat of the intcBtinee, each M

^^ 18 determined by fright, wet fii>l, «Lroug odor», moral affections, «te.;

L 4. (.'hnmio apyretic fliftrrhu-u;

^^L 5. Dry iliarrh<i^i. (HroutututH.)

^^f ItoHtan. uttribtibcs diarrhoea, like every other excess of the mticons ex- '

halation to: I, iutliuimmtory Hclinii; 2, chronic disease of long date; It, a
particular orgunii- ilis[ioi^itioii (only probable) of the inueouB membrane;.
4, the influence of tho norvomi! xj-ntom.

The {.'omperidiuni of Medicine girea the following claKt^ifif nation: 1,.
Idiopathic diarrhcRa; 2, Symptomatic diarrhtpa; ;1, Critical diarrhcfsi.

TroiiiiKuaii ndmitn tTTen kinds: catarrhal, gndoriLl, nervoiiR diarrhcvas,
diurrha-a duo to exLCSdivo intcBtinal flux, d iarrhcra dwo to cxcc«Bivo tonicity
of the intestiiif, diuirlwi'u due to divers organic disewteaof the inteatlne.

8|iriiig lulnptB tho following claoiilication : cnipniouii diarrhrrm, toxioJ
diarrricra, Bunplemcntriry diarrho>a, caturrhal diarrh<Trt, infantile diarrhofa,
hiliotiH diiirrluea. cbohM-aic diarilw'ti. ulceiout* diLirrha'a, depuniLorj- diar-
rhea, dyahiernic diurrhci'n, nervcun dianhu-a.

Ovrmain Ki'a hoti taken aa tho IwiaiM of luti elassHication the state of tl

*H« UM« the oatid [leptoneK, ^ving 3 to 6 table. xpoonrtlk da^ljr, togvthvr
wIDi ii quail, at niiLk,

THE TKEAT3JK^'T OK DIARBIIffiA. 3?9

^foecnl matters, luid gives mncous, wrouti, t>iliBr.r uiid ulbiitninoue diarrhotas
according as muciift. Lile or wrum, etc., [ireduniiimtes in the diwliargeft*

■ HiKmiitli is oUl.iiiu'd priticiptiliy from Snxoiiv. Tli« subnilmtH is
obtained tvom the metal by <iisolvin*g it iu dilute nitric acid and concen-
tmting tliu fluliitiun. uiid tliun {irccipitutiti^ by adding a ]arg« aiiantitv of
watwr. The U- S. prcxietw h mure coiii|)lirat(!d. (See V. S. Ph.) fl i»
a white, iuBipid, inodorouH [>owder, intwluhlc in cold water, bluolccning
with 11,8. Seguauld Uunkatliat ttiiewlt nvtitruIizc'8Giil[diuretted hydro-
gun in the Intestines, forming auLphidv of bismuth, and sHttlnj; free nitric
acid, which may hare a beneficial topical Bflect.

For the modoe of purification, see tbe U. S. Pharmacopa'ta. ITie fol-
lowing are staiulani American pifjHvratioiis:

Take of: eubnilrate of bismuth, pulv. creta- co. cum opic, fift gr, T.
Mix. One dow. In diwrTlia-a, Take of: eubnitrate of btarautli, 20
grains; mucilage of tragaailttb, J ounce; tincture of cinnamon, 10
niiuiius: water to 1 ounce. Mix — One doi»e. Take of; eubuitrale of bis-
miitb, 80 grains; camphorated! tincturtt of opium, 2 dr&/'luatt: ctialk mix-
tare, 2 ounoee: Mix. Dosp — one fluid drachm in dinrrhniiF nf chil-
dren. Take of: hiBninth siibnltrate 3j., pnlv. opii grj., while siipir r ii.
Mix and divide int^s 4 powders. Sig. (hie ns often an remiired to phoek
diarrlifPft. The J-'rL'noh arc fond of combining bierauth with chalk, mag-
llcain, gam tmgiiciuith, eto, l*fttcrBOU*a [uwiilles contain subnttrale of
biiimuth with m^ieiiiii., Mugar, aud gum arabic; each |iastille weighis I
gnimme.

'Chalk is given as antacid, nlunrhentand antidiarrho'ic in the done of
i, S nnd eren ^C> grammeii a day. In Knghind the preroired chalk \i
inneh in use, iind h the hima of numcrniiH mixturcji: tnc jtrineiiiHl is
known as C'/ifll' Mvrture, the ingrcditivt* of which arc chalk, sugar, gum
anibic, and cimmmcii wjiIlt, and of which the dose ia a tablcspoonfiil.
The mmpouttd chn/i- jxiiader (aromatic powder of rimlk) conitists of chalk,
cinnamon, nntmeg, »itFron, c)ovo>^ eardamoms, and Hiigar; do«e 3 s« to
3 j: this jwwdvr m combined with opium in the J'nln'a vrttw armnalicus
enm opii. of which uverv two acruptiw coaitaju uii« grain of opium. Du«e
-from twi to forty grains.

' TriB Eyes of the Obav-Fisii {OcvitU Cancrorum).

ThoM arc oonerotions forniud of cyirbonaUr of Iim© which aro found in
the stomijch of the cniv-fiidi, {Enfachn* Jluvin(iliH) at the time of moult-
ing, and which are dest'ined for the renewal of the carapaco. It in given
in th« same doee as clialk.

^_ 'The "Whitk Decoction of Sydexiiam." (See page 132.)

^f 'I'hompHon s ukodilicution of Hope's LHarrliuaa Bliitare deeorveii repro*
ducvion in this connection. — [Tnins.

t9 Add nitric, dilute, 3 it
TiDct catnph.. tinct. opii A ft 3 us
Synip of ^nger, \\
Aquani Cmiuimon, lul 2 '^
M. Sig. Two tCMpoonfuls in a little water. (Mod. Kooord, 1876,

*bauva^:es. Nosoloida M&li«tlc. DronKmis ILstoire dm PhlufttaaiHCM, t. ii.
IbaUui, CIIiij(]u<> MfOicuk. t. li., |>. 101. Sjirin^, Symtitomatolo^e. t i., p. 184.
i^Chnii^ui: UAdii^ulc. It^. U ii. , |). 411. Uttooeou dc Mumj, Clinkiu*
i., I1.1B.

;wo

mtiKAStt) OP TItK STOMACH.

\atte :9'J.) Tlope'e Mixture ia higlily epoken of hy Dr. Mareli in >[edical
iintl Surg. ltc[)orter, March "til, ISTi. Jli» line found it of eigmJ (tervico
ill diarrhuiiK.

'Tannin or tannic kH. A vegetable prodnct, e«»ntially wtringent,
(txisting in init galls, onk Imrk, cincliona, cat«i*hii, kino, ro«o Ipiivor, the
ra«plH.Trj- and iftiuwbfrrv pUinU. (ititt-ntitlu, huoiucU, «to. Thi' lannic
jicid of niwiitinc is crcliiiarily got from nut gitllc. It in yellowish white.
nntryiitHlIi»ib!(!. inodoroiiK, sliglttljatnd in its rt«aati«n, and of yeirartrin-
f^ont tasto, Rolutiln in wator, Icea 8o]ubl(> in ether iind alcohol; it prcoipi-
tat«8 iilbuiTit;n nm) gL-lutiiie.

THiinin coniliinvH with mrtals (orminj; tannatds. THnnin la pniiiloyftt
as tonic and Hstringcnt in hemorrhagcur nmcou« and strous flnxeu. m nro-
fiisc sweats and diarrhu^as. It is incompittiblc with metallic raits, alku*
loid*, iron, antimony, lend, miTcnn-, gelatine, alhumen, lime water, ett-.

Glycekitii oi* Tasnix,
Tftko of:

Tmiiiin. 2 oancus.

Glvrerine. i pint.

Hub tlivm tof;etber, then hoal gently aiiUl the acid h distiolv«<L Doao
—10 to 40 auiunia.

PttJiti or Tjinkin.

Tike of:

'I'linnin ^r, ijea.

Muuilugts of tni^icunth, ..... q.s.
For 1 pill. In li»?nioptyain and night Bwvaljt Do*? — 2 to 10 pilU a
day.

ASTRIJSnUNT ELECTTARy,

Take of:

Tannin, 50 contiirninis (7^ gntinn).

lleodoriwd Inmlaiium, . 10 drops

(jonmTVP of roses, . . .10 grammes (1,10 gntine).

Mix. For on« doBc.

ASTBINOENT LaVKMEST.

Take of:

Tannin, 1 emmme (gr. xt.)

Deodorized liindanum, ... 6 dropR.

Water, 3O0 graranieB ( S i,)

Mix fur u Uvi;mi.-nt.

PownBRS OF Tannin and Opii'u.
Take of:

Tannin, 2 drachms.

Powdnrod opium, 6 gntioa.

Sugar, &uf1ici»nt.
Mix and divide into C powders.
Done — one powder every 2 houm. In profuse diftrrhtna. (OppoUer.)

' Kkamkria Triandra, {Rhntany.)

In n South Ameriean shnih. Tlie root is officinal. It in long and
brannhinff, of a lyddish color and lift* an U8tririg«nt taste. The extract
rch«nihlt'H kino. Rhutuny its u powcrftd tonic uiid aetringcnt, and ia given

TIIK TnilATMKNT OF DIARRIIQEA.

in (loaee of 20 to 3() gniiiu. The cMrart contaiiia 43 ^wrcenc of tfltmin.
Thfi ofliciiuU pi-oparatioiiB, (V. S. I'll.), arc the Kitnict, Infuflion, l*ulv.
('Atochn Co., Syrtipus Knitnpri*, »nd the Tinrtnni Kramerw. The fol-
lowing non-offiriiial prepnnitjoim niv from the praotioe of Knglinh pliysi-
oihtib:

T»\te of: powdered rhatany root ^m, builitif WHt«T Oii. Roil down
ont* tliinl and stmin. Hose — three lubK-spooufulB every tbirtl hour. Jn
ubutiuAte diurr)io-a. (Ih-. Joy. )

tnke of: tinctnre of rhatany 3 i, oquie caluis 3 rl. Mix. I)oh< — a
dcemrtfpoon'fu 1 three or four titn'cB a day. (Kt'oco.) Tako of rhatany in
courao powder 5 iii. pnlT. cunella * iii, dilute Kiiirii Oii. Mix, diecel for
10 davs ami strain through papnr. Posp — one dnwhm. (Spniguef) The
(•xtnif't Iff knoin'riu mnv Imi pivpn in doaeii of from ft to 10 crain-s the
Fluid Kstnu'tfU. «. I'li.). indosot^of 10 to 40 ms.. the i?yruu(lj. S. I'lu).
in duHf* of 1 to 4 IxtiMpuonfuIi^ The tincrtiirv i» j^ivL'U lu dmehni domw.
Meigs and IVpjKT givw u iiiixturB of rhatjinv wliioh is quite popular in tli©
V. N It is miwlo fL8 foilowa: Take of: tfiu'ture of rhatany, 1 dra<.-hm;
tinctnro of opium, G drops; ljirarl)Oiiat« of ncHlinni, 'J(J grants; mmip of
ginger, 7 drH(-hm«: w»t«r, '2 otmcee. Mix. I^oee — a tea«poonful 3 or 4
times a duy ia infuntile diarrhoea.

■Cat«t'hu is an extnu^t from the woo«3 of the Aciacia ratechu. a treo
indigenouB to India. It runHists tniiinly of bmiiie acid uiul extnuHivc,
Bttd u powerfully utttriuf^eiit. The doee i« 10 to 30 p-aiiut. The oflicinal
prepuationfl an; tlie coni|H>urid infuHiun, which conlaine oatechu and
eiiinnmoii, (dose t to 'i euiieeu); tlio tincture, vt which the doee is a l^ea-
ffpoonful; the c-omtH>und powder of cuteehu, (catechu, kino, ciimamon,
rnataiij and niitmeK). do»e — "20 to 40 grains; and the catechu lozcneee,
which are made as follnwH, (wc :)dopt the formnla of the French codex):

Take of:

Catechu 50

Whito supir 20

Gum tnigiu-aiilli, 1

Tritnrato togctlu^r, make a paste ami dirido into loxenges of 7 grams
each. Doae — 1 to B.

The author** notes give the following prnparationn: 1, a ptisan mado
by iiifusring 8 gin«. in (lij tioiliiig wiit.'r. l)«*r — two or throe tJil)l)>H{>o<m-
fuU; 'i, a iavvnient iniule by uuKpending H gma. eaUi'hu in Ch» of warm
water. Catt'cliii ia uu exoelieut addition lu chalk totxturv, aa iu the fol>
lowing formu)a:

"nikeof:

Mist, eretnt, t ^YH,

Tinet. catechn, f 3 H

Mis.

Take two or throo tablcdpoonfuls afttrr moh littnid cmeuation.

"The isdigenouH artringent planla containing tannin are tery nomor-
ona. Among these we mention the following: tlie fmgaria venca, or
strBwberry, (rosacea); the tdrmentilla. (putentilla tormentilla) whicli in
naofal in decoction ( ? «! to the Oj), dose ? j to ; iii; bistort (|)o]yconiini
btfltorta). oKcful in decoction; the walnut, (juglans regia), of which a
decoction of the lenvefl in a domestic remedy in diarrUuMUi; kino, tlie m-

PIBKASEB OF TUK STOJIACil.

spiaeated Juice of ptorocnrpue msrenpinm (India), a very valniib)o nstrin-
eent of which one [>rc<)iaration, the ewnvcund A-ino jweder, is oep<>cuill}' to
uu uomnieiuied, (kino, cinnamon, aim o}iitiin> — Jose, S to 20 grains);
blackborry root (ItubUB C'anHdcnsiu ami Itubus rillosus), a faforito tiome*-
tic rcmoJy in the U. S. which nmy he given in infusion, an ounce of tiio
root tttriTi^ !<t^Rpe(l (witli a liltlt- cmnsnion) in u jiint and a half of vater
down to a pint, and given in wtneglassful ilom>H; red rones (Rcwa gaUica)
which i» ii fiooA nstringent and en^ra into Hnveral ^-alu»ble omcinal pr«[ia-
i-ations vt Lliti U. S. Fu., Bticli as Infos. Koiw Co., Coufvctio Kosr galltca;,
eti:.

its

"' Tim formnla of dinsoonJium (which is probably seldom or nevor
scribed In the United States) la a rery complex one; ou account o(
popularity in Franrc tliiw formula is licrc given in it» entirety:

Extract of opium, . . . . ^ . . 1

Dried gerinitudur lenvca, 4tt

Red rm» Xvnvm, Iti

Bistftrt root, • . . 16

fjpiitian *' 16

TornientilU root 16

Burberry 8(<edii, 16

Gin^-r,' 8

Louff (x'pper, 8

Cassia lignttA, IS

CuDolla 18

tVL'tiin (littjuiy, 18

Stonix IS

ClullMLtitim, 16

Gum iira.bic 16

Prfpari'il iirnienian bole, 64

Hoimv of rosoa, 1000

8pu]iieh wiiic, S50

I^Hsolvu thf Lxtniict of onium in tlip wine; add the honey of roses liaue>J
fied, then littlH by little all tlie other suhstanc^s in the form of fine fx>wa«?r,
and stir well th<* hiubb so as to obtain a thorough adTnixture; koop the
electuary in a iit^lktly etopix^rcd jiir. I'lUH^ordinm rtonhiina 2i cent!-
miriinie)! of ojiium to t-wry 4 gniiniiieg of electuary. Itouclmrdafs niodi-
n(.-attoii is Ht) lolluws: (wvery giumrae containe two milhgmmmcs of mor-.
phiu«:)

Morph. miiriatift, .
Tannin, ....
Tin*;, tfdn.
f 'onsen-e of roses ■
i'orphyri7.ed phosphate of UmO;

" Heverpe's lavement is as foIloWB:

ALX'titti* of lead, 4 gntmmeR.

Carbonate of noda, '2 "

Vin. opii,

Water (|.8. for 1 lavenieiiL

THE TEGATMENT OV DIARRinXA.

333

^

"Tlif following poUoius am highly iaeonuDcndoil by Parrot for iafiui-
tile diarrha'a:

TMko of:

Subiiitraio of bUmiith, 3 parte;

Syrup of btiM-klK'rry, (svnip Kuhi), , . . 100 "
M. T>o«e— a tedspootiEiil every thinl hour boforo nureiug.

8 Snbnitrate of biainuUi, ..... 3 part*.
Limt! wiit«r,
SjTiip ruhi. fi a 50 "

M. Dose — aa abovo. Tliis prt-ia^iplion is prpfprrwl wOk-ii thr alonts
are gr«on. [The translator has eubstituted the et/rMfi rubi of thu U . S. Ph.,
for the sffrup of cwtifreg of the Pr. codex. ]

'" In acute athrepeia Parrot administerfl PTcrr ten minntpfl. altomutely,
a t«aspooufiil of oue or the otlier of the following mixtures, l>oth of which
aro ioml:

1 Old hrandv, 1 part.

Water, '. . _ 20 parte.

2. 'ilie soconil is a nutrient broth, made of lean bM>f wiUiout vcgetahlM.

Twi<H' or thn.'« timoe during the day the infant in immereiHl for fire
minutes in a warm hath at nlioiit the blood hent. Intn this water a littlo
^ of muBtard flour may l»e allowed to soak; two ounces of muHtanl naji-
fidhg for six gallons of water.

SuMMAftY.— Uyseiitvry— Aepeot of Fwcal Matters at Different Stages —
Pharmaceutical Trwiimt'nt — Bloo<l Lotting — Calmative* — A»trin-
guntK — <-'aIoinol — Ipecac — Brazilian Motliocl — St^^ond's PUIh — Ailan-
' tliui Olandnloaa — Cataplasms — Hygienic Truatmcnt.

GKNT1.RUKK: 1 wish to devote this lecture to the study of the troatmetit
of dyeenterr, audi do thin for somrai reasnnii; first, bw^msciilocronsf^olitis
ig u. diw?iiw whii^h you will often obwrve in your oonntry practice; more-
over it is a diwaei^ uf our aniiii-s. aud in accordance with the new rvfcuU*
tioiis t'liforcod by the recruiting aervice, vhich obligi^s n«ar]y all of you
to perform the ofliw of military Burgoon, yon vill donbtlew often be
oWigi-d to apply tho rminstnlB whirh 1 bIirU give yon to-day; but the
dnmiiiaiit ruason i^ tliut dyncntery is u diwuM.- wliieb denuuidii an vnergctic
tvttiunent, u trufttmoiit, moreoTcr, whieh is almoet alwaya euccessful if
you Imvv an opportunity to iuatitute it at an early stage.

I Hball not hi're detail the n^nnptorim of dysentery, and shall refer yon
therefor to yotir text-liooks, and hIihII iniiiiit nn only oro point, and that
a very im|)ortuiit one, hiiviii}; a niurked beariag on the diagnosiit, progiio-
»\s and treatment: I refer to the sliitv of the discharges. One may, in
fact, say tbikt the dJHgiioeie of the dteakse is in the stooU, and that it is
from the aupeet whieh these jireseiit that yoil are to obtain the data for
your prognosis and the leading iiidieatiuiw of your therapy.

At tlio onset the fiecal matters are glairy, spumy, prvM-nting here and
there grumous miweos resembling frog spawn; there ar« etroaks of biood,
a little fat and n few t«cylmla floating in the niid»«t of tho liquid; there 'i».
niorectver. no biliary cwloration. and this is an im|Mirtiint wgn. There in
a lack of odor, and in thia re8p«>ct dyet^n teric »Louls differ from ordiuaiy
fKcaC matters; thi« is explained by the fact timt the odor of fseceagent'rally
deiH'iids on altemtionB nmlergone by eerttiiii elemonla of tJiu bile, and as
lute is wanting in dv'iientery, the odor is lacking aluo: this \x the fintt atoge.
Ill the second stage, the eolor of the stook is reddish; there is an adraix*
ture of pnsand blood with niemlmuioua dehria from the nuicoea, renum-
bling Wef- washing* or a-rapiugB of the gut. Thue far the prognosis i«
favorable; you can and ought to cutv the |)»tieiit at tlieee periods.

It is not so in the third jxTioil; here the reooarcei of art arc generally
ioipotvnt, and your progiiiMis will he grave, lu thia stagu tbv color of

blood is more marked, and the etools \mvv bu.-n coRi[MH¥tl to maaliRd rasp-
bcm<!s; this in thn luet degree at thc> alTeciioii. In thei^ tlireo eta^B ot
the iliitMuw tlie lirliary ReRrBtion is lacking, ati'l this i« mi important eir-
cumstjuioe from the point of view of pro^OHiR nnd tmatmcnt, for the cure
Uaemired whvn br aii Hppropmtti treutmeiit j-ou sliall bavv restorad to
the fie^^t matters the preaetice of bile.

The atooU arv more or lets Abundunt. luitl accompanied by a sp&emodio
]>ht<noDienon descrilxHl nntlor the niune nf tf^iinuniis, whicli miiv ufTet^t both
rt-ctuiii aud bladder; rectal ffiiexiiiuK, ttxiat? tenemnus. The number of
etools is eometiinett gT«at. and Trotiiucau, to churw^terizr tb<^>se stools, hsH
madti QM of a very liappy term, vUicb ought to be perpvtuutcd; he calls
them thn Jtpufa of flip intfufitif. ((en^rally wioh diRoharpc of farnl
iimttvni IK followwl by a feeling of relief; in the interval the abdomiual
pain8 art* keen, and an- K-utod in the tract of tbu large intetitine.

All theae sjrmptoniH are accompunied by more or lute f;mve genera!
ph«itomemi. ttnd iiccording to the predominance of this cr that symptotnu-
tie nffgrvypite wo find niimeroiin \'«rietie8 of dvsr'ntery doacrihed, such ttg'.
bilioiu. hemorrliagie. typhoid, algid, nholeriform, and rhenmatlc dj-sen-
tert'. IjAstly. the di^nu^e may pass to a ehroiiic state, and yoii bure then
to do with chronic dysviitery. I do not jmrirooe to enter into a discussion
nf throe formg, and 1 Khali como at once to the esMMitinl ]mrt of this
Iwliirv. the treiitment of dyBentory. We have two ordere of therapenti-
oi! aprncies, furnishwl us by hygiene and hy pharmacy.

The pliarmaceutieal treatment vHrit» ucuordin^ to thu viuwa h«1d m to
tho nature of the atTection. Some counsel antiphlogirtic*, and make
ehief account of the inflammatory nature of the diBiiuK<; oiIh'iv urg« the
cihibitiou of calmutiTcs. to alliiy both pain and diarrluea; othem om-
ptuifiiise tlie tiecesaity of making it tho ]ihy»ician'8 principtd duty to com-
tMt the diarrh'i-a with powerful aHtrin^nts, this may h« called the stiti-
diarrbo-a miMlimtinn: liutly, a mur«> rational syxtem of treatment called
the Kubstitutive or ewtuuit medication hax been propoaod. I shall jmlsh
these kinds of treatment in review and diMMiss their valne.

If there is a diseoBe in wliieli the doctrinu of Bronmiii ha« produced
mofit diflwtrou* offocta it ik oertainly dysentery. For n Jong tiin« this
nrvolntionary icj-rtem impoM>d on army and naval phytnletans a pcrnirious
tliempy buHud on repwited Mood-lettingH, and you would not iMilieve th©
inntimcrablo quantity of Iwchet* tJiut were wont to be applied over the
aUIomoii of patitnts, and the bleedings jverforDivd to combat the ulcerous
colitia. Thia w a mode of tnutment to be utterly and forever diacnrded;
it« only result is to augment the mortality, already so comidenblo, of this
diwaae.

Calinfltivea, with opium at th<tir hvttd, whoso end is ti allay pain and
nm-trt diarrhiPB. arc nloo lo bi> rcjwted, for tJiey give no fnvorablv romlti.
What I Nty uf opium, recommended by Sydenham, I eay ot all ilB nrepara'

336

I>IdEASKd OF THE 61V1LVC1I.

tioii£, niid I eav the aime of the eolanam dtriratiTOit. At tho Bamc ti
Leolerc »f Toum and Hamon of Frc'siuty luiru vaunUxl, the onn. Ifao n
ploymoiit of bfllodonna, t)ie oUier, caUipWms of tlio leiiii's) of tbe ^x^itiito
plant. 1 bvliuYU tliot tliuvc meanK huvo but u doubtful utility, and
simply mentio)! without reoommeailuiK thorn.

I hftVL*. lis you eeo, alrwidy ooirlBinnLHl blood-letting and tin? mli
tivefi; 1 mnxt also coiidomn the aiiti-iliurriKk'ie medi cation. RurtiL<m
that wo huTfi not hero to do with ordinary dian-hii>a, and that the dnty
of th« physician cotieiata tathcr in iMtuounij^ins tlio nppvotuncc of f.i'[»I
niatt(>r». which are very scanty in tho stools of dynpnlt-ric [uitioiitx, bow-
«rei' abunibtnt them uvacuitlions inay be. I recoininetid, then, niiit
the employment of iwtrin^cnta, nor of inert pnwdors, although Mount-
hufi cliumi-il tluit M'ltb uiibuitmtti of biuituUi in Ihu doee of euve
grammeti (over two oiiiiovii) a day, tho dyRontery may be cnrwL

The true, the only nktionat troAtmeiil of dysvnlery cotiEists in tho
playmont of a cabstitubivo method, enabling one to r«»tore the bilious
M.'cn-tion iind flow, that Ih to my. in tho Lunploy of pnrgittivra. Thia was
the practice of Stull, Zimmerman, I>ogiier. Pringlv. JirctonncAU, and
'l>ous8>Miii. It 18, ns boforo said, the ouly ratioual treatment, and e&n
alono bring almni a cure.

What piiTjfativoe should you employ? l)o not forget that the 1
iitteftine is the eoat of a BuTcro inllammatioii, and that it us noccmary
Hvntd nil dm^tic ciitluirtii»i hiiYing iin irrituting station on the miic
mt-nibrane; therefore you have at your ditijioHil only th» mild purgaliv
Ndinos, and obulugogues. Among the tir»t Iiave been Taunted m:
Rnd tamarinds, and it ia with tlie«) BybBtanccB that Pyicnhiira comi
his piirtfativG ])ution, which bus rendored so great «orriro in tho treatm
of iiy»;t'ntery. Zimmerman preferrud eri-iini of tarUir and biniarin'
Begnrr, nmnna. Stnll tiie neutral salts, ami Iliinullier. liochelle nalts.'

It must he wlmittod, tliat utthuugh thiii trattmont is sa]>erior to the
otlier kinds mentioned, theee purgatives are nerertholca inferior to tho
Chokgugiiv purgativt-a which I am about lo study.

I have already li»d mnch to sxy about the abseiico of bile in d\'senterio
dischitrgcs; I hnvo told yon that ynu may regard your patient as curvd
when once the bilvnppeanf aiiuw iu the etouk. You audorituud then
iinpurUin<;i> of chotagogue purgatlrett in tlie treatment of dyfwntcry.

Among tliL'By latter ageiiU Priiigk' has t'xlolled rhubarb,* but OEilmnci'
18 far pi-eferabie. Much cnipluyed by the English, thii* mild mercurial ia
■dminiatored either in massiYB dosetf, {from seron to fift.ccn groins), or hi
minute do«a, — fronk three to five grainfi a dny, in powders containing ^
of K grain given every hour. AVithont disputing the pood elTecti* of culo-
mel. I consider it aa inferior to ipecacuanha, the medicament par excti-
hura of dysentery, and which h almost aa much a spcciflo for this diaoue
06 is C|uiiiiiic for intcnnittent fever.'

TlliC TRKATMKNT Or J>VSKNTKRV. 337

You know that this member of t\w. Rnbiaccw lias been long known aa

' an anti-Ovsentoric rL-mi-tly. uud that it wua in 1086 thiit a mcmliiiiit of
I'ari^, On'nior by nnmo, jint t)u3 drug into the ixuuwKRlon of n physician
of rppuU?, Afurti, vfho, bowuvor, iirndtf but litUe trial of ipecjic in dynpn-
tery, while Helvctius, bis pupil, nnulennmerrjiis careful obwrvationsuf tliu
action of this modii-iinient in tbisdiMmMiand ilmTcrd groi^tadvniitnge from
it. liolvctiiw ciircil muny aiecB of dyRentcrv, and kept Xho Tcniciiy wicrcl,
bnt Louis XIV., sftur Imvinj; consulted hit! pliysician IXArpiin, and hia
TOnft'Nwjr. (albiT Lti C'liaise, Imught this ('(•cnn from Hvlvetiiw f«r 10,000
louis in gold. HHTotina k«'pt tha entini Bum, notwUlint«nding the
protcstiitioQu of Grcnicr.

Bnt it, in not pnoit^h to know that ipeoao onroR dynrntery, yon miiRt
aim know how to a.dmiiiisti<r il; imd here you have one of th«; btfst in-
itanoM tliat I could cite of the neceBfdty of understandinj;, not only the
pmgtertieA of Iho malicamont, but aUo its tnodo of udminietnitinn. It iH a
singular circumstnncc thut w» Ixith obUiin ijiociic from Bmzil und doriro
from this country the method of tusiiig it, und it is this method which I
aball now dcBcTibc.

I Tak« eight grammes ('i dnichms) of powdered ipecac; infuiw in SOO

^nuamea (fii ouncet!) of water, filt>-r»nd ndminisKT in tabWpoonfnl dosoa
the Orstdsy, giving nlmnt il ttthluspuonrul every two hniini; the Kniond day
infnw anew the residue of your wght grammes remuiniug on tlio filter in
200 gmiumvti of water, (litter n. twcnnd time and administer this infusion
the acoond day; the third diiy ijifutic yet onco more th« dregs of your

I powder in 20(i gmmmoa of biiiiinjf wiiter, but do not now decant or filter;

I 8tir w<'ll together and give the whole in dust* of a tableHpoonful at fre-
quent inUTvalrt; if the stools iire not clmngt'd, you begin the procutts agiiin
and continue it till bilo appoara in the dejecta.

The Brazilian method is complicatwl, ami I mucli pwfcr tlio proewhiro
nf Deiionx of Savignac, who tuu< done na miii-lt for the ehimdiilirji] luid
treatment of dysentery. This ia tlie formula of Delioui reduced to the
Amcrioin system:

^^ Take of:

^^k I'ow<ler(>d ipeoiu-iianha, 3).

^H Boil 5 minutce in wutur, . . 3 x.

^H Piltnr and add:

^B Tinct. Opii., Zm.

^H Syrup of ginger, 3 vijsa.

^H • repiwrminl water • ^ i-

^K^ M. Sig.— A tahlespoonful eTery hour. The opium in this formula

^^Boftir its ohJL'ct to cause thn ipecac to l>e toleratwl, for in order to obtain

^^Wanti-dyaenterio action wu niu^t guard against the eroetio action of tlio

ipecac.*

* The tramlator has taken Itii! Ilht'i-ry ti> iiuidify Mimrwhiit I>«Jiotix'« formula.

tl It might be made aviulublu Uy Aiii<-n4;nn pnu.-tiUoncrB.
no

338

DBKAARS OK THE BTOUACIT.

As before said, tlie ordinary Hoee of Lhiii tire]ianttion ie a lableHpoonful
ererjr lionr, but care must be taken to mAtcc tlie interrolB longer if vouuL-
itijfehould ciiittte. Tim uiitiru irot-ion, in g^nivc lueuu of dyeciitunr', ou|;])t.
to h« tiiken in tlio twotilyfour hourR. In miM cawsi, howvver, voii iicc^l
not giT« but balf l\w potion. You kIiuuM ooutiiiue ihu adtiiiniittmtiMn of
tlie ipecac till bile apix'^rs in tin* ittooU. This ett«ct w oft<>n obtaineil in
thu coarse of twcaty-fiMir hours: in otlivr ca5i>!) it is well to prulong the
medication for two or three dnyi*. Itorengcr-Keraud, in his remurkabl*
work on dyaentDrjv* baa propowd to vary the l^raziliaii uiellLOd l»y giving
tlu- ijMjcuc in Hiu[>un9ii>n in cold water, a modification which requires no
previona jirpitaration, and givefi good r««ulto.

How does ipvcac act? Acconlin); to koiqd uutlioritios, it destroys tli«
upooial virus pm|)(>r to tlio disnuiu; ucnonlin); ta others, it acti) hy atimu-
luting the intwitiiie and promoting tht" biliary w-uretion. Emetia. the
active principle, si:-«tni8 »!ho tnhftve an iiction of its own in l>eiiig eliiniiiatiHl
by tfao intitetine, and in locally modif>'iiig thu intestinal ulccrutioao. Itow-
ever this may ho, ipecac in the heroic i-emedT in dywntexT. In cc-rtaiti
vuM>H, to iiicreuso its action, (inhnin'I Js «KBo<_-iatL>d with itK-^'ac. and this
comhiuatiou vonstituU-s Second's pill» so much used in ibo murine Hurvice. '

It hafl lat^-ly Itwn propoeed to fiulistituto for i^HMxi; a plant to-day com-
moil in Franci', tiio ailanthus giandulom or Japaii vnrniRh. The root is
utilizod in the following way: Tritumto from oiiu to two ounoea of the
fn.«h root iu a mortar with fivu tub1i'i<|K)onfuU of wntttr, ^en exprcse tbe
whole through a linen rlotli; dose a lirsHerlHpoonful.'

Thi» ia a remedy eniployt'd by UoKtI in hiB navy pntctico. Oiivad
and r)n;^t-I')Btnblicr iiavu tihown tliu ad\'ntits;^>ii uf this preparation, which
J was till.' llml Buvci'iwfully to try iu France. The ailanthux gluuduloita is
a pownrfnl enieto-cadntrtio, whose actiim rcjenible* that of i|iecac, but ita
tw^te iii very diisai;roc'ihK' and it needs tlio Huunian'ti palate to be able to
take an na»ty u dose; 1 have ^iren it in lavement, and have obtaine<l good
effoetH, which were nevcrtheleiis inferior to tlioso of iptjcac.

Id this rapid enunverallon of {diannnceutical mea.n8 which you can
employ in the treatment of dysnntury, I hare only mentioned the princi-
pal medicines, leaving one side those whose utility has not been establisbod,
michuH nux voniica, (wmiBL-llM by Hagtruoni. llufulund. and Gwldiiigs of
Itttltiiiiore, ergot ot rye employed by Delionx of Savigiiac, and [terchloride
of iron, recommnndml liy the eiimc mithonty.

All tlicKc inedicine« buve la-en abandoned. There arc, Itowevur, others
which you may uh>; I refer to toiiie^ and atiniulanta. Thus it is that
arnica htut htt-ii conxiderwl by Stoll as a 8[>ecitii:! iu dyeentcry:— he gave
the powder of the root in the doee of a druclim every two hours, till an
ounce and a half was taken. Cinchooa has aleo hccu employed by uU
* Benjng«r-Feriiiiil. Ttivoretical uikI Clinical Treatise on DyMsatwy. Paris.

-rU£ TKKATUKKT Of UYSKXTKRY.

339

mrities as the tonic jxir tac^Uence. Ton can adtl canella, which, ac-
conliiig TO TX-lioui, i» one of the lieM RtiTniilnTits in the iidytianiiii pn>
vokol hv thv d,v«ei)tvriu Qux; uulmi^uud siomroulu qimsviji oti^Ut uUo
be miif^Dil in the siinie category.

The lavement tit an important moani) of troatnmtit in 'iTevutBry. As
Uie (liseafie is fteatetl in tho large intestine, and towarti its inferior ex-
trumitr, it \b tmtural tliut it ahtiuUl h»re occurred to pliysiciaiis to attempt
to treat locally tiie ulceratiotia of the colon; hencft it is that kvi-nicnt* of
groAter or less Htroiigth turu )>een propoacd, with thu int4>nt of topi<'a1ty
modifying the tieut at thu Uwionn. Onu of the most simpK- xs thu aatnii-
gent larement, and it is one to which I liave frcf|ueDt recourse; I )>egiii
truitmotit liy the nil ministration of ipemc, and when the flools lie4M>me
biliotu, I em|)loy the sugnr of load iHTonient, containii^ a draclun of
Goobird'ti extmrt to eij^ht fluid oancen of wat«r.

Tronmuau has Kounsellwl a very active method, the nitrate <rf alver
injection, and onr regretted friend Dr. Uros waa cnthnttiastio itaiieeting
the K00<) rceulta obtainetl by thia a^eiit in the dysentery of young childNli.
In the caw "f iiifniit* n Envement is employed eontaining from one to two
grainx of nitmtr of silver to four fliiiil ounces of wat4>r: in the ca«e of
adults, the done is nitich larger; from five to eight grains to eight fluid
ounces. Delioux of Savigiuic ha» modified thii< fornnila: he has maflo'
mnch nee of an albnminoun injection with nitrate of »?ilver, h\it hy gr*«tly '
prefers the iodiirettwl lavement!-, wliieli he was the liret t« recommend.'

tjoxtly, tlo not forget that ipcac may he employed in lavements, which
giro, Alt I have already told yon. p>od rnsulta in the choteriforni dinrrhon
of iiifjincy;* you can utilize them iiccordnif^ to the practice of Bourdon
id of ( 'hoitp{M> in the treatment of dyKentery.

Djitentery is, as yon know, mq opidetnic dieenso, which is dfti-eloped
■under multiple iiiflnences; meteorie, alimrnurr and infectious. Atmoa*
jtbehc variationH eui)i<titn1u one of the ]irinci[ntl caUHcit of dysentery and
promote thie diseaau in two way»; under the influence of a very high at-
mospheric heat, or after a uudden fall in tlie temfierature. 'IliiH accountii
for the (act that dy^onteric epideniics have liwii chiefly ol»erved in our
climates during M-ationa exceptionally hot, mich lu charactrrin-<l the years
\9l% 1^4 and 194C.

Diet also plays a certain part in the genesis of dy«ent«ry, and when-
«Ter this is insnfHcient or of tiail tiuality, consisting for instance' of gnM>n
frtiit« or fialtrd menta in etre-w. we see dj-seiitery develop. It id, how-
orer, undeniable that it is to water of bgid quality, and particularly U>
stagnant water, as Colin lias shown, tlwt we arc to aatign the principal
part in tho otiology of ulcerous colitis. tt'henevLir the water wiircM
destined for alimentary usages are fouled by regetable or organic matters

340

DISEASB^ or THE STOJIACU.

nndorgoing pntrebiction, you will tee two dieiMmd prcTail vliiuh han
many {ioint« of contact — intermittent ferer mid djriieiLterj.

An (or iuJoctious ousm. iIk-bc rt-sult f»|>i.'ciBlly from vitJatiou of the air
by overcrowding, and thii^ it is 'which ex])laine how it comva to \yaea lliab
dyBontory ia par txeelhnce tlio disi-nso of thickiy sottlod locftiitie*. Ibo dis-
c»n> of iLrmicft; niul 118 Colin hiis well said, it« part in human mnrtAlitv
rcwnibles tluit of tlie jitagmi. jflii)w (evur and cliolcni. 'J'hcrr has
never bwiia prolonged war in any part of tlie world that liits not Wi>ii
accompanied with epidemics of dT«nt«ry. During the lato war between
i<'ninco and GorniaTiy, dv^ntvry niudv great mvagvs; the same may be
Biiid of the Crimean war, aliw of the Italian and Mexican wa». In
Aniurioi during the war of the i^ei»ion. out of 6,000,000 soldiers t&ai
entered the bo^pitaU. S.OOO.OOO wer« cfisee of dysentery.*

Is dysontopv (lontajjions? This ii< & (jui'etioii which liai; b«im much
discawtod, and while KrfVfiip adniits a dysent^iric milium, and Ttndd and
Dotinon uflirm that there exiotM in tha disoiiHR a contn^ou of juinMitio
miture, CoUn ou thu coiitrarv dfiiiuB all t.'ontugioiu

The prophylactic means readily puggi-ct themselves from tbe detaiU
into which I havu just entered. By approprintu clothing avoid aaddcm
chilling; have great care nhoiit the diet.; see tliat only water of good
quality is drunk; any suspncti-d wati-^r HJioniii hu boiled: combat aa far aa
possible the vifect* of ovcrcrowdiHR; euch are the preventive meaanres to
bo taken to avoid epidoniica of dytw-ntery. Lastly, without taking (jart
either for or against the doi-trine of onntajfion, I believe it is a gooil prac-
tice to dtiiinfect and to dextroy as won as possible thu eIooIb of dyeentcric
puticnts.

As soon as the outbreak of the diaease Ib declared, yon will take t^ore
to maintain sufficient aeration in thu tihamber or hospitid ward of your
patient, and yon will redouble your eiidejivors to ensure entire cleanliness.
Yuu will insij-t that the patient shall not quit hi* bed to {i« to stool, but
that he shall use the bod-pun, for in gettinfr out of bed to go to the night
chair lie may tiike cold, and contnict uu intercurrent disease which will
be fatal.

Heat IB an essential etenwnt in the treatment of the dyflonterie [aitieiit,
wbo^o tcm[»craturc fails rapidly under the influence of the tnteatiiial flux.
You will eee the patient shivering in hiii bed, cnrlvd,up, with the ulothing
tightly Wnipped around btni. In order to lose as little beat as poerible.
You niu«t tlien promote the bodily heat by all the meann in nao in such
cases; bed clothing, frictions with warm clothi), Btimiilating drinks, hot
ponlticoB over the abdomen, warm-water Ixittleii, Ixitha and other exci-
tants. Ilelye has even gone bo far us to maintain thai culoriQcation is the
sovereigu Ireatmi-nt of dysentery.

TUK tKKATMKNT OF DYSENTERY.

341

Tou should WAtcli witK care over tlw iiliiiiuiiUtion of voar [nti«uL

You will eustaiii him by vine &nd liy foocln which an* abBorl)ed in tlioir
entirety, (md ou (hia'accouiit k'svc but littlo r«id uc, such mt miik, licwf ten.
ami ei-en raw nieut. Itoditi of Pichonnerie, and Mondiero. hitvo Tauntod
albumoD, aud have even claimed tlkat bv this alone one might cure
dysentery. I believe thiw to lie an cxaggcnition, and tliat albumen has
hot a secondary and vury iiiiorior piucc ainung anti-dvHenteric remedies.^

In onr climate, dysenlen' rarely passes to the chronic ^tatc: bul it ia
not BO in warm countries, and wo find, niiliappily too often, in France,
such caws of chronic dysentery contmcUMl by our countrymen in Cochin
China and in Africa.

Thi« nITcction cluima n tri-atnicnt bosecl exclusively on hypono; in-
diriduals affected with chronic dvaenter)' must be rigorously aubjectod ton
milk diet: I say rigoniHsIy, byciuiso after a alight amelioration the imtit-nl
tliinking hirasolf cured resumes \m onlinar}' diet, which causes a relapM.'^
and tlio nnfortunak; virtim of the dificuN; finds himself nnntinnnllT puss-
iu^ from tnmHiunt uinelio rat ions to rcliL|isi-s iiioru and [iiore frccjut'ut. till
death t'U'ifl the scene. You will also orler your patiente to ejwnd a aeason
■t Vichy; it a the only elation ivhosii water will give good ruenltH in such
caws: and yet you should rrtmrniilM-r that these wiitei"s nan only be lued in
bikthfi, or if dnmk at nil tbt;y miut be taken with cn-at pnidencc.

Such, geatlemon. are the therapeutic considerations which I wish to
prrai-nt respecting the tnaitmeiit of dj'nentt'n,-. I propose to devote the
next lecture to the study of the treatment of certain tractions of the
rectum.

ISOTES TO LEUITTHE XSlll.

' Zimmerman was in the hubit, of giving cream of tartar in the doee of
an ounce, tjiniarinds in the doee of tlireu ounocH to adults, two ounoea
to children of llie Hrst dentition. The«? metlicametits wen! mixed with
one or two (|uarts of wiiut. Uuniilbier in the trentment of mild cnsoa
g»T« every dny hiilf ad ounc« of Uochollo saltd in |>otiou.

' Pringle, after a <Miiimt>ncing emetic, prescribee every day from 30 to
50 grains of rhubarb in fractional dosea

* liwcncuauhn. This p]imt is the Cophaelis IpecjLcnanha (Bn1>i4K!ea!i.)
It ie a Brazilian shrub with a stem two or throe foct hmg, Ihnugb portly
nndtirgronnd, and often nnwiimbent at itabaae. Tlio root in from 4 to
inch""* long, about ns tliicK as a goose quill, gonerally somewhat bninohed,
di<6i-«iiding obliquely into the ground. There aro Hveral kinds of j|)ocac-
nanliH, among wliirh are thrjic: I. otiicinal or annulat<<d ipociH-niinha.
(nu1i\ ip^-CHCuanhn); 2. strinU'd or bliii-k ipe<*aciianha, radix jisychotri*) ;
3. the whit4.' or undulated iiwcftcunnlia, (radix Kichardsonin?). The root,
principally that of the annnlatcd ipec-acuanha^ is the juirt vrhich is bffi-

342

IJIBEABBS OF THK STOMAai.

cinal; it is in pin:«a two or thire lines thick, presenting on its saHaxx
promiiifiil riiif^ or nigH* KoiiuniUHl hv iinrrow flsmreK. lu odor ig uanaeii-
ting, its tastc' fitter aju) a littk> iicri<il, its traeturs is granular with wtutish
or ^i^'ish rcRinnid nflpect.

Ipcrjiciiaiilia owpii itii properdeii to emetia wid to ipeca«nu»nhic acid,
nn umnr]>)ioii.-( rwldish-brown bitter RiibRtailcfl belonging to the group of
glucosidc^.

Kmt-tiit was disuoi'crvd in 1817 by IVllotitT und Idigondio. lb la an
inodorous (-ulorlwa sultBtanro. of a bitlor taitte, vary soluble in warm
water, less eolublo in coUl wiiler, soluble in chloroform, U«s in ether; it
mtlt.8 111 70'' C.

Iliec-iic [lowdi-r is an irritant; in contact with the skin deprived of iU
opidiTinJH it pr(Mlutt>a u kt'(>u irritiition :u!il inllummiition; in contact with
miicoiiH Biirfiicei^ it Qcni^oits it reilnecw. then »ri intUimmation, which is
sometimes very scvfrre (as wen in »nimalH ]K)i.son(ii bv emetia.)

Tiikon into tin.' etomnoli, ipe^ius pnni itct-R, lirst iiiiiioeii, then vomiting;
when this dow not tako pliicc ono observes ordinarily a pnppativo effect.
When it is not dmrcd t(i ubtiiin an emt:tic urtion. but only nauarUf
ipeuu! 13 given in nne or two gniin dosaii; to obtiun vomiting, /mm 15 to
30 grainB iiro re<iuin^l; the pnti^nt' tako-S this done in separate portions
u'itu a fovr iiiinntf^w of intvrvul. »nd tia eoon an vomiting commenco^
plenty of iv'urm wiiter in admini^LereLl to favor tlio vomiting. To THnder
the ornetio oflect more thorough, a grain of tartar emetic is oft«n added
to the potion.

Emetift given liytKMlermicalty lias'not been fonnd to have as aatiaflK-
torj- results iis i]ioc«c jmwder pivmi by mouth,

(Jivi'U in very snuill dosug, to wit, | gmin erory hour or two, ipeeu
I)roduw'a a KtiitL' of muluiHo with profiiiw sweat* and tendency to lipothymiit.

An an ex (letrtomnt. ipeaio. is given in di»ie« of from ^ grain to a grain
four er Hve times a duv. ~

Ipc-cac is iucompntible with snbetancps ooutaining tannin.

CoMPocNu Syrup of Ipecac (French Codex.)
Take of :

I'ondrred ipeeae, 30 parts.

Senna leiivt'fi . 100 "

Wild tliyiiie t . 30 "

Corn poppv flowers ...... 195 "

Eusom iailts 100 . "

Wliitowine ....•., 740 « '

Oninge flower water 7flO "

Boiling water 730 "

White mignr q.s.

TiifupB the ifcbuvL' ingrwlients, omitting the snlpbuU' of magnveift *"«
KugHr. then atntin and luld the latter ingrL'dietita. heating until solatioiil^
effected. TkiBe — Half a fluid ounce to two uuneeu. (This IB the ftiin™]
.Syrup of Deeessttrta) ,

Tlicre are various officinal preparutions. Those most in use arc it**
Wine, Syrup. Fluid exti-ael iiud llie Troehos. The syrup is an excellw't
prepai-ation for infants. If givon for emetic effect it is well to aM a lirtlc
powdered ipecaie to the doBt-.

The troches of the TI. S. Vh. are substantially the same as the padSitt^
of the ?'ronch Codex.

TIEB THKATMKNT OF DlfSKNTKUV.

343

* Sogond's pilU arc made m follovs:

Tokocf:

Puh-. ii^ecoc, ........ 0,40

Calomel 0.20

Ejttraet of oi)ii, 0.U5

Syrap of juniper q.s. for six pills,

BerpnpT-Foraml gives ipecac in djsentorj- til aci: Into u flvc-onnoo bot-
]c fiilixl with cold viater ti« addo ifwoao powder 3j; the bottle is well
Bboken and u deeaortspooiifnl fpven at once; thm dos« is rcpeut«d crery
hour.

' AiUuthxis glanduloe» is a woll-known troo in the United Stikt«8, where
it has hettn cnltivntpd i(i!)i.Hha<l» tror. its growth being rapid and its fohago
abundant. In its gttnonil a«iHK:t and tb<< chiiraetRr nf itt* fotiagft it rii>sern-
bloB n frip'-i^ti*^ Kiinmi^li. It ii< (>ii11i>il in Kniiioi^ " Jitpnn Tarnish," thniigh
it in not t!u' tnic Jilimiii viiniish trw. which is a etimiich.

Thf piirtH nmpluyt'd an- the bark mid tht- root. Tin- powder app1iL-ii
to the skin ])rfKliiPfi3 » slii^ht vcsinilion, and introdiufd into the iritt'Htino
of a dt^, cun^'j purpiitioti. When ciiewnd the iKirk bus a bitt«ri&h taeto
and caiiSL-s shortly iifti-rwiirils » sense of discomfort auA ffcbleiit-iw, dax-
xh'nj* &<>n)ijitioiiB bi-furu thu oyttt, with cold swi<«t8 and iiauM^ (Diijiirdin*
Beoumetz. )

After taking a moderate dose of tlie infuaion, which is Tory bitter,
tuinsca and sometimi-K vomiting 8U[^K>rveno: there is a diminntion in the
nnmlier with a slowing of tko heart's pulaations, which gymptoms soon
sutwide.

The leaveR and the root are employed an anlhelmintirji, and it ia under
tliis ImimI Ihftt the ailnntluw in cnnniderwl in earlier wlitionB of the (L S.
I>i(qK-iiaatori'. Piigtit-Kstdblior. Robert and (Jiraud hate tested the anti-
dym-nteric pniperties of thcniliintbnH. Diigat miv'ses this mo<Io of ad-
miniiitratiun: Takti two ounrcH of tht> frpsh bark of tht- root, tritunitv in
a mortar with thn help of a few iim'^hmsi of water. Exprt'sa throii^jb a
liiR'ii eloth. Ktir wi-ll bt'fon- k'^''"J?« "•"<' onlura tenet Kionfnl ^ ^"^ t^iken
in Ihtt nioniin{f fasling: the dc>M> may be given in ii cup of weak tea.
Ropeiit tliis duHs for thnM> momingR. The diet the (inA few dny^^ i^honld
Iw milk, then little by little j^rueU, |>iiuada, etc. This regimen ought to
be continued a fortnight If nt tbe end of that time tlie piticni Be not
j^^ieU tbe trcutmuut is to Lie recomnieneed.*

^K * This U the formula for the albuminonai nitrate of silver lavemcula.
T)tS8olTe the wIiilE> of one egg in ii{ oimr>eK of water, and add iiimultane-
onsly two solutions, the one coiitaiiiiug ^ grains of nitrate of silTer, tbe
other »8 much of coinnioii mult.

^—^ Elmer's moditicatiou of Delioux's iodine lavoment is as foltows:

■ Take of:

^H l^lre iodine, 4 to S grains.

^H Iodide of potassium, . q. s. to dissolve.

^B Distilled water, 1 to 3 ouncefl.

^y M. Foru lavement wbieh may be repeateil twice in twentj'-foiir hours.

L * Kobort. ArcbivM du MeddciDe Nsvole, 1874. Oironl, De rAJIumhuH Olundu*

Insa. Ttirw de Paris, IS7*. DujardiTi-H*-ftnm.-1x, Soe. d« Thcr., \97i. Diigsiri &-
' Julilicr. On titi: Employment u( AilauUiua Glauduloea in tbe Dfsenierr of W>fm.
JiBBtes.

344 DIBEAS:^ OF THE 8TOMAOH.

The nitrate of silver and iodine Iflveraents are not the only ones which
have been proposed in dysentery. Cinchona bark has been given in lave-
ments; charcoal powder, (from half an ounce to an ounce of charcoal in
a pint of a thick infusion of flaxseed); chlorinated lavements, (1 drachm
of Labarraque'a Solntion in five ounces of water); injections of chamo>
mile tea, etc. The latter have been very much vaunted by Delioax of
Savignao.

' Bodin would administer every day as a drink a quart of water with
the whites of sis eggs. Mondiere gives a much larger quantity, and aLso
gives the egg in lavement.

LECnmE XXTV.

ON THE THKATMENT OF lIEMORRnOIDS.

8irui[\BY. — llemorrhoids — Tlio IlaniorrboidaJ Veina — Their Coursw — Eti-
ology — Mechanical Causes — Anal SpMm — Active Causc« — Diathetic
Causea — Symptoinutologj- — Iloinorrhoidal fins— Thcrapoutir [ndic»'
tiOM— OiipUt I'ili.'s to bi' Cured ?~llypenic Treotmeut — I'lurmaoea-
timl Trentmoiit — Purgatives — Aiiti-hemorrUoidal Medir^inoii — Hnmii*
uii'lia — IxK'uI Trwitmynt — Forced Ditintation of tho Aniin — Oporalini
l*rop«hirfi — Sui^inil Troatmont^— DilTeront Proooseea — Heinorrbftidal
Swelling — IVotuptnu of iHe Aniu — ArtiticiiU IVoductioii of Humor-
rhoids.

I DEStKE to devote tHis lecture to a tevr therappntical indicatiotiB \iot-
taining to crrtain disctuci of thu roctum, and in purttcnW to hcmorrhoiiU.
u tlisuuK! which 18 very frequent and vrbooe troatmcut dutfcn-tu »|KH.-iul
consideratiun,

Vfa havo to-day n pretty clonr nndoretanding of those riMstAl and aDsl
tumora descritwd under the htaul of hcmorrhniilR, and For this knowleilge
wc are largely indebted U> Iho thorough isludii-a of (loseeliii and VtTiiiiuil.
They are, as you know, varicoee dilatations of the hemorrhoidal wina,
and art-'onling lu i\wae viirieeH ])i-rt:iin to the oxt«>riiitl or inlomal hemor-
rhoidal veins, we have what are ralleti external or interns] ]>ile«.

Tbcae hemorrboidul voiim are to-duy well known. Oonelin, Vomenil,
Dabreoil and l^ul Kichard and e8])ecially Ihirct,* hav« given u« a very
eonplete deticription of thvm. The interniil or xuperior hemorrhoi^hila
empty as you know into the inferior mesenteric, and tlierefore belong to
the portal syBteni. The estemal hemorrhoiilal veintt, on tlie crther liaud.
are liranches uf thu hyiM^mtric ami intx^niid pudic, and therefore an> a
\ruTi of the general venous aystcin. But the most interesting point con-
nected with thiaanatomioiil urmugemeut is that these two veiioiut isystems,
iiisteiul of liAviiig free iTilercommtinication. a» was fonnerly supposed,
are unitcil hv hnt a Tcnr few amall reins whoee ptOBBncw can only be
detnoiuitrated hy quite line lujcctious.'

Do ttot forget, gentlemen, the presence of thoac muscular hands whieh

* G<Mw«lln, Lcf OBX rur \t» Hemorrh<kl(lo8. Parte, 18M. Vemeun, Aaatainla
?atliul. lUull, da la Soc. Analom.. 1839, U xxx.. p. 179). Diibruuh uod l^^lMinl.
Vi-iii«<i( tlMUectuin. i!tc.. In Arcli. FliyiL. 1. 1. DureUOn tli« l^tlKiir*nj' of lluu-
WThoUls. (Arch, .ie Med., D«-., IHTO, !».««.)

U6

DU$£ASIS OF niK STOJUCH.

have bi-on (lenmttEtratcd by Vemeuil, Dubrenil, and RiohAnt, and whi
ninxiuTiil tlic «ii)H>rior humorrhoidal reins when lb«eo latter pi^rct) t
- walls of the rectum to join the TcinB of the portal system. Ho not foi;g*'t,
moreover, that those contmctJlo riogn wliich constitute the nphincltT or
rathiT tho uphineterB of the unus encircle the veins which eonnoct the tvfn
vfiious homorrlioidul sj'KteniB, infi-rior iiiid ti;u[)erior. You will see. ua wu
go on, whnt important r6le belong to thnu) mnncular zonea both in tliq
iwtliolofiy and trcBtnirnl of hfimirrtioidB.

Ilcniorrhoida ar« due to numerouH causes. I cannot hero f^x^ thi
all, but as etiolof^y pluyu an iiii|K>rtaiit part in tho therapeutics of thi
utTwtioiiB, permit mv to mt^ntion the princijial determining oonditioiis.

\Vu have lirst nf nil the group of mechanical causes, which producs
what Verneuil coIIj? jHuaitv hetmrrhw3t. Thi-ee are the cases ol ob-
Btnictiid ciruiilation In the portal rein, Buch iis inoccadionud by intra ab
doniiiud tuiiior«, pr»*piuinL'y, cirrhotic idlt^rittioni! of the liver; altuulio
which axe all to u grctitcr or leas cstt^nt accompanied by piles.

It is in the eiinie <;ruup of meL-iiaiiicul cuumx that wo should place con-
sti|wtion u» a cautm of hemorrhoida Here the canso has a dnnblo cffi-ct:
ve hare first tho prest-tieo of fwcal matters, which in]{H.>d(> Ihe returiiinf^
circulation of the intestinal veinH; then the violent efforts of defecntjou,
which aufrment thuvt-nonK tcn»ion in the simc part. According to Du
slrainiiig iit stool is the most influontiiU factor in the pathogeny of rvctol
variot'g. lleniorrhottU wlicnoneo produced hinder di>focatiou. and in iliia
■way det*»nnine constipation, which in ita turn foBtera the hemorrhoidal
condition.

Anal spA^m, about which so much has bc«n said, whether primary oi
aeeoiutary, act« a]t!0 hb a mechanical means by coinpreiuing the veins vhicl
mak(* the wiperior hemorrhoidal system commntiirate with the infitriiWi
it ^'X» like tile ligature whit-h wc^ upply round the arm to caueo dijst4nisii
of the veins prejiaratory to blood letting.

In other cireumstancex liemorrhoidii Imve an active cauM^ an wlien tii
rectal mQcouti membrane \» under initation. ur when there arv cnngustiva'
diaeaacs of the bladder or prostate gluud in the nude, of the nteruti and
ovaries in the female.

I^istty, hemorrhoids may bo a diatbotio manifoRtntion, and it must bO'
rccognixi-d that this is one of the most frequent conditions of their pro-
duc^on. The dintheris which lias the itrincipid causal uiilueuce on
hemorrhoids is without doubt the arthritic diathosia. Interrogate tha
majority of persons who have liemorrhoida. anil you will find that tln-y
have either pronounced arthritic nuuiifestatioun thooiaelveitf or eijie gouty
ur rheumatic parenta.

Tho herpetic diathesia has also an otiolo^cal infiuenoe, but one which
islesadear, andwithreepectto theaediathesea, imthologiBle have even gona
further and conrtitiited or imagined a spetTinl diatliesis, tlie hemorrlioidal
diatlicsts.

wo

the I

iou^^

p

TREATMKNT OF 7rKJItiRRlIOID&

S47

Jt vill not do to fxatggcraio tlic influ«nco of diutltpBee in tlio genc«ta of

I bemorrboitlii, und romtnit th(> niistiike of 8lehl^ whn tntuW of theeo viirici'8

one of 1}|« most inijiortaiit |ioinL8 in pathology: iiiid while granting tho

iinqnuetionabln influence of diiithei^is, we must also recoguizc Uio often

dominant iiction of locul cause*.

11 I have dovotod no nmeh tinio to pathogeny, it is bccanso, as yon
now Mw, w« have from h tlit-nijiPHtic point of view mtmy prnlilums to solve
witb rrgani h) licmorrliuiiU. Oufihi wi? to cure them, or oii;rht wf to re-
spect them? or on tli«oth(>r hand, are tlierepircntnetancefl where wr ought
to favor their dovelopmont? Thceo arc iinportaiit qtu-rtions which I eliall
..Bodoitvor to answer, hnt in ordpr to nnd<'rKtniid tht^ mibjort in nil its tx«r-
'ingSf it '8 iiwciWMiry hrinflj to «uin up the sj-niptoinatologj-of heniorrhoitlE.

Bemorrlioids may remain during a whole lifetime, «8i>oc}ally if ex*
tinnuil, in the Htiito of littl? tumors n'liich nro not painful and occfifiion no
inconvcnienee to the oponoiiiy. I.n other cii'cnnistanoes the«« tnmors iu-
craaiH* in »lxe, i>siH>ciiiny when they are internal; they embamiHt defeni-
tion; tliey keeji npn dit<a{;reral>Iu sensation of itchiiij^aud wei);ht in tho
ann», and to euch »n ext<.'iit aa oUmn to lieacaufte of byixichondriaHiii;
morcMivpr thoy prodnflc n spiiBniodio irritation of tlio anus, and in many
caseti by thuir weight, and in coimeijuenc'e of hard BlraiTihig at stool, they
. drag the rectal mucouK Dieuibnino outride tho sphincter, and deli'rmine
prnhixiiitiK. lli?nce then the pri«enoe of hemorrhoids, epiiwnoilie coutiuc*
lion of tho 8phinct«r ani, and proiapsue of the rectum are Tory hkely to
Ijo foond together, iind dcmnrd a treatment that shall be du-ected U> tho
removal of the hemorrhoidR.*

Hemorrhoids may also bo tho sent of bemorrhnpos (bleeding pilnt).
These fluxes are Bometimes periodical, somvtitiiea irregular, and give rii»e,
it may Ije, (o a flow oi blood trifling in amount and ben«'flcinl in il* efTeits;
it may he to abundant liemorrhngeB. wliieh eonniderably enfeeble and
auicmiatu tbe {nitieut, thus constituting a veritable hcniorrhoidat cachexia.
■laatiy, tlieso Taricva may be the starting-point of iiiftammatione more or
' ]«M grave, and even of gangrenes. Such in, iu brief, tho epnptomatologj
of hemorrhoida. We nsjnow to bott^-'radvaDtago venture npon the study
of their tre-atment

Will it do to cnru all cnms of hemurrhoide? Not by any mttinB, and
irithont (larlakingof the exufcgtrmted viewt* of a former a^, I beliere tliat
we ought in a great many iiiBtantes to apply lo homorrhoidg only a jsdlia-
tivo treatment.

Wc have Brut of all that largo gmiip of hemorrhoids arising from a.
gouty or rheumatic diathetiie. where but insigni&taiit looal symptoms tu;>
company the tumors; all that needs to be done in the«e caeos is to direct
tll6 diet, order suitable exerciEc, inntEt u{)on |;reHt regularity in tb« idools,
in order lo ntainuiin the hemorrhoids in a latent «tate, which in uo n>-
Bpect inconveniences tlie economy.

348

DISEASES OF TIIK STOMACIT,

P

Then comos a EMc>ncl group of iKmoirhoids, with periodical oongOb
tioiis. uik) a flux whicli Wts several davK. In tliesc caeea nleo I hvsitatte
mncli to interfere, eaiJccially wHpii thu pationta nre of a certain age, bo
tween forty and. fifty ycnrs, with munifeat coiiBi.*rtivo tondoncy, and who
ftiiil in this luial congGxtioit nml in l\wsn poriotjiml llnxnfin renl rrliof for
tlieir ht'iiilBchi'S and wrt-hnii congusLion. I preaoribe an uvtive treatment,
ou the other liand. for patients who experienoe too abuaiisni rectal
hemorrliiigee, or in thf case of whom the rectal tumors produoe, either
Uk> M'Ton' jMiiji in the regioji of tho nnuii, or a gptismodic contraction of
this orifice, or u prolapsus of the rectum.

But before stutiiig Ibe therupeuiie iueasun» whi<!h you may put in
U3L*, 1 wieh to Bay a few vronls concerning the creation of livmurrhuiila in
certain iuditidttale. I refer to poreoiisof murkfil hemorrhoiiJal tendencies,
who. after tho siipprengion of thoir anal varieee, s«« symptomg of greater
or lesH gravity supL-rveiio. In auch catww it ia well to endeavor as quickly
an {XjtMiblv to recall thu piles, Sanguinious and plutboriu individuals,
with manifert conge»tivo tendencies, and in vrhom the appearanoe of
hetnorrhoiiltf iip|>enrw to pmdnoe a real relief, belong to tho samo category.

liimtly, there exist a certain niimlier nf ludi^'iduala in whom nervoQ?
munifcatatiouM of u coiDplex order may disupjjCTir by the creation of
hemorrhoids. 1 know how ilifticult of explanation ia the bond which
pma to exist between Rbdominai plethora mid hottohh troubles, I know
■vlgo how obwriire arethe explaiiiitionH giren by Stahl and his school; but
I none the lotu r^L'ognixo the farorablo action of piles in c^ertaiii neuro'
pathies. and I could cite yon nnmerona innUinces drawn from the pnu:tie«
of my master, Dr. Moissonetj and from my own practice, in proof of thia.
As you 8uiL>, from thepointof view of treatment, we ghnll then haro to study
here not only the means proiwr for miring httmorrhoida. but also tho«e
which can provoke them, and this ii< wliat I slinLl now do,

U]'gi<^>i(! playsan impcrtunt role in thu treatment of heniorrhoida. To
diminish thuBe reictul and anal rarice«, yon wlli recommend the patient to
avoid all cireiimstances which may mugest the [»oivii' organx, such as
atraining at stool, and renmiuing too long time in u sitting purtortv
There is aimther simple mutU-r which I should mention: the sufferer
from piles ehonlil not n«e onliiiikry piipftr with which to wi|>e tho p*rta
nftiT :i stool; better by far to bathe Iheni with warm water. ,\nother hint
of importance— sexiud relationK should be moderate; you will also recom-
mend him not to ride lioraoback. Such is the advice to give to hemor-
rhoid iil patients.

The vi<:-tim uf piles should also abstain from food of too abundant or
too excitant a clmnicter, and should alwavH have care to Jnchido in hia
daily dietary vegetables and esix-eiidly rijie frnitl^ But es]>ccial attention
shonld Im given to the bowels. A hemorrhoidal patient should go to sUx)l
every day, and Nelaton strongly reeoinmendod tliat the habit should he

TREATSIKNT OF iiKMonRiromei.

34 1>

w

iormvt] nf a ilikily uvocutttion before retiring nt night, bo that the piiea may
go bock while the patient is in a recumbent poetur«.

It is n good plan often to titko n cold iuJBction before attomptjng a
movement of thi> bowels, and OarTin in^^te that a patwut with piloR
should never go to stoot without tlii» iirvraution. These cold iaviimpiita
play a vcrj* important r61e in the treatment of Ihcst; affuctione, and it is
well to make great account of tlwm. You can also recommend iwriiiuil
ftnd rectftl donch'ps, which tonify these organs and may tbuH giro giMxl
resalta.

Next in order come tho pluirmoceutieal means which are atldre^si^d,
•oms to the constipation, others to the hemorrhoidft thcmsolvvs, aud to
the pain as well as the bloodv lliix of which they are the aeaL

Aa regularity of the tmwels ib an absolute necessity in order to atay the
progreiM of the hemorrhoids, j-ou tnuet take cure tliat oonHtipation aluill
be obviated, and I refer yon in this regard to the fliapt*r« on thia mibje-ct;
but do not forget that then^ i^ a group of drastic purgatives which irritate
tliH intestine, and favor, ralhpr than comliat, the rectal varices. Aloes.
which in eiipocially prone to oium; congestion of the rectal mncosa, ought
to be ubsoluUily proscribed.

You will then use the mild purgjtivoa, siiocliariric or oleaginoob Van
Bjii has ereu maiutainod that liiueed oil has a 8]jucial cumtive action in
hemorrhoids.* You will employ also the saline pargntives. and it is in
theso cases that oiu- may prew'riln.- tu advuntagv t+io ptirgativo mineral
waters. Sulphur has greiit repute aa a Uxative, and glvcerino is to bo
farormbly spoken of in this connection: acconling to David Young, in
tableepoouful do«eti, morning and evening, it promotes freedom of the
bowels, and caun;H piles to dianppoar.

After having secured regularity in the alnno eracnationa, you can
iildrC88 your tnyitment to the piles themsielvesL Certain internal medicft-
ments have been rwomniended an having a sjiecial cumtive ac-tion in
Iwjmorrhoids; thus ii in tliat Iazhk Riviere, Albert!, Hufelaiid, aud more
recently Teissier of Ityons. have vaunted the employ of yarrow,' while
Bcrlemont of Joncoiirt, and Van iloli>cck have Bignaliied the benefit* of
tbe lenereelandiiie (Kanniimitna tic^uria), as having also u»ti- hemorrhoidal
virua.' Moreover cnyenne pepjwr. (capsicum auiiuumK is the fatorlU'
remedy of aui-h authorities as Allcgre, while Droflir, the late distinguished
English Pui^-on, has highly extolled the piper nigrum/

With the exception of capsicum, which I have at timea testotl with n
ccvtuiii amount of soooess, I have no experience with the other substances
just ntentionei] ; thev are none of them, however, dangerous, and you ciui
ly time trj' Ihem if yoii wisli.

all these substances, and at their hc»d, should bo added a vegetal
(lotion which Ua« a great reputation in tho United States in tho tnmt-
mgntot hemorrhoids; 1 allude to the Hamameli* virginiou From "

350

DISEAS1!S OF TmC STOSIACn.

leaves Knd tv!^ of Uiis slirub, wbicli grows in abundance In th9 narsli;
IiihiIh wliurh Imnicr on tlic Mi»it9iippi, thum JH miide a )iT<ln>-alcoholiit,
<» product of dii<tilIutioii). to which Ainiricaun huvu givi-n tbu ll»m^oi
extract of vitch-hazcl, or Pond's extract With the sumc jiorta i»f the
p!anl« tiricturL-B mid othor pr«))anition(i tiri» mado, mme of which are now
officiiuil in thw V. S. I'harmncopo'ia.

lIvnimniDndctl for thv lii-fit linic hi 1S32 bj ?ilpmt and Delrns at pos-
aoesiug ppL>ouil curulivo propvrtive, I1il> etudy ot liuituinivJiv \im boon ufcaiQ
tukoii up during Iho last tvvt Tears. i'si>tfiiilly by lioimiK)(«athic {diyacians,
and r liiivo tuyasAt investigated the physiological and therape'itic actioii of
thitt jiliint.'

It 1)08 been mid that haniamvliH ponweeti u ha'mostabc and epocial dec-
tivu a^^Lion, tho lattor [«Ttainifip to the vonoua syntcm, and tliat wlim Rd-
niini(tt«ri«d iut«riuil)y it not wily hua a curMtivo inllnenco oti honiorrhuida.
liutalsoonvnrioeB. I harp, in fact, obtained in certain on«>ii of hemorrhoidi
rail i^tirulivL- vflr<-ta from hainumuliii, hut 1 tiaru uoniplutvly tailed m tbu
trcatmi'tit of varict'8.

The aiiti-honiorrboidtd action of hnmamelis finds no uxplauation hi its
phyfiinlo^ical elTertK. whirh in animitlH are Hlumlntttly nil. Moreover, TOU
will tind in thi- i-xcclk'iit tht-Bie of my pupil tiuy » dctuilud uuwunt of a
jtreftt number of pbysiolofcical reeearches, contirmatory of this etaUMnenU
HiiTnameltH ie deatitntv of all toxicity.

If yon make nm of h»mameli« yon can employ Pond'n extract, giving
it in tcnsgmanful dnsoH tlirt-o or four timiw a dny, or, vrliat in doubtk«t a
bL-tlvr pr(;pu.ralion> you may jpvc the fluid extract of the V. S. Ph. in the
same doBc, or the Frendi tincturu, a very strong alcoholic preparation, in
doswt of tt-n drojw as often as ri'i{uiritl.

Then romc the viLrions locnl mcann which may he employed in soch
CMcc, Bud) an lu^triiigenttf, in1otioneumloinlmKnt<; iBTcmuntawithocotete
of lead, 118 connsf lied l>y Watson;' lotions of iKtuorphimbi. aarwom mended
by Riclmrd ut Canlxl; taniiiu uintmuuts, nhich have Ijocn highly vxtoUod
"by Herpin."

All thcwc mcami have for their end to diminish the conj^wlion and
dbetenlion of thv walls of the veiiia, and they an.? applied to piles whether
Suent or uon-lUmnt, but it^iecially to thoHL> whicli iu-l> tho si>at of a bloody
&ux: and, in such cases, to all the mcanx which I hnT<> just nnitmentted,
you may add the iwrchloriiU- of in>n, which in appliwl directly to the
hemorrhoidal Kwtdlinpi, or employed in lavcmunts.

Pain, nil I have Kaid, is a frequent symptom in faemorrhoidti. It ia gen-
ornlly due to a sjiasmodiii xtatt- of tho sphinctunt of thu anuit: honco it a
that a grcut niunbt-r of anodyne ointments have beon Hdriaed in tfa«n
cueoB. The poplar ointment'* is highly Yauut«4l without any very mb-
Btantial vrklcnoe iu ita favor. Nuxt come Huppc6itorie« or pomadee, with
extrnct of Iwllatlonna or opium."

TREATUKNT Or laCMORUUOIDS.

351

»

But if the ]mn ppraitito anc] becomes intolerable, as hnppens witen (he
licniorrlioidd arv coniplkiitoil with iixsuru of the iinus, thcec muune fuil in
tnoiiit nigPK, aiitl yon are olili^^ to liaro riM'iiurRe to an 0|>eratt()n of a more
ndic-ut kind wliiohgiwxcxwlli'iit rvBulU: I n-fer toiliUitHtioo of tlu-anuD.

CoimaelUid first hr KniRonneiive, who revived the procedure of Keca*
mirr, {vtIio liwl beforo rt-coDimt'ndud and jicrformcd forced dilatAtion of
tlw anw, ami had hinuolf bnrrowe<l the practice from the qnack Moltcnot,)
ttiis fomed dilatation luis now lK>(!oni« — thanks to tJie oonlriliutionii of
Gowt-Hn and Venioui) — one of tlie best modes of treatment, not onlj of
anal ejaLHni but alan of hemoirlioidti.'*

Prof, Vemeuil has, in toot, slioini tlutt in c&tea of hemorrhoids the
oontmiTtioti of the Bphinct^'m pla>'B a predominant mlo: nnd it tiuflidtfi for
mo to recall to vour renu.*mbniiice wliat I itaid ut the beginning of thiM
lentnre on the dispotntion of the venoas syntom of the anas and rectum, to
viukMu you to undwrslond tho prL-i>onJcrant iiifliirnot of rontnw-tion of
the Rpbiueters of the anus in rendering hemoirboids turgesoent and
puinf 111. ~

So then, if you hare to do vith painful homorrhoidg. or with spliiikc-
teralgia — that is to say, tiiom? jtaroxyma nf pain wbicli acrompany spaem
of tiio anu« — or with tliow flaaorefi which aro bo fre<|uent in women aftor
(x>ntinL>nient, yon iihould ri'inrt to anal dilatution. It is one of the must
simple of opemlionH, whieli wery physician Hboiilil know how to perfonii.

AnieHthesia in always indiented preperaton' to dilatation, which can
hardly bo practised without ether or chloroform. Place your patient then
in a recumbent posture and wtministor your aiuAthetic; torn him on his
side; let your assistant mtaa one of the thighs. tliL'n introduov back to
back your two thumbs iutu the anus, and forctltly t^ret^li them aa widely
afMrt as you can, or till the jmlmnr surface of the thnrobs tonched tlie
tuber iechii on each side. Vernctiil and Kichot prefer diluting with the
Sjieeiilum, cither Kieord's or CuBTio's, which in introduced whut into iho
anoa, and then opvned wide and withdrawn. Then yon re])lart< the
pilietit oQ bis bark, aud apply oold compn^ULV to the anus, and at tlie
«nd of a few days your jutient ia well. Do uot forget to give a purgative
the evening before the operation, and a lavement a little while before
cUlatation. Such ii* the operation of forc«d dilatation of the amu, which
in the majority of nurn if not in all will give yon a complete ctire, whether
of hemorrkoids. sidiinctemlgia or Qanire of the auus.

Thero are» however, caaca whore the lixe of the hemorrhoida i« so great
tint it is naCMBBry to resort to more formidable opemtionx. which belong
more oapecially to the domain of sargen,*. I cannot here without depnrt-
ing from the province of these lectorca oz|mtiate at any length on the mir-
fncal meane which an put in naage in anch caaoa, aad shall only touch
upon tliom brieflv.

'Iliere is first of all compreaabn, which Itnrns lias ao mach Tnnntad,

I

a
I

a

I

353

DISKA8BS OF TirK BTOUACH.

and which is only emjiloytK] at tbe iin-Bcnt day for [iroljipsun of the rec-
tnm; next comes inciaion, xccommcniled by Uoinet, and which conBieta,
BK iu name indiosUw; in Inv punctures hy mcaiiiH of a bistoury of the mwt
TolaminoiiH ]>ile&

It hftfi U-fi] of luto pntposcd to nrnko injections of carbolic acid into
the interior of these rftrtco«e bw«1Uiikv. umi Kdniuixl Andrews of Chicago,
Kt-lacy in thu Amurican Journnl of Medical Scionc-UH, uiid uthcra iu the
United StatoK. bare reportvH very fiivorafaly of this method of breuting
hemorrhoid!!. A pnindiirnt hemorrhoid is Hclerii^l, and from five to ten
drops of a mixture of tbv melted a-)'8lal8 of imrbolic tkoid and glycerine
tav iaj«cted into its Bnbetance bj means of a hy|K)dcrmic syringe- Tho
0[M>rntioD is oompamtively poiales^ and tho lieniorrhoid soon ihrinki
awav, with vcr^- little Hloughtng. Xotirithntanding the auooeoB of tlus
method in tliu United Statos, it bae not yub come into geucral favor ia
France."

Tbv ligature is of much more ancient origin, sinoe it goe« beck to Oie
days of Tlip^HXTatw; it hiw been employed especially in England and the
United Stales, but it has not oome extensively mto uae iu this country.
Anotlier procen consiete in excising the liemorrhoide, whether with scte-
fliMn, nocordiiig to I>iipnytren"8 method, or with the <!'cnwear, nccording
to Cha«aignac. This oixracion bad a great repntation for a while, but
nnoe tbe improTcments cflfcM^trd in giilntno-iaiutery ap)ilianc««, and es-
pecially ainco the employment of dilatation, it haa considerably gone out
of vogue.

Cauterization bns be*n largely renortod to in tlie trcatinent of hemor-
rlioid^; by this mcuiu tlie neriouv liemorrhagfti are avoided which Boroc-
Umce folluir tlie cuttinj,' openitions. Surgeons hiive employed for the
removal of piles caut«r)icnti(m with r«l>hot iron, a mode which gooK back
to the moist remote antiquity, and is still in nav iu our day: also cnuteriia-
tion by the gahmnoHstuury. which has been eepecially ratuited by
Vemeuil; finally certain chenueal snbstanote in a aaltd or litivli state
have bwa utilized for the purixwo of deetroying hemorrhoidal swellings.
Tbus :>cdi]Iot stul AmnBsat have vnij^oyed Vienna paste, while Ilontiton
of Dublin, and more recently still Goeadiu, have recommendeil the rioikk
hydral^ nitric acid.

In otiior euK« one may combine cauterisation wntli cmshing, accord-
ing to the practice of Kicliet, who hao inventtxl a cauter}- foreeiw for lliis
purjKiv; tlu' wifaors of the new IV|Uolin thenno-cantery may be uwd
for the g».me objecL

What is the relative valne ot all theec operations? I can hardly pm-
noonco an opinion from my own personal experience in such matters,
which is rather limited. What I nun ofHrra, however, is that it is not lie«t
to resort to the«> proredun« till the hemorrhoids have reeietrd all other
aodea of tr«atotcnt, and in particnLtr dilatation, and till the patient fiuda

TRKATMENT OP )IK»0KKII01I>4.

.S53

his pil(>ii inich a Houixie of umoyance tliat ho cannot pureoe hui rugular

OL'CUIWtiOII.

Whil« admitting thnt in the in^rit; of caaea tb« nbliition of the
ht^morrboiiU ttoi^tt not entail nny gmvo oomptication, wlif^tlu-r lut n sequel
of tlie operation, or n» a conwf^itence i>f the Biippremion of an habitoal
bloody flux, it muet bt- rcmumbL-rL-d novLTtht-k-fis timt oftt'n as u. rcmilt of
t\u.-M o[K-ratione certain evils ariM^ Biich a« etricttinis of tbu uiul orifice,
which are exceedingly inounveiiiviit. While a pupil of Chaaeaignac, I
ofCeu bad occnKioii to wd thin miffortiinv follow tbv perlta]« mtbcr too
nnmerooH iipplicittionci which my i>xc('ll<-nt master waa in tli« liabit of
making witli tin- mimimbk- inBtruiiicnt. with whiiih he ban undowL-d Bur-
g«ry — 1 allude to the {crascur.

Hemorrhoids am oftoii uccompaiiicd by the protniision of a rim-like
strelling extemiilly, and iIiIh taken plar^i whennvpr t]i« |iciti«nt perfortns
heavj- lifting, or Btniima iit stool. Ordinarily thu pilra return of tht-ni-
mIvqc but it Bomotimcs happens that the reduction beoi>mei verj diflicnlt,
and the {latient tnsy bo unubic to accompliHli it himself; in Rich an erimt
jou niaj bv CAlIed in toa«»i»t. Yon will almost aluaj-sencoeed in rfnlno
ing the piles by slow and melhodtoul prf»Ann-, but under other circum-
stanceK you will hi' obli);ed to wait eomu time iK'forv attaining thin Tvtuiilt,
■nd then you may be comiHrllwl to liavo recouffe t« the applioati<m of
^b coinpreesefl wet with eold water. Ic« luu even bec-ri prapoRni in order to
^ diminish the turgescence of the Tarices, and thns render the retom of tlie
homorrlinidal tnmon more ituty.

IIu agi,-d persoUB tliere is @omctink^-8 aesoctated vith these hemorrlioids
a pmlaptH-d eoiidition of Uiu metuni, and tiiey cannot make the least effort
vitbout the immediate proininion of a conKidemble estt-nt of the lower
bowel. Yon nhonld in these uuK-ii mcoraniPiid cold-water injertions, as-
, triitgont lavement*. {Bwabbings of tlio rectum with pcrchloride of inm
liave even been propeeed); yon will make your putients wear abdominal
bells with anal i>&A», wliicli, l)eiiig applied tjgbtly over the lower outlet,
^^mdto keep the n^ctnm in it^ place

^^^^Hou know tliat in young ehildrc-n pmlapsiu of the rectniji ia ()nite

^^mquent. In these caaee the diBease may be eucocasfnUj tratted by Uve-

iiiunu aiid lotiuuK of cold water, by electricity, or by Babcntaneoua injeo-

tiona of strychnine around tho anuv after the ciiKtom of Foncher and

• Dolbcau."
Ba.«iiig himself on the coutraotilc power upon the muecokr fibre of
ergot of rye, Vidal has pro|K)«t(i to tresit the hemurrhoido-rectal pmIn]iBiia
by subcutanoon» injections of ergotine, which ar» made around the aitiis.
This in a perfectly mfu mcatnire to which one can always resort before
piocewliug to the graver operations.
^_ 1 come new tu the Xaet subject demand ing our attention to-day, namely,
^^the creation of homorrhoids, or thoir reeulL While thero are no grounds

wltaUo-er For Uie populur belief id tbe offioacy of rectal v&rioes — wbcuco
tho Frunch €pitlu<t, irittes d'or, golden voiiia — 1 nvrertheloxa think tlmt
in niiiriy c»»e» it ix well to maintain n nnngcetivR utate of tho mini nml
Lumorrlmidal roins. You will obUiin tim uffect by tlm unt" of a medicn*
inent which ia truly heroic in such caai-e. I rc-fi-r to atuL-s, which you nui)-
administer intcmnIlT in tho form of pilhi (the jiil. uloos of the U. S. Ph.
cnntjuns (Hjual jmrts of alo«« nnd soup, ant) is th« most uvuilable fonn)^ or
wliirh yoH may «tnpl<»y externally in tJie state of HUppository or pomade.
ue l>ci]>uytr«u rui;onunundiHi. A drachm of Soootriuo aloe* in mliheJ np
with an ounce of lard, and applied three or four times ft day in frictious
to Uit; aitnl region. Tn))i«i««nii iiiwd to giNMik in praise of siipjjositoriGS of
tiirtjir emetifi.^two to fivo ^linn of tho latter to a draehm of cucuo butUif
for oiiii oappiwitory, which vnu iiiLroduuud into tho roctum.

You can also (.-oujoiii to tliow tunins unnniitic fuinigalioniiund vrurm
uitK Italhx, but you tibould remember that while it Is easy enough iu
pomonR prediRpostMl to piloB by heredity to induce or augment a hemor-
rhoidal i:ondiLion, it id very difTiirult to obtain thiN resalt In persoiifl who
have no tcutluucy to Ihits ufleclioii.

XOTES TO LECrURK XXIV.

'Thifl is the unatomicul distribution of the veiiia of tho rcctnm and
aniiM. a(;aon]ing t4i Gosseltn, Vertiunil and Duret. Tlie nuiierior homor-
rhoidalR, whioli empty Into the inferior mosvnteric, are diiitribnted to the
mucous membrane of the rectum aa far as tlio margin of the anue. and
camnmiitcate by inetuis of u very few and extremely miniit<; veatelii with
tlm middle mid inferior hemorrhoidnU. whieh come from the hypu^iwtric
and internal iiudic. Ourot lias dt'scribed in this connection three venona
pltxiifte^; Ml b-sphinct^iriaii, pyri-ephmiTtorinn. aiul rei^tal.

The rectal veins seem to ariw.' two rentimetros from the periphvrv of
tho anna by little oval jioiiehi'8 or nmpulln*; then they aaeond, flexuous,
jvanblhd, and dose toiruthor, about tvn or twt-lvf L-L-ittimutro». whi'in; they
Biidilciily bt^nd on thi-mselvcs and jn-rforatc tho rvcla] wall pi'rf)fndi<rHlarly;
as tht'v |)a«a throngli the niusL-ulJir cont Ihoy are Hurroiindnd by button-
hoh'dfke muscular bands which aro deprived'of protoctiiv; tibroiis rii^s.

At their lower part, and on a levul with thennipnlla or pouch, of which
vo liave jiiKt KpokeiL, the rt'Ctul veins »r<^' connected with a little venule
■which passes through tho sphincters of the anus to empty into the exter-
nal hemorrhoidal vi'in. (See the plati>8 arrompaiiying Duret'a work.)

•(ioBseliti has described external and internal homorrlioidB. Iledivid««
the iixtLTtial into three subdivisions: I, llncnd ln'moiThuitbs; 2, tur;ge»cent
llumurrboids; 3. indurated vxtenml hemunhotd^.

H» makoH two ci'uu|)» of internal hemorrhoids: 1, internal hemor-
rhoids properly so-ciilled, i.e., thoae concealed within the rectum; *, proci*
dent hemorrhnids, nhirh may he retluciblo or irreducible.

TREATMEXT OF IIKMORRHOIDS.

355

Hero »ro itomu of tin- clmrm^tcrs of tliu difloreut. la-raorrliouis:
Th« llm;<'i«l I'lU-rnal jiik's aiR' u.lways itituiiU-d uut»ii(li< «f tiu' iiiiiis: tln'P
I »re solitary or multiple, and their size Taries from tliat of a pen to llmi ot
ahxMstuui; tlioy »rv always tieNnile. that it) tu flay, they liave no iM-itii-Ic;
thoy (.'oiitikin no blooi]; whicli is due to tli« fact that aC Bonic jieriud of
their evolution & dot formed in a dilatod win nnd wtw thoti ulworlwd.
Tbeoxtoriial turgrwsoiit kind ie only eeon at twrtuin pcriodti: ne for tlifl
Fextcmal iiidnrated. thpy result from the disappwirance of the veins nnd
from hypertrophy of tho librouB otrnma which surroiinrls tlirni.

Tho interufll uon-procidcnt hcmorrhoide are constituted simply hy
dilaU'd veins, and by the iiDu-hy|>crtroi)hieJ rw.'tal mui;osn whifih ininie-
diately eovers them. OojfMeliii iiisisto on lliu iiuii-alteratioii of the miicoKa
in internal hemorrhoids, The«e latter may be reducible or irreducible,
auconUuj; to eircum3tanc(.>ft.*

• Pr. Van liirTi vas in the habit of giving internally a large doee of
luiBecd oil ('^ nnnceii) morning iiik) (ivening.

'Yarrow (achilloa millefolinm) is a very common field plant (iKhUlta,
from Achillc-s, who ia Kiid to have emjiloywl thia wi-cd u» a vulm-iniry). '
I Sovenil Frvni'h authorities have lii;;iily vainilixl the uftt of yarrow in
intoatitiu.1 iluxes; it in given internally in tlio fonu of iofuuiun or the ex-
proraod juico. \

'The IveHser Celandine (ranunonlus fiearia) hiw been n«ommended by
! Ik-rlcnioiit of Joiicoiirt; an iafnaion of tliu root ia jriven inti-rnally. In-
futte two ounces in a i^iiart of water, and give a wine{jlai»ful U i. d. \*uu
UoldsLtek endonu'S thi^i Iruattnent.

I •Allegre hiiM proiHjftcjd aipifirum annuum (raiynnne pepper) in piles, iind
tlio commiwitiiii nominated by the Academy has meo^iizod the bunntita
of thix trattmonl. Cayenne puppcr ia ^vuu in the form of pilU or pow>
der, in the dodu of 5 to 15 or even 'iO graiiu) a liuy.t

(Thceonfeutio pijieri«. or confection of bliick pi-jjper, *' Ward's pujfte,"
« acquired some rc<|nitutien in (.ireat Britain as a remedy in pilea and
''idoerations of the rectum. 'L'o do ^ood it mui^t lie continued, according
to Brodie, for two, three or four monCba. Tbu dose is from one to two
Icaapoonftilg three timeti a duy.J

i ^The Hamamelia Virginira. otlierwime known hh witch-ha^iel, is too
well known in the United StuU-w lo n^uir*? dcecription hero. It is a
alirub frnm a U> \'t feet hi^h, and ^rows in idmust uU |>arto of tbu United
States. It is n'lnarkahle for the lale a[i[Miiir«nce of iu yellow flower*;
the Fmit, wliiuh is a nut-like camule re%>mbling the hazel nut. is often
minf;:ledon tlie same plant with the new blo(<soni8: from this cireumatance
the name kamanielis is di'rivL'<l : (irtui at the smuic time, and m/Xny fniiu )
TbuK far ehvmieul aiuil\tti)ii luu: revualeil no alkaloid in thi« phint: tlio
active part ueoms to be an es^ntial oil discovered by Moiigin. There ia
kUo considerable tannin in tlie biirk.

Ikaidea Pond's extmct, bo [lupular in the 17. S., aad wliicb ia dimply a

■ OmmIIr, LfMODs on Ht^morrhoids. Durot, in Arclt. ■)« Me<l. , 187*.
f TeiMJer of Ljrona, On the Tn-:iimi>ut of tiemorrbuiiUil Fluxva by yurruw
[■(AdiillMi MillcfnliiimX (Bull, da Tlipr.. t. lii., p. 170.)

356

UISKA8KS or TUK STOitACH.

distillate, there is a fluid extract, aim a tinctnre, which nhouM be nude of
the frtwh bark, and in eritiUo<l to moro confidenca thna the ditrtiiM extiwt:
tho doec is ij to '^0 ilru^tH t. i. J. The iluid extmci U glTtti ui tt.-iisiKKfuful
doHoti nvciy two hoard.

Pomade fok Piles.
Take ol:

Tiiictura of hamamelis, 3 parts.

Vaseline, 30 "

SI.

SiiPFOsrruRinft of IIauaurlis.

Kxtmct of huniumolis, ..... 8 gnina.

Cuoio buLlLT, to "

M. One auppoailory.

llnmamrlis wajt intrwlucwl into tlicTapcmtiM in 18:12 by Merat and
Doleiift, It wiis first known in Kuropp in K:IG, lx>ing bronglit tliorn by
Bollintoii. Knun timi* inimoinonnl tlic Imliiins ]ui\o imido iitw of it in l\w
treatment of certain tumors as a discutieiit. It Uiiches, a homceopathic
phvsi<?ii>n,wiis the liret tu iridicuti- it*; usu in varicL-u and liemorrhoidK. Lud-
laiit cummendLHl its ntility in ur«.-Ui(i& Halt* luut iiiodt! a tnivcial Htudy of ita
tnultiyile carativo virtuca from u honitPOjuithic point of view. Mtieser of
Fhiludtiiphia lias hij^bly recommend t?d it for vnriccR, and advisee ite inturuul
adininiMtration. Seri-and and Tisoii (IS81-1883) were the first to iutro-
duc» hamaniL'lit; into Fninee. the former insietiug on its bi>u(>fi1« in affec*
tions of the hin-nx. In ltiy4 IMjardin-Beanmetz, at the Society of Thera-
peutica, cnmrnnnicatcd the remilts of hin rxpcricnre with this new remedy,
and (iny has fmboilied these roanlts in his theniR.*

' Watson ndvipoa for hlotMling pilps lavemenfci of tni^r of lend — SmU>

5 ij of water. He also E]K:«,ks hlf^ldv of a Inveniunt of uolu|>lionr 1 part, of

honey a paris-f Richard of Canlal makes applications to the anna of a

compress wmked in the following solution: Liij. Plumb, diacetatiii, 3 i.

aqute £ 3 Iv. M.

* ITernin's ointment for ordinary non-fluent piles is aa fotlowa:
TaniLin, 1 jwirt. cold cream nintmeiit, h jiartii.

As ft mirj»ative, ho roeommends a t*>iispoonfnl every morning of ft
mixture of efinuL parlo of Uuwerti of itulphur, culciued iiuigueeiu uuu augar
of milk.

[Vuii Buren'u laxative for hemorrhoids, much iu use in the U. 8., ia aa
foUowB:
Take of:

Sulphnr, .....

Sulphate of mngnema.
Calcined nincneaia,

Sugar of milK

PuTv. anise, 3 ii>

jtf. I>ose — a tea«poonfnl in water at bed time.] Herpin ordurs a diet

" Gtiy, Tii^iie dtt Piu-iK, l^n4. nnd Boxum Mtitft-^l iint) Suivk.!tl Journal. ItWS.
l>ujar.IiIi.B«a.iini*ti, Bull de la Soc. de Ther.. May. I.H84. Linflum, U. 8. MPid. *
&uTg. Juur. Hide. M<bl«ri(i Mniliva, etc., 4tli TA., vol. I., ]t, 345. Uiit^liee, £le-
nieiils of Fliuniiaeodj-namia. etc. TUwii., BuIL ds Thar., April 15, 1883.

fOu. dea mp., Dec, l&M.

hi

!:ss.

TREATJ-UCNT OF lUUIUBBlIOIDS.

357

Inrfjolyof fruits, an*] (?a(>i>oiii.Ily HtT»wbHrrie8_. whioh heconsidcra
lly iH'iiL-ttcuil ill lifiiinrrhoids.*

The uiifn>(^i)tum iMpiiUmm (French codex) is made by hruinne in a
imtrlilo murtur ami lioniii^; iti 2000 parts of Innl with » ftiMitlo Ciro till the
nioiistiirc is diesipatix^: 'ioO purts tiioti of tlif Cre^li k-nvoa of tliv black
pupny, ikiulW iiii;ht»lia(k-. hviiluiiiv. and blnok iii);)it«liitde; Iheti mlitin);
ol liiE* ilrit'd buds of thv Iduck (xtgjlur Itruinuil, S''t )iiirU; digsKtine for
twpnty-fi>ur litturB. ittniiiiiiic with a stronjj [>xj>]^'(»)iutu and liriullv allow-
ing the oiiUmoitt to cool. It is an anmh-ne ointment tnncli wmijloyed in
Europe. The rirtiies of poplur huda ore analagous to tnrpentmes and
ho^aaml^.

f " Cnlnuitive Bii|>|K)sitorieB are omtk' an foUowx: ITiig. populwum, gin. i. ;
exl. hyos, gin. «.30: uaoHO biitlvr, white wax, A ft grn. ii. Kor I auppoai-
torj'. B. Ext. opii, gra. 0.10; ext. etramonii, gm. 0.10; cacao l>utt«r,
^ni. viii. For '2 enii|K>Hitorie». E. ExL rJiatany, gm. O.ftO; muriate of
morpliia, gm. 0,02; oncao buttor, gni. iv. For 1 HiipiKisitory.

" In lfi38 the trilinnal of Orleans romlcrmw! a oharUtan ivf name of
Moltcnot, who, for tht> first titn<». performed (i^)hinL>teri<i dilatation under
the name of rmfi-^iifff c^danee. In the «unc year Recarajer took up ajj^in
the pmoticru uiA applit-d it to tlit^ troatrnvnt of B{>Eui(n of tbi? iitiux. This

Jrooedua* waa rujK'utud in lSi7 by Maiaiiineuvf umler the name of foroud
ilatation of the aphiiioter. In 1S49 Monod. Ijofnri' tlu' Sooifty of Surg«*n',
advocated forced Oilabitton. IWnet in lfr'50, Ixtpclletier and Knncmann
in t851. defpiidtii this method ns of grwit ntiHty in sphiiK^trral^ia and
livmorriioids, Vprni?uii also advoaiten it for pih*s in 1ST4, and his pupil
t'ristofuri in hi« them Ime dcecribod the method of his miirter, Fontan
lastly, in IS7C, mudo tonxil dihitation the subject of t\ memoir before the
Society of Nurjien,-. in whjeh the merits of this i<implu »urgi<.'n1 expedient
in the treatment of hemorrhoids were ably defMiJod-t

"Aeeonlingto Edmund Andn-ws ol Chicajro, the metliod of ljyi>o-
dermic injections of plicnie mid hiu« been applied by over 30(t physicians
to ItaiH'i^affB of hi'morrhoidn. He repirds this inetliuii of treatinj^ pilen
a» less danpemuw tlmn the others, while Iwing (luito tc* sure ns any. The
injwtione of six or eight drops of equal purls of Hlrong ejirliolie mrid and
giyoerine an- made into (lie (substance of the liemorrboid; guiivruUy not
moTti than two or three are triMLted at one time, sometimes only one, with
a week or ton dnvK of inti-rval ludore aitothiT irt injet^ted, and so on.

SI have foim"! it in several Jnstancea to l>e a very certain and comiMUA*
y iiaiiUcat* way of Kcttiug rid of bemorrliotda. If tboy are internal,

'Heqilii on tho Trcatn>'eat of Non-Fluent Uvmorthoids, Ball, do Th£r., t.
U.. p, a«.

f RM-iuniffr, On tbi! Exti^nsioTi of Mn)»in)ie and of Cadeneed Pereussion to tlw
Tr*»tnieiH of Jliuwiilar 8p«ni, lli^vue M6d.. IS**; L«pell«tirr. «<«. »!« Thir., 1««;
Muiiuiiit^iivi'. Cliulqiie Cblr,. t, ii., p. 300: Monod. On Fniwii Diliitationns a Meiuui
of TrtHiiiig KiKKiin' of tli" Amm witli Con»tri(^tJen of the 8phin<'t*r. Biili. iIp Li S.v,
d(? Cliii-.. Mav, IMi; Crihtolori, On the Siuvical Tirmlninrtit of llr^inorrhoidn, etc,
Th. f\f Pario: Foutau. Oii th« Tiwatment of Ui'iiionhoiitsi by Fumnl DilaloUun of
lio Sphtn4:1«r, 19TQ; Aali^-^, lt«]H>rt on tli« Memoir of Koiitun <BuU. de La Soc. tl«

inject a fow rirops of the abore^mpntiuned BOlutJon into tbc most promi-
nent of tlio \»k'!-, tut tiiL-y come iIowil. Tbv pile ho uijuctvd aoon stinveU
up uikI <It»upj)L>:int. Tmiu.]

PrufBgsor Vt^nicuil ubl-s tbu gnlruiio-oitilery. The juiliciit ie »ri!i>8ih<.>-
tiztxl or u«t, as ht- prefers; is phvevd on hU ^itio nciir tin? vlge of the bed;
the piles are i^rnwii iUtyrn with h (]nul)li; tL-niir.ii1uin. imd the lai;ge on«8
selected for the o|ii'rotion. Tlip piilvmto-<M.ntery kiiifw ih held like n pen,
fujd when duly hotited hy thp ourrt-nt is iniuio to p<tnotmt<i gnuliinllT tho
hemorrhoid in u dinniion jHimllul to tbu rectum, aiul to u dupth of to
1& millinintnui. Tliu muit uf the iiiHtrumt^'nl i» made lo pprfunn n sliglit
movement of (!irctiiiiuuetif>n in tho int(>riur of tliu tumor to inorenap the
si-jic of tho c-ecbar. For a tumor the sixe of n lilbort onv puucture auf-
GcK.'.s. The opcrutioii is nil Lbr(jii;;h in four or five minut«.tt; tliv Cflohar is
cuitipumtively Hlight, and Llm aftiT LruiLtmfnt in almoKt iiotliiiicr. Com-
]ircs«e« wot with colli wtiter tilliiy iiiflanimfition ami nwelling. In ten nr
twelve days the ploughs nopantte, iind nidy a little circtiinmcrihed iiiduni-
tiou romainti. There h no iMjssildlity of (*nlwi»qiieiit stricture.

(iossolin pn'fem tho olaor oi>eriitioii with etronjr nitric »cid. It id
applied hy means of a mop of lint or UAbe«tufi fiwleiicU Hjwtii ti wooden
IiiukUp, rare heing taken to uvoid totieliing the hii rroii nd ing skin, whi<h
indeed hitd bntter bo Bmeured with ivftin uenitn. The eiiUKtio n sot al-
lowed to remain long in contact with the tumor; after two or tliro* eoconiU
the mucous mL-mbniiic whitens und tho desired effect is pi-otluced.

Iti<:)iet'B favorite method (a camhinution of crushing and cttntcriei>
tion) ifi as Follows: Tho hemorrhoidal swelling is transUxed in aerernl
[X>iiit8 ttf its circumference byusilver wire which is twisted nroiind pevenil
]x>rtioi]8 of the tumor at itti base, jiedlculatlng them. Then the skui of
Lbe anal ijeripherv. having beuii previously protecti'd by u wet curnpre>iia
or by collodion, the Itaso « each [tediele is Beize*l between the Ijladea ot
the fopx-jis heated to a white heat, and in less tlian five si^eomls, by the

SresKurc jninwl tJ> the ejuitorizntiofi, oiR-h jtortinn of the hemorrhoid is tv-
iicod to tho iitati' of n thin ehrcd of blackened tinaue completely oluirrwi.
{'are must he tuhcn (and this is tlm imporUinL |M>int) to lea^-e a little
lieiilthy tissui* between eiieh portion whith is caiiterixed. Tlie operation
Ix'ing eompU^ted, the ti^ttiires nro withdmwii, and eoinjiretacs wet with
eold wuUrr are upplied to the charred ptirts.

[In my ouu exi*cneiiee the ligiitiire i.s the most eertuiii and HtttsfiictorT
inetlitnl of dittposiug of inti-'nial piltPH. and it wa» the favorite nietliwl of
tho lat«? IJr. W. II. Van Buren of New York. {See his work on IHaeaaea
of tlie Rectum). Translator. ]

"Seliwartz was the first, in W-iQ. to recommend preparations of nnr
vomica in the tresitmeiit of prohipHe of the reetuui, and TJitehauesoy cnuri-
Klled the hypodermic method, & method whicli vas moon a<lo|ikil by other
pliyaicians. The needle is iiiwrte*! one ceniiiuetre from tim ituus. uiid
plunged to tho rle|itl) of lialf a eentimctru; tibout -ji.tli of u gmiu of
stryi'linia is then injeeted.

(toasi^Iiti liaa proposed electro puncture. \MBt\y, surgical mpdes of
treatment liave lieen proposed; ablation of the irretuicihio juirts has been
tnetl, und the excision of a portion of the mucous mcmbntne; in other
oases cauterization of the mtii^osa with a hot iron or with caustic« haa
been pniutiseil. Ihipuyticn and others have counselled removal of a con-
siderable portion o:f the ekiti immediately contiguous to tho anus.

TEEATMBNT OF HEMORRHOIDS. 359

In 1876 Vidai first advocated the treatment by ergotine injeetiona. He
was in the habit of employing a solntion of ei^otine, ^th, of whic)i from
5 to 15 drops were inj'ected 5 millimetres from the anas. Gnyon, Ferrand
and others nave obtained good results from this method.*

• Vidal, Traitement du Prolapsus Rectal par lea Injections H;poderniiques
d'Ei^tiDe. Detourbe, Du Traitemeut du Prolapsus Rectal et de la Procidence
Himorrholdale par les Injections Hypodermiques d'Ergotine. These de Pui-is, p.
261, 21 Juin, 1880. Jetle, Du Traitement du Prolapnus Rectal par les Injections
Hypodermiques d'Ergotine. These de Paris, 1862.

SuMltARY.— Inteetittal Wonns — Their Treatment — Oxjnrea — Anthel-
BUiitic lAVomonta — Gh'eoriiio Lnvomoiics — SuppofitraricB of Mtr-
curiftl Ointment — LumbricoiJos — Migrution «f LumbritoideH — Calo-
mel — Coraioui Mosb — Worm St-wl— HantoniDL- — 'fajaiaa — Their Pnv
queiicy — The Unarmed and llie Armed Tienia — Devulopmcot ol
Tfflniaa — Ttenirugcs and Tamieidea — Pumpkin Seeds — KousM —
Kiimft!ft->M«lp Kom — Pomejfniniite JJark — The PelletifrinoB — Their
Phrsiologiiial Action — Thi-ir Mods of Administration — 'Hinnate of
Pellctitrine — -Thi? Botliriocupliulua.

Oestlem kn : 1 dodire to tonninut*; thene ItxtiiroH on the treatment of
difiL'iidL-K of th« intustiuett by eoniu ttuf^^uetioiia cououming cvrlain afTcc-
ttons f'>r which yon will often be consnltoti, and which have a great inter-
fat from a therapeutic; point of view, einc-u th«y almost alwayn end in
reoovery under a judicious treatment; I refer to vermiwoii* disviiwi! of the
intestines. In studying tlui* qucstimi T Bhall nviiil niywjif freely of the
recent laWrs of \'an Benudeu. Laboulbi-ne. etc. , mid ospodidly of the work
of iMrninc, which isn moft vahmbb contribntion to helminthojogy,

I Bhall in this eliaptur oidy Kpt-aJc of the oxyurin, lumbrieuB, and tieiiiit,
leaving one Mdo tlio triehocephalus' an<1 the ankylnstema duodenale.* wliioh
you will jirobably never soe; I fihall ii1k<> aiy nothing obnut thn anguillnU
storcoraliB,' discovered recently in connection with the dinrrhrea of Cochin
Chinii. This in a. Kti)iji>(>t pertaining tu unothor climate than our own, and
demands new reaeurehes.

The oxyuris ' is id little white worm thin as a thread — hence the name
thread M'orm — nine to ten millimutrus lon^, which inhabits the ixictum of
little children, whore these ontozoa, whieh arc endowed with rapid moTO-
ment, determine a more or Hess severe iri'itutiun. These wunnnare some*
times found in iunnmemblv numbers, a<nd are matted together In tMiUa
in the rectum, which is the fioat of predilection, if not tho oscluaive seat,
of these vermin. In little girla these worms leave the anuB and penetrate
the vulva or %'nj!:inii., where they produce nn itching which often provok&s
habits of niHNturlnition. We know but little uf the origin nnd develop-
nii'iit of these iiMKrides; we are alwo ignorant of the infliiniiee whieh regi-
men has on their development. To deatroy these pin worms, whoee habi-

TRKATMEKT OF INTK8TIKAL WOR5I3.

;vji

I

*

tat is 80 easy of actis^, yoii itlioiiid resort to u purely hcvl trt-»tinviit, ami
for tbi» purpose you noi-d only nee lavementa and euppoBitoriea.

As [or tHVi<inc'tits, smma tuiv'im ^iniplv iiij^wtions of cold naWr, others
add ooniiDon Halt, otheni nugur, while Htill otliers, imputing anthelmintic
pn)pertiGS to garlic, rfconimcnd clyators imprv^mlud with tliis siilustauou,
I>clutAuv« has proposed larvementa of other, Latteniand. th« iintuntl sul-
phurwutenj; liivumetita of 6ool Lavo uiw) be«ii rwJomiiH'iulL'd. For my part
] prafer gljrcvriiie lavementa, the glycerine being dilated with an equal
qnaiititj of wilier.

At the Bnmc time, in children whero the odniitiistrotion of Uir«mcntis
ii difficalt, or in casen where these worma are In iurinTnera1)1o quantity,
there is another mmudyeuitorior to gUt^H^rini', naniL'ly iiit-rctii-ial ointnuMiL
Thi« jou fan introduce into the anas in tlie state of jwinatie, nr under
the form of tittle HtipiKMitorica. Dnmas of Montpvllidr mudo use of a
lump-wick sinoareil with mercurial ointmcut. And Leffrous rocommeuds in
rubelliuiiB casee to introdinse with tliL> syringt; the ttaiuu oiutmeut iu a
melted xtatt-.

M\ these meann rapidly hring al>out the cure of thrmul worms, only
there is a liability to rclapec. llvnci: it it u good plan in itiich patieutit to
exntnino thi> anus frt'fjHoritly. and energetically to combat tliis affection,
nhitili seeiiiK to be nuthinj^. and wliich yet, by the itcliing wluuh it occa-
gions, by the vuginitis which it dcTelopii, by the IkuI habits which It en-
OKuagW, may priHlucu Huriuiut diN^i-iluru iu the linilth uf cUildrcn.

Quito different if> the troatmont of the himbrictoidoa or round worms.*
Here It ia no longer the rectum, but tlm first jMirtion of the iutestiue
which is the seat. This woi'ni U larger than the thread worm; it is
twenty to thirty centimrtres iu length; it ia reddish white, and reeembles,
u yon know, an earth worm. It hn« its ttvut iu the small iutuctine, but
may migrate to ntlu-r \ttiTU, and yon will find in the n'ork of Duraine nn
iuterosiitig aoouuiit of thetie migrations.

What it IS well to rcinenilwr i» that this lumbric is of it*elf incapable
of perfomting tlie intcntinal paiietes, and tliat if it ba» occaaion&lly been
found at mmo distance from it« habitnal ecat and onteide of the intestine,
thin nun only liave arisen from tu)niL' altemtion (softening or uleeration)
of the digestive tube before or after di-ath, which hits caused the intestinal
walls t» givo way so us to emibte the worm Ut i-i9«i[H-*. Thcac ronnd worma
ofli-ii find acoesfl to Hie Htonmch, and are ejecle"! by voraiting, or they may
penetrate the large inteatinc and l>i> voided in the irtoaL

On an nrerage there arc generally found from three to fire of theao
worms, but sometimos tar^ numbom inhabit the small intestine. What
»u know about their development is tliat Ihey are probably communicateJ
by drinking water. In fact the dejecta of pereons affected with lumbrici
ain an onrjrmou.=i qoantity of th« o\» of the«) worms; nnd ns these
may renirtin five or i\x months in the water without loaiug ■' ~=-

I

3 S3 DI8EA8K8 OV TIIK tiTOSCACIl.

Titalitj. it is eaey to see 1h»t wlxinorer tieoA mattore beconto mingled witli
tlic vator which KirTeK fnr drink Itig pnrjKwee, us is rnrqiu-iitly the case in
tbe country, tliv coudilioiui arc fuvorallu for the dcvclypmciit of lumbricL

Thoa- iiik-'utiiial vrornia clt'tvrminu Hymplunui whiob are bnt little pro
nomic«c], m\<\ it in not ^Mierallj till th« c1ii]il i» Mck or nt tbt.- Dii^-t i>f
some gravp »ffec:tiim, tlutt y«u will nep- tlu-sc lumbricB voidwl in grvater
or Ivfs quantity by vomiting or by eivol. Ilovt-uvcr thie may lie, as booti
aa the preaonoo of tlie worma ie mode manifitftt, tlie w^vice of tJiQ physiciau
is Bouj^Ul.

To combAt these worms an internal innlicution is neoded. ami witliotit
moro than mentioning milk tinil garlic, which old niir»e» always trouriM-l
in sacli caaee, I will enumenitc the principal modicinoB wliich have u tvti]
eumtivB tuition. \Vi< liavi- first of all railomel — already coiLKid«re(t in a pre-
vious chapiter niider the hwwl of cholagoguo pur^tiro^ — the miMlitament
piir cxrullonco in dintHM^H of the livt-r, where it Ih mxich employed for ita
epL'cial action on tliut gluiul. Hut wliut particularly iittcrcsta us herv, is
that this mild proto-<'hloride of mrrrury in a good vrrmifiigc. It may he
given in tho dow of from five to lifteeii gru.iiiswith thcpreeautionH beforo
nteutioned.

I^hen comeB Corncan moea,* wliii^h is nuniposed, ob you know, of aevcnil
Bpce>(^ of algiP. and in partioiiiar of njirinni coraliine. You make an in-
faaion or decoction of Ibis ]ilunt: if yuu jirefpr the iiifnaion, yoii sloop
for een-vral liourK onu draclini of the nio»8 in a gill of water, redtiring it
about oii« half and givn tlin whole qnantity; the decoction, containing thu
NHiie proportion, nt-od bo boiled only n few niinutoa. The doKe for an
aiiult in twrt or thre*' timeB the above (juatilitj'. Cowiean moes i« to-4ay
ahandonwi, not bwaiuto its cffecto are bad, but becHuite a sabBtaripe has
been found which is very mnch enperior, namely, santoiiinv.'

Santoniiie, th« active principle of Ktirojwan worniHced — onceeni|>1oy<'d
aa a vemifnge — ii< givnn in the iIobo of two to fiTc grains, neillot has
niiule a L'arefiil study of thi« aiitliulmintio, which is genemtly wel! taken
by children, to whom it is administered in the form of lozimgL'ti of one
third of a gniin. Thiw nudirament haa not generally any toxic action,
but if given in too large doses, or in certain idiosyncmBice, it may havo
nuploavant effects (vomiting. coHe. syncope), and produce a enrioiiR opti-
cal illneion — objects are se^-n colored yellow; the urine ulso presents a
character istie yellow tint. (Tiienrionprez of Lille hasahown that eantoiiit-a
and suitoiiiue do not always give Batitffactory rcHult«; be profcra the evacu-
iiiit method with purgntives.

li remains for inn to xpenlc to yon of the ta'uia or tajie worm, which
ought to receive a moro lengthy uttciition from aa, not only by ivaaon of
the grave symptoms which it may dctermiuo, but ».\vo because it often
preet^nts a soriouB rcsiutance to tborapeutit; vfTort^. Wo idinll hoi'c etiidv
two i.-anBtieH of theae cestoids, the t«nia, and the botbriocop]

ophalua. J

TKEATMKNT OP IKTKSTLNAL WOBMtJ.

3(13

I

In man there Iirtc bwn obecrvctl thnw kinds of lap«> worm; t)w ituHta
toiium or round ta>nia, the ttenia nudiocaneUata or unarin«(l Uenia, aud
ihv i IP Ilia nana.

1 eball conoeru myself vith only tlie two tnU wliicli on; thu must
often observed; aud it uuitit \yo ncknovledgud tliut, during the laat few
jr«Arit, it is the Bwonti VMvinty, tlie iiniirnied (jptua, wliicli bus bwii
moxt frvquoiitly mut with. Vou aro nil iuY]iuiinted witli tli(> gr«at
diiitinctioii vrliiob dillvrcnliat^ tliuao worme.'^tlic Isniu ttulium, witli its
rostnun being' arm«<l with ib«t double circle of hookleta wbicb tturoiouut
th(t four beniispborieal cii^vliko euokor^ coii^ti luting ittt liL-utl; the im-
annwl twnia, on the contrary, being dentitut* of hook» and of roslnini.
You know iUmo tho lurKcr eizc- of the Ui-iiiu irionnis. and the dongateil ncK;k
of the ttenia eoliiim a? com[.>arcd with tho sboi'ti-r iivc-k of tlio umuincd
ispiiia. But wlmt from Uie point of view of diag^noBJB prefientB the greateat
intorwt, is Uio [loii^ibility of detecting Uie wonii tind it« epocivs buforo its
entire oxpnision under antlielmintJc tn»tmcnt from the intestine. We
Hru ubiv tO'duy to muku the diugnostK quite uiKily,

Wo will suppose it tu be a case where the patient witnvsaos bcj[-
meuts of tbti worm voided without bis knowledge or wilL You muy
be persuaded tbiit you have to do here with the unarniod twniii. Ex-
uniiiie then witli uaro thu M-fj^mentu thus voided. If you find tlie genital
apertures, which are, as you know, on tho sides of proglottides of tape
worms — if. 1 ttuy. you see thcue gonital ])ori>a irregtilariv iilternating; ou
the two xiiles, eometimes on the right, Bomelimei* on tho left, you liare
to do with the unarmed tH.-nia. Ijistly, the niicroscupe i-nabtcs u» to
nxx^iizu tho disposition of the fenutle orf^uis. aad if tbo divisions of tliv
uterua are very iLuineruuii and fine, you have a new proof of the esisteinje
of the unarmed tA-niii. In the ta-nia solium, in fact, the j^imitat portw nru
regularly idtomute. disiMJKed, the one on tho right, the other on the left,
and the uterus htis cintrv<i'r divitiiouK. prL-aeiiliii^ tiii uspect )et» denlritic —
lees branched and leai cnjwded. Such are tho vlianicters which enable
us to roeogiiizK the variety of the Ueiiia before the espuliiion of the worm.

Thn natunl history of theKo tagxi worms preiients a great intivrcBt, and
tlii-i it is whieli enables uk to know the origin of theise wormx. and to
eipiain their fre()uency in man. Already, in the lectures on Diseases of
the Stomueti, I bavu alluded to tho |>rincipnl points of intomst in this
■Cndy, whieh [ desire to complete toHlay.

It was Fortueuiin, in 1SU4, who wtut thu fin^t to show tho n.-1ulion M'bich
cxiata Iwtwevu the presence of Uti>e worms and the diet of oertiuu in-
dividuaU. To-day we know the reason of this relatioiiahip, and modern
bemiuthologiiitK. in pointing out the diHeront t>Uit«K which the worm luut
to go through before aiuiining M deliiiitivc form, have given us Uie key
to this intemtting subject.

These wfrtiiB must, in fuct, before ntiainingtbeirperfeet condition— that

I
I

is to eay, that of th« tenia — {Msb throu^li an intermediate resioular state in
th<>body of another animal; nn<) a man has only to intnxlucointo htsc]igc»>-
tivc tube meat crontJiinJng thew ciyvts tn nuuHe the dcvplopment vithin
lum of u tape- worm — the arniud Utiiiu, if it comeii from the cvistjcorciui of
pork, the unnrmetl Uenia if it he derirei from thu cjeticercus of beef.
Wp give, OB TOO know, the nnmo mmvly to auimalB thus diseased, and
jou will «?e, when we complete thiK rtudy by that of hydatid cyste, that
mtui, contracting the diHcueo from ntriwly meat, may himself become
meady by iuiiiartinji the diiwaBc in hia turn to other animals.

Some donbt has, however, lately been raised respectinjc the abeolute
necewity of the pa^mgo of thoee worms through the iiiteniit'diale or vesica-
lar stage in another organiinn, and Mogiiin Irn^ maintained that tho un-
armed hi-nia may undcr^ alt its metamorphoses in the intestine of man
or of animals. This is u question whicli I cannot ilmJL-. However this
may be, a careful inspection of butchers* meat will cauge the rejection of
any that ie measly, and, at any rate, prolonged hoihng will prevent Uie
production tif tape worms by kilhng the germa, and this is the only ppo-
phyliiotio tri'iitmcnt of any aniil.

But when once the taenia has found lodgment and undergone develop-
ment, what arp you to do? Theee paraHitca must be killed and expelled;
hat before attempting the study of tjeiiifiiges, I must give you a geneml
idea of the mode of lu^tion of these medinimrnts.

All niedicincBdenigiied to act ae tienifugi-s niuKt flrnt jmison the worm,
or at least put it in such a state that it can no longer make use of its cup-
shftjuxl sucken;; then it i« neeeevary to take advantage of this stu[)i?fa('tion,
or state of appaj-ent death, by ejqielling the worm in the stools, and this
OK quickly vji i>OH>ih!f. in onler that it ehjill not again have time to root
itaelf to another pan of the intestine. You see, then, that theeo Tcrmi-
fugwfi have two diatinvt jiL-tioiiH: first a toxic action on the worm, seeond
an expulsive action by which tlie jmnisite is got rid of. It is uecexHiry
tlukt thcM! two effects should hr HimultaneoHsly exerted, or that the second
shoald immuiliatciy foliuw the lintt, and all the art of the therupeutlrt
consists in bringing to the front the t*niciJe and the ta-nifnge.

Generally itnthelminties of this group are ta-iitoidex, and the ta*nifuge
action iH obtained by a purgative, which is H<iniinii4t(-red along with the
benicidc, or a short time after. Hut do not forget that it will not do to
wait too long; the worm may recover frum '\Xs> Btnpefnction, and agaio
hook on to the munoun membrane, and all your (Hiins aro lost. As u
general rule, it will not do to let morL* tlmn an hour vlajHW between the
administration of the tfenir.ideand that of the tisniftige.

Tliere are still sonic general rcmarki! appliruhlu to all these substances.
In order that the mediciiment may have an aetion nn tbi* worm, the diges-
tive liiliL' inuBt as far as possible be free from aUniontnry matters, llenee
the neocgaity of purging the jMtiont the evening before, and of r«iuiring

TRKATMENT OP INTK8TINAL. WOKM3.

3ti5

I

I

him to take tbe medicine fasliiijf. Tlu> patlont is genemlly k«pt ou milk
diet t]je day beXore, and goi>« without liia supper.

It i». moreover, absolutely necewan' in ordi^r 1« a coni|ili:tc cure, tlmt
tW entire worm, head imd oil, should bo got rid of. In order u> nttnin
thi8 result, vn n^qniro tho patient to go to stool in a tcsboI full uf warm
water, uhich preveuUi Uie tnu^tiotiti which often separate tbe head txtaa
the rest of tlio hody of tbe voriii.

Uaring once taken th«M) precimtione, what vcrniifugf will you employ?
1 ehall bo briof und<>r this head of antholmiritics, and sbal] only mention
mediciimentii which hiivu bmn well teHlfnl. I Rhidl \y(tiss over tho suti-
HtuiiL'c-s derivud from i\ forci^ Qara, such u» suoriii, tutxi', nuunietma, also
the uncertain anthel mimics fnirli aa the salUi of tin, phenic acid, petn}>
leum, salicylic acid, ether, eabadilla and spirits of turiwutinc. I shall
but mention uux vomica, rocommcnded by Prof. Masse of JJordenux. and
I eome now to pnmpkin srwis. vinmted by Tynon in tOS3, and uii which
3Iongcny of lk>rdcsaux biu writtt-ii ii good monngmph.* According to
liui^kcl, th« tint hoi mill tic property of punipkii) Mi-dti dova not b«rlnng to
the entire ueed, but is limited to one of the foverinjje of the periqwnn,
tmd TOBulte from tbe prenencMi of a resin to which hae binm given the name
fteporemH.

However thie roay bu, pumpkiu rnxxlit arc excellent as an antlielmintic
tor children. You prepare with these eeede, by bruiang them, a party
maai which is sweetened, and which ehildrvii readily take; or the crushed -
piH'dn deprived of their outer coating niiiy be nuwlo into an emulsion by
rubbing them with pugur and a little wati-r. The daee of the neolf for an
adnlt is about twoounces, to be taken in the moniing fustiiig. imd followed
in an hour by a dose of L'ustor oil. Unforlunaloly this anthelmintic, «t
tssy to take, i« often inefUoicious, and the head i« but oxceptioiislly rotdud.

We miiut give a far higher pitice to kouMo,* whieh van for a long Umo
the only ofhcaciouaunUielmiiitic: n-medy, but is to-day virtually abaiidnnetl.
An infusion is made with the flowers uf kou^xo, l)y steeping half iin ounce
in eight Huid ounces of disliUed wulcr; the whole sliotild bu iufused in a
corered veKwl for Hftven minutes, and taken in one done. I'faia infutiion,
vbcMe odor and 1a»te arc very difUgretMiblc, was always taken witJi diill-
cnlty, and the jiutiont would very oft<'u vomit before having swallowwl
tho dnoght The high price of kouseo on tbe one hand, its naaty taste
on the other, and. more than ail, the diacovery of iredicanit^nt* qnite as
efficacious and aiaicr to take, have conduced to tho abandonment of this
drag.

It wati for a time the rastom to eubetitute for the above-men tionwl
reraody kamaln (or kameela), which i« admirusU>ri>d in jwwder or in tiuc-
taw. This is a Tory good modicanient, being both twnicido and ta-nifngo,
bot it i* now vr-ry little iwod in France."

It is not Ml wiili tJte male fern {Aaj'tdhmJUU ruaa), of wliiob an etbemil

366

DKIRA»KS OK TItK STOMACir.

extract u niiulc. which gives excellent roaalta in the trvKtmcnt of tsvnift."
'riiiLiiks to tlie iin}>roreii»>iits whirli Imvc K-eii effected in tliu [»V)>ihnitLuti
of this extract bj* Pcschier and l>y Kim, wc Iwvo liorp n very ttot'we medica-
ment; in the (lone of from tliixt' to four grammes { 3m to 3 i) it givM
reeultis which iirw pi-iicrullv Kiitisfiicton'. Imt it is iiecc«ary to uN«i)riHte
with it a purgntivt'; and Orcqiiv lia« made an excellent conihinnliuii
whinh connsta in incloBing in a p-apsiile half a grain of calomel -with from
five to ten tlroyis of the othen-nl oxtraet of rmie fern. The pntient is
niiide to tiike (wenty of th««c (■&]«» t<*s in tlic conrw of uii hour, iimminting
in nil to tun grains of calomi4 »nd a tluiil dnivhm of the oil of mate fern.

To little children, who cannot take th«8o cApanles. you can administer
this Pthprwil nxtmet in polion, inking care to a^tocinte with it a |nirg«tive,

LhhIIv, gentlemen, these ethereal extraets Kerte hk the Imnis of xevcnil
welt known anthelmintic n'mwlies. tnid juirticularly of I'eBchier's pilU or
boluses, which are daily employed on the Imiiks of the lake of Genem.

I eome now to pomegrnTuUe (I'nn'wi gmnatum), whoso Anthelmintic
propertieti, although known to the ph^raieiaiiH nf antiquity, had lieen quite
forgotten till ttie upix'-anince of the work of Oomcz, in 1823, reatorcil this
inoompArahle twnicide medicament to theni])euticA Since this time the
doeoctioii of pomegraniite bark lins been very genen^Uy eniployod, and
signal Buecess ha» attendeil it« use. Prof. I*.boull>^no,wlio hau given spocial
attention to the treatment of tajie worm by pomegninatB, nonsideni this
ae the eureet aud niO!<t enicm-ioua remedy. Quite reeently. iu itti excellent
monograph, Dr. Marty lias shown that the twigs ae well m the rooto of
this tree po88e«i anilielniintio profwrties."

But the recent liwiovory ot Taiiret. who haei siieceeded in isolating tho
alksloitle of pomegnvnnte. [\a» given u marked progntutre im|)etna to the
therapeittio application of thia ta'nteide, untl tis I have made a speciot
rtudy of those different alknloidn, |KTmit me to tfiini wp in a fow words
the prpHent Htate of the Bubjeet,

'i'anret lias found four alkaloids in the iHnnegniiutte. To tlieso he fans
given tho name of rplletierines in honor of the distitigniHbed ohomist
PclK'tior, to whom we owe the discovery of qnitnne and bo many other
natural alkaloidR; and, to rtistingiitHli theui* different {»>! letieri nea from cJich
other, h« has deitigtmled them hy the mimes of pQltetifTine. ii!0]K>lletierine,
pMudo-iK-lIetifTine and methyl-jielletifTine. Only tho two first are employed
as tnnicides.

I have experimenbMl on nnimnlx and on man with tho diverti alkaloids
of pomegnuiate. and my |mpil. Dr. De Itochmiire, in an i-xeelleut theaiii
on the Bubjec^t, lias n-porUil tin- results.* These experiineiito have xhown
us that the iwdletierines determine identical toxic eyniptoms in aiiimalst
aiid that the only ditferenoc between them comiistri in tho intensity of the

TREATMENT OF INTESTINAL WORMS.

3C7

I

I

I

h

I
I

phenomena. In tliis rvsp«:t polleti^-rine in the mort itcth'o; oeitt in tbe
onlpr nt'toxic'ity coinus ieojwltoti^-rine, lli«« pwudo-pellptifrinp. nnd Iniitly,
inutliyl-j.^'lletii'riue; sml to show the ratio of toxic (»ow«>r of tliL-SL- (lifft-ivut
flikaloida, I call your ntu-ntioii to this fact, that it taki-a eeveuteen r.«aU'
grams of pelletii'-rino to canae tlie dotitti of a hnro in from t«n to fitt««ii
iiitnut«8, while the quantity of Uu]K-n^lkTuiE>. iiwndo-iiellfltii'rine and
ni(.*tlirt'|K.'lietieniie nocesaary to bring nhoiit thv samu n^ull in the sinie
timeiaroBpectivoly twoiitj-, forty, and fifty eentigitunB. Oiiedropof ateii
|>or cent. w>)iitioTi of nulphate of pfillpti/Tine will kill a frog in a relatively
brief Rpocti of tiniu, whik' a. k-L-uh iinniuDHHl in ii ] /^i nolution of jwlleti^-r-
inv dies at the end of ten niinutes.

On examining the i>ubJL>ct more attentively, 1 found that pellKti^-rino
vaa <lostino(l tn incrow* the number of poimns which act like curai'e, and
Iit'ncu are called rurariitrt; it limits its inflnence to the extremity of the
motor nenrea, of which it destroys the neurility, while pnatenring mnec!!-
lar contractility and general seni^ibiiity intacL But lot uh now return to
our eiMXrial subject, which is the thcn)i>eutic« of u-enia. and see how we are
to utilize tbo^e alkaloids, nndcr what form, nnd in wliat dose.

At the outset of our experiments we combined the four alkaloids in
tbe xtate of Hulphute, umd, despite signal succfsscs. wc hail ocnmioii to note
Bevcrul fuilun-e. I then rcjuested Tunn^t to add a little tannin lu the
imiiMtration, in order to bring it us near as i>o«>ible to the state in which
the alkaloids are found in )w>mejrninnte hark, which coiitainiii (annin priii-
ciptee in great t|iiiintity. and wc decidei] hennpforth to adntiniitter thirty
centigrams (five gmins) of Kulpliates of [nlluticrino and impellotii'-rine in
a solution containing fifty ocntigrams (eight grains) of tannin. Jt is this
mixture of sulpbatei) of i«OIotifTines iu a tannin solution tliat we call,
rather improiwrly. taniiate of [telloti^rine.

Among these difTerent alkaloids which the analysia of their phyjiiologi-
ad effecte has enalJcd a» to c1a»ify in thu ratio of their toxic power, which
poeaces anthelmirtio iiroi»rtieg? This is a question which Iterangcr-
Fontuil haftanswcrod in a positive maimer.* Making comparative ex|>eri-
tnents with these dilTerent polleti^rines, h« has oW; rTc>d tlutt while pmndo-
pelleti^rine and methyl-pelleli^rine never cause the expulsion of tape
womu, i-rcn in targe dosee, pellcti/rino and isopcllctif-rinc, on the con-
tnry, whether a1ono or given together, always gave satiKfiictoiy rcmilts.

As VOtl sec, bv ri-anon of all tliese researches, tbe question was Iteing
rcOuced to greater and still greater deSnitences; the addition of tannin
waa already a step in advance. Thanka to the inrestigations of Ilerangi-r-
Feraiid. wo were ablo to discard, as devoid of tenifuge properties, metbyl-
3>elletii'rine and peeado-iKtlletiirine; thoro retnajned the queatkin aa to

* B«T»iWor-F«ir:iu«t. On tbe TlITa[^lR<> AetioD of the Four AlkoloidB

naU-. (Doll J" Thor.. L acviii., p. «17-397.)

868

DIJSKASKS OF TUK 8T0MA01I.

tho dpsinibilitj of giving h ]»nrgative in connection with the pomegranate
aikuit^iidn. It occurrt'ii tj inc itt Ihu comnifiicunicnt of thc«- rct=carc;ht»
that it would be woU to associate a puTgatiTe with tho pellotierines. Taking
A hint from what Criqiiy luid don« for oil of nialu luni, 1 cnmbined thoro-
iore in tho ame potion thn coniponnd tinctiii-e of jala[>, Rwe»'t«-n(«l witli
E^TUp of senna, and the mixture (if Biiljihiitt-s of pfllrtit'rincs with binnin.
Tlio rraulb obtained did not confirm mr I'lfrisioue, luid I rutorncd to the
pfpvioiia nu'lhod of giving the ptirgativo half an hour afteT the ingestion
of the [H'lli'iif-rinci. I conwder tho German tinutnri' of jalap iw tho h*«t
prupuiution to giva in Huch cuooe. and 1 do not hesitate to administer an
mincfof thiu tinuturu, but-auM^ the proivncu of the tanuinoii the unehiind,
and on the othvr, the pikmlyzing effvtrt of the pomegranate alktiloiUs on
the inn«cntnr fibre of tho inl«>8linc«, opiiOM'! thi- action of tho purgative.
I admit, however, that good renultii are obtained with ca«tor oil, one to
two ouiicus half an hour to an hour after the udmlniHtrution of tlie ulka-
loids. Beranger-Ferand prefera infusion of eenna.

\Vhat«vi>r may Ik> th*- {nirgiilivv whit-U you may employ, give it at the
lateft. half an hour after the administration of the pelteti^riiw, and th(>«c,
in briff. arc thi- ruhs which you should follow in order to be almost Hiire
to obtain the expulsion of tlio worm. Muk« your pi»tJi-nt tuku u mild
purgative the erening befon>, and notliing but milk for his supper; the
following moniing adminirter to him fasting 3ll ccntigmnis (five grains)
of the sulphittt-H vi pfilutit'rine and iaopelletitrine in tiohition with ftfty
ct^ntigrams (ui^ht grains) of tannin; Ivn miuntvH after give n tumblerful
of water, Uien, ut tlie end «if ImU an hour, a purgative, and. kiatly, require
tho patioiit to 8it at Btool in a vei^el ncu-rly full of wann water. A tsw
mintttce after the ingestion of the mMlicam«iit, the patient exjtertenoes
slight vwrligo, and thu tape worm in voidL-d. as n rule, fonr hours after
the a<!mii)i8tration of the remedy.

In tho va«(<ft (which aro hkely to bo very few) where you meet with
failorea, that is to aay whrre the pelleti/ rines have cause*! the almost
ootnplcto expulsion of the worm, but without tht; head, it will not lie heet
to resort immediately to the administration of another do«', Imt to wait
A cortain time, two or thrco niont)i» for iii8tan<je, and what I aay here
applies not only to tlie alkaloids of poraegninato, but to all other twnicide
medicines an well.

8iuce we have eiitabliehed tlieee mtee of treatment, and whcrovor
patients have ecmpulouely complied witti them, we have had numerous
MioeesKB, and in nine autea oat of ten we obtain tlie worm with the head.
I think mjitclf warranted in affirming tlmt the j)ctleti6rines thus admim^*
terwl are im excellent remedy tor tape worm, if not the very bt-Bt, at leiutt
in the adult, for, till I have had more experienoe, I eliould uot daro to
adriH) tliiB me<licament for children. "

ExcuRc me, gentlemen, if I hare no long dwelt on thix 8i>ecial action

I
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ot the pelleti^rincc, but the mcwt of jou Imvo followwl thU yoar, iii my
hospital sopvico, thn nutiioroiis triulB whioli wt^ have miulo wali t)io«o alk»-
loidn on patientu atfectwl witli tajjf worm, ami oar »*xperimpnt« on animals
with tht'BO sarud atkaloide, and it Beemecl important to aum up for you the
princi)m] nvults of tlioao «xperimoQtaI rcscorchce. ■

In 6nr«hing what pertainH ta tlip titjatniert at t^nia, I ought to Imve
mentioned ii iipw-tn''nifupe muchompl»vHd b_v tho uativLttsof FoutaDjallon,
under tho niunv of (iogo, nivl whicli Prof. IIcck«l has recognizee! ua Iw- ■
lolling to tliP family of Amomac»si>. iind which he hjia tlonu mv tht ^nttt
honor to name after me, the I'hri/inuni lifumnftii. Hut the trials whiuh
I h«vo miulo witli this plant havo not biwn suffii^ifntly thorough, so that I
may pronounce as to thi- real value of this new tienifngp.'*

I [uee now to tlio ntudy of the tfothriowphalus, a tupo worm wliich is
very common in certain countries, aiicl o«(peciany in Switaorland, so mucli
BO, in fftot, that wlien you noe a bothrioftephaluB you are almost Vinrnuitt'd
in affirming the Swiss nationality of thn patient.""

It in not known wliat is the cause of their frequency. C'arl Vogt, in a
communication which lie mada at tho Iiitiimationat Congress of (iCUCTo,
says that h« hu iiovcr nbtwrvefl any jinriisiteji in Uie tiHh»s of thi> lake, and
particularly in the ffra, <rommon)y reputed to be the Iniiismittvr of the
tHithriocephal UK. This worm demands the same tri'atment a^ the tirnia.
I am aware, however, that the preparations of male fern havo been proved
to be of thu grcJitest utiUty; nevcrthtficss even nt (lenova pomegranate
Imrlc hiLK lieen employed with ftiietwwi, and in Fnino« the expulsion of Lliis
worm has been obtained with pelleti/Tine.

Whether you have tn do with a tienia or a bothriocephalus, tin con
can not be coustdcrod as complete till the haul of the worm ho* baon
obtninod. Nevertholeiw there have itometimeji been exceptions to this
rule, and for my part, T know a number of individuals who, notwith-
standing ttie most careful seun-hing. have not been able to tind the \\itaii
Tritli tlie frflgmoiit« of Uenia expelltnl, and who at the same timo havo been
«Oinpl«to!y cured. It is easy, moreover, to iiiiderBtaml that, (-•ontudering
the oxtTPmo tonni^ of the filiform extremity of tlM^tte ocwtoiils. the head
may eseape tho most careful insfjiecliou.

However thi« may be, you onght not to repeat your attempt to oirpe]
the tapo worm after a failuro to find the bead, till the pntient shall have
[)ai<«ed segmental in his Rtools, vohiniarity or involuntarily, as generally
bappoiiH two or thn«o months after fin-t voiding jwirtiom" of tlie worm.

Such, gi<ntiemcn. are the considerations wliich I wished to preflunt con'
oeming iutetitinal worms. I have now completed the disooMe of tbo i&t«*<
tines, and propose to {levotc the coming courso of lecturoti to th« troat*
in«nt of utTection* of the liver and Icidneys, hoping therein to find still
Don) vouvincing proufa of (hu utility of Clinical TherapeatioB.

I

870

DISEASES UF TlUf SIOMAOO.

KOTES TO LECTURE XXT.

'Tlio tricliowplislus liominis is a ncinatoitl worm vith an elonffnted
boi]j fonnctl ttt twD jiurl^. blic- luiU-'rior lurieiT thiiii tlio ]K>steri(>r filiiormi
tho piMteriur iM)iii<-wliiit prutiib«raiil. Tim iimlu itt 87 millimittrvs in
Icnji^n; ita postt-rior piirt is rolled up, iiiid bears at its extrt'mitv 4 aort of
cylindrical eliftntli rroin wbich ii^iies Die spicule. The female i« 30 to 6U
initlimvtnxt long; tliu posterior pnrt protalienint anil but little incurretl;
thi' tHi) u-iUi blunt ]H>int.

The tricl)oc«pbiilu() was discovered in 1761, It mftjr exist at ttny a^,
but it in mevo common in the adult, especially in Iboae who sncciirnb to
tyiilioiri ie\er.

It is comiiiuiiientAd I>t drioking unttcr, like tho M(^ridc«. Th* orn,
Bwalluwnl with tho wutox, uiidLTgw Jc-vrlopincnt in tlio intertinu, uiul giro
rise to tho tri(.<hn(^phaluK. This wurtu bits tor it« seat of predilsotion the
cubouoi of man.

* Thf ttukTlostonm iluodcnale ia a tiematoid worm, diHOOvc-red at Milan
in ld<18 bv Diibtni. It in well kiiowu in Eg^'pt. This vrorin occupiefl tlio
duodoiiuiii and jejunum of man. It ia a cylindrical worm from (t to 9
milIimetr<.-8 long, of ttn iiahr gn»y oolor. Thi» hvail is rounded at the top;
tht! month is clliptiml, and fnrnitilieil vith unnqual conical paptDKi
tRrminati'd by hooks, which enable tho worm to fiwtan itself to tho irallB
of tlio intfstiw;.

*Tliu uiiguiltula etercoruliH, a little nvmutoid worm, wa» discor^vd
in 1870 hv Nonimiid of Toulon. Jt lias been found in abundance in
the intL'sUnal nncri'lionH of iiuLieuU atfectcd with the diarrhma of Cochin
China. This worm is 1 millimetre long and O.U-1 millimi;tr<.'ii in breadth.
i\a many as HM),()l)(t huve bfen found voided in thu stuols of one day in
a jMTjipn Bufteniig from t\m diarrluca.

Another worm of a similar kind, though larger, the angiiillula inte«-
tltmlis, Ims been found by Normand in the dinrhargcs of })atioDt8 affected
with the diarrhiPtt of (Whin China.

l^vemn and I.iliprmimn of I'liriR have mruie n Btndy of this vwrminotw
diarrhoui in ^oldivrcj retiiniing frota Cochin China.

Tbu trt'iitrnvnt which bus iieeini-d to mccccd best is a milk diet long
continued.

'Oxgvrii rermieulariJi. Synonyms: Ascaris vetmicularie, scat worm,
pin worm, maw worm, thread worm, ascarideK. Is a little white cylindri-
cal or almost fusifoi-m worm.

Tho femalp, which in onliimrily soon in tliL> greatost abaudance, is a
white cylindriL-ttl worm, lnjifring towards both extremities. The hi*ad
end is thickunL-d. iind i« provided with three prominent labial papillie
onel<iising the mouth. The posterior end extends from tho nnal aporture
in » long and straight. nitiTowcd and conical, shnrp-pointi-d hiil. Tho
doubii! uterine tube, di&tciKk'd with eggs, terminates in a vagina, tlie cs-
tenial aperliire of which is giliiati-d viMitnilly near the anterior third of
the body. Tho itmallcr nudf liardly tapers behind, hnt is incurved, »!k1
endaiu'a short, blunt, conical tail.

^'niRlRinhrinuH,(iuicanti 1 iiinbrK^oideN), U»whita or ynltowigh cylindrical
womi, with a Ixuly moni alteiiimbul l)t*(ore than behind, prewntinp tntiiii-
Toreo etrine.and foiir loiij^itiKliiial sulci. The mule is 15 to 17 ix>ittim<;tix.i)
lun^, titf ft^niule XM lo Cu cciitiiiiftrt^ The tuil of tliu nuilc is urchrd and
funusliod wilk two short, Bhur[>-c-un'wi eiiioulic; thiit of the female i»
straieht, wttliout Bpicula-; the vulvar urifieo U situated in front, in tbo
miflcrie of the body.

Till' ovft are 0.075 millimetres long and 0.0ri8 niiltimetren in 'widtli,
and invc>Ht«d with tvr'> vnve1o]ie)}; tho total nnmbor iu a single female haa
lM>en efltimat«d at 6U,UOO.0U().

The liPiwl of this iiematoid worm proneiit* a month fiimitthed with threo
fleghy valves, one KUlMTior, and tvF0l«t«m1; these have |ifipill»' ]>nivid«d
on tlioir (row border with micro«copio t*<'th-liko in*ieiitAtioiia serving for
mafittuatien. A muscular and fuaiforiii owijiliiijriii! aurmilM the mouth; the
fttnniach in thin and niemhniiious: tin- int».«tine in xlightly Kinuoun and
tvmiiimtoH in a tnins^'onud uniu, placed at the |)Odteri»r extremity of the
body.

Lumbricii may exiist iit greater or less number iii the eame indiridua];
onlinarilv there are but two ur three, but sumettmes hundreds.

It iii i» children about the aee of five or six years that they arc oftunctft
met with. All oliildrcu may be infested by them, but th«y arc more
liJcelv to be found iu fovble, >tcrofidouK children, and euehut; are subjected
to a Wl hygiene or faulty tdimoutiition. Tlioy arp ciccptionally met witb
in adaltA. n'hmi wnnnn am common in all countries and climates; no
clasHW and no ngen c-an \w. raid to he exempt from them.

fy^mo nuthr>ntie« have deecribett verminous opidoDiice, (Bonillet*
Brand. I'riiiglt. i-tc.)

Drinliiug wator aeemn to be thf- principid mode of tninKmisnion of the
Inmhricns thmugh the eggs. In fiict, being espelled with tlio fneco*,
which somvtiuK-e ooutain tocm in tliousiiinU, these ova nmy Ix- cjirrit'd by
the rain or overflowing (wbbiwoIb into Htr^-aiiiis wells, or other sonmcH of
drinking water, and thence Imd untnince into the hunuin boily; Uie ova,
obtaining lodgment in the int^tiiie, undergo development into Inmbriei.
To obviate this danger, potable waler shonld )x> lii'st ttlti.«ri>d or builod.

The aiKaris hinibricioides lives in the small int4>8tine; it u eomntimca
found in the Htomivch and largo iiitoetino, but ita placu of election ia tlie
email intestine. Iu exceptional cases it hae been found not only in tlie
stomtirh, hilt a-lsn in the o'sophagiin, the nasal foswe, the car, the larhry-
mnl panages, tho larynx, the traehm, the pancreatic and biliary ducts,
the peritoneal cavity, "etc, (Leitly in IVpper^s System of Mcdicint.)"

* Oniveilbter. Dirt. d« TAid.. «t de Cblnirg. pratiques. Entoxoaim. Lava-

cJier. Ouiclp Mt^iHi-jil ii™ Antiilifs Piiriii, 1K94, lliujiiiii, OlwurvalioiiG elng. sur
d«a afTix-ttuHB viTiiiint^uoeutJoiim. dvMeO., Cbiruri;. Paj-iK, 177V, 1. xxxiv.) Doull-
let, HiM. «li' fAt-ail. my. d«i ncU-niTf, 1 >JW. Brand, ftiir une rij-menlerie vermin-
OU&e. Act. cie C'oiienlia^c, 1677>16T0. Fringle, Oliwrv. sur leu aiiUadl4w ilmt
anii^ot, iwrt I, cbu]). iii,, tnid., Paris, 1855. Mikrie, Jouro. dc HM. de B^diUoti
t. xxi. Paris. 1800. Bourses. Joum. ile M6(l. dc S^dUlot. t. xxxvi. 1H09. Davaiiw,
tt«<cl)nrdi4A l«ir In di-ivlopp. ot In propof^tion do iriohmSlphaU tIiax I'horom* 9t
de I'nMrarMe lunibrit'oTdo <Com|>t«» n-ixluH dv i'.^i^ad. d«t> Hcicnn«, 1. xlvi. 1608.)
L. AmnMKihn, M^iii. Kiir I'intnxUirtion dm nrii danM Ivn voie« m^rfenneii (Areh.
^n. d^ M^l.. -.>• f^rio, IKS*. I. x). CiwrHint. did. de ni^ijecioe. 1888, t. xxi Amlrul,
AonU pu^i. Puiiv, 1920, U iL Blomlio, AnuU tupograiii. PariB, Ittm. TuniieM,

I

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vlT2 vmASBS or thk stomach.

"CoBsrcAX Mors.

This Uamiiture of nearly twvnlr-fiveiliffcrontspecieflof algn- The
8|>eciniPn» seen in romniprre VHry arcxirHing to the source tcom wnich they
nro dcrivorl. ('omcan moss has a very strong ftiid diugroeoble mariue
odor, and a very wilt)- ta«tc.

According to IleuTlfr'a anulysiit, it eontUDS io 100 parts:

VcKutal f^latine W.2

Vupetiil stroina, 11.

Cuk-iuiii »iiJpImU> H.^

Chloride of sodium, 9,3

Carhniiate of lime 7.S

Iron, ma^ntiein, silica, phos. lime^ .... 1,7
Then; tiio alao tnuxw nl io<liiie.

PlU BMACECnCAL PottMS.

1. DcTOction or infusion; Imlf nn oanco to 5 or 6 ottnoM of mter.
To bf drank freely.

3. The powder. Dose 15 to 1*20 grains (1 to 8 granui) in 8W(wt«ned
water or milJc.

:i. Jelljf, dose one or two otinopa. i. Syrup, 1 to 3 onncoa The
iltcoction IS u.leo given in Uvumoiit^; ouu to two ouucvs,

VKRMiFrGB Potion.
Take of:

CorHican moss, .siniplc Airru]>, of aaoh . . I ounce.
lioiling vat«r, 6 ounces.

Inftiso the mo«» an hour, etrain. ex])rei» and add the syrQ]). Take
the wholf at one doee, or in tww doseo.

Vermifcoe Milk. (Bouchardat.)
Talte of:

Corsirftn mose^ 1 part.

DoiUngmiik 30 jxirts.

Sugar 4 "

Int'iisf and expreea. To be giren freely to children of from one to
five y«ara of age.

AsTiiELMlSTlc PowDEa. (Bouehflrdat.)

Take of:

Conucan moss, SO parts.

Kuropean wormseed, SO "

Calomel S "

Boee — 7 to 30 grains.

Rifiexioiis «t utmerv. siirlfflaoddtfritxpnx'iiitM p»r]«itrprx lombrica (Jonm. hebd.
VtM'ls. \SiQ. I. ivt. ThoiDH! BaHliolint, EpisU niedioin., cent. 1. #|ti(il. IxU. IftU,
Hat:iii Coinituiii. 1740, Drouixsiin, Hint, ilat iihlcLrnnwii.'s duoniqiiiv^ Paris,
1^4*20, 4'' Mil. t. lil. Lieulaiid, Iltfltdrin anatniiilai'meitka stnli^iK. (>l». flOT.
Vami, Biliara. lombnciR obtumtii. (t*:u'i»iil.i, ITHT, L i.) Fnuconnmii'Dii[ri>8U(t, Pr^
CIS dc!i rtinJutlkft tlu luh v\ ilu iiaitcr^us, Purb. 1):<SQ. Lut^iiit!i\ di«t. ilea ncii-itn^'*
M^caJGH. aniilt- Amariilt.'n. Li'lipri. Tr.iitt li'iinul. pitlliolog. gin. et »ti>^\
Paris, Itf57, t. i. Davaine, Tnxit4dM<>ntozoairCA, 1800.

TEKATMTWT OF INTESTmAL W0UM8. 373

' BcROrBAK WOKMSBBD. {Saittanici SfttHn, Stmen Clwi/w.)

A prcHhict of the arUmisia cotttra, wkicb growe in the Kaat, anil con-
sbts, not of tlie seeds, but of tlic^iiiall globular nnexpaudeil tlowi^rs of
tlio pknl . mixed with thuir broken pi-duiiclcH; it has a strong odor reaem-
blioc cuiQphor, And nronui.tic taste.

ft'ornifK-etl contains ii volatile oil and a reeiinotM cstractive matter, but
ovm its |>eculinr rirtuee to santonins, a bitter principio dtacoverud by
Kohlcr in 1830.

SantonicH may tm ^ivcn in jvowdor or icifniiion. The dose in BubBtniice
IR 10 to :tO gruins, which nhould be rcixKit^l momiug nnd oroning for
wsveral days, mill t,bon followed by a briBk cathartiip. It i« littl* used in
thu United SUt4.-s. liaving ^ivcn idaco to the fruit of (^nojKiciium att-
tMnnnticum, which i» univeraally known there bj the name of worm-
■eed.

Santonisb.

Tho actire princijilo of enntonica vns discoverod by Kohlor, a pliarnui-
cirt of DitEevIdorf. It ert'stallixvs in rhombic: prisms, \s inodorous iiml
nearly tnsteiesH, proiluoing aftorwurds a slight senne of bitteniesH. It
tnoltA by I) moilomte boat, at a higher heat volatiliiiing in denao white
irritatinfj Tftpors. Stiutoninc becomes yellow on erposnrc to tUo iigiit,
though it» L-hcmiuil eorajKwitiou is niichungeiL It m nairly iiiBotuble in
cold water, but Uouite Holuble in boiling akohol, and to sume extent in
cold alcohol ; the alcoholic aolution ia very bitter and d iaigreeabte.

As a Vfrmifuge, tuntonine may be given in tlie doec of " or 3 gntiiu
once ur twicL- a day to t^'hildren, and in tM'ice tlmt q^uantitv to ailulbt. It
IB convemently :uhnini«t«red in syrup. Santoninu i»< miicti preaeribed in
the form of lozcngye made with «Uj^r and gum tragacauth, each lozeuge
oontaitiing Jih gni.iii; the doao would be from .'i to 20.

LozEN*oE8 OP SAKToxufE. (French codex.)

Take of;

Himtonine in fine powder, 40

White suanr, 2000

Cochineal, 1

Mncihige of tragaountb, 180

V, S. A. tablets, each weighing "i gmimt.

The Santoniiif pills eaeh contain 1 grain of mntonine rubbed np with
honev* and ertnit^ of liquoriee. The Frtmeh pharma^'iats also niakv
Tcrmifugu biocuitfi with u full doee of aantoiiinc incorpomted into a litUa
dough, and l«ki'd in the foVm of a biacnit.

uuermouprL'z bhvs that santoiiino i» not alwav^ indieatcd in the treat-
ment of ai<candee lumbriooidcs, and that it is injuriuns rather tiian bene-
ficial if i\\v worms are old, and in considerable nambers. He gi^'cs befoir-
hsud, for )i<>veml dayn in Ruecession, tliroo timei a day. large doeos of Botne
bitter propsRition, m wine of einchoiui, and then a' calomel or C48tor-oil

fiurgc. Knchenmeifiter afliniiii that the iumbricoidoa may live for^-«)glib
mure in a strong infmiion of nntonJca.

'Pumpkin weda — tbo seedit of Cnrurbita Pepo. Tliis plant haa but
lately been introdnoed into the I*. S. Ph. The common pumpkin is a

Clant too well known to netil lUwrri ntion. Th>' iMJod »nifititA of ii llrpu
rittlo coating, and a wliitti oily keniolj it cunbuiu a fixed oil, an aronuitjo

•

principle, tin>^r, gum, nnil an acid ttolnhle in wnter luid nicohni, for whioli
tlio nnmp ciimllio acid has been proitowd. The K-cda of the \mm)ikin
Imvt' biiL^n long uswl in the trt.iitiiieni. of tono worm. In the year \friO,
Moiigunv. a ijlivsii^mn of Cul»a, ]m\»!iHhe»i liiu nwulla of his oxju'rimpnU
with tlie Ik'sli of lhi> pumpkin st^ an aiith(.']minti(!, while Itninct nJid
Laniotheof Bordeaux Tcritiutl thoKUU^iiiL-iitsof Moii^'uyas tu tht: udiotu.v
of ttio renicdv iti t-Tiiiu, tMnployiii^', huwt^vur. n iKtKk> nitula from thu sihhI^
ill tilt' qunDtitv of ail otinu> hiIcI a Imlf with as mncli sugnr. Some physi-
ciiins do not reel the ae&ia at ul!. According to Dariiine, the doee of
pumpkin scedrt roct-ntly hulled iiiiiy Ijc miscd to thnsft ouitoes and even
more; in children from hil otiiicu to nu oumw and a half eulBcua. Tho
medicine is Hdminiiit'MM.>4l in on« dcso, or in teuepoonful doseg orory hour.
An hour or tiK'o after tha IsBt dose the patient is girc>n ono to two ounc»t
of wiKtor oil.

Aiwordinn; to Hrrkel, tlio (iRtirn |mrt rcHidcs in thtt nnhiiitoii!' ni<'m-
brauv of the pcria]HJrm. UiiLf nn ountv of tliis pt.'Uiel« mixod with eugur
is su6i(.>ii-nl to CMUtte the expulsion of ii tape worm.

* Konwio, {Jintyera anthrlfHintim). Tho flowcTB and top of an Abys-
sinian tree, 20 fopthigh; tho ppopprties of thi-sw flowors, which havo a
d(>cid<»l antliflmintir motion, wrm nrat Htiidii'd by Krayer, a Frenpli physi-
cian at Constantinople. Analysin shows the flowering topo to contain:
tannin, an iiorid iiiul bitter rpsin (Witt^ttoin, 1^40), an iM'tiro prinoiplo
koiiewin (rwiai. Bwhdl, IS'tS). u voUitilu oil. (Willinf;), fatly matters,
wax. vie. KuuM.-(() Imii a disii;;reciLl)1o iind luitiM'Ous odor.

The lUiwers aro given in the form of jxjwder niixrO with lialf a pint of
wann wator, the niixtnre he'mg allowed to ittnnd l» minutes, thvu «tii'n.*d
up and takttn in two or three aniuf;ht« at nhort interval*. The UKvliuni
dojie of lli» imwdt-r for an ndnit is half lui ouiii-f. It may bo neee»airy to
follow tliia dom hy a brink withaplie. The liifusitm Ctt»»e ie oHicinal.

'• Kamala. — The jMJwder and Kaira obtained from tho capHule;! of liot-
tlem tinctoriti. Synonym^ — .Mallotua Philln>inenniK. Tha kaniula ia u ttvi'
from IIj tu H) fm^t in hi-i^ht, );rowiii2 in Llnidoi^lAn, in eijrvtTal of the ]ini>l
India idlandit, in Arabia and Au^tndiii. The fruit is a tlirev>YiilTi>d L-at>*
Hule, about thi> eixM of :i t^muIl eheiTv; then? eat»itik-« eontuin oxtvrnatly
iiumcrouB Uttio red glaiide, which when bruiwd give the iwwder whicli is
called kamala, which in employed as a dye Etuff, as well aa a tienic-i(l&

Anderson hiw obtained from kamak a resinomi mihi'tanee in llio form
of minut* crystalline plates, i»f a yellowish eoior, inwthiblo in water, and
little fiolublu in eold ait'oliul, tnit tf>luble iu ether: to this euhHtanre he
has given the nania rattkriit. Thf inseslion of kanmla gjvca rise «ome-
timcn to nanseji and blight colic, (MafckuiBOn, Anderson, Gordon). 'Hio
|jowdvr may be preecribeu siiapenddd in water; doeo one to three draolmis;
in thu latter do!*e it sonietiinoB ftt-ts violently. Tlic worm is generally ex-
pellwil dead at the tliiinl or fourth i^tool. (\S. S. Di8{H<ni«torv). Andei-sun
of tho British niivy roiommend* tho tineturw {»\x nnnces to Ic fluid ountx-a
of alcohol); doao, 1 to 4 fluid drai^hmtj. Bloiidcau (Son. ile Ther. IHTf),
hiiif given with succeiss six dnichinit of the tincture, withomt nansoa or eolio
supervening.

Da raino has found kamala ellicacions against the bothrio(^vphaln& He

S refers tho tincture to the jiowder, and give« it to little children in drachm
osa&j to adults in tabk>>4poonfnl doeei>, alonjr with pupparniint for wmu
Other nromatie) water, and oinngo syrup.

TRKATMBNT OF IKTESTINAL "VrOKlIS.

»7<

If Tine. Katn»lft,

M

To

Synip of cirnnge,

SO

120

20

taken m four (lows, an lioiir spnrL If the vrorm is not voiiled
uitliiii two lioun ii(t«r th« laiit dusv, {five an ounce of oautor oil.

fern. The oflicinal part is tho rbiiioina of the

I

"FilizMaa. Mole
plant, (it.H|)i<lttim).

Tliw jitimt. whtcli is very common in Sonth Afrim, is naed oa foor) by;
tho KatHnl The loaves arc u»A for iiinkiiiK muttreMce and cusliiouts
rof»mmoiiiipii for «_to(u1oii», ilcljilitiiteil mid nicbitio children. The root
or rluxoma is alono inetlioiiiul. It i»> inurt* nctivv wliuu fr««h than in the
<!r»ii Btitte, and contains, according to Morin, volntil* oil, fixed oil,
{sicuriuu and oU-inO> tiuiiiin, gnllic ncid, atretic acid, crye^tulliz^lile :^iigar.
ittun-'h, gelutiiiotis niattar inttohiWe in viaXt't and aloohol," wooily tlhnw and ■
iutlie&. Tcseliier liiw noticed in tho ethorcnl extract a coIotIobb ervstalliuo ■
sulMtaucc which Lu»;k lian tsilled flVi'ciV add; tho ethcrt-al t.*xtnict containa
hIbo a f(Hty oil. wliich ia Htjioniliril ami fnriiishdn filisoid iicid.

Ariruniiiig to IVw^liitT, the Ijiuls eaiitiuii \-olatit« oil, brown n>ain, fat-
ty nuittt'ra, (solid and liquid), vurioita odorono principles and extractire
mattcra

Male fern i» given in decoction, in water or wliito wine: 1 to 2 ounces
to the myirt, to Iw riHluced by boiling to a pint; in powdiT, 1 to S drachma
in omulfion; in resinous exir;u;t, and lu ethcrval extract prejxircd with
the ^llI»lJU or liiids (ixbauwter] bv ether ^Peschif^r of Geneva). The oleo
reiin of male fern (eAtnictiiin fillcis li>iuidnm) of the L'. S. Ph., is made
by 8uhj«;tinfi the powdered rhizoina to the action of ether in a percolater. ■
It 18 an ethen;*! extnict of the fern root, eonsiiding mainly of oily and ■
reuaoun inalter. and in much lined in Enroiw under the name of oH of
fnaie/prn. The doBo ia 30 to 40 dropB, one naif Ut be taken at night, tho
other Imlf in the tnonitn:;, and followed at tho interval of ui hour by an
oiuioe and a Eialf of i-ustor oil 01uver of (ienevu.)

'I'rousK'Hu'ii melhuii of aditiiniKtrution wan ss follows: milk diet the
tint day; the second day, in the morning faatuig, a drachm of oil of male
feni in four dorwsa quarter of an hour apart; the third day, a fluid draehm
of the oil in four ilum^ a quarter of an hour ajxirt, then two ouneen ot
Bvrup of ether, and half an honrafterwwrdg three drops of erolon oil in
the white linrtitH [or in cutitnr oil.]

Liumui'in'N t^^ipstdra contain e^eh ?A grains of extract of male fern and
one grain of calomel. The patient takes !(> of them, two at a time erciy
10 luiQUt««.

Vbrmipuob BoLrsES. (Pkochikr.)
Take of:

Ethereal extract of male fern, . . .2 docigruninvs,
I'owdorod rw>t of male fern, ... 5 **

C«naervo of roHeii, (\.». tor » bolus.
Itoae — 10 hoiuKec at ouee. 'Vn be taken lifter a seaiitv gruel diet
two da\-9. After ^wAllowing the bolutk's. the |Mtieut dnnlc" a cnp of I
fern tea, and two houra afterwards, ho takoH an ounce of cantor oiL

'* It ii> the iNirk of pomcgranatv root which almost all authorities hATft^
rvootnmendiHl; >[eral, Itourgeoi^. Davaine, Tarneau, Itanson, Oauvet.

I

»76

IIIHlMtlKK OF -niK (;toiia<iii.

TMUlU.'

Miirty liiiii iitinwn, howovor, cliaC the baric of tbe atenw of tho pmn«0n»-
nt« |ioHM-iUK-t< uritlii'lniiiitic properties u certain w thosp of iKc tiaix <''
tli» riKttH, ami that these pro|>uriiwabo uxist iiiljict in the tuudium-iiaeii
liniiirhm.

Thu c]i-raction mseam to bo tbo pret«rabl« prepamtion; it is made as
fulluwn:
'I'ftko of:

Kntfh bnrk of ih« root, or of tlio
HtomN of jKiniegninnU^, . . 60 grBinmeR ( t !■)•

Hnt OTitiT 750 " il TXv).

Iteductt thv iKtrk to small fniKiMnts, atxl pour ou thv hoi \rutcr: ttt
l6orat«i twi'iitv-four hour!i. tlieii vrapotabu Jowii to 5(>0 jiummw (Uj.).
The othumil uxtract ani) tbv aqtiiKiiu uxtmct do notgiva aatl
II ltd *

Alkaloids of tiik Pohcokanatb.

Ill a rmtf coramuiiiciitod to tlif Atwli'inv of Soionrpn, IKarcli 31it,
182i), 'hiiin<t points out tlio (>xisU>n<H> of four alkiiloids in the pomi^p-Aliste.

'Po oMnin llioiw alkiiloids, 'I'^nret beftins bv truatinft tinft with Trutet
till* iHiwilor of thi- bark mixt-^t with milk of liinv, ihon by rbluruform.

To M>|wniU' ihi« (liffi-reni alkatoidg. he avails liimseff of the pronert)'
irhk'h bittirlMitwt*' of ^Hiu luis of dwniniKwing tlw; ailts of two of tWm,
whilo it in without iirtion on thoee of tho two othore; be also puts to profit
tlii» gnwl hygwnu'ti-icity of two of tlu>ir snlnliat^e.

Tlttitu, trmtmcnt? by bii'artmnato of nmai ami caustic iMsda pve two
mixtim'«. wbioU an> tnuisforuiiHl iiito sulphates aud allowed to crystallixe.
Thf m-Kt»U bpinp spnxbl u|x>ii blotting ]«)ior. tite dcUqnraccnt mlphatcf^
(iiwin}; to thi> va|H>r of wiit**r in tlie iiir) ix-nptnito the iMi]x»r. wh/'mi* thi-y
*p\' t'\inn't»>*l by nn aflcr pr(K'<?ss: ihe otiivrs remain crvstatiiiod upon lii#
pn|n^<r. Iliiviii^ tiic eult». th« nikuloids are caaily aepwitted.

Ill o|ii>nitiiig ill thb war, thrrv is obtained vith bicartMnate of aodaa.

liquitl and d«>'CTrri^%-Ta« atkiuoid. n»d a enreUllisod alkaloid without KCtJoB

'«n {wlnrinHl li»;ht: withcMUttc «oda two liquid alkaloids thv oite Itevosj-

ni». th*' otlior without rottttoni- jiowpr. These alkaloidg are all »<ilatii»-. "

TKiin-t hati ib'sifHiNttxl tlK> two Alkaloids Dot d im l a ead tron llivir
br biowlHMiato of soda undor the iiaratf of pelMierine (C„n,^XO > awl
vi ii«i|M>lluiitTiiK\ aiid he hai! diMrhbcd those which ar» displaced by bi-
«MrIotiuitt' of wila uitdcr thv iiamv of paaudo-peUeli^rine, C,.lI„yO, and
im'tbvl-|»i-lU'ik-nm\ (C.,U XO,)-t

The vAp«Ttmvut« which I>ii(jar<iia-BeaaBkets and De Bodunnrc faaT«
■undo with i<rllt>tK'nit« bare beru made oa froga. harm omI teevboa.

Thv Viwti. in mlntionji of ?. lUHO, rapidl; lom ths prapNty of ooatract-
)t« it) ««<.>k•^rs: in two minata it ioaw iti power M attodunc itaeU »
^3r«*B. and in liflL-rn mtuntes aH its nomneDtB are an ni lu l afceat nor can
U W iwMlktl lu ItfcL When th» eJtpeiUMat U tri«>d vhh inaUitiMne,
it ta)»« tlw mtantvs after the iMmenioa to d^jviw tha baml ssdceref

ts; tbt>

aH its pcvpMtks, attd
iMQh eaa be ivrivnl.

tw«iatT miawtM to anniSilatir afl

• httvM 0«ibaiti. AkIl J> UUl, VOX Bonr^!*,:^ G»& 4m Hip, ISU.
Laho«IWw,B«ILABTtk4r..IsaL J. Uart^.OtttteBilatixv ¥•*■>«< lh*Di«ms(

|T>Mi».0»»bpA n iii l H al P i w^ ii M ii. Mifc

TRKATMKNT OF ENTFSTINAL WOUSIS.

377

With mothjl-pclloli^rine it in at the end of ninf! minnteii that tlic
leecli lows the power of attiiclimeiit; it can bo restoreti to life.

With iwoiido-pulletierinv, a leuoh pliiut-d in atsoliiljoi! uf uomo strt-riKth
do€a not loee its jiower of movfuiont till aflwr lw«nty minuteii ot imnrer-
Bioiif and may I»o reoaUed to life.

In frogn, "Imlf a drop of a ten per cviit. aotiition of pelleticrina does
not dertroj life, iind tli« aiiimiil presents only a general paralyais lusting
nbont tlir«e hours, fu Mipbh ni«i» tho hyoidian roepiration is not com-
pletely suspended, and tho bcftrt contmcts as ordinarily, although slightly
unffi'blcd.

With mor4^ than hnlf a <lrop, i.t>., with one drop, two drops, throe
drop», the frog in Ifillinl. iind th(> iihi>nnmenii of poiHoiiing nro tbo more
rioloiit. and liuiith is thu more mnid, tlic larf^-r thu duw iiijecU;d.

TliH toxii; Mvuiptonu coiuiat ur»t in a ultvous oiccitHtiuii. maiiife^Ling
itself by L'unvulsiun» and eoiitnLcLiotitt, thvii in iiii exlutuifliun of t)i<* motor
powers, Bhowing itself undor the form of complete and definitive muaoulac
resoliitimi. Tho limha — especially thonc nearest tho w-at of the injection
— Mre first ullected, then the abcfominal Tnnsctec, thoeo of tlio liyoid ap-
paratittt, and lastly, the heivrt, which is arrested in dinctole. Tlic reflex
movementH Riinrivu thu Toliintary moveinenta, but uro anon extinguished.
Dentil mipervf'neti in u riuuw of time which rarie* ncnording to the Aons
Injected, Wtwcon one nnil »ix honrs; it iaBtitl miiru tiirdy when the poiKon
in udmininU^rvd by mouth. In the luire. pell'Hiiriin; in tlif Joeo of 15 to
20 eentigninui (2 to 3 gniins) kills in u few minult's. The tosic phimoniena,
when the iloae in but nittLiitiuni, eousittt in a tiim]ile must-uliir piiresis: id
the do»o of '.; or '-i grains?, in a progrewive piiralysis affecting fii-st the iu-
fLTior nK:nilien(, tlii-n thu uuu-rior pari of the body. ears, neck, thorax,
ami lastly, the limit. Thu voluntarv nioveniutits diaapiK'ur hofori' tho
rpfk'?( muvc>mL>nti4. Itei!|tiratiun inat nret h'«H iimpleHiia in pretinitatud;
then tho movements become slower and more painful; finally, tttey are
completrt'lir suspended. The heart still heiits, hnt in a tiimnltnonH and
diftonierwl manner; then it hecometi feeble nnd vt orroatod. Death is
}>rocuded br a few convnUiont. A slight elevation of t«iD}>ontara u
noticed at the cIobc.

In man when the dotte is nttchod of -10 nentignimmes (6jf grainn) ot
pelletifrine, there, is obsu^n-ed vertigo, ocular tronhlps, iindmnRnnlar parnly-
'b; the YeHi;;o and ocular dit<turlMn<,'ett are nuuiife^tly connecUnl with &
rked congHatiuTi of the vuhl'Ih of the fundns oculi, a eonj^^tion wluch
extendi! to the entire eiicopluilon.

Attentive exaininalion of the toxio i>henomena, and very numeroait
experiments on frog8, show tlint pelletti'Tine act« liki* nurare, and that all
the phv>tiologi(?til ex{K-rinie)Ll8 that Imw been made with the hUter may
be reproduced with the sdts of |)cllotif-ririe.*

" In SH caiteB of tienia truuted by tiinnnte of pelleti^rino* as rvportad by
Rochmnre, there were :iU completely succeiaCul. one a probable snooa^ aiu
two failure-s.

The L-xpnlxion of tho taenia took placo on au avorago four hoars aft«r
tAking the [H-lleti/ritie.

Keranger-Feraml has given an interesting table rospecting tbo action
|;«f tbo diner^-nt t^vniftiges administered at tho hospital St Mondrior at

lion. Thin tultlc- inaa follnws:

llhijardin-Bcnumctji, On tite Pbyjioloj^cAl atiil Thcmpoutia Action ot thn ScUu
slli>ti«rine. Bull. <l« Th^T.. t. czvlli.. 1B80. p. 188.

378

DISBA81M OK TllK STOMACH.

Bkuasubu-Phbai'd'h Tabt.k.

Hucties!UC!L pAn.m)RS. Totau

Calomel 2 2

Garlic, 4 4

Pow(iL»p of ma\p fern, .... 5 iS

Oil of malo fwrn 2 2

EticHtyL)tiis. tl 8

Pumpkin st-etl. .... 4 77 T7

Extract of koui>do 3 3

Koiiew in jwwi^er. . . . U 159 173

Pomejirftiiatt' Iwivo*, ... 1 4 4

Ponic^nuuiti.' twigs, .... '7 7

Driit! rout of nume^'mnaU-, . . 23 154 177

Bark Ktwprwl ni H otmc'i-K whut, .1 16 17

Powti^in'il Imrk of [lomogniiiat*, , . * 6
Suliibaic jiullctiuriiiD ami iiuipi<lleti£r-

ino, T 13 20

Tatinste of pclletifriim, . . 61 17 T.**

At is eceu hy tkis table the advantage indisputably belongs to
of pelletifrine.*

" Acoordine u> a numufwript notv at-ut mi; bv Prof. Ilcckcl, the natives
of Fonta Djnlloii miik(.- use vt Die rhizomu of Kioil*^ '" tliis vrayi they boil
two ottiiwi! of tliu uuinii,' ]K>w(U'r of tht- root in Imlf a, pint of wator, n^
diii-iiijr it about (Hit? hiilf. mul thuy HwiiUow tho dt'ooctioii, dregs and all.
Sfvcml hours after, thi*y take a dose of ctiHtor oil.

'Pliis tmhRt:uici' is wiid to Ixi a ccrtJiiii tieiiifage wlieu the fresh plant
is used, but it \» muvli Ices aotJre when ta tho driud state.

" IJotliriottepliahia lattis. or tho broail tjipe worm, Tliia worm, ribbon-
liko, and joiiilwl'. roniinniwlj of a very prest immlmr of riiip-liko engmeuta^
U flix to twenty yiirds loiitj. It dilTtrw froia t Im UKiiia &olmm by its hoad»
vhicli has noliooku or proliottci^, and lius nu uvai or oblong tmckere; its
hend is oblong, with Iwu latL'iitl utun^ilL-d suckiTti; it« Bugiiuoitx are wider
than thpy are long. The genital orilicc* are aitnaUid in tho mwlian line;
th« penis is short, smooth, prominent, and Kituitted above the Tiilva.

It is 80 coiimion in Oonova that Odier, a phynieian of tliia city. ha»
snid that ** tho bvnia lata ie so provnlcint with n* tlint at leiu<t a fourth of
the iiiliubttants haTo it, have had it, or will have it." It htus boen ob-
served also on the Ixjnlers of the Raltir in SwitKerlaml. in St. ]V-lorsl»nrg.
in Kinliind, and in Holland. This eentoiri worm, of a prayish bliit-k color,
hm its neat in the human injbj«ct in the smttll inte!*tine. It may dorelop,
though vtTv raruly. In tho same individual, in conjunction with tlie Uenia
Boliiun.

We know but little about the evolution of the bothrioct-pliHluB. Reason-
ing from ntnilogy, it issnpposcd that the frufeiiiliryoof this worm sojourns
In the wiiter and tinds a lodgment in flshtw. and vapecially in thoso of tlio
genua wilmoii. Hertnliis hiw miiintiined tliat the liijtila nndam, which in
found in Bpeeie* of the gLirius sulinon, repreeenl* the intcnncdiato phaae
between the embryo and the i)rogIotti&

• Beranger-Feraud. The Tit-niu ut llie HoBi>ltal St. Mandricr. Bull, de TWr.,
t. jccix,, p. 4y,

TREATMENT OF INTESTINAL WORMS. 379

Knoch and Leackart have, hovever, claimed that the parasite may
develop in its entirety in the same individual. In administering to dogs
embryos of the bothriocephalus, Knoch affirms that he Iins found adult
worms in the digestive tube of these animals, but Davaine thinks these
statements need to be confirmed by other experiments before they should
be accepted.

[Recently Braun of St Petersburg, after determining the presence of
Bcohccs of bothriocephaluB in the muscles, liver und organs of generation
of the pike, trout, and eel pout, by feeding these to cats and dogs, suc-
ceeded in rearing worms which differed in no respect, except in being
smaller, from the bothriocephalus of man. Such oeing the case, it be-
comes endent that a man may ordinarily become infested with the para-
site by eating raw or insufficiently cooked fishes of the kind mentioned,*]

* Davaine, Des Cestoids, Diet. EucyclopEed. M4d. Pepper's Syst. Am. M6d.,
Vol. n., p. 989.

^VaohiU'Ka millofoUum (Yarrow) in

AncallW in nold d}irp«p«iii, !35 ^H

^^V heiuorrhotdti, SM

Aloen. 301 ^^^^

Achro-destrhio, 8

AoiyloiNiiu. to ^^^^H

Anid (lyi*i>v|B>Ea, 134

Au»«tLi»)ii, ivctul, 357 ^^^^H

Anlds In putrid dy(i|X*p«la. 119. Pre-

Angina pectoris l|]«wudo) £02. 300 ^M

Hcriptiotu containiug iioids.

Anoroxia, IDS, 177 ^H

131

pathology Knd trcAtint^nt of, l<9 ^M

Ailftcthas-glandulosa. in the treat*

Autht^luiiiitiui, 'M2: Otmloan tnosA, ^H

meat of dysentery, :M3

31)1!; calomel. 3US: xauturiiiii), ^M

Albcrtonl, i>x|»eriiiiMitn of with nutri-

'J«2: KOJ-lic. i((t-^ H

tive laveiiieiitK. 2'A

Anus, artificial exiieriment^ with. 13 ^M

AlbuiuDO. digcvtioii of, 5

ApcMtoli on cWtrlKation of thestoiu- ^M

lnd)'H»nt«ry, 344

»nh, 171 ^M

AJbnniinow. 7

ApiilifjLiK. f ritlu«nct* of tn djcpppxla, ^M

, Alcohol, influence of OD digMtlon, 45

■

expvritiiimtal raMATcbea on, 40,

ArgeatI nitraA in ukor of tb» ftcui- ^1

47. «1

acli. 'i2K ■

in the trvotuiuat of imtritl dyit-

Araetlic in giutrie neuroMn, 180 ^^|

' p^i«la. 1W

pn^IMintt ionn of. 1K(t ^^^^H

^^ in th& trentmettt of voiiiltinft, 160;

Atlirepeia. 207 ^^^^H

^^K twrc?ent«ire of, in Freonh wines.

Atonin .lyjiiwpsla, 144 ^^^^B

^ HI

Auliis. watun of Id dyepepeiu, 304 ^^^H

Alift. writers of, 14Jt

^^^H

Alimentary prindplM. 5

Ba(i*(oi.ks water of, 143 ^^^^|

AliinmttK of vo;r>^lal))i) orlf^ii, 42

Buuiu^, hittvr dro]>« of. 14S ^^^^|

^^B of tuiiiuiil oritpn, SJ)

Bt.iiuiiiMUt. table •>.'. 11 ^^^^1

^^1 co)n|>IW«>. Ht

[teitiiN, nutritivr valua of, 44 ^H

^H CMDplfX. ID. 3:1

Beef pur^e, 37 ^^^^H

^^f nu-tur.yirtoii». 'i^i

■j^^l

r Alliuenlalton.fi^; |>!aittk' and rraplra-

BerauKer-FerBud on the tr«atinent ^M

^^ tory frKxIi*, 85; Lithig'H tli^^ry,

of ta|Ma-wonu, 377 ^H

^^m ft'ti haris of aUmeiitntifiii, fiS;

Ke-zonnlfi, SIM ^M

^^M au-lwiivv rvicimvii*, HA; vvw'ta-

Bimuutli in ac^id dyipotwu, 1X5 ^^^H

^H bio diet, 00; njtroffenoaa diet,

in ulcer of the ntoitiaeli, 9^ ^^^H

^H 00; mixed diot, 6fi: nutritive

In tniatuient of dltvrbiBa, UW ^^^^|

^^H equlvaleiitH. AT; qtianttty of al-

niston, asi ^H

^^M lm«nt«. Hi; iriMifUi^ieDt aliiuen-

ninok tlmught <hAiititaii mg«r)

^^1 tation. 117- eict^HHivv idimriitii-

PIixhI. dietetlr valuo of, 43

^^1 ticm, 119; itidigcwtiuti. Id: qiinl-

Buuohardnt uii tnwtiueQt of artbrit- ^H

^^1 ityof alUuvntn. >ti: tudiicentibk

iKiu. 'AM H

^^M Eouds. 71: t'xiM.-tn«w iu divietjo

his I'Uuwlflcutlon of purKiUivoH. ^H

^^^^^ t^rt'M'.rlptloii!'. 78

ast __^^^B

^B ^^^I?DEX^^^^^^^^^^^^^H

^^H Botichanl nii ilflatHtion of the stoiic

r>irli>l)ml. water of. 142. 143 ^H

^H

Cuiwani. BSjfrada. SOA V

^^H OQ alknloiiln in fietral tiinttfm, 258

CtumU,VUIi

^^H Boaclmt. uicIIuhI uf vuuiiiifrHtiiiK

rniitor oil in dlanfaffia, SS6

^H milk i;lobul4>fs :iin

Cntephu, 831; preparatlaiui <if 381

^H Bouliuim. lt>'i [sm

Cttyennt* fiepper (capsicatu aiinnuni).

^^H Bolhri<M.-e|»luiIii»! bitua. treatmeiit of.

In pllra, »&S

^^H llrttn, nutrilivo valuta of. 44

Oreolc, coniparativo snalyTilK of, 54

^^m Breail mtil tmst'l-iruikiiiK. U, 5&

Oliaik hi diarrhiriiL. l{2Jf

^^H Kridtw, wutf-rof, 143

CbiLitioinilM in atonic dyiifiwila. IM

^^M VrinUiii.otirt-Ht iu the trcntuient of

Char<'o«l in atonic dyspepsia, 140

^^M alccr of the rtoiuarh. £)l

Bolloc'a iiowdvr. 149

^^H Briquet. c>xiM>riiii<tiitH nsiMs^tliig nli-

Chatel (iuyoii. water of, 142

^^H »or)itioa of quiuiiie bv tectum.

Chfwory, 15»

^^m

Chloral iu nlci-rof the rtoDiHoh, 239

^^M Broths, -ft): I.iebig'& broth, AT: Begtn'a

in vomiting of Bea-«io1uien, iOt,

^^^^^^_ reciiiu for broth, 58; Aiuerivau

r.\

^^^^y

ChloTOfonn water, Iftl

^^^^^

Cholera infantuin. 3241

^^F CABBAaK. niitritiTe value of. 48

Cbouivl on tlie hniit df dapot^m^TU

W c'nffeln. YitI«riKtii(1ti of. In voiultiuii,

on gart roctnsiJt. t.W

1 K'J

on dry diet, trratiuent of, IflO

1 C^UiiucIvfH hi ilyheiiterj-, SVi

Uiacbona iu cly>>«ntvry, 338

1 ill pilm>. KT

Olynter. history of, M6

I Calomel iu dysentery, 886; In troAt-

t:ocffl. IMl

^^H HiiMit of Intestinal wornin 862; m

Condne iu froslFalKii*, 1W

^^H a punitiilivH. 2I>1

Colucynth. ao4

^^ Cfthiinlift (coluniM, 149, 188

CondinientK. 50

L (.'(luner of the M*iiiiiu;Ii. 3il3

ConrecliK pipcrisi. 8S1

^^^L fultipruiicura. 'ii'i; eiiai:»r dln^n<»

Beoiiie. i',li)

^^H timdt^l from K<u>trwtK>ia, ',i'j-');

bulphuris. mS

^^H dinKiiottin of nutcM-r by tiumin-

Coiiwrve i>f Dauifu*, 3*. 53

^^^^^^ Htioh of ttio c(uaJitity of area,

Cotifitipultiin. -.'HO; definition of. SOO;

^^^^^B UBS; by acidity of ttuvtrio juit-c.

ci.>urite of alimentary bolus, SW;

^^^^^H 934 : t hemptmtlcB of f«aner. 230 ;

drfecutiun, 203: fflM»l iiiuttrra,

^^^^^H milk aiKl meat powdt-m, ZlTt;

ronipositiou of, Wi; dan^eni

^^^^^^ lavai^c, SW3; cancer of pylonis.

of cnnHtJpatlou, 263; dietetlfl

^^M aSft: of cardla, WO: trc«tu>»iit

treatment of, 288; oxeroi»i« in

^^H of, 3Hlt; tn«tiii«iit of vouiitln^

tn'iitiiieiit *if, S(W; Influenee of

^^H of cancer, 330; of the jiiiiii, '£i6:

habit in. 361; UK^ntal and eiuo-

^^H mrcicaU irit«rrentloii in. 2S7:

lliMiai Ktate.'). &M: voAo-iiiotor

^^V ga«tTOBtoiuy, SS»; mdlcuitioiiB

caUM<)i. 315: 1reatiiii>nt of, 2A.t:

lor. aSB

lavement!-, -iW; action of lavo-

Oaiia sugar, it« difreHtloD. fl. n

nieotit, their iwlvuiit4i|ic« and

CarlMtIc Reld in thi.) tn-atUMxat of

diwulvantat^eB. 867

livtuorrlioidit. 'VH

Onton oil in treatment of intcvtioal

Carbon biwutphlile, wat^r of, in pn-

orehiklon. 308: aa a drHstIc cs^

triti (lyifiieptiia, ]S3; innoarosea

thartie, 'iO^ mi

of the t<tonincU. 17*!; in unli-

Oruxttu.TniU' nt> aliments, 3S

^^H MpUc intwtfoal tuetlicatioa.

Cierny. conehmioiiH of, rccpecting

^V 389

fiinctiona of large inteatiiia,

P Cardlalfrftt, TT4, (»i» dyspepaia)

au

INDKX.

38»

IlKi.'OCTinx, RiifrlUh Rtomiiehal, 14U

White of ^'ydeIl^laDl. 133
neCnwiK*, bi» prfiiaration at pniicre-

■tiiip, 107
X>euiar(|iitiy t»ii ubt«>ri>tii>M of lufdi-

cLin** tjy tvctuiii. '-WT
Debovt'. rt'HiiIbi of IiIm (ixpwIfiiKO with

forrfij ret^lin^. IW
DeverK'i*. lavi^meut t>t. In iliaxrhivH.

DIftrrhiiui, Slfi; cauoiw uud pathaiceny
or. 310: alituentary 3t»L vu«u-
moCor, DID; front <vk<>p>ui of i.-nn-
tractUity. 3Ii»: dlathctk, Sid;
(horaiM'Ul li- lnclic-jition>'. 320;
hyg^ifUic treatment, Diti; tiillk
and ntw iiichT, iVM; pliiinniKvu-
HcaI triyititw-n t , Bill; inert jxjw-
dfiTs .1i-,'; biNiJuith. il25: chnlk,
833: whil« decoction. Xi:i: oxide
of 7J110, a28; lutriUKPntB, S^W;
tannin. 333: opium. X23; 4lia«-
oontium. XiS; local applf (NUioiid,
825; lav«n«i)t«, 830; cholera in-
fantum, tronttiii'iit of. A^i-. %i«T-
nom'Tiiia, H2~; Vichy wittor in
<I)HrrhiiMi, 82«

DlnNoiinliiini. a»3; HouchanUl'Hmod-
iflcrtUitn of, s:«

l>ia«t«JM.', ill baccal dyspep!*[a. 188.
I!>4

DlgeatioiLfiivorodbyminute division
of toodft, 5; of albuiiiliioKl luat-
tem, ft; of starchy matt^n*. »;
of snrvhiLrlne nutttfr*. B; of f«t",
,10; of Nvliiiu inattem, 10; of
J milk. Ift; of iiiwttK. sa; duration
tof i1m« ktoiitachitl (li|{it<ti»ti. H
■Joflttpiirfof rvKituL't) on digcii-
tfon. 76

I)nllie*r, on wiuMvof Intettlnal occln-
diun, S\4

Onplayon thi^nuisesof gnstrectaxlo,
155

DulonUu Beaiini(>Tz.«iperlin»ntal n>-
•eiuvjipc ou alrohol poivfjiiinfi;;
40. 47. «1

lt«rj'. 334; Kspool of fiocMl itiiit-
toni at dllTpn>nt stn«>|!e*<, 'AM;
syniptonifi. SX"; phnriiiMviiticiil
treutiui-ni, ;ai; bloud It'ttlni;,
8S5; f>|>iAt(M.. *li>; calomel, lR«t;

purgativm. SM; rhabarb, SMI:
ipecai-. 3:t7: uiudcorKivint; t)»«-
€M\ Xi7: Scfiond's pilU. a»;
ailnnlhiiHiflniidiiloKa. XW; stini-
uLintvuiMl loniw in dyoeatery,
S'J»; taveuients. 389; lavviuvnt
ofnitntt«of nilver. XMI; of Ipo-
ca^,. ;B9; dietetic trratiuent.
sail; iiirwttiuiH i-anM-M. 3*); pro-
phylactic nieans, 3-iO; chronin

dy»cnlcr>'. 341
I)y«)ntxfa. 105. 177; treatin«ut by

opiutn, 178
T)ympii|>Ion«, 15

I>yFi|M>[xHJH, by suiH>mbiinilaat all*
uivntatiou, 70

Irregnlarity of menlit. 71

boil quaJity of food. 73

deficient oxyiren. W*

jgiHitnii-iifnt enercwe. 79

menlMl t>itiitti'>ii^ HI

wtunl vX4?«wea. 83

diviHloiie of. 101. 107

from deficiency of gaBtrlc jiiiee.,
104

dyKcnutic ami dyabwiuie. 10S

I*utrid Jy*.pep»ift, III; «yinpt«M [
of put rill i!yni>epsf»»., US; pto-
maines and Mu^iniiuTim, 112,
144; clinical prooewww to eeti-
niate the »iccrfti<>ii of ■fu'trio
juiptf. l!4; H-sts of the acidity
of the 'ffaatriv juice, 11$; troat-
tiientof pulriil dyiqiepsta. )I6; _
tr<!atm«nt by poptin. n»t; ■
aindeaof prvpanttioii, le»t»uii(l
kin<U of iiepHin. 117, 118. ISA;
acid medication 111); eamlvor- M
iHiH plaitli*. Mft; diet in putrid. |
dyBpejJsia, 120; hyiln>t hernial
trmtmont, 131; bii^ulphide of
carbon in. 133. 123; dljcwitlve
fertuentR in treatment of putrid
dyHi»«p»la. 119. ia&. Buo<»l<ly»-
pep»iA. ltj7;HytiiptoitifliUidaaa>
HM, IH7; treatment of IM8; dla*
totic triwtiutfiit. iW; pltariua-
en'iitica] trentineiit. twi; by
dtustAif. 1litK;t>yoxtnietof malt,
IPIN. Inhfttinal dys|N?|K>iu, ltt>i
trvalmvnt of. 191; by paiiori'tt-
tinu. 102. Acid and pitillto;

I

1 mOBac. ^^^^^^^1

^^M djrspefHila, 131: pyrosb.lS'l; oar-

Ellxim, of iMpaIn, tS8, tSO ^^^H

^H dJiUidn, VU. PltuitouH (lypficrt

of ooluiubo, \99 ^^^^^1

^H Bia. 134-l]t». Treatiupiitofaold

of paDcraUJn, IW ^^^^H

^^H ilyKpt'iuiit, Kft; l>y alkalims lit-'t;

vitriolic, fif Mytiftioht. 131 ^^M

^^H by inert powilera, 135; Iiil1iieni>4-

vl»r«nJ. of Hoffman. 14!) [Si(» ^H

^^H of alouliolH ill &«i(l (tytipcipKUi.

Kntvrof.lidiii iii intvvtiiuU m^lasion, ^^M

^^B 137; KlLiiietitary rvKi>ii«» ot, 1^7,

Brifot io ulcer of tli« HtoiuNcIt, S3S ^^M

^^1 laS: milk iliut In plmltoua dys-

Blliitr. preiKimtkins of. 189 ^^M

^^H ]M!|»4H.lU8;liydrothi>riualtts>nt-

Hpray of. In Iivatiuent of vointt- ^^M

^^M iiif It t of. iW. H2, Sprudcl water

Uig. lOtt. 173 ^H

^^H ]ii, 143. Atonio (IVHjietwiji. 144.

Btioliiirical thentpc tttlcR, 2, 106 ^^M

^^H Flat.iilcnr ilyspepHiii, 14A. Dlla-

Eviuii. watvmof. 143 ^^^

^^H tatiuii of the otuiutu-h in at<)iiic

KKcretinv, 2411 ^M

^^H UvHiwiwia. I4K: ca.uiMM of. 141);

Exerciwe, Intluenw of. 7i3; (ryiunas- ^H

^^H syiuptniuaof. 147; vomiting in.

ti<?H. 77, 8.^: Snwlisb |{}-iiiuaa- ^^M

^^H 147. Treuliueiit of lUoaic dys-

tjui. 77. »6i Inuuiuir. 78. tfU ^H

^^M iHt|»!n. 148: by 8tr>'chnla. I4R;

^H

^^H by quaaala, 148; by columbo,

Fat.s their digmtinn, ^H

^^H 14t):*by ubeorbentiio'wtlifns UB;

Fisli, digcetion of. 331 ^^M

^^H by lodoroni), 149. UyBpejiHia

FoodM. IJel>li;'H dliialon of. B5 ^^H

^^H of iiifantfi. ;>07; mitk of rlit- hii-

Kniit^, 44 ^H

^^^^^ loiut ffiiiulf. 3011; lactometer.

^H

^^^^H 217; liow urt»>D Hhoiiitl 11. linby

Oarlaxh. »]K>riai«nt» of. :a)4 ^^M

^^F hs luimed, -JIl; artiRcial lactit-

(iaseB of stoioaeb, IIU ^^|

^^H tiun, •iV2: the niintrnic iMtlh'.

Uaxlnvtuisia. IW; truntuKUit of. ISO; ^^|

^^H 2i:t: »aniii>jil. 214. 333; weaii-

bynuLHHaf^. Ifil; by electricity. ^H

^^^ lii^. £14; hytnenic rulm of th«

151, 10»; by aliuentAtioD, I5S; ^M

^^B newly Wni. £34: cotwclpaClon.

Brovrii'8Lf)niinl'i> metliotl, LS3; ^H

^^B 215: (liurrhcea, 213, cmiil^y-

by lava^«, l&O; by dry diet, ^H

^^B inent of pboaphfttoof lllue, Sir*.

153, IW; by outdoi^r exercise, ^H

^H

154; by hydrotlierapy. lAO. LSS; ^|

^^H Secondary dy>ipf>ptiiiis; 109, Cor-

th«miti1 treiuiiieiit. i^ ^H

^^H dLac dyi*[M!|]r<iu IWl, Hrpitli^

i1iu4trli* Juice, its eMtential compo- ^H

^^H ilyniwiHiiH ItKi. Tabetic dyiiiM>|i'

nmitn. U. 134; ito ntrUI, 12:1; lu ^H

^^H sja. ClilAmtic (ly^|>epeiit. ^V>,

niottr><d priiipiple. A ^^H

^^H Diathetics dyt^jM-jmlti. '^1, Ar-

(iaj^ritie of druiikardf, 13l> ^^|

^^B thritli; dysiiepRia. S«l. Treat-

(■imtroHtoiiiy in cancer of thv Mtom- ^H

^^H montof secondary <ly8(»;pMli^

^H

^^M £01; Etuftrio vertiiiroT '-^Oi. SOS;

Onutlor, on ptonialnnn and leuoo- ^^M

^^H pwudo anifliui pact^rix, 2()'i,

iiiairiM^ 124 ^^

^^V IMS; dyitjMpHia, with roruiliug

tal>Ie of, Indinatiiig tlM> compoei-

^H predouiiuaiit, SOa. SU&

ttoii or difTiiri'iit lueatH, £4

Gavage, 9(i. iii9 ,

Bai- PK Thkdkn, 131

Gfilatinc, it* (U<'toTlc value. 8. IS ^H

Elateritini. :t04

G«>ndrin, antacid (lowdcr or, I4t ^^M

EffK*. 22. 31

G«ntia]i, in aloniedyspopHia, 13fl ^^M

Elvctricity. a« u luuscular purgative

Gvophniritii 10" ^H

Wft

Oentuuidpriii titoiilr dynpepala, 168 ^H

'^ In atonic dyspepsia, lAi

Giaoomim, biKchuKiltoutioiiof iHirgB- ^H

in Irt'MtiJit'iit of vtiiuiliiitc. M7

ivi'«, S68 ^1

iii iifuriMi*9> lit tlioxtoniiu-h. 1.17

Glycerine aa n laxative in iiiirniat ^^|

19) iiitowtintil oc'-hision, Bll

d

pilcK. 340 ^H

^ IMDRx! SBSV

^V Qufco aa an antli«lmlnti«. 878

Irucesta, divLiion of, 3 ^M

^H Goaae. experiment of. S. 10

latflstinul jaice. lll& ^H

^H GoMwUn. hiR divlalon of hemor-

IntaRtine, rruiii it Eli(>rMp4iitti<> xCond- ^|

■ rbotdx. 3H

point. S44: uiuitomy and ]>by-

^H Ompm and (trupe^ <!ure in dynpeii-

HlotoKy of IntMktitiott. 244; iii-

^1 »]». 44, III

t«)^tinai ((InndH. 344; functions ^|
of ii)tmlitut]iMuirona,24S; tuiw- ^M

^B Onyuti on vtMiiEtiiiK <>r urwwia. 173

^M Gj'miutKtk-0 in ruiiHtipatiun, 204

tioii of muciHsiL of larxe iDt««-

^L SvedUb, In dyspepsia. Hti

tlnfi, 247; oxperlmenTal r«-

Ecorrhe* on fuDctiooa of ]n-

^H HjiUA.HKi.itt, In trentuient of hemor-

^■^ tMtiiMM. £4K; lav4Mii«nt)tof nieat

H rhoidx. a^)

^^ broth and miik. S4^; their in-

^H HiLiiiiiMmd, t'lperiineiit hy, 11

^B ffTlcncy. 240; jieptoni led

^H Heuiurrliutdi^. "M^k v^it)\^^^•. 34fi: itiv

lav«iiieut«s '2.V); Iheir nalritive

^^L cbanicul niu#v». S-tfi; active

jKiwvr, 2M; adiitmii>tFutiou of

^^1 caiisLis. 346: diuTlictk- C4U1M-9s.

medicaments, by reelum, MO;

^H S47: Hyiiiplmiiatolog}-. SIT;

iii(i[|(>iiinltiiveniont«. S-KI; mii*-

^H tliurapuutitr iihdicatioiu. 'M^:

ciilar oiHt of inte«tin(>, 304;

^H hyKtcnfc irtwtuieoi. M6; pibar-

niovt>iiiviiit»uf int«Mttn(>. 250; in*

^V niaceutical tn.>»tiiii>nt. 341); pur-

fluenoc of nen'oiu syst«m on.

^H i[iitivit>, 349; huiuaiutflJB, 850;

S91

^V loi'al treatmvtit, it50; by fctntfnl

Iodine, In treatment of x-nmltlii^;, lOH

^H dllntntionof tl]nniiiirt..'t.'il; ^ur-

Iodoform in dy*jK>p«fA, Un

^H iriral treatment. HAS; prttlapeiiti

Il>e(»ruaQhn iudywtntery, !UI; nniu-

^H of thft niitiH. :i.^I; c-n>uiioii fiF

|H>tiiul synip of, 342; ' tiuc^iMS

^^1 bMiiorrhoidR, :{Mt; trentiii<>nt<)(

u(, »4S 1

^^H lirliKtrrbiiidn by iiijrt'lliititi <if

'

^^1 Farlxilic atrid. 3A3; bjr uauteri-

jAi.Ai<, sm

^H xatiitn, :i5'i

compound powder of, 3^8

^H Henninger. bid ntudlt^H nt peptoii<^it.

^K

Kauala. itH tiPuioid«> proprrtiM, 374

^H H«t«ivpiut4dru>. loo. 109, m.

Kareil, outhtiokimuUktriNitiutfUtof

^B Holly. lAli

nlciT of (be Htuuaf b, 331

^M Houey. 3»0-308

Keflr. (see mitk), 2a

Hope, bir dinrrlinrft intstnrc, SSH

KouuiiM. 3S, 38 m
Kiuo. 8»3; ooiupooiid powder of. 3S3 f

II Humrer. iwait of. IM

^K Hiiiiyiuli JiiiioH, 'iKt

KiM)»rig«n, waWn of, in putrid dy»-

^B Uutrbinm>u, on Mit? dlafrioAiH of lu-

pepeia. 189

^H t««tinf(l stmiiuiiliition. S\^

KmuitTli^ (mw Rbatauy). a23

^K HrdroGblorie aeld In dyBpepaia, 1 10,

■ 183

Lactombtkr. 317

^H fiydiotberapy in tmatmnnt of dys-

lAparotomy. in Intestinal ncipluKton,

^H jMpaiA. »i. IfO

818.

^V Tlr^ii^ii^ tbt^rn]wiit!i-n. i

littvaKv* of ll«! Htomiicb, IM): dtworip-

^H Hyiflf^oic ruiv»i fur tbe newly born.

(ion of. 91: difBc-uitlw of. IIS;

H S^

nimiie of. Wt. W: \ifv» of, M. K,

^H Myiteria, vomltliiB of. IM; lavage

TAvemt^nlK of Ipecac in dyf^nlvry. 881>

^H and gitvn^ In, 88, 167

of Miuiir iif tivul ill d\')H>nlt>r}', 83D

^H

»f rikntt<! uf silver In dysentery.

^H IcR and icdd drinks, iutraatmaot of

aav .

^B rouiitinf;, 16S

of KInff Ixwiit XIV. . m ^

^H Inajiitloii, efTecta of, 67

puDitative, SKI ^M

8Rii

vfruKX.

f

LavpuiMitK. prptMiizrd. 2-VS

ena thny pi'iicirate ih« small In-

Lewhart on the nonual pneiition nf

llltfEKlltlHCll, l>Vt

Lvabe, bbi mrthod of dlagnoMUcst'
In^r eanoer of tbe rtciinach, 241

Ljiltrtniiuwl, BtLiirx*, etxpt^rittirvntii

or, 4
I.*.»piin>. 13; t#»l ff>r, l!t
Leven. oxp^ritii^tits of, m, I !, 32, >
Liebix'n fsfnirt of tumt, Ml;

rood, 323
I.iiiKMd 4iil. na a laxntlvr in pfl««, '
Liuubr>cou1c». S6l -, treatment of. by

eakniicl. WU: hy Conleiin uotut,

892: tjy wiitouiiu*. 863

Macvksia. milk uf. 286; Mlalbc'tt
prx'twratiou, 2WJ; cirtT^irptenl
riirateof. S8V

Miilaptii. 105. 177

M'llc frrn, utl of, oa a t»nicid«. 906

Mult. UKPM ot. 168; proparatltitM of.

Mniiim. 21)8 [IM

Manual lule of Tronchin, 201

MrircliniJil. oii ii.ltiKinunlltitw of milk.

KturitHibiul. n-nl^ror 142 [2lff

MiitiMii*"!. oil tlif nctioii of iittttalluT
iiieirvury lii Ititfwtiiuit stnuigii-
iHtKin. 3111

Meat)>. 2:1; n>A5t, ■\^. !}1; (IIkpsMod nf,
■;«; rt-UUvftdlKt-BlililUty of. 24;
Almpn> tnblo, 2(1. l-lnh. iligr-c-
tion of, 3d. R«<K 81 <>y»t<-iv,
83. Utlt8l*'n(..i3. ltHwiii«il.!«l.
Meclif'inn] tapioca prvrrld^, :i<i,
MfHt (NiwtkT, 37. as, 55. Meat
uianiialaclp. W

MedieUie ol >«|K)l«in. 3IH, »)3

MfiBi^in^rou iK>ptoii«e. S

Jtltfrciiriat (ijiitiiK'iit, in tlitttreatuiMit
of tliri'iul woniiK. MI

Merjfbim, l»»

Mii^ro-4iri:iiiii<i:ii(i in (ivriil matterp.
34it. -mt

llUk, itodi^trstion. 7: coiuponitioo. 27;
milk diet, 20; wliey. 21. 38; wliey
onr*, aa. SB; kpttr, '22, !«); koil-
iiilw; 21. 20; milk ill illarrliii-n,
330; milk ilint, iti iilc^r uf llii*
Btomach. 231

Uinural watew of thp V. ft.. 2*1
Bforaiu. Ill)) I'liMirluitwu on purga-

tiVM, 3W
Uorphinv. 106. 173. 189: 3la«endle's
Koltition of, 183; pills of. 182
In IntMtinal oAcluttlnn. Sli
in YotiiHJiiKof Mw. fiokiinu). 1<M.
Mufttanl ttetxl (white), 28S [ITl

Myaiu^iii, in

NKVRO»tKi> of Ihp Htomach. 174

paniialfitH. 17-1

guptruljinf ilyi^i>c[Kiauii<l Kaetral-
gta. 174

tr«iktm«iil by pr»paratlui)B of
iipiuiu. ITS; anfiik*. liR; nrti-
flolal allm^iitalEfm. IW; billi^ni
atiil toiiii?)', IKD; c-hloml. 175;
phlnnif<tnH wjilfir, ITS; ntonllif,
180; electricity. 177; iiwrt pf>w-
dure. 177
Kitrat« of i)ilv«r. in treatmeot of gtuh

tric iik-^r. 238
Xitric- aeid, tu putrlU dyHpepftiR, laS

in tliui-rliuja, 329

OcCI.ri<IOjt, intiutinnl. HOA; pntbOji-
eny of. 30(1, itl4; ayinptoniH.
m)T.»14; di)4mu»iKOfn>iiiw.307.
308, 31A: dioA^nonif) of i>e»t, 806,
nitl; tn-Atriiciil. W3; by pur>ca-
tires. aaS; by iiiei'hanlcvil
itiHtitK, lUlU; by luotallic i»<>rcii-
ry. JtWI; by fdmnl irrl^tion.
am>; by tili-ctririty. SU; hy Iw-
buvco itijectimiit, 310; by iw,
311; by monihiiiic, 812; by Iti-
parotomy, 818
Opium, ill treatment of roiniting, lOS

n«iiroM>« of the »tniuacb, I7n

(linrrboia, HQA

dyftentcry, HUB

ukvr nf tliti xtomach, 28d

caniN>r of the Htuiimoh, SS8

vrinesiif. iwi

linrturr-H of, 181

synipn off IKl

blnrk drops and wlilte ilrriiw. iFid
Oiygvii. im|iortanc« (if. In tUgvfUiou,

SO, 88
(tsyures, trcutriiirnt of. 300

by tavemenu. 301

d

WDKX.

387

p

Oxyiirc-M by glycerine laveniento. 361
b; uierpurittl olntiuertt, 341

I'AMTHRA.t, ftiiictii>ri» f>r, 10

PftnPTofttifl juiee. Hl«

pBiiervutiu, IVi; |>rep&nitioQS of,

lil2. 1B7
PapoiiK'. l-W
PnrHpcplijiie, 8
Parrot, table indicdtinic tbv daily

quantity of milk needed foriii-

tootB, Sii'i
Pattwntrtii'd jHiwder. IBfi. I-H)
pAstiUt-*, I'jttteiwjn'o, for dijirrli<nn.

Pellet iirJiicw, tlwlr valuH hm tiviti-

(KldeK, 3SS. 807
Pepaiii. lie. 133

it* rile in cHgeatiou. (I
th«rup«utiv V(ilti4) of po|»lna, 119
t««t.i for pfliiHlnK, ISA
Peptones. 7. 118. 129; ruitiiiv of. 8;

Mfllin'gi teat for, 7; mitritiro

vuliiL- i)f. 8; CnlilloTi'tt [it^iHoncs.,

12U
Peptouizntioti, rAlv nf thv Flowovii

in, 8, rile of the pancren* in.

9, i>eptuni»Ml lavfimtntn. 2.15
Prptov'ioiittfiibtttAiu-.ett, 41. SO. 00
Peril on fariulizatiuti uf tlif oUiiiiHcli.

im

Phf«pluH*H, calriac, in iufatitile tlwr-

ii[H-iiti('K. 2t'>, Tin
Pathwis, v,.iiiiting of. IftH
Plorr}', hin (livioioiiaof coiidtipattoD.

PIIU yf luurphiiii;, 182, of M««k^'W.
U». nntecltnuu. lUO. iSOi; uf pnti-
(rn-iLtiii, liH, tif Si>g«»u<l, *t3, of
nliH-n. 'ilfH-, of taniiiii and opium,
!ini>: of Kiiiiiiniiic. ;i~t; Rli.-i f '«.,
■SK; Swt^'li (AnderwiirK). ;«>2

Plunibit-rrj". witter of, in ntouio dyn-

|M>pNl». I'lll

Podophylliitit. :M)0

PcMiieicnuintf. itn udt m un anthel-
mintic. WW

PotwUi, bitartmte of, 387; t«rtntt«
ofBodaanil. 2ft7, iiwsof in dy-
wntery, :t-n; sulpluiteof. aK7

Pwtioii of Hivi^irr, 171 [211

Pnttuuuey. iikHueiiit'ornalactHlioii.

Protein and pmieiitaceoiw sulmtaii-
ITIwui*. bitlM. 138 [ee«.

Ptomainett and Ie«<.><>iuitiii4v. S51, 35U
Pufiipkiti Kffdn, tlicir use in the

treatmem of tnnla, :iVi
PurixativM. S74: cU»ilimtiou of.
374; by their pbytiinloKiral ar-
tlon, 275; icaliiie. 273; experi-
ments with. aiB; luterpreta-
tkpii of fiicts, a7ft; Wilts of to-
diutti, 27S; pnrgBtlx-e water of
St, .LVutoine huifpitaJ, 2TB; sul-
phate of Hoda. UIH; chloridw
of wmIIuri, 270; HingnftdA, 3711;
E]woiu salts, '2Vi ; Uorvault'n
experiiiienta. £M0: Ijabordv'K t*X'
]>i-riiiieiitK, St*0; salts of potas-
(duin, 360; RovIii^IIk Milt><. 2M);
purtEAt ive (rulers. Stil ; sudlc kdU
phate waters, 3*11; i;arUba<l,
Marirnbiid, Prauzenbad, S81;
tnat^nesiaQHulphatMwaten.^l;
A]D«-rican mineral wiitere, 2W*;
Bae(-hannepur);atlvea,3IK»i vi^f-
eUibln tioii draxiu', 291; (irastic.
a»S; Illlvuru^ SiiS; hont-y, 2Bt!;
nwwin, 28fi; tamarlndit. *JDI:
pruiii*K, 2U1; ealomol. 203; rliii-
barb. 31)2; podophylluiu. 2^3;
neuniL, 293: Jidap, HU; scain-
mony, 394; (tir[)c>th, SM; eroton
oiU 2V5; mticmular. 2tt5; twllodon-
na,3Ui1: Uyt<seyHmtis,2!yn: stryeh- ^|
nia, 'JIIj: eleetrii'ity; witli loeal H
action. SOS; white tniiittHrd
mmhI*. 2!I<3; oHy purifHtlvvM, 200;
fastnr oil, 21M; therapoOTio ap-
pliI■atioll^ 297
I'yrtwis. i:H

QUA^IA. Iftl. 1S8

t^natemary albniulnnld mattpm. 7

t^ninciM, syrup i»f. In iliiirrhioa, 2t

KAnirs. antacid iwtion of. 141
Ration of work, 73
Raw nifut, iM; Ui dinrrhow, 8S0
lUyinten, 76; excluslvo. fiO; dle1etl«,

fiH, fceurmi hygienic, 7B
Renx-tii^n uf stuinarli, HI
Rhatany I K nuneria triaiidra) In

diarrhii-a. Ul

3S8

INDJCX.

Rhubnrh. MO

In dysRutfiry, S41
Rk'tiet, c*»i)*rliiif ntc ■>(, 4
R<)bi-rts. I'lpi-rinients i»f, ft, 17
KiiiumoliBre, hU luetbed of tlla^ioniii

of cancpr of the xUnunt^h hj"

«xrrvtk>ii »( area, iW

Rijyiit, wiitvr of, H2
Ittiliiiiul. wnt«r«of. 3S1

Bai.NTB NBCTAJRR, w&tvr of, 149
t4aIl])eo, thetr of&oe In nntrJtfoD, 10,

ir, 22

Holivo. U'»; it»ofBw,l(J7
SiLrftinji TentricuJi, ITI

Si-a&ir, luIvaiita^M of, 60

Sra eicktieMi. 1«4. 171

S6a, Germain, hia djriBion of purga-
tivm, i!tf4; his uUtwIQcntiim of
illarrhnia. ;t2»

Sctnmolfv on giuttmlffio dyKpt^pulri, IHI

AeniiH, |>pft[MiratIono of, 802

St'ptirnfiiiin, iiit**tlii«l, WW

Si-liiff, tfj]M*rliuent8 of, on g&strio
juicv, oil ]iO|wiii. "-t, T-l

Soda, blcnrbonate of, in Hi^iil ■ly8|j«>p-
niii, 175; Hiilphld<> of, 137; snl-
pbate of. 3M; oitrntf of. 485:
tnrtrAlo of, 283; phosphate of,
9SS: tnrtrote of antl ]X>Tft'h, 288

ftpnIlnnEani, cxiieriiiiwita of, it

SpHng, hit* (livitiiuri!- of (.'oiiKtlpHtion,

St. Gtr>aic, wjitcr of. U3 [370

St. Irfoii, TiilniTal w»tfrof. itiS

Starffti, cIlKcstlon of, tt, 17

Hteapein, 10

StttveiiK, expipriuienta of. on di(pjB-
tiun, K

8touiiMsti. itt* aaatoniiciU ttxtiirv,
lai, IK*. 154. IflS; nerve* of.
14fi; fnnfltionHHfiiiiiiAonlarooiit,
10^, 144; of uiUL-ouD ooat, I09-,
dUatatlun of. 1441; ruufctilar
d^mnnv'ioouts of. 144

Stinuiiy, on thcopomtioii of jjnotroit-
toriiy. 243

Siippositorie*. 357

mliuativo in pilt*, 857 •

Synip of thebaloa. 181
yellow auiber, 181

Tamar Indfen, 281

TaiitariTKU. 2m

in dyftenlery, 941

Tibiinin in iliurrli(«i. fISO, {dyMrltc of,
330; pillK of, 390: elBctuar>- of.
^30; powdftru of, with opinm,
■xm

TanmtoQtriuiKrr>nuatinnnlp«ptoneii
into alkidoidit, SS8

Tdiie vfomw(Tmrii«l, 3ftS; natnml HIh-
toryof,8U8; tnuifUR^<8undt>viii-
(fidtw, S83,8W; spiriUof turiwu-
tine. 36^: pumpkin bo«1h. 3'A3:
ktMiKM). Sil'i; male fern. idS;
poine^oQate, S(W; pt^llctimuca.
8(M. 3fl7; mode of aduiiiitiil ra-
tion, 8BB; go«(i, SUB; liM»tiiM»Qt
of liotlirit>ot-|)lia]u8, S49

T«i .iritl w>fr«w. 4«. 03

Teetli, their e-volntlon. MS

TbuntpinitiuK kj'Kionitv S: ctLolo^-

Tij«n*> roy«.lp, :W3

Tnbat^RO, influence af. In dynpepsla,

50
TobaMO-ADtoktnfiC in trefttment of

vouiitinic of pnitnmnuy. IIM
TormentiUa. aai
'I'nwt^iiir'ii pnwd«r. 148, I&7
TrldirM-cplmluB honuniit. 380
TrvijxHHjline. l')2
'rrouMWKu.iuiti-Uyupepiic potion of,

lai; pi>wd«rof, 141: on (1li:cNti-

blllty. '1; Ills claBsiAeatkiD of

diittrhwih. ii^H
Trnuwiean and I'idom, their division

(if piirti^IlveH, 283
Typbln. fl
TurpPth. aiKi

Ulcku of the Btiimiii'li. S37; aymp-
totiiB of. 337; ])Iuirniaceuti«al
treatment «jf, 23.^: ititrnte of
utlvcr, 228; perehlorlde of iron.
328: biwuuth. 22tt; chloral. 83*1;
opintfH. tiSS; dl4't4>tin ri'^nieii,
230: 1)L\'t4j;e, Q30; milk treatment
of, S^ll; trmtuionl of the? Iintui-
atemeais, 'i3i; traiUtfuMoo. 333

L'n^entiini popiilouni, 357

L'nni. ((uiuitity of, in uaooer uf utoui-

ni'h. aas

INDKX.

389

Valtuljb conniTentee, S63

V^etarianiam, Baxwell's ol»ei va-
tiona respecting, 74

Vemes, on the stability of calomel,
800

Vemeuil, his gastrostomy, 12

Vertigo, Btomachal, 202. 205

Vichy, waters of, in dyspepsia, 185,
1S9, 140, 158

Villi of intestine, 268

Visceral elixir of Hoffman, 149

Vitriolic elixir of Mynsicht, 131

Voltaire on effects of constipation,
270

Vomitfng, treatmentof, 161; mechan-
ism of. 101, 109; by uterine in-
flaence, 165; general therapeu-
tics of IfS; dietetic treatment
of. 168, 165; iced drinks in, 163;
effervescent mixtures in, 163;
plasters and suppositories in,
168; sodium hyposulphite, 108;
vomiting of sea sickness, 164;
treatment by chloral, 164, 171;
by morphine injections, 164,
171; of pregnancy, 165; treat-
ment by iodine, 165; by alcohol,
165; by ether spray, 166, 172;
by tobacco smoking, 166; by

oxygen inhalations, 166; vom-
iting of hysteria, 166; treatment
by lavage and garage, 167; by
electricity. 1U7, 172; by pro-
longed baths, 167; vomiting of
nrtemia, 168, 173; vomiting of
pulmonary complaints, 168,
178
Vulpian, his experiments on saline
pui^atives, 283; bis conclusinnn
as to the action of purgatives,
284

Watbr, in the genesis of dysenterj-,
839; natural, 40. 64; influence
of on constipation, 263
purgative of Bt. Antoine Hos-
pital, 2-7S

Waters, bitter, their action in consti-
pation, 282
magi:ie8ian sulphate, their eoiu-
posttEon, 282

Wurtz, table of woman's milk, 217

Xasthoprotbic acid. 6
Yves', mode of testing meat powders,
55

Zymogene. 196

A^r^ Beaumetz, G.O-