CHAPTER VI.. On the Proper Regulation of the Bowels.

ON THE PROPER REGULATION OF THE BOWELS.

Functions of the intestines--The action of the bowels bears a natural relation to the kind of diet--Illustrations--And also to the other excretions--Practical conclusions from this--Different causes of inactivity of bowels--Natural aids to intestinal action--General neglect of them--Great importance of regularity of bowels--Bad health from their neglect--Especially at the age of puberty--Natural means preferable to purgatives--Concluding remarks.

Having now taken a general view of the objects, nature, and laws of digestion, and of the structure and mode of action of the various organs concerned in its performance, and made ourselves acquainted with the principles on which our conduct ought to be regulated, so as to second the intentions of Nature for our welfare and happiness, I have only to add a few practical remarks on the proper management of the bowels, and then conclude.

The proper uses of the intestines are, as we have seen, to serve, 1st, for the performance of chylification; 2dly, for the absorption of the nutritive chyle; and, 3dly, as a reservoir for the indigestible residue of the food, and an outlet for both it and the effete matter which requires to be thrown out of the general system. The processes of chylification and absorption having been treated of in a former chapter, it is in the last capacity only we have now to consider the intestinal canal.

Besides the bowels, there are several other channels by which the waste materials of the body pass out. The most important of these are the skin, the lungs, and the kidneys; and in certain circumstances, where the action of the one is impaired or repressed, the natural alliance subsisting among their respective functions, enables the rest to come to its assistance, and even for a time to supply its place. Thus, when, by continued exposure to cold, the exhalation from the skin is much diminished, the blood is thrown in upon the internal organs in larger quantity, and, as a consequence, the urinary secretion and the exhalation from the lungs are both increased, and full relief to the system is temporarily obtained. During hot weather, on the other hand, when the skin is in high action, and perspiration flowing freely, the urinary secretion is greatly lessened. The same principle applies equally to the case of the bowels; and hence the sudden application of cold to the surface of the body, and consequent suppression of perspiration, often increase the intestinal secretions to such an amount as to induce bowel-complaint. On the other hand, the excited action of the bowels by laxatives, tends equally to diminish the activity of the skin; and hence, indeed, one source of the cooling effect of saline purgatives administered in fever and inflammations.

The bowels being thus the outlet of the indigestible portion of the food, and of waste matter from the system, it follows that, in health, their action ought to bear a relation to the kind of aliment used, and to the state of the other excretory functions; and consequently, that what may constitute healthy action at one time, and in one individual, may be very far from presenting the same character at another time, and in a different individual. If, for example, a person be fed chiefly on milk, rice, or farinaceous aliment, which is almost entirely appropriated to the purposes of nutrition, and leaves very little residue, the bowels, having little to throw out, will naturally act seldomer and less fully than when the diet consists chiefly of bulky and innutritious vegetables, which leave a large portion of indigestible matter to be evacuated. Most persons are aware of the difference of effect between the two kinds of diet, but, from not being acquainted with the principle on which it depends, are apt to conclude that, because in the first case the bowels act less, therefore they ought to be assisted by laxatives. The inference, however, is by no means necessarily sound; because the diminished intestinal action consequent on an exclusively farinaceous diet is then the natural and healthy result; and accordingly, where such diet is required, the mere costiveness is attended with no injury to the constitution. The proper conclusion to be drawn from it is, that the permanent and exclusive use of concentrated food is not in harmony with the structure and functions of our digestive and assimilating organs, and that, therefore, instead of continuing their use, and merely resorting to purgatives to excite an action for the removal of a residue which does not exist, reason requires that we should select a diet better adapted to the constitution and laws of the organization by which it is to be acted upon.

The same remark applies to those who are accustomed to dine chiefly on animal food, and rice or bread, without any sufficient admixture of herbaceous or other innutritious substances. If, in such circumstances, the aliment is almost entirely converted into nourishment and absorbed, it follows, as a matter of necessity, that little will remain to be thrown out of the body, and that the bowels will act less than with a different kind of diet. If the state of the constitution at the time be such as to require the exclusive use of this kind of aliment, forced action of the bowels by purgatives will not be needed, because their slowness will be natural and healthy. But if it be not, then the proper remedy is, not to excite the bowels by irritating purgatives, but to remove the cause of the intestinal inactivity by changing the system of diet.

It may be answered to this, that there are many instances in which the stomach is unable to digest any vegetable or innutritious food, and in which, consequently, the diet cannot be altered without injury. I admit that, in the present state of society, cases of this kind are common; but their number would be greatly reduced if a proper mode of life were systematically adopted, and that regard paid to the conditions of health which their intrinsic importance deserves. There are very few individuals who, when in health, and with the aid of a proper regimen, cannot digest aliment suited to the natural constitution of the stomach and bowels; and when such cases do occur, they constitute exceptions to the general rule, and must, of course, be treated either by the use of laxatives, or such other remedies as the circumstances may require.

As the frequency and amount of the intestinal evacuations may thus vary according to the nature of the diet, without necessarily involving any disturbance of health, so may they also vary according to the state of the other excretions; and hence, again, is evident the absurdity of considering the same standard as applicable alike to all persons, times, and circumstances. If, from continued exertion, perspiration is kept unusually active, the excretion from the bowels may be proportionally diminished, not only without injury, but even with advantage to the health; because, if the same waste were to go on by the bowels as before, and the increased exhalation from the skin also to continue, the system would speedily become reduced. In consumption, for example, exhausting bowel-complaint and profuse perspiration are frequently observed to alternate, and whatever remedy is given to check the one generally aggravates the other. But if both were to run their course together, instead of singly, how much more rapidly would the system be undermined!

From this relation between the different excretory functions, it follows, that when sluggishness of the bowels is induced by excess in another excretion, the first step ought to be to remove or diminish the unnatural stimulus which has occasioned that excess, before attempting, by means of purgatives, to force the bowels to act. If the cause which has produced the deviation from the due proportion of the excretion be left unabated, the only effect of strong laxatives will be, not to relieve, but to irritate and weaken.

The mere fact of the bowels not being emptied so frequently as usual, is therefore, when taken by itself, no evidence that they ought to be stimulated by medicine. Before coming to this conclusion, we ought to determine clearly whether the diminished action results from morbid sluggishness of the intestinal canal, or is the natural result of an accidental change of diet, or temporary excess in the other excretions; because the remedy which is appropriate and efficacious in the one case, may be altogether inapplicable to the other. Where it arises entirely from the aliment leaving little residual matter to be thrown out, the health may suffer from the diet being inappropriate, but it will not suffer merely from the diminished action of the bowels. Whereas, when the diet is of the ordinary mixed kind, and the costiveness proceeds from morbid inaction, then general derangement of the system will be induced, unless the bowels be attended to, and their natural action restored. This distinction ought never to be lost sight of.

Judging from the prevalent notions on the subject, from the universal reference of all kinds of bad health to derangement of the stomach and bowels as their source, and from the scarcely less universal use of purgatives as remedial agents, one would be apt to suppose that, to ensure health and long life, nothing more was required than to procure, no matter by what means, an intestinal evacuation regularly every day; and the inference would, to a certain extent, be confirmed by the acknowledged extensive utility of laxative medicines. The real state of the case, however, is not quite so simple; and as it is of importance that it should be understood, I shall attempt to explain it as clearly as I can.

We have seen that inactivity of the intestinal canal may arise from the use of too concentrated aliment, and from excess in the other excretions. In the great majority of cases, however, the cause is very different. In general, the diet is sufficiently varied and abundant, and the balance of functions sufficiently equal to leave a considerable quantity of alimentary residue and effete matter to be thrown out by the bowels; and if it is not regularly expelled, some obstacle of a different kind must exist, which, in the first place, ought to be removed, before we can expect to succeed in restoring the natural action. To learn what that obstacle is, let us turn our attention for a moment to the natural means by which the intestinal evacuations are effected.

The progress of the intestinal contents along their canal depends, first, on their affording the necessary stimulus to excite the contraction of the muscular coat; secondly, on the assistance derived from the free action of the abdominal and respiratory muscles, not only during respiration, but during every kind of bodily exercise; and, thirdly, on the inner surface of the intestine being duly lubricated with the mucous secretion. If any or all of these conditions be unfulfilled, the inevitable result will be morbid sluggishness of the intestinal action, and the various consequences dependent on it; and hence, when the evil exists, the first point to be determined is the nature of the cause by which it is produced.

As already remarked, farinaceous and other concentrated aliments do not afford the requisite stimulus to the muscular fibres of the intestine; because they are in a great measure absorbed, and leave little to be thrown out. If, therefore, concentrated food be the cause of costiveness, the proper remedy is to alter the diet, and to have recourse to other means only where that proves insufficient. If, again, the inactivity of the bowels proceeds from the food not being sufficiently digested, and from their contents being on this account inadequate to excite them to healthy and regular action, it follows as a necessary consequence, that before we can expect to obtain intestinal regularity, digestion must be improved by steady perseverance in a proper regimen, and such other means as may be required to restore the tone of the stomach. It is in cases of this description that the practitioner is most frequently consulted. If he and the patient are satisfied with simply procuring relief, he has ready means at hand in any of the ordinary purgatives. But if a cure is their object, they must go back to the root of the evil, and begin by restoring the digestive organs to health as the first step towards permanent success.

The observance of a proper adaptation between the quantity of the food and the state of the digestive organs and mode of life, is then not less essential to the proper action of the bowels than to that of the stomach. If we eat more than the system requires, the bowels become oppressed and weakened by their load; and it is in such circumstances that purgatives afford immediate relief by the removal of the superfluity, and, by blinding the individual to the real nature of the evil, tempt him to recur too frequently to the use of medicine.

Where, however, as most frequently happens, the constipation arises chiefly from the absence of all assistance from the abdominal and respiratory muscles, and in part only from an inappropriate diet, the first step to be taken is again to solicit the aid of the former--first, by removing all impediments to free respiration, such as stays, waistbands, and belts; and, secondly, by resorting to such active exercises as shall call the muscles into full and regular action: and the next is to proportion the quantity of food to the wants of the system, and to the condition of the digestive organs. If we employ these means systematically and perseveringly, we shall rarely fail in at last restoring the healthy action of the bowels with little aid from medicine. But if we set these natural conditions at defiance, we may go on for years, adding pill to pill and dose to dose, without ever attaining the end at which we aim.

How, indeed, can it be otherwise? If the Creator has so constituted us that the free play of the lungs and muscles is indispensable to proper intestinal action, it is in vain for us to struggle against the arrangement, and expect to substitute beneficially the stimulus of purgatives for that of the natural play of the muscles. Either we must give up our own obstinate adherence to sedentary pursuits and conform to the divine laws, or we must submit to the punishment inseparable from disobedience, and merely endeavour to mitigate its severity by such partial remedies as lie within our reach.

Where bodily weakness, or any other cause, absolutely prevents us from engaging in active bodily exertion, corresponding moderation in eating, and continued kneading and rubbing over the region of the bowels, when used daily and persevered in till the strength is restored, are of great service in promoting their healthy action. Where great sluggishness of the bowels exists, and no exercise can be taken, the rubbing generally requires to be continued for an hour or more daily, or even twice a-day.

Sometimes intestinal inaction proceeds from defective mucous secretion on the surface of the internal coat, caused either by errors in diet or by local irritation. When costiveness is excited in this way, a mild diluent regimen will generally remove it. It is in such cases that saline medicines, which act by increasing the mucous secretions, are often very useful; while aloetic and other stimulant purgatives increase the evil by aggravating the irritation.

Such being the mode of action of the bowels, and such the natural agents by which it is carried on, we can now appreciate the folly of seeking to apply the same remedy to every kind of costiveness, no matter from what cause it proceeds. If a clerk who sits motionless all day in an office, who indulges his appetite, and has no bodily exercise to facilitate respiration and give a natural impetus to the bowels, begins after a time to complain of constipation, it is not difficult to tell what is required for his cure. The first step which a knowledge of the animal functions would suggest, is to diminish the food to such a quantity as the stomach can digest; the next, to use such a diet as is calculated to excite the muscular coat of the intestine to healthy activity; the third, to seek the natural aid arising from exercise of the abdominal and respiratory muscles; and the last of all, to have recourse, when necessary, to such medicines as may be required for a time to restore the tone of the bowels, and enable them to act without further assistance. The course usually adopted, however, is widely different from that here described. From ignorance of the laws of organization, the patient is not aware of the extent to which he infringes them in his conduct, and consequently rests satisfied with lamenting his hard fate in possessing such a bad constitution, and resorting to strong medicines to force that action which he feels to be essential to health, but which he will not consent to elicit by the means with which Nature has furnished him.

Among the middle and higher classes, very many females act on the same erroneous plan, and with equally unfortunate results. In them the evil is aggravated by the tightness of their clothing impeding almost entirely the descent of the diaphragm, and the free play of the abdominal muscles, in respiration.

From this view of the nature and causes of costiveness, it will be evident, that, as a general rule, the bowels are perfectly competent to the discharge of their functions, when the conditions essential for their healthy action are duly fulfilled. And hence, whenever they become morbidly inactive, we may rest assured that, in some point or other, our own management is or has been defective; and the surest way to remedy the evil is, not to have instant recourse to medicine, but to begin by discovering and amending the defect. In the rare occurrence of constipation among children and other actively employed persons, we have ample proof of the fundamental principle that the bowels do not naturally stand in need of the stimulus of medicine, but require only to be properly treated to fit them for the office with which they are charged.

While, then, I entirely agree with public opinion in attaching great importance to the proper regulation of the bowels, and in tracing much suffering to their neglect, I am only the more anxious that we should, as far as possible, follow Nature in our arrangements, and reap the benefit of her aid. If we do so, we shall not only be less frequently obliged to have recourse to medicine, but, by our knowledge of the causes of the deficient action, be greatly assisted in our selection of an appropriate kind of laxative, and thus avoid forcing the constitution too far. It sometimes happens, for example, that, from debility of the muscular coat, the peristaltic motion is insufficient to propel the contents of the intestines, even with the aid of proper diet and exercise. In such cases, small doses of aloes or rhubarb, or other laxatives, which act chiefly by exciting the muscular contraction, will be sufficient to clear the bowels, especially when any mild tonic is conjoined with them; while saline laxatives which act chiefly on the mucous coat, may be given freely, and even cause numerous watery evacuations, and yet the real or solid contents of the intestines continue unremoved. In practice this often happens; and hence the frequent mistake of supposing that there is proper passage from the bowels, when in reality there is no such thing.

The period of life at which intestinal inactivity is attended with the most serious consequences, is at and for a few years after puberty. At that age a sudden change is often made from the restless activity of youth to all the stillness of a sedentary profession, without any corresponding alteration being made in the quantity of food consumed. The vigorous appetite, which is perfectly natural during a period of growth and great bodily activity, remains at first unimpaired, and impels the individual to eat an amount of food far beyond the present necessities of the system or the powers of digestion. The consequence is a tendency, not only to fulness from excessive nutrition, but to severe digestive disorder from the stomach and intestines being weakened both by want of exercise and by excess of food. I have known many instances of dyspepsia, constipation, and mental affection, and even of active inflammation, thus produced. In one case, four years of continued bad health in an otherwise sound constitution were the penalty inflicted before the real cause was accidentally discovered. During all that time, too, temporary relief invariably followed the use of purgatives, and seemed in some measure to point to the truth; but from the mind never having been directed to the principles, its practical bearing was overlooked, and now the individual wonders that the cause did not, even at first sight, arrest the attention of his medical advisers.

In cases of this description, however, it ought to be observed, it is not the mere constipation which injures the health and requires to be removed. It is in reality to the mode of life which induces it that we ought to direct our attention; for, unless that be amended, all our efforts to preserve the health by merely removing the effect will prove insufficient.

In the natural and healthy state, under a proper system of diet, and with sufficient exercise, the bowels are relieved regularly once every day. In some constitutions, however, the ordinary period is shorter or longer than this--twice a-day, or only once in two days; but such differences are unimportant when they do not proceed from morbid causes, or in any way disturb the health. Habit, in this as in other operations under the influence of the nervous system, is powerful in modifying the result, and in sustaining healthy action when once fairly established. Hence the obvious advantage of observing as much regularity in relieving the system as in taking our meals, and the impropriety of attempting to break through the habit when once formed. Sleep seems to be favourable to the progress of nutrition, and it is apparently during the night that the assimilation of the daily food is completed, and its residue prepared for being expelled along with the other excretions. Hence there is a natural tendency in the bowels to act in the morning, and we ought therefore to encourage it by a voluntary effort. Even the reception of breakfast into the stomach seems to act as a stimulus to intestinal contraction, and in consequence many persons experience the inclination immediately after their morning repast, and suffer if they are prevented from yielding to it.

Where, either from constitutional weakness, sedentary occupation, or other unavoidable causes, the bowels are unable to act sufficiently to relieve the system without assistance, we have, of course, no choice but to select that which is most suitable to the circumstances and most gentle in its operation; because, if assistance be not afforded, the health will assuredly suffer. Numerous examples of this kind are met with every day; and, when treating them, we should always be careful to aid Nature as far as possible by an appropriate diet and regimen, and not trust to medicine alone for rectifying the consequences of the patient’s misconduct. We ought, in short, never to lose sight of the great truth, that, if the bowels were originally constituted by the Creator with power to act sufficiently on the application of their own stimulus, food, there must necessarily be a wide departure from His laws in some part of our conduct to cause the loss of that power; and therefore, whenever we find the bowels unable to act without medicine, our first business ought to be to discover and rectify the error into which we have fallen,--and recourse should be had to medicine only in so far as it shall be necessary to remedy the consequences which the transgression has brought upon us.

As the sole object of the present volume is to make the reader acquainted with the natural laws of the animal economy, and with the means by which aberrations from them may be prevented and health preserved, I shall not enter at all upon the discussion either of the morbid conditions of the bowels, or of the remedies by which these may be cured--and consequently shall say nothing farther of the use of purgative or other medicines. The consideration of these matters is not only foreign to the subject, but would require an extent of detail much beyond my present limits.

Perhaps some persons may think, that, before concluding, I ought to apologize for having introduced to the notice of the general reader such topics as those discussed in this and some of the former chapters. In doing so, I have been actuated by a deep sense of the misery arising from the prevailing ignorance on topics which, although in themselves as interesting and important as any to which the human mind can be directed, have nevertheless been passed over in silence, partly from not the least suspicion being generally entertained of their real bearing on our health and happiness, and partly also from false notions of delicacy diverting attention from their calm and deliberate examination. In endeavouring, therefore, to unfold what I conceive to be useful truths, in the language of reason, I confess that I feel no apprehension that any well-constituted mind will receive contamination from the perusal of what is contained in these pages.

INDEX.

Abercrombie, Dr, quoted on intemperate eating, 225, 282.

Absorbents of the bowels, 163.

Absorption most active before breakfast, 195. Rapid absorption of liquids from the stomach, 38, 79, 117, 140, 195.

Acids, in what cases they promote digestion, 104. Acidity of stomach, 283.

Ages, different, require different kinds of food, 255.

Americans intemperate and rapid eaters, 223, 294.

Animal food more digestible and nutritious than vegetable, 118, 138, 281, 283. Cause of its greater digestibility, 140. Also more stimulating, 141. Why apparently more binding, 183. Improper for infants, 264.

Anxiety impedes digestion, 300.

Aorta, 170.

Appetite, its necessity as a warning that nutriment is required, 10, 11. Susceptible of being trained, 32. Not to be relied on when morbid, 34. See Hunger. Thirst.

Arrowroot, 125, 138.

Barras quoted on the sensibility of the stomach, 85.

Bathing improper immediately after meals, 295.

Beaumont, Dr, his view of the exciting cause of hunger, 18. Quoted on mastication, 53. His observations on the stomach of a patient named St Martin, quoted, 73, 78, 88, 106, 112, 128, 133, et seq., 283, 285, 289, 308, 319. Makes little pretension to the honour of discovery, 108, 147. Summary of inferences drawn from his experiments, 147. Quoted on the quantity of food proper to be eaten, 219.

Bile secreted by the liver, 173. Account of it, 174. Not found in the stomach during health, 175. Its presence there facilitates the digestion of fat and oily food, 285.

Birds, gizzards of granivorous, 50, 71.

Blaine quoted on hunger, 20.

Bladder, 170.

Blood circulated in the stomach increased by its action, 77, 289. Breathing necessary for the conversion of chyle into blood, 168. Fulness of blood, 240. Bloodletting improper immediately after meals, 295.

Bloodvessels of the stomach, 76.

Boarding-schools, time for breakfast and dinner in, 193, 201, 205. Insufficient food often given there, 250, 277.

Bowels described, 154. Their different coats-- the peritoneal, 156; muscular, 158; and mucous, 160. Action of purgatives on the, 158, 162. Contain air, 160. Their sympathy with the skin, 161. Excretion and absorption of the, 161. Conditions essential to their perfect action, 169. Their vermicular or peristaltic motion, 158, 179, 330. Their nerves, 169. Why most open when vegetable food is used, 183, 326. Do not naturally require the aid of laxatives, 238. Their uses, 324; as an outlet of waste matter, 325. Their action bears a relation to the kind of food, 326. Causes of their inactivity considered, 330. Natural aids to their action, 159, 330. General neglect of these, 331. Bad health thence arising, 332. Their regularity important, 337.

Bowel-complaint frequently produced by chill of the skin, 162, 325.

Brachet, his experiments shewing that hunger is an affection of the brain, 14. Quoted on hunger, 20.

Brain the seat of the sensations of hunger and thirst, 12. Should not be overtasked in childhood, 271. Influence of its state upon digestion, 296, et seq.

Breakfast, proper time for, 193. Labour before it improper without refreshment, 193. Diseases easily caught before breakfast, 194. Reading newspapers during it improper, 52. Liquid food necessary, 307.

Brigham, Dr, referred to, 271.

Caldwell, Dr, quoted on intemperate eating in America, 223; on the influence of the state of the brain as a source of indigestion, 301.

Carnivorous animals have small organs of digestion, 68, 140, 145. Their existence necessary, 98. Their gastric juice, 102.

Carsewell, Prof., on softening and erosion of the dead stomach by the gastric juice, 99, note.

Cassius, his leanness as described by Shakspeare, 300.

Cheerfulness promotes digestion, 126, 297.

Chewing, 40. See Mastication.

Chicken, 286.

Children, great importance of regulating their diet properly, 204, 232. Prevalent error of over-feeding them, 233, 273. Suffer also from deficiency of food, 249. Animal diet not to be given them too early, 264. Impropriety of tasking and confining them too much at school, 269. Dull children often become talented men, 270. Whether they ought to be allowed wine, 315.

Cholera, loss of the fluid parts of the body in, 38, 162, 305.

Chyle, 62. Its composition the same, from whatever food derived, 58. Chylification described, 152. This subject rather obscure, 153. Chyle converted into blood in the lungs, 167.

Chyme, 62, 127.

Clark, Dr, on the great importance of the proper regulation of diet in youth, 266, 267, 276.

Clarke, Adam, a dunce at school, 270.

Climate ought to modify food, 143. Appetite in warm climates, 28.

Coagulation of milk and albumen by gastric juice, 100, 116.

Cœcum, 178.

Coffee, 209, 307, 312.

Colon described, 178.

Condiments, 150.

Constitution, food ought to vary according to, 252. Susceptible of being greatly modified by regimen, 279.

Consumption, pulmonary, how productive of leanness of the body, 167. Often the result of mismanagement of diet in childhood, 266, 276.

Cornaro, 226.

Costiveness, causes of, 159, 239, 326. How removable, 329.

Cumberland, Richard, beneficial effects of his temperate habits, 299.

Deffand, Madame de, quoted, 19.

Deglutition of food, 55.

Diet. See Food. Meals.

Dietetics, principles of, viewed in relation to the laws of digestion, 187.

Digestion vigorous and rapid in proportion to the quantity of nourishment required by the body, 22. Organs of, described, 58, et seq. Its wonderful power of reducing the most opposite varieties of food to the same substance, 58. Nervous energy essential to, 83, 296. Different theories of, 109. Is a chemico-vital process, 111. Conditions requisite for it-- 1. A sufficiency of gastric juice, 112; 2. A temperature of 98° or 100°, 119; and, 3. Gentle agitation of the contents of the stomach, 121. Aided by laughter and cheerfulness, 126. Ill performed when previous meal remains in stomach, 129. Comparative digestibility of different kinds of food, 133. Time required for digestion of the same article different in different states of the body, 136. Animal food more digestible than vegetable, 118, 138, 281, 283; and why, 140. A proper selection of food not the only requisite of good digestion, 188. Is the temperature of the stomach raised during digestion? 146. Vegetable food partly digested in the intestines, 180. Vigorous in youth, 272. Retarded by bodily or mental exertion immediately before or after eating, 288, et seq. Intellectual vivacity diminished while digestion is going on, 290, 296. Influence of the mind upon digestion, 296, et seq.

Dinner, proper time for, 199. Necessity of early dinner-hours for children, 204. Fashionable late dinner-hours, 207. Relaxation necessary after dinner, 208. Time for dinner ought to vary with circumstances, 209. Second courses, 226. Drams at, 323.

Dressmakers, an improvement in the regulation of their establishments suggested, 230.

Drink necessary to supply the waste of the liquid portions of the body, 36. Bad effects when withheld, 37. Absorbed directly from the stomach into the system, 38, 79, 117, 140, 195. Temperature of drinks considered, 308. Water as a drink, 314. Wine and other fermented liquors, 314. Spirits hurtful, 316. Sudden changes of its temperature hurtful to the teeth, 45. See Liquid. Thirst.

Dunglison’s Elements of Hygiene quoted and recommended, 305, 311.

Duodenum, 62, 170.

Eating ought not to be too rapid, 51, 122. Times of, 188. Eating too much, a prolific source of disease, 24, 219. Conditions to be observed before and after eating, 273. See Food. Meals.

Epiglottis, 55.

Excrement, 153, 178.

Excretion of waste matter into the bowels, 161.

Exercise renders appetite keen, 19, 21, et seq. Prevents costiveness, 180, 332. Improper immediately before and after meals, 288.

Farinaceous food, 118, 138, 284.

Fat and oily food, 281, 285.

Fermentation and digestion different processes, 110.

Fermented liquors, 314.

Fever, loss of appetite during it a wise arrangement, 31, 107.

Fish, 286.

Fluids. See Drink. Liquid. Thirst.

Follicles of the stomach, 77.

Food necessary to supply waste of the substance of living beings, 5. Requisite quantity varies according to circumstances, 6, et seq. Warning given by hunger when food is required, 10, 11, 19, 218. Most necessary during growth, 22, 315; and when the life is active, 23, et seq. Error of eating too much, 24, et seq., 219. Thirst varies in intensity according to the kind of food, 37. Mastication, 40, insalivation, 49, and deglutition of food, 55. Its quality modifies the amount of saliva secreted, 53. The most opposite kinds of food reduced by digestion to the same substance, 58. Different stages through which food passes between its reception into the stomach and its assimilation, 61. Size of the stomach varies according to its quality, 67. Advantages of our want of consciousness of its presence in the stomach, 85. Sudden and extreme changes of diet injurious; and why, 103. Ought not to be rapidly swallowed, 51, 122. Thoroughly mixed with the gastric juice in the stomach, 124. Concentrated food, why digested with difficulty, 125, 142, 326. Ought not to be taken till previous meal is digested, 129. Comparative digestibility of different kinds of, 133. Animal food more digestible and nutritious than vegetable, 118, 138, 281, 283; and why, 141. Farinaceous food, 118, 138, 284. Soup, 117, 125, 139, 281, 312. Changes of food in the bowels, 152. Injection of food into the bowels, 164. Times of eating, 188. Quantity to be eaten, 218. Bad effects of eating too much, 222. Are mixtures of food hurtful?, 226. Food of children, 204, 232. Food of the poor too scanty, 247. Errors of over-feeding and underfeeding children, 234, 249, 259, 273. Proper food of man, 251. Different kinds of food suitable in different climates, 143; for different constitutions, 252; and at different ages, 255. Sensations after eating furnish a valuable guide, 280. Food of invalids, 286.

French meals, 210. See Meals. Eating.

Gall-bladder, 174. Gall-stones, 175.

Game, 286.

Gastric juice, 61, 87. Secreted only when there is food in the stomach, 93. Its chemical composition, 96. Acts only upon dead inorganic substances, 97. Its power of coagulating milk and albumen, 100, 116. Its antiseptic quality, 100, 117. Adapted in different animals to the nature of the food, 101. Modified in the same individual according to the wants of the system, 104. On which of its elements does its solvent power depend?, 112. The amount secreted always in proportion to the quantity of aliment required by the body, 105, 220. Its secretion retarded by disagreeable mental emotions and feverishness, 106, 322. Indispensable to digestion, 112. Thoroughly mixed with the food in the stomach, 124. Adaptation of food to its qualities in different individuals, 141. Quantity secreted at each meal, 289. Time occupied by its secretion, 295.

Gizzard of granivorous birds, 50, 71.

Grief enfeebles digestion, 126, 297.

Growth, periods of, require an increased supply of food in vegetables, 8; and animals, 9, 22, 221. Diet during, 315.

Gullet, 55.

Head, Sir Francis, quoted on the quantities of cold water drunk at the brunnens of Nassau, 196; and on the prejudicial effects of intemperate eating, 222.

Heidler, case quoted from, 229.

Herbivorous animals have large organs of digestion, 68, 140, 145. Their gastric juice, 102. The digestion of their food partly effected in the intestines, 180.

Hippocrates, his theory of digestion, 109.

Horse, should not have diet suddenly changed, 103. Digestion of the, 181. Is not fed immediately before or after a journey, 293. May sometimes drink a little though perspiring, 313.

Hufeland quoted on the beneficial influence of laughter in aiding digestion, 127.

Hunger, necessity of the sense of, as a warning that food is required, 10, 218. An affection of the brain, 12. Allayed by narcotics, 14, 15. Influenced by mental emotions, 16. By what condition of the stomach is it excited?, 17. Felt keenly when the body is in need of repair, 19, et seq. Sharpened by muscular exercise, 19, 21. Its absence during fever a wise arrangement, 31. Susceptible of being trained, 32. Error of confounding it with taste, 33. Morbid cravings of hunger when food is not required, 34. Instances of extraordinary voracity, 35. Periodicity of, 189. Does not return till stomach has been for some time empty, 190.

Hydra, stomach of the, 63.

Ices and ice-creams hurtful after a meal, 309. Ice useful in warm weather when used with caution, 311. Examples in Italy and Virginia, 311.

Ileum, 177.

Indigestion, why prevalent among sedentary persons, 29, 301. Injures the teeth, 47. Often beneficial in warding off more serious diseases, 245. Caused by grief, anxiety, and over-study, 126, 297.

Infants, food proper for, as indicated by the state of their teeth, 45. Diet of, 232, 256. Prevalent errors in the treatment of, 233. Proper time for weaning them, 263. See Children.

Infection, why most easily caught before breakfast, 194.

Injection of food into the bowels, 164.

Insalivation of food, 49.

Intemperate eating a prevalent cause of disease, 222. Drinking, 319.

Intestines described, 154. See Bowels.

Jejunum, 177.

Jelly, 125.

Kitchiner, Dr, quoted on digestion, 120, 190.

Lacteals, 62, 163.

La Trappe, diet of the monks of, 191.

Laughter aids digestion, 127, 297.

Laxatives, 158, 238, 326.

Lent, rapid recovery of the sick in Catholic countries during it, 222.

Liquid food, 79, 117, 139, 281, 304. Too cold or hot injurious, 308, 312. Different kinds in use, 314.

Literary men, indigestion of, 209, 297.

Liver, its function, 173.

Londe, Dr, quoted on the digestion of vegetables, 182. On the diet of infants, 235.

Luncheon, 203.

Lungs, how wasting of the body is produced by their disease, 167. See Consumption.

Lymphatics, 164.

Mastication, process of, described, 40. Its apparatus various in different animals according to the nature of their food, 50. Bad effects when mastication is incomplete, 51. Purpose of, 53.

Meals, at what times and after what intervals they ought to be taken, 187, et seq. Relaxation necessary after them, 208. Principles on which their times and number ought to be fixed, 213. Conduct proper before and after meals, 288. Inaptitude for bodily and mental exertion after them, 290. Rest and tranquillity then necessary, 291. Whether drink is proper during meals, 306. French Meals, 210. See Food. Eating.

Meconium, 238.

Menstruation ceases during pregnancy and suckling, 262.

Mesenteric glands, 166.

Mesentery, 157.

Mesocolon, 158.

Milk, coagulated in the stomach by the gastric juice, 100, 116. Digested with ease, 139. The natural food of infants, 237, 256. Causes of its vitiation in mothers, 259.

Milliners, an improvement in the management of their establishments suggested, 230.

Mind, its influence on appetite for food, 16. Deteriorated by defective nutrition, 249. Its efficiency depends on the health of the body, 106, 126. Ought to rest during digestion, 291. Its influence on digestion, 296, et seq.

Mirth promotes digestion, 126, 297.

Mixtures of food, whether prejudicial, 226.

Montègre’s opinion of the use of the saliva, 54, 99.

Morning, exposure before breakfast often dangerous, 194. Vigour of the system then least, 198.

Mortality of children, 233. Mortality greatest among the poor, 248.

Mothers generally ignorant of the rational mode of treating children, 232. Their duties in relation to suckling, 258.

Mucous or villous coat of the stomach, 74; and intestines, 160, 172.

Muscular coat of the stomach, 72; and intestines, 158. Muscular exercise. See Exercise.

Mutilation of animals, unsatisfactory nature of experiments so made, 82.

Napoleon not a bright schoolboy, 270.

Narcotics allay hunger, 14, 15.

Nerves of the stomach, 21, 79. Of the bowels, 169.

Nervous energy essential to digestion, 83, 296.

Newton, Sir Isaac, a dull schoolboy, 270.

Nursing of children, 233, et seq. 256. Nurses ought not to be overfed, 260.

Nutrition required to repair waste of substance in living beings, 5. See Food.

Œsophagus, 55.

Operatives ought not to resume work immediately after meals, 298.

Opium allays hunger, 15.

Pancreas, and pancreatic juice, 62, 176.

Paris, Dr, an opinion of his controverted, 137.

Pastry not easily digestible, 285.

Periodicity of appetite, 189.

Peristaltic motion of the bowels, 158, 179, 330.

Peritoneum, 72, 156.

Perspiration affects the other secretions, 325.

Philip, Dr Wilson, an opinion of his controverted, 128.

Pneumogastric nerve, 80.

Poor have larger stomachs than the rich, 67. Their food too scanty and innutritious, 247. Their minds thereby deteriorated, 249.

Precocity of talent little to be desired, 270.

Purgatives, their mode of action, 158, 162. Not required by nature, 238. When improper, 329.

Putrefaction, digestion different from, 110.

Pylorus, 67. Allows only digested food to issue from the stomach, 132.

Quantity of food proper to be eaten, 218.

Rapid eating improper, 51, 122.

Reading during meals improper, 52.

Rectum, 179.

Respiration, use of, 63. Digestion aided by, 126, 180. Necessary for the conversion of chyle into blood, 168. Aids the action of the bowels, 332.

Rice, 118, 138, 284.

Roget, Dr, quoted on nutrition, 26; on varieties of food, 59.

Rumination of animals, 42, 50. Stomach of ruminants described, 69.

Sago, 138, 284.

Saliva, secretion and purpose of, 49. Its amount greatest when food spicy, 53. Different in quality from gastric juice, 99.

Salt meat, how productive of thirst, 37.

Sanguification, 63, 167.

Satiety, 220.

Schools, children too much confined and tasked in, 269. See Boarding Schools.

Scrofula frequently the result of a penurious diet, 250, 278; also of too exciting food, 276.

Sedentary habits, how productive of indigestion, 24, 301; and costiveness, 159, 180, 332. Less food required by sedentary than by active persons, 228, 299.

Sheridan a dunce at school, 270.

Siesta, 295.

Skin, its sympathy with the bowels, 161, 325.

Smith, Dr Southwood, quoted, 185, 248.

Soldiers, private, why inferior in strength and health to officers, 248. Ought not to eat immediately after a march, 293.

Soup, digestion of, 117, 125, 139, 281, 312.

Spirits, their indiscriminate use hurtful, 316.

Spittle, 49. See Saliva.

Spleen, 170.

St Martin, Alexis, remarkable case of, 88. Suggestion as to farther observations on, 92, note. See Beaumont.

Stays injure the action of the bowels, 159, 180, 333.

Stomach, peculiar to animals, 6. By what state of it is hunger excited?, 17. Its sympathy with the rest of the body, 18, et seq. Described, 63, et seq. Stomach in the lowest class of animals, 63. In man, 65. Various in size, according to quantity and quality of food, 67. Stomach of ruminating animals described, 68. Coats of the stomach--external, 72; muscular, 72; and mucous or villous, 74. Its muscular action, 73. Its bloodvessels and follicles, 76. Its sanguineous circulation increased during digestion, 78. Its power of absorbing fluids, 38, 79, 117, 140, 195. Its nerves, 21, 79. Contracts when each morsel is introduced, 122. Its motion during digestion, 124. Is its temperature then increased?, 146. Contains no bile in the healthy state, 175. Sensibility of the, a sign of disease, 85. Numerous diseases unjustly laid to its charge, 241.

Study before breakfast, 193, 196. After meals, 297. See Literary Men.

Suckling of infants, 233, 256.

Supper, in what cases proper, 211.

Swallowing, process of, 55.

Sympathetic nerve, 84.

Tartar on the teeth, 46.

Tasso, his genius precocious, 270.

Taste, error of confounding it with appetite, 33. Its gratification proper, 51.

Tea, 209, 307, 312.

Teeth described, 43. Modified in different animals to suit their habits of life, 42. Milk-teeth, 44. Changes of the condition of the teeth indicate the propriety of certain kinds of diet, 45, 256. Necessity of keeping them clean, 46. Impaired by indigestion, 47. Sudden changes of temperature hurtful to them, 48.

Temperaments, different, require different kinds and quantities of food, 252. May be greatly modified by regimen, 279.

Temperance in eating may be carried too far, 250. Temperance Societies, 319.

Temperature necessary for digestion, 119. Whether that of the stomach is thereby increased, 146. That of drinks considered, 308.

Thinking, intense, impedes digestion, 296.

Thirst necessary as a warning when drink is required by the system, 10, 36, 304. Nature of, 12, 36. Greatest when body in need of liquid nourishment, 36. Varies in intensity according to nature of the food, 37. Consequences of its craving not being gratified, 37. See Drink.

Thoracic duct, 62, 166.

Time in which the digestion of an article is effected varies with circumstances, 136. Times of eating, 188.

Tobacco allays hunger, 15.

Tooth-powders, 46.

Travelling before breakfast frequently improper, 106. Diet in travelling, 216.

Trituration, digestion not effected by, 110.

Vegetables, continual waste of their substance, 3. How repaired, 5. Quantity of nourishment requisite for them varies with circumstances, 7. Principle of forcing their growth, 8.

Vegetable food less digestible than animal, 118, 138, 281, 283; and why, 140. Also less nutritious, 139. Its digestion effected to some extent in the intestines, 181. Why more laxative than animal food, 183, 326.

Venison, 286.

Vermicular motion of the bowels, 158, 179, 330.

Villous or mucous coat of the stomach, 75; and bowels, 160.

Vomiting, inverted action of the gullet and bowels in, 57, 158. Vomiting of bile, 175.

Voracity, remarkable instances of, 35.

Waste universally the attendant of action, 1. Food the means of repairing it in living beings, 5. See Food. Waste matter excreted into the bowels, 161, 325.

Water safe as a drink, 314. Cold spring-water dangerous when person overheated, 308.

Water-brash, 77.

Weaning of infants, proper time for, 263.

Wine, how productive of thirst, 37. Circumstances in which its use is proper and improper, 314. Preferable to spirits, 318.

Worms in the bowels, 163.

Youth, appetite keen and digestion vigorous in, 22. Importance of properly regulating the times of eating in youth, 204. Supper frequently necessary, 212. Importance of attending to the development of the body in youth, 271. Period of transition from youth to manhood a critical season, 231. Diseases of the stomach and bowels why then common, 335. See Children. Infancy. Mothers.

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MENTAL DERANGEMENT, &c.

By ANDREW COMBE, M. D.

In the above work, dedicated to the elucidation of the Causes, Symptoms, Nature, and Treatment of the various Morbid States of the Brain and Nervous System which are productive of Insanity, the Author has endeavoured to apply the same pathological principles by which we are guided in our investigations into diseases of the other bodily organs, and to point out the analogy which subsists between many of these and the less familiar affections of the nervous system.

Dr Combe’s “work upon insanity is short, and sound, and modest, like all that gentleman’s writings, and richly deserving the perusal of every educated person, whether in the profession or not.”--Dr son’s Clinical Lecture on Insanity in Medical Gazette, No. CLXX.

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FOOTNOTES:

British and Foreign Medical Review, vol. ii. p. 378.

Spectator, 7th May 1836.

Dyspepsia (from the Greek words δυς, dus, bad, and πεπτω, pepto, I concoct) is synonymous with indigestion.

Brachet, Recherches Experimentales sur les Fonctions du Système Nerveux Ganglionaire, chap. iii. Paris edition.

It is difficult, as in the above sentence, to avoid occasionally using expressions and referring to processes, which have not previously been explained; but it would only lead to confusion and unnecessary repetition to stop at every page and introduce explanations, which, after all, the reader would scarcely understand on account of their brevity. In the present instance, therefore, where I allude to the process of digestion, it is better to refer the reader to the outline given at the beginning of Chapter IV, than to distract his attention by introducing it also here.

Vol. iii, p. 40. Paris, 1809.

Brachet, Recherches Experimentales sur les Fonctions du Système Nerveux Ganglionaire, p. 181.

Blaine’s Outlines of the Veterinary Art, third edition, p. 273.

Roget’s Bridgewater Treatise on Animal and Vegetable Physiology, vol. ii. p. 112.

Principles of Physiology, &c., chapters IV. and V.

See p. 14.

For some very curious details on this subject, the reader may consult the last Edition of Dr Mackintosh’s Practice of Physic.

In Latin, cuspis signifies the point of a spear; canis, a dog; mola, a mill; incisor, any thing which cuts.

M. Cadet de Gassicourt recommends the following compound as a safe and excellent dentrifrice, viz. of white sugar and powdered charcoal each one ounce, of Peruvian bark half an ounce, of cream of tartar one drachm and a half, and of canella twenty-four grains, well rubbed together into an impalpable powder. He describes it as strengthening to the gums and cleansing to the teeth, and as destroying the disagreeable odour in the breath which so often arises from decaying teeth; and as a preventive of toothach, I have heard washing the mouth and teeth twice a-day with salt and water strongly recommended by a gentleman who had both experienced and observed much benefit from it.

Experiments and Observations on the Gastric Juice and the Physiology of Digestion, by William Beaumont, M.D. Platsburgh, 1833, p. 67.

See Roget’s Bridgewater Treatise, note at p. 58, vol. ii.

Id. vol. ii. p. 59.

For a full explanation of the nature, importance, and laws of respiration, see the author’s Principles of Physiology, &c. 4th edition, chap. vii.

Cuvier’s Règne Animal, vol. ii. p. 295.

The above descriptions and figure are taken, with slight alterations, from the Treatise on Animal Physiology in the Library of Useful Knowledge.

Principles of Physiology, 4th edition, &c. pp. 142, 192, and 277.

From πνευμων, pneumon, a lung, and γαστηρ, gaster, the stomach, or lung and stomach nerve.

Philosophy of Health, vol. i. p. 80.

Cyclop. Pract. Med. vol. ii. p. 635.

I cannot help thinking that, if St Martin be still alive, which is most likely, the Royal Society would do honour to themselves and render an essential service to science, by using their influence and means to have him brought over to this country and subjected, under the direction of a committee, to such further experiments as may throw light upon a variety of important points which Dr Beaumont, as an individual, had it not in his power adequately to investigate. In throwing out this suggestion, I need scarcely add, that I am far from undervaluing what that gentleman has accomplished, and that I consider it no disparagement to him to say, that he has left some subjects of interest connected with the inquiry still undetermined. Dr Beaumont has done his part too honourably and too well to risk any loss of credit by the subsequent researches of others; and as a case so pre-eminently favourable for carrying on the investigation may never occur again, it is the more necessary to turn it to the best possible account while it is yet time. If funds be wanting for the purpose, it is not unreasonable to suppose that Government would at once grant them, were the request urged by such an influential scientific body as the Royal Society, particularly as a few hundred pounds would suffice. If this suggestion shall ever be acted upon, special care should be taken not to injure St Martin’s health by withdrawing him entirely from his accustomed diet and mode of life, otherwise the whole value of the experiment may be lost--the object being to ascertain the laws and conditions of HEALTHY DIGESTION.

The reader will find the same line of argument most eloquently and successfully pursued by Dr Buckland in his admirable Bridgewater treatise on “Geology considered with reference to Natural Theology,” which appeared subsequently to the first edition of this volume.

Professor Carsewell of the London University has rendered an essential service to practical medicine, as well as morbid anatomy, by demonstrating, in an excellent paper published in the 34th volume of the Edin. Med. and Surg. Journal, that softening and erosion of the stomach, considered by Broussais and others as always results of inflammatory irritation during life, are generally caused by the digestive action of the gastric juice after death. The essay is well worthy of an attentive perusal; but it would carry me too far to notice it here at greater length.

Macgillivray’s Description of the Rapacious Birds of Great Britain, p. 24.

Blaine’s Veterinary Art, 3d edit. p. 247.

Art of Invigorating and Prolonging Life, 3d edition, p. 160.

Art of Prolonging Human Life, English edition. London, 1829. P. 282.

Paris on Diet, p. 93.

The inferences are given in Dr Beaumont’s own words, and the italics also are his. It is needless to say that Dr Beaumont does not present these inferences as discoveries. Most of them were known before; but he has the merit of adding greatly to the strength of the evidence on which they rest, and of substituting certainty for doubt in many instances. The very title of “Inferences” which he modestly gives them, implies that he does not even consider them as proved, and still less as discoveries; although a learned reviewer of the first edition charges him with this presumption.

Principles of Physiology, &c. chap. ii

Londe, Elemens d’Hygiène, tome ii. p. 16.

Bubbles from the Brunnens of Nassau.

See the Principles of Physiology, &c. chap. iii. p. 87.

Respecting the proper regulation of exercise, see The Principles of Physiology, chap. iv. p. 144.

Beaumont’s Observations, &c., p. 63.

Transylvania Journal of Medicine for September 1832, p. 313. See also Dr Caldwell’s excellent Thoughts on Physical Education, and the True Mode of Improving the Condition of Man; reprinted for A. and C. Black, Edinburgh, 1836.

Abercrombie on Diseases of the Stomach, &c., 1st edition, p. 72.

The Art of Prolonging and Invigorating Life. 3d ed., p. 168.

Art of Invigorating, &c., p. 171.

Heidler. Marienbad, et ses differens moyens curatifs dans les maladies chroniques, p. 62.

Principles of Physiology, &c. chap. vii. p. 256, and chap. x. p. 372.

Londe, Elemens d’Hygiène, vol. ii. p. 161.

Smith’s Philosophy of Health, Chapter IV.

Clark on Consumption and Scrofula, p. 823.

On this and kindred subjects, the reader will find much valuable information in Dr Brigham’s Remarks on the Influence of Mental Cultivation and Mental Excitement upon Health; reprinted, with excellent practical Notes, by Dr Robert Macnish. 2d edition, Glasgow, 1836.

Clark on Pulmonary Consumption and Scrofula, p. 230.

Dr Forbes in Cyclop. Pract. Medic., vol. i. p. 698, foot-note.

Abercrombie on Diseases of the Stomach, &c. 1st edit. p. 73.

Beaumont’s Experiments and Observations, &c. p. 243.

Beaumont’s Experiments and Observations, &c. p. 249.

Beaumont’s Experiments and Observations, &c., p. 185.

Cumberland’s Memoirs, vol. ii. p. 204.

Art of Invigorating Life, 3d. ed. pl. 73.

Caldwell’s Thoughts on Physical Education, p. 94.

See Professor Dunglison’s Elements of Hygiene, p. 324, in which the reader will find a great variety of very useful information on all the branches of the subject. The remarks on the different kinds of food and drink are among the best which I have met with.

Dunglison’s Elements of Hygiene, p. 331.

Beaumont’s Experiments and Observations, &c. p. 237.

Transcriber’s Notes:

1. Obvious printers’, punctuation and spelling errors have been corrected silently.

2. Where hyphenation is in doubt, it has been retained as in the original.

3. Some hyphenated and non-hyphenated versions of the same words have been retained as in the original.

4. Where appropriate, the original spelling has been retained.

5. Italics are shown as xxx.