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Contributions to the Physiology of the Alimentary Canal by William BrintonProvincial Medical and Surgical Journal (1844-1852), Vol. 14, No. 23 (Nov. 13, 1850), pp. 632-633Published by: BMJStable URL: http://www.jstor.org/stable/25501496 .

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632 REVIEWS.

a subject not less novel than interesting; for, with the exception of the articles in the various medi cal dictionaries, and some other productions,

more remarkable for wit than science, obesity may be considered as almost unbroken ground. The materials of which this treatise is composed, were originally presented to the public in the form of the Gulstonean Lectures, but as the author informs us, and as we can well conceive to be the case, the solicitations of numerous friends have induced him to consent to their

present republication. The entire work consists of ten chapters on

corpulence, and an appendix on emaciation. The first four chapters are especially devoted to the

physiology of the subject, embracing the physical and chemical attributes of fat, its uses, and the

consequences of its non-elimination from the' blood.

In discussing the origin of fat, which he does in the second chapter, the author inquires-1st,

whether it is taken ready made into the food P 2nd, whether it is formed from other alimentary principles P 3rd, whether it is formed from the

decomposition of other tissuesP He decides that it may be contributed by the two firat

modes, the former being the readiest, as in that the fatty matter requires little elaboration. There is no evidence of the latter on a normal process.

In the third chapter, on the assimilation of fat, Dr. Chambers subscribes to the truth of the

theory propounded bfy Bernard and Frierich, that it is effected through the agency of the pancreatic fluid, and is not the result of the action either of the gastric juice or the bile.

In the fourth chapter we have the relations of man to oleaginous food. The author shews that the love of fatty ingesta is general, but that it varies with age, young people being more averse to it than adults. This is seen particularly in girls, who are observed to exhibit an increased fondness for fatty articles of food at and after the period of puberty. An anecdote is related

which strongly illustrates this fact. We shall pass over chapters 6 and 6, in which

the bearings of the fatty development upon life insurance are commented upon, and briefly notice the contents of the subsequent chapters.

The predisposing and exciting causes of obesity and its influence on fertility are minutely treated of in chapter 8. Of the exciting causes, none

appears so important as the occurrence of an

attack of acute illness. So also, surgical injuries sufficiently severe to make confinement requisite

without at the same time inducing serious de rangement of the system, often lead to it.

Tranquillity of mind and cheerfulness are so well known to predispose to obesity, that to

"laugh and grow fat" has become a.proverb. The treatment of obesity is not a very promis

ing, though a most important part of the author's

inquiries. Hereditary fatness, especially when it declares itself at birth, and goes on increasing,

is, the author believes, invariably fatal before

puberty. It is in fact a monstrosity. If, how

ever, the fattening process commences later in

childhood something may be done to counteract

it. The first thing, observes the author, is to

stop the supplies, more especially interdicting all

fatty principles, or those readily convertible into

fat-as sugar. The meals must be light, and

exercise heavy, except in the case of elderly

people, and those in whom we have reason to

suspect that the heart has participated in the

fatty deposit. In such, we doubt not the author,

though he does not say so, would advise caution

in this matter.

Among the medicines which may be called to

our aid, in the melting of the " too-too solid

flesh," the author enumerates purgatives, which

are useful in the plethoric form, diuretics, and

bitters. But he places most reliance on liquor

potassae in half or one-drachm doses, in milk; by'

this, he informs us he has succeeded in reducing the weight of fat subjects as much as two stone.

In the appendix, "Emaciation" meets with

the same philosophical investigation that the

author has brought to bear on the subject of

obesity. The occurrence of wasting as a symp of phthisis is particularly noticed, and its im

portance in prognosis strongly pointed out. The

powers of cod-liver oil are spoken of in the

highest terms and certain rules for its exhibition

are laid down, for which the reader is referred

to the original. In conclusion, we beg to thank Dr. Chambers

for his little volume, which we do not doubt

will be very generally read and appreciated.

Contributions to the Physiology of the Alimentary

Canal. By WILLIAM BRINTON, M.D., Londin., Licentiate of the Royal College of Physicians, &c. Parts I. and II.

THESE papers are a reprint from the Medical

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REVIEWS. 633

Gazette, in the pages of which journal they appeared in the course of last year. The first part is occupied with the movements of the stomach, the second with the physiology of intestinal obstructions.

In the first part the author tells us that much difference exists in the quantity of muscular tissue in different parts of the stomach, it being perceptibly thicker round the pylorus than elsewhere.

The muscular actions of the stomach are

thought to be but little understood, and the author appears to have studied them himself by actual experiment. It appears from his observa tions that in the empty state the viscus is com

pletely at rest, but when it contains food, two chief varieties of peristaltic action are seen. In the early stage of digestion, a transverse con striction occurs, which sets in from the cardiac

extremity, and travels slowly towards the pylo rus, after reaching which there is a temporary rest for about a minute, when the contraction is renewed.

At a later period, in some respects, a different movement occurs; the chief visible contraction is by a constriction above, midway between the orifices of the viscus, which passes onward to. the

pylorus as a circular concave indentation, and which almost obliterates the cavity as it pro ceeds. A slight relaxation follows. In general terms the differences are stated by the author to be as follows:

"Soon after ingestion the peristaltic movements are more general and uniform, while in the latter part of the process of digestion the cardiac extremity experi ences less movement, and the peristalsis of the pyloric extremity becomes more rapid and vehement."

Turning from the movements of the stomach itself, the author next studies the motions which

they impress upon the food. As regards the human stomach, he here relies on the unique observations of Dr. Beaumont, so often quoted, but in addition to these he illustrates his views

by experiment with an artificial stomach. The result is the opinion that there are two currents, so to speak, in the stomach during digestion, the one peripheral, the other central and reversed.

In his remarks on the physiology of intestinal

obstructions, the author gives the following theory of faecal vomiting:

"When any part of the intestinal canal has its

cavity obliterated by a mechanical obstacle, a movement of the ordinary character propels its contents forwards, until they are arrested at the obstructed point. A con

tinuance of the process distends this part of the canal, and gradually the dilatation extends upwards. The

analogy of the intestine to the stomach, and the vague results of atmospheric stimulus, lead us to consider its

normal movement as almost certainly of a peristaltic order, and if the contents of the dilated part are fluid, this peristalsis tends to develop an axial reversed

current, which returns matters from the immediate

neighbourhood of the strangulation to some higher

point in the canal; and thus, if the distension have

reached the upper portion of the duodenum, a portion of fluid, possessing the properties of the intestinal

contents, occupies the immediate neighbourhood of the

stomach, and a continuance of the movement introduces

the fluid through the unresisting pylorus into the cavity of that organ. Having attained the interior of the

stomach, either by distension or irritation, or both

combined, it provokes vomiting, and is expelled by the

mouth."-p. 24.

Lectures on Clinical Medicine. By JOHN HUGHES

BENNETT, M.D., F.R.S.E., &c., &c. Nos. I. and II.

THE reprinting, in a separate form, of lectures and papers which have previously been pub lished in various medical journals, appears to be

a. growing custom, if we may judge by the

number of such productions which reach us from

time to time. It is obvious that the end of

many of these would be sufficiently answered by their being allowed to remain in their original

position; but not so in the case of Dr. Bennett's

labours, which are abundantly worthy of a circu

lation more extensive than they would be likely otherwise to meet with.

The first part of Dr. Bennett's "Clinical

Lectures" embraces the subject of exudation

in general, which he divides into three principal forms, the simple, the cancerous, and the tuber

cular; these are again subdivided into secondary

groups, each of which is minutely described and

illustrated by woodcuts.

The second part is replete with practical in

formation on a branch of pathology which is not

sufficiently studied in this country, viz., that of

cutaneous diseases. The subject of favus is here

most elaborately illustrated, in its history as

well as treatment. The pathology adopted by the author is a modification of the vegetable

theory. He considers that it depends essentially on a form of abnormal nutrition, with exudation

of a matter analogous to, if not identical with, that of tubercle, and constituting a soil for the

germination of cryptogamic plants, the presence of which is pathognomonic of the disease.

In the treatment of favus Dr. Bennett relies

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