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Reviews and Notices of Books.Stomach and Intestine. "Cyclopædia of Anatomy and Phy-

siology." By WILLIAM BRINTON, M.D., Physician to theRoyal Free Hospital, &c. London: Longman and Co.

On the Organic Diseases and Functional Disorclers of theStomach. By GEORGE BUDD, M.D., F.R.S., Professor ofMedicine in King’s College, &c. London: John Churchill.

Digestion and its Derangements. libe Principles of RationalMedicine applied to Disorders of the Atianeutary Canal.By THOMAS K. CHAMBERS, M.D., Physician to St. Mary’sHospital, &c. London: John Churchill.

IT has been related of Montesquieu that he more than onceobserved, "I labour under the malady of making books, and ofbeing ashamed of them when I have finished them." How

many of the literary members of our profession suffer in thesame manner, we are unable to say; but we fear that if theyplace a true estimate upon the fruit of their exertions, thenumber cannot be very small. However, the authors of theworks, the titles of which we have placed at the head of thisarticle, may fairly be congratulated upon having much lessreason to be dissatisfied with their labours than many of theirbrother book-makers; and though we fear their writings willscarcely live as long as those of the illustrious author of the"Esprit des Lois," yet we can fairly say, that they have made i

very valuable contributions to the medical literature of the

present day.Although Drs. Brinton, Budd, and Chambers have all

worked very diligently at the same text, yet it would hardlybe possible to find three books more dissimilar in every way;in fact, beyond the subject-matter, they have very little incommon. Dr. Brinton does not confine himself to merelywriting an anatomical and physiological description of thoseportions of the alimentary canal known as the stomach andintestines. He very wisely insists that it is impossible to treatthoroughly of these parts without at the same time fully con-sidering their functions; and hence he gives a brief account ofall that is at present known of the physiology and chemistryof the whole act of digestion. Commencing his article with arough but valuable sketch of the anatomy of the stomach andintestines in the lower divisions of the animal kingdom, hegradually examines the advance of development and increasedcomplexity of these organs, as they may be traced from thelowest infusory to the highest mammal; showing how " asimple excavation first became a membranous canal; howit then acquired an additional orifice; an organ of mastication;a salivary apparatus; a stomachal dilatation; a subdivision ofintestine; a liver; a pancreas; and, finally, a compound cha-racter of mucous membrane, by virtue of which the wholetube might be compared to one vast expanse or aggregation ofglands." (p. 306.) The alimentary canal in man is then de-scribed, noticing the structure and functions of its various

parts, their relation to digestion and nutrition, the nature of thedifferent varieties of food; and, finally, the effects of diseaseupon the abdominal viscera, and the constitution generally.

Dr. Budd—who has already published the contents of hisvolume, with the exception of a few pages, in one of the

weekly medical journals-avoids all mention of those subjectswhich are the most ably treated in Dr. Brinton’s paper; and,without any prefatory matter, begins at once by devoting twolong chapters to the consideration of Post-mortem Digestion ofthe Stomach-a subject which, from the complete and detailedmanner in which it is treated, must, we think, be a favouritehobby-horse of the professor’s, and one which he probablytakes every opportunity of riding. The various organic dis-eases of the stomach are then ably described, followed by afew lectures on the Functional Disorders, of this Viscus, inwhich a clear account is given of the important subject of sym-pathetic vomiting as it arises from irritation or disease of thebrain, lungs, liver or uterus: we then have two lectures on

Indigestion; and, finally, the work is concluded by severalpages devoted to the consideration of the most prominentsymptoms of Stomach Affections generally, and the specialremedies employed in their treatment.

; The volume by Dr. T. K. Chambers is divided into two

portions: the first of which is physiological, and the secondpathological. In the former, a clear and comprehensive de-

scription is given of all that is at present known of the physio-logy of the alimentary canal, but without any effort at ori-ginal research; the author’s object being-to use his own words--’’ simply an attempt to join the disjecta n2enabrcc of recent obser-vation on the subject of indigestion into a connected sketch-to offer a concise picture of these vital processes, such as maybe present to the mind of a practitioner who is continuouslyemployed in modifying them for the relief of pain and pre-servation of life, without overloading his scanty leisure by pro-longed quotation:" in the latter, the morbid affections of themouth, pallet, and stomach, in so far as they affect digestion,are considered; together with the subject of regimen generally,this being by many degrees the most novel, and, in our opinion,the most valuable portion of the work.Few diseases have hitherto presented a larger field for wild

conjecture, and certainly none have afforded more ample scopeto the empiric for rash treatment, than disorders of the diges-tive canal-of that canal which may, as Dr. Brinton observes,be regarded as the threshold of the House of Life, where deadmatter is first endowed with those properties which enable itto become a living constituent of the animal body. The diffi-

culty of diagnosing correctly the various morbid affections ofthe stomach is by no means slight, since not only are we forthe most part ignorant of any direct means of ascertaining itsphysical conditions during life, but the prominent symptomsof many of its different diseases are almost identically thesame. Thus we find pain and soreness at the epigastrium notonly common to most of the organic affections of the stomach,as to cancer, simple ulcer, and inflammation of the mucousmembrane, but also to many of the merely functional derange-ments of this viscus, being generally present in the sympa-thetic vomiting of phthisis and many diseases of distant organs.We may, however, be assisted in forming our diagnosis by re-membering that when the pain depends upon organic disease,it is generally most severe soon after taking food, especially ifthis be heavy and indigestible; while, when it is due to func-tional disorder only, it is often relieved by food. This last facthas been explained on the supposition that the uneasiness ismainly due to an unhealthy condition of the gastric secretions,which of course act the less violently the more they are di-luted. In ulcer of the stomach, pain is usually constantlypresent, being merely aggravated by food; in cancer, it is of adull, aching character, only coming on after meals, and con-tinuing while the stomach is full. A light farinaceous dietwill often relieve the pain which follows meals; while thatoccurring when the stomach is empty may generally be curedby sedatives, alteratives, bismuth, &c. The pain of simple in-digestion-the remorse of a guilty stomach, as it has been

facetiously called-merely requires abstinence for its allevia-

tion. Another important symptom-vomiting-may be pro-duced by a greater number of circumstances than those whichgive rise to pain, as, for example, by organic disease of thestomach, by mechanical obstruction of any part of the alimen-tary canal, by irritation in distant organs, or even by morbidstates of the blood. When due to organic disease, it generallyco-exists with pain, and may be diminished by eating verylight food, by taking but little at a time, by counter-irritationto the epigastrium, and often by bismuth. In the vomitingFrom mechanical obstruction of any part of the alimentaryanal, we learn much by noting the time of its occurrence, themature of the vomited matters, and the extent and urgency of,he co-existent symptoms. Thus, in stricture of the pylorus,.he vomiting only takes place when the stomach is full and

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distended, so that the matters brought up are large in quantity.When the constriction is in the small or large intestines, thecontents of the bowel are returned into the stomach by an anti-peristaltic motion, and then rejected. In the sickness fromirritation in a distant organ, or in that caused by an unhealthystate of the blood, there is usually a constant and very de-pressing feeling of nausea, but no pain ; flatulence is also oftencomplained of, and there is often disordered action of the

bowels. This leads us to speak of a third general symptom,which is often very annoying, and not always easily relieved-viz., flatulence, or the undue collection of gas in the intestinalcanal. It may arise from one or more of the following causes-i. e., from air swallowed, from gas generated by decompositionof the contents of the stomach or bowels, or from gas secretedby the mucous membrane of the intestinal canal. In the first

instance, the air is thrown up by eructation, and is nearlyodourless and tasteless; in the second, the gases are passedupwards or downwards, are very fœtid, and often accompaniedby nausea, griping sensations, tenesmus, &c.; while in the

third case the gas is generally expelled per anum, and has theodour of healthy faces. Pyrosis or water-brash, voracious

appetite, depraved appetite, sick-headache, &c., are all symp-toms of different varieties of dyspepsia, dependent upon variouscauses, to treat of which would require more space than wecan afford.In studying the morbid anatomy of diseases of the stomach,

care must be taken not to mistake the alterations which this

organ undergoes after death from the action of the gastricjuice, with the changes of structure due to disease from naturalcauses, or to the use of deleterious agents. John Hunterfirst taught, that the walls of the stomach may be dissolved ordigested by the action of the gastric juice after death; andnumerous observers have since verified the accuracy of this

physiologist’s deductions. It was Hunter’s opinion, deducedfrom the observation of cases of accidental death, as well asfrom experiments on animals, that post-mortem digestion ofthe stomach was most commonly and most extensively foundin persons who had died a violent death, though he remarks,that "there are few dead bodies, in which the stomach, at itsgreat end, is not in some degree digested." Spallanzani, onrepeating and varying Hunter’s experiments, confirmed thegeneral accuracy of his statements, while he also showed thata certain degree of heat is requisite to develope this solventpower of the gastric juice; and it now seems to be allowed,that the more nearly we imitate the gastric temperature ofwarm-blooded animals-96’ F. to 1000 F.-the more rapidlyand extensively will solution occur. At the present time, ourknowledge of cadaveric softening of the stomach seems toamount to this: it is most frequently found in hot weather, orwhen the body has been kept in a warm room; the fundus, orthat part to which the liquids in the stomach gravitate fromthe position of the body, is the most frequently affected; thesoftening or ulceration is sometimes confined to the mucous

membrane, but frequently it extends through the whole of thecoats; the excavated patches are of various extent, with thin,soft, irregular, and sometimes fringed edges, thus presenting amarked contrast with the swollen and often abrupt, hardenedborders of ulcers; the colour of the blood remaining in thevessels of the stomach is often darkened by the acid of thegastric fluid, giving rise to appearances resembling those pro-duced by chronic inflammation; the softened tissues have anacid reaction, so that they putrefy less readily than other parts,owing to the antiseptic virtues of the gastric juice; and lastly,this phenomenon occurs most frequently in cases of accidentalsudden death, where food has been taken a short time pre-viously, although it is very often found where death has arisenfrom disease of the stomach, from phthisis-especially in

women, from inflammatory disease of the brain, from typhoidfever, or from disease of any of the abdominal viscera.

Abernethy used to say, that no person could be persuaded to

pay due attention to his digestive organs until death, or thedread of death, was staring him in the face. Without eithersubscribing to, or denying the truth of, this dogma, it is cer.

tainly fortunate, that of all the organs of the body, the stomachis that on which we can exert the most powerful action, bothindirectly and directly. Daily observation has taught us allhow thoroughly digestion is improved by those means whichinvigorate the system generally, as by rest and early hours,relaxation from severe studies or from the harassing cares andanxieties of business, change of air, sea-bathing, cold or tepidsponging, horse exercise, the disuse of tobacco and of alcoholicstimulants where these have been too freely indulged in, andso on. As regards diet and therapeutical agents, Dr. Buddwell observes :-

" I have before observed that we have greater power overthe disorders of the stomach than over those of any other organof equal importance. In the first place, we can for a timelessen its work, and so lessen its vascularity, more than thatof most other organs. The action of the lungs must go onwithout ceasing. The blood that has ministered to nutritionis returned from every part of the body to the lungs, and mustthere evolve the carbonic acid with which it is charged. In.

terruption of the process, even for a few minutes, is death. Inthe liver and in the kidney an active process of secretion isalways going on, and we have no power to arrest it, for how-ever short a time. But, if needful, the stomach may be keptentirely without food for twelve or twenty-four hours, or longerstill, and its work may be greatly lessened for a considerabletime.

" This power to give the stomach entire rest for many hours,and to lessen its work, and so lessen its vascularity, for a con-siderable time, is of great avail in subduing or mitigating theinflammatory diseases to which it is subject.

" Again, we can act by medicines more directly and more.variously on the stomach than on any other organ. Our medi-cines are applied directly to it, and have, many of them, a,

direct local action upon its coats. Ipecacuanha, rhubarb, andginger increase its secretion; and bismuth, lime, and the

vegetable astringents, restrain undue secretion by their directaction on the secreting membrane. Opium, prussic acid, andcarbonic acid, allay pain and check vomiting, not only by theirinfluence on the system at large, but also by their direct actionon the nerves of the stomach itself. Ice-water, which is anotherpowerful agent in controlling vomiting, when this dependsupon an inflammatory condition of the coats of the stomach,acts directly by lowering the temperature of the stomach itself.Acids and alkalies, which are very efficient remedies in somekinds of gastric disorder, in addition to their more remoteeffects, have a direct action on the lining membrane of thestomach and on the fluicls secreted by it. Carminatives, again,probably owe their efficacy chiefly to the immediate actionthey exert on the coats of the stomach.’’-p. 325.Within the last few years numerous works have been pub-

lished on the employment of alcoholic ciriiiks, and apparentlystrong arguments have been unphilosophic3.lly drawn againsttheir use from their abuse. That intemperance is a curse,leading to shattered health, poverty, misery, and crime, nonehave ever doubted; but may not a poor man enjoy, and receivehealth and strength from, his beer and pipe, as his more wealthyneighbour complacently sips his Rhine ivines, without beingbeguiled into frantic intoxication ? We are not, indeed, afraidthat the Maine Liquor Law, or any such legislative interference,which only tends to make drinking cheap and private, willever be tolerated in this country; but we will even go further,and confess that, in our opinion, remembering man’s passionsand propensities, and seeing how largely wine and beer minis-ter to his health and comfort, the good derived from them out-weighs the ill. Dr. Chambers very carefully considers thislast question, and answers it in the affirmative. He particu-larly refers to the experiments which Dr. Bocker made uponhis own person as to the effects of beer and wine. With re-

gard to the latter, Dr. Bocker took daily, without otherwisealtering his diet, from one and a half to two and a half bottlesof Niersteiner, a good second-class white Rhenish wine, or ofWalportzheimer, a red wine made from the Burgundy grape."The results were," says Dr. Chambers, " in both cases, a

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scarcely perceptible alteration in the bulk of the cutaneous,urinary, and faecal excretions indeed, but a diminution, devoidof doubt, in the quantity of carbonic acid expired, and thatthis latter phenomenon was more marked in the red Walportz-heimer than in the white Niersteiner. That which, however,seemed peculiar to vinous liquors, and which probably is thephysical effect of most practical import, was a striking diminu-tion in the quantity of earthy phosphates in the urine. Whenwe consider the important tissues from whence these phos-phates principally come-no less than the bones and the brain-and what an overpowering influence their renewal or de-struction must have, too great value cannot be attached to anagent which possesses the property of modifying them. Itmust indeed be a two-edged sword in the hands of the employer,capable of doing infinite good and harm."-p. 235.With regard to the specific medicinal virtues of stimulating 0’

drinks, we need say but little. It is, no doubt, true that thestomach which requires them to enable it to act efficiently canhardly be said to be in a healthy state; but at the same timewe must remember, that the battle of life is not waged with-out much wear and tear, without almost overwhelming anxie-ties and sickening disappointments, and that the digestiveorgans are the first to sympathize with the depressions of themind, no less than with the fatigues of the body.

In concluding these necessarily cursory observations, it onlyremains for us strongly to recommend such of our readers ashate empiricism, and are dissatisfied with merely traditionalprecept, to peruse for themselves the writings we havebeen noticing; advising that such should be done in the orderin which we have arranged them. Dr. Brinton’s paper is ex-

ceedingly creditable to him, since it not only shows a thoroughknowledge of all that other observers have done to forwardour knowledge of the anatomy and physiology, as well as

of the diseases, of the stomach and intestines, but alsoindicates a large amount of original experiment, together withthe results of a long series of important and practical obser-vations. The volumes of Drs. Budd and Chambers are also noless valuable; for although they present a smaller amount oforiginal matter, yet they may, perhaps, be found more adaptedto the exigencies of the busy practitioner, or, at least, to thosewho are content to be guided by the conclusions to be drawnfrom the scientific doctrines of the day, without entering mi-nutely into their details, or very closely studying the generallaws of organized beings. The somewhat musty proverb on theshortness of life and the duration of art, is only too true; butstill we may proudly remember, that " studies serve for

delight, for ornament, and for ability," and that " readingmaketh a full man."

THE ARMY SURGEONS IN THE CRIMEA.

A meeting was held at the Medical Head-quarters of theFirst Division on the 3rd of January, at which upwards oftwenty of the staff and regimental surgeons of the divisionattended, for the purpose of hearing the principal medicalofficer, Dr. Williams (who was called to the chair), expoundhis views on the subject of the position of surgical scienceand of medical officers in the army.The CHAIRMAN impressed upon those present that they

should show the members of the profession at home that

they were not indifferent to its interests, and to their ownclaims and duties. He suggested that meetings should beheld for the discussion of subjects connected with militarysurgery, and made some valuable remarks on the nature andworking of an ambulance corps. The failure of the corps mustbe attributed to some extent to the fact that the militarysurgeons and medical officers of the army had not been consultedrespecting its details and its supposed improvements. He thenproposed that a society be established by the medical officers ofthe First Division, Crimean Army, for the purpose of discuss-ing professional subjects, and that it be called the militaryMedical and Surgical Society, First Division, British Army." i

Dr. BLEEINS, Grenadier Guards, then addressed the met-ing, and thanked Dr. Williams for the opportunity thus afforded ’of enabling medical officers to become more acquainted, andto establish such a society as that proposed by Dr. Williams.

Dr. SALL then addressed the meeting on the subject oordering professional works from home, but it was decided topostpone it for further consideration.

It was then proposed by Dr. WILLIAMS, and seconded byDr. BARR, 13th Regiment :-

" That a secretary be appointed, and that Dr. Thornton,9th Regiment, be requested to act as such. "-Carried.Proposed by Dr. SALL, and seconded by Dr. BLENKINS :—" That this society being now established, they meet weekly,

on Thursdays, at two o’clock, P.M., and that a paper be readat each meeting on subjects of professional interest, and thatnotice be sent to the secretary on the previous Tuesday, men-tioning the subject of the paper to be read and discussed, sothat the other medical officers of the society may direct theirattention to the matter."

Dr. BLENIMNS, at the request of the meeting, promised thathe would read a paper on the ensuing Thursday.

The following documents will be found interesting :—

" Head-quarters, Dec. 3rd.

" SiR,—I find that, in reference to your letter of yesterday,the sick of the batteries and troops of Horse Artillery atKadikoi are, by defects in the hospital huts, exposed to wet.I gave positive directions that the huts occupied by sickshould be attended to before anything else, and Sir R. Dacrestells me that, until yesterday, he had no felt or means of sodoing.

" But I wish to remark one point ; the moment there is a

difficulty, an evil to be remedied, plenty of demands andrepresentations are made by the medical officers that theywant this, and that they cannot get the other ; they come toyou, you come to me, &c." wish the regimental medical officers to consider them-

selves part of the regiments, to identify themselves with theircommanding officers, to share the weal and as little of the woeas they can with their regiments, and not to consider them-selves as a separate department of the army. They areessentially part of the regiment ; and I am quite sure thatwhen they make themselves so in feeling, spirit, and practice,they get more advantage for the sick under their charge, thanby an attempt to separate themselves from it.

" Sir Richard Dacres, and any General of Division, willreceive any representation as to the welfare and condition ofthe sick from the Staff medical officer; it is by their super-intendence and observation that he is guided for the generalgood of his division ; but it is right for regimental surgeons ofbatteries and regiments to refer, as other officers do, to theirimmediate commanding officer-viz., captains of batteries andofficers commanding in all things not relating to medical treat-ment.

" I should be glad if, in any communication with themedical officers of the army, you would show that this is myview of the best and most satisfactory means of carrying outtheir important and humane duties.

" I am,’’ W. J. CoDRiNGTO, General Commanding."

Dr. Hall’s circular is as follows :-

"Head-quarters, Camp, Crimea, Dec. 7,1855." SiR,—I have the honour to enclose a copy of a letter which

I have received from the Commander of the Forces, in replyto a communication of mine regarding the defective conditionof some hospitals huts belonging to the Roval Artillery.

" Sir William Codrlngton, you will see, is under an impres-sion that regimental medical officers do not identify themselveswith their regiments, but wish to be considered a separatedepartment.

" I am not aware that any feeling of this kind exists hereit is certainly contrary i,o the common usage and to my longexperience of the service, nor would it be judicious if it didexist, for the interests of the sick are more effectually securedby cordial co-operation on the part of the surgeon and com-manding officer than by antagonism ; and, acting on thissupposition, I naturally infer, when references are made tome, that all local means and applications have failed in pro-curing what is wanted; but I should be glad to be favouredwith the result of your experience on this point, and to knowif you have found commanding officers as willing to listen to,and anxious to carry out the suggestions of medical officers asSir William seems to think they are.

" I have, &c.,, "J. HALL, Inspector-General of Hospitals."