]S T o. 4. Price, 35 Cents. PUBLISHED I $8.00 SEMI-MONTHLY. LIBRARY '/ PER YEAR. OF Medical Classics. Oct. 15, 1881. Indigestion and Biliousness, BY J. MILNER EOT H ERG ILL, M. D., MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON ; SENIOR ASSISTANT PHYSICIAN TO THE CITY OF LONDON HOSPITAL FOR DISEASES OF THE CHEST ; LATE ASSISTANT PHYSICIAN TO THE WEST LONDON HOSPITAL ; ASSOCIATE FELLOW OF THE COLLEGl>*rti PHYSICIANS OF PHILADELPHIA. “What is one man’s meat is another man’s poison.” NEW YORK: BERMINGHAM & CO., PUBLISHERS, 1260 & 1262 BROADWAY. Library ofMedical Classics. Published by Bermingham & Co., No. 4. Nos. 1260 & 1262 Broadway, New York. Price 35 Cents. INDIGESTION AND BILIOUSNESS. J. MILNER FOTHERGILL, M.D.; MEMREI OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON; SENIOR ASSISTANT PHYSICIAN TO THE CITY OF LONDON HOSPITAL FOR DISEASES OF THE CHEST (VICTORIA PARK) ; LATE ASSISTANT PHYSICIAN TO THE WEST LONDON HOSPITAL; ASSOCIATE FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA. '* What is one man’s meat is another man’s poison.” PREFACE. The study of chronic disease has compelled digestion, in its various forms, becomes intel- the writer to pay minute attention to the sub- ligible. Chaos “without form and void” ject of assimilation and its disturbances. thus becomes “dry land and waters.” Research in the deadhouse, even when aided The disturbances of the digestion are terri- by the microscope, can never supply more bly on the increase in the present day; and a than the anatomical factors of disease. It is chapter is appended on “The Failure of the important to instruct us as to disturbance of Digestive Organs at the Present Time.” function. Physiology —an acquaintance with For a contribution to this subject, as well function in health, can alone guide us to a as other favors, I here acknowledge my in- knowledge of disordered function. debtedness to Duncan Bulkley, M. D., of New The following book is written from a physi- York. ological standpoint. For aid in revising the proof-sheets I have The history of normal digestion precedes to express my thinks to David J. Johnson, and introduces the subject of indigestion; first Esq., M. B. in the alimentary canal, then, secondly, in the 23 Somerset Street, Portman Square, W liver. By such study the management of in- June 21st, 1881. CONTENTS. Chapter I.—Introduction 2 Chapter VIII.—Diet and Drink 38 Chapter II. —Natural Digestion—Starch— Chapter IX. —TheFunctions of the Liver. 41 Albuminoids—Fat 3 Chapter X. —The Phenomena of Liver Chapter III. —Primary Indigestion 7 Disturbance—Biliousness 46 Chapter IV. —Suitable Forms of Food— Chapter XI.—Phenomena of Liver Dis- Artificial Digestive Ferments 12 turbance (continued )—Liver Indiges- Chapter V. —Tissue Nutrition 20 tion 56 Chapter VI. —Secondary Indigestion— Chapter XII. —The Treatment of Liver — — Neurosal — Reflex Cardiac —Toxae- Disturbance Medicinal and Diet- mic 24 etic 68 Chapter VII.—Indigestion as an Intercur- Appendix.—The Failure of the Digestive rent Affection 35 Organs at the Present Time 79 INDIGESTION AND BILIOUSNESS. CHAPTER I. ture. If digestion were merely a deficiency of gastric juice due to disease of the walls of INTRODUCTION. the stomach, its treatment would be ren- There are many ailments, many disturb- dered very simple; it would consist in giving ances of health, which embitter our existence, after a meal so much gastric juice derived and limit our power of labor, that are not from our omnivorous congener—the pig. In illumined by any side-light from the dead- many cases, doubtless, this is enough to house. They are essentially the maladies of achieve what is required; but this is not the the living! whole, nor even the main part of the rational It is not disputed that in certain cases treatment of the various forms of indiges- changes are found in the dead-house, enab- tion. ling the cases to be classed as chronic gas- Starch, albuminoids, and fats; each of tritis, gastric ulcer, gastrid cancer, or gastric these has its own digestion, its own portion dilatation; but then, these are the ultimate of the digestive act; which must be allowed changes at the end of the case. Before these for in our diagnosis, and in the selection of pathological conditions have been developed, our remedial measures. The treatment of in- there has been a long preceding his- digestion is like the fitting of a suit; there are tory of functional disturbance; and even the three component parts of the suit—coat, when they are fully developed, the waist-coat, and trousers—to be seen to. Two stomach retains some of its functional may fit; but the third does not. So in dys- powers until the last; or until very near the pepsia! Or the whole may be badly made, or last. Such mere anatomical division of the ill-fitting. The treatment of a complex mal- maladies of the stomach is useful diagnostic- ady, is like the makingof a suit; it has got to ally, and, prognostically; even more so fit the individual exactly. Some persons can in the aeadhouse; byt for all purposes go into a ready-m,ade shop, and buy an article of rational treatment such division is as ster- which may fit very fairly. So some dyspep- ile as a Vestal virgin. tics only require pepsin wine for their cure. To be of practical avail to the patient, the But this is not the rule; rather is it the ex- stomach must be looked on from the stand- ception. Some people are “ bad to fit,” in point of its physiological function; which is tailor’s phrase; and tailors differ in their ca- not abolished by the particular form of the pacity. Some people arenot “easy to treat;” disease. In all those myriads of cases where and perhaps all medical men are not alike in there is no gross disease, but where there is their capacity. Then again, there are some only decided dyspepsia, any classification persons, whom even very competent tailors, founded on pathological changes is powerless cannot fit; only one tailor cap manage tp fit to help us. them. So there are a proportion of persons Nor are we correct in thinking that the who find out that one medical man alone can greatest activity of the digestive act, is to be prescribe satisfactorily for them. With tailors found in the stomach; really, the seat of and doctors alike this last class, fortunately a greatest activity is beyond the pyloric ring, in very small one, really is unpopular; nor is the duodenum. The stomach is specially the there any difficulty in conceiving that this seat of the digestion of albuminoids in an should be so. acid medium; consequently the morbid Then again, “biliousness,” is connected changes in the coats of the stomach are not with disturbance of the digestive process in the anatomical substrata of all disordered the liver; a matter we now do kpow some- function. In certain mofbid conditions of thing about. Until recently, yea very re- the stomach, the mucous coat is found dis- cently, vye really did know nothing, or little eased, and the gastric follicles more or less more than nothing of the function of this mutilated; but what would this tell us even if huge viscus. But lately, thanks to such we could see it with the eye in life? It would physiologists as the late Claude Bernard, Lud- demonstrate the necessity for encouraging wig, and Pavy, and Lauder Brunton, in our other parts of the digestive system than the own country; our knowledge has of late made stomach! How this can be done,, will.be giant strides; and enlarged physiological shown further on. We will never under- knowledge has led the way and broken a path stand digestion, its disturbances, and how to for a rational comprehension and treatment of meet them, by poring over the morbid changes the disturbances of the liver. The chemical found in the post-mortem room; even when composition of the bile-acids tells of their aided by the microscope. We might aswell at- albuminoid origin; and speaks with no indis- tempt to study the construction of a building tinct utterance of the dietetic management of from the examination of it in ruin, and by biliousness, as well as the remedial measures minute inspection of the material of which it to be employed. consisted. It is this study of the digestive The chemical composition of the urine canal after life has fled, which has led us solids has long years ago cleared up the gene- astray from the real study of the digestion as alogy of gout; but we recognize nevertheless, a physiological process; how it comes to be that gout does not take its genesis solely in deranged, or defective; and how to remedy port wine and gluttony. Certainly these two the . different disorders, according to their na- can, in the course of time, provoke gout, if NATURAL DIGESTION-^STARCH—ALBUMINOIDS—FAT. 3 sufficiently persisted in; even in the healthiest become familiar with each section of the systems. whole. Consequently it is only in acquaintance Our knowledge of the digestive act, as with the digestive act, and the disturbances said in the Introduction, is very recent; con- thereof, first intelligently comprehended, and sequently medical teaching, until the last de- then carefully reasoned upon in the consider- cade, had littLe to say on the matter. Now ation of assimilation as a physiological pro- physiology has acquired articulate speech; cess, that we can lay the foundation of a and can talk sufficiently well to tell us much, rational comprehension of the maladies—in- of the greatest importance, on subjects which digestion, biliousness, and gout; and of a interest the medical practitioner in almost treatment which is successful, except by a every case which comes under his notice in lucky guess.