CHAMBERS ON DIGESTION AND ITS DERANGEMENTS."
THIRTY years ago, books on diet and digestion were all the fashion ; whence it may be inferred that indigestion was the prevailing com- plaint. Some years afterwards, Dr. Andrew Com be and Dr. Southwood
Smith look a larger view of the subject, treating it philosophically as well as physiologically. They showed how the various func- tions charged with the reparation of the body are connected with each other; that the lungs and the skin, for example, contribute to healthy digestion equally with the stomach, though not so ob- viously. It was of small use for a patient to swallow blue or other pills, to weigh his food and study its selection, if he ate at impro- per times, took insufficient exercise, breathed an impure air, and allowed his insensible perspiration to be habitually impeded. Since that time, many books have been written on popular physiology and hygiene, few on digestion per se; so that, in spite of larger towns and closer competition, the stomach seems not to be so complain- ing an organ as it was when George the Fourth was King.
Neither is the Digestion and its Derangements of Dr. King Chambers one of the old treatises about dyspepsia; which, no- minally addressed to the profession, was in reality intended for that class of well-to-do persona who are debarred from one half of the French wit's requisite for the enjoyment of life—a good stomach. As might be expected by any one acquainted with the Doc- tor's work on Corpulence, or Excess of Fat in the Human Body, the more general portion of the present book on Digestion is distin- guished by great good sense, as well as medical acumen in all that relates to the direct treatment of disease and the dietetic self- management of a patient. As a whole, the work is rather ad- dressed to the medical man than the general reader. The physi- ological character of the different organs in any way concerned with digestion is described in their anatomy and considered in their healthy functions, beginning with the mucous membrane or lining of the alimentary canal, and going through the organs particularly—as the stomach and the liver. In the second part, the same organs are even more minutely considered in the diseases to which they are subject, the symptoms these various diseases exhibit, and the best methods of treatment. The student has thus before him at the same time the organ and its functions in health, with the same organ in disease, exhibiting, of course, abnormal functions, symptoms, and the best method of treating the dis- order. A few chapters handle subjects more generally connected with dyspeptic derangement ; but the main feature of the book is the organisms of digestion in health and disease.
As handled by Dr. King Chambers, this is a new method of treating the subject. He has also imported into his book a good deal of new information on the function of organs, drawn from late experiments by German or French physicians, and as yet locked up for most Englishmen in foreign publications. Consider- able value would attach to the labours of Dr. King Chambers had he gone no further than this ; but the great value of the book con- sists in the principle on which it is founded. Rational medicine, says the Doctor, is not based on the study of what is called mor- bid anatomy. Death itself induces changes in the more delicate parts of the body ; disease, nay even death, may take place with- out producing any change that the anatomist can detect : in dis- eased or even altered structure, action of some kind is still going on, and, under the circumstances, as naturally as in health. A wide separation of physiology and pathology leads, moreover, to erroneous theories and faulty practice. The nature of man must be looked at as a whole, whether in health or in sickness. There are not opposite powers at work, " any contest of Ormuzd and Ahriman, any prevalence now of evil now of good," in the micro- cosm. Man is subject to disease from two causes : one internal— as hereditary disposition, peculiar formation ; one external—as violence, noxious influences. The consequences that follow either one cause or the other are as natural as any healthy action. It is these actions, or the modes of discharging functions, that should be mainly considered, great regard being had in practice to indi- vidual idiosyncracies.
"Diseases, therefore, and more especially chronic diseases, must be treated not in lots, according to their nomenclature or as if they were the progeny of some evil power, but according to the mode in which each individual is affected by the union of outward circumstances with the peculiar form of his body. We must treat the man and not the ailment, or we are nearly as likely to make matters worse as we are to make them better. And we must act with the conviction that everything happens, both as respects the patient's body and the drugs or discipline which we adopt, according to identically the same laws which are to be observed in health.
"The only systematic nosologist who has been far-sighted enough to an- ticipate a doctrine which is just beginning to acquire a proper influence, is that great but incautious genius Dr. Darwin. His Zoiinomia, or the Laws of Organic Life, contains descriptions of diseased as well as of healthy ac- tions. ' Hunger' is included in the same genus with 'heartburn,' as arising from decreased actions of the gastric membrane; 'dry tongue and fauces' in the same with gall-stones' and costiveness,' inasmuch as in each of them the balance between the supply of fluid and its removal by the absorb- ents is disturbed. I quote here striking and semi-paradoxical instances on
purpose. * •
"There is nothing in which the present advancing state of rational phy- siology and rational medicine will benefit mankind more than in adding to our acquaintance with what may be called the internal features of the body. It may be stated without the slightest hesitation, that every one's viscera differ from his neighbour's as much as his face and hands do, and from their greater extent admit of a greater variety of combinations. We are gaining in this way a knowledge of what are in one sense incurable states ; but the more familiar with them we are, the better we are able to cure the diseases of which they form part, to prolong life and alleviate pain."
• Digestion and its Derangements: the Principles of Rational Medicine applied to Disorders of the Alimentary Canal. By Thomas K. Chambers, M.D., &c. &c., Author of Decennium Pathologieum," &c. Published by Churchill.
The treatment which the author deduces from his views is not of a very striking or "active" kind, as the thoughtful physiologist will readily suppose. In fact, the remedies are frequently vety simple, considerable attention being paid to what some might deem trifles. The views of diet appear to us very sound, and with a tendency to "the benign extreme" when the patient is not actually ill, in which case he seldom wishes to eat. Dr. King Chambers is not an advocate of spare living. "To reduce the diet so as to accustom the stomach to take only just enough to supply the ordinary waste, is not wise. The well-known Vene- tian, Luigi Cornaro, did this, and published his experience. He lived indeed to a great age, but then he passed a sort of vegetable life in his palace and his gondola which would be intolerable to us Saxons. Dr. Stark tried simi- lar experiments, and got on pretty well so long as he had nothing to de be- aide weighing himself ; but when he came to undergo a contested election for St. George's Hospital it killed him outright, as it would have done Cornaro, Hilarion, Simeon Stylites, or any other hero of asceticism. If the body is to be exposed, as it is in all modern civilized life, to sudden extraordinary demands, it must be prepared for them by being habituated to take in rather more than is ordinarily required."
Here in another way is an example of caution injudging from almost the only organ we can see in a natural state, the tongue.
" Accidental circumstances must not be allowed to interfere with our judgment of tongues. In the notes which I have preserved of persons in robust condition and easy circumstances examined for insurance, there is every variety of tongue which we are in the habit of associating with chronic disease, and many of acute disease, produced in perfect health. Tobacco is guilty of a great many of these deceptions, producing in some persons who smoke it hot a fur, in others a white coat, and in some who spit a great deal an unnaturally clear aspect. I was once surprised to see even the orange- brown on a white ground of the typhoid state closely represented in a mer- chant who had never been ill, and found that such an appearance is not rare in those employed in tea-tasting, an occupation in which he had been en- gaged all the morning."
To experimentalize upon living animals, which is mostly another word for torturing them, has been censured by moralists except under peculiar circumstances, and is revolting to the feelings of man- kind. The practice probably is subject to the same rule as " se- verity in war." The probable gain should be much greater than the actual suffering to the non-combatant or helpless animal. A man who conscientiously believes that a torturing experiment may produce great benefit to mankind may be justified in adopting it. Needless repetitions, aimless or cruel experiments, or seeking after results without distinct utility, are as criminal as they are cruel. And after all, how difficult if not impossible is it to judge of the normal condition or action of an organ under an experiment which tortures every fibre. The trials made by certain foreign physio- logists in reference to the liver seem to be of this character, not- withstanding the alleged absence of torture.
" Fistulous openings have been made into the gall-bladder or ducts of vari- ous animals, and while all passage into the intestine was cut off by a liga- ture, the secretion was collected at leisure. At leisure may be fairly said, for M. Blondlot kept a dog in this condition alive for five years, and some of those used in the Derpt laboratory were mercifully killed after two months' observation, still in a viable state. The operation is a less violent one than might have been anticipated ; of eleven dogs so treated, with the precautions detailed by Dr. Bidder, only two died of peritonitis. The injury also was less than might be supposed, the principal inconvenience arising from factor of breath and flatulence ; symptoms in spite of which many of our own species continue their daily occupations and amusements. The authors too seem most careful that the animals should be in as normal a condition as possible : for example, on cats they did not begin to record their observations till the pulse and breathing were of the ordinary rapidity, and the creature would purr when stroked ; and on the first shivering ceasing to take notes. And the dogs are described as cheerfully disposed, rising up and following their
masters round the laboratory when called. • •
" M. Blondlot's pointer was still more frisky ; she used to go shooting with her master, and suckled annually a litter of puppies for the five years he kept her. If the hepatic duct really was impervious, her food must have been no slight expense, if we may judge from the observations made at page 173. See Comptes Rendus de Academie des Sciences, June 23d, 1851."