Illustration. While attending a Miss B., of N. H., sick of fever, I pronounced her better, withdrew medicine, directed a simple, low diet, and the exclusion of all visitors. In the evening I was sent for to attend her. There was a violent relapse into the disease, which continued to increase in severity until the fourth day, when death terminated her sufferings. I learned that, soon after I gave directions that no visitors be admitted into her room, several particular friends were permitted to enter the chamber and talk with the sick girl. Their conversation produced a severe headache; and, to use the language of the patient, “it seemed as if their talk would kill me;” and it did kill her.
992. No solid food should be taken in the first stages of disease, even if the affection is slight. The thirst can be allayed by drinking cold water, barley-water, and other preparations of an unstimulating character. It is wrong to tempt the appetite of a person who is indisposed. The cessation of a desire for food, is the warning of nature, that the system is in such a state that it cannot be digested.
993. When a patient is recovering from illness, the food should be simple, and in quantities not so great as to oppress the stomach. It should also be given with regularity. “Eat little and often,” with no regard to regularity, is a pernicious practice.
994. When a physician attends a sick person, he should have the special management of the food, particularly after the medicine has been withdrawn and the patient is convalescent. The prevailing idea that every person may safely advise relative to food, or that the appetite of the convalescing person 429 is a competent guide, is dangerous; and cannot be too much censured.
Give an illustration. 992. What suggestion relative to food in the first stages of disease? How can the thirst be allayed? 993. When the patient is convalescent, how should the food be given? What is said of the practice of eating “little and often”? 994. Who should have the special management of food when medicine is withdrawn? What idea prevails in the community?
Illustration. In 1832, I attended a Miss M., sick of fever. After an illness of a few days, the fever abated, and I directed a simple, unstimulating diet. Business called me from the town two days. During my absence, a sympathizing, officious matron called; found her weak, but improving; and told her she needed food to strengthen her; and that “it would now do her good.” Accordingly, eggs and a piece of beefsteak were prepared, and given to the convalescent girl. She ate heartily, and the result was a relapse into a fever more violent than the first attack.
995. It is very important in disease that the skin be kept clean. A free action of the vessels of this part of the body exerts a great influence in removing disease from the internal organs, as well as keeping them in health. If the twenty or thirty ounces of waste, hurtful matter, that passes through the “pores” of the skin in twenty-four hours, are not removed by frequent bathing and dry rubbing, it deranges the action of the vessels that separate this waste matter from the blood, and thus increases the disease of the internal organs.
Illustration. Mrs. M. R., of N., Mass., was afflicted with disease of the lungs and cough. This was accompanied with a dry, inactive condition of the skin. As medicine had no salutary effect in relieving her cough, she was induced by the advice of the clergyman of the parish to enter upon a systematic course of bathing twice every day. Soon the skin became soft, its proper functions were restored, the disease of the lungs yielded, and the cough disappeared.
996. Every sick person should breathe pure air. The purer the blood that courses through the body, the greater the 430 energy of the system to remove disease. The confined vitiated air of the sick-chamber, not unfrequently prolongs disease; and in many instances, the affection is not only aggravated, but, even rendered fatal, by its injurious influences.
Give an illustration of the evil effects attending such an idea. 995. Does the skin exert a great influence in removing disease from the internal organs, as well as in keeping them in health? Give an illustration 996. Why should every sick person, particularly, breathe pure air?
Illustrations. 1st. In 1833, I was called, in consultation with another physician, to Mr. H., who was much debilitated, and delirious. For several successive days he had not slept. His room was kept very warm and close, for fear he would “take cold.” The only change that I made in the treatment, was to open the door and window, at a distance from the bed. In a short time, the delirium ceased, and he fell into a quiet slumber. From this time he rapidly recovered, and the delirium was probably the result of breathing impure air.
2d. Formerly, every precaution was used to prevent persons sick of the small-pox from breathing fresh air. When Mrs. Ramsay had this disease in Charleston, S.C., her friends, supposing that life was extinct, caused her body to be removed from the house to an open shed. The pure air revived the vital spark. The result probably would have been different, had she been kept a few hours longer in the vitiated air.
997. The influence of habit should not be disregarded in the removal of disease. If food or drink is to be administered, however small in quantity or simple its quality, it should be given at or about the time when the ordinary meals were taken in health.
998. Again, the usual time when the patient was in the habit of retiring for sleep should be observed, and all preparation necessary for the sick-room during the night should be made previous to this hour. Efforts should also be made to evacuate the waste matter of the digestive and urinary organs at the period which habit has formed in health. This is not 431 only a remedial agent in disease, but often precludes the necessity of laxative or drastic cathartics.
Are not diseases prolonged, and even rendered fatal, from breathing the impure, vitiated air of the sick-chamber? Give illustration 1st. Give illustration 2d. 997. What is said respecting the influence of habit in removing disease?
999. Medicine is sometimes necessary to assist the natural powers of the system to remove disease; but it is only an assistant. While emetics are occasionally useful in removing food and other articles from the stomach that would cause disease if suffered to remain, and cathartics are valuable, in some instances, to relieve the alimentary canal of irritating residuum, yet the frequent administration of either will cause serious disease.
1000. Although medicine is useful in some instances, yet, in a great proportion of the cases of disease, including fevers and inflammations of all kinds, attention to the laws of health will tend to relieve the system from disease; more certainly and speedily, and with less danger, than when medicines are administered.
1001. Thomas Jefferson, in writing to Dr. Wistar, of Philadelphia, said, “I would have the physician learn the limit of his art.” I would say, Have the matrons, and those who are continually advising “herb teas,” and other “cure-alls,” for any complaint, labelled with some popular name, learn the limits of their duty, namely, attention to the laws of health. The rule of every family, and each individual, should be, to touch not, taste not of medicine of any kind, except when directed by a well-educated and honest physician, (sudden disease from accidents excepted.)
999. What is said of the use of medicine? 1000. Of its use in fevers and many other cases of disease? 1001. What remark by Thomas Jefferson to Dr. Wistar? What should matrons learn? What should be the rule of every person in regard to taking medicine? What exception?
1002. The nurse requires knowledge and practice to enable her to discharge aright her duty to the patient, as much as the physician and surgeon do to perform what is incumbent on them. Woman, from her constitution and habits, is the natural nurse of the sick; and, in general, no small portion of her time is spent in ministering at the couch of disease and suffering.
1003. As the young and vigorous, as well as the aged and the infirm, are liable to be laid upon the bed of sickness, by an epidemic, or imprudent exposure, or by some accident, it is therefore necessary that the girl, as well as the matron, may know how she can render services in an efficient and proper manner. No girl should consider her education complete who is not acquainted with the principles of the duties of a general nurse and a temporary watcher.
1004. It is to be regretted, that while we have medical schools and colleges to educate physicians, there is no institution to educate nurses in their equally responsible station. In the absence of such institutions, the defect can be remedied, to some extent, by teaching every girl hygiene, or the laws of health. To make such knowledge more available and complete, attention is invited to the following suggestions relative to the practical duties of a nurse.
1002. Does the nurse require knowledge and practice in her employment, as well as the physician? Who is the natural nurse of the sick? 1003. What, then, is incumbent on every girl? 1004. Should there be schools to educate nurses, as well as physicians and surgeons?
1005. Bathing. The nurse, before commencing to bathe the patient, should provide herself with water, two towels, a sponge, a piece of soft flannel, and a sheet. The temperature of the room should also be observed.
1006. When the patient is feeble, use tepid or warm water. Cold water should only be used when the system has vigor enough to produce reaction upon the skin. This is shown by the increased redness of the skin, and a feeling of warmth and comfort, after a proper amount of friction. Before using the sponge to bathe, a sheet, or fold of cloth, should be spread smoothly over the bed, and under the patient, to prevent the bed-linen on which the patient lies from becoming damp or wet.
1007. Apply the wet sponge to one part of the body at a time; as the arm, for instance. By doing so, the liability of contracting chills is diminished. Take a dry, soft towel, wipe the bathed part, and follow this by vigorous rubbing with a crash towel, or, what is better, a mitten made of this material; then use briskly a piece of soft flannel, to remove all moisture that may exist on the skin, and particularly between the fingers and the flections of the joints. In this manner bathe the entire body.
1008. The sick should be thoroughly bathed, at least twice in twenty-four hours. Particular attention should be given to the parts between the fingers and toes, and about the flections of the joints, as the accumulation of the excretions is most abundant on these parts. In bathing, these portions of the system are very generally neglected. The best time for bathing, is when the patient feels most vigorous, and freest from exhaustion. The practice of daubing the face and hands with a towel dipped in hot rum, camphor, and vinegar, 434 does not remove the impurities, but causes the skin soon to feel dry, hard, and uncomfortable.
1005. What should a nurse provide herself with, before bathing a patient? 1006. When should cold water be used? 1007. How should the bathing then be performed, so that the patient may not contract a cold? 1008. How often should a sick person be bathed? What is said of daubing the face and hands merely with a wet cloth?
1009. Food. It is the duty of every woman to know how to make the simple preparations adapted to a low diet, in the most wholesome and the most palatable way. Water-gruel,[24] which is the simplest of all preparations, is frequently so ill-made as to cause the patient to loathe it. Always prepare the food for the sick, in the neatest and most careful manner.
1010. When the physician enjoins abstinence from food, the nurse should strictly obey the injunction. She should be as particular to know the physician’s directions about diet, as in knowing how and when to give the prescribed medicines, and obey them as implicitly.
1011. When a patient is convalescent, the desire for food is generally strong, and it often requires firmness and patience, together with great care, on the part of the nurse, that the food is prepared suitably, and given at proper times The physician should direct how frequently it should be taken.
1012. Pure Air. It is the duty of the nurse to see that not only the room is well ventilated in the morning, but that fresh air is constantly admitted during the day. Great care must be taken, however, that the patient does not feel the current.
1013. Bed-linen, as well as that of the body, should be aired every day, and oftener changed in sickness than in health. All clothing, when changed, should be well dried, and warmed by a fire previous to its being put on the patient or the bed.
1009. Should every woman know how to make the simple preparations adapted to a low diet? 1010. Should the nurse strictly obey the injunctions of the physician relative to food? 1011. What period of a person’s illness requires the most care in regard to the food? 1012. Give another duty of the nurse. 1013. What directions respecting the bed-linen of the patient? What is necessary when there is a change of clothing?
1014. Temperature. The warmth of the chamber should be carefully watched by the nurse. The feelings of the patient or nurse are not to be relied on as an index of the temperature of the room. There should be a well-adjusted thermometer in every sick-room. This should be frequently consulted by the nurse.
1015. The temperature of the sick-chamber should be moderate. If it is so cold as to cause a chill, the disease will be aggravated. If, on the other hand, it is too warm, the patient is enfeebled and rendered more susceptible to cold on leaving the sick-chamber. The Latin maxim, “In medio tutissimus ibis,” (in medium there is most safety,) should be regarded in the rooms of the sick.
1016. Quiet. The room of the patient should be kept free from noise. The community should be guided by this rule, that no more persons remain in the room of the sick, than the welfare of the patient demands. It is the duty of the physician to direct when visitors can be admitted or excluded from the sick-room, and the nurse should see that these directions are enforced.
1017. The movements of the attendants should be gentle and noiseless. Shutting doors violently, creaking hinges, and all unnecessary noise, should be avoided. Most persons refrain from loud talking in the sick chamber, but are not equally careful to abstain from whispering, which is often more trying than a common tone.
1018. It is the duty of the nurse to ascertain the habits of the patient as respects the period for eating and sleep, when in health, that she may prepare the food and arrange the sick-room in accordance with the practice of the patient. 436 If the person who is sick is ignorant of the necessity of the removal of the waste products from the system the nurse should invite attention to these functions at such periods as are in accordance with the previous habits of the patient.
1014. Why should there be a well-adjusted thermometer in every sick-chamber? 1015. What is said of the temperature of the sick-chamber? 1016. Why should the sick-room be kept quiet? 1017. What is said of noise in the sick-chamber? Of whispering? 1018. Should the habits of the patient be regarded in reference to the period for eating and sleep?
1019. The deportment and remarks of the nurse to the patient should be tranquil and encouraging. The illness of a friend, or persons who have recently died, should not be alluded to in the sick-room. No doubts or fears of the patient’s recovery, either by a look or by a word, should be communicated by the nurse in the chamber of the sick. When such information is necessary to be communicated, it is the duty of the physician to impart it to the sick person.
1020. The nurse should not confine herself to the sick-room more than six hours at a time. She should eat her food regularly, sleep at regular periods, and take exercise daily in the open air. To do this, let her quietly leave the room when the patient is sleeping. A watcher, or temporary nurse, may supply her place. There is but little danger of contracting disease, if the nurse attends to the simple laws of health, and remains not more than six hours at a time in the sick-room.
1021. These necessary assistants, like the nurse, should have knowledge and practice. They should ever be cheerful, kind, firm, and attentive in the presence of the patient.
1022. A simple, nutritious supper should be eaten before entering the sick-room; and it is well, during the night, to take some plain food.
1019. What should be the deportment of the nurse toward the patient? Should doubts and fears of the patient’s recovery be communicated in the sick-room? When necessary to impart such intelligence, on whom does it depend? 1020. How long should a nurse remain in the sick-chamber at a time? 1021. What qualifications are necessary in a watcher? 1022. What directions in regard to the food of the watcher?
1023. When watching in cold weather, a person should be warmly dressed, and furnished with an extra garment, as a cloak or shawl, because the system becomes exhausted toward morning, and less heat is generated in the body.
1024. Light-colored clothing should be worn by those who have care of the sick, in preference to dark-colored apparel; particularly if the disease is of a contagious character. Experiments have shown, that black and other dark colors will absorb more readily the subtile effluvia that emanate from sick persons, than white or light colors.
1025. Whatever may be wanted during the night, should be brought into the sick-chamber, or the adjoining room, before the family retires for sleep, in order that the slumbers of the patient be not disturbed by haste, or searching for needed articles.
1026. The same general directions should be observed by watchers, as are given to the nurse; nor should the watcher deem it necessary to make herself acceptable to the patient by exhausting conversation.
1027. It can hardly be expected that the farmer, who has been laboring hard in the field, or the mechanic, who has toiled during the day, is qualified to render all those little attentions that a sick person requires. Hence, would it not be more benevolent and economical to employ and pay watchers, who are qualified by knowledge and training, to perform this duty in a faithful manner, while the kindness and sympathy of friends may be practically manifested by assisting to defray the expenses of these qualified and useful assistants?
1023. When watching in cold weather, what precaution is necessary? 1024. What is said relative to the color of the clothing worn in the sick-room? 1025. What suggestions to watchers relative to the arrangement of the sick-chamber? 1026. What should watchers observe? 1027. What is said of employing those persons to watch who labor hard during the day?
1028. Poisoning, either from accident or design, is of such frequency and danger, that it is of the greatest importance that every person should know the proper mode of procedure in such cases, in order to render immediate assistance when within his power.
1029. Poisons are divided into two classes—mineral (which include the acids) and vegetable.
1030. The first thing, usually, to be done, when it is ascertained that a poison has been swallowed, is to evacuate the stomach, unless vomiting takes place spontaneously. Emetics of the sulphate of zinc, (white vitriol,) or ipecacuanha, (ipecac,) or ground mustard seed, should be given.
1031. When vomiting has commenced, it should be aided by large and frequent draughts of the following drinks: flaxseed tea, gum-water, slippery-elm tea, barley water, sugar and water, or any thing of a mucilaginous or diluent character.
1032. Ammonia.—The water of ammonia, if taken in an over-dose, and in an undiluted state, acts as a violent corrosive poison.
1033. The best and most effectual antidote is vinegar. It should be administered in water, without delay. It neutralizes the ammonia, and renders it inactive. Emetics should not be given.
1034. Antimony.—The wine of antimony and tartar emetic, if taken in over-doses, cause distressing vomiting. In addition to the diluent, mucilaginous drinks, give a tea-spoonful of the sirup of poppies, paregoric, or 440 twenty drops of laudanum, every twenty minutes, until five or six doses have been taken, or the vomiting ceases.
1025. Is it useful to know the antidotes or remedies for poison? 1029. Into how many classes are poisons divided? 1030. What is the first thing to be done when it is ascertained that poison has been swallowed? 1031. What should be taken after the vomiting has commenced? 1032. What effect has an over-dose of ammonia? 1033. The antidote? Should an emetic be given for this poison? 1034. What effect has an over-dose of the wine of antimony or tartar emetic?
1035. The antidotes are nutgalls and oak bark, which may be administered in infusion, or by steeping in water.
1036. Arsenic.—When this has been taken, administer an emetic of ipecac, speedily, in mucilaginous teas, and use the stomach-pump as soon as possible.
1037. The antidote is the hydrated peroxide of iron. It should be kept constantly on hand at the apothecaries’ shops. It may be given in any quantity, without injurious results.
1038. Copper.—The most common cause of poisoning from this metal, is through the careless use of cooking utensils made of it, on which the acetate of copper (verdigris) has been allowed to form. When this has been taken, immediately induce vomiting, give mucilaginous drinks, or the white of eggs, diffused in water.
1039. The antidote is the carbonate of soda, which should be administered without delay.
1040. Lead.—The acetate (sugar) of lead is the preparation of this metal, which is liable to be taken accidentally, in poisonous doses. Induce immediate vomiting, by emetics of ground mustard seed, sulphate of zinc, and diluent drinks.
1041. The antidote is diluted sulphuric acid. When this acid is not to be obtained, either the sulphate of magnesia, (epsom salts,) or the sulphate of soda, (glauber’s salts,) will answer every purpose.
1042. Mercury.—The preparation of this mineral by which poisoning is commonly produced, is corrosive sublimate. The mode of treatment to be pursued when this poison has been swallowed, is as follows: The whites of a dozen eggs should be beaten in two quarts of cold water, and a tumbler-full given every two minutes, to induce vomiting. When the whites of eggs are not to be obtained, soap and water should be mixed with wheat flour, and given in copious draughts, and the stomach-pump introduced as soon as possible. Emetics or irritating substances should not be given.
1043. Nitre—Saltpetre.—This, in over-doses, produces violent poisonous symptoms. Vomiting should be immediately induced by large doses 441 of mucilaginous, diluent drinks; but emetics which irritate the stomach should not be given.
1035. What is the antidote? 1036. What should immediately be done when arsenic is swallowed? 1037. What is the antidote? Can any quantity of this preparation of iron be given without injurious results? 1038. What should be given when verdigris has been taken into the stomach? 1039. What is the antidote? 1040. What should immediately be given when sugar of lead is taken? 1041. What is the antidote? 1042. Give the treatment when corrosive sublimate has been swallowed. 1043. What effect has an over-dose of saltpetre? What treatment should be adopted?
1044. Zinc.—Poisoning is sometimes caused by the sulphate of zinc, (white vitriol.) When this takes place, vomiting should be induced, and aided by large draughts of mucilaginous and diluent drinks. Use the stomach-pump as soon as possible.
1045. The antidote is the carbonate, or super-carbonate of soda.
1046. Nitric, (aqua fortis,) MURIATIC, (MARINE ACID,) OR SULPHURIC (OIL OF VITRIOL,) ACIDS, may be taken by accident, and produce poisonous effects.
1047. The antidote is calcined magnesia, which should be freely administered, to neutralize the acid and induce vomiting. When magnesia cannot be obtained, the carbonate of potash (salæratus) may be given. Chalk, powdered and given in solution, or strong soap suds, will answer a good purpose, when the other articles are not at hand. It is of very great importance that something be given speedily, to neutralize the acid. One of the substances before mentioned should be taken freely, in diluent and mucilaginous drinks, as gum-water, milk, flaxseed, or slippery-elm tea. Emetics ought to be avoided.
1048. Oxalic Acid.—This acid resembles the sulphate of magnesia, (epsom salts,) which renders it liable to be taken, by mistake, in poisonous doses. Many accidents have occurred from this circumstance. They can easily be distinguished by tasting a small quantity. Epsom salts, when applied to the tongue, have a very bitter taste, while oxalic acid is intensely sour.
1049. The antidote is magnesia, between which and the acid a chemical action takes place, producing the oxalate of magnesia, which is inert. When magnesia is not at hand, chalk, lime, or carbonate of potash, (salæratus,) will answer as a substitute. Give the antidote in some of the mucilaginous drinks before mentioned. No time should be lost in introducing the stomach-pump as soon as a surgeon can be obtained.
1050. Ley.—The ley obtained by the leaching of ashes may be taken by a child accidentally. The antidote is vinegar, or oil of any kind. The vinegar neutralizes the alkali by uniting with it, forming the acetate of potash. The oil unites with the alkali, and forms soap, which is less caustic than the ley. Give, at the same time, large draughts of mucilaginous drinks, as flaxseed tea, &c.
1044. What is the antidote for white vitriol? 1047. What is the antidote for aqua fortis and oil of vitriol? Should emetics be avoided? 1048. How can oxalic acid be distinguished from epsom salts? 1049. What is the antidote for an over-dose of oxalic acid? When magnesia cannot be obtained, what will answer as a substitute? 1050. What is the antidote when ley is swallowed?
1051. The vegetable poisons are quite as numerous, and many of them equally as virulent, as any in the mineral kingdom. We shall describe the most common, and which, therefore, are most liable to be taken.
1052. Opium.—This is the article most frequently resorted to by those wishing to commit suicide, and, being used as a common medicine, is easily obtained. From this cause, also, mistakes are very liable to be made, and accidents result from it. Two of its preparations, laudanum and paregoric, are frequently mistaken for each other; the former being given when the latter is intended.
1053. Morphia, in solution, or morphine, as it is more commonly called by the public, is a preparation of the drug under consideration, with which many cases of poisoning are produced. It is the active narcotic principle of the opium; and one grain is equal to six of this drug in its usual form.
1054. When an over-dose of opium, or any of its preparations, has been swallowed, the stomach should be evacuated as speedily as possible. To effect this, a teaspoonful of ground mustard seed, or as much tartar emetic as can be held on a five cent piece, or as much ipecacuanha as can be held on a twenty-five cent piece, should be mixed in a tumbler of warm water, and one half given at once, and the remainder in twenty minutes, if the first has not, in the mean time, operated. In the interval, copious draughts of warm water, or warm sugar and water, should be drank.
1055. The use of the stomach-pump, in these cases, is of the greatest importance, and should be resorted to without delay. After most of the poison has been evacuated from the stomach, a strong infusion of coffee ought to be given; or some one of the vegetable acids, such as vinegar, or lemon-juice, should be administered.
1056. The patient should be kept in motion, and salutary effects will often be produced by dashing a bucket of cold water on the head. Artificial respiration ought to be established, and kept up for some time. If the extremities are cold, apply warmth and friction to them. After the poison has been evacuated from the stomach, stimulants, as warm wine and water, or warm brandy and water, should be given, to keep up and sustain vital action.
1057. Stramonium—Thorn-Apple.—This is one of the most active narcotic poisons, and, when taken in over-doses, has, in numerous instances, caused death.
1051. Are vegetable poisons as numerous and as virulent in their effects as mineral? 1052. What is said of opium and its preparations? 1054, 1055, 1056. What treatment should be adopted when an over-dose of opium or any of its preparations is taken? 1057. What is said of stramonium?
1058. Hyosciamus—Henbane.—This article, which is used as a medicine, if taken in improper doses, acts as a virulent irritating and narcotic poison.
1059. The treatment for the two above-mentioned articles is similar to that of poisoning from over-doses of opium.
1060. Conium—Hemlock.—Hemlock, improperly called, by many, cicuta, when taken in an over-dose, acts as a narcotic poison. It was by this narcotic that the Athenians used to destroy the lives of individuals condemned to death by their laws. Socrates is said to have been put to death by this poison. When swallowed in over-doses, the treatment is similar to that of opium, stramonium, and henbane, when over-doses are taken.
1061. Belladonna—Deadly Nightshade.—Camphor. Aconite—Monkshood, Wolfsbane. Bryonia—Bryony. Digitalis—Foxglove. Dulcamara—Bittersweet. Gamboge. Lobelia—Indian Tobacco. Sanguinaria—Bloodroot. Oil of Savin. Spigelia—Pinkroot. Strychnine—Nux vomica. Tobacco.—All of these, when taken in over-doses, are poisons of greater or less activity. The treatment of poisoning, by the use of any of these articles, is similar to that pursued in over-doses of opium. (See Opium, page 442.)
1062. In all cases of poisoning, call a physician as soon as possible.
1058. Of henbane? 1059. What should be the treatment when an over-dose of stramonium or henbane is taken? 1060. What name is sometimes improperly given to conium, or hemlock? How was this narcotic poison used by the Athenians? How are the effects of an over-dose counteracted? 1061. What is the treatment when an over-dose of deadly nightshade, monkshood, foxglove, bittersweet, gamboge, lobelia, bloodroot, tobacco, &c., is taken? 1062. Should a physician be called in all cases when poison is swallowed? 444
The essential parts of every secretory apparatus are a simple membrane, apparently textureless, named the primary, or basement membrane, certain cells and blood-vessels. The serous and mucous membrane are examples.
The division and description of the different membranes and tissues are not well defined and settled by anatomical writers. This is not a material defect, as a clear description of the different parts of the system can be given by adopting the arrangement of almost any writer.
Fat is one of the non-nitrogenous substances. It forms the essential part of the adipose tissue. Chemical analysis shows that all fatty substances are compounds of carbon, hydrogen, and oxygen. They are lighter than water, generally fluid at the natural temperature of the body, and burn with a bright flame, forming water and carbonic acid.
Caseine is abundantly found in milk. When dried, it constitutes cheese. Alcohol, acids, and the stomach of any of the mammalia coagulate it; and it is also soluble in water. It is found in the blood, bile, saliva, and the lens of the eye.
Chondrine is a variety of gelatin. It is obtained from cartilage. It is soluble in warm water, but solidifies on cooling.
Lactic acid is common to all the solids and fluids of the system. It is found united with potash, soda, lime, or magnesia.
The word duodenum is derived from the Latin, signifying “twelve,” since the intestine, of which this is the name, is usually about twelve fingers’ breadth in length. The jejunum is also from the Latin jejunum, empty, since it is usually found in that condition after death, as the food seems to pass rapidly through this part of the intestine. The term ileum is from the Greek, signifying “to twist,” since it always appears in a contorted condition. The name cæcum is derived from the fact of its being a blind or short sack, perforated by the extremity of the ileum. The name of the next division of the intestine—colon—is from the Greek, “to prohibit,” as the contents of the alimentary canal pass slowly through this portion. The rectum is named from the straight direction that it assumes in the latter part of its course.
The food is forced through the alimentary canal by contractions of its muscular coat, produced by the nervous filaments of the sympathetic system, not being at all dependent on the cerebro-spinal centre. This is called the peristaltic, or vermicular motion. The great length of intestine in all animals, and especially in the herbivorous ones, is owing to the necessity of exposing the food to a large number of the lacteals, that the nourishment may all be taken from it.
The different processes through which the food passes before assimilation are of considerable interest. The mastication and mixture of the saliva with the food are purely of a mechanical nature. When any solid or fluid substance is placed upon the tongue, or in contact with the inner surface of the cheeks, by an involuntary act, the salivary glands are stimulated to activity, and commence pouring the saliva into the mouth through the salivary ducts. As soon as mastication commences, the contraction of the masseter and other muscles employed in mastication stimulates the salivary glands to increased action, and a still greater quantity of saliva is secreted and forced upon the food, which is constantly being ground to a finer condition, until it is sufficiently reduced for deglutition.
Whether the salivary fluid acts any other part than simply that of a demulcent to assist the gastric juice in still further dissolving the food, is yet a matter of some doubt, although it is found that no other liquid will equally well subserve the process of digestion and promote health.
After the food is in the condition ready to be swallowed, by an apparently involuntary motion, it is placed upon the back of the tongue, which carries it backwards to the top of the pharynx, where the constrictions of the pharynx, aided by the muscles of the tongue and floor of the mouth, with a sudden and violent movement thrust it beyond the epiglottis, in order to allow the least necessary time to the closure of the glottis, after which, by the compression of the œsophagus, it is forced into the stomach.
Here it is that the true business of digestion commences. For as soon as any substance except water enters the stomach, this organ, with involuntary movements, that seem almost like instinct, commences the secretion of the gastric juice, and by long-continued contractions of its muscular coat, succeeds in effecting a most perfect mixture of the food with this juice, by which the contents of the stomach are reduced to the softest pulp.
The gastric juice, in its pure state, is a colorless, transparent fluid; “inodorous, a little saltish, and perceptibly acid. It possesses the property of coagulating albumen, and separating the whey of milk from its curd, and afterwards completely dissolving the curd. Its taste, when applied to the 446 tongue, is similar to that of mucilaginous water, slightly acidulated with muriatic acid.” The organs of its secretion are an immense number of tubes or glands, of a diameter varying from one five hundredth to one three hundredth of an inch, situated in the mucous coat of the stomach, and receiving their blood from the gastric arteries. A chemical analysis shows it to consist of water, mucilage, and the several free acids—muriatic, acetic, lactic, and butyric, together with a peculiar organic matter called pepsin, which acts after the manner of ferments between the temperature of 50° and 104° F.
The true process of digestion is probably owing to the action of pepsin and the acids, especially if the presence of the chloro-hydric or muriatic be admitted; since we know, by experiments out of the body, that chlorine, one of its elements, is a powerful solvent of all organic substances.
The antiseptic properties of the gastric juice, as discovered by experiments made on Alexis St. Martin, doubtless have much influence on digestion, although their true uses are probably not yet known.
As soon as the food is reduced to a state of fluidity, the pyloric orifice of the stomach is unclosed, and it is thrust onwards through the alimentary canal, receiving in the duodenum the secretions of the liver and pancreas, after which it yields to the lacteals its nutrient portion, and the residuum is expelled from the body.
There have been many hypotheses in regard to the nature of the digestive process. Some have supposed that digestion is a mere mechanical process, produced by the motion of the walls of the stomach; while others, in later times, have considered it as under the influence of a spirit separate from the individual, who took up his residence in the stomach and regulated the whole affair; while others still would make it out to be a chemical operation, and thus constitute the stomach a sort of laboratory. But to all these ridiculous hypotheses Sir John Hunter has applied the following playful language: “Some will have it that the stomach is a mill; others that it is a fermenting vat; and others that it is a stewpan; but in my view of the matter, it is neither a mill, a fermenting vat, nor a stewpan, but a stomach, a stomach!”
At the present day this process is regarded as a complex, and not a simple operation. It seems to be a process in which the mechanical, chemical, and vital agencies must all act in harmony and order; for if one of these be withdrawn, the function cannot be sustained for any considerable length of time; and of the chemical and mechanical parts of the process, since the former is much more important, and, as a matter of course, the vital powers are indispensable, therefore digestion may be considered as a chemical operation, directly dependent on the laws of vitality, or of life; since the proper consistency of the food depends, in a great measure, upon the character of the solvents, while the secretion of these fluids, their proper amount, 447 together with the peculiar instinct—as it almost seems to be—necessary to direct the stomach in its many functions, are exclusively and entirely dependent on the laws and conditions of life.
As food is necessary to supply the waste and promote the growth of the body, it follows that that will be the best adapted to the system which contains the same chemical elements of which the body is composed; viz., oxygen, hydrogen, carbon, and nitrogen. These elements are found in greater or less quantity in all animal food, and in many vegetable products. Hence, that article of food which contains all these elements in a proper proportion will tend much more to the growth and strength of the body than those kinds which are deficient in one or more of them. Much experience on this point, and scientific research, seem to show that a reasonable amount of animal food in health tends to give greater strength of muscle, and a more general sense of fulness, than in ordinary cases a vegetable diet is able to do, owing to the presence of nitrogen in animal tissues. Yet there are examples of the healthiest and strongest men, who live years without a morsel of animal food; and the fact can only be accounted for, by supposing that the system has the power to make the most economical use of the little nitrogen offered to it in the food; or else that it has by some means the power to abstract it from the atmosphere, and transform it to the living animal substance.
The proximate principles, which are the most important in nourishing the body, are albumen and fibrin. These constitute the greater part of all the softer animal tissues, and are also found in certain classes of vegetables, such as peas, beans, lentils, and many seeds. Hence, in many cases, a vegetable diet, especially if embracing any of those articles, would be sufficient to sustain life, even if no animal food should be eaten. But no animal can exist for a long time if permitted only to eat substances destitute of nitrogen, as in the case of a dog fed entirely on sugar, which lived but thirty days. And owing to this fact, Baron Liebig proposes to call substances used for food, containing nitrogen, “elements of nutrition,” and those containing an excess of carbon, “elements of respiration;” since, according to his view, the food is necessary to support the growth of the body by replacing the effete and worn-out particles with new matter, and also to keep up the supply of fuel, in order to promote a sufficient degree of heat in the system. Accordingly, under the first division would be included all lean meats and vegetables, such as peas, &c.; while the fat of animals, vegetable oils, sugars, tubers, (as the potato,) and all other substances containing starch, would be included under the latter division.