Thomas Lauder Brunton

“ In all cases of fasting, whether voluntary or compulsory, life is prolonged to a much greater extent if water be freely supplied. Without water the individual quickly dies, however much other nourishment he may get, but with abundance of water he may live for a considerable time, even if he take no solid nutriment at all. Here it is not that the water acts as a food; it supplies no new energy to the body, for, unlike starch, or sugar, or fat, or proteids, it has already undergone complete combustion. It can not, like them, unite any further with oxygen and thus supply energy. ”

“ And so it is with the functions of life, only that, these being less understood, many a man acts in regard to them as the child does to the fire. The man thinks that his brain is not acting because he has not supplied it with sufficient food. He takes meat three times a day, and beef-tea, to supply its wants, as he thinks, and he puts in a poker to stir it up in the shape of a glass of sherry or a nip from the brandy-bottle. And yet, all the time, what his brain is suffering from is not lack of fuel, but accumulation of ash ”

“ And now, having run over in this cursory manner some points connected with digestion and with the functions of the liver, we come back to the question of why it is that the mental worker becomes depressed, irritable, melancholy, and, it may be, stupid and forgetful, after a few months' work, although every part of his body may be organically healthy, and a month's holiday may be sufficient to restore every organ to perfect functional activity? ”

“ This melancholy weighs most deeply upon him during the night, and if he happens to wake in the small hours of the morning, as he not unfrequently does, life seems not worth living, but a burden of which he would willingly be quit. ”

“ It is well known that, usually, irritation of a sensory nerve causes dilatation of the vessels in the part supplied by that nerve, and contraction of the vessels in the other parts of the body. This may take place without any alteration whatever in the beats of the heart itself; but if the irritation be very strong, or applied to certain nerves, the heart also may be acted upon. There seem to be certain nerves which act more readily upon the heart than others, and more especially is this power possessed by the fifth nerve, the roots of which are very closely associated with those of the vagus. ”

“ I believe it is to the late Lord Palmerston that we owe the saying that "the outside of a horse is the best thing for the inside of a man," and it is very near the truth. A brisk trot for fifteen minutes will cause more pressure upon, and stimulation of, the liver than a lazy lounge of an hour or more. The time for this will depend in a great measure upon the engagements of the patient. It should not be taken immediately after a meal, and for most men whose days are fully occupied almost the only time to take it is before breakfast. ”

“ The explanation of the fact probably is that the solids, entering the stomach first, stimulate it to secretion and movement; whereas, if it already contained a quantity of liquid at the time they were ingested, they would not have this effect, and imperfect digestion would be the result. At dinner, wine or beer may be taken if the patient finds them agree, but in all probability he will be better without them. There are some brain-workers who require them and must have them, but it is better for a good many others to avoid either wine or beer, and to take some effervescing water instead. ”

“ The bile, which may be looked upon as a waste product of the liver, not being removed, the other functions of the liver are disturbed. Assimilation becomes imperfect, we find lithates appearing in the urine; the circulation in the liver itself may be altered, and thereby the whole circulation in the stomach and intestines may be impeded, for it must be remembered that all the blood from the stomach and intestines has to pass through the liver before it again reaches the general circulation. ”

“ As stimulation of the brain causes dilatation of its vessels, and increases the flow of blood through them, mental action of itself not only attracts more blood to the brain, but provides to some extent for the removal of waste products. The movements induced by the cardiac pulsations are not so extensive as those caused by the respiratory movements or by muscular exertion, and therefore, when the brain is overworked, and the respiration and muscular movements are underworked, the cerebral nutrition will be diminished by the imperfect removal of waste from its substance. ”

“ Having said so much on reflex action as a cause of disease, we will now consider it as a method of cure; and the first instance that suggests itself to our minds is the beneficial effect of a blister. Two theories have been proposed to account for the action of a blister. One is, that it dilates the vessels of the skin in the part to which it is applied, and, by thus drawing away some of the blood from the inflamed organ below, lessens the pain and inflammation in it. The other theory is, that the blister acts reflexly upon the organ itself. ”

“ If the vagi are cut in the living animal so that the cardiac pulsations become excessively rapid, the heart's movement ceases almost as soon as the animal dies; but, if during life the vagi are irritated so as to make the heart contract very slowly indeed, it comes to resemble more nearly the heart of the crocodile, and continues to pulsate for a considerable time after the animal's death. The heart, too, resembles voluntary muscles, inasmuch as, if we wash out of it the products of its own waste, it will continue to beat for a much longer time than if we allow them to accumulate. ”

“ And yet it is more essential to life than any of them, for without it the products of waste can not be removed from the tissues, and the vital fires, so to speak, are smothered in their own ash. If we take the excised muscle of a frog and stimulate it to repeated contraction, the contractions become feebler and feebler, until at last they cease altogether. But this is not because the fuel which the muscle contains in itself has been so completely burned up that none of it is left to furnish the requisite energy to the muscle ”

“ Under ordinary circumstances, nearly the whole of the sugar formed in the intestine and absorbed from it is arrested in the liver, so that very little passes into the general circulation and appears in the urine, although even in healthy persons traces of sugar are excreted by the kidneys. Under exceptional circumstances, however, sugar may pass through in considerable quantities, as, for example, when the individual takes, on an empty stomach, a large quantity of sirup. However healthy his organs may be, sugar will then appear in the urine. ”

“ Hitherto we have been accustomed to regard the phases of digestion, gastric digestion, pancreatic digestion, and intestinal digestion, as almost separate processes, any of which we might increase indefinitely without doing any harm to the patient. We forget the relation which each bears to the other; and yet such a relation undoubtedly exists, for we find that when pepsin is mixed with bile it is precipitated and rendered inert. Further transformation of foods by the gastric juice is thus arrested as soon as the chyme leaves the stomach. ”

“ Two things are necessary for the combustion, fuel and oxygen; sometimes it is the fuel that fails, but not unfrequently it is the oxygen. Sometimes, no doubt, our fires go out because the fuel is quite exhausted, but this is very rarely the case. It is only under very exceptional circumstances that we find a fire burned away so completely as to leave nothing but ash. Almost invariably some fuel still remains—often, indeed, enough to make up a good fire when properly put together. ”

“ All throughout the body we have most elaborate arrangements for removing waste products. In the muscles, for example, we find that the fascia which surrounds them forms a regular pumping arrangement, the two layers of which it consists being separated from each other at each muscular relaxation, and pressed together at each contraction. [2] The lymph and the waste products which it contains are thereby actually pumped out of the muscle at each contraction, and sent onward into the larger lymph-channels, so that the muscular action itself removes the waste products. ”

“ Sometimes the patient may be able to take walking exercise, but when he does it is generally only for a short time during the day, and of so gentle a character that the respiratory movements are but very slightly increased, and the liver is hardly more stimulated by the pressure of the diaphragm and abdominal walls during the walk than it would have been had the patient remained quietly at home. Time is an important element in many cases. ”

“ But although the abdominal vessels are the chief ones concerned in alterations of blood-pressure, yet local alterations in the various organs may have an even more powerful action upon the nutrition of these organs themselves; for it is probable that although the abdominal vessels may be caused to contract by powerful stimulation of almost any sensory nerve, yet that the blood-vessels in different organs of the body—such as, for example, the kidneys or mucous membranes—are more affected by irritation of some nerves than of others. ”

“ Reflex action is the effect produced by an impression made upon a sensory nerve, transmitted by that nerve to a nerve-center, and reflected or thrown back along a motor nerve in much the same way as we may imagine the force to be which is applied to one end of a string running over a pulley and transmitted in a different direction by the other end to produce a certain effect. ”

“ The excretion of bile is greatly aided by the pressure which is exerted upon it by the movements of the diaphragm during respiration, and indeed so low is the pressure under which the bile is secreted that, but for the assistance given by the respiratory movement, it would just barely find its way into the duodenum. Although we are accustomed to say "as bitter as gall," according to my own observations fresh human bile is not bitter. When it is thrown up in consequence of indigestion it is intensely bitter. ”

“ It is probable that the extraction of teeth would, under all circumstances, be an exceedingly dangerous operation, were it not that in the waking condition irritation of the dental nerves sets in motion two pieces of mechanism, one of which, to a great extent, counteracts the effects of the other. As I have already mentioned in a former paper, I was once asked how it was that the application of ammonia or acetic acid to the nose of a fainting person was proved by experience to be beneficial, when theoretically it ought to be injurious by arresting the already enfeebled heart. ”

“ The muscle is like a fire in the grate, which goes out long before the coal is entirely consumed, on account of the ash which smothers it, and just as we can revive the smoldering embers by supplying them with oxygen by the use of bellows, so the muscle revives more quickly when its supply of oxygen is increased. The quicker the fire burns the sooner will it be choked in ash, and the more rapidly the muscle contracts the sooner will it lose its powers. ”

“ An impression made upon a sensory nerve, for example, may produce motion of either a voluntary or involuntary muscle, or may affect the nutrition of a tissue. Under the head of involuntary muscles we must class the muscular fibers of the vessels, and those vascular changes which in themselves play a great part in nutrition and secretion may be very greatly influenced by impressions made upon sensory nerves. ”

“ We find only too frequently that both doctors and patients think that the strength is sure to be kept up if a sufficient quantity of beef-tea can only be got down; but this observation, I think, raises the question whether beef-tea may not very frequently be actually injurious, and whether the products of muscular waste which constitute the chief portion of beef-tea or beef essence may not under certain circumstances be actually poisonous. ”

“ The common practice of mixing the linseed-meal with hot water, and applying it directly to the skin, is quite wrong, because if we do not wish to burn the patient we must wait until a great portion of the heat has been lost. The proper method is to take a flannel bag (the size of the poultice required) , to fill this with the linseed poultice as hot as it can possibly be made, and to put between this and the skin a second piece of flannel, so that there shall be at least two thicknesses of flannel between the skin and the poultice itself. ”

“ But, even with all this care in food and drink, with all this attention to what is to be taken and what avoided, with medicine morning, noon, and night, how are we to keep the liver in order without exercise? ”

“ But, if it be exposed to the action of sulphuretted hydrogen, the leaves, instead of shriveling, simply begin to look flaccid, and droop. This seems, at first sight, to be a less deadly action than that of the sulphurous acid, but when the leaves have once begun to droop in this way the plant is dead, and does not recover when removed from the action of the gas. This gas is rarely generated in the intestine in such a quantity as to give rise to symptoms of acute poisoning, but it has sometimes this effect. ”