Dr. Priestly exposed the blood of a sheep successively to oxygen gas, atmospheric air, and carbonic acid gas; and found, that in oxygen gas its colour became very florid, less so in atmospheric air, and in carbonic acid gas it became quite black. He filled a bladder with venous blood, and exposed it to oxygen gas; the surface in contact with the bladder immediately became florid, while the interior parts remained dark coloured.
All these facts prove, that the red colour which the blood acquires in the lungs, is owing to the oxygen, which probably combines with it, and the last mentioned fact shows, that oxygen will act on the blood, even though a membrane similar to the bladder, be interposed between them.
The same effect, probably, takes place in the lungs; the blood is circulated through that organ by a number of fine capillary arteries; and it is probable that the oxygen acts upon the blood through the membranes of these arteries, in the same manner that it does through the bladder.
In short, it seems likely, that the blood, during its circulation through the lungs, becomes combined with oxygen; that this oxidated blood, on its return to the heart, is circulated by the arteries to all parts of the body; and that, during this circulation, its oxygen combines with the hydrogen and carbon of the blood, and perhaps with those parts of the body with which it comes into contact; it is therefore brought back to the heart, by the veins, of a dark colour, and deprived of the greatest part of its oxygen.
This is the most probable theory, in the present state of our knowledge; it was proposed by Lavoisier, who imagines the focus of heat, or fireplace to warm the body, to be in the lungs: others, however, have thought it more consonant to facts, to suppose, that, instead of the oxygen uniting with carbon and hydrogen in the lungs, and there giving out its heat, the oxygen is absorbed by the blood, and unites with these substances during the circulation, so that heat is produced in every part of the body; and this doctrine seems certainly supported by several facts and experiments.
The circulation of the blood, though so simple and beautiful a function, was unknown to the ancient physicians, and was first demonstrated by our countryman, Harvey; when he first published his account of this discovery, he met with the treatment which is generally experienced by those who enlighten and improve the comfort of their fellow creatures, by valuable discoveries. The novelty and merit of this discovery drew upon him the envy of most of his contemporaries in Europe, who accordingly opposed him with all their power; and some universities even went so far, as to refuse the honours of medicine to those students, who had the audacity to defend this doctrine; but afterwards, when they could not argue against truth and conviction, they attempted to rob him of the discovery, and asserted that many of the ancient physicians, and particularly Hippocrates, were acquainted with it. Posterity, however, who can alone review subjects of controversy without prejudice, have done ample justice to his memory.
LECTURE IV. DIGESTION, NUTRITION, &c
The human body, by the various actions to which it is subject, and the various functions which it performs, becomes, in a short time, exhausted; the fluids become dissipated, the solids wasted, while both are continually tending towards putrefaction. Notwithstanding which, the body still continues to perform its proper functions, often for a considerable length of time; some contrivance, therefore, was necessary to guard against these accelerators of its destruction. There are two ways in which the living body may be preserved; the one by assimilating nutritious substances, to repair the loss of different parts; the other to collect, in secretory organs, the humours secreted from these substances.
We are admonished of the necessity of receiving substances into the body, to repair the continual waste, by the appetites of hunger and thirst. For the stomach being gradually emptied of its contents, and the body, in some degree, exhausted by exercise, we experience a disagreeable sensation in the region of the stomach, accompanied by a desire to eat, at first slight, but gradually increasing, and at last growing intolerable, unless it be satisfied.
When the fluid parts have been much dissipated, or when we have taken, by the mouth, any dry food, or acrid substance, we experience a sensation of heat in the fauces, and at the same time a great desire of swallowing liquids. The former sensation is called hunger, and the latter thirst.
From the back part of the mouth passes a tube, called the oesophagus or gullet, its upper end is wide and open, spread behind the tongue to receive the masticated aliment: the lower part of this pipe, after it has passed through the thorax, and pierced the diaphragm, enters the stomach, which is a membranous bag, situated under the left side of the diaphragm: its figure nearly resembles the pouch of a bagpipe, the left end being most capacious; the upper side is concave, and the lower convex: it has two orifices, both on its upper part; the left, which is a continuation of the oesophagus, and through which the food passes into the stomach, is named cardia; and the right, through which the food is conveyed out of the stomach, is called pylorus: within this last orifice is a circular valve, which, in some degree, prevents the return of the aliment into the stomach.
From the pylorus, or right orifice of the stomach, arise the intestines, or bowels, which consist of a long and large tube, making several circumvolutions, in the cavity of the abdomen; this tube is about five or six times as long as the body to which it belongs. Though it is one continued pipe, it has been divided, by anatomists, into six parts, three small, three large. The three small intestines are the duodenum, the jejunum, and the ileum; the duodenum commences at the pylorus, and is continued into the jejunum, which is so called from its being generally found empty: the ileum is only a prolongation of the jejunum, and terminates in the first of the great intestines, called the caecum. The other great guts are the colon and the rectum.
The whole of what has been described is only a production of the same tube, beginning at the oesophagus. It is called by anatomists the intestinal canal, or prima via, because it is the first passage of the food. It has circular muscular fibres, which give it a power of contracting when irritated by distension; and this urges forward the food which is contained in it. This occasions a worm like motion of the whole intestines, which is called their peristaltic motion.
The mesentery is a membrane beginning loosely on the loins, and thence extending to all the intestines; which it preserves from twisting by their peristaltic motion. It serves also to sustain all the vessels going to and from the intestines, namely the arteries, veins, lacteals, and nerves; it also contains several glands, called, from their situation, mesenteric glands.
The lacteal vessels consist of a vast number of fine pellucid tubes, which arise by open mouths from the intestines, and proceeding thence through the mesentery, they frequently unite, and form fewer and larger vessels, which pass through the mesenteric glands, into a common receptacle or bag, called the receptacle of the chyle. The use of these vessels is to absorb the fluid part of the digested aliment, called chyle, and convey it into the receptacle of the chyle, that it may be thence carried through the thoracic duct into the blood.
The receptacle of the chyle is a membranous bag, about two thirds of an inch long, and one third of an inch wide, at its superior part it is contracted into a slender membranous pipe, called the thoracic duct, because its course is principally through the thorax; it passes between the aorta and the vena azygos, then obliquely over the oesophagus, and great curvature of the aorta, and continuing its course towards the internal jugular vein, it enters the left subclavian vein on its superior part.
There are several other viscera besides those I have described, which are subservient to digestion; among these may be mentioned the liver, gall bladder, and pancreas. The liver is the largest gland in the body, and is situated immediately under the diaphragm, principally on the right side. Its blood vessels that compose it as a gland, are the branches of the vena portarum, which, as I mentioned in the last lecture, enters the liver and distributes its blood like an artery. From this blood the liver secretes the bile, which is conveyed by the hepatic duct, towards the intestines: before this duct reaches the intestines, it is joined by another, coming from the gall bladder: these two ducts uniting, form a common duct, which enters the duodenum obliquely, about four inches below the pylorus of the stomach.
The gall bladder, which is a receptacle of bile, is situated between the stomach and the liver; and the bile which comes from the liver, along the hepatic duct, partly passes into the duodenum, and partly along the cystic duct into the gall bladder. When the stomach is full, it presses on the gall bladder, which will squeeze out the bile into the duodenum at the time when it is most wanted.
The bile is a thick bitter fluid, of a yellowish green colour, composed chiefly of soda and animal oil, forming a soap; and it is most probably in consequence of this saponaceous property that it assists digestion, by causing the different parts of the food to unite together by intermediate affinity. When the bile is prevented from flowing into the intestines, by any obstruction in the ducts, digestion is badly performed, costiveness takes place, and the excrements are of a white colour, from being deprived of the bile. This fluid, stagnating in the gall bladder, is absorbed by the lymphatics, and carried into the blood, communicating to the whole surface of the body a yellow tinge, and other symptoms of jaundice.
The jaundice therefore is occasioned by an obstruction to the passage of the bile into the intestines, and its subsequent absorption into the blood: this obstruction may be caused either by concretions of the bile, called gall stones, or by a greater viscidity of the fluid, or by a spasm, or paralysis of the biliary ducts.
The pancreas, or sweet bread, is a large gland lying across the upper and back part of the abdomen, near the duodenum. It has a short excretory duct, about half as wide as a crow quill, which enters the duodenum at the same place where the bile duct enters it.
The food being received into the mouth, is there masticated or broken down, by the teeth, and impregnated with saliva, which is pressed out of the salivary glands, by the motions of the jaw and the muscles of the mouth. It then descends, through the oesophagus, into the stomach, where it becomes digested, and, in a great measure, dissolved, by the gastric juice, which is secreted by the arteries of the stomach. It is then pushed through the pylorus, or right orifice of the stomach into the duodenum, where it becomes mixed with the bile from the gall bladder and liver, and the pancreatic juice from the pancreas. These fluids seem to complete the digestion: after this, the food is continually moved forwards by the peristaltic motion of the intestines.
The chyle, or thin and milky part of the aliment, being absorbed by the lacteals, which rise, by open mouths, from the intestines, is carried into the receptacle of the chyle, and from thence the thoracic duct carries it to the subclavian vein, where it mixes with the blood, and passes with it to the heart.
The food of animals is derived from the animal or vegetable kingdoms. There are some animals which eat only vegetables, while others live only on animal substances. The number and form of the teeth, and the structure of the stomach, and bowels, determine whether an animal be herbivorous, or carnivorous. The first class have a considerable number of grinders, or dentes molares; and the intestines are much more long and bulky; in the second class, the cutting teeth are predominant, and the intestines are much shorter.
Man seems to form an intermediate link between these two classes: his teeth, and the structure of the intestines, show, that he may subsist both on vegetable and animal food; and, in fact, he is best nourished by a proper mixture of both. This appears from those people who live solely on vegetables, as the Gentoo tribes, and those who subsist solely on animals, as the fish eaters of the northern latitudes, being a feebler generation than those of this country, who exist on a proper mixture of both. A due proportion, therefore, of the two kinds of nourishment, seems undoubtedly the best.
Having taken a general view of the course of the aliment into the blood, I shall now examine more particularly, how each part of the organs concerned in digestion, or connected with that function, contributes to that end.
The food being received into the mouth, undergoes various preparations, which fit it for those changes it is afterwards to undergo. By the teeth the parts of it are divided and ground, softened and liquified by the saliva, and properly compressed by the action of the tongue and mastication.
The mouth, in most animals, is armed with very hard substances, which, by the motion of the lower jaw, are brought strongly into contact. Those parts of the teeth which are above the sockets, are not simply bony, they are much harder than the bones, and possess the property of resisting putrefaction, as long as this hard crust continues to cover them. The teeth are divided into three classes: 1st. The cutting teeth, which are sharp and thin, and which serve to cut or divide the food: 2nd. The canine teeth, which serve to tear it into pieces still smaller: 3rd. The grinders, which present large and uneven surfaces, and actually grind the substance already broken down by the other teeth. Birds, whom nature has deprived of teeth, have a strong muscular stomach, called the gizzard, which serves the purposes of teeth, and they even take into the stomach small pieces of grit, to assist in grinding to a powder the grain that they have swallowed.
Among those parts of the mouth which contribute to the preparation of the food, we must reckon the numerous glands which secrete saliva, and which have therefore been called salivary glands. The saliva is a saponaceous liquor, destitute of taste or smell, which is squeezed out from these glands, and mixed with the food during mastication. In the mouth, therefore, the food becomes first broken down by the teeth, impregnated with saliva, and reduced to a soft pasty substance, capable of passing with these, through the oesophagus, into the stomach. It is here that it undergoes the change, which is particularly termed digestion.
Digestion comprehends two classes of phenomena, distinct from each other: 1st. Physical and chemical: 2nd. Organic and vital. The object of the first, is to bring the alimentary substances to such a state as is necessary, that they may be capable of the new combinations into which they are to enter, to obtain the animal character. The object of the second is, to produce those combinations which some have thought to be very different from those produced by simple chemical attractions.
The physical and chemical phenomena of digestion, relate chiefly, 1st. To the action of heat; 2ndly. To the dissolution of the alimentary substances. The heat of the animal is such, as is well fitted to promote solution.
That digestion is performed by solution, is evident, from several experiments, particularly those made by Dr. Stevens, who enclosed different alimentary substances in hollow spheres of silver, pierced with small holes. These were swallowed, and after remaining some time in the stomach, the contents were found dissolved. The great agent of solution is the gastric juice, which possesses a very strong solvent power. This juice is secreted by the arteries of the stomach; it may be collected in considerable quantity, by causing an animal that has been fasting for some time, to swallow small hollow spheres, or tubes of metal filled with sponge.
This liquid does not act indiscriminately upon all substances; for if grains of corn be put into a perforated tube, and a granivorous bird be made to swallow it, the corn will remain the usual time in the stomach without alteration; whereas if the husk of the grain be previously taken off, the whole of it will be dissolved. There are many substances likewise which pass unaltered through the intestines of animals, and consequently are not acted upon by the gastric juice. This is the case frequently with grains of oats, when they have been swallowed by horses entire, with their husks on. This is the case likewise with the seeds of apples and other fruits, when swallowed entire by man; yet if these substances have been previously ground by the teeth, they will be digested. It would appear therefore, that it is chiefly the husk or outside of these substances which resists the action of the gastric juice.
This juice is not the same in all animals; for many animals cannot digest the food on which others live. Thus sheep live wholly on vegetables, and if they are made to feed on animals, their stomachs will not digest them: others again, as the eagle, feed wholly on animal substances, and cannot digest vegetables.
The accounts of the experiments made on gastric juice are very various: sometimes it has been found of an acid nature, at other times not. The experiments of Spallanzani show, however, that this acidity is not owing to the gastric juice, but to the food. The result of his experiments, which have been very numerous, prove, that the gastric juice is naturally neither acid nor alkaline. No conclusion, however, can be drawn from these experiments made out of the stomach, with respect to the nature of the gastric juice; nor do the analyses which have been made of it throw any light on its mode of action. But, from the experiments which have been made on digestion, in the stomach, particularly by Spallanzani, the following facts have been established.
The gastric juice attacks the surfaces of bodies, and combines chemically with their particles. It operates with more energy and rapidity, the more the food is divided, and its action increased by a warm temperature. By the action of digestion, the food is not merely reduced to very minute parts, but its chemical properties become changed; its sensible properties are destroyed, and it acquires new and very different ones. This juice does not act as a ferment; so far from it, it is a powerful antiseptic, and even restores flesh which is already putrid.
When the alimentary substances have continued a sufficient time in the stomach, they are pushed into the intestines, where they become mixed with the bile and pancreatic juice, as was before observed. What changes are caused by these substances, we have yet to learn; but there is no doubt, that they serve some important purposes. By the peristaltic motion of the bowels, the alimentary matters thus changed are carried along, and applied to the mouths of the lacteal vessels, which open into the intestines, like a sponge, and by some power, not well understood, absorb that part which is fitted for assimilation, while the remainder is rejected as an excrement.
The lacteal vessels are furnished with valves, which allow a free passage to the chyle from the intestines, but prevent its return. The most inexplicable thing in this operation, is the power which these vessels possess of selecting from the intestinal mass, those substances which are proper for nutrition, and rejecting those which are not.
These lacteal vessels, as was before observed, pass through the mesentery, and their contents seem to undergo some important change in the mesenteric glands. The chyle which passes through vessels, appears to be an oily liquor, less animalised than milk, and its particles seem to be held in solution by the intermedium of a mucilaginous principle. It is conveyed along the thoracic duct in the manner already described, and enters the blood slowly, and, as it were, drop by drop, by the subclavian vein; in this way it becomes intimately mixed with the blood, and combining with oxygen in the lungs, it acquires a fibrous character, and becomes fit to nourish the body.
We have now seen how the process of digestion is performed, at least, so far as we are acquainted with it, and how its products are conveyed into the blood. But to what purposes the blood is employed, which is formed with so much care, we have yet to discover. It seems to answer two purposes. The parts of which the body is composed, namely, bones, muscles, ligaments, membranes, &c. are continually changing: in youth they are increasing in size and strength, and in mature age they are continually acting, and, consequently, continually liable to waste and decay. They are often exposed to accidents, which render them unfit for performing their various functions; and even when no such accidents happen, it seems necessary for the health of the system that they should be perpetually renewed. Materials must therefore be provided for repairing, increasing, or renewing all the various organs of the body. The bones require phosphate of lime, and gelatine, the muscles fibrine, and the cartilages and membranes albumen; and accordingly we find all these substances contained in the blood, from whence they are drawn, as from a storehouse, whenever they are wanted. The process by which these different parts of the blood become various parts of the body is called assimilation.
Over the nature of assimilation the thickest darkness still hangs; all that we know for certain is, that there are some conditions necessary to its action, without which it cannot take place. These are, 1. A sound and uninterrupted state of the nerves. 2. A sound state of the blood vessels. 3. A certain degree of tone or vigour in the vessels of the part.
There remains yet to be noticed another set of vessels, connected with the circulating and nutritive systems, called lymphatics. These vessels are very minute, and filled with a transparent fluid: they rise by open mouths in every cavity of the body, as well as from every part of the surface, and the course of those from the lower extremities, and indeed from most of the lower parts of the body, is towards the thoracic duct, which they enter at the same time with the lacteal vessels already described. They are furnished, like the lacteals, with numerous valves, which prevent their contents from returning towards their extremities.
The minute arteries in every part of the body exhale a colourless fluid, for lubricating the different parts, and other important purposes: and the lymphatic vessels absorb the superfluous quantity of this fluid, and convey it back to the blood.
It must be evident therefore, that, if the lymphatics in any cavity become debilitated, or by any other means be prevented from absorbing this exhaled fluid, an accumulation of it will take place: the same will happen, if the exhaling arteries be debilitated, so as to allow a greater quantity of fluid to escape than the absorbents can take up. When the balance between exhalation and absorption is destroyed, by either or both of these means, a dropsy will be the consequence.
Before we finish the subject of digestion, I shall take a short view of some of the morbid affections, attending this important function of the animal economy.
A deficiency of appetite may arise, either from an affection of the stomach, or a morbid state of the body: for there is such a sympathy between the stomach and the rest of the system, that the first is very seldom disordered, without communicating more or less disorder to the system: nor can the system become deranged and the stomach remain sound.
A want of appetite may arise from overloading the stomach, whereby its digestive powers will be weakened. And this may be occasioned in two ways. First, by taking food of the common quality in too great quantity, which will certainly weaken the powers of the stomach. An excellent rule, and one which if more attended to, would prevent the dreadful consequences of indigestion, is always to rise from the table with some remains of appetite. This is a rule applicable to every constitution, but particularly to the sedentary and debilitated.
The second way in which the stomach may be debilitated, is by taking food too highly stimulating or seasoned; and this even produces much worse effects than an over dose with respect to quantity. The tone of the stomach is destroyed, and a crude unassimilated chyle is absorbed by the lacteals, and carried into the blood, contaminating its whole mass. Made dishes, enriched with hot sauces, stimulate infinitely more than plain food, and bring on diseases of the worst kind: such as gout, apoplexy, and paralysis. "For my part," says an elegant writer, "when I behold a fashionable table set out in all its magnificence, I fancy I see gouts, and dropsies, fevers, and lethargies, with other innumerable distempers, lying in ambuscade among the dishes."
All times of the day are not equally fitted for the reception of nourishment. That digestion may be well performed, the functions of the stomach and of the body must be in full vigour. The early part of the day therefore is the proper time for taking nutriment; and, in my opinion, the principal meal should not be taken after two or three o'clock, and there should always be a sufficient time between each meal to enable the stomach to digest its contents. I need not remark how very different this is from the common practice of jumbling two or three meals together, and at a time of the day likewise when the system is overloaded. The breakfast at sunrise, the noontide repast and the twilight pillow, which distinguished the days of Elizabeth, are now changed for the evening breakfast, and the midnight dinner. The evening is by no means the proper time to take much nourishment: for the powers of the system, and particularly of the stomach, are then almost exhausted, and the food will be but half digested. Besides, the addition of fresh chyle to the blood, together with the stimulus of food acting on the stomach, always prevents sleep, or renders it confused and disturbed, and instead of having our worn out spirits recruited, by what is emphatically called by Shakespeare, "the chief nourisher in life's feast," and rising in the morning fresh and vigorous, we become heavy and stupid, and feel the whole system relaxed.
It is by no means uncommon, for a physician to have patients, chiefly among people of fashion and fortune, who complain of being hot and restless all night, and having a bad taste in the mouth in the morning. On examination, I have found that, at least in nineteen cases out of twenty, this has arisen from their having overloaded their stomachs, and particularly from eating hot suppers; nor do I recollect a single instance of a complaint of this kind in any person not in the habit of eating such suppers.
The immoderate use of spirituous and fermented liquors, is still more destructive of the digestive powers of the stomach; but this will be better understood, when we have examined the laws by which external powers act upon the body. The remarks I have made could not, however, I think, have come in better, than immediately after our examination of the structure of the digestive organs, as the impropriety of intemperance, with respect to food, is thus rendered more evident.
The appetite becomes deficient from want of exercise, independently of the other causes that have been mentioned. Of all the various modes of preserving health, and preventing diseases, there is none more efficacious than exercise; it quickens the motion of the fluids, strengthens the solids, causes a more perfect sanguification in the lungs, and, in short, gives strength and vigour to every function of the body. Hence it is, that the Author of nature has made exercise absolutely necessary to the greater part of mankind for obtaining means of existence. Had not exercise been absolutely necessary for our well being, says the elegant Addison, nature would not have made the body so proper for it, by giving such an activity to the limbs, and such a pliancy to every part, as necessarily produce those compressions, extensions, contortions, dilatations, and all other kinds of motion, as are necessary for the preservation of such a system of tubes and glands.
We may, indeed, observe, that nature has never given limbs to any animal, without intending that they should be used. To fish she has given fins, and to the fowls of the air wings, which are incessantly used in swimming and flying; and if she had destined mankind to be eternally dragged about by horses, her provident economy would surely have denied them legs.
The appetite becomes deficient on the commencement of many diseases, but this is to be looked upon here rather as a salutary than as a morbid symptom, and as a proof that nature refuses the load, which she can neither digest nor bear with impunity.
In healthy people the appetite is various, some requiring more food than others; but it sometimes becomes praeternaturally great, and then may be regarded as a morbid symptom. The appetite may be praeternaturally increased, either by an unusual secretion of the gastric juice, which acts upon the coats of the stomach, or by any acrimony, either generated in, or received into the stomach, or, lastly, by habit, for people undoubtedly may gradually accustom themselves to take more food than is necessary.
The appetite sometimes becomes depraved, and a person thus affected, feels a desire to eat substances that are by no means nutritious, or even esculent: this often depends on a debilitated state of the whole system. There are some instances, however, in which this depravity of the appetite is salutary; for example, the great desire which some persons, whose stomachs abound with acid, have for eating chalk, and other absorbent earths: likewise, the desire which scorbutic patients have for grass, and other fresh vegetables. Appetites of this kind, if moderately indulged in, are salutary, rather than hurtful.