A treatise on those diseases which are either directly or indirectly connected with indigestion: comprising a commentary on the principal ailments of children

Front matter

ACCESSION NUMBER

PRESS MARK

Ui'/IKS, D.

Preface

The history of the present publication is soon told. A friend, who conducts one of the Journals, requested me to draw him up a paper on the popular subject of di¬ gestion ; and while occupied in complying with this request, it occurred to me that a treatise, somewhat more excursive in its plan than any of those with which my duties as a reviewer brought me into contact, might, if properly executed, be well received. 1 found, indeed, an intimation to this effect in one of the tracts that came under critical examination - — an intimation which I have transcribed on my own title-page, and which may be received as an apology for the under¬ taking now submitted to the judgment of the public.

With respect to the execution of the work, apology were useless. Readers will think for themselves, in spite of what authors

b

VI

PREFACE.

advance in the way of extenuation ; and all attempts to soften the severity of criticism are, as they ought to be, vain and nugatory.

My principal apprehension in regard to manner is this, that while aiming at strength I have been betrayed into harshness ; and that I have not appeared always sufficiently careful to take as a guide, both for sentiment and expression, that liberality which ought to characterise every thing connected with a liberal profession. If such be the feeling of my reader, I earnestly request that he will refer to the imperfection of mode what he thus finds objectionable in point of matter. I am too deeply convinced of the impropriety of dogmatism to be myself dog¬ matic ; and although I should never wish unduly to compromise, I never would desire imperiously to dictate.

Differences of opinion must, and ever will, exist among the cultivators of a science which is so very far removed from what the French call eocact ; but these differences ought always to be entertained and ex¬ pressed under a liberal conviction, that variety in creed (in medicine at least) need not interfere with feelings of friendship,

PREFACE.

Vll nor even break in upon the mutuality of esteem.

I have been thought, in some previously published strictures, to allude with unjusti¬ fiable severity to a class of men who are among the most honourable, the best informed, and demonstrably the most useful, of which so¬ ciety can boast. If that be the case, it is with the utmost readiness that I cry out peccavi ; for, although I should hope to be one of the last in caring about abuse, or in truckling to popular feeling, I would be the first and foremost (if I know any thing of the constitution of my own mind) in listen¬ ing to respectful remonstrance, and bowing to kindly rebuke.

A retraction of expression does not, how¬ ever, imply a recantation of principle ; it still does appear to me, that individuals who devote their time and talents to the higher departments of surgical science, are not those into whose hands the practice of what is called medicine, in contrast with surgery, would be best committed. It has been urged, that there is a manifest inconsistency in acknowledging the surgeon-apothecary to be a legitimate practitioner, and not extend-

Vlll

PREFACE.

ing the same admission to the surgeon him¬ self. But the cases are not parallel. The education and habits of what is called, in the present day, a general practitioner, are precisely such as to consitute him the best practitioner in general ; and although it appears to me that the dignity and rank of the profession would be most securely main¬ tained by withholding its highest honours from those who, whatever may be their talents and acquirements, have not been liberally educated ; and although I would contend for the separate rights and privi¬ leges of the separate departments of prac¬ tice, — I would freely and fully admit the rectitude of an opinion, expressed nearly half a century since by a learned physician, that “ the best schools for medicine, after all, are an apothecary’s shop and a London hospital.”

But in both departments, it would surely appear consistent with the occasional diffi¬ culties, uncertainties, and perplexities of practice, that referee practitioners should exist ; and in respect to surgery, I must feel, that excellence in its pathological and opera¬ tive department requires such an exclusive

PREFACE.

IX occupation of mind upon certain particulars as is inconsistent with pharmaceutical details, ready habits of discernment in disease, or more reflective and generalising powers, brought to bear upon the same subjects. The omniasm, however, of the present day, must, even if ill founded, be attended with this good, that it will give freer scope for the scramble of talent, and will incite the student of medicine to be attentive, during his studies, to all its branches, and thus properly prepare himself for any one or more that the development of his feelings, or the destiny of his fortune, may, in after life, appropriate to him. Even the oculist, the dentist, and the aurist, ought to be well informed both in physic and surgery ; for, although excellence in their art implies mechanical tact, while to the physician be¬ longs observation, and reflection, and general science, nothing that has to do with the living body can, with propriety and effect, be undertaken and pursued upon the prin¬ ciples merely of mechanism, or in the spirit of a mere artisan. Sed hcec hactenus — ^. preface to a small tract must not be mag¬ nified into a dissertation on medical art, nor

X

PREFACE.

converted into a disquisition on distinction and degrees in medical science.

I will just further say, that my little book has no loftiness of pretension. The habits of the times seem to sanction three distinct species of medical writing. One erudite and technical, and exclusively calling upon professional readers ; a second the con¬ trast to this, avowing its design of making every man his own physician;” and a third being only so far professional as to be readable by the professions, and only so far popular as to be interesting to the man of general intelligence. It is in the third class that I design to rank the present attempt; and whether its plan and exe¬ cution be worthy of its rank, I must, of course, submit to the decision of others.

CHAPTER II. Anatomy of the Digestive Apparatus . 11

Physiology . 13

Blood-vessels of the Stomach, &c . 17

Office of the Spleen . . . i . 18

Nerves of the Digestive Organs, &c . 20

Dr. Philip’s view of the Nervous System . 23

Mr. Charles Bell’s arrangement of the Nerves . 24

Peculiarities of the Central Nerves . 27

Nervous and Bilious Disorders . 28

CHAPTER III. Varieties in Temperament, or Constitutional Susceptibilities 31

Nervous and Sanguine Temperament . 32

Nature of Scrofula . 33

Principles of Medicinal Action . 34

Xll

CONTENTS.

Page

Humoral Doctrines . 36

French and English Practice . 38

Medical Scepticism . 39

Medicine demonstrably useful . 40

CHAPTER I. Effects of Indigestion in Children . 42

Atrophy and Brain Disorder, how connected . 45

Diet best adapted for Infants . 47

Action of Foxglove in Children’s Diseases . 50

Combination of Foxglove with Deobstruents . 53

Water in the Brain more directly induced . 60

Croupal breathing in Brain Disorder . 61

Remedies for Water in the Brain . . 65

Convulsions in Infancy . 66

Limits of Blood-letting in Convulsions . 68

Action of Opium in Children’s Complaints . 69

Warm Bathing, &c . 70

Ventilation and Change of Air . 73

Worms . 77

Mode in which they are generated, and principles upon

which they should be counteracted . 79

Affections of the Skin . 83

Sympathy between the Surface of the Body and Stomach. . 84

Treatment of Cutaneous Disorder . 87

St. Anthony’s Fire and Measles . 91

Ammonia in these Affections . 92

Hooping-cough, external and internal Remedies for . 95

Parts affected in Hooping-cough . 98

Convulsions in Hooping-cough . 100

COf^TENTS.

xiii

Page

Change of Air . . 101

Croup, its Nature and Treatment . 102

Its tendency to recur . 105

CHAPTER II. Origin of Consumption . 107

Dyspeptic Consumption ? 108

Varieties in Consumption . . . . 109

How is Tubercle formed ? . . . . 112

Objections to extreme Abstinence . 114

Contrary Error of Excess . 115

Change of Climate in Consumption . 119

Spitting of Blood (Note) . 120

Atmosphere suited for the Consumptive . 121

Remedies for Consumption . 123

Hardening Method of Treatment . . . 128

CHAPTER III. Asthma . 130

Connexion of Asthma with Indigestion . 131

Galvanic Phenomena as explicatory of an Asthmatic Fit . . 134

Importance of a regulated Diet in Asthma . . . . 136

Preventives of Asthma . 137

Remedies for Asthma . . . 138

Curious Effects of Stramonium . 140

Tendency of Asthma to produce Water in the Chest (Note) 143

Affections of the Heart . 144

Difficulty of distinguishing between Functional and Organic

Derangement . 145

Medicine gradually available . 148

Angina Pectoris . 149

XIV

CONTENtS.

Page

Ammonia in Affections of the Heart . 153

Connexion between the Stomach, Respiratory, and Cardiac Nerves, as explanatory of sudden Deaths and of Heart

Disorder . . 156

Apoplexy . . 159

This disorder not always occasioned by Pressure on the

Brain . 160

Blood-letting in Apoplexy? . 163

Emetics and Stomach Pump? . 165

Epilepsy . 170

Action of Nitrate of Silver ? (Note) . 174

Tic Douloureux, large doses of Iron for . 175

Sick Headachs . 177

Mental Disorder . 178

Brain and Stomach Conditions in . 179

Liver Affection . 181

Jaundice . 183

Affections of the Spleen . 186

Diabetes, is it a Stomach Disorder ? . 187

Treatment . 189

Gravel, how far connected with the Stomach ? . 190

Caustic and mild Alkalies, Magnesia, and Acids . 193

Gout, connected with Calculous Disorder . 196

Treatment . 200

CHAPTER IV. Differences between Sympathetic and other Disorders .... 201

Remarks on the Pulse . 202

State of the Spirits . 205

Appearances of the Countenance . 206

Emaciation . 207

Difference in the Perspirations . 208

CONTENTS,

XV

Page

Variety of Pain . . .

Anticipation of the Sufferer . 210

Medicine a Practical Art . 211

Part The Third, Chapter L

Digestion, &c. popularly considered . . 213

Ultra Doctrines in respect to Diet . . 215

Questions respecting the Constituents, &c. of Digestion and

Indigestion . 218

Nature of the Gastric Juice . . . 219

Digestion a Peculiar and Vital Process . . . 221

Rationale of Hunger . 224

Of Thirst . 225

Quantity of Food ? . 226

Fatal Abstemiousness . 228

Objections to Animal Food, moral and physical . 229

These objections replied to . 230

Drink with Meals ? . 232

Fermented Liquors . 233

China Tea — is it injurious ? . 234

General Rules for Diet . 235

CHAPTER II.*

Indigestion — Causes and Preventives . 237

Stages of Indigestion ? 239

Pain not necessarily inflammatory . 240

Stomach not prone to Inflammation . 241

Over-feeding a cause of Indigestion . 243

XVI

CONTENTS.

Page

Fast Eating . 244

r T 4

Impure Air . 245

Exercise, mode and times of? . 246

Friction and Sponging of the Surface . 248

Warm, Cold, and Sea Bathing . 249

University Studies . 250

Warm Clothing — Wash-Leather . 251

Ardent Spirits, Anecdotes respecting . 253

Opium, Tobacco, and Spices . 255

Mental Exertion — partly in the power of the Individual . . 256 Melancholy the result of Pride, &c. (Note) . . . 257

CHAPTER III.

Remedies for Indigestion . 258

Aperients and Alteratives . 259

Blue-Pill and Bitters . 260

Acids and Peruvian Bark . 261

Galvanism . 262

Remedies for the second stage of Indigestion — Antimony

and Nitre . 263

Ammonia . 265

Colchicum in Stomach Rheumatism . 266

White Mustard Seed . ‘ . 267

Popular Theories (Note) . 268

Bismuth . 270

Structural Disorder at once promoted and suspended by

nervous excitement — Case of Napoleon . 271

A

TREATISE,

ETC. ETC.

CHAPTER 1. Introductory, — Medical Theories

It has often occurred to me, that the most tenable ground upon which the sceptical objector against the claims of medicine might make his stand, is that of the continued differences of opinion among systematic theorists. If some assert that dis- ^ order is general, while others contend for its local and partial origin or essence ; if one indi¬ vidual refers you to the stomach, and another to the brain, and another to the fine membrane which lines internal surfaces, as the parts upon which disordered impulse directs primarily and principally its operations,— -what security am I to

B

DISEASE VARIOUSLY MODIFIED.

have, might the lay oppugner of our science say, that any of these principles or propositions are correct or substantiate? And with respect to the practical inferences which are drawn from them, how awfully distant from the right point may that physician be who is forming his reme¬ dial indications from an erroneously conceived locality, who is supposing the malady partial, when it is, in fact, universal ; or who is looking into the liver, when he ought to be considering the brain !

A great deal, I think, of this objection to the correctness and value of the medical art might be done away with, did its systematic professors recognise the variable nature and incidental sus¬ ceptibilities of disordered essence and cause; and did they take into account, that physical and moral man is so constituted as to modify dis¬ ordered manifestation to an extent very far beyond definable limits; as, indeed, to change circum¬ stance into cause, cause into effect, incident into essence, and essence into incident, almost ad nitum.

If I am asked whether I subscribe to the doctrine of Clutterbuck or Broussais, I reply, to both, and to neither. Does any one appeal to me on the disputed point, whether asthma and hooping-cough are affections of the stomach or the lungs, I say that they are both, and they are neither. Even the much-disputed point of conta¬ gion, is only, as it seems to me, susceptible of

THEORY INFLUENCING PRACTICE.

any thing like satisfactory solution, by assuming that fever is at once communicable and not com¬ municable, contagious and not contagious : and all these discrepancies in disease, let it be duly observed, are referrible not so much to difference (except in degree) of excitant, as to the consti¬ tutional and circumstantial variety of condition with which the excitant is engaged.

In looking, then, for the abstract essence of disease, we look for what is not in nature. We commence from a petitio principn, and fill volumes with unmeaning controversies and absolute no¬ things. Were this, indeed, the extent of the mischief, the error in principle might be per¬ mitted to pass without deprecation or censure ; but the progress of science is obstructed, the use¬ fulness of the healing art abridged, and medicine brought into unnecessary obloquy, by such dispu¬ tations as those to which allusion is now made.

Medical science is, indeed, of such a nature that a great deal of what is good in practice will occasionally connect itself with what is futile

\f

or even false in theory : it so happens, moreover, that the process of reduction or excitation is not seldom the same, whichever part of the system you may suppose demands especially to be re¬ duced or excited : but it must not be concealed, on the other hand, that a partiality to a particular code of medical precepts, obstructs, in too many instances, the exercise of what we may term em-

MUCOUS membrane” mania.

pirical good sense ; and gives a bias to practice, injurious to the interests of the practitioner, and detrimental to the well-being of the patient. I can well recollect the time that, when fresh from a school in which excitement was taught^ I obeyed the commands of its dicta too much, in defiance of what my better or untrammelled judgment would have told me to be the truth of the case ; and it is but a very little time since, that I was struck with the statement of a sensible physician whom I met in the street, which was to the following effect : — I have just seen two patients who were sinking into the arms of death under the timid practice of " mucous membrane ’ assumption ; I have administered to them medicine and diet of a supporting cordial nature, have left the ‘ mucous membranes ’ to shift for themselves, and have the satisfaction to find that the individuals are rapidly recovering from a needlessly protracted ailment.”

If I add to this instructive anecdote another, which places in a still stronger point of view the mischievous influence which certain principles have upon the minds of men of sense and science, I shall go far to excite the scepticism of some of my readers as to its truth ; but I am induced to present the statement as it was made to me, from the conviction I feel, that one of the greatest benefits to be conferred upon a medical student is that of warning him against the passive adop-

STOMACPI EXTRAVAGANCES.

tion of any particular creed which the ability, ^ although wrong-headedness, of his instructor shall have impressed on his plastic mind. My story is as follows : — A convalescent from fever unexpect¬ edly relapsed ; the reason of this was puzzling to his physician, until he accidentally cast his eye upon a jar which contained the remains of some currant jam, part of which the patient had been swallowdng. Now, says our theorist, all is clear, eureka, the seeds of the fruit have irritated the mucous membrane of the stomach and bowels, and the disorder has returned upon us in con¬ sequence of this irritation !”

Equally outre as this are many of the sto¬ mach’' tales with which every company you fall into is constantly entertained usque ad nauseam; some of them of course highly coloured, but others correctly narrated ; and let it be observed that the individuals who propound and propagate these extravagances do not appear to do it in the spirit of charlatanisim, or in the way of trying how far the gullibility of the public will go. No, they are men of intellectual excellence and moral worth ; and we have every right to suppose their prin¬ ciples are the results of their convictions, and that they imagine themselves teaching important truths and legitimate doctrines. Nay, the prin¬ ciples and doctrines are true, and are important to a certain extent ; and it is only in these, their

NOSOLOGY, OBJECTIONS AGAINST.

ad-absurdum extremes, that the most sober and judicious can object to them.

The naming or classifying error is the one to which I would next allude, as calculated to per¬ petuate unjust notions, and to vitiate medical theory. Nosology is nonsense, if the word be meant to convey the feeling that you can bring the multifarious items of disordered action and being into the compass of a system, in the same way that you proceed when the objects of your endeavours are the objects which come under the cognizance of what is called natural history. We might almost as well expect to see two human countenances precisely similar, as to witness a complaint capable of being traced and characterized through all its shades, and bearings, and varieties, by an abstract term. Scarcely can the indefinite, much less the definite article, be applied to disease. Is my malady the fever, the asthma, the scrofula, the epilepsy ? are questions conceived and put too much in ignorance and misunderstanding ; and although this sort of language is still sanctioned by pro¬ fessional usage, it will, I imagine, become more and more obsolete, as just and clear views in pathology break more and more upon our view.*

* The exception to, or qualification of, this principle will occur to every one in the instance of what are called specific disorders, or those affections which invariably originate from

MORBID ANATOMY.

If, then, to name a disease be, in one sense, to commit an error, how can we, with any thing like propriety, imagine the power of abstract classifi¬ cation ? And yet there are men among us, and some of our first men too, who gravely fill pages full of nosological disquisition as to what class, and order, and genus, and species, a disease natu¬ rally and properly belongs.

Another error in medical philosophy arises out of a false appreciation of what is termed morbid anatomy — and this is especially the error of modern times. Let not my reader take fire. Let not the ardent student in anatomy for a moment suppose that I would intimate the pos¬ sibility of learning medicine as we ought to learn it, or practising it as it behoves every honest man to practise it, without a thorough knowledge of structure, and an intimate acquaintance with those changes in structure which diseased action in-

a peculiar source — as the small-pox, the measles, the hooping-cough, &c. But even these exceptions I take to be more limited than is generally supposed. In a paper which my late esteemed friend, Mr. Gifford, did me the honour of publishing some time since in the Quarterly Review, I ventured to suggest, that there is probably too much division employed even in affections manifestly acknowledging a specific origin. I there stated that, in my judgment. Dr. Thomson was quite right in contending for the essential identity of small-pox, cow-pox, and chicken-pox — the varieties being referrible to time, place, and circumstance; and I also stated my opinion, that even small¬ pox and measles were originally one and the same disorder.

VARIOUS SOURCES OF ERROR.

duces. But there are morbid anatomy as well as nosological trammels.

Many, many changes, however, take place in the condition of our frames, both topically and generally, of which mere structural reasoning can have no cognizance : then, again, when you do detect altered form, after protracted disorder, you cannot always say how far this change has been cause, or consequence, or incident ; so that infer¬ ring from what you see after death not seldom leads to fallacious conceptions of the circum¬ stances and requisites during life. Your mere morbid anatomist seems constantly to feel and to act under the impression that nothing can take place but what implies formative and vascular, and visible and tangible change : if it is not with him the mucous membrane,” it is some other portion of the body’s structure, which is subjected to the influence of active irritation ; and all medi¬ cinal indication that is not based upon an anti¬ inflammatory foundation is to his conception erro¬ neous or inapplicable.

Thus it may be seen how likely error is to assail us on all sides, unless we duly recognise the peculiar nature and limits of our art and science. The metaphysical, abstract, nosological physician prescribes by rule, in defiance of recog¬ nition, and practises upon principles that have

CONSTITUENTS OF A GOOD PHYSICIAN. 0 an imaginary base ; the organic theorist limits his observations to a part, when he should be taking a survey of the whole; the hasty generaliser is mischievously regardless of parts and peculiarities ; and the morbid anatomist can never be brought to appreciate any thing but structural and inflammatory ailment.

While the individual who shall have been made duly sensible of the conjectural and com¬ plicated nature of the healing art ; who shall be cautious against a too hasty deduction from iso¬ lated facts ; who shall understand that membranes and organs are often affected by their connexion, so to say, with the whole physical and moral construction ; who shall, at the same time, receive and appreciate the fact, that topical derange¬ ments may be of sufficient power, under certain general susceptibilities, to derange the whole har¬ mony of the system; — this man will prove the purest and ablest physician, coming, as we must suppose him to come, to the bed-side of his patient well imbued with all the collateral know¬ ledge which the word medicine in its extent of signification implies ; having well studied and learned anatomy, in connexion with physiology and pathology — having taken every opportunity of observing the mode in which disordered action implicates or alters structure — having paid due attention to the qualities and actions of medicinal substances, both in their simple agency and com-

10 APOLOGY FOR THE PRESENT INTRODUCTION.

bined effects — and having, above all, been studi¬ ously observant of the physiognomy of disease, and studiously attentive to learn in the school of clinical experience what neither the ex cathedra instruction of the professor can convey, the dis¬ secting-room supply, nor a whole museum of morbid preparations teach. Ne nimis illinc luxurietur animus, ne nimis hinc arescat ; tota fer^ cum sit in eo medicinae vis, quo, tanquam machinatione aliqua, moventur artis instrumenta.”^

If there be any propriety in the preceding remarks, they will not, it is hoped, be deemed an inapplicable preliminary to a treatise which goes upon the principle of breaking through the bound¬ aries of nosological niceties — treating of disease not so much in the abstract, or by name, as by nature — and recognising the latter clause espe¬ cially of the motto found on its title-page, viz.

that more than half the cases we meet with in practice (might not our author have enlarged the number ?) are comhinations of diseases, rather than simple diseases.”

PHARYNX AND LARYNX.

CHAPTER 11.

Anatomical and Physiological Sketch of Parts and Organs more immediately connected with the Stomach.

It is to the distribution of the blood-vessels and nerves, especially the latter, that we are now principally to call the attention of the reader; but, in order to make this subject more intelli¬ gible and interesting, it will be right to present a preliminary sketch of those parts generally that are concerned in the process of digestion and assimilation.

This organization commences with the mouth and pharynx ; the two principal openings from the latter are that into the larynx, windpipe, and lungs, going downwards and forwards, and that into the stomach through the glottis, or oesopha¬ gus. The pharynx itself is a membranous pouchy which is curiously elevated as it were by the act of mastication, and enlarged in the same way, says a modern author, as the mouth of a cornsack is held for the reception of grain — -and the comparison is not inapt.

Now, when the food is received into this pouch, to be transmitted to the stomach, it necessarily, in its passage, goes over the opening into the

GULLET AND WINDPIPE.

trachea or windpipe ; and accordingly we find that the expansion or elevation of the pharynx forces down what is called the epiglottis, so that in the act of swallowing, the passage leading into the windpipe is closed. After the morsel has passed over, and the gulp is completed, this little body is raised again, partly by its own elasticity, into its natural position, so as to admit air freely into the windpipe.

The oesophagus or gullet, as it passes down to terminate in the stomach, is situated behind the windpipe and before the bones of the neck ; and it must always be recollected that these several parts, beside their contiguity, have a connexion with each other through the media of blood¬ vessels and nerves, — so that an affection of one part frequently induces an affection of the others. It is indeed for the sake of pointing out these intimate associations of organs, that we engage in this slight delineation of their anatomy.

While, then, the windpipe runs down upon the anterior part of the neck, to be expanded ulti¬ mately into the air-cells of the lungs, the gullet descends to terminate in the stomach, which is a membranous pouch, lying across the upper and principally the left side of the abdomen, immedi¬ ately under the musculo-membranous partition by which the cavities of the chest and abdomen are separated ; and from this position we may see how a distended state of the stomach — a disten-

DIGESTION, HOW EFFECTED.

sion beyond its due limits — comes to press upwards upon the lungs, to lessen the cavity of the chest, and in this way to interfere with free and full respiration.

The openings into and from the stomach are curiously constructed ; the latter is especially so formed, and so endued with sensibility, as to permit an easy transit into the intestine of duly prepared aliment ; while aliment not yet having undergone the necessary change, if brought to the orifice, is forced back into the stomach, again to perform its proper round.”

Of digestion itself, in the present place, we shall say nothing further than that the food is made to come successively under the influence of the gastric secretion, — a fluid poured out from the internal surface of the organ ; or, as it is expressed by Dr. Wilson Philip, the layer of food next the surface of the stomach is first digested, and in proportion as this undergoes the proper change, and is moved on by the muscular action of the stomach, that next in turn succeeds, to undergo the same change.”'^

* There is something exceedingly interesting in the mode by which this successive application of portions of food to the surface of the stomach is eftected. It is, indeed, brought about by virtue of that peculiar action which is called peristaltic, and which extends down the whole line of the intestines. When I first read Dr. Philip’s remarks on this particular, in his work on indigestion, I conceived them to be as novel as they are interest-

BILE, AND PANCREATIC FLUID.

From the pyloric, or exit opening of the sto¬ mach, commences the intestinal tube ; but there is a peculiarity in the construction, position, and office of the first of the intestines, named the duo¬ denum, which it is necessary to point out : it is so constructed, in the first place, as to be more fixed in its situation than are the other portions of the intestinal canal ; and it is so circumstanced, that the aliment, already much changed by the action and secretion of the stomach, is here destined to undergo a still further alteration — an alteration partly effected by the internal coat of the gut itself, but more particularly and essen¬ tially by the fluid received from the liver and the pancreas ; the ducts transmitted from these organs terminating in the duodenum, and thus convey¬ ing their respective secretions.