August 1,
DK. PAKKES' CEO ONIAN LECTURES.
1871.]
substances of the food
DR. PARKES' CROON IAN LECTURES.
strongly urge that these admirable lectures attentively studied by members of the medical profession ; they seem to us to have a special value for those engaged in practice in India, on account of the evidence they contain regarding the formation of urea in the liver, and the other glandular organs of the body, and we need hardly remark how deeply concerned those working in this country must be,?to gain information relating to the functions of the be
liver in health and
We would also call attention to
disease.
"
the fact that in these lectures Dr. Parkes states that
nearly
years ago in India I examined the urine in a number of cases of hepatitis and hepatic abscess; and while I found
thirty
that in
some
instances there
abundance of urea, in others
was
scarcely any, and in some it appeared to be wanting altogether." These observations were made long since in this there
was
country, and have been continued with energy and perseverance, being given in these most valuable Croonian lectures ;
the result but
this
during
period
field afforded to medical
of
years, vast
thirty
in this country,
men
as
has been the do not meet
we
single Indian officer among the references Parkes, by investigations bearing 011 the important subject alluded to by him in the above quoted extract. We do not say that the urine has not been examined and perhaps systematically in such cases, but where are the records ? with the
made
name
of
a
Dr.
to
Dr. Parkes demonstrates in the first instance that the exit from the
of
adult is
governed by the amount consumed as food ; aud to a very small extent by the muscular and nervous action of the body itself. The elimination of nitrogen, therefore, is not perceptibly increased or diminished by exercise or by rest, but is directly in proportion to the amount a person eats; for instance, supposing a man consumes about 13 ounces of meat, one pound of bread, 13 of
nitrogen
body
a
healthy
of potatoes, 3 ounces of sugar, one of butter and 6 ounces of milk per diem, which would be equal to about 270 to 302 grains of nitrogen, we shall find that of this quantity 26 grains
ounces
are passed by the bowels, and no less than 271 grains by the kidneys as urea. The question arises,?where does the conver-
sion of the albuminous substances of the food into urea take place ? It can hardly occur in the muscles, for if so, the quantity eliminated during active exercise, or in diseases such as
tetanus, would be increased, but this is not the case ; nor is there any evidence that the change in question takes place in the action of the nervous system. But Dr. Parkes thinks that there
is evidence that it is in the
is transformed into urea; and
gland
we
the liver stands in the first rank
may as
cells that the albumen "
fairly
conclude that
agent of this
an
;
and
blood-cells, and perhaps other glandular same way, though naturally in a less marked
that the
and
splenic bodies, act in the degree. It may also
be inferred from the absence of urea in
the muscles that when the albuminous substance of the muscle needs repair, this is not done by transformation into urea in situ, but that the physically altered albumen passes into the
circulation,
is
inapt
for further
appropriation by
and nerves, and becomes the food or prey,
gland-cells
in the liver and other
these conclusions of Dr. Parkes
disease; for,
as
so
to
muscles
speak,
of the
parts."
It is not difficult to understand how
treatment of
are those which are chiefly concerned growth and repair ; while the non-nitrogenous substances are especially, though not solely, concerned 111 the evolution of energy; we can get work out of the fully formed organs of the body by feeding them on fat and carbo-hydrates, but wo cannot cause growth and development on food of this description. On the other hand, would it not be possible to starve In reply Dr. Parkes writes "that the an overgrowing part?
in
We cannot too
should
167
extremly important
are
in reference to the dietetic
he
remarks, the albuminous
heart may be thus starved I cannot from But could not the rapidly growing cells of the
or
proliferating
cells of
a
mucous
evidence doubt. an
irritated liver, be thus
membrane,
In can we not go beyond this ? over-feeding simple explanation of many enlarged livers, and in starvation from nitrogen possess the readiest and simplest cure. We often beneficially use what are called sustaining and restorative measures. May we not both sustain and starve, that is to sny, can we not feed the body with fats and starches, from which heat and motion may be formed, and yet starve it for a time by holding back the chief material of growth?the nitrogen, without which growth is impossible ?" With reference to alcohol, it seems certain from Dr. Parkes' recent experiments, that it by no means lessens the expenditure of nitrogen, by storing it up for future work as some suppose. In pyrexia the nutrition of the muscular and nervous systems are evidently impaired ; the muscles, in fact, are known in some forms of fever to undergo granular degeneration ; the starved ?
But
have the
we
weakened powers of the mind
are
evidence of nervous im-
pairment ; on the other hand, the liver, spleen and other glands often increase rapidly in size. There is increased elimination of nitrogen, far in excess of that supplied as food? often thirty times as much?evidently from the wasting muscles and nerves, which in fever give up their nitrogen as albumen to the blood, and this being converted into urea, and at the same time feeding the glandular organs causes their increased bulk. The greater the development of the muscular system before the attack of fever, the greater will be the loss of bulk, and the severer in proportion the complications of the liver and spleen, and the greater the danger of their overworked cells giving way, and the half changed albuminoid matters being retained in the blood and deposited in organs, giving rise to secondary disorders, and producing those complications which In ague, doubtless, a special are known to be so dangerous." condition exists for the rapid enlargement of the spleen. Considerations such as these hardly justify us in prescribing the animal diet so much in vogue in pyrexia; soups, or rather the albumen they contain, can hardly be apijropriated by the muscular and nervous tissues of the body while in a process of disintegration, as they are in fever; on the other hand, fats "
seem
any
to
rate
aid the formation of form
a
organ-albumen,
and should at
part of the diet of fever patients.
The carbo-
hydrates, such as starches and sugar, are invaluable, evidently furnishing, as they do, force to the heart and other muscles. Deaths in the Provinces of Oude.?The death-rate for the month of March was,?per 1,000,?cholera 0 0, small-pox 0 05, fevers 0'86, bowel complaints 0-08, injuries 0 05, all other There were 115 deaths from suicide causes 0 05; total 1-14. (65 males and 50 females) ; 59 from wounds (34 males and 25 females) ; 357 from accident (182 males and 175 females) ; 74 from snake-bite and wild animals (47 males and 27 females).
Population 11,223,581.
DK. PAKKES' CEO ONIAN LECTURES.
1871.]
substances of the food
DR. PARKES' CROON IAN LECTURES.
strongly urge that these admirable lectures attentively studied by members of the medical profession ; they seem to us to have a special value for those engaged in practice in India, on account of the evidence they contain regarding the formation of urea in the liver, and the other glandular organs of the body, and we need hardly remark how deeply concerned those working in this country must be,?to gain information relating to the functions of the be
liver in health and
We would also call attention to
disease.
"
the fact that in these lectures Dr. Parkes states that
nearly
years ago in India I examined the urine in a number of cases of hepatitis and hepatic abscess; and while I found
thirty
that in
some
instances there
abundance of urea, in others
was
scarcely any, and in some it appeared to be wanting altogether." These observations were made long since in this there
was
country, and have been continued with energy and perseverance, being given in these most valuable Croonian lectures ;
the result but
this
during
period
field afforded to medical
of
years, vast
thirty
in this country,
men
as
has been the do not meet
we
single Indian officer among the references Parkes, by investigations bearing 011 the important subject alluded to by him in the above quoted extract. We do not say that the urine has not been examined and perhaps systematically in such cases, but where are the records ? with the
made
name
of
a
Dr.
to
Dr. Parkes demonstrates in the first instance that the exit from the
of
adult is
governed by the amount consumed as food ; aud to a very small extent by the muscular and nervous action of the body itself. The elimination of nitrogen, therefore, is not perceptibly increased or diminished by exercise or by rest, but is directly in proportion to the amount a person eats; for instance, supposing a man consumes about 13 ounces of meat, one pound of bread, 13 of
nitrogen
body
a
healthy
of potatoes, 3 ounces of sugar, one of butter and 6 ounces of milk per diem, which would be equal to about 270 to 302 grains of nitrogen, we shall find that of this quantity 26 grains
ounces
are passed by the bowels, and no less than 271 grains by the kidneys as urea. The question arises,?where does the conver-
sion of the albuminous substances of the food into urea take place ? It can hardly occur in the muscles, for if so, the quantity eliminated during active exercise, or in diseases such as
tetanus, would be increased, but this is not the case ; nor is there any evidence that the change in question takes place in the action of the nervous system. But Dr. Parkes thinks that there
is evidence that it is in the
is transformed into urea; and
gland
we
the liver stands in the first rank
may as
cells that the albumen "
fairly
conclude that
agent of this
an
;
and
blood-cells, and perhaps other glandular same way, though naturally in a less marked
that the
and
splenic bodies, act in the degree. It may also
be inferred from the absence of urea in
the muscles that when the albuminous substance of the muscle needs repair, this is not done by transformation into urea in situ, but that the physically altered albumen passes into the
circulation,
is
inapt
for further
appropriation by
and nerves, and becomes the food or prey,
gland-cells
in the liver and other
these conclusions of Dr. Parkes
disease; for,
as
so
to
muscles
speak,
of the
parts."
It is not difficult to understand how
treatment of
are those which are chiefly concerned growth and repair ; while the non-nitrogenous substances are especially, though not solely, concerned 111 the evolution of energy; we can get work out of the fully formed organs of the body by feeding them on fat and carbo-hydrates, but wo cannot cause growth and development on food of this description. On the other hand, would it not be possible to starve In reply Dr. Parkes writes "that the an overgrowing part?
in
We cannot too
should
167
extremly important
are
in reference to the dietetic
he
remarks, the albuminous
heart may be thus starved I cannot from But could not the rapidly growing cells of the
or
proliferating
cells of
a
mucous
evidence doubt. an
irritated liver, be thus
membrane,
In can we not go beyond this ? over-feeding simple explanation of many enlarged livers, and in starvation from nitrogen possess the readiest and simplest cure. We often beneficially use what are called sustaining and restorative measures. May we not both sustain and starve, that is to sny, can we not feed the body with fats and starches, from which heat and motion may be formed, and yet starve it for a time by holding back the chief material of growth?the nitrogen, without which growth is impossible ?" With reference to alcohol, it seems certain from Dr. Parkes' recent experiments, that it by no means lessens the expenditure of nitrogen, by storing it up for future work as some suppose. In pyrexia the nutrition of the muscular and nervous systems are evidently impaired ; the muscles, in fact, are known in some forms of fever to undergo granular degeneration ; the starved ?
But
have the
we
weakened powers of the mind
are
evidence of nervous im-
pairment ; on the other hand, the liver, spleen and other glands often increase rapidly in size. There is increased elimination of nitrogen, far in excess of that supplied as food? often thirty times as much?evidently from the wasting muscles and nerves, which in fever give up their nitrogen as albumen to the blood, and this being converted into urea, and at the same time feeding the glandular organs causes their increased bulk. The greater the development of the muscular system before the attack of fever, the greater will be the loss of bulk, and the severer in proportion the complications of the liver and spleen, and the greater the danger of their overworked cells giving way, and the half changed albuminoid matters being retained in the blood and deposited in organs, giving rise to secondary disorders, and producing those complications which In ague, doubtless, a special are known to be so dangerous." condition exists for the rapid enlargement of the spleen. Considerations such as these hardly justify us in prescribing the animal diet so much in vogue in pyrexia; soups, or rather the albumen they contain, can hardly be apijropriated by the muscular and nervous tissues of the body while in a process of disintegration, as they are in fever; on the other hand, fats "
seem
any
to
rate
aid the formation of form
a
organ-albumen,
and should at
part of the diet of fever patients.
The carbo-
hydrates, such as starches and sugar, are invaluable, evidently furnishing, as they do, force to the heart and other muscles. Deaths in the Provinces of Oude.?The death-rate for the month of March was,?per 1,000,?cholera 0 0, small-pox 0 05, fevers 0'86, bowel complaints 0-08, injuries 0 05, all other There were 115 deaths from suicide causes 0 05; total 1-14. (65 males and 50 females) ; 59 from wounds (34 males and 25 females) ; 357 from accident (182 males and 175 females) ; 74 from snake-bite and wild animals (47 males and 27 females).
Population 11,223,581.
