more thoroughly than it has been up to the present, it is just possible that we may by and by find that the digestive ferments, like all other powerful agents, may do much harm as well as much good. 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. And well it is that this should be so, for if the pepsin were not rendered inert it would destroy that pancreatic ferment (trypsin) which acts on albuminous substances, and thus interfere with digestion by it. How far this prolonged peptic digestion and impaired pancreatic digestion of albuminous substances has to do with the production of poisonous digestive products in cases where the quantity of bile poured into the intestine is deficient it is at present impossible to say, but it is a condition which ought to be kept in mind in all cases where there is deficiency of bile in the intestine, and the advisability of nourishing the patient by farinaceous food is constantly considered in these cases.
And now comes the question, How is it that in healthy conditions of the intestine peptones do not pass into the general circulation, and are therefore unable to exert any poisonous action upon the nerve-centers? This question is one which we can not at present answer quite satisfactorily.
Usually the peptones disappear from the portal blood before it reaches the general circulation. Indeed, Ludwig and Schmidt-Mühlheim found that even in the portal blood, before it reaches the liver, very little if any peptone is to be found. They have not succeeded in discovering where the peptone undergoes change. Plósz and Gergyai, and also Drosdorff, have discovered peptone in the blood of the portal vein, and Plósz and Gergyai have been led, by their experiments, to regard the liver as the seat of the transformation of peptones. In consideration of the more recent experiments of Ludwig and Schmidt-Mühlheim, we can not entirely adopt the view of these authors, though it is nevertheless possible that they are to a certain extent right, and that the liver, to some extent at least, serves the purpose of preventing any peptones from getting into the general circulation, which may have escaped transformation in the portal blood before reaching it.[1]
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 de-
- ↑ *Schmidt-Mühlheim, "Archiv für Anatomie und Physiologie; physiologische Abth.," 1. & 2. Heft, 1880, p. 33. Albertoni, "Centralblatt f. d. medicinischen Wissenschaften," 1880, p. 577.
