SOME 
PRACTICAL POINTS 
IKT 
DIGESTION, 
By J. MILNER F0THERG1LL, M. D., 
Senior Assistant Physician to the Victoria Park Chest Hospital, <Jc. 
(Kruui the PRACTITIONER.) 1881. 
I). D. Conies, Printer & Stationer. 
183 Broadway, N. Y. Some Practical Points in Digestion. 
Hy J. MILNER FOTHERG1LL, M. D., 
Senior Assistant Physician to the Victoria Park Chest Hospital, &c. 
The subject of Digestion and Assimilation has 
received a decided impetus from the recent Lumleian 
Lectures delivered before the Royal College of Phy- 
sicians, by Dr. William Roberts, F. R. S. of Manches- 
ter. In considering the digestive ferments and artifi- 
cial digestion, he laid before us lucidly what has 
recently been done by physiological experiment and 
observation, and showed how it bears on practical 
medicine. We all know, only too well, what a large 
proportion of the ailments we are called upon to treat, 
are directly, or indirectly, connected with the digestive 
act. Not only with the digestive organs, but with 
those errors of “interstitial digestion” which produce 
either struma, or tubercle. We all recognize, that 
failure of the digestive tract is now on the increase, ol 
which dental caries is a part only. Why and how 
this failure is becoming so distinct and so widespread 
at present, can scarcely be discussed here. It is suffi- 
cient that we recognize the clinical fact. 
All digestion is a process of solution by hydration; 
i.e. as starch is converted into sugar by adding a mole- 
cule of water to it, under the action of a ferment, so 4 
SOME PRACTICAL POINTS IK DIGESTION. 
the albuminoid “ proteid" is converted in the stomach 
into a “peptone'1'' by a like process of hydration. It 
is easy to see that our food could not very well be 
stored in soluble form by the vegetable world, which 
from ammonia, water and carbonic acid, builds up for 
us starch, sugar, albuminoids, and fats. If soluble in 
water they would constantly be dissolving in rain. So 
they are insoluble, and the digestive act renders them 
soluble, so that they can pass from the intestinal canal, 
through its walls, into the blood first, and from it 
again to the viscera and tissues. Let us take the ca- 
reer of starch. The act of bursting the starch granule 
open by cooking, is a preparatory act of no little value 
in lessening the demand upon the digestive processes. 
This is illustrated by the practice of advanced agricul- 
turists who cook the starchy matters of the food of 
their stock, or ferment them by brewer’s grains. 
Under the influence of the ferment of the saliva starch 
is converted into sugar. This ferment is known as 
“diastase;” and an identical “ferment*'' is produced 
in the process of malting barley, where the starch of 
barley is “ hydrated " into malt. This barley ferment 
is now largely used medicinally for ill-nourished infants 
and invalids, and very useful it is. But the manner 
in which the makers instruct us to use it in their ap 
pended labels, tells how little is really known of the 
body ferments. On huge gallon bottles of maltine 
we read that a teaspoonful must be taken after a meal. 
Now, as it happens, “diastase/’ whether from saliva 
or barley, it matters not, is inactive in the presence of 
an acid; and taken into the acid stomach, as directed, 
it is inert; simply thrown away so far as it is a fer- 
ment, and reduced to the level of other food—no 
longer a digestor and itself to be digested. It is in 
the brief time before starchy matter reaches the acid 
stomach that “ diastase” is active and functually oper- 
ative. What starch reaches the stomach is, in all 
probability, left to be digested by the action of the 
pancreatic ferment. 5 
SOME PRACTICAL POINTS IN DIGESTION 
Well now, what practical lesson is taught us by ihe 
possession of this physiological information? In the 
first place it tells us that children and dyspeptics, as 
well as invalids, should take their food slowly. It 
should not he bolted, even when simple milk and por- 
ridge; it ought to be well chewed in the mouth and 
thoroughly mixed with saliva. In fact, time must be 
given for the saliva ferment to act upon the starch 
in order that it may be operative indeed. And this 
brings us to a matter on which a few words may be 
said with advantage. 
All digestion is a process of solution; but for 
proper perfect solution disintegration is essential and 
indispensable. The food, no matter whether starchy, 
albuminoid, or fat, must be reduced to tiny minute 
particles before the ferments can act efficiently. We 
grind our corn before we cook it. We desintegrate it 
before it is subjected to a process which chemically 
affects it. That is, so much “digestion'’ is actually 
performed upon the food before the digestion of the 
body is brought to bear upon it. So we cook our 
ilesh in order to make it less tough, i.e. in order to 
make the tiny fibrillae of the muscles fall more readily 
asunder. This reduces the act of chewing very con- 
siderably and so reduces the work of digestion. The 
Ilesh of the pig and calf is especially indigestible, be- 
cause it is not readily disintegrated; as dyspeptics 
know to their regret when they have been indiscreet 
enough to partake of either, often when some persua- 
sive woman’s voice has persuaded that “that little 
piece can’t hurt you.” These persuasive women are 
valuable allies for the profession! Cooking and mas- 
tication then reduce the labour of the stomach in dis- 
integration. And again we see how bad teeth, and 
habit of eating, rapidly lead to indigestion. With bad 
teeth mastication is imperfectly performed, and disin- 
tegration by the movements of the stomach rendered 
more difficult, and also painful. The digestion in the 6 
SOME PR A CTICAL POINTS IN DIGESTION. 
stomach is thus converted from a painless, rather com- 
fortable matter, to a painful and uncomfortable matter. 
The food should then be thoroughly chewed for divers 
reasons. 
Now we can profitably return to the matter of the 
effects of artificial diastase. It is quite clear that child- 
ren and invalids should be taught to eat slowly, and 
mix their food patiently with saliva. The dairy farm- 
er’s wife and maids used of old to patiently feed their 
calves “off the finger/’ i.e. they made the calves lick 
the milk from their fingers, and so it got well mixed 
with saliva. But the increasing pace at which we live 
has reached the slow-going agriculturist, and now the 
calves are allowed to bolt their milk, with the natural 
consequence of too firm curds in the stomach, diarrhoea 
to get rid of them, a bottle of medicine to stop na- 
ture’s efforts, and an increased mortality among calves. 
So when children do not eat slowly, their digestive 
processes are embarrassed; and especially is this the 
case where the milk teeth are decayed. 
Then again, in order to aid the defective action upon 
starch by the natural diastase being deficient in quan- 
tity or impaired in power, we add the artificial diastase 
“maltine ” But, as Dr. Roberts points out, in order to 
make this ferment operative, it must not be taken 
after a meal is over. Rather it should be added to the 
various forms of milk porridge or puddings before 
they are taken into the mouth. About this there ex- 
ists no difficulty. Maltine is a molasses-like matter 
and mixes readily with the milk, gruel, &c., without 
interfering either with its attractiveness in appear- 
ance, or its toothsomeness; indeed its sweet taste ren- 
ders the gruel, &c., more palatable. A minute or two 
before the milky mess is placed before the child, or in- 
valid, the maltine should be added. If a certain por- 
tion of baked flour, no matter in what concrete form, 
were added to plain milk, and some maltine mixed 7 
SOME PRACTICAL POINTS IN DIGESTION. 
with it, before it is placed on the nursery table, we 
should hear much less of infantile indigestion and 
mal-nutrition. 
And one practical point must be well borne in mind. 
In the present furor for fluid beef juice now much 
prevailing, beef-tea—the stronger the more beneficial 
of course think the laity; of Liebig’s extract &c., &c., 
the necessity for starchy matters is being quite over- 
looked or, to be very safe, underestimated. These 
meat products furnish, the best of them, little glyco- 
gen, or animal starch, and yet that is the fuel-food of 
the body far excellence. We must be more guided 
by rational knowledge, by physiology, and not by 
fashion in our dietetics. When there is a very feeble 
digestion then the digested milk, and milk gruel advo- 
cated by Dr. Roberts must be employed. Full direc- 
tions for their preparation are provided along with 
each bottle of the Liquor Pancrcaiicus which he ad- 
vocates for artificial digestion. 
Such preparations are indicated when milk curdles 
too firmly in the stomach; and the resultant curd re- 
sists the solvent action of the gastric juice, and passes 
per anum in such quantity that it can be seen in the 
stools. Whether in typhoid fevers, or other condi- 
tions, it is well to attend to this point. For solution, 
disintegration is indispensable, if the curd formed in 
the stomach is too firm to be broken to pieces, then 
the milk cannot be digested. When such firm curd- 
ling is present, whether in child or adult, then it must 
be dealt with. In milder cases equal quantities of 
milk and lime water, with a teaspoonful of baked Hour 
mixed in each pint, will check the excessive curdling. 
Here the particles of the Hour mixed with the milk 
undergoing the curdling process, mechanically render 
the curd less firm and tenacious. If the acidity be still 
more pronounced then it may be necessary to mix ten 
grains of prepared chalk or five grains of carbonate of 
magnesia to each pint of milk, or milk and water, 
along with the baked flour. If beef-tea, or mutton- 8 
SOME PRACTICAL POINTS IN DIGESTION. 
broth be taken, it is well to add to each pint a tea- 
spoonful of baked flour, or fine oatmeal, or maize 
flour; or even some boiled arrowroot, which is very 
thin. Such addition is requisite to give the meat ex- 
tract a higher food-value. 
Then comes the question of the digestion of album- 
inoids. Under the influence of the gastric juice an 
insoluble albuminoid, a “proteid" is converted into 
the soluble “ peptone/' As such it passes into the 
blood, where it at once passes back to proteid form. 
This digestion into a “ peptone" is achieved by the 
addition of a molecule of water, and as soon as the 
soluble peptone has reach the blood it is dehydrated 
back to a proteid. This is the special function of the 
stomach, viz. to digest albuminoids. And here again 
we see that disintegration is essential to solution. If 
the albumoid be flesh it must first be cooked, which 
makes it tender, so that one minute fibril readily parts 
from its next neighbour. And as persons advance in 
years they usually prefer their meat well done, while 
youthful appetites like underdone meat generally. Then 
it must be masticated so as to thoroughly break down 
the seperate fibrillse. If these two preparatory opera- 
tions have been imperfectly performed, then the work 
of the stomach is increased. Hence the movements 
of the stomach are active and prolonged, so that the 
individual becomes conscious of them; this is the in- 
digestion of “ imperfect disintegration.” This form of 
dyspepsia is very amenable to treatment, and the in- 
dications are plain enough. Suitable food must alone 
be taken, mastication must be efficient and careful. 
If the teeth are decayed, the dentist must be consulted 
and false teeth if necessary supplied. Practically milk 
puddings, with or without stewed fruits, “steam- 
cooked crushed cereals” to be procured of leading 
grocers; fish, especially short fibred white fish, and the 
white flesh of fowls, are to be preferred. Let the 
time spent at meals be sufficient for proper mastication, 
and the mixture of the saliva with the starchy or gly- SOME PRACTICAL POINTS IN DIGESTION. 
9 
cogenous matters of the food; by this last the starch js 
converted into sugar, which being soluble, passes from 
the stomach to the blood, and the gastric digestive 
act is not embarrassed by the presence of too much 
starch. These little matters reveal their practical im- 
portance under the bright light which advancing phy- 
siology is throwing upon them. They have long been 
known to careful clinical observers empirically, and 
as matters of fact, but now we know them scientifi- 
cally, which reveals their importance to all. Thus 
perfect disintegration is essential in all cases of dys- 
pepsia. After that comes the question of “solution/’ 
Digestion is really solution. The gastric juice is the 
solvent of the albuminoid elements of our food. Now 
when this juice is secreted in insufficient quantity, or 
is impaired in quality, then the solvent process does 
not progress properly. We have then indigestion 
from imperfect action of the gastric juice. Having 
secured for the patient a suitable dietary, and as per- 
fect disintegration as the circumstances of the case 
will permit, we come to the next matter, the gastric 
juice. We must secure more gastric juice, or a better 
quality of it. For this end we stimulate the secretion 
by appropriate measures, or we employ artificial diges- 
tive agents, procured from outside the organism. For 
the purpose of whetting the appetite and thus acting 
reflexly upon the gastric secretion, we employ the class 
of agents known as bitters. To this we add hydro- 
chloric acid. Ringer has pointed out how an alkali, 
taken into the stomach before a meal when the stomach 
is alkaline, produces a freer flow of acid afterwards. 
Consequently we comprehend the value of that well- 
known preparation indifferently termed, “Haust. 
Stomach,” or “Mist. Mirabilis,” or “Mist. Rhei-et 
Gentian,” in the various hospitals, a combination of 
worldwide fame. One drawback to this combination 
of rhubarb, gentian, and soda is that the student be- 
comes familiar with it, and its virtues, but remains ig- 
norant of its exact composition, and so loses sight of 10 
SOME PRACT/CAL POINTS IN DIGESTION. 
it when he enters upon practice for himself. Such a 
mixture, before meals, followed by ten drops of hy- 
drochloric acid after the meal, will often make the 
difference betwixt imperfect digestion, producing dis- 
comfort, and digestion so perfect that it does not pro- 
voke consciousness. Or where there is much irrita- 
bility in the stomach, i.e. when a bare red tongue 
imperfectly covered with epithelium suggests a like 
condition of the internal coat of the stomach, then 
bismuth is most soothing. , The mixture of soda, bis- 
muth, and calcimba is in use for such indigestion with 
good results. The dietary in such a case should con- 
sist of the blandest food, milk, with or without baked 
flour in it, beef-tea with baked flour, nothing more 
till an improved condition of the tongue tells of a 
more normal condition of the stomach. In such cases 
a plain opium-pill at bed-time often soothes the stom- 
ach very nicely. Then there are cases were imperfect 
digestion is accompanied by the production of fatty 
acids, butyric and others, which add the phenomenon 
of “ heart burn ’’ to the symptoms; or they may be 
later products formed which cause the bitter hot taste 
in the mouth on awakening in the morning or after a 
post-prandial nap. It is usual to treat “heart-burn''' 
by the exhibition of an alkali, but this is not good 
practice. In union with an alkali the offending mat- 
ter is nearly as objectionable as in the form of free 
acid. It is much better to give a mineral acid, as the 
hydrochloric, or phosphoric, which breaks up the feeb- 
ler organic acid. By such means we can aid the di- 
gestive act. Then at other times the indigestion is 
due to lithiasis, where the presence of uric acid impairs 
the efficiency of the gastric juice. In these cases all 
measures which do not entertain the casual relations 
of the dyspepsia are of little use. By the administra- 
tion of potash in a bitter infusion well diluted, taken 
half an hour before a meal, this element of trouble is 
removed. In all cases of gouty persons suffering 
from dyspepsia, do not forget this cause of impairment 
of the gastric juice. SO.tr/■: PR A C 7VCA I. POINTS in digestion. 
11 
Having thus cleared the digestive act of all imped- 
ing factors, there comes the question of direct stimu- 
lation of the flow of gastric juice. We know that 
there are agents which in considerable quantities ex- 
cite imflammation of the coats of the stomach, and 
which, when taken in medicinal doses merely, increase 
the vascularity of the gastric mucous membrane, and 
so stimulate the flow of gastric juice. Such agents 
we possess in arsenic, and ipecacuan, and certainly al- 
cohol. The action of the latter is often excellent in 
weak digestion, either taken with the food, or as a 
fillip to the appetite immediately before food. This 
is seen in “the nip of gin and bitters” so commonly 
taken before dinner by men who wish to thoroughly 
enjoy their food. 
Ipecacuan formed a portion of a good old-fashioned 
dinner pill; and betwixt its direct action upon the 
gastric mucous membrane, and its action upon the 
liver as an hepatic stimulant, it must come into use 
again before long. A dinner pill of:— 
Pulv. Ipecacuan, gr. j. 
Strychniae, gr. 1-20 
Pulv. Pip. Nig. m. ii. 
Pil. A1 ct Myrrh, gr. ijs. 
every day will often produce excellent effects. Then 
arsenic may be taken as three drops of Fowler’s Solu- 
tion after dinner; or in the above pill substituting the 
same dose of arsenic for the strychnine. 
Beyond these measures lies the use of artificial pep- 
sine. Pepsine if properly prepared will digest album- 
inoid bodies outside the body. The pepsine of the 
pig or calf is potent within the human stomach. But 
as pepsine only digests albuminoids in an acid medium, 
it is clear it must be given shortly after a meal. And 
from what has been said before, it is quite clear that 
in each case the medical attendant must distinguish 
betwixt the indications for giving maltine to digest 
starch, and pepsine to digest albuminoids. There is 
room for fear that this distinction is not invariably 12 
SOME PRACTICAL POINTS IN DIGESTION. 
made as carefully as it ought to be made. Yet it is 
evident that in every case such discrimination is ne- 
cessary for its right management, and it will not do 
to give maltine or pepsine indiscriminately. By care- 
ful attention to these different matters, clearly distin- 
guishing the indications for treatment in each case, 
the difficulties can usually be surmounted successfully; 
but it is by no “happy-go-lucky" plan, or rather want 
of plan, which will enable the practitioner to so diet, 
and treat these patients, as to be generally successful.. 
A chance success here and there may be attained, but 
systematic success can only be hoped for by systematic 
study of the subject. 
All this time fat has never been discussed. Trie di- 
gestion of fat is not affected either by the saliva or the 
gastric juice. It is a moot point, yet, how far some 
portion of the fat in the stomach may not be broken 
up into fatty acids and glycerine, and that these fatty 
acids may aid the bile and the pancreatic juice in the 
emulsionising and saponifying of the rest of the fat. 
But the digestion of fat takes place beyond the stom- 
ach, to speak broadly. When the contents of the 
acid stomach pass the partially relaxed pyloric ring, 
they come into contact with the bile and are rendered 
alkaline. And then the action of the pancreatic se- 
cretion comes into play. About this last matter older 
practitioners know little. That is not their fault how- 
ever. The subject is one which has been cleared up 
since their student days. The pancreatic secretion 
contains four principles; (i) a ferment which changes- 
starch into sugar; (2) trypsin which digests albumin- 
oids in an alkaline medium; (3) a substance which 
will curdle milk; and (4) another substance which will 
emulsionise fats. Consequently contrary to what is 
thought by many, it is beyond the stomach that the 
greatest digestive activity occurs. When the contents- 
of the stomach pass into the small intestine the pan- 
creatic secretion commences its operation. The re- 
maining starch, unconverted into sugar by the saliva^. SOME PRACTICAL POINTS IX DIGESTION. 
13 
is acted upon now, once more ; the albuminoids not 
already digested by the gastric pepsine are digested by 
the pancreatic trypsin, while the fats are emulsionised 
so that they can be taken up by the lacteals in the 
villi of the intestines. Here then we have digestive 
activity in its most pronounced form. But of indi- 
gestion here we as yet know nothing; we merely 
know that fat is not digested in certain cases. Yet 
there are some matters connected with the digestion 
of fat which arc not made as much the subject of 
thought as they ought to be. There is the broad fact 
that cod-liver oil, cream, butter, the liquid portion of 
fried bacon, are the most digestible fats; that these 
can often be assimilated when the ordinary fat of meat 
is not digested, and is turned from with loathing. 
Many a child will reject with disgust the fat of meat, 
so sweet and toothsome to many persons with good 
assimilative powers, and readily take cod-liver oil; ad- 
mitting that the latter is not attractive by its taste. 
There is clearly something here in the albuminoid en- 
velope of the animal fat. Fat as found in the bodies 
of animals, consists of connective corpuscles crammed 
with fat globules. Before such fat can be digested 
the albuminoid envelope must be removed. How far 
this film of connective tissues interferes with the di- 
gestion of the fat contained in it, we cannot yet say. 
But the facts stand in a very suggestive relationship. 
Now what means have we for influencing this por- 
tion of the digestive act? Again we may stimulate 
the pancreas, or fall back upon artificial pancreatic se- 
cretion. For the purpose of stimulating the pancreas 
we possess one agent alone of which we as yet have 
any knowledge. This is sulphuric ether. Dr. Balt- 
hazar Foster, of Birmingham, first brought forward eth- 
er for this purpose, giving it with cod-liver oil, where 
the oil alone did not seem to be assimilated. This work 
has been corroborated by the report of a commission 
appointed in the United States of America to investi- 
gate the matter. It is certainly a measure well worth 
trial in cases where pancreatic digestion is impaired. 14 
SOME PRACTICAL POINTS IN DIGESTION. 
Then there is the use of pancreatic secretions ob- 
tained from that useful omnivorous animal, the pig. 
These, if well made, are of great potency, and are not 
objectionable in taste. We all know that Dr. Horace 
Dobell has long had before the profession a “ Pan- 
creatic Emulsion ” for the treatment of phthisis espec- 
ially. There can be little if any doubt about the fact 
that it is the imperfect assimilation of fat which im- 
pairs “ interstitial digestion ” in the body. This im- 
pairment gives us those modifications of nutrition 
which are summed up in the word “struma.’ We 
know that if we can manage to enable a patient with 
pulmonary phthisis to digest and assimilate cod-liver 
oil, tissue nutrition becomes so altered that the devel- 
opment of tubercle is usually arrested. That is, we 
have once more given to growing tissue that fat which 
is essential to healthy formation. Call growths of 
tubercle by what name each man pleases, Virchow’s 
broad view that tubercle is a growth of connective tis- 
sue corpuscles degraded in quality, while produced in 
great quantity, is the one to hold in order to best 
grasp the subject from its therapeutic aspect. What 
we have to attempt to do is to give to the tissues the 
fat without which they are not healthy. Now the 
perusal of the foregoing remarks will tell every reader, 
him that reads and runs, as well as him who reads 
slowly, that in the treatment of tissue malnutrition, 
whether of phthisis, or some other form, there are 
many points to be attended to beyond ordering cod- 
liver oil, or change of air. The last, as being directed 
almost solely to the effect of the inspired air upon the 
lining membrane of the air tubes locally, is a very 
narrow and limited view of phthisis; and it is desirable 
that the doctors who sing the praises of different 
health-resorts should know a little more of general 
medicine, and be a little less taken up with the atmos- 
pheric disturbances, and the mere number of hours of 
sunshine of different localities. For instance, a young 
lady was sent to Davos the winter of 1878-79, and SOME PRACTICAL POINTS IN DIGESTION. 
15 
came back considerably improved. She after that 
came under my notice professionally, and I put her 
upon a course of pills containing arsenic and iron. On 
this she improved nicely, and I insisted upon her con- 
tinuing the medicine during her stay at Davos last 
winter (1879-80), so as to derive the maximum bene- 
fit for the heavy expenditure. But when she got to 
Davos her doctor stopped the medicine without any 
communication with me in the matter. What are the 
consequences? She comes back in such a condition 
that her mother gives her the pills again, on which 
she soon improves. Now will any reasoning being 
believe that if that course of arsenic and iron had been 
continued during the stay at Davos, the girl would 
not have been all the better for it ? 
In tissue-malnutrition it is not sufficient to merely 
order cod liver oil and change of air, as is evident by 
what has gone before; but to first see that the diges- 
tive and assimilative processes are going on properly; 
that the food contains the requisite quantities of nu- 
tritive power with ready disintegration; that the na- 
tural digestive ferments are encouraged, or supplemen- 
ted by artificial ferments: and then comes the question 
of the assimilation of fats. The last is the crowning 
point of the therapeutic edifice, not its foundation. 
It should not be the first thing done to order the cod- 
liver oil, but to lead the organism up to its ready di- 
gestion, and ultimately to that of other less digestible 
but more stable fats. Then it is of the utmost mo- 
ment always in disease to watch the condition of the 
tongue and the humours of the stomach. However 
capricious the latter, it must be humoured and concili- 
ated; and whenever the tongue becomes denuded of 
its epithelium, or is covered with a layer of dead epi- 
thelium, the plan of treatment must beat once suspen- 
ded; and if nausea or eructations follow the oil, then 
for a time it must be withheld. No matter how tan- 
talising to see a satisfactory progress checked, submis- 
sion to the stomach is essential; to pursue the same 16 
SOME PRACTICAL POINTS IX DIGESTION. 
line when the stomach is disturbed is not good gener- 
alship. To retire for strategic purposes is not always 
the equivalent of defeat; it may be a wise and prudent 
manoeuvre. Very often indeed the ultimate result of 
a case hangs upon the readiness with which this stra- 
tegic manoeuvre is executed. It is to be feared that 
the clinical skill of a generation or two ago in these 
matters of apparent minutiae, have been largely for- 
gotton by a race who study disease in the dead-house; 
and who look at tissues, healthy and diseased, too ex- 
clusively through a microscope. When the stomach 
will not tolerate milk, or milk and seltzer water, or 
lime-water, even in small quantities, and great discom- 
fort, only relieved by vomiting, follows any ingesta, 
then the case is very serious. In such cases then we 
may fall back upon the artificially digested milk and 
milk-gruel of Dr. Roberts. Full directions are given 
along with each bottle of the Liquor Pancreaticus, 
without which the artificial digestion cannot be carried 
on, so they need not be repeated here. Further, a 
nutritive enema, with the requisite digestive ferment 
’in it, is also described on the wrapper. It is not only 
that Dr. Roberts’ work is good and sound and valu- 
able in itself; but it has a further and almost priceless 
value in its suggestiveness, and the thought about the 
matter of digestion in the minds of others which it is 
exciting.