Vascular troubles in later life : inaugural address delivered before the Midland Medical Society, at Birmingham, on October 28, 1909 / by Sir Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Vascular troubles in later life : inaugural address delivered before the Midland Medical Society, at Birmingham, on October 28, 1909 / by Sir Lauder Brunton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    17/31 (page 13)
    the intestine into the circulation. This gland has the two- fold power of either returning certain substances to the intestine, and thus preventing absorption, or of destroying the poisons altogether. Thus it will return copper, manganese, iron, and probably all heavy metals (29). It will almost completely destroy coniine, hyoscyamine, and cobra poison (30), or the toxin of diphtheria (31). It has the power of breaking up uric acid and forming urea (32), and appears to intercept bitter substances formed during digestion and to return them back with the bile to the intestine (33). This process is repeated again and again, until perhaps they accumulate to such an extent as to pass through the liver into the general circulation, and produce symptoms of poisoning such as headache (34). The bitterness of gall is proverbial, but fresh bile as obtained from a biliary fistula is not bitter at all (35). It is only when the bile has passed from the liver into the intestine and back again, several times, that the bitter substances increase to such an extent as to give to the bile its proverbially bitter taste. The action of mercurials is even now imperfectly known. They are usually reputed to act as cholagogues, but according to Eutherford they do not really increase the secretion of bile (36). What they appear to do is to stimulate the peristaltic action of the duodenum, so that, in place of the bile being absorbed and again re-excreted, it is swept on to a lower part of the intestine, and there either changed by the digestive juices or excreted altogether, along with leucin and tyrosin (37). If this be so, mercurial purgatives do not merely remove bile, but they remove toxins from the body, and this is probably why their action in many cases is so very different from, and so very much more beneficial than, that of simple purgatives which act on the intestine alone. The formation of toxins in the intestine depends not only upon the kind of microbes present, but upon their relative proportion, and the nature of the intestinal contents upon which they act. As I have already mentioned microbes have the power of adapting the ferments which they excrete to the pabulum on which they feed, just like the pancreas of higher animals, but they cannot alter this power so quickly as the higher animals, and therefore one