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Graphics and Animation on iOS
Graphics and Animation on iOS

Vandad Nahavandipoor

Beijing • Cambridge • Farnham • Köln • Sebastopol • Tokyo

Graphics and Animation on iOS
by Vandad Nahavandipoor

Copyright © 2011 Vandad Nahavandipoor. All rights reserved.

Printed in the United States of America.

Published by O’Reilly Media, Inc., 1005 Gravenstein Highway North, Sebastopol, CA 95472.

O’Reilly books may be purchased for educational, business, or sales promotional use. Online editions
are also available for most titles (http://my.safaribooksonline.com). For more information, contact our
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Editor: Andy Oram Cover Designer: Karen Montgomery

Production Editor: Kristen Borg Interior Designer: David Futato
Proofreader: O’Reilly Production Services Illustrator: Robert Romano

Printing History:
May 2011: First Edition.

Nutshell Handbook, the Nutshell Handbook logo, and the O’Reilly logo are registered trademarks of
O’Reilly Media, Inc. Graphics and Animation on iOS, the image of an Asian civet, and related trade dress
are trademarks of O’Reilly Media, Inc.
Many of the designations used by manufacturers and sellers to distinguish their products are claimed as
trademarks. Where those designations appear in this book, and O’Reilly Media, Inc., was aware of a
trademark claim, the designations have been printed in caps or initial caps.

While every precaution has been taken in the preparation of this book, the publisher and authors assume
no responsibility for errors or omissions, or for damages resulting from the use of the information con-
tained herein.

ISBN: 978-1-449-30567-3

[LSI] [2011-05-27]

1305917297
 Table of Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Graphics and Animations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Basic Concepts for Adapting to Different Screen Sizes 2
Creating the Project Structure in Xcode 3
Enumerating and Loading Fonts 10
Drawing Text 12
Constructing, Setting, and Using Colors 13
Drawing Images 18
Drawing Lines 21
Constructing Paths 28
Drawing Rectangles 31
Adding Shadows to Shapes 36
Creating and Drawing Gradients 41
Displacing Shapes on Graphic Contexts 49
Scaling Shapes Drawn on Graphic Contexts 52
Rotating Shapes Drawn on Graphic Contexts 55
Animating and Moving Views 55
Animating and Scaling Views 66
Animating and Rotating Views 67

v
 Preface

Face it—animations make apps really attractive to users. If your app presents a simple
user interface, but only does what it says it does, chances are that users will choose a
competitor’s app, one with a better user interface that makes use of iOS SDK’s fantastic
animation and graphics capabilities.
This book is written to teach programmers how to incorporate smooth animations,
along with skills such as loading custom fonts and drawing images in their apps.

Audience
This book is written for programmers who are fairly new to Cocoa and iOS program-
ming. However, it is assumed that you know basic Objective-C and have done some
Cocoa programming. I also assume you know some elementary principles of computer
graphics, such as coordinates and the RGB color scheme.

Conventions Used in This Book

The following typographical conventions are used in this book:
Italic
Indicates new terms, URLs, email addresses, filenames, and file extensions.
Constant width
Used for program listings, as well as within paragraphs to refer to program elements
such as variable or function names, databases, data types, environment variables,
statements, and keywords.
Constant width bold
Shows commands or other text that should be typed literally by the user.
Constant width italic
Shows text that should be replaced with user-supplied values or by values deter-
mined by context.

vii
 This icon signifies a tip, suggestion, or general note.

This icon indicates a warning or caution.

Using Code Examples

This book is here to help you get your job done. In general, you may use the code in
this book in your programs and documentation. You do not need to contact us for
permission unless you’re reproducing a significant portion of the code. For example,
writing a program that uses several chunks of code from this book does not require
permission. Selling or distributing a CD-ROM of examples from O’Reilly books does
require permission. Answering a question by citing this book and quoting example
code does not require permission. Incorporating a significant amount of example code
from this book into your product’s documentation does require permission.
We appreciate, but do not require, attribution. An attribution usually includes the
title, author, publisher, and ISBN. For example: “Graphics and Animation on iOS
by Vandad Nahavandipoor (O’Reilly). Copyright 2011 Vandad Nahavandipoor,
978-1-449-30567-3.”
If you feel your use of code examples falls outside fair use or the permission given above,
feel free to contact us at [email protected].

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viii | Preface
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Content Updates
May 27, 2011
• Fixed a minor issue in the text where an .xib file was mislabeled as an .m file.
• Added a paragraph explaining how readers can add images to their Xcode project,
as suggested by a technical reviewer.
• Added the code examples to the O’Reilly catalog page for this book.

Acknowledgments
In 2007, after iOS became so popular among programmers, I started to learn how to
program in iOS SDK using an Xcode that was much less advanced than what we use
today. My first impression after seeing some iOS apps was: “My God, they look gor-
geous!” I had never seen such smooth interfaces, graphics, and animations rendered
on a mobile device before, and the big touch-screen added to that excitement. If you
are thinking of writing iOS apps that require smooth animations and graphics render-
ing, then this is the book for you.

Preface | ix
Although I did my part to write this book, I feel the need to thank my wonderful col-
leagues and friends, Andy Oram and Brian Jepson of O’Reilly, for their continuous
support and help in every project we have worked on together so far, including the
book you are reading right now.
I would also like to thank Sarah Schneider, Rachel James, Betsy Waliszewski, and
Gretchen Giles of O’Reilly for always being very helpful and responsive to my annoying
requests to create SVN repositories, change book titles, and so on. Thanks also go to
Gary McCarville, Kirk Pattinson, Shaun Puckrin, Sushil Shirke, Simon Whitty, Mark
Harris, and Shency Revindran for being great friends and colleagues.
A big thanks to you as well for deciding to read this book. I hope that you will enjoy
reading this book as much as I enjoyed writing it.

x | Preface
 Graphics and Animations

You’ve certainly seen applications with beautiful graphics effects on iPhones or iPads.
And you’ve probably also encountered impressive animations in games and other apps.
When the iOS runtime and Cocoa programming frameworks combine, they make an
amazing variety of graphics and animation effects possible with relatively simple cod-
ing. The quality of these graphics and animations depends partly, of course, on the
aesthetic sensitivities of the programmer and artistic collaborators. But in this short
book, you’ll see how much you can accomplish with modest programming skills.
I’ll dispense with conceptual background, preferring to introduce ideas such as color
spaces, transformation, and the graphics context as we go along. I’ll just mention a few
basics before leaping into code.
In Cocoa Touch, an app is made up of windows and views. An app with a UI has at
least one window that contains, in turn, one or more views. In Cocoa Touch, a window
is an instance of UIWindow. Usually, an app will open to the main window and the
programmer will then add views to the window to represent different parts of the UI:
parts such as buttons, labels, images, and custom controls. All these UI-related com-
ponents are handled and drawn by UIKit.
Some of these things might sound relatively difficult to understand, but I promise you
that as we proceed through this book, you will understand them step-by-step with the
many examples I will give.
Apple has provided developers with powerful frameworks that handle graphics and
animations in iOS and OS X. Some of these frameworks and technologies are:
UIKit
The high-level framework that allows developers to create views, windows, but-
tons, and other UI related components. It also incorporates some of the low-level
APIs into an easier-to-use high-level API.
Quartz 2D
The main engine running under the hood to facilitate drawing in iOS; UIKit uses
Quartz.

1
Core Graphics
A framework that supports the graphics context (more on this later), loading im-
ages, drawing images, and so on.
Core Animation
A framework that, as its name implies, facilitates animations in iOS.

Basic Concepts for Adapting to Different Screen Sizes

When drawing on a screen, one of the most important concepts to grasp is the relation
between points and pixels. I’m sure you’re familiar with pixels, but what are points?
They’re the device-independent counterpart of pixels. For instance, compare the
iPhone 3GS to the iPhone 4. Both devices have 3.5-inch displays. However, the number
of pixels that iPhone 3GS can draw in portrait mode is 320×480. The same screen size
on the iPhone 4 is capable of drawing twice as many, or 640×960, pixels in portrait
mode.
Now imagine you are writing an iPhone app that has only one screen, and that you are
simply filling the whole screen with the color green. Imagine that you naïvely specify a
rectangular area of 320×480 pixels. When iPhone 3GS users run your app, they will be
quite happy because “it does what it says it does”—fill the entire screen with the color
green. iPhone 4 users, on the other hand, will be quite unhappy: what they will see is
quite different, as shown in Figure 1.
To remedy this problem, Apple introduced device-independent drawing methods to
help developers focus on how their shapes and graphics have to appear on a device
instead of worrying about the screen sizes and resolutions of different devices that run
the same code. To fix the issue we saw in Figure 1, the developer of the app can simply
use the relevant APIs to specify the green rectangle in points instead of pixels. That will
allow the same code to run on the iPhone 3GS and the iPhone 4, ensuring that the
screen on the iPhone 4 will be filled with the rectangle. For this reason, many of the
methods that you will see in this book will rely on points (or as Apple calls them, logical
points) instead of pixels.

The origin point of the screen on an iOS device is the top-left corner.
Screens whose drawing origin is on the top-left corner are also referred
to as Upper Left Origin, or ULO, screens. This means that point (0, 0)
is the topmost and the leftmost point on the screen, and that positive
values of the x axis extend towards the right, while positive values of
the y axis extend towards the bottom. In other words, an x position of
20 is further right on the screen than a position of 10 is. On the y axis,
point 20 is further down than point 10.

2 | Graphics and Animations

Figure 1. Device-dependent pixel rendering yields different results on different devices

Creating the Project Structure in Xcode

In this book, we will be using view objects of type UIView to draw shapes, strings, and
everything else that’s visible on the screen.

I assume you have the latest Xcode from Apple. If not, please head to
Xcode’s website in order to download it.

In order to be able to incorporate some of these code snippets in an application, I will

first show you the required steps to create a new project in Xcode and subclass
UIView, where we can place our code:
1. Open Xcode.
2. From the File menu, select New→Project.
3. On the left side of the screen, make sure the iOS category is selected. Select Ap-
plication under that category (see Figure 2).

Creating the Project Structure in Xcode | 3

Figure 2. Creating a View-based Application for iOS in Xcode
4. On the right side of the screen, select View-based Application, and press Next (see
Figure 2).
5. In the Product Name box (Figure 3), select a name for your project. I’ve entered
Graphics and I suggest you enter the same name to avoid confusion later on.
6. In the Company Identifier box, enter a bundle identifier prefix, which will be pre-
pended to the Product Name you chose. This is usually com.company. I have chosen
com.pixolity.
7. In the Device Family, select iPhone, and then press Next.
8. On the next screen (Figure 4), select where you want to save your project. I’ve
selected Desktop. Press Create.
Now your Xcode project is open. On the left side of Xcode, expand the Graphics group
to reveal all the files that Xcode created for us when we created the project. Now we
shall create a view object for our view controller. Please follow these steps to do so:
1. Select the Graphics group from the left hand side in Xcode.
2. Right click on the Graphics group and select New File….
3. In the New File dialog box, make sure iOS is selected as the category on the left
side, and select Cocoa Touch as the subcategory (see Figure 5).

4 | Graphics and Animations

Figure 3. Setting the options for a new project in Xcode

Figure 4. Saving the view-based Xcode project to the desktop

Creating the Project Structure in Xcode | 5

Figure 5. Creating a new Objective-C class in Xcode
4. On the right side, select Objective-C class, and then press Next (see Figure 5).

5. In the next screen (Figure 6), make sure that the Subclass box has UIView written
inside it, and then press Next.
6. In the Save As dialog, set the file name to GraphicsViewControllerView.m.
7. Select Graphics in the Group drop-down box (see Figure 7).
8. Make sure the “Add to targets” checkbox is checked for the project that we created
earlier, and then press Save (see Figure 7).
9. On the left side of Xcode’s main window, click on the GraphicsViewControl-
ler.xib file. Interface Builder will be displayed on the right side of Xcode’s screen,
as shown in Figure 8. We will not be using the .xib file at this point.
10. From the Xcode menu, select View→Utilities→File Inspector. The file inspector will
be displayed, by default, on the right side of Xcode’s window.
11. Click somewhere inside the gray view that is created for you in Interface Builder.
The contents displayed in File Inspector (on the right) will change to reflect your
selection (see Figure 9).

6 | Graphics and Animations

Figure 6. Creating a subclass of UIView

Figure 7. Saving a subclass of UIView

Creating the Project Structure in Xcode | 7

12. In File Inspector, choose the Identity Inspector tab on top (see Figure 10).
13. In the Class box, under the Custom Class section, enter GraphicsViewController
View (the view object we created before), and press Return on your keyboard.

Figure 8. Selecting our view controller’s xib file

Now we are ready to start coding. What we did was simply creating a view class of type
UIView so that later on in this book, we can change the code in that class. Then we used
Interface Builder to set our view controller’s view class to the same view object that we
created. This means that now our view controller’s view will be an instance of the
GraphicsViewControllerView class that we created.

8 | Graphics and Animations

Another random document with
no related content on Scribd:
 Dr. Fraser[180] has shown that when increasing doses of snake-
venom are injected into an animal a condition of immunity is brought
about, so that finally fifty times the dose which would have proved
fatal at first, becomes innocuous. As Fraser found, the bile of such
animals contains an antivenine, and he made use of this bile as an
antidote against the original venom.
These experiments prove that the bile contains poisonous
substances, including pathogenic bacteria in an attenuated
condition, and also that it has antitoxic properties. Thus we may
understand how it can neutralize putrefactive products from the
intestines. Not only bacteria, but all the various kinds of poison
which the liver destroys, are eliminated by the bile; hence the
importance of a free circulation of this fluid. The liver serves as a
depot for metallic substances like iron and copper, and also for the
more dangerous ones such as lead, mercury, arsenic, or antimony.
After first keeping them in storage, it then attempts to eliminate
these noxious substances. According to Slowzoff and Bamossi, the
various poisonous metals and alkaloids enter into combinations with
the proteid bodies of the liver. Animals that have been richly fed
have been found to be better protected against these poisons
because of their livers being richer in proteid contents and glycogen.
The liver also protects the body against the numerous toxic
products formed in the stomach and intestines during the process of
digestion and assimilation. The most important of these are the
carbamins and ammonia salts, which would be injurious to us if the
liver did not protect us by converting them into urea.
When the liver is excluded from the circulation, as Nencky and his
pupils have done by establishing an Eck fistula, toxic symptoms arise
when the animals are given albuminous food, and these symptoms
can only be explained from the fact that the liver is unable to
destroy toxic products. The more albuminous food taken, the more
marked are the symptoms of intoxication.
The liver aids in the transformation of the poisonous end-products
of proteid metabolism by bringing about the combination of the toxic
end-products with sulphuric acid (Baumann, Emden and Glaesner).
Thus these dangerous substances are eliminated as ethereal
sulphates, which are practically harmless. Even when these ethereal
sulphates are present in large amounts in the urine there may be no
symptoms of auto-intoxication.
When the liver is extirpated, a condition of acidosis arises, and a
large quantity of ammonia is eliminated, which is produced in order
to neutralize the acids present. The liver protects us against acids
formed in the organism. After eating a quantity of meat, we would
be menaced by the acids formed through its decomposition, were
the liver not active.
We can prevent acidosis if we eat a considerable amount of
carbohydrates, at least 100 grammes a day as Hirschfeld has proved.
It has been shown by Waldvogel that these carbohydrates do not
prevent acidosis if they are given by a method which precludes their
passage through the portal circulation,—e.g., subcutaneously.
As we have seen above, the liver receives an enormous amount of
toxic products from the stomach and intestine, which it transforms
or destroys. Like any other organ which is overworked, the liver may
undergo certain changes when continually subjected to a strain, and
great quantities of these toxins might be able, after a long-continued
action, to alter the liver tissue. Such a condition we may note in
gastric and intestinal diseases, especially in those cases where large
amounts of fatty acids are formed.
Bouchard found an enlargement of the liver in 23 per cent. of all
his cases of dilatation of the stomach.
We can understand that when fatty acids, as a result of gastro-
intestinal disease, pass for a long time through the liver, they may
destroy the delicate epithelium of this organ. Boix demonstrated this
by experiments. By feeding animals with lactic, butyric, and acetic
acids, he produced hepatic cirrhosis.
So long as the liver is healthy it is able to withstand the constant
inflow of toxins and will transform them into less harmful
compounds. But when the liver is altered, as in cirrhosis, things are
different. We then find a diminution of urea, and an increase of
ammonia. Happily such a condition arises only when there are
considerable anatomical and histological changes in the liver.
Salaskin and Zaleski have shown in animals that when there are
serious anatomical changes in the liver, the ammonia is increased,
and the urea is diminished. We may suppose that in old age, when
the connective tissue is more or less increased and important liver
elements destroyed, a similar decrease in the urea formation may
take place just as in chronic cirrhosis.
That in diseases of the liver toxic products are formed and
eliminated by the urine in increased amounts, has been shown by
Professors Bouchard[181] and Roger. They found that the urine of
patients suffering from diseases of the liver is more toxic than that
of normal persons.
That the normal urine is toxic has been proved by Séglas and
Vauquelin,[182] and also by Bocci.[183] Bouchard has designated as the
urotoxic unit the quantity of urine necessary to kill an animal
weighing 1 kilogramme, and as the urotoxic co-efficient the relation
of the urotoxin eliminated in twenty-four hours to the body weight of
the animal. This latter, then, indicates the quantity of urotoxins a
man eliminates in twenty-four hours.
All these calculations of Bouchard have had no great success,
however, for many authorities, as Gumprecht,[184] Heymans v. d.
Bergh, etc., have shown that the toxic effects of the injected urine
may be explained in part by the difference in osmotic pressure
between the injected urine and the blood.
Still the fact remains that the urine of many cases of liver disease
has been found to be more toxic than the urine of other persons.
When the liver is damaged it cannot destroy poisons in the normal
manner, as was shown by experiments. Thus, the liver cells have
been experimentally injured when it was found that such a liver was
not able to destroy strychnine as well as a normal liver. Very
important findings have been made by Roger and Gamier.[185] They
have ascertained that privation, bad nutrition, etc., can also lower
the vitality of the liver and diminish its antitoxic properties.
 CHAPTER XIV.

The Hygiene of the Liver.

We have often observed that people suffering from diseases of the

liver feel and look much better after abstaining from meat and living
on milk and a vegetarian diet. If such a diet be beneficial in cases
where the tissues of the liver are degenerated, it appears reasonable
to assume that it will be equally efficacious when the liver has not
yet been altered by disease. We must realize that the various
unwholesome matters we eat or drink are carried to the liver to be
dealt with, and that the end-products of the decomposition of the
meat, and other elements contained in preserved meat which may
not be perfectly sound, may injure the liver-tissue, or, at any rate,
throw more work on this organ than food in the nature of vegetables
or milk.
A milk diet has the further great advantages that it assists in
destroying toxic products in the intestine, and also that it can hinder
the development of gall-stone disease (see Chapter XXXIX).
Not only meat used in abundance, but also various kinds of spices,
condiments and stimulants may be very injurious, especially alcohol,
if taken in large quantity. Gin and brandy are the most deleterious in
their action. Wines containing little alcohol are less harmful, but acid
or strong white wines may injure the liver-tissue.
The well-being of this organ is essentially dependent on the good
condition of various other organs with which it stands in very close
relation, in particular the intestines, for instance. It is from here that
most of the toxic products enter the liver, either by the portal vein or
through the choledochus. The intestine always contains myriads of
microbes, which may enter the liver either by the blood or the bile,
and thus provoke very important changes in the liver-tissue.
Professor Adami,[186] of Montreal, found colon bacilli in a cirrhotic
liver.
It follows, therefore, that we must maintain the intestine in the
best possible condition, and avoid constipation and stagnation of
fæcal matters, with the augmentation of toxic products. That
constipation is very deleterious to the liver can be best shown by the
fact that very often affections of the liver and bile-ducts,—and
especially gall-stone disease,—are developed in persons suffering
from habitual constipation. The best treatment for these liver
affections is a purging treatment, and it is mainly on account of their
action in this manner that certain alkaline mineral waters have
attained so great a fame; in addition, due to increased peristalsis,
the circulation of the bile is enhanced.
Proper movements of the bowel are indispensable to a sound
condition of the liver and for the prevention of hepatic disease, and
we, therefore, refer the reader to the chapter that deals in detail
with the prevention and treatment of constipation.
Not only the intestine, but the stomach also, must be in good
condition. It has been noted by Bouchard and Hanot that chronic
gastric and intestinal troubles are apt to cause enlargement of the
liver. Bouchard has found an enlarged liver in 23 per cent. of his
cases of dilatation of the stomach. Hanot and Boit[187] have shown
experimentally that the different acids formed in the gastro-intestinal
tract are able to produce a genuine cirrhosis of the liver. Therefore
acid fermentation must be carefully avoided; and to prevent such
fermentation in some degree in the stomach and in the intestine, it
is necessary to masticate the food thoroughly, as will be shown.
Another very important organ, the sound condition of which is of
great importance to the liver, is the pancreas. It has been found by
several authors, particularly by Steinhaus,[188] in his investigation of
some 40 cases of hepatic cirrhosis, that the pancreas is also affected
in each case of this type; and we further know that after disease of
the pancreas, as in diabetes, for example, the liver is also, as a rule,
altered. Thus these two organs are in close relationship.
As pancreatic diseases are among the most difficult to diagnose,
and people suffering from them live and die, as do also many
diabetics, without their particular state having been recognized, so,
the rational treatment of these diseases being still imperfect, we
cannot offer advice in regard to their prevention. But, at any rate,
the safest course will be moderation in diet, especially fatty food,
which exacts the active co-operation of the pancreas. As in the case
of all other organs, long-continued overwork will exhaust this gland,
and thus induce a diseased condition. Moderation in diet will be the
best policy for the pancreas, as also for the liver; and to maintain
these organs in sound working order, meat in particular should only
be taken in small quantities, and fat also should not be partaken of
in large amount.
Milk and vegetable food, with but little meat, and that preferably
as fish, will certainly furnish the best diet to avoid diseases of the
liver. As Quincke[189] mentions, experience shows also that water in
large quantities, especially certain alkaline saline waters, can
increase the flow of the bile; and therefore, as also for other reasons
mentioned in this book in Chapters XXXIV and XLI, water should be
drunk in sufficient quantity every day. The alkaline waters referred to
are certainly superior in their action to ordinary water, especially
those kinds which at the same time cause purging.
Hot climates have a deteriorating effect on the liver. We have
often noted the great frequency of liver complaints under these
conditions, and we have never had a patient from the hot parts of
Mexico who has not had a hypertrophied liver. We are inclined to
believe that it is not so much the climate as faults in hygiene,
especially in diet and in the use of stimulants, which are the cause of
such a condition in Europeans residing in tropical climates.
 A vegetarian diet is certainly the best in tropical countries, as we
personally found during a stay in Southern Florida, Texas, and
Mexico. Just as for the kidneys, so for the liver, a bath, and
particularly a sweat-bath, is of great benefit, since by means of it
toxic products may be eliminated which would otherwise be carried
to the liver.
We have found these baths to be of great benefit in liver diseases,
and considering the amelioration of the processes of oxidation
brought about by such baths, it seems highly probable that they are
capable of improving also the working condition of a liver not as yet
diseased.
In general, it is our opinion that to prevent disease in an organ the
surest method is to use those means through which that organ,
when diseased, is found to benefit. Of course this is only meant as a
general statement; but in the children of those suffering from liver
complaints such preventive treatment is particularly indicated, as
these conditions, we have found, are most frequently inherited. We
have treated cases where three or four generations of one family
had been sufferers from the same complaint.
Here, as always, let us follow the wise precept: “Prevention is
better than cure.”
 CHAPTER XV.

On the Destruction of Toxic Products by the Adrenals.

There is ample evidence in support of the contention that the

adrenals play an important part in the destruction of toxic products
in the body. As long ago as 1853, one of the leading authorities on
the adrenals as ductless glands, Brown-Séquard, noticed that the
blood of animals without adrenals was more toxic than that of
animals the adrenals of which had not been removed.
Langlois and Abelous[190] confirmed the conclusions of Brown-
Séquard. They also established the fact that the blood and muscular
extracts of frogs whose adrenals had been removed, were toxic, and
contained a poison of the nature of curare. The animals died from
auto-intoxication, and these savants came to the conclusion that the
adrenals were created to neutralize or destroy poisons which are
evolved during muscular work. Frogs from which the adrenals had
been removed showed also lessened resistance to muscular fatigue.
Similar results have been observed by Langlois in the case of other
animals: rabbits, dogs, guinea-pigs, etc. Albanese[191] also found that
animals operated on as above exhibited more fatigue than those
whose adrenals had been allowed to remain intact. The recent
labors of Sajous which have shown conclusively that the adrenals
furnish to the blood one of its important immunizing constituents
explain all the above observations.
The fact, observed by all these authorities, that when one of the
adrenals is removed the other becomes hypertrophied, sometimes to
a great extent, seems also to point to the conclusion that greater
demands are made on the gland that remains, the hypertrophied
condition of which appears to be due to the increased work required
of it in protecting the body from infection.
That these organs really assist in the defense of the body against
the attacks of microbes or the introduction into it of certain toxic
products can be best demonstrated by the fact that after such
infections the adrenals are, as a rule, altered, showing that a
pronounced reaction antagonistic to these agencies has occurred.
It has thus been proved by a succession of authors: Charrin,[192]
Langlois, Roux, Yersin, Professor Roger, and more recently by
Oppenheim and Loeper,[193] that in experimental or in spontaneous
infectious diseases the adrenals present important alterations as a
result of the reaction against infection.
Oppenheim and Loeper found that important changes followed
upon experimental infectious diseases; for example, after infection
by the bacilli of diphtheria or anthrax, or by the pneumococcus; also
in such infectious diseases as diphtheria, pneumonia, small-pox,
typhoid fever, etc.; and also after experimental poisonings, as with
arsenic, phosphorus, or mercury. There occurred leucocytic reaction,
diffuse diapedesis, or infectious nodules, and also a congested
condition of the adrenals, sometimes so marked that hæmorrhage
took place, with complete destruction of the parenchymatous tissue
of the glands.
Very important are the conclusions of Oppenheim,[194] that when
animals have received poisonous products, together with adrenal
extracts, after having previously lost these glands by operation, such
animals show a longer survival, sometimes even of indefinite
duration, as compared with animals without adrenals to which have
been administered the same toxic products, but without adrenal
extracts.
With phosphorus and urinary poisons in particular, this author has
obtained most striking results from the injection into animals of
adrenal extracts at the same time as the poisonous substances.
 Oppenheim comes to the same conclusion as Abelous, Charrin,
Langlois and Sajous: that the adrenals play a great rôle in the
destruction or neutralization of microbic or other poisons introduced
into the system.
We are thus in possession of powerful arguments in support of the
presumption that the adrenals are antitoxic glands. The fact, found
by Langlois, that the adrenals contain less adrenalin after
experimental infectious diseases, and that established by Luksch,
that after certain experimental infectious diseases such as
diphtheria, typhoid, or tuberculosis, the extract from the adrenals no
longer produces an increased blood-pressure, do not seem to us
sufficient to invalidate our belief in the antitoxic properties of these
glands; for here we are witnessing the same occurrence as has been
previously noted in reference to the thyroid,—that the functional
hyperactivity of the gland may be followed by its exhaustion.
Moschini, Nicholas, and Bonnamour have also found histological
evidences in the adrenals in infectious diseases indicating a
hyperactivity of these glands.
The fact that different toxic products, such as alcohol, can produce
alterations in the adrenals, indicates also a rôle of these glands in
defending the body against toxic doses of this substance (see
Chapter III).
It was found by Aubertin[195] and other authors that there is a
hyperplasia of the adrenals after experimental intoxication of the
guinea-pig by alcohol. Bernard and Bigart found important
alterations of the adrenals after experimental poisoning by mercury,
arsenic, lead, etc. As shown by Professor Sajous,[196] various drugs
act on these glands, and he attributes the rise of blood-pressure
therefrom to the action of such drugs on the adrenals, whose
function, as is well known, is to raise the blood-pressure. We can
thus understand how if alcohol be taken in large quantities it is able
to produce atheroma and arteriosclerosis, as are also other toxic
bodies, such as nicotine.
 It is well known that arteriosclerosis is frequent in great smokers.
It has been found by several authorities, among them Borylac, that
inhalation, or mastication, of tobacco produces atheroma, and by
Boverie and Loeper[197] that similar changes have followed
experiments with tobacco or ergotin. Very important data have also
been established by Drs. Isaac Adler and Hensel, of New York,[198]
who have found that atheromatous alterations of the aorta can be
produced experimentally by powerful doses of nicotine. Such
alterations were similar to those effected by adrenalin, but were
neither so constant, nor so marked.
These experimental facts, together with observations by Dr.
Sajous, prove that the atheromatous condition brought about after
using certain drugs, such as alcohol and tobacco, can be ascribed to
the adrenals. Josué, in 1893,[199] showed that by injecting adrenal
extracts (solution 1:1000) into the veins of a rabbit, atheromatous
patches of the aorta will appear after five or six weeks. The changes
described by Adler and Hensel from the effects of nicotine confirm
the probability that tobacco acts on the adrenals first, then, by their
medium, on the blood-vessels (see, also, Chapter XLIII).
The above observations show that the same is also probable in the
case of alcohol, to which we may add a case of Widal and Boivin,
who found in a young woman dipsomaniac a hyperplasia of the
adrenals and atheroma of the aorta; and to complete the value of
these observations we subjoin those of a series of cases of atheroma
by Joshua, in three of which a hyperplastic condition of the adrenals
was found.
It follows logically from the foregoing effects of alcohol and
tobacco, that we must avoid large quantities of these substances if
we desire to keep in a normal condition the heart and blood-vessels,
upon the perfect state of which depends, in a great degree, our
chances of a long life and extended youthfulness.
We will deal further with the latter points in the following chapter.
 CHAPTER XVI.

Hygiene of the Adrenals and of the Circulatory System—A

Few Remarks on the Cause, Prevention, and Treatment of
Arteriosclerosis.

In order to obtain the best hygienic condition of the circulatory

system, it is indispensable to avoid all that are harmful to the
adrenals. There can no longer be any doubt that these glands
exercise a controlling influence on the heart and the whole
circulatory system. They are in intimate relation with the principal
nerves that regulate the heart: the sympathetic and the vagus.
Thus, for instance, emotions that act on these nerves excite through
them a hypersecretion of the adrenals and a contraction of the small
blood-vessels, with a rise in the blood-pressure. By the hyperactivity
of these glands their secretion, in larger quantity than usual, is
thrown out into the system, producing toxic effects which result in
an atheromatous condition of the arteries. According to our present
knowledge, we imagine this atheromatosis to be due to the toxic
effect of the adrenals quite independently of the increase in the
blood-pressure, for it has been distinctly shown that even
substances which diminish blood-pressure, such as amyl nitrite, for
example, are also capable of producing atheroma. The toxic effects
of adrenalin are proved by the experiments of Amberg[200] in the
laboratories of the Johns Hopkins University.
We must especially insist on the fact that high blood-pressure is
not a condition essential to arteriosclerosis. It has been shown by
Sawada,[201] Groedel,[202] and Ferranini,[203] through measuring the
blood-pressure by Riva-Rocci’s instrument, that numerous cases of
arteriosclerosis can arise without any increase at all in the blood-
pressure. According to Professor Romberg,[204] there is only high
blood-pressure in such cases of arteriosclerosis where there is a
diseased condition of the kidneys. According to this leading authority
on heart diseases, high blood-pressure is one of the earliest
symptoms of kidney complication in arteriosclerotic persons. We
believe that the high blood-pressure found in kidney diseases may
be brought into correlation with the previous statement, by the fact
that in such conditions, and especially in sclerosis of the kidneys, the
adrenals, if examined, are frequently found to be hypertrophied, as
was noted by Parkes Weber,[205] Lemaire, and in four cases of Troin
and Rivet.[206] At the last Congress of German Physicians and
Naturalists in Dresden, 1907, it was proved by Schur and Wiesel, as
also in their previous communications, that the blood of patients
affected with kidney diseases contained the characteristic substance
that gives the adrenalin reaction with perchloride of iron, and
produced mydriasis if dropped into a frog’s eyes.
It is of singular interest that all those agencies that produce a
hypersecretion of the adrenals are the same which are known to be
harmful in causing arteriosclerosis. In the front rank of such are
tobacco, alcohol, and different kinds of poison, such as lead,
mercury, etc.; also infectious diseases, especially syphilis, the
important rôle performed by which, in the production of
arteriosclerosis, has been treated of very competently by Professor
Edgreen,[207] of Stockholm, and Darier, of Paris. Arteriosclerosis can
also be produced very frequently by abundant meat food and by
strong tea or coffee. There is as yet no scientific proof to show that
abundant meat food has the same deleterious action on the adrenals
as upon the thyroid, ovaries, pituitary body, pancreas, liver, kidneys,
etc., upon which we have enlarged in previous chapters of this book;
and, moreover, we have no knowledge of any work written on this
subject; but as such a diet is very efficacious in producing a sclerotic
condition of the kidneys, it may, for these reasons alone, tend to
further the development of arteriosclerosis, considering that so often
in such conditions both kidneys and adrenals are found in a
hypertrophic condition. This disease may be produced by alcohol,
tea, and coffee, by causing a great variation in the tone of the
capillaries. According to Professor Romberg and others, it remains to
be proved whether they affect the adrenals at all; but we have
already shown what their action is on the kidneys.
To keep the adrenals in good condition and thus prevent
arteriosclerosis, it is necessary to avoid all the above harmful
agencies. It is true that there are some people who can enjoy these
things in large quantities with impunity and without injurious effects
until they reach a considerable age; but it is different when they all
act together. Especially deleterious are mental emotions, grief, and
sorrow, on which we have dwelt in the introduction to this chapter,
and on the effects of which we have previously remarked; they
produce a great variation in the tone and calibre of the blood-
vessels. We will therefore endeavor to treat of the prevention of a
prolonged continuance of this most disastrous agency in our
chapters on the hygiene of the mind. Emotions of a sexual character
are, perhaps, more than emotions from other sources, disastrous to
the heart and blood-vessels, as shown by the fact, which may often
be observed, that persons addicted to sexual excitations frequently
die from sclerosis of the coronary arteries. That the sexual glands
are in intimate relations with the heart, which can often be irritated
in consequence of changes in these glands, especially in women, has
been already mentioned.
We should like to add that, as the above agencies are also harmful
to the thyroid gland, the antagonist of the adrenals, its degeneration
can further the development of arteriosclerosis in the same way that
Eiselsberg produced an atheromatosis of the aorta in dogs after
extirpating the thyroid gland. According to Minnich, arteriosclerosis is
very common in people with goiter, appearing in them at a very early
age. Fries and Pineles found that alterations of the blood-vessels
occurred in goats after extirpation of their thyroid gland.
 Since arteriosclerosis is so frequent in old age it must be due to
the degeneration of the thyroid and also to the aggregation of all the
above-named harmful agencies during a prolonged period. To avoid
it, and also premature old age, it is, therefore, most essential to
guard against all agencies harmful to the thyroid and adrenals, to
which we have referred above; and this is the best basis for the
rational treatment of arteriosclerosis. It is most fortunate that
Dellamare discovered in old age a hypertrophy of the adrenals.[208]
All this is greatly strengthened by the recent investigations of
Sajous, which show that besides its action on the blood-pressure
and the heart, the adrenal secretion actually supplies the substance
which in the lungs, takes up the oxygen from the air to sustain life in
all our tissues. It thus becomes evident that harm to our adrenals is
bound to shorten life.
To recapitulate: There exist two chief agencies for the production
of arteriosclerosis: 1. A hyperactivity of the adrenals, causing a rise
in blood-pressure. 2. A degeneration of the thyroid gland, which,
when normal, antagonizes the first by lowering the blood-pressure.
Although from the above-mentioned facts high blood-pressure
cannot be considered as the chief cause of arteriosclerosis, still no
doubt it certainly contributes to it; for each time that there is a rise
in the blood-pressure more blood is forced through the arteries,
thereby causing them to dilate; and after a repeated number of such
dilatations the elasticity of the vessels will eventually be impaired,
especially so in the aged, where one part of the elastic fibers is
already replaced by connective tissue. As a result of the
arteriosclerosis the passage of blood through the capillaries will be
impeded, and in consequence the work of the heart will be
increased; likewise the nutrition of the walls of the vessels will be
diminished. The best preventatives of arteriosclerosis will therefore
be: 1. To avoid all agencies which may tend to cause excessive
activity of the adrenals; and 2. To increase the activity of the thyroid.
Moderation in food is necessary above all things, for much food
causes an increase in the abdominal circulation and a larger amount
of blood to be carried through the vessels; if the food consists of
much meat, then its viscosity is augmented, as previously stated,
which indicates that a vegetable diet, with milk, and little or no
meat, is the best; but too large quantities of milk should not be
taken at one time.
Much bodily and other exercises, in excess, such as too much
climbing, should be avoided, as they promote arteriosclerosis by
frequent excitation of the splanchnics and adrenals. As Romberg
observed, there is sclerosis of the arteries in the extremities of
persons who do much physical labor, and Remlinger[209] found the
same in the lower extremities of peasant women who walked a great
deal.
Not only by a diet, chiefly vegetarian, is the viscosity of the blood
diminished and the circulation facilitated as found by Determann, but
also by means of iodine administered in the shape of iodide of
potassium or iodide of sodium. This has been proved by the
experiments of Ottfried, Müller, and Inada.[210] For many years it has
been well known that iodine can greatly benefit the condition of
arteriosclerotic persons. In combination with a preparation of iodine,
Professor Senator[211] favors the use of nitrites, and Professor
Huchard also recommends nitroglycerine in the intervals between
the iodide treatment. Besides inorganic iodine, it would appear to us
logical to try organic iodine preparations, such as thyroid extracts,
the principal element of which is iodine. For the above reasons it is
also necessary to take special care of the condition of the kidneys,
which can be done, as we have shown, by hygienic and dietetic
measures, already described in the special chapters of this work. An
improvement in the condition of the kidneys, and probably also in
the arteriosclerosis, may, in our judgment, be obtained by the
administration of kidney extracts, with which we will deal more fully
in the chapter on the treatment of old age by organic extracts.
According to Edgreen, about 25 per cent. of the cases of
arteriosclerosis is caused by alcohol. It acts by causing a constriction
of the small vessels (Traube), just as does adrenalin.
 But much more harmful in the production of arteriosclerosis is
tobacco. According to Claude Bernard, Huchard, Basch, Oser, Isaac
Adler, and Hensel, tobacco produces a constriction of the small
blood-vessels. Thus nicotin, adrenalin and alcohol have similar
actions, which also corresponds to the observations of Sir Lauder
Brunton. We have had a great many smokers among our
arteriosclerotic patients; but, on the other hand, we quote further on
the cases of some great smokers who lived to a very old age as we
have seen. But this latter class is not numerous.
Similarly, the hygiene of the intestines is of the utmost
importance, especially as poisons generated in the intestines play a
leading part in causing arteriosclerosis, according to Huchard,
Senator, and others. We must take great care to have a daily
evacuation of the bowels, and especially to prevent flatulence, for
this distention of the colon or the stomach, by carrying the
diaphragm upward, may interfere with the expansion of the lungs
and thus produce a mechanical hindrance to the movements of the
heart and a free circulation of the blood. Those with a tendency to
angina pectoris must specially avoid such dangerous courses. Hill
climbing, during which not infrequently such people suffer sudden
death, should also be avoided. More than from 1 to 1½ liters of
liquids per day should not be allowed.
 CHAPTER XVII.

The Elimination of Toxic Products Through the Intestines

and the Improvement of This Function.

The intestines contain billions and billions of microbes, their

number increasing downward throughout the length of the intestine.
The duodenum contains the least, and in some parts of it there are
none at all.
The presence of these bacteria is a great necessity to us, as
without their assistance we could not exist, for they take an active
part in intestinal digestion and help to form the intermediate
substances, especially from albuminous food and fat, for our
nutrition. They also assist fermentation and thus induce a better
peristalsis of the intestines, by which the contents are expressed.
That animals cannot exist without cultures of bacteria in the
intestines is shown by the experiment of Schottelius, who
demonstrated that young chickens could not thrive on a sterilized
nutrition, and Nuttall and Thierfelder had great trouble in keeping
their guinea-pigs alive when feeding them for a time on sterilized
milk.
All those bacteria which are found in the intestines are, we may
say, innocuous; they assist digestion and do no harm. But among
such are often virulent bacilli against which, under normal
circumstances, we are well guarded, as the epithelium of the
intestines is so wonderfully arranged that so long as it is in a healthy
condition it does not admit the passage of these microbes; but in the
aged, or in those exhausted by debauchery or previous disease, or
when there is an inflamed condition of the intestines, stagnation of
hard masses of fæces for a very long time cause mechanical lesions
of the epithelium when, conditions now having changed, nothing will
prevent these microbes from entering the walls of the intestines and
either cause disease, like typhoid or tuberculosis, or from passing
through and entering into the blood.
Besides these dangerous bacteria many other harmful substances
pass from the stomach down into the intestines, whence they are
taken up by the portal vein and brought to the liver. When the latter
is in good condition so much the better for us, but when they arrive
in too large quantities, or when the liver is more or less
degenerated, as in old people, drunkards, gourmands, etc., then
trouble arises.
When the number of bacteria in the intestines is much greater
than usual, certain dangers arise from such a condition, as thereby
the immigration of bacilli into the bile-duct is facilitated causing
inflammation of the gall-ducts and gall-bladder, and subsequently
gall-stone disease. Further consequences of such a condition may be
the closure of the bile-duct, and then no bile can reach the
intestines. The presence of bile, however, is very important, for,
according to current opinion, this exerts an influence on the
checking of putrefaction in the intestines. Bile is a natural antiseptic
of great efficacy, and has also a stimulating effect on the nerves of
the intestines, promoting their peristaltic movements.
It would, therefore, greatly interfere with the useful work of those
organisms normally present if we permitted the formation of
enormous quantities of bacteria, especially of such as are harmful to
us; so we must endeavor to eliminate them and not give them the
opportunity to turn against us, and we must do all in our power to
keep the peristalsis of the bowels in good working order so as to
prevent any stagnation of their contents, as such a stagnation, in
addition to favoring the growth of bacteria, also facilitates the
development of auto-intoxication. Even if it is true that most of the
end-products of proteid food in our intestines, like indol and skatol,
are not able to produce severe poisoning if injected into other
animals; still there is no doubt that in medical practice not
infrequently cases are observed where the retention of all these
products together results in very grave conditions. Thus Ewald[212]
has published the case of a woman who, for about a month,
retained the contents of the bowels and in consequence presented a
serious condition of intoxication; after eliminating a large quantity of
fæces—pitch dark—she recovered and the symptoms of intoxication
disappeared. Senator also published a very interesting case of auto-
intoxication with hydrothionuria.
We often have occasion to note cases of persons having no bowel
action for two to three days, who then complain of headache, loss of
appetite, and various nervous symptoms, neurasthenia, etc., all of
which may, perhaps, be regarded as of reflex origin; but when we
see in such people a yellow or yellowish-gray complexion which,
after a good purge, resumes its clear condition, clinically, we regard
it as auto-intoxication.
Even if, as already mentioned, most of the elements of albuminous
catabolism are not toxic if injected into animals, still, occasionally,
toxic products can be formed, such as cholin and neurin, which
come from the former. These elements arise from decomposition of
the lecithin, which, of our various foodstuffs, is contained in the
greatest quantity in eggs; and these substances can provoke serious
nervous symptoms. In such cases there is, of course, a stagnation of
long duration of the bowels, but such a condition as the latter can
arise without a stricture or obstruction, although these are the most
frequent causes. Another toxic product is the pepto-toxin of Brieger.
Stagnation takes place in sluggish bowels. As a general rule, fæcal
movement is caused by peristalsis of the intestines, which consists of
circular contractions of the bowel by which the contents are
propelled toward the end of the same; besides these movements
there are also pendular or vermicular contractions of certain parts of
the intestines; all these movements also assist the admixture of the
chyme with the juices of the intestines. All these contractions are
caused by impulses from the nerves which lie in the walls of the
intestines, the plexus myentericus; they can also be provoked by
impulses coming from the central nervous system.
The nerve ganglia that lie in the walls of the intestines can be
influenced mechanically by the contents of the intestines, when such
are bulky, and also when they are fermenting; therefore, the
bacteria, by promoting fermentation, also aid in peristalsis. The
bulky condition of the bowel contents can be best induced by food of
the vegetable kingdom through its cellulose contents, of which tissue
the cells of plants or fruits are largely formed. When these irritating
agents act on the nerve filaments in the intestines, the bowel will
contract and expel its contents.
But when food contains no irritating substances and is easily
assimilated without forming residues, or when the innervation by the
vagus is sluggish and the peristaltic movements are slow, the
contents of the intestines can remain longer, especially in the
haustra of the intestines. It may be that the bowels move every day,
but that does not prove that everything in the intestines has been
expelled therefrom, for some amount of fæces can yet remain in the
haustra of the intestine even for many days; so that in such cases
there is still a constipation of one part of the bowels. We have
observed, personally, and on patients, that, after a good opening of
the bowels, when a purge is given—for instance, directly after a
meal—a short time afterward there has been another copious
discharge that had evidently remained behind. Thus, no doubt a
retention of fæces, and sometimes a condition analogous to auto-
intoxication, can be caused in people who have the bowels opened
every day, although not to the extent of those having obstruction or
habitual constipation.
To avoid such a condition a good purge should be taken at regular
intervals, say once a week, even by persons who have a movement
daily, in order to eliminate matter which may have remained. It will
not be necessary, naturally, to use a too powerful purgative, but one
adapted to the necessity of the case; taking, as a rule, such a purge
as will act a little better than the ordinary bowel movement, and
graduated according to the strength of the person so using it.
Before closing this chapter we must also briefly insist upon the
importance of the fact, that the secretions of the intestine and of its
glandular annexes have also an anti-bacterial and antitoxic action.
Very important is the rôle of the bile for the disinfection of the
intestine, as it contains two acids, the glycocholic and taurocholic,
which possess highly anti-fermentative properties. As already
mentioned, the bile also assists in the assimilation of fat, and also
exercises a stimulating action on the peristalsis of the intestines.
 CHAPTER XVIII.

On the Prevention and Treatment of Habitual

Constipation.

We all know from physiology that the expulsion of fœcal matter

from the intestines takes place in such a manner that the contents
therein act as a kind of extraneous body with stimulating action
upon the walls of the intestines and the plexus myentericus
contained in the same. Consequently there follows a contraction of
the walls of the intestines, and their contents are expelled. All
nerves, the plexus myentericus included, are under the control of the
central nervous system, which creates motor impulses through the
medium of the pneumogastric (vagus), or may cause a check to the
peristaltic movements through the intervention of the splanchnic
nerves.
Thus, as we see, different agencies influencing the central nervous
system, like strong emotions, shock, etc., may cause an irritation of
the pneumogastric, the motor nerve of the intestines, and thus
occasion a movement of the bowels. Different toxic products may
act also upon the pneumogastric; strong motor action of the
intestine with diarrhœa may also be caused by the abundant
secretion of the thyroid gland, as in Graves’s disease, where an
excess of toxic matters of the thyroid gland are secreted.
In the same way we can also produce diarrhœa if we give thyroid
extracts in too abundant quantity; but giving the same in more
moderate doses will effect an improvement in the peristaltic
movements.
That the thyroid gland has a controlling influence on the
innervation of the intestine is evident from the fact that, when the
thyroid is degenerated, the bowels are very sluggish. Under such
conditions we often find very stubborn constipation; but when we
administer to such persons thyroid extracts for a given time, we note
a considerable improvement of the bowels, which can even go to the
extent, if too excessive doses be given, of causing diarrhœa as
already mentioned.
In addition to the thyroid gland, there are other ductless glands
which seem to influence the peristaltic movements by acting on the
splanchnic nerves, and these are the sexual glands. In women they
are frequently altered. Dysmenorrhœa, amenorrhœa, and other
troubles are frequent, and constipation is a typical symptom of such
conditions. This may also serve to explain why women are more
often constipated than men.
But the alteration of the sexual glands can also cause constipation
in men, if we may draw the inference from the great frequency of
constipation in diseases of the prostate gland, which to some extent
may be in relation with the subject with which we are now dealing.
In order to avoid constipation we must therefore observe a careful
hygiene of the thyroid, and also of the sexual glands, following the
advice we offer in special Chapters XVIII and XLVIII.
Besides constipation, as above, from the central nervous system,
the same may be caused through the lack of a stimulation which
may come from the intestinal contents. As we have already seen,
the peristaltic movements of the intestine and the expulsion of fæcal
matter take place through the stimulation of the nerves in the
intestinal walls by the intestinal contents, which act either
mechanically or by the irritation which their fermentation causes.
To prevent constipation we must take such nourishment as will act
in a stimulating way, either mechanically, owing to its bulk, or by the