Gros Ventre

“ When it attacks the glands of the mesentery, the belly becomes large and hard, while the legs and arms waste; the patient is voracious, yet his food fails in affording sufficient nourishment, and he gradually loses his strength and dies. ”

“ The morsels soften, the fibres of the muscle break short off and come asunder; the fat is set free from the chambers in which it was stored up by the living ox or sheep, and, melted by the warmth of the stomach, floats in great drops on the top of the softened pulpy mass of the half-digested food. Rolled about in the stomach for some time by the contraction of the muscles which help to form the stomach walls, losing much of its proteids all the while to the hungry blood, the much-changed meat is squeezed into the intestine. ”

“ We distinguish the segment dorsad of the stomach as the dorsal mesogastrium, directly continuous with the remaining segments of the common primitive dorsal mesentery, while the portion ventrad of the stomach forms the ventral mesogastrium in which the liver develops. The segment of the ventral mesogastrium between liver and stomach becomes the lesser or gastro-hepatic omentum, while that between liver and ventral abdominal wall forms the falciform or suspensory ligament. ”

“ The belly is covered with a transparent substance likewise, but more resembling a skin then a shell, for ’tis grain’d all over the belly just like the skin in the palms of a man’s hand, and when the belly is empty, grows very flaccid and wrinkled; at the upper end of this is placed the stomach HH, and perhaps also the white spot II may be the liver or pancreas, which, by the peristalick motion of the guts, is a little mov’d to and fro, not with a systole and diastole, but rather with a thronging or justling motion. ”

“ The gland becomes very intimately connected with the serous layers of the primitive dorsal mesentery. In order to clearly comprehend the adult serous relations it is necessary to make a distinction between two divisions or portions of the gland, based upon the altered relations of the primitive dorsal mesentery which result from the differentiation of the primitive simple intestinal tube into stomach and duodenum. ”

“ And it is not at all strange that they should, since there is so much pressure from within, so much pressure downward, and so much pressure from without—all through the requirements of fashion, indulgence, and ignorance. But the stomach, upper portion of the duodenum, and small intestine, cæcum, the ascending colon, and especially the transverse colon and sigmoid flexure, are susceptible to various forms of displacement, inhibiting the ready flow or passage of food stuffs, gases, and feces from one segment of the digestive apparatus to another, until the vent is reached. ”

“ The abdomen of a lady aged 52 years, having been afflicted for a long time with plethora abdominalis, began at last to swell and to grow hard, her complexion being tinged with a greyish-yellow colour, whilst her organs of digestion were impaired at the same time. ”

“ To cause the necessity of it to be perceived, we must remember that the vertebral column, forming one of the walls in the cavity containing the intestines, is firm and inflexible. Whence it follows, that the excess of weight which intestines acquire as soon as obesity causes them to deviate from the vertical line, rests on the envelopes which compose the skin of the stomach. ”

“ When the stomach is distended, it does not even then materially obstruct the expansion of the left lung, or the descent of the left diaphragm, for the abdominal walls relax and allow of the increasing volume of the stomach to accommodate itself. The spleen, R, is occasionally subject to an extraordinary increase of bulk; and this organ, like the enlarged liver and the distended stomach, will, to some extent, obstruct the movements of the diaphragm in the act of respiration, but owing to its free attachments it admits of a change of place. ”

“ Indeed, there is no comparison between these two processes; we have only to consider what the stomach contains—phlegm, bile, pneuma, [innate] heat, and, indeed the whole substance of the stomach. And if one considers along with this the adjacent viscera like a lot of burning hearths around a great cauldron—to the right the liver, to the left the spleen, the heart above, and along with it the diaphragm (suspended and in a state of constant movement) , and the omentum sheltering them all—you may believe what an extraordinary alteration it is which occurs in the food taken into the stomach. ”

“ Of these diverticula the left ventral disappears early, [1] but the right ventral, which is really an outgrowth from the lower part of the common bile duct, forms the head of the pancreas. The body and tail are formed from the dorsal diverticulum, and the two parts, at first separate, join one another so that the ducts communicate, and eventually the ventral one takes almost all the secretion of the gland to the intestine, while that part of the dorsal one which is nearest the duodenum atrophies and forms the duct of Santorini. ”

“ But the damage is not done to the heart and lungs alone. The liver is crowded out of place until it sometimes reaches clear across the abdomen and is creased with ruts from the pressure of the ribs upon it. The stomach is also pressed out of place. It belongs close up under the diaphragm, but it is crowded by the pressure down until it lies in the abdominal cavity, as low down, sometimes, as the umbilicus, six or eight inches below where it belongs. ”

“ The stomach lies on the ventral or under side of the body, but above the nervous cord, which lies still more ventrad. The stomach opens posteriorly into the small intestine, which is followed by the colon, the latter in turn being succeeded by the rectum. ”

“ Into the ventral mesentery the liver grows as diverticula from the duodenum, so that some of the mesentery remains as the falciform ligament of the liver and some as the lesser omentum. Into the dorsal mesentery the pancreas grows, also as diverticula, from the duodenum, while the spleen is developed from the mesoderm contained in the same fold. As the stomach turns over so that its left side becomes ventral, the dorsal mesentery attached to it becomes pulled out, in such a way that part of it forms the great omentum and part the gastro-splenic omentum. ”

“ Nature has beautifully apportioned the space in the abdominal cavity, each part of the viscera having ample room for the performance of its special function, but any abnormal increase in size of any part of the contents of the cavity must necessarily create disturbance. Now, when the food leaves the stomach, where it has been churned into a pulpaceous mass, it passes into the duodenum or second stomach, where it receives an augmentation of liquid material from the liver and pancreas ”

“ Many ailments, such as lumbago and kidney troubles, as well as hernia, are directly traceable to unsupported corpulency. To wear abdominal supporters is to prevent disease and add grace and comfort to the body. ”

“ And afterwards I parted the stomach from its external tunic, as I had done the intestines. I found no obstruction in the mesenteric glands; but every evolution of the mesentery firmly cohered together. The liver also adhered closely to the diaphragm, and its adjacent parts: and in the vesicula fellis I found the bile pretty thick, neither too green nor too yellow, but a tint between both. I met with nothing remarkable in the other parts of the abdomen. In opening the thorax, I found the lungs closely adhering to the ribs laterally, and posteriorly and interiorly close to the pericardium. ”

“ Now the liver, stomach, and all the intestines below the diaphragm, have no support from above, and so the question is, what sustains these organs, weighing from six to twelve pounds, so that they do not sink down on to the delicate pelvic organs below? The answer is, they are held up chiefly by abdominal breathing, as above explained. For at every rise of the diaphragm a vacuum is made above the abdominal viscera, lifting them upward, and this is done at every breath, and we breathe about twenty times each minute. ”

“ The small intestines were carefully cleaned and turned inside out to preserve the outer coating of fat, then dried and woven into a kind of mat. These mats were packed into parcels of the same shape and size as the meat. Even the muscular coating of the stomach was preserved. The large intestines were stuffed with flesh and used without delay. The vertebrae were pulverized with a stone axe after which the crushed bone was boiled. The very rich grease that arose to the surface was skimmed and preserved in bladders for future use. ”

“ The abdomen extends from the arch of the diaphragm to the lower extremity of the pelvis. It contains all the viscera of alimentation: the digestive system together with the glands belonging to it; the liver and pancreas, besides the renal system and, in women, the organs of generation (uterus and ovaries) . The diaphragmatic arch, having its convex side uppermost, enters the thoracic frame as far as the first dorsal vertebra. The intestinal [Pg 306] mass is more noticeable and prominent in persons having a narrow pelvis; in children, for example, the abdomen is very prominent. ”

“ The stomach, while it retains its general tubular form increases considerably in length and assumes the shape and structure found in the human large intestine. It is partially subdivided by folds projecting into the interior and separating compartments resembling the colic cells of the human large intestine. The time required for the passage of food through the stomach is thus increased and the action of the gastric juice is prolonged and rendered more intense. ”

“ The blade of the knife is held slightly obliquely against the mesenteric insertion of the intestine, and as the left hand pulls up the coils of intestine against the knife, the latter in the bowing or sawing movement severs the mesentery from the intestine as close to its insertion as is possible without cutting the intestine. The freed portions of intestine are caught in the tray resting on the thighs, and the left hand grasps in succession new portions of the small intestine and pulls them against the knife until the entire intestine is freed up to the duodenum and the root of the mesentery. ”

“ But if the man has an enormous stomach, projecting by reason of its obesity, over her thighs and flanks it will be best to lay her on her back, and to lift up her thighs toward her belly; the man kneels between them, with his hands having hold of her waist, and drawing her towards him, and if he cannot manage her in consequence of the obesity of her belly and thighs, he must with his two arms encircle her buttocks. ”

“ The breasts sometimes attain an enormous size, hanging down to the gastric and even to the umbilical region. The abdomen is greatly enlarged, the fat in the anterior abdominal wall projecting more especially in the hypogastric region, hanging down in two or three horizontal rolls over the tops of the thighs, and pushing the mons veneris downwards, so that this latter itself projects over the genital fissure. ”

“ But even in these rudimentary forms the point where the liver develops from the entodermal intestinal tube marks the separation of fore- and midgut. The stomach, when it develops, is situated cephalad of the entrance of the hepatic duct into the intestine. The section cephalad of the duct opening may be very short, and the food digested further on in the intestinal tube. Consequently a function which in these lower vertebrates is assigned to the midgut becomes transferred in the higher forms to a specialized segment of the foregut, situated cephalad of the hepato-enteric duct. ”

“ When the large intestine is full, palpation through the abdominal wall demonstrates that the material in the lower descending colon and in the sigmoid flexure is usually composed of hard, incompressible lumps, while that in the ascending and transverse colon and the cæcum is soft, permitting the walls of the gut to be easily pushed together. ”

“ The Muscles of the Abdomen.—These muscles are most important for breathing and therefore for health, for the retention in their normal position of the various abdominal viscera, for good digestion and regularity of the evacuation of the bowels. Sluggish digestion and constipation are among the commonest evils in life, and they are generally connected with relaxed abdominal walls and flabbiness of the abdominal muscles. Active pressure of the abdominal muscles on the viscera massages the liver and presses onward the contents of the intestines. ”

“ At the time when the intestine still presents the primitive arrangement of the umbilical loop (Figs. 104 and 130) this vessel passes between the layers of the dorsal mesentery through the narrow duodeno-colic neck to reach the two limbs and the apex of the intestinal loop. In its course it gives off successively branches to the gut from each side. Those from the right side of the main vessel pass to the duodenum, pancreas, jejunum and ileum. ”

“ The constriction of the waist crowds the small intestines, with the accompanying mesentery and colon, into the pelvis; if the rectum is loaded with feces and the bladder empty, there follows an anterior displacement of the uterus; if, on the other hand, the rectum is empty and the bladder distended, there is a backward displacement of the uterus. In very many of these cases the compression and constriction are great enough to interfere with and retard the peristaltic action of the intestines, and constipation is produced. ”

“ If, after removing all pressure, and giving those wonderful organs in the abdominal cavity full opportunity to perform their vital functions, the mischievous effects of the long continued pressure do not at once disappear, you may percuss and knead the abdomen a few minutes, morning and evening. Weak digestion, torpid liver and constipation are, by this simple means, frequently cured, and invariably relieved. ”