Bolus

“ It has also been found, that as each bolus, or mouthful, enters the stomach, the latter closes, until the portion received has had some time to move around and combine with the gastric juice, and that the orifice of the stomach resists the entrance of any more till this is accomplished. But, if the eater persists in swallowing fast, the stomach yields; the food is then poured in more rapidly than the organ can perform its duty of preparative digestion; and evil results are sooner or later developed. ”

“ When the food has been thoroughly moistened and crushed in the mouth and rolled into a lump, or bolus, at the back of the tongue, it is started down the elevator shaft which we call the gullet, or esophagus. It does not fall of its own weight, like coal down a chute, but each separate swallow is carried down the whole nine inches of the gullet by a wave of muscular action. ”

“ In these cases I have given from ten grains to a scruple of the fresh root twice or thrice a day, made into a bolus or emulsion with unctuous and mucilaginous substances, which cover its pungency, and prevent its making any painful impression on the tongue. It generally excited a slight tingling sensation through the whole habit, and, when the patient was kept warm in bed, produced a copious sweat. ”

“ The earliest manifestations are those of impediment to the prompt passage of the bolus to the stomach, repeated acts of deglutition or additional swallows of food or drink being necessary. Large masses are swallowed and propelled onward more readily than small ones, and solids more readily than fluids. There is often a characteristic gurgling attending the passage of fluids along the tube. Swallowing is best performed in the erect posture. These symptoms increase in severity as the paralysis increases. There is little pain or none at all. In some cases there is no regurgitation of food ”

“ Thus fifteen grains of musk, with three grains of camphire, and six grains of salt of hartshorn, may be made into a bolus with a little syrup, and given as above.
If the fever should happen to intermit, which it frequently does towards the decline, or if the patient’s strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the stomach will bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. ”

“ According to Nothnagel, Mall, and others, the formation of these peristaltic waves is always due to a local stimulus, usually the presence of a bolus of food. The intestine contracts immediately above the point of stimulation and the mass of food is forced downward. ”

“ The head is raised each time after the mouth is filled, and the fluid by its own weight trickles into the œsophagus, through which it is carried by peristalsis.
In the cat the movement is always peristaltic, and slightly faster than in fowls. A bolus takes from nine to twelve seconds in reaching the stomach. Liquids move somewhat more rapidly than semi-solids in the upper œsophagus. In the lower or diaphragmatic part the rate is very much slower than above, and is the same for liquids as for solids. ”

“ Most ruminants swallow masses of hairs, and these, by the rotary action of the paunch, are aggregated into peculiar dense, rounded balls which are occasionally discharged from the mouth and are known as ``hair-balls'' or ``bezoars.'' The food bolus, when the animal is lying down after grazing, is passed into the oesophagus and reaches the mouth by antiperistaltic contractions of the oesophagus. ”

“ The marks of a redundance of bile are, a sickness at stomach, a sense of scalding at the anus when the stools are passing, and the yellow or green colour of the stools themselves. It is apt also to excite symptoms of fever, such as a foul tongue, a hot and dry skin, with thirst. When collections of it are suspected in this disease, it is best to evacuate it by vomiting, for it is thereby prevented from irritating the bowels, and from arriving at the inflamed parts with, perhaps, increased acrimony, acquired in passing through the whole length of the intestines. ”

“ The acute type has an abrupt onset; pain is felt in the lower part of the abdomen, and the motions, rarely exceeding thirty daily, are accompanied by much griping and straining. Blood and mucus are present in the motions, and occasionally greyish material, consisting of leucocytes, mucus, Charcot-Leyden crystals, amœbæ, and bacteria, sometimes with particles of tissue. Nausea and vomiting may occur. Digestion is usually deranged. The abdomen is sunken, the liver and spleen are normal, but tenderness is felt along the course of the large intestine. The urine may be diminished in quantity. ”

“ One of the effects of the bile in this operation is to extinguish acidity, whether proceeding from substances taken in, or generated in the stomach. The blood in all climates, and in all situations of life, is subject to have part of it thus corrupted, which, being separated from the common mass by the liver, is mingled and discharged with the common feces; but external heat continued for any length of time tends to augment this corruption of the fluids, and therefore to increase the secretion of bile ”

“ A little attention however to the state of the digestive organs will generally point out to them, that it was connected with indigestion, flatulence, or costiveness; or perhaps all these together: frequently it is the consequence of having eaten some particular kind of food, which experience shews always to disagree with the stomach. There are certain kinds of food which will constantly produce this [Pg 105] disease in such as are at all liable to it. Hildesheim, in his Spiceleg. De Affectibus Capitis, says: Qui scire cupit, quid sit Incubus? ”

“ But vomiting of black bile taking place without fever, or any other symptom of malignity, indicates a weakness of the retentive faculty of the spleen. A weakness of the expulsive faculty will bring on anorexia, the melancholic superfluity being no longer carried to the orifice of the stomach and exciting the appetite. When the melancholic humour is infarcted in the spleen, in the first place inflammation of it occurs, indicated by heat, pain, and tightness, but afterwards it passes into scirrhus, the heat and pain having ceased, while the swelling and hardness remain. ”

“ The large intestines are easily cured, but the small ones with difficulty, and the jejunum is utterly incurable, from the multitude of its convolutions and the magnitude of its vessels, and owing to its coats being thin and nervous; besides, it receives all the bile in an undiluted state, and is nearest to the liver. The under and fleshy parts of the stomach we may attempt to cure, for we may succeed, not only because these parts are thicker, but because curative medicines are more readily applied to them, owing to their situation. ”

“ The matter discharged from the stomach and bowels is generally yellow or green, but the stools are sometimes slimy and bloody, without any tincture of bile. In some instances they are nearly as limpid as water. Worms are frequently discharged in each kind of the stools that has been described. The children, in this stage of the disease, appear to suffer a good deal of pain. They draw up their feet, and are never easy in one posture. The pulse is quick and weak. The head is unusually warm, while the extremities retain their natural heat, or incline to be cold. ”

“ Jejunum, or empty gut, continuate to the other, which hath many mesaraic veins annexed to it, which take part of the chylus to the liver from it. Ilion the third, which consists of many crinkles, which serves with the rest to receive, keep, and distribute the chylus from the stomach. The thick guts are three, the blind gut, colon, and right gut. The blind is a thick and short gut, having one mouth, in which the ilium and colon meet: it receives the excrements, and conveys them to the colon. ”

“ Postmortem digestion of the mucosa, often leading to perforations, postmortem hypostasis, imbibition of bile, pseudomelanosis, and contractions of portions of the bowel must not be mistaken for pathologic conditions. Redness of a portion of the intestine does not in itself mean inflammation; the latter condition is shown by excess of mucus, swelling of the mucosa, hyperplasia of the follicles, hæmorrhage, etc. The contents of the small intestine are usually gruel-like in consistence, thinner in the upper part, thicker toward the ileocæcal valve. ”

“ Identifying the human stomach with the bird's gizzard, Borelli was led to attribute to the walls of the stomach an enormous force, estimated at more than a thousand pounds; whose action, he said, was the very essence of digestion. Valisnieri, on the contrary, having had occasion to open the stomach of an ostrich, had found there a fluid which seemed to act on bodies immersed in it; this fluid, he said, was the active agent of digestion, a kind of aqua fortis that dissolved food. ”

“ In some cases a great deal of yellow mucus is thrown into the lower bowel. The liver at times throws off so much bile that it makes the patient alarmed. This should cause no uneasiness. When the bile is forced upward into the stomach it is very disagreeable. The discharges from the bowels are often very dark.
There is a tendency toward chilliness, especially to have cold hands and feet. Skin eruptions and heart palpitations are occasional symptoms. Nervous, irritable and fearful people have symptoms too numerous to mention. The more they are sympathized with the worse they become. ”

“ Cælius Aurelianus gives a very comprehensive description of dysentery, the principal symptoms of which are fever, anxiety, rumbling of the belly, sometimes retention of urine; tongue rough, furred, and black; tenesmus and pungent pains of the intestines and anus. The disease, he says, consists of a defluxion from the belly with ulceration, and is preceded by diarrhœa, cholera, or inflammation. He animadverts upon the treatment of others with his usual freedom. Thus he blames Erasistratus for using nothing but astringents, whereas many cases of dysentery require laxatives. ”

“ Pleurisy, peripneumony, melancholy, acute fevers, frensy, lethargy, ardent fever attended with hiccough.—When any disease is about to attack the bowels, some of the following symptoms announce its approach: In the first place, the belly is griped and disordered, the food and drink seem bitter, heaviness of the knees, inability to bend the loins, pains over the whole body unexpectedly occurring, numbness of the legs, slight fever; when any of these occur, it will be proper to loosen the belly by a suitable diet without medicine. ”

“ The diverticula communicate with the bile-ducts, along which the ova of the parasites, and sometimes the parasites themselves, escape into the intestine. The affected liver is enlarged as a whole, although the tissue in the immediate neighbourhood of the diseased bile-ducts is atrophied. The spleen, also, may be hypertrophied, and the intestine in a condition of chronic catarrh. Some instances are recorded of the presence of this trematode in the pancreatic ducts, in the duodenum, and in the stomach. ”

“ Besides its poisonous infection, it distends or bloats the stomach, bowels, and tissues—a fact especially noticeable in the abdominal region, giving the appearance of corpulency or obesity to many, when really it is only abdominal ballooning or gaseous obeseness. Roly-polies—and there are a great many of them—will have their pride greatly hurt by accounting for their condition in this way, but the truth must be told and they might as well face the facts first as last. Gaseous obesity, or borborygmus, is spoken of popularly as wind in the stomach and bowels. ”

“ In Yellow Fever, and in several other diseases, the bile which is brought up by vomiting is frequently of a vivid green colour, and some writers have attributed the phenomenon to a morbid condition, or action of the liver or gall bladder; the fact however is, that the bile itself undergoes a chemical change in the Duodenum and Stomach. That bile does undergo such a change from decomposition, is proved by a variety of facts observed to take place out of the body ”

“ BUT because many of the Infected have a Loathing at Stomach, and an Inclination to vomit, in the same Manner as an Overload of Eating and Drinking occasions, Medicines in solid Forms suit best with such, as they are not so easily thrown up, and adhere better to the Sides of the Stomach: Of this Kind we have the following Composition, which at taking may be made into Boles of ʒ ij. each adding thereunto Salt of Carduus, or Wormwood ℈ j. or more or less according to the Exigency of Symptoms. ”

“ When bile is redundant, the intestinal excretion is often putrid and offensive, with bilious diarrhœa or dysentery, in repetition and quantity profuse, exciting tenesmus, and sometimes excoriation of the anus; to these may be added pain in the stomach and intestines, tension and elevation of the belly. According to Lind, the tropical remittents are the most virulent, yet are not contagious, unless accompanied with dysentery, or the sick crowded together ”

“ Antiperistaltic globus may occur from various causes; and either in the intestines or the œsophagus.
That of the intestines is met with chiefly in advancing age; and is generally produced by daily and often-repeated pressure on the abdomen, as practised in various professions. Hard labour and bad diet also greatly aggravate it. At first pain in the intestines occurs, aggravated by labour; together with derangement of digestion.
The sensation of a globe then appears on the lower and left side of the abdomen; and, after performing various circuits, finally reaches the stomach ”