Intestate

“ After the small intestine is opened the enterotome is introduced through the ileocæcal opening and the large intestine cut in the anterior tænia as far as the rectum. The opening of the intestine within the body should be left until all the other abdominal organs have been examined, because of the disagreeable mess made by the escape of the intestinal contents into the cavity. ”

“ The small intestine commences at the pylorus, winds into many convolutions, and terminates in the large intestine. In the adult it is about 20 feet in length. It is arbitrarily divided into three parts—viz., the duodenum, the jejunum, and the ileum. It constitutes four-fifths of the whole intestines, the larger making up the other fifth. They are used to aid in assimilating the food after digestion, and convey forward the excrementiticus matter. ”

“ The retention of fluids, transuded serum, bile, intestinal juices, and partly-altered food is hurtful. Decomposition sets in and gas is developed, which by distending the bowel causes great suffering and increases the inflammation. The movements of the intestine are not entirely under control; the patient must be fed; digestion and assimilation involve the activity of inflamed parts. The stomach can be made to do most of the work, but the sympathy of action is so close between the stomach and intestines that one cannot function without the other being excited into activity. ”

“ 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. ”

“ At a short distance below the junction of this gland with the stomach, the intestine contracts, and twists upon itself. There is no true pyloric valve, but this turn in the intestine to all intents and purposes acts as one. The intestine next proceeds towards the liver. This organ is large, its upper surface concave, its lower convex; it is divided by the suspensory ligament, which attaches it to the walls of the abdomen, into two lobes; in the adult male it is of a dark brownish colour, mottled; it overlaps the stomach and portions of the small intestine. ”

“ By means of the intestinal canal food or substances necessary to provide the energy which the living tissue transforms are introduced. This food is liquefied and so altered by the action of the various fluids formed in the glands of the intestine and poured out on the surface, that it can pass into the interior of the body and become available for the living cells. Various food residues representing either excess of material or material incapable of digestion remain in the intestine, and after undergoing various changes, putrefactive in character, pass from the anus as feces. ”

“ When peritoneal adhesions that cannot be easily torn are present it may be necessary to remove the intestines with mesentery attached.
After the removal of the intestines from the body they are opened by the intestinal shears, beginning either with the jejunum or the large intestine, the cut being made in the line of the mesenteric attachment. As the intestine is opened careful attention should be paid to the contents of each portion. It is very poor technique to dilate the intestine with water or to run water through it before it is opened. ”

“ The food is masticated by a very complicated system of jaws and teeth, and after it has been mixed with a secretion, which is poured into the mouth by salivary glands, it passes through a long muscular œsophagus into the stomach, where it is acted upon by fluids furnished by a liver and other glands, before it passes into the long, convoluted intestine, where the nutritive portions are absorbed into the blood, while the waste products are discharged from the body through the anus. ”

“ The constriction is especially severe at the junction of the rectum with the sigmoid colon, where it flexes upon itself in the region where the bore of the rectum is less. The comparative shutting up of the caliber of the upper end of the rectum and lower portion of the sigmoid colon occasions undue retention of the feces and gases which accumulate, and in accumulating dislocate various portions of the large intestine, thus forming pouches, sacks, reservoirs, prolapse, etc., which hold the products of putrefaction as well as the irritating, poisonous mucus thrown out from the inflamed tissue. ”

“ Four or five of these folds enter into the intestine, and here, for about a quarter of an inch, they become but very slightly elevated; as they approach that peculiar semiflexion in the intestine referred to above, they increase in number, and also in depth (Fig. 4) , and, from their very close and compact appearance, I am led to suspect that this portion of the intestine, between the pyloric orifice of the true stomach and the orifice of the biliary ducts, is more than an ordinary duodenum, and acts somewhat as a secondary stomachal cavity. ”

“ All kinds of foodstuffs, at all hours, with seeds, stones, etc., are poked into its stomach, followed by constipating remedies to quiet inevitable troubles, or brisk purgatives given with the hope of expelling the arrested contents of the bowels. Is it any wonder that ninety-eight persons of adult age out of every hundred suffer more or less from chronic inflammation and ulceration of anus, rectum, sigmoid flexure, colon, or appendix? ”

“ The intestine is straight from one end to the other but in this straight, and consequently short intestine, is a winding, cork-screw, spiral passage, through which the food, not without several circumvolutions, and, in fact, by a long route, is conducted to its exit. Here the shortness of the gut is compensated by the obliquity of the perforation.” This structure of intestine, which all the true Placoids possess, and at least the Sturiones among existing Ganoids, seems to have been an exceedingly common one during both the Palæozoic and Secondary periods. ”

“ Intestinal Digestion.—The chemical changes which food undergoes in the small and large intestines are exceedingly complex. Digestion in the intestine is due to the combined action of the bile, pancreatic juice, and succus entericus. The material which enters the duodenum from the stomach is known as the chyme. The acid chyme provokes a flow of bile and pancreatic juice. It acts upon the prosecretin in the duodenal mucous membrane in such a manner that secretin, a hormone, is formed and carried by the blood to the cells of the pancreas which it stimulates. ”

“ The integrity of the functions of the intestines is of supreme importance, for it is here that absorption and assimilation of most 183of our food occurs. If our intestines are not in perfect order we shall soon waste and dwindle away, even within a short period, and sometimes very rapidly. Thus if we wish to retain our strength we must treat the intestine with the greatest care. This is especially the case in old age, for then an atrophy of the glandular mechanism of the digestive tract, stomach, and intestines, takes place. ”

“ When full of food, the intestines are opake, and of a crimson colour, extending from the thorax quite through the abdomen and a great part of the tail, exhibiting a fine view of the peristaltic motion, or those gradual contractions and dilatations of the intestines, which propel their contents downwards. Numerous ramifications of vessels, both longitudinal and transverse, surround the intestines. The abdomen is not only capable of contraction, but also admits of such a degree of extension, as to form a case for all the other parts of the body. ”

“ From the important and complex function of the intestinal juices, and the very great share they take in the solution of food, there must be many phases of departure from the normal state. The processes of intestinal digestion are more intricate than those of gastric digestion, of a higher grade, and the chemical reactions are more numerous, depending upon the participation of the bile, the pancreatic juice, and the succus entericus; while intestinal absorption is a more complex act than that of gastric absorption. ”

“ When a portion of small intestine has been lost by mortification or otherwise, and the patient has recovered with an unnaturally situated or artificial anus, the intestine, although at first in contact with the wall of the abdomen, is gradually, in many cases though not in all, retracted into the cavity—it has been supposed by the dragging of the mesentery upon it at the point of union of the divided extremities outside where the eperon or valve is formed ”

“ A few of the many primary symptoms of proctitis and colitis are con­sti­pa­tion, diarrhea, indigestion, biliousness, flatulency, putre­fac­tion, and gaseous and bacterial poisons—a foul gastro-intestinal canal, through which there are daily absorbed from the bowels two-thirds to three-fourths of the excrementitious matter into the system. With these facts before us we need not be astonished at the statement that nine-tenths of human ills have their origin in the digestive apparatus. ”

“ As this mass passes into and through the colon, being propelled by regular peristaltic waves, it acquires odor from the development of a substance which is a final product of the putrefaction of albumen.1 Gradually the more fluid elements are absorbed, and in the descending colon a less fluid or semi-solid consistence of the feces is reached. A healthy digestion and assimilation, with active and regular contractile movements of the muscular walls of the small and large intestines, are essential to normal defecation. ”

“ The motions of the large intestines, sufficient to carry the feces into the rectum, would not, in a state of health, be powerful enough to expel them entirely, by overcoming the resistance which the sphincter constantly presents; in expelling the feces, the contraction of the intestine is assisted by the pressure which arises from the lowering of the diaphragm, and by the contraction of the abdominal muscles. ”

“ INTESTINES, in anatomy, are those hollow membranous tubes of the human body, commonly termed the guts or bowels, which extend from the right orifice of the stomach to the anus. They are six times longer than the whole body, and by Nature destined to receive the chyme, or the aliment, so called after it is converted into a kind of pulp, which they retain for a time ”

“ Only in our own day has come the greatest confirmation of the notion then first introduced into physiology, of the surpassing importance of intestinal digestion. The removal of the whole stomach for malignant disease is now undertaken without any fears as to the ultimate result on the patient's general nutrition. The operation has been done many times, and the surgeon's confidence that the intestines would compensate, as far as digestion of food was concerned, for the absent stomach has been amply justified. ”

“ The peristaltic movements are greatly increased in rapidity and force, and the faeces are carried rapidly from the upper to the lower parts of the intestine. They are thus passed through the large intestine in so short a time that the fluid they already contain has not time in which to be reabsorbed, a process which apparently takes place normally in the large intestine. At the same time there is a much larger quantity of fluid secreted into the lumen of the intestine than takes place in the normal animal. ”

“ It has the advantage of removing the old, solid feces, obstructions and mucus, from the intestines, without causing the usual diarrhea and constipation as an after effect. It is to be used in the beginning only, as an aid, and will not have to be used continually. As soon as the intestines are cleansed from the retained masses of feces and other obstructions and the mucusless or mucus-lean diet is taken up, you will realize the truth of the previously stated facts. ”

“ Constipation may be absolute, without the discharge of either feces or gas. Very often the contents of the bowel below the obstruction are discharged. The abdomen is usually distended and when the large bowel is involved this is extreme. If it is high up in the small intestine, it may be very slight. At first, the abdomen is not tender, but later it becomes very sensitive and tender. The face is pale and anxious and finally collapse symptoms intervene. The eyes are sunken, the features look pinched and a cold, clammy sweat covers the skin. The pulse becomes rapid and weak. ”

“ HOW AUTO-INFECTION AFFECTS THE GASTRIC DIGESTION, AND VICE VERSA.
Frederick the Great said that all culture comes through the stomach. This saying emphasizes pithily the dependence of psychology upon physiology. The stomach with the intestines is certainly the source from which every portion of the body receives its nourishment and most of its diseases. The physiological plus and minus processes leave their reflex on the mind. ”

“ This is owing to the frequent concurrence of the two conditions, the gastric symptoms taking precedence of the others. The more complex nature of the intestinal function is another reason, intestinal indigestion having more modifications in its phenomena. In the stomach there is only one active secretion; in the intestine there are three, all participants in the act of solution. An alteration in the quality or quantity of one of these—the bile, for example—would lead to different symptomatic results than would follow another defective secretion, as that of the pancreas, for instance. ”