Peristalsis

“ In contraction the powerful, writhing peristalsis involves the small intestine above the impediment, and in stricture the large bowel above the obstruction. In both stricture and contraction inflammation of the bowel and peritoneum may supervene. In contraction, when inflammation sets in or when enteritis and peritonitis are absent and the attack of constipation is insurmountable, I have noticed that the symptoms are more urgent and rapid in their course, and danger of death from collapse greater, than when these conditions exist in stricture. ”

“ To any one making these experiments there can be no doubt that the increased peristalsis is the direct result of the injection of the salt. It can be readily proven in the following way: As will be shown in a later chapter, the peristalsis and secretion caused by the saline purgatives can be inhibited by the administration of calcium or magnesium chloride. If now in a rabbit in which the intestine has been set into active motion by the intravenous injection of sodium citrate, a small quantity of m/6 CaCl2 be administered intravenously, all of these movements cease within a minute or two. ”

“ Recently evidence has been presented that gastric peristalsis is dependent on the stretching of gastric muscle when tonically contracted. [47] The evidence that the stomach is in fact strongly contracted in hunger—i. e., in a state of high tone—has been presented above. [48] Thus the very condition which causes hunger and leads to the taking of food is the condition, when the swallowed food stretches the shortened muscles, for immediate starting of gastric peristalsis. ”

“ This is followed by others, in man at regular intervals of about twenty seconds, so that the pyloric part of the organ is soon in active peristalsis. The fundus of the stomach is not actively concerned in these movements; it simply acts as a reservoir. At certain periods, but not with each peristaltic wave, the pyloric sphincter relaxes and allows a portion of the fluid acid chyme to escape into the duodenum. It only opens when stimulated by fluid material; if solid food be forced against it it remains tightly closed. ”

“ Complete and perfect cleansing of the infected abdominal cavity is impossible in large animals.
In other cases the animals should be left completely at rest, and purgatives should be avoided. Movement or the administration of purgatives provokes peristalsis, and, as a consequence, almost inevitably leads to generalisation of a lesion which might otherwise have some chance of remaining localised, as in pelvi-peritonitis and peritonitis due to foreign bodies issuing from the rumen or reticulum. ”

“ The common understanding of the manner in which food passes through the intestinal canal is that the chyme ejected from the stomach is pressed downward by a peristalsis, which passes slowly over a part or all of the small intestine. The peristaltic waves of the colon are supposed to constitute an independent group, similar to those of the small intestine, but weaker and slower. Movements of the food other than the uninterrupted advance have been mentioned by some observers. ”

“ Change of Mode of life and Intestinal Control.—An interesting phase of the neurotic or mechanical disturbance of peristalsis is found in the interference with regular movements of the bowels when persons are aboard trains for long distances, or for more than twenty-four hours. ”

“ The normal peristaltic action of the intestines propels the nutritive as well as the effete material through the canal at a rate that allows of both proper absorption and timely elimination. But when excessive peristalsis occurs, neither absorption nor elimination will be normal or suited to the requirements of the system.
Undigested foodstuffs may become an irritant, or increase, as is usually the case, the established irritation, and thus bring on an acute attack of diarrhea. ”

“ The activity of the large intestine has been described as simply peristalsis of a slower rate than that seen in the small intestine.
The best known of the intestinal movements is the normal peristaltic wave. This wave is slow, having a rate of about two centimetres per minute, is regular, and by most observers is said to move always in one direction. The progress of the contraction, as suggested by Nothnagel’s experiments, and as clearly stated by Mall and by Bayliss and Starling, is dependent upon a local reflex. ”

“ This constipation is not congenital, as it always is when the colon is unusually long even for an infant, and when the sigmoid flexure is of double or even treble length, but makes its first appearance about the end of the first or the beginning of the second month. It is relieved only when the increasing muscular power of the intestine results in more effective peristalsis. The second symptom is the thoracic groove, to which I shall allude later, and a gradual thickening of the costo-cartilaginous junctures, with or without periosteal pain on pressure. ”

“ Unhappily, a large proportion of pregnant women suffer from constipation, particularly during the later weeks, though women who have always had a tendency of this kind may have trouble from the very beginning of pregnancy. Sluggish peristalsis, due to pressure by the enlarged uterus upon the intestines, is probably the prime cause, though impaired tone of the stretched abdominal muscles also may be a factor.
The bowels should move regularly every day, and to this end the patient should regularly attempt to empty them, immediately after breakfast usually being the best time. ”

“ The more or less conscious assumption of definite positions of the muscles of the abdominal region in order to save the body from the action of the unsteady movement of the train, seems to be reflected in the sphere of peristalsis with consequent constipation. There are other features, such as a lessened consumption of food and water and absence of exercise, that seem also to have an influence. ”

“ Because when a drug, given hypodermatically, purges, it is not proof that the drug acts as a cathartic in the circulation, and that it does not act locally, for it may be inactive till it is excreted by the intestinal mucous membrane, and then act locally.
At present I will speak of peristalsis only. Perhaps as good a way as any to proceed, though unsatisfactory, is, first, to exclude the brain, and then, second, the abdominal ganglia, and then, third, experiment on the excised living intestine. ”

“ The old idea that in peristaltic action lay the great danger of increase of the hemorrhage and perforation of the bowels, is giving way to the more rational view that gaseous distention and septic absorption, are what bring about fatal results from these complications, and that the moderate peristalsis of the intestinal walls lessens these dangers by closing the gaping ends of the injured vessels, and expelling the septic matter and foul gases. ”

“ Of course it is necessary to learn first the lifting power of the peristalsis in the same dog without a cathartic.
(5) By injecting a solution of the cathartic into a ligatured loop of intestine in the living animal. It is better to use a rabbit or dog that has been starved for several days so that the intestine will be empty. After several hours remove the loop and measure the amount of liquid. If it is increased the drug stimulates secretion. It must not be forgotten that the irritation of the ligature stimulates secretion, so it is better to have a similar loop for comparison. ”

“ There may or may not be well-marked peristalsis taking place, but quite commonly large hardened tumours can be felt in various situations in the abdomen, corresponding to the contracted intestinal walls. ”

“ Iron, with quinia or arsenic, is needed in obstinate cases.
Intestinal catarrh which proceeds from the presence of undigested food or hard fecal lumps in the bowel is benefited by early removal of the irritating cause. It is not often that substances of this kind are retained when the stools are large and frequent. The peristalsis is here as active as it need be, and no good, but only harm, can come from over-stimulating the contractile muscles. ”

“ An ice-bladder should be laid upon or suspended immediately above the abdomen during the whole duration of the flow. The injection of ice-water into the bowel should be practised only in cases where the hemorrhage is believed to come from the colon. Otherwise, the peristalsis it awakens may only aggravate the danger. Should rest and cold fail to quickly check the hemorrhage, resort should be had at once to ergot. ”

“ These occur in young women who have all the symptoms of an approaching intestinal evacuation, and then find when they have excused themselves that there is nothing but gas to be passed. This gas is nearly always quite inoffensive, and is evidently air that has been present in the intestines for some time, and has in the midst of the excitement of peristalsis been forced on into the rectum and gives the sensation of an approaching stool. These cases are coming into notice much more commonly since young women have taken up business occupations. ”

“ For he says that the stomach contracts peristaltically round the food during the whole period of digestion. But if it contracts, without in any way being diminished in length, this is because downward traction of the gullet is not a property of the movement of circular peristalsis. For what alone happens, as Erasistratus himself said, is that when the upper parts contract the lower ones dilate. And everyone knows that this can be plainly seen happening even in a dead man, if water be poured down his throat ”

“ Indeed, the muscular system is amongst the first to suffer. In the same way in which the voluntary muscles are not competent to raise and support the head or to allow a baby to sit up without a functional kyphosis, the involuntary muscles of the intestine are too feeble for normal peristalsis. The infant of a month or two months of age may have had normal and sufficiently numerous evacuations; gradually, however, constipation sets in; the feces become dry, but are perhaps not much changed otherwise. If no other cause be apparent, the suspicion of rachitical constipation is justified. ”

“ No action is observed until after an interval of 10 to 15 minutes after the salt solution is placed in the lumen of the intestine, while application of the same solution to the peritoneal surface causes movements of the intestine within one minute.
FOOTNOTES:
[31] Pohl (Arch. f. exp. Path. u. Pharm., Bd. 34, S. 87) stated that all sodium and ammonium salts increased the peristalsis when applied to the peritoneal surface of the intestine.
[32] MacCallum, J. B.: Amer. Journ. ”

“ They proceed to pass on this quantity of food, store up two or three days' rations, digest what is nutritious and eliminate what must be rejected, without rising into consciousness. If either stomach or intestines once begin to attract attention, then it will be difficult, unless care is exercised to distract the mind from them, to replace and keep them back in the sphere of the unconscious once more. Peristaltic movements are constantly taking place in the digestive tract. Various things may interfere with peristalsis, and the disturbance of it will almost surely cause some sensation. ”

“ Our idea of digestion has been so largely one of digestive secretions, to the neglect of the motor side of the gastric and intestinal functions, that we have missed some important points. If a person leans over a desk shortly after a meal, there is no doubt that the crowding of the abdominal viscera hinders peristalsis, at least to some degree, not of course in the robust and healthy, but in those who already have some irregularity or sluggishness in this region. ”

“ The gut is usually relaxed below the bolus, and the general statement [Pg 3] has been made that a stimulation at any point causes a contraction above that point and an inhibition below it. It is generally thought that Auerbach’s plexus is concerned in the propagation of the peristaltic wave since the peristalsis takes place also when the intestine is separated from the central nervous system, and does not occur when nicotine or cocaine is given to paralyze the intrinsic nerves of the intestine. ”

“ Magendie published a theory of deglutition, in Paris, in 1836, which was practically accepted until 1876, when Dr. Professor Angelo Mosso, of the University of Turin, Turin, Italy, established the theory of sole peristaltic assistance in swallowing. Again in 1880 Dr. Professor Kronecker, of Berne, Switzerland, in connection with Dr. Falk, and later in connection with Dr. Meltzer, of New York, produced evidence to prove a more complicated process in deglutition than that of peristalsis alone. ”

“ Little by little he increases his dose, as the digestive mechanism grows less responsive to the stimulus, until presently an overdose sets his intestines churning around with a violence never intended by nature. Then, under this abnormal peristalsis, as it is called, the appendix becomes infected, and there’s nothing for it but the surgeon’s knife.”
“Would you have people run to the doctor and pay two dollars every time their stomach got a little out of kilter?” ”

“ Symptoms. In the domestic animals the first indication of illness is a lazy, tardy disposition, The subject stands apart from the herd, with drooping head and ears, listless, indifferent to all around him, and often without appetite; or, in cattle or sheep, rumination. There is usually extreme thirst, but without correspondingly free urination or defecation. Peristalsis is virtually 330abolished and nothing whatever passes from the bowels. The patient is likely to be found lying down and it is difficult to get him up, and when raised he moves stiffly and with reluctance. ”