THE LANCET,] MR. LANE: CIVILISATION IN RELATION TO ABDOMINAL VISCERA, ETC. [NOV. 13 1417
pylorus no longer depends for support on it, the point of strain in the concavity of the stomach approaches the œsophageal attachment in a degree proportionate to the downward displacement of the liver. The importance of these points of strain is that in the presence of auto-intoxication these two factors produce engorgement of the mucous membrane, its excoriation, ulceration, and later its infection by cancer.
The descending colon acquires a connexion to the peritoneum lining the abdominal wall external to it, partly to fix it, and partly to transmit the strain exerted by the transverse colon through it. The loop formed by the sigmoid section of the large bowel falls into the pelvis and struggles with the cœcum. the transverse colon, and pelvic organs for the mastery. As the contents of the sigmoid are fairly solid, this piece of gut is a very unpleasant and obnoxious companion. Therefore Nature endeavours to fix it in the iliac fossa as a straight immobile tube connecting the descending colon with the rectum. This is effected in the manner already described—namely, by the development of acquired bands of adhesions resembling peritoneum in appearance. These tags connect first the outer surface of the meso-sigmoid and later the outer wall of the sigmoid to the iliac fossa, till finally a straight fixed tube, whose muscular coat is comparatively thin, with a partial peritoneal covering, replaces the original mobile loop. The left ovary is in immediate relationship with the outer aspect of the meso-sigmoid, and very frequently becomes involved in the tentacle-like peritoneal processes fixing the meso-sigmoid and later the sigmoid. Later it becomes embedded in the adhesions and then completely surrounded by them. After a time the ovary becomes cystic and enlarged, when it forms around itself a serous covering so that it moves freely in a cavity. This covering gives way, and when the aperture is sufficiently large the cystic ovary escapes. It continues to enlarge and elevates the cæcum, transverse colon, and stomach, and to a great extent meets the disabilities consequent on intestinal stasis, of which it is itself in this instance both the effect and the cure. Unfortunately, these cystic ovaries are more often malignant than was originally supposed. In a large number of cases in which I have removed large cystic ovaries I have been able to demonstrate, beyond a shadow of a doubt, the presence of the nest or cavity in which the cystic ovary grew.
In a certain proportion of cases the acquired tags or bands of peritoneum do not grip the meso-sigmoid uniformly owing to the escape of the centre of the loop. In this case they attach only the extremities of the loop, approximating them to one another and kinking both. In consequence, an obstruction exists at the junction of the descending colon and sigmoid, and again in a more severe form at the end of the sigmoid. In consequence of the latter obstruction the loop becomes abnormally large and nature's efforts being only partially effective produce a condition which is infinitely worse than the normal loop, and a so-called volvulus results. The fixation of the sigmoid as a straight tube is unfortunately associated with a diminution in its calibre and in its muscularity, and irritation, abrasion, ulceration, and cancer of the mucous membrane result. In some instances abscesses form in or about, the wall of the fixed sigmoid in consequence of the traumatism to which it is habitually exposed from the passage of its contents being rendered difficult by its fixation and limited calibre and muscularity. Associated with the intestinal stasis are the very serious symptoms that ensue from the absorption of toxins into the symptom.
The earliest, feature is the inhibition of the respiratory centre, and accompanying this, and apparently consequent on it, is the very definite enfeeblement of the circulation. These patients depend more or less completely on their diaphragm for obtaining enough oxygen to carry on their mechanical relationship to their surroundings which becomes more and more modified as the condition progresses. This brings about the several resting postures with which we are all so familiar and which we attempt to cure by exercises alone, regardless of the factor which produces them. Their resisting power to the entry of organisms is subnormal and the organism which most commonly effects a foothold is tubercle. The younger the subject the more readily does tubercle appear to be able to invade some tissue damaged by traumatism. The pulse is very feeble and soft. While the trunk is fairly warm, a hand passed over the shoulder of a toxic patient comes very abruptly at the level of the insertion of the deltoid on a cold zone, and this coldness becomes more marked as the hand descends to the fingers. The skin covering the back of the upper arm is reddish-blue, very thick and gelatinous in appearance and consistence. It is not infrequently rough from the presence of large prominent papillæ. This condition causes much distress to the mothers of girls who wear short sleeves. The skin of the forearm is bluish and marked into islands by lines of a darker hue which correspond to the superficial veins. The hand is mottled partly by blue, partly by yellow patches. The sensation imparted to the hand of the observer by that of the toxic patient is unmistakable. It is cold and clammy, and moist on its palmar surface. The ears are also bluish and feel cold, as also does the nose, but to a much less degree. These symptoms vary considerably with the surrounding temperature, but are readily recognised in the warmest weather.
The pigmentation of the skin in these toxic people is a very marked feature. Like many of the symptoms which result from intestinal stasis, but in a greater degree, it varies with the colour of the hair. While dark-haired people show pigmentation in a very marked manner, those with red hair show it slightly or not at all. In some peculiar manner red-haired people appear to possess a comparative immunity to the effects of intestinal stasis. Except for the face, the areas that show pigmentation most conspicuously are those exposed to friction, such as the inner aspects of the upper parts of the thighs, with the adjacent opposing surfaces of the buttock, the spines and abdomen where the corset or dress presses, the axillary folds, the bend of the elbow, and the neck. Pigmentation commences in the eyelids, spreads over the mouth, side of the nose, and later over the cheeks.
Loss of flesh is a very serious symptom and is productive of necessity of many secondary troubles. In the pelvis the loss of fat, aids in producing the elongated contracted cervix uteri and the flexions of the uterus which are so commonly present in these cases. In the loin it removes that elastic support which keeps the range of movement of the kidney in what is regarded as normal. The loss of fat in the face and neck produces an appearance of age, distress, and disappointment which is most pathetic, particularly in the young subject. The loss of muscularity is shown in a complete want of tone, the muscles being flaccid and inelastic. In the case of the abdominal muscles this is particularly serious, since one important factor in controlling the position of the viscera is lost more or less completely. The individual is also unable to lead an active physical life because of the poor muscular development. The muscles are not only small and feeble, but become very soft and friable, so that they tear readily, and when sutured yield and afford no security to the ligature. The condition of the breasts is also a very important one. First, the upper and outer zone of the left breast, and later the same portion of the right, show changes. In the young subject they become hard and nobbly, and may be sore and painful at the menstrual periods. Later in life they develop a cystic change, which may be painless or may be associated with attacks of pain owing to the distension of one or more cysts. Still later these degenerating breasts are very liable to develop cancer. Though the degenerative change commences in the upper and outer zones it may spread to the entire breast. It is very much more common in the virgin, and only arises in the married woman when intercourse is abstained from or is very irregular. These toxic people have very little or no sexual appetite, just as they lose their appetite for food and even hate the sight or smell of it. Perhaps the most interesting and accurate description of the influence of intestinal stasis on the sexual appetite has been written by Rudyard Kipling in "The Light that Failed." I do not think Kipling knew that his heroine was affected by intestinal stasis and probably constipated, but he describes an individual with that accuracy of observation and power of description in which I believe he has no equal. I need not recall the red-haired companion of the heroine, as I am sure all are perfectly familiar with the characters in the novel.
Perhaps one of the greatest of the many great men of whom America can boast was Brigham Young; he by irrigation converted a very poor district into one of the most fertile of the United States. He also attempted to popularise polygamy, and his efforts in this direction were met by a success almost equal to those in the direction of agriculture. I am unable to form any definite opinion as to how his action was
