OF THE STOMACH AND INTESTINES.
- 1. Of swallowing our food. Ruminating animals. 2. Action of the stomach. 3. Action of the intestines. Irritative motions connected with these. 4. Effects of repletion. 5. Stronger action of the stomach and intestines from more stimulating food. 6. Their action inverted by still greater stimuli. Or by disgustful ideas. Or by volition. 7. Other glands strengthen or invert their motions by sympathy. 8. Vomiting performed by intervals. 9. Inversion of the cutaneous absorbents. 10. Increased secretion of bile and pancreatic juice. 11. Inversion of the lacteals. 12. And of the bile-ducts. 13. Case of a cholera. 14. Further account of the inversion of lacteals. 15. Iliac passions. Valve of the colon. 16. Cure of the iliac passion. 17. Pain of gall-stone distinguished from pain of the stomach. Gout of the stomach from torpor, from inflammation. Intermitting pulse owing to indigestion. To overdose of foxglove. Weak pulse from emetics. Death from a blow on the stomach. From gout of the stomach.
1. The throat, stomach, and intestines, may be considered as one great gland; which like the lacrymal sack above mentioned, neither begins nor ends in the circulation. Though the act of masticating our aliment belongs to the sensitive class of motions, for the pleasure of its taste induces the muscles of the jaw into action; yet the deglutition of it when masticated is generally, if not always, an irritative motion, occasioned by the application of the food already masticated to the origin of the pharinx; in the same manner as we often swallow our spittle without attending to it.
The ruminating class of animals have the power to invert the motion of their gullet, and of their first stomach, from the stimulus of this aliment, when it is a little further prepared; as is their daily practice in chewing the cud; and appears to the eye of any one, who attends to them, whilst they are employed in this second mastication of their food.
2. When our natural aliment arrives into the stomach, this organ is simulated into its proper vermicular action; which beginning at the upper orifice of it, and terminating at the lower one, gradually mixes together and pushes forwards the digesting materials into the intestine beneath it.
At the same time the glands, that supply the gastric juices, which are necessary to promote the chemical part of the process of digestion, are stimulated to discharge their contained fluids, and to separate a further supply from the blood-vessels: and the lacteals or lymphatics, which open their mouths into the stomach, are stimulated into action, and take up some part of the digesting materials.
3. The remainder of these digesting materials is carried forwards into the upper intestines, and stimulates them into their peristaltic motion similar to that of the stomach; which continues gradually to mix the changing materials, and pass them along through the valve of the colon to the excretory end of this great gland, the sphincter ani.
The digesting materials produce a flow of bile, and of pancreatic juice, as they pass along the duodenum, by stimulating the excretory ducts of the liver and pancreas, which terminate in that intestine: and other branches of the absorbent or lymphatic system, called lacteals, are excited to drink up, as it passes, those parts of the digesting materials, that are proper for their purpose, by its stimulus on their mouths.
4. When the stomach and intestines are thus filled with their proper food, not only the motions of the gastric glands, the pancreas, liver, and lacteal vessels, are excited into action; but at the same time the whole tribe of irritative motions are exerted with greater energy, a greater degree of warmth, colour, plumpness, and moisture, is given to the skin from the increased action of those glands called capillary vessels; pleasurable sensation is excited, the voluntary motions are less easily exerted, and at length suspended; and sleep succeeds, unless it be prevented by the stimulus of surrounding objects, or by voluntary exertion, or by an acquired habit, which was originally produced by one or other of these circumstances, as is explained in Sect. XXI. on Drunkenness.
At this time also, as the blood-vessels become replete with chyle, more urine is separated into the bladder, and less of it is reabsorbed; more mucus poured into the cellular membranes, and less of it reabsorbed; the pulse becomes fuller, and softer, and in general quicker. The reason why less urine and cellular mucus is absorbed after a full meal with sufficient drink is owing to the blood-vessels being fuller: hence one means to promote absorption is to decrease the resistance by emptying the vessels by venesection. From this decreased absorption the urine becomes pale as well as copious, and the skin appears plump as well as florid.
By daily repetition of these movements they all become connected together, and make a diurnal circle of irritative action, and if one of this chain be disturbed, the whole is liable to be put into disorder. See Sect. XX. on Vertigo.
5. When the stomach and intestines receive a quantity of food, whose stimulus is greater than usual, all their motions, and those of the glands and lymphatics, are stimulated into stronger action than usual, and perform their offices with greater vigour and in less time: such are the effects of certain quantities of spice or of vinous spirit.
6. But if the quantity or duration of these stimuli are still further increased, the stomach and throat are stimulated into a motion, whose direction is contrary to the natural one above described; and they regurgitate the materials, which they contain, instead of carrying them forwards. This retrograde motion of the stomach may be compared to the stretchings of wearied limbs the contrary way, and is well elucidated by the following experiment. Look earnestly for a minute or two on an area an inch square of pink silk, placed in a strong light, the eye becomes fatigued, the colour becomes faint, and at length vanishes, for the fatigued eye can no longer be stimulated into direct motions; then on closing the eye a green spectrum will appear in it, which is a colour directly contrary to pink, and which will appear and disappear repeatedly, like the efforts in vomiting. See Section XXIX. 11.
Hence all those drugs, which by their bitter or astringent stimulus increase the action of the stomach, as camomile and white vitriol, if their quantity is increased above a certain dose become emetics.
These inverted motions of the stomach and throat are generally produced from the stimulus of unnatural food, and are attended with the sensation of nausea or sickness: but as this sensation is again connected with an idea of the distasteful food, which induced it; so an idea of nauseous food will also sometimes excite the action of nausea; and that give rise by association to the inversion of the motions of the stomach and throat. As some, who have had horse-flesh or dogs-flesh given them for beef or mutton, are said to have vomited many hours afterwards, when they have been told of the imposition.
I have been told of a person, who had gained a voluntary command over these inverted motions of the stomach and throat, and supported himself by exhibiting this curiosity to the public. At these exhibitions he swallowed a pint of red rough gooseberries, and a pint of white smooth ones, brought them up in small parcels into his mouth, and restored them separately to the spectators, who called for red or white as they pleased, till the whole were redelivered.
7. At the same time that these motions of the stomach and throat are stimulated into inversion, some of the other irritative motions, that had acquired more immediate connexions with the stomach, as those of the gastric glands, are excited into stronger action by this association; and some other of these motions, which are more easily excited, as those of the gastric lymphatics, are inverted by their association with the retrograde motions of the stomach, and regurgitate their contents, and thus a greater quantity of mucus, and of lymph, or chyle, is poured into the stomach, and thrown up along with its contents.
8. These inversions of the motion of the stomach in vomiting are performed by intervals, for the same reason that many other motions are reciprocally exerted and relaxed; for during the time of exertion the stimulus, or sensation, which caused this exertion, is not perceived; but begins to be perceived again, as soon as the exertion ceases, and is some time in again producing its effect. As explained in Sect. XXXIV. on Volition, where it is shewn, that the contractions of the fibres, and the sensation of pain, which occasioned that exertion, cannot exist at the same time. The exertion ceases from another cause also, which is the exhaustion of the sensorial power of the part, and these two causes frequently operate together.
9. At the times of these inverted efforts of the stomach not only the lymphatics, which open their mouths into the stomach, but those of the skin also, are for a time inverted; for sweats are sometimes pushed out during the efforts of vomiting without an increase of heat.
10. But if by a greater stimulus the motions of the stomach are inverted still more violently or more permanently, the duodenum has its peristaltic motions inverted at the same time by their association with those of the stomach; and the bile and pancreatic juice, which it contains, are by the inverted motions brought up into the stomach, and discharged along with its contents; while a greater quantity of bile and pancreatic juice is poured into this intestine; as the glands, that secrete them, are by their association with the motions of the intestine excited into stronger action than usual.
11. The other intestines are by association excited into more powerful action, while the lymphatics, that open their mouths into them, suffer an inversion of their motions corresponding with the lymphatics of the stomach, and duodenum; which with a part of the abundant secretion of bile is carried downwards, and contributes both to stimulate the bowels, and to increase the quantity of the evacuations. This inversion of the motion of the lymphatics appears from the quantity of chyle, which comes away by stools; which is otherwise absorbed as soon as produced, and by the immense quantity of thin fluid, which is evacuated along with it.
12. But if the stimulus, which inverts the stomach, be still more powerful, or more permanent, it sometimes happens, that the motions of the biliary glands, and of their excretory ducts, are at the same time inverted, and regurgitate their contained bile into the blood-vessels, as appears by the yellow colour of the skin, and of the urine; and it is probable the pancreatic secretion may suffer an inversion at the same time, though we have yet no mark by which this can be ascertained.
13. Mr. —— eat two putrid pigeons out of a cold pigeon-pye, and drank about a pint of beer and ale along with them, and immediately rode about five miles. He was then seized with vomiting, which was after a few periods succeeded by purging; these continued alternately for two hours; and the purging continued by intervals for six or eight hours longer. During this time he could not force himself to drink more than one pint in the whole; this great inability to drink was owing to the nausea, or inverted motions of the stomach, which the voluntary exertion of swallowing could seldom and with difficulty overcome; yet he discharged in the whole at least six quarts; whence came this quantity of liquid? First, the contents of the stomach were emitted, then of the duodenum, gall-bladder, and pancreas, by vomiting. After this the contents of the lower bowels, then the chyle, that was in the lacteal vessels, and in the receptacle of chyle, was regurgitated into the intestines by a retrograde motion of these vessels. And afterwards the mucus deposited in the cellular membrane, and on the surface of all the other membranes, seems to have been absorbed; and with the fluid absorbed from the air to have been carried up their respective lymphatic branches by the increased energy of their natural motions, and down the visceral lymphatics, or lacteals, by the inversion of their motions.
14. It may be difficult to invent experiments to demonstrate the truth of this inversion of some branches of the absorbent system, and increased absorption of others, but the analogy of these vessels to the intestinal canal, and the symptoms of many diseases, render this opinion more probable than many other received opinions of the animal œconomy.
In the above instance, after the yellow excrement was voided, the fluid ceased to have any smell, and appeared like curdled milk, and then a thinner fluid, and some mucus, were evacuated; did not these seem to partake of the chyle, of the mucous fluid from all the cells of the body, and lastly, of the atmospheric moisture? All these facts may be easily observed by any one, who takes a brisk purge.
15. Where the stimulus on the stomach, or on some other part of the intestinal canal, is still more permanent, not only the lacteal vessels, but the whole canal itself, becomes inverted from its associations: this is the iliac passion, in which all the fluids mentioned above are thrown up by the mouth. At this time the valve in the colon, from the inverted motions of that bowel, and the inverted action of this living valve, does not prevent the regurgitation of its contents.
The structure of this valve may be represented by a flexile leathern pipe standing up from the bottom of a vessel of water: its sides collapse by the pressure of the ambient fluid, as a small part of that fluid passes through it; but if it has a living power, and by its inverted action keeps itself open, it becomes like a rigid pipe, and will admit the whole liquid to pass. See Sect. XXIX. 2. 5.
In this case the patient is averse to drink, from the constant inversion of the motions of the stomach, and yet many quarts are daily ejected from the stomach, which at length smell of excrement, and at last seem to be only a thin mucilaginous or aqueous liquor.
From whence is it possible, that this great quantity of fluid for many successive days can be supplied, after the cells of the body have given up their fluids, but from the atmosphere? When the cutaneous branch of absorbents acts with unnatural strength, it is probable the intestinal branch has its motions inverted, and thus a fluid is supplied without entering the arterial system. Could oiling or painting the skin give a check to this disease?
So when the stomach has its motions inverted, the lymphatics of the stomach, which are most strictly associated with it, invert their motions at the same time. But the more distant branches of lymphatics, which are less strictly associated with it, act with increased energy; as the cutaneous lymphatics in the cholera, or iliac passion, above described. And other irritative motions become decreased, as the pulsations of the arteries, from the extra-derivation or exhaustion of the sensorial power.
Sometimes when stronger vomiting takes place the more distant branches of the lymphatic system invert their motions with those of the stomach, and loose stools are produced, and cold sweats.
So when the lacteals have their motions inverted, as during the operation of strong purges, the urinary and cutaneous absorbents have their motions increased to supply the want of fluid in the blood, as in great thirst; but after a meal with sufficient potation the urine is pale, that is, the urinary absorbents act weakly, no supply of water being wanted for the blood. And when the intestinal absorbents act too violently, as when too great quantities of fluid have been drank, the urinary absorbents invert their motions to carry off the superfluity, which is a new circumstance of association, and a temporary diabetes supervenes.
16. I have had the opportunity of seeing four patients in the iliac passion, where the ejected material smelled and looked like excrement. Two of these were so exhausted at the time I saw them, that more blood could not be taken from them, and as their pain had ceased, and they continued to vomit up every thing which they drank, I suspected that a mortification of the bowel had already taken place, and as they were both women advanced in life, and a mortification is produced with less preceding pain in old and weak people, these both died. The other two, who were both young men, had still pain and strength sufficient for further venesection, and they neither of them had any appearance of hernia, both recovered by repeated bleeding, and a scruple of calomel given to one, and half a dram to the other, in very small pills: the usual means of clysters, and purges joined with opiates, had been in vain attempted. I have thought an ounce or two of crude mercury in less violent diseases of this kind has been of use, by contributing to restore its natural motion to some part of the intestinal canal, either by its weight or stimulus; and that hence the whole tube recovered its usual associations of progressive peristaltic motion. I have in three cases seen crude mercury given in small doses, as one or two ounces twice a day, have great effect in stopping pertinacious vomitings.
17. Besides the affections above described, the stomach is liable, like many other membranes of the body, to torpor without consequent inflammation: as happens to the membranes about the head in some cases of hemicrania, or in general head-ach. This torpor of the stomach is attended with indigestion, and consequent flatulency, and with pain, which is usually called the cramp of the stomach, and is relievable by aromatics, essential oils, alcohol, or opium.
The intrusion of a gall-stone into the common bile-duct from the gall-bladder is sometimes mistaken for a pain of the stomach, as neither of them are attended with fever; but in the passage of a gall-stone, the pain is confined to a less space, which is exactly where the common bile-duct enters the duodenum, as explained in Section XXX. 1. 3. Whereas in this gastrodynia the pain is diffused over the whole stomach; and, like other diseases from torpor, the pulse is weaker, and the extremities colder, and the general debility greater, than in the passage of a gall-stone; for in the former the debility is the consequence of the pain, in the latter it is the cause of it.
Though the first fits of the gout, I believe, commence with a torpor of the liver; and the ball of the toe becomes inflamed instead of the membranes of the liver in consequence of this torpor, as a coryza or catarrh frequently succeeds a long exposure of the feet to cold, as in snow, or on a moist brick-floor; yet in old or exhausted constitutions, which have been long habituated to its attacks, it sometimes commences with a torpor of the stomach, and is transferable to every membrane of the body. When the gout begins with torpor of the stomach, a painful sensation of cold occurs, which the patient compares to ice, with weak pulse, cold extremities, and sickness; this in its slighter degree is relievable by spice, wine, or opium; in its greater degree it is succeeded by sudden death, which is owing to the sympathy of the stomach with the heart, as explained below.
If the stomach becomes inflamed in consequence of this gouty torpor of it, or in consequence of its sympathy with some other part, the danger is less. A sickness and vomiting continues many days, or even weeks, the stomach rejecting every thing stimulant, even opium or alcohol, together with much viscid mucus; till the inflammation at length ceases, as happens when other membranes, as those of the joints, are the seat of gouty inflammation; as observed in Sect. XXIV. 2. 8.
The sympathy, or association of motions, between those of the stomach and those of the heart, are evinced in many diseases. First, many people are occasionally affected with an intermission of their pulse for a few days, which then ceases again. In this case there is a stop of the motion of the heart, and at the same time a tendency to eructation from the stomach. As soon as the patient feels a tendency to the intermission of the motion of his heart, if he voluntarily brings up wind from his stomach, the stop of the heart does not occur. From hence I conclude that the stop of digestion is the primary disease; and that air is instantly generated from the aliment, which begins to ferment, if the digestive process is impeded for a moment, (see Sect. XXIII. 4.); and that the stop of the heart is in consequence of the association of the motions of these viscera, as explained in Sect. XXXV. 1. 4.; but if the little air, which is instantly generated during the temporary torpor of the stomach, be evacuated, the digestion recommences, and the temporary torpor of the heart does not follow. One patient, whom I lately saw, and who had been five or six days much troubled with this intermission of a pulsation of his heart, and who had hemicrania with some fever, was immediately relieved from them all by losing ten ounces of blood, which had what is termed an inflammatory crust on it.
Another instance of this association between the motions of the stomach and heart is evinced by the exhibition of an over dose of foxglove, which induces an incessant vomiting, which is attended with very slow, and sometimes intermitting pulse.—Which continues in spite of the exhibition of wine and opium for two or three days. To the same association must be ascribed the weak pulse, which constantly attends the exhibition of emetics during their operation. And also the sudden deaths, which have been occasioned in boxing by a blow on the stomach; and lastly, the sudden death of those, who have been long debilitated by the gout, from the torpor of the stomach. See Sect. XXXV. 1. 4.