Part 23
In the transverse colon, which is free from the slowly moving rings, the antiperistaltic waves have full sway. In the region of the tonic rings an infrequent or even a slowly periodic relaxation and contraction are often to be observed. These changes seem to take place in all the rings at about the same time. Once I saw antiperistaltic waves running over the uppermost of four segments, but since the rings on either side of the segment held tightly, the waves had merely the effect of churning the material of the segment and did not move it onward. Inasmuch as the material in these segments at first is soft, so that the segments are easily compressible, while the fæcal masses which are the final result are relatively hard and dry, it follows that even within the confines of these persistent rings some absorption is taking place.
DEFECATION
The process of clearing the colon is a process of repeated reduction of the amount of material present. Figure 8 (3.11) is a radiograph showing the food in the colon at 3.11 P.M. About 3.25, with a slow, sweeping movement, the gut swung around so that the ascending colon was lying in the position of the last half of the transverse colon, and the transverse colon had taken the position of the descending part (Fig. 8, 3.25). At the same time the tonic constrictions disappeared and were replaced by a strong, broad contraction of the circular muscle, tapering the contents off on either side in two cones. The region of strongest contraction was apparently drawn downward with the rest of the gut by a shortening of the descending colon. As the intestine swung around, more material was forced into the rectum, and when the swinging of the intestine stopped, the constriction which divided the lumen passed slowly downward, and with the aid of the muscles surrounding the abdominal cavity, pushed the separated mass out of the canal.[35] After the terminal mass had thus been pushed out, the colon with the remainder of its contents returned to nearly its former position (Fig. 8, 3.46). About two hours afterward this remnant had been spread throughout the length of the large intestine by means of the slowly moving rings. Figure 7 is a radiograph of the same colon pictured in Figure 8; the radiograph was taken at 11.50 A.M., and at 12.15 P.M. the material in the lower descending colon was forced out in the manner above described. Within three hours the remaining portion had been spread into the evacuated region, as shown in Figure 8, 3.11. The manner in which the material is spread from the region of the antiperistaltic waves into the region of the slowly advancing rings presents a problem. During normal living new food constantly arriving in the colon must force the old contents forward just as the later parts of a meal force forward the earlier parts; there is no doubt, however, that most of the contents of the cæcum and the ascending colon may be passed onward even during starvation. The emptying of these regions, according to my observations, is never complete; for after considerable time has elapsed and the large intestine is cleared and dilated with gas, some substance is still to be detected in the cæcum and clinging to the walls of the ascending colon. The only activities manifested here are the antiperistaltic waves and the strong tonic contraction of the whole circular musculature shown in Figure 6. It is clear that the latter activity would serve to press into the transverse colon a considerable portion of the contents of the ascending colon, and the remnant seen clinging to the walls would be the part not thus pressed forward.
[Illustration: 3.11 3.25 3.46
FIGURE 8.--Two radiographs and a tracing showing the changes taking place in defecation. 3.11, material in the colon. 3.25, colon carried downward and terminal mass separated. 3.46, after defecation, when the colon returns to former position. Defecation occurred at 3.27.]
Twice I have seen appearances which might account for the emptying of the first portion of the large intestine in a more thorough manner than that above described. At one time, without apparent stimulation, strong tonic contraction occurred along the entire length of the ascending colon, which forced the contents almost wholly into the transverse portion. This action seemed merely an exaggerated form of that observable after food passes the ileocæcal valve (see Fig. 6). At another time, after a mass of food had passed through the ileocæcal valve, after the ascending colon had contracted generally and the antiperistaltic waves had coursed over it in the usual manner, a deep constriction appeared at the valve and ran upward without relaxation nearly the length of the ascending colon, pushing the contents before it. For an instant the wave paused; then the constriction relaxed and the food returned towards the cæcum. These observations indicate that either a general contraction of the wall of the large intestine or a true peristalsis may be effective in pressing waste matter from the region where antiperistalsis is the usual activity into the region where the slowly advancing rings may carry it on to evacuation (see Fig. 7).
THE QUESTION OF ANTIPERISTALSIS
In 1894 Grützner published an observation and made an assumption about which there has since been much controversy. He maintained that when normal salt solution, holding in suspension hair, powdered charcoal, or starch grains, is injected into the rectum, it is carried upward into the small intestine and may even enter the stomach. These experiments have been repeated by several observers. Some have confirmed Grützner’s results; others have failed, after using most careful methods, to find any evidence of the passage of the injected material back to the stomach, and they have declared that the apparent success was due to carelessly allowing the food of the animal to become contaminated with the test materials, so that these were introduced into the stomach by way of the mouth. That antiperistalsis does not occur in the small intestine seems to be proved by Mall’s experiment of reversing a portion, sewing it in place, and then finding that the food does not pass the reversed region, but collects at the upper end. Sabbatani and Fasola reversed stretches of small intestine of varying length, and found that the reversed portions allowed fluids to pass, but that the persistence of the physiological direction of movement caused an accumulation of undigested food in the region of the upper suture. However a portion of the intestine lay in relation to the rest, it always manifested the normal peristalsis. Many other observers working directly on the intestine confirm this testimony and state that the progress of the constriction-rings is always downward, and that antiperistalsis is not physiological. In 1898, however, Grützner took his stand again in favour of a backward movement in the intestines, and in a somewhat metaphysical manner argued that peristalsis and antiperistalsis belong to each other just as relaxation of muscle is related to contraction. He assumed that as the contents are advanced by slow peristalsis, so are they returned by a similar movement in the opposite direction, and he mentions several pathological cases (fistula of intestine) to substantiate the assumption.
By means of the X-rays it is possible to see just what takes place when a fluid is injected into the rectum. For the purpose of determining how nutrient enemata are received and acted upon in the intestines, I have introduced thin, fluid masses in large and small amounts, and thick, mushy masses in large and small amounts, in different animals. The enemata consisted of 100 c.c. of milk, one egg, ten to fifteen grams of bismuth subnitrate, and two grams of starch to hold the bismuth powder in suspension. To make the thick enema all these were stirred together and boiled to a soft mush; to make the thin enema all the parts were boiled together except the egg, which was added after the boiled portion was cooled. The small amount injected was 25 c.c.; the large amount almost 90 c.c., about the capacity of the large intestine when removed from the body. The animals were given first a cleansing injection, and after this was effective the nutrient material was introduced. In order to make sure of the observation, a control radiograph was first taken to show no bismuth food present, and other radiographs taken at varying intervals after the injection to record the course the food was following.
[Illustration: 1.50 2.15 3.00
FIGURE 9.—- Radiographs showing that after a large nutrient enema (about 90 c.c.) has been given the food is forced more and more from the large into the small intestine. The enema was introduced at about 1.40 P.M. At 3.00 segmentation was occurring in many loops.]
These experiments show that when small amounts of nutrient fluid are introduced they lie first in the descending colon. In every instance antiperistaltic waves are set going by the injection, and the material is thereby carried to the cæcum. When large amounts are injected they stop for a moment in the region between the transverse and descending colon, as if a constriction existed there. Then a considerable amount of the fluid passes the point, and antiperistaltic waves carry it to the cæcum. In any case the repeated passing of the waves seems to have the effect of promoting absorption, for in the region where these waves continue running, the shadows become gradually more dim, and finally the bismuth appears to be only on the intestinal walls; in other regions, _e. g._ in the descending colon, the shadows retain their original intensity. Small injections have never in my experience been forced even in part into the small intestine; but with the larger amounts, whether fluid or mushy, the radiographs show many coils of the small intestine containing the bismuth food.
The passage of the injected material beyond the ileocæcal valve is probably due entirely to antiperistalsis in the colon,--a factor unknown to both Grützner and his opponents. The valve, which is thoroughly competent for food coming normally from the small intestine into the large, is curiously incompetent for a substance, even of the consistency of thick cream, introduced in large amount by rectum. When the valve first permits the food to enter the ileum, the fluid pours through and appears suddenly as a winding mass occupying several loops of the intestine (Fig. 9, 1.50, about ten minutes after the injection). The mass is continuous from the valve to the other end; antiperistalsis is therefore not visible in the small intestine under the circumstances of this experiment. The antiperistaltic waves of the colon, however, continue running; the transverse and ascending colon are thus almost emptied, and the small intestine more and more filled with food (Fig. 9, 2.15 and 3.00). After a short time the typical segmenting movements can be seen in the loops, busily separating the food into small masses, and over and over again dividing and redividing them.
I have never seen food material pass back from the colon so far as the stomach; but once, about ten minutes after an injection of 100 c.c. of warm water, the cat retched and vomited a clear fluid resembling mixed water and mucus. In the fluid were two intestinal worms still alive.
The importance of the mechanism by which nutrient enemata are passed backward in the intestine is evident. In the colon the nutrient material is worked over by the antiperistaltic waves, intimately mixed with whatever digestive juices may be present, and exposed to the organs of absorption in that region. If the enemata are large, the digestive and absorptive processes are by no means confined to the colon, but may take place along extensive surfaces of the small intestine. I have repeatedly seen rhythmic segmentation active throughout many loops of the small intestine, thus exposing the injected food to the same mixing and absorbing processes as affect the nutriment which has come through the stomach in a normal manner.
THE EFFECT OF EMOTIONS AND SLEEP
Observations on the stomach of the cat showed that the peristalsis is inhibited whenever the animal manifests signs of anxiety, rage, or distress. Since the extrinsic innervation of a large part of the intestinal tract is the same as that of the stomach, it is of interest to note the effect of emotional states on the movements of the intestines. Esselmont, in a study of the dog’s intestine, noted constantly after signs of emotion a marked increase of activity lasting for only a few moments. Fubini also observed that fear occasioned more rapid peristalsis. There is no doubt that many emotional states are a strong stimulus to peristalsis, but it is equally true that other emotional states inhibit peristalsis. In the cat the same conditions which stop the movements of the stomach stop also the movements of the intestines.
[Illustration: FIGURE 10.--Tracings showing the effect of excitement on antiperistalsis in the colon.]
The female cats used in these observations ordinarily lie quietly on the holder and make no demonstration. Sometimes, however, with only a little premonitory restlessness, the cat suddenly flies into a rage, lashing her tail from side to side, pulling and jerking with every limb, and biting at everything near her head. During such excitement, and for some moments after the animal becomes pacified again, the movements, both of the large and small intestine, entirely cease. Such violence of excitement is not necessary to cause the movements to stop; a cat which was restless and continually whining while confined to the holder showed no signs of intestinal movements during any period of observation (one period lasted more than an hour), although the changes in the distribution of the food observable from one period to the next proved that movements were going on during the quiet intermissions. In another cat, uneasy and fretful for fifty minutes, no activity was seen; then she became quiet for several minutes, and peristalsis of the small intestine appeared.
When the segmentation process in the small intestine is stopped by excitement the segments unite and the series of parts returns to the form of a solid string. The change occurring in the large intestine when the antiperistalsis is inhibited by excitement is shown in Figure 10. The tonic constrictions in the descending colon are apparently not affected by emotional states, for they do not seem to relax in the excitement which causes the movements to cease.
By holding the mouth and nostrils closed, or by pressing between the rami of the jaw, the breathing may be stopped. As soon as the cat shows distress from lack of breath every form of intestinal movement stops.
The statement is sometimes made in text-books of physiology that the gastric and intestinal mechanisms cease to act during sleep. It is worthy of note that nearly all the animals curled up and slept during the time between observations; nevertheless, the progress of the food through the intestines continued. The statement is also made that at night, even without sleep, the intestines are almost entirely at rest; that this is their normal time for repose. I have seen both large and small intestines actively at work, however, from half past nine until half past ten o’clock at night.
SUMMARY
1. Bismuth subnitrate, 10 to 33 per cent, mixed with the food renders the movement of the intestinal contents, and thereby the movements of the intestinal walls, visible on the fluorescent screen.
2. The activity most commonly seen in the small intestine is the simultaneous division of the food in a coil into small segments, and a rhythmic repetition of the segmentation each time applied to the new segments formed from parts of those just divided. In the cat this rhythmic segmentation may proceed at the rate of thirty divisions per minute. The effects of the constrictions causing the segmentation are the mixing of the food and the digestive juices, the bringing of the digested food into contact with the absorbing mechanisms, and the emptying of the venous and lymphatic radicles of their contents by compression of the intestinal wall.
3. Peristalsis is usually combined with segmentation. As the food is advancing, interfering constrictions often separate the rear end of the mass from the main body. The separation is momentary, however; the rear end is swept into union with the main body again, and the whole mass is pushed onward until another constriction repeats the changes.
4. The ileocæcal valve is thoroughly competent for food entering the colon from the ileum.
5. The usual movement of the transverse and ascending colon and the cæcum is an antiperistalsis. This recurs in periods about every fifteen minutes, and each period lasts commonly about five minutes; the waves recur during a period at the rate usually of eleven waves in two minutes. This antiperistalsis gives new significance to the ileocæcal valve; for the food, now in a closed sac, is thoroughly churned and mixed by the constrictions running towards the cæcum, and again exposed to absorbing walls without any interference with the processes in the small intestine.
6. As soon as new food enters the large intestine a strong general contraction takes place along the cæcum and ascending colon, forcing some of the food onward; a moment later antiperistaltic waves begin to pass.
7. With the accumulation of material in the transverse colon, deep tonic constrictions appear one after another and carry the material into the descending colon, leaving the transverse and ascending portions free for the antiperistaltic waves.
8. In emptying the large intestine the material in the lower descending colon is first carried out by combined peristalsis and pressure of abdominal muscles; the remainder of the material is then spread into the evacuated region, and this region is again cleared; the second remainder may be similarly affected. In normal life the new food arriving in the colon must force forward the old contents of the ascending and transverse colon.
9. The observations have revealed no evidence of antiperistalsis in the small intestine, but since the ileocæcal valve will allow nutrient material under pressure to pass backward, the antiperistalsis of the large intestine may force into the small intestine a considerable portion of a large nutrient enema. Segmentation in the small intestine affects such an enema precisely as it affects food which has passed normally through the stomach.
10. Signs of emotion, such as fear, distress, or rage, are accompanied by a total cessation of the movements of both large and small intestines. The movements continue in the cat both during sleep and at night.
THE BATTLE CREEK LABORATORIES
THE MAMMOTH SANITARIUM AND THE LARGE ADOPTED FAMILY OF DR. AND MRS. J. H. KELLOGG
[A report of one experiment has been selected from _Modern Medicine_ relative to the work of the laboratories connected with the Battle Creek Sanitarium because it relates to the effect of cooking and mastication upon food in illustration of the statement of Dr. Campbell pertaining to these aids to digestion. Much more evidence could be had from the Sanitarium reports, but sufficient has already been given herewith from various authoritative sources to justify our claims of the great importance of mouth-treatment in human nutrition.
It may be said here, however, that the trial of thorough mouth-work as an aid to digestion, which has been in progress at the Sanitarium for more than a year, and which has finally been accepted and prescribed as the first requirement of the treatment of patients, is of the utmost significance. This is, by far, the largest sanitarium in the world, having some hundreds of physicians, nurses, and other attachés, and treating many thousands of patients annually. The “cure” is based upon natural methods of recuperation, and while all of the staff, both medical and surgical, are fully equipped diplomatists, and whereas the organisation has a legally and professionally accepted medical school of its own, so-called medicines are rarely used, and never except as antidotes to specific poisons. Nature is assisted by scientific means to do the curing, and now that an economic nutrition to relieve the exhausted system of the patient from all possible strain through ample mouth-treatment of food, as intended by the anatomical, dental, and chemical plan on which man is constructed, has been tried and accepted as a fundamental principle of the institution, it gives a practical indorsement of the claims set forth in “Glutton or Epicure,” and in this present book, and declares that they are of greatest importance in securing health and efficiency.
The Battle Creek Sanitarium is a philanthropic and humanitarian institution operating under a perpetual charter which compels the use of all the profits gained to foster the spread of the humanitarian work. More than sixty branches of the parent institution have been established in or near large cities in different parts of the world, under the title of The American Medical Missionary Association, and each of these branches conducts a life-saving business on Good Samaritan principles. The organisation started its medical missionary work some thirty-seven years ago, with almost no capital and only one patient, in a small two-storey frame house, in the then small village of Battle Creek, Michigan. The incorporators were religious enthusiasts who believed that Christianity should be expressed in works as much as in faith, in curing the sick and healing the wounded, and thus preparing the unfortunate for the reception of moral and spiritual inspiration.
The best evidence that this scheme of procedure to attain the ultimate end was a good one is shown by the success of the institution in its growth from such small beginning to the immense proportions of the present time, with one of its buildings nearly a thousand feet in length and five storeys in height and numerous other buildings radiating from the main one and scattered about it in a finely wooded park. Fire came and destroyed the old building and all its contents, but yet it was soon rebuilt, and the concern goes on growing and growing, because the foundation principle of the institution is the beautiful Golden Rule, and the method of treatment employed is taken from the open book of Nature.
While the organisation was primarily based upon a special religious creedal enthusiasm, it has become so broadly altruistic as to suggest a return to original Christianity as defined in the Sermon on the Mount. In such Christian expression honest agnostics, born Buddhists, and the tolerant of all the different Christian creeds may join and say amen!
One of the splendid results of an economic nutrition, attained by following the natural requirements and impulses, is the curing of many diseases, among them several forms of constipation. The writer has a genuine admiration for the spirit that is the motive power of the Battle Creek Sanitarium and firm belief in the Christianity demonstrated in the work, especially in the private experiment of Dr. and Mrs. Kellogg, with their family of adopted waifs. Twenty-four children of unfortunate parents, waifs so unfortunate in their attractability as to be hopelessly neglected, have been gathered under this sheltering roof and are showing their mettle and gratitude by splendid behaviour and brilliant accomplishment in a manner that any proud parent might approve. To miss any opportunity to express gratitude to Dr. and Mrs. Kellogg for giving us such a splendid example of the true meaning of practical Christianity would be showing symptoms of the worst form of constipation; viz., constipation of appreciation and affection.—HORACE FLETCHER.]
EXPERIMENTAL INVESTIGATION OF THE INFLUENCE OF MASTICATION AND COOKING OF FOOD, ETC., IN THE LABORATORIES OF THE BATTLE CREEK, MICHIGAN, SANITARIUM, UNDER THE DIRECTION OF DR. J. H. KELLOGG
From _Modern Medicine_