1416

of the recumbent or of the squatting posture.

In the former the viscera tend to displace upwards by theirown weight, while in the latter they are forced upwards by
In our state of
the forcible apposition of the thighs.
civilisation the recumbent posture is only assumed at night,
and even then only partially, since the heavy buttocks and
thighs sink deeply into the bed. The squatting posture, so
Therefore
common among savage races, is never employed.
with us, from an early hour in the morning till a late hour
in the evening, or for at least 16 out of the 24 hours, thetendency to drop of the viscera exists, while during the
night this tendency is more or less in abeyance, but in a
degree below the normal of the savage.
Nature deals with this modification of the normal,
mechanical relationship of the individual to its surroundings in precisely the same way as it deals with any

assumption

CIVILISATION IN RELATION TO THE

ABDOMINAL VISCERA, WITH
REMARKS ON THE

CORSET.
BY W. ARBUTHNOT
SURGEON TO

WE hear a
the enormous
its influence.

LANE, M.S. LOND., F.R.C.S. ENG.,

GUYS HOSPITAL ; SENIOR SURGEON TO THE

FOR CHILDREN, GREAT ORMOND-STREET.

HOSPITAL

great deal of civilisation, as it is called, and

advantages that accrue to humanity through
Perhaps the most apparent advantage is the

the individual from the possibility of damage

creatures. While I would not wish to dispute
the benefits which are derived from it, I would like to call your specialised mechanical function, whether active or passive.
attention to the fact that there are many very serious disad- First, as regards the large bowel or cesspool of th&
vantages associated with it. These deal chiefly with the gastro-intestinal tract : it attempts to oppose the downward
mechanical relationship of the individual to his surround- displacement of the cascum into the pelvis by the formation
ings. I do not propose to do more than call attention to the of peritoneal bands, not inflammatory in origin, but
number of conditions which very materially shorten the life functional, if I may so use the term, which pull upwards the
of the man who makes his living out of laborious pursuits, hepatic flexure and secure it with as much firmness as
and limit in a corresponding manner his capacity for the possible in the upper and back corner of the right
enjoyment of life. These physical conditions represent the loin. Acquired bands secure the outer surface of the
fixation and exaggeration of attitudes of activity, and are all ascending colon and cascum in a similar way to the
progressively depreciatory, since they necessitate a shortened peritoneal lining of the adjacent abdominal wall. They
life, not only of the joints affected, but of the entire body. also grasp the appendix, commencing at its base and
Again, the fixation of attitudes of rest, such as lateral curva- forming a new mesentery, which is more or less distinct
nas a similar uamagng
from its normal mesentery. In this way a portion of the
ture, na1i-IOot, KnocK-Knee, <KC.,
effect, both on the altered joints and on the body generally, appendix takes on the function of a ligament of the csecum,
and materially affects the length of life and the capacity of tending to oppose its downward displacement. Unfortunately tor its new function, the appendix being a hollow
enjoyment of the individual.
What I wish particularly to call attention to is the tube whose mucous membrane secretes fairly abundantly, it
disadvantage that the individual experiences from the habit is ill adapted for this purpose. The pull exerted by the
of keeping the trunk constantly erect. This habit of keeping heavy loaded cascum upon such of the proximal portion of
the trunk erect from morning to night, whether the erect or the appendix as is fixed by acquired adhesions to the abdosedentary attitude is assumed, is almost universal in the minal wall produces a kinking of the appendix at the junccondition of civilisation which exists with us in the present , tion of the fixed and mobile portions. In consequence of
day. It is necessitated by our habit of using chairs and by this secretion tends to accumulate in the distal portion of
the fact that circumstances and surroundings do not lend the appendix and concretions form in it, or it may become
themselves to our lying or squatting on the floor. The erecti more or less acutely inflamed, producing varying conditions
posture affects men and women differently, for the reason of what is called appendicitis. And unluckily for the right
that the abdomen of the woman is relatively much longer ovary, the appendix becomes a near neighbour, and the
than that of the man, while the female thorax and pelvis irritation and annoyance of the ovary may result in a cystic
differ materially from the male. The abdominal wall of the degeneration of that structure.
Again, the recurring
woman is alo rendered less efficient by pregnancy and by the
menstrual engorgements of the ovary serve also to encourage
the appendix to manifest the effects of its mechanical
support afior led by her dress.
To reiterate, I would formulate three general principles. disability at these periods.
When an attitude of activity is assumed on a single occasion
The transverse colon, especially when loaded, tends also
certain tendencies to change exist. If this attitude is to fall into and occupy the pelvis. The abnormal acquired
assumed habitually these tendencies to change become fixation of the hepatic flexure in the right loin and of the
actualities, and the skeleton varies from the normal in pro- , splenic flexure in the left loin help to oppose the downward
portion to the duration and severity of the attitude. The I displacement. Some of the load is transmitted to the
skeleton is first fixed in the attitude of activity, and later ascenamg anu aescenamg coion uy means or acquireu
that attitude is progressively exaggerated. The same is true adhesions, which connect the descending and ascending
of an attitude of rest assumed on a single occasion and also portions of the transverse colon respectively to the
when assumed habitually. The skeleton of the ordinary or ascending and descending colon.
Above the connexion
normal individual rests upon a combination of the tendencies of these tubes is direct, exaggerating very much the
to change consequent on the assumption of complementary kink at the flexures.
Lower down the strain is transattitudes of activity and of rest. Now, when the trunk is mitted along an acquired mesentery which stretches from
erect, there exist tendencies to the downward displacement one to another. The greater portion of the load i&
The transmitted along the great omentum to the convexity of the
of the viscera contained in the abdominal cavity.
several viscera are influenced by this tendency in a varying stomach, which may itself be loaded up at the same time.
degree in proportion as they themselves vary in weight. For This abnormal drag on the convexity of the stomach is met
instance, the stomach and the large bowel are probably the by the formation of peritoneal adhesions or bands, which
most variable in weight, since a quantity of material collects attach the upper and anterior aspect of the pylorus to the
in them and passes along at a comparatively slow rate. The under surface of the liver. The upper attachment commences
in the vicinity of the transverse fissure and extends forwards,
more or less fluid nature of the contents of the large bowel
assists in its accumulation at certain points, as, for example, along the under surface of the liver, not infrequently attachin the cascum and in the middle of the transverse
ing the gall-bladder or its duct. The effect of this upward
while in the stomach the pressure is exerted on its convexity. drag upon the pylorus and of the pull on the convexity
The mechanics of the abdominal wall are such that the of the stomach is to interfere with its normal functioning
muscles exert a firm pressure on the viscera and tend to and to result in its progressive dilatation. The strain
prevent their downward displacement. Still, in the abdomen, on the stomach is experienced along its upper margin, and !
as well as in the body generally, the anatomy is so arranged
especially on either side of the pyloric attachment. It would
that there must be a suitable relationship between the anpear that in the male subject the teariug strain is greaterattitudes of activity and those of rest, or, in other words, on the upper aspect of the first piece of the duodenum,
that the erect posture, in which the viscera tend to drop, must while in the female it is greater on the proximal side. This
be alternated snfficiently with a position in which all strain varying distribution of strain would be readily accounted for
is taken off the viscera and the tendency for them to drop by the different form of the abdomen in the two sexes.
is in abeyance.
This latter may be obtained by the Again, if the liver itself is mobile and displaced, and the

safeguarding
by his fellow

colon, I

1417
for support on it, the point of
of the stomach approaches the
- eesophageal attachment in a degree proportionate to the
downward displacement of the liver. The importance of
these points of strain is that in t,he presence of autointoxication these two factors produce engorgement of the
mucous membrane, its excoriation, ulceration, and later its

pylorus

no

longer depends

- strain in the

infection by

concavity

cancer.

connexion to the periexternal to it, partly

to fix it, and partly to transmit the strain exerted by the
transverse colon through it. The loop formed hy the sigmoid
- section of the large bowel falls into the pelvis and struggles
with the c93cum. 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 de3cending colon with the rectum. This is effected in the
manner already described&mdash;name)y, by the development
of acquired bands of adhesions resembling peritoneum in
These tags connect first the outer surface
appearance.
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 tentaele-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 serons
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 csecum, 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
prpQpnce of the nest or cavity in which the cystic ovary

descending colon acquires a

toneum lining the abdominal wall
The

very auruptlyat the level of the msettion ot the deltoid

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 papillse. This
condition causes much distress to the mothers of girls who
The skin of the forearm is bluish and
wear short sleeves.
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 npse, but to a much less degree. These symptoms vary
considerably with the surrounding temperature, but are
readily recognised in the warmest weather.
comes
on a

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 redhaired 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 ovf-r 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
SMW.
particularly serious, since one important factor in controlling
1)"" ".
iu a certain proportion of cases the acquired tags or bands the position of the viscera is lost more or less completely.
of peritoneum do not grip the meso-sigmoid uniformly owing The individual is also unable to lead an active physical life
In this case they because of the poor muscular development. The muscles
to the escape of the centre of the loop
.attach only the extremities of the loop, approximating them are not only small and feeble, but become very soft and
In cmspqnpnce, an friable, so that they tear readily, and when sutured yield and
to one another and kinking both.
obstruction exists at the junction of the descending colon afford no security to the ligature. The condition of the
and sigmoid, and again in a more severe form at thp end of breasts is also a very important one. First, the upper and
the sigmoid. In consequence of the latter obstruction the outer zone of the left breast, and later the same portion of the
loop becomes abnormallylarge and natures efforts being right, show changes. In the young subject they become hard
only partially effective produce a condition which is infinitely and nobhly, and may be sore and painful at the menstrual
worse than the normal loop. and a so-caled volvnlns results.
periods. Later in life they develop a cystic charge, which may
The fixation of the sigmoid as a straight tuhe is unfortunately he painless or may be associated with attacks of pain owing
associated with a diminution in its calibre and in its to the distension of one or more cysts. Still later these
muscularity, and irritation, abrasion, ulceration. and cancer degenerating breasts are very liable to develop cancer.
- oi the mucous membrar e result. In some instances abscesses Though the degenerative change commences in the upper and
form in or about the wall of the fixed sigmoid in consequence outer zones it may spread to the entire breast. It is very
of the traumatism to which it is hahituallv exposed from the much more common in the virgin, and only arises in the
passage of its c intents being rendered difficult by its fixation married woman when intercourse is abstained from or is very
and limited c ,libre and muscularity. Associated with the irregular. These toxic people have verylittle or no sexual
intestinal stasis are the very serious symptoms that ensue appetite, just as they lose their appetite for food and even
from the ahsorptinn of toxins into the symptom.
hate the sight or smell of it. Perhapi the most interesting
The earliest feature is the inhibition of the respiratory and accurate description of the influence of intestinal
- centre, and accompanying this, and apparently consequent stasis on the sexual appetite has been written by Rudyard
on it, is the very definite enfeeblement of the circulation.
Kipling in " The Lhrht that Failed." I do not think Kipling
These patients depend more or less completelyon their knew that his heroine was affected by intestinal stasis and
diaphragm for obtaining enough oxyen to carry on their probably constipated, but he describes an individual with
mechanical relationship to their surronnr3ngs which becomes that accuracy of observation and power of description in
more and more modified as the conditi..). progresses
This which I believe he has no equal. I need not recall the redbrings about the several resting postures with which we are all haired companion of the heroine, as I am sure all are
-so familiar and which we attempt to cure b exPrcises alone,
perfectly familiar with the characters in the novel.
regardless of the factor which produces them. Thpir resisting
Perhal s one of the greatest of the many great men of whom
power to the entry of organisms is subnormal and the organism America can hoaf-t was Brigham Young ; he by irrigation
which most commonly effects a footh")d i.; t,B1he.cle. The onred a very poor district into one of the most fertile of
younger the suhj"ft the more Ieadilv does tuhNrcle appear the United States. He also attempted to popularise polyto be able to invade some tissue damaged hy traumatism. gamy, and his efforts in this direction were met bv a success
The pulse is very feebe and soft. While the trunk is fairlyv almost i-qiial to those in the direction of
agriculture. I am
warm, a hand passed over the shoulder of a toxic patient unable to form any definite opinion as to how his action was
.

J.

rra.. I

1418 T
influenced by the knowledge of the influence of intestinal Owing to a want of knowledge of the pathology of intesstasis on women, and the benefit which these people derivei tinal stasis the corset has not received the attention it
from matrimony. His views on this subject certainly did not deserves, so that by far the most important factor in the
meet with encouragement in the United States, partly, I treatment of intestinal stasis and of its effects has been left
suppose, because of religious or legal objections, and probably in abeyance. I would strongly urge its therapeutic value on
to a great extent from the ignorance of the public and even the medical profession as being the most effectual means I
of our profession on the subject of intestinal stasis. I am know by which the trouble to which I have called attention
inclined to think that when women know more about the in these remarks may be avoided or mitigated.
physiology of life they may exert some influence on legislaCavendish-square, W.
tion. This is more likely to develop, in the first instance, in
the United States, where both men and women hold broader
views and are less tied by creeds and tradition than they are
ON RHYTHMIC INTERRUPTERS FOR USE
in the old world.
The mental condition which is brought about by autoIN ELECTRO-THERAPEUTIC WORK.
intoxication is most distressing. While it renders the subjects miserable, and unable to concentrate their attention BY H. LEWIS JONES, M.D. CANTAB., F.R.C.P. LOND.,
MEDICAL OFFICER IN CHARGE OF THE ELECTRICAL DEPARTMENT,
on work or pleasure or to control their tempers, it makes
ST. BARTHOLOMEWS HOSPITAL; LATE PRESIDENT OF THE
them most unpleasant companions.
An alcoholic woman
BRITISH ELECTRO-THERAPEUTICAL SOCIETY.
under
the
be
cheerful
influence
of
her
but
in
no
may
drug,
circumstance does the toxaemia of intestinal stasis produce
THE advantage of using regularly varying currents in
other than a depressing influence on the mind and on the
1__J_
Medical
body generally. iviecticat men are very tond or calling tiliss many of the procedures of electrical treatment is gradually
These patients readily become becoming more widely recognised, and although such
condition neurasthenia.
melancholic. They frequently suffer severely from headache, currents have not yet come into general use, I consider
either continuously or at intervals, and they awake in the that they are shortly destined to do so. One of the causes
morning with a headache, feeling they have obtained no rest which have delayed their adoption has been the difficulty of
or advantage from their sleep, and that they are just as tired obtaining apparatus for providing regularly varying currents,
and exhausted as when they went to bed. The world seems but this has now been overcome.
During rhythmical electric stimulation the tissues stimualways chill and gloomy to them, quite apart from the
intestinal pain and discomfort which they so often experi- lated are given recurrent intervals of repose in the course of
ence.
My friends have often said to me that they were the treatment, and time is thus given for renewal of bloodsure patients would never submit to such a serious operasupply and fatigue is prevented. A sustained stimulation
tion as removal of the large bowel.
They forget without any intervals tends to induce fatigue quickly, parthat to these sufferers life has no attraction, and the ticularly in weak or paralysed muscles, and it is probable
risk of the operation at least affords them a chance of that harm may be done by electrical applications which set
escaping from it. I do not think that any patient has up a sustained tetanisation in such muscles. If experimental
expressed to me the slightest anxiety on this score, but proof were needed of the value of rhythmic stimulation, it is
has most willingly grasped the opportunity of parting to be found in the experiments of Debedat upon the muscles
with his other troubles at all costs and at the earliest of young rabbits. He showed that rhythmic stimulation
of the muscles of one hind limb for 10 minutes daily caused,
opportunity.
The patients usually suffer from abdominal symptoms, after 20 days, an increase of 40 per cent. above the weight
varying from a colicky pain due to obstruction at a flexure of the corresponding untreated limb. The current used was
or at the sigmoid, or to a flatulent distension of the stomach
that of an induction coil. With continuous current also
or intestine due to decomposition produced by the delay in
applied rhvthmically the increase was only 18 per cent.
evacuation of the contents, or to the presence of a When similar applications, but with no rhythmic intervals,
pancreatitis or of gall-stones. These conditions have were used the gain in weight was nil both for interrupted
resulted, partly from a direct infection of the pancreatic or and continuous currents. Bordier, working with human
biliary ducts by organisms from the small intestine subjects, has obtained similar proofsof the good effect of&pound;
whose level in the small intestine has been materially
currents, for he reports an increase in girth of&pound;
raised by stasis, and partly from a reduced resisting half an inch in the arm after two months of rhythmic
power to organisms consequent on the auto-intoxication. stimulation.
This infection of the pancreatic and biliary ducts does not
the term rhythmic interrupter "is meant a mechanical
appear to take place in such cases of intestinal stasis as device for turning currents on and off in a regular periodic
arise early in life. I have never seen it in patients in whom manner, and there are two main varieties of rhythmic
loss of flesh has been a marked feature before 20 years of interrupter, giving different effects, and both are valuable in
age. Infection of the gall-bladder and later of the pancreas medical treatment. In the older type the current is simply
arises in stout patients who develop intestinal stasis at or switched on and off at a uniform rate, the change from
beyond middle life. It would seem that the loss of flesh and I I on " toI I off " being abrupt ; while in the newer type there
of vigour consequent on the tox&aelig;mia of intestinal stasis so is a gradual growth of current from zero to its maximum,
affects the mechanics of the gall-bladder as to produce an followed by a similar gradual decrease to zero again. This
accumulation of bile in it and in association with the infec- is the most generally useful type of rhythmic interrupter,
tion of the ducts to determine the formation of stones in it. but the first type requires some brief notice, too. It will,
Here again intestinal stasis is responsible for an inflamma- perhaps, suffice to say that for sudden turning on and off
tion of these structures followed later by a cancerous of current a simple metronome with wires dipping into mercury
infection.
cups and out of them filJs the requirements completely. This
I have endeavoured to indicate the importance of the fall apparatus is well known in physiological work and is known
of the viscera in the erect posture.
Obviously the most as Kroneckers (more correctly Bowditchs) metronome. This
effectual means of mf eting this condition is by the type of rhythmic interrupter, in one form or another, has been
exercise of a sufficient pressure exerted appropriately on the in use since the very early days of electro-therapeutics. It is
lower abdomen. For a long time women have been in the of very great utility in electrical diagnosis, and I have found
habit of wearing corsets for the purpose of supporting their it valuable in the treatment of wry-neck and of other
dress and of affording attractive outlines to their bodies. spasmodic affections, and in functional aphonia. It appears
The English corset is disastrous in that it exerts a constrict- that for these cases the steady rhythm- of the make and
ing encircling pressure on the abdomen about the lower costal break has a psychological effect of a useful kind, and when
margin and exaggerates the tendency to downward displace- treating functional aphonia I insist on the patients counting
ment of the viscera. The straight-busked French corset is in time with the beats of the instrument, with the same
much less harmful, and if skilfully made and applied serves object. With this metronome the rate of the rhythm can
to exert a moderate pressure on the lower. abdomen. be varied within sufficiently wide limits, and the duration of
The corset that is most efficient is one that, while each period of flow of current can be regulated by adjustexerting a firm and constant pressure in a backward ments of the mercury cups and the dipping wires to permit
and upward direction on the abdomen below the umbilicus, of the dipping wire to plunge either deeply or slightly, as
leaves the upper portion of the abdomen quite free. desired.
____

--

--

rhythmic

By