The People's Common Sense Medical Adviser in Plain English Part 4

_7_. Transverse colon. _8_. Descending colon.

_9_. Sigmoid flexure of colon. _10_. r.e.c.t.u.m.]

The _Intestines_ are those convoluted portions of the alimentary ca.n.a.l into which the food is received after being partially digested, and in which the separation and absorption of the nutritive materials and the removal of the residue take place. The coats of the intestines are a.n.a.logous to those of the stomach, and are, in fact, only extensions of them. For convenience of description, the intestines may be divided into the _small_ and the _large_. The small intestine is from twenty to twenty-five feet in length, and consists of the Duodenum, Jejunum, and Ileum. The _Duodenum_, so called because its length is equal to the breadth of twelve fingers, is the first division of the small intestine.

If the mucous membrane of the duodenum be examined, it will be found thrown into numerous folds, which are called _valvulae conniventes_, the chief function of which appears to be to r.e.t.a.r.d the course of the alimentary matter, and afford a larger surface for the accommodation of the absorbent vessels. Numerous _villi_, minute thread-like projections, will be found scattered over the surface of these folds, set side by side, like the pile of velvet. Each _villus_ contains a net-work of blood-vessels, and a lacteal tube, into which the ducts from the liver and pancreas open, and pour their secretions to a.s.sist in the conversion of the chyme into chyle. The _Jejunum_, so named because it is usually found empty after death, is a continuation of the duodenum, and is that portion of the alimentary ca.n.a.l in which the absorption of nutritive matter is chiefly effected. The _Ileum_, which signifies something rolled up, is the longest division of the small intestine. Although somewhat thinner in texture than the jejunum, yet the difference is scarcely perceptible. The large intestine is about five feet in length, and is divided into the Caec.u.m, Colon, and r.e.c.t.u.m. The _Caec.u.m_ is about three inches in length. Between the large and the small intestine is a valve, which prevents the return of excrement.i.tious matter that has pa.s.sed into the large intestine. There is attached to the caec.u.m an appendage about the size of a goose-quill, and three inches in length, termed the _appendix vermiformis_. The _Colon_ is that part of the large intestine which extends from the caec.u.m to the r.e.c.t.u.m, and which is divided into three parts, distinguished as the ascending, the transverse, and the descending.

[Ill.u.s.tration: Fig. 30.

Villi of the small intestine greatly magnified.]

[Ill.u.s.tration: Fig. 31.

A section of the Ileum, turned inside out, so as to show the appearance and arrangement of the villi on an extended surface.]

The _r.e.c.t.u.m_ is the terminus of the large intestine. The intestines are abundantly supplied with blood-vessels. The arteries of the small intestine are from fifteen to twenty in number. The large intestine is furnished with three arteries, called the _colic arteries_. The _ileo-colic artery_ sends branches to the lower part of the ileum, the head of the colon, and the appendix vermiformis. The _right colic artery_ forms arches, from which branches are distributed to the ascending colon. The _colica media_ separates into two branches, one of which is sent to the right portion of the transverse colon, the other to the left. In its course, the _superior hemorrhoidal artery_ divides into two branches, which enter the intestine from behind, and embrace it on all sides, almost to the a.n.u.s.

The _Thoracic Duct_ is the princ.i.p.al trunk of the absorbent system, and the ca.n.a.l through which much of the chyle and lymph is conveyed to the blood. It begins by a convergence and union of the lymphatics on the lumbar vertebrae, in front of the spinal column, then pa.s.ses upward through the diaphragm to the lower part of the neck, thence curves forward and downward, opening into the subclavian vein near its junction with the left jugular vein, which leads to the heart.

[Ill.u.s.tration: Fig. 32.

_c, c_. Right and left subclavian veins. _b_.

Inferior vena cava. _a_. Intestines. _d_. Entrance of the thoracic duct into the left subclavian vein. _4_. Mesenteric glands, through which the lacteals pa.s.s to the thoracic duct.]

[Ill.u.s.tration: Fig. 33.

The inferior surface of the liver. 1. Right lobe.

2. Left lobe. 3. Gall-bladder.]

The _Liver_, which is the largest gland in the body, weighs about four pounds in the adult, and is located chiefly on the right side, immediately below the diaphragm. It is a single organ, of a dark red color, its upper surface being convex, while the lower is concave. It has two large lobes, the right being nearly four times as large as the left. The liver has two coats, the _serous_, which is a complete investment, with the exception of the diaphragmatic border, and the depression for the gall-bladder, and which helps to suspend and retain the organ in position; and the _fibrous_, which is the inner coat of the liver, and forms sheaths for the blood-vessels and excretory ducts. The liver is abundantly supplied with arteries, veins, nerves, and lymphatics. Unlike the other glands of the human body, it receives two kinds of blood; the arterial for its nourishment, and the venous, from which it secretes the bile. In the lower surface of the liver is lodged the gall-bladder, a membranous sac, or reservoir, for the bile. This fluid is not absolutely necessary to the digestion of food, since this process is effected by other secretions, nor does bile exert any special action upon, starchy or oleaginous substances, when mixed with them at a temperature of 100 F. Experiments also show that in some animals there is a constant flow of bile, even when no food has been taken, and there is consequently no digestion to be performed. Since the bile is formed from the venous blood, and taken from the waste and disintegration of animal tissue, it would appear that it is chiefly an excrement.i.tious fluid. It does not seem to have accomplished its function when discharged from the liver and poured into the intestine, for there it undergoes various alterations previous to re-absorption, produced by its contact with the intestinal juices. Thus the bile, after being transformed in the intestines, re-enters the blood under a new form, and is carried to some other part of the system to perform its mission.

The _Spleen_ is oval, smooth, convex on its external, and irregularly concave on its internal, surface. It is situated on the left side, in contact with the diaphragm and stomach. It is of a dark red color, slightly tinged with blue at its edges. Some physiologists affirm that no organ receives a greater quant.i.ty of blood, according to its size, than the spleen. The structure of the spleen and that of the mesenteric glands are similar, although the former is provided with a scanty supply of lymphatic vessels, and the chyle does not pa.s.s through it, as through the mesenteric glands. The _Pancreas_ lies behind the stomach, and extends transversely across the spinal column to the right of the spleen. It is of a pale, pinkish color, and its secretion is a.n.a.logous to that of the salivary glands; hence it has been called the _Abdominal Salivary Gland_.

[Ill.u.s.tration: Fig. 34.

Digestive organs. _3_. The tongue. _7_. Parotid gland. _8_. Sublingual gland. _5_. Esophagus. _9_.

Stomach. _10_. Liver. _11_. Gall-bladder, _14_. Pancreas.

_13, 13_. The duodenum. The small and large intestines are represented below the stomach.]

Digestion is effected in those cavities which we have described as parts of the alimentary ca.n.a.l. The food is first received into the mouth, where it is masticated by the teeth, and, after being mixed with mucus and saliva, is reduced to a mere pulp; it is then collected by the tongue, which, aided by the voluntary muscles of the throat, carries the food backward into the pharynx, and, by the action of the involuntary muscles of the pharynx and esophagus, is conveyed to the stomach. Here the food is subjected to a peculiar, churning movement, by the alternate relaxation and contraction of the fibers which compose the muscular wall of the stomach. As soon as the food comes in contact with the stomach, its pinkish color changes to a bright red; and from the numerous tubes upon its inner surface is discharged a colorless fluid, called the _gastric juice_, which mingles with the food and dissolves it. When the food is reduced to a liquid condition, it acc.u.mulates in the pyloric portion of the stomach. Some distinguished physiologists believe that the food is kept in a gentle, unceasing, but peculiar motion, called _peristaltic_, since the stomach contracts in successive circles. In the stomach the food is arranged in a methodical manner. The undigested portion is detained in the upper, or cardiac extremity, near the entrance of the esophagus, by contraction of the circular fibers of the muscular coat. Here it is gradually dissolved, and then carried into the pyloric portion of the stomach. From this, then, it appears, that the dissolved and undissolved portions of food occupy different parts of the stomach. After the food has been dissolved by the gastric fluid, it is converted into a h.o.m.ogeneous, semi-fluid ma.s.s, called _chyme_. This substance pa.s.ses from the stomach through the pyloric orifice into the duodenum, in which, by mixing with the bile and pancreatic fluid, its chemical properties are again modified, and it is then termed _chyle_, which has been found to be composed of three distinct parts, a reddish-brown sediment at the bottom, a whey-colored fluid in the middle, and a creamy film at the top. Chyle is different from chyme in two respects: First, the alkali of the digestive fluids, poured into the duodenum, or upper part of the small intestine, neutralizes the acid of the chyme; secondly, both the bile and the pancreatic fluid seem to exert an influence over the fatty substances contained in the chyme, which a.s.sists the subdivision of these fats into minute particles. While the chyle is propelled along the small intestine by the peristaltic action, the matter which it contains in solution is absorbed in the usual manner into the vessels of the villi by the process called _osmosis_. The fatty matters being subdivided into very minute particles, but not dissolved, and consequently incapable of being thus absorbed by osmosis, pa.s.s bodily through the epithelial lining of the intestine into the commencement of the lacteal tubes in the villi. The digested substances, as they are thrust along the small intestines, gradually lose their alb.u.minoid, fatty, and soluble starchy and saccharine matters, and pa.s.s through the ileo-caecal valve into the caec.u.m and large intestine. An acid reaction takes place here, and they acquire the usual faecal smell and color, which increases as they approach the r.e.c.t.u.m. Some physiologists have supposed that a second digestion takes place in the upper portion of the large intestine. The lacteals, filled with chyle, pa.s.s into the mesenteric glands with which they freely unite, and afterward enter the _receptaculum chyli_, which is the commencement of the thoracic duct, a tube of the size of a goose-quill, which lies in front of the backbone. The lymphatics, the function of which is to secrete and elaborate lymph, also terminate in the _receptaculum chyli_, or receptacle for the chyle. From this reservoir the chyle and lymph flow into the thoracic duct, through which they are conveyed to the left subclavian vein, there to be mingled with venous blood. The blood, chyle, and lymph, are then transmitted directly to the lungs.

The process of nutrition aids in the development and growth of the body; hence it has been aptly designated a "perpetual reproduction." It is the process by which every part of the body a.s.similates portions of the blood distributed to it. In return, the tissues yield a portion of the material which was once a component part of their organization. The body is constantly undergoing waste as well as repair. One of the most interesting facts in regard to the process of nutrition in animals and plants is, that all tissues originate in cells. In the higher types of animals, the blood is the source from which the cells derive their const.i.tuents. Although the alimentary ca.n.a.l is more or less complicated in different cla.s.ses of animals, yet there is no species, however low in the scale of organization, which does not possess it in some form.[2]

The little polyp has only one digestive cavity, which is a pouch in the interior of the body. In some animals circulation is not distinct from digestion, in others respiration and digestion are performed by the same organs; but as we rise in the scale of animal life, digestion and circulation are accomplished in separate cavities, and the functions of nutrition become more complex and distinct.

CHAPTER V.

PHYSIOLOGICAL ANATOMY.

ABSORPTION.

[Ill.u.s.tration: Fig. 35.

Villi of the small intestine greatly magnified.]

_Absorption_ is the vital function by which nutritive materials are selected and imbibed for the sustenance of the body. Absorption, like all other functional processes, employs agents to effect its purposes, and the _villi_ of the small intestine, with their numberless projecting organs, are specially employed to imbibe fluid substances; this they do with a celerity commensurate to the importance and extent of their duties. They are little vascular prominences of the mucous membrane, arising from the interior surface of the small intestine. Each villus has two sets of vessels. (1.) The blood-vessels, which, by their frequent blending, form a complete net-work beneath the external epithelium; they unite at the base of the villus, forming a minute vein, which is one of the sources of the portal vein. (2.) In the center of the villus is another vessel, with thinner and more transparent walls, which is the commencement of a lacteal.

The _Lacteals_ originate in the walls of the alimentary ca.n.a.l, are very numerous in the small intestine, and, pa.s.sing between the laminae of the mesentery, they terminate in the _receptaculum chyli_, or reservoir for the chyle. The mesentery consists of a double layer of cellular and adipose tissue. It incloses the blood-vessels, lacteals, and nerves of the small intestine, together with its accessory glands. It is joined to the posterior abdominal wall by a narrow _root_; anteriorly, it is attached to the whole length of the small intestine. The lacteals are known as the absorbents of the intestinal walls, and after digestion is accomplished, are found to contain a white, milky fluid, called _chyle_.

The chyle does not represent the entire product of digestion, but only the fatty substances suspended in a serous fluid.

Formerly, it was supposed that the lacteals were the only agents employed in absorption, but more recent investigations have shown that the blood-vessels partic.i.p.ate equally in the process, and are frequently the more active and important of the two. Experiments upon living animals have proved that absorption of poisonous substances occurs, even when all communication by way of the lacteals and lymphatics is obstructed, the pa.s.sage by the blood-vessels alone remaining. The absorbent power which the blood-vessels of the alimentary ca.n.a.l possess, is not limited to alimentary substances, but through them, soluble matters of almost every description are received into the circulation.

The _Lymphatics_ are not less important organs in the process of absorption. Nearly every part of the body is permeated by a second series of capillaries, closely interlaced with the blood-vessels, collectively termed the _Lymphatic System_. Their origin is not known, but they appear to form a _plexus_ in the tissues, from which their converging trunks arise. They are composed of minute tubes of delicate membrane, and from their net-work arrangement they successively unite and finally terminate in two main trunks, called the _great lymphatic veins_. The lymphatics, instead of commencing on the intestinal walls, as do the lacteals, are distributed through most of the vascular tissues as well as the skin. The lymphatic circulation is not unlike that of the blood; its circulatory apparatus is, however, more delicate, and its functions are not so well understood.

[Ill.u.s.tration: Fig. 36.

A general view of the Lymphatic System.]

The _lymph_ which circulates through the lymphatic vessels is an alkaline fluid composed of a plasma and corpuscles. It may be considered as blood deprived of its red corpuscles and, diluted with water. Nothing very definite is known respecting the functions of this fluid. A large proportion of its const.i.tuents is derived from the blood, and the exact connection of these substances to nutrition is not properly understood.

Some excrement.i.tious matters are supposed to be taken from the tissues by the lymph and discharged into the blood, to be ultimately removed from the system. The lymph accordingly exerts an important function by removing a portion of the decayed tissues from the body.

[Ill.u.s.tration: Fig. 37.

1. A representation of a lymphatic vessel highly magnified. 2. Lymphatic valves. 3. A lymphatic gland and its vessels.]

In all animals which possess a lacteal system there is also a lymphatic system, the one being the complement of the other. The fact that lymph and chyle are both conveyed into the general current of circulation, leads to the inference that the lymph, as well as the chyle, aids in the process of nutrition. The body is continually undergoing change, and vital action implies waste of tissues, as well as their growth. Those organs which are the instruments of motion, as the muscles, cannot be employed without wear and waste of their component parts. Renovated tissues must replace those which are worn out, and it is a part of the function of the absorbents to convey nutritive material into the general circulation. Researches in microscopical anatomy have shown that the skin contains mult.i.tudes of lymphatic vessels and that it is a powerful absorbent.

Absorption is one of the earliest and most essential functions of animal and vegetables tissues. The simpler plants consist of only a few cells, all of which are employed in absorption; but in the flowering plants this function is performed by the roots. It is accomplished on the same general principles in animals, yet it presents more modifications and a greater number of organs than in vegetables. While animals receive their food into a sac, or bag called the _stomach_, and are provided with absorbent vessels such as nowhere exist in vegetables, plants plunge their absorbent organs into the earth, whence they derive nouris.h.i.+ng substances. In the lower order of animals, as in sponges, this function is performed by contiguous cells, in a manner almost as elementary as in plants. In none of the invertebrate animals is there any _special_ absorbent system. Internal absorption is cla.s.sified by some authors as follows: _interst.i.tial_, _recrement.i.tial_, and _excrement.i.tial_; by others as _accidental_, _venous_, and _cutaneous_. The general cutaneous and mucous surfaces exhale, as well as absorb; thus the skin, by means of its sudoriferous glands, exhales moisture, and is at the same time as before stated, a powerful absorbent. The mucous surface of the lungs is continually throwing off carbonic acid and absorbing oxygen; and through their surface poisons are sometimes taken into the blood. The continual wear and waste to which living tissues are subject, makes necessary the provision of such a system of vessels for conveying away the worn-out materials and supplying the body with new.

CHAPTER VI.

PHYSICAL AND VITAL PROPERTIES OF THE BLOOD.

[Ill.u.s.tration: Fig. 38.

Red corpuscles of human blood, represented at _a_, as they are seen when rather _beyond_ the focus of the microscope; and at _b_ as they appear when, _within_ the focus. Magnified 400 diameters.]

[Ill.u.s.tration: Fig. 39.

Development of human lymph and chyle-corpuscles into red corpuscles of blood. _A_. A lymph, or white blood-corpuscle. _B_. The same in process of conversion into a red corpuscle. _C_. A lymph-corpuscle with the cell-wall raised up around it by the action of water. _D_.

A lymph-corpuscle, from which the granules have almost disappeared. _E_. A lymph-corpuscle, acquiring color; a single granule, like a nucleus, remains. _F_. A red corpuscle fully developed.]

_Blood_ is the animal fluid by which the tissues of the body are nourished. This pre-eminently vital fluid permeates every organ, distributes nutritive material to every texture, is essentially modified by respiration, and, finally, is the source of every secretion and excretion. Blood has four const.i.tuents: Fibrin, Alb.u.men, Salts (which elements, in solution, form the _liquor sanguinis_), and the Corpuscles.

Microscopical examination shows that the corpuscles are of two kinds, known as the _red_ and the _white_, the former being by far the more abundant. They are circular in form and have a smooth exterior, and are on an average 1/3200 part of an inch in diameter, and are about one-fourth of that in thickness. Hence more than ten millions of them may lie on a s.p.a.ce an inch square. If spread out in thin layers and subjected to transmitted light, they present a slightly yellowish color, but when crowded together and viewed by refracted light, exhibit a deep red color. These blood-corpuscles have been termed _discs_, and are not, as some have supposed, solid material, but are very nearly fluid. The red corpuscles although subjected to continual movement, have a tendency to approach one another, and when their flattened surfaces come in contact, so firmly do they adhere that they change their shape rather than submit to a separation. If separated, however, they return to their usual form. The colorless corpuscles are larger than the red and differ from them in being extremely irregular in their shape, and in their tendency to adhere to a smooth surface, while the red corpuscles float about and tumble over one another. They are chiefly remarkable for their continual variation in form. The shape of the red corpuscles is only altered by external influences, but the white are constantly undergoing alterations, the result of changes taking place within their own substance. When diluted with water and placed under the microscope they are found to consist of a spheroidal sac, containing a clear or granular fluid and a spheroidal vesicle, which is termed the _nucleus_. They have been regarded by some physiologists as identical with those of the lymph and chyle. Dr. Carpenter believes that the function of these cells is to convert alb.u.men into fibrin, by the simple process of cell-growth. It is generally believed that the red corpuscles are derived in some way from the colorless. It is supposed that the red corpuscle is merely the nucleus of a colorless corpuscle enlarged, flattened, colored and liberated by the bursting of the wall of its cell. When blood is taken from an artery and allowed to remain at rest, it separates into two parts: a solid ma.s.s, called the clot, largely composed of fibrin; and a fluid known as the _serum_, in which the clot is suspended. This process is termed _coagulation_. The serum, mostly composed of _alb.u.men_, is a transparent, straw-colored fluid, having the odor and taste of blood.

The whole quant.i.ty of blood in the body is estimated on an average to be about one-ninth of its entire weight. The distinctions between the arterial and the venous blood are marked, since in the arterial system the blood is uniformly bright red, and in the venous of a very dark red color The blood-corpuscles contain both oxygen and carbonic acid in solution. When carbonic acid predominates, the blood is dark red; when oxygen, scarlet. In the lungs, the corpuscles give up carbonic acid, and absorb a fresh supply of oxygen, while in the general circulation the oxygen disappears in the process of tissue transformation, and is replaced, in the venous blood, by carbonic acid. The nutritive portions of food are converted into a h.o.m.ogeneous fluid, which pervades every part of the body, is the basis of every tissue, and which is termed the _blood_. This varies in color and composition in different animals. In the polyp the nutritive fluid is known as _chyme_, in many mollusks, as well as articulates, it is called _chyle_, but in vertebrates, it is more highly organized and is called blood. In all the higher animal types it is of a red color, although redness is not one of its essential qualities. Some tribes of animals possess true blood, which is not red; thus the blood of the insect is colorless and transparent; that of the reptile yellowish; in the fish the principle part is without color, but the blood of the bird is deep red. The blood of the mammalia is of a bright scarlet hue. The temperature of the blood varies in different species, as well as in animals of the same species under different physiological conditions; for this reason, some animals are called _cold-blooded._ Disease also modifies the temperature of the blood; thus in fevers it is generally increased, but in cholera greatly diminished.

THE blood has been aptly termed the "vital fluid," since there is a constant flow from the heart to the tissues and organs of the body, and a continual return after it has circulated through these parts. Its presence in every part of the body is one of the essential conditions of animal life, and is effected by a special set of organs, called the _circulatory organs_.