The instant relief that Osteopathy can give in acute indigestion is
one of its outstanding achievements. It impresses the patient and
his friends with a deep conviction of the superiority of osteopathic
therapy. The results in these cases are not, in any sense, a matter of
chance. They follow logically from the osteopathic viewpoint, teaching,
reasoning, and practice. In dealing with the manifestations of disease,
such as heredity, onset, course, duration, subjective and objective
symptoms, etc., and in the effort to differentiate cause from effect,
and to reconstruct a mental picture of the sequence of cause, effect
and sequelæ, the osteopath has the advantage of binocular vision in
that he recognizes two distinct pathologies cooperating to produce the
symptom complex, syndrome or disease which he is called upon to treat.
One pathology is to be found in one or more of the vertebral and rib
articulations and the immediately adjacent or corresponding segments
of the spinal cord. The other is in some one or more of the organs or
tissues connected with the pathological segment or segments of the cord.
=The function of the joint is MOTION.=—Unrestricted normal range
of motion is essential for the normal function of all parts of the
articulation as well as for the nutrition of the nerve mechanisms
immediately adjacent. When a spinal articulation ceases to perform
its function all of its parts are more or less impaired, muscles
atrophy, ligaments lose their tone, and circulation to and from the
spinal segment is interfered with because action is a large factor in
promoting the flow of blood and lymph and maintaining normal stimulus.
As a result of this spinal pathology, internal organs and tissues,
supplied by nerves arising in the segment that is in lesion, will be
variously disturbed in their function.
Dr. Carl P. McConnell says: “My observation of lesioned animals so
far as the digestive organs are concerned is that the lesion affects
the reflexes of and through spinal and sympathetic ganglia so that
the vasomotors are involved with a consequent hyperemia of the
submucous coat. This means involvement of the endothelial layer of the
blood-vessels, diapedesis, derangement of the secretory function and
disturbance of the motor mechanism, all of which lead to functional
upset and disturbance.”
The dominant part played by the osteopathic lesion as a causative
factor in acute and chronic diseases of the alimentary canal becomes
increasingly evident as clinical observation and laboratory research
permit a more thorough appreciation of the anatomy and physiology
of the parts involved. The abnormal stands out more clearly from
the normal. Finally, the task of restoring normality is becoming a
clear-cut problem to which the correction of the osteopathic lesions
furnishes an almost complete solution.
The normal alimentary canal transports food, macerating it, mixing
it, and treating it with various chemicals and enzymes on the way,
breaking it down physically and chemically, and absorbing from it
such end-products as are needed to maintain metabolism. The abnormal
alimentary tract may be at fault in any of these functions. This
delinquency is generally traceable to a mechanical origin. Correction
of the mechanical deviation is followed by restoration of normal
function except in cases where extensive tissue changes have occurred.
=Thorough mastication= is essential to good digestion. Any dental
defects or deficiencies should be corrected. =The temporo-mandibular
articulation= should be examined, and full free motion restored if
lacking. The muscles on the affected side are softer than on the sound
side. Tonic spasm rigidly closes the mouth. It may be due to tetanus,
caries of the lower teeth, cutting of the lower wisdom tooth, or other
irritations to the sensory branches of the inferior maxillary nerve.
There is enough space back of the wisdom teeth to pass a catheter to
administer food.
=The tongue= assists in mastication and deglutition and is the seat
of most of the nerves of taste. The hypoglossal nerve, which supplies
it, leaves the skull through the anterior condyloid foramen and may
be impinged there or lower in its course. =Lesions of the occiput and
upper cervical vertebræ= and obstructions to the lymphatic drainage
at the angle of the jaw may cause pressure on this nerve and cause
disturbances in the movements of the tongue, atrophy, swelling, etc.
Swelling may be due also to endocrine disturbance, constitutional
diseases, anemia, glossitis, local irritants, injuries, etc. Pressure
may be made on the hypoglossal nerve behind the angle of the jaw.
=The special sense of taste= plays an important role in normal
digestion. The lingual nerve supplies the anterior two-thirds of the
tongue with taste. The sense of taste may be lost, impaired, perverted
or otherwise abnormal.
The sense of smell plays an important part in our appreciation
of flavors, and when it is impaired by colds, adenoids, or other
affections of the nose or pharynx, the sense of taste is measurably
impaired. =Normalization of nose and pharynx= restores the sense of
taste in such cases. Impairment or loss may also be due to lesions
of the chorda tympani, or glosso-pharyngeal nerves. Lesions of the
mandible, hyoid, occiput or upper cervical nerves, parotid disease or
obstructed lymphatic drainage behind the angle of the jaw may cause
pressure directly or indirectly on the glosso-pharyngeal and chorda
tympani nerves. Perversion of taste occur in pregnancy, hysteria,
epilepsy and insanity.
=Foul taste=, fetororis in the mouth is frequent in pneumonia, typhoid
fever, peritonitis, septicemia and other severe fevers; also after
ingestion of pungent foods or strong drugs; in constitutional diseases;
as a result of inattention to oral hygiene, excessive smoking, mouth
breathing at night, furred tongue, etc. It clears up on removing the
cause.
=Furred tongue= occurs in gastritis, fevers, and a variety of other
conditions. The fur is composed of broken down epithelium which would
normally be removed by friction with solid food. When none is taken,
the fur accumulates. When blood or hematin becomes mixed with the
broken down epithelium, the fur is brown. Ordinarily it is white.
=A clean red tongue= is frequently found in hyperacidity. It is
probably due to vasodilatation due to hyperactivity of the autonomics
or inhibition of sympathetics. The sympathetic supply is from the
=superior cervical ganglion=. It may be affected by lesions of the
occiput, atlas, axis and third cervical vertebra, of the hyoid, by
anterior cervical muscular contractures, by obstruction to venous and
lymphatic drainage and blood supply. Correction of the lesions named
and normalization of the other structures involved will usually restore
the tongue to normal condition.
=The salivary glands= have a two-fold innervation. The thin, full,
watery, salty secretion is produced by activity of the cranial
autonomic fibers; the sparse, viscous secretion containing the organic
elements, ptyalin, etc., is produced by the sympathetics. =The
sympathetic nerve supply= is from the middle and superior cervical
ganglia and can be disturbed by lesions affecting them as mentioned
above. The secretion of ptyalin may be disturbed by any lesion from the
fifth dorsal up.
It must not be forgotten that a =posterior occiput= draws the superior
cervical ganglion back against the axis and third cervical with
just as much pressure as is exerted by an anterior atlas or third
cervical. This pressure or stretching tends to inhibit it, preventing
vaso-constriction and permitting vasodilatation of the internal
carotid artery and its branches and congestion of the parts supplied,
mid-brain, cerebrum, etc.
If, for any reason, the venous drainage from the lateral sinus into
the internal jugular vein, or the ebb and flow of the cerebrospinal
fluid between brain and cord, is reduced or hampered, an extra burden
is thrown on the cerebral veins and sinuses, and the intra-cranial
pressure is raised at each heart-beat, ultimately producing pressure
on the meninges and causing violent headache over the fifth and tenth
cranial nerves which supply the meninges with sensation. These nerves
are intimately connected with the digestive system. Any increase of
intra-cranial pressure causes increased irritability and hyperactivity
of the cranial nerves, many of which are concerned with various
functions of the digestive system. Moreover, the nuclei of these nerves
lie on the floor of the fourth ventricle which is supplied mainly by
the vertebral arteries and the basilar artery. Lesions of the cervical
vertebræ affecting the plexus on the vertebral artery or filaments to
it from the upper parts of the cervical gangliated sympathetic cord,
may impair the blood flow through the vertebral arteries and cause
similar increased irritability of the nerve cells in the medulla,
mid-brain and cerebellum. Such disturbance is reflected in awkward
movement, hyperesthesia, and symptoms due to increased irritability of
the autonomic nerves such as slow pulse and respiration, watering of
the mouth, hypersecretion and hypermotility of the gastro-intestinal
tract, rapid digestion and poor assimilation, vasodilatation,
impoverished blood, and so through a vicious cycle back to still
greater impairment of nutrition to the nerve cells within the cranium.
Until the lesions are corrected, the condition becomes progressively
worse till exhaustion occurs.
Ordinary medical hygiene can do little or nothing. The palliative
remedies employed simply mask the symptoms, or actually accelerate the
destructive process. Lesions that irritate the cervical sympathetics
would cause vaso-constriction and give rise to opposite symptoms,
namely, cerebral ischemia, decreased flow of saliva, atony of stomach,
lack of digestive juices, sluggish intestinal peristalsis, rapid
pulse and respiration, etc. Correction of the lesions and restoration
of normal blood supply and drainage to the brain and removal of any
lesions tending to inhibit the sympathetics from the fifth dorsal up,
will usually in a short time restore the activity of the salivary
glands to normal. The otic and sphenopalatine ganglia can be disturbed
by abnormal conditions within the pharynx. These must be corrected when
found.
=Deglutition=, or swallowing, is a very rapid, highly complex movement.
It takes not more than a second for the food to cross the pharynx. The
soft palate and larynx are raised to close off the air-way, making the
food-way practically continuous for the second needed to complete the
transfer of the food across the air-way. The tongue is pressed against
the roof of the mouth and the mylohyoid contracts vigorously and shoots
the bolus of food across the pharynx. Bolting the food leads to serious
digestive disturbances, not the least of which is the loss of the
normal reflex which prevents swallowing unprepared food. When lost,
this reflex can be restored by thorough mastication for three or four
months.
The voluntary part of swallowing is performed by the motor portion of
the fifth cranial and the hypoglossus. The involuntary part involves
afferent impulses over the superior laryngeal and efferent impulses
over the inferior laryngeal. The levator palati which raises the soft
palate is probably supplied by the spinal accessory nerve through
the pharyngeal plexus. This nerve can be affected by lesions of the
occiput, atlas, mandible and hyoid, and by any obstruction to lymphatic
drainage which increases pressure behind the angle of the jaw. In
paralysis of the levator palati, as =after diphtheria= or other
peripheral neuritis, fluids regurgitate through the nose during the act
of swallowing. The raising and closing of the larynx is accomplished by
the superior and recurrent laryngeal nerves by way of the pharyngeal
plexus. Pain in swallowing is generally due to some inflammation or
infection of the tonsil or pharynx. This does not occur when everything
is normal from the fifth dorsal up.
The second and third stages of swallowing occur in the =esophagus=.
The esophagus receives esophageal branches from the vagus, carrying
autonomic fibers which contract its longitudinal muscles and dilate
its arteries. It also receives sympathetic impulses from the plexus
on the arteries which supply it. These sympathetic impulses convey
vaso-constriction and constriction of the circular muscles of the
esophagus. Any lesion from seventh cervical to ninth dorsal might
affect the esophagus; probably fifth dorsal is the most nearly
specific, as the heartburn which results from regurgitation into the
esophagus is usually localized there.
Lesions of the upper six dorsal vertebræ interfere with digestion and
nutrition in another vital way by reducing the activity of the lungs
and consequent =intake of oxygen= into the system. If there is not
sufficient oxygen to oxidize the proteins to amino-acids there will be
harmful products left for the tissues to neutralize. Lesions of the
third, fourth and fifth cervical affecting the =phrenic= may have a
like effect. Sub-oxidation must be noted when present and treated by
removing lesions affecting respiration, by deep breathing exercises,
and by diet rich in the needed mineral salts, and properly balanced.
An improperly balanced diet changes the structure of the tissues and
amounts in effect to an osteopathic lesion which causes disturbed
function. It must be searched for, found if present, accounted for,
corrected and kept corrected to obtain maximum therapeutic results.
The stomach, intestines and rectum are intimately related with the
other abdominal viscera.
It will therefore be readily seen that any disturbance of the liver,
gall-bladder, pancreas, spleen, duodenum, pleura or peritoneum will
disturb the function of the stomach, and that any disturbance of any
organ will disturb the function of the intestine. In fact, clinically,
it would seem that the majority of cases can be accounted for by
the lesions found, the stomach or intestinal disturbances which are
regarded as reflex from some other organ, being in reality caused
by the same lesion as disturbed the organ which first manifested
disturbance.
Going more deeply into the nature of the mechanism whereby symptoms
of gastro-intestinal disturbance are produced, we find that the
alimentary tract has an ingenious conveyer mechanism with a number of
sphincters. These are operated by intrinsic sympathetic or myenteric
nerves, called plexuses of Meissner and Auerbach. In conveying food,
impulses are passed from one portion of the tract to the next over
these myenteric arcs. Normally the peristaltic movement is always
forward because the point of highest irritability is at the proximal
end. There is an exception to this rule in the ascending colon, where
antiperistalsis occurs normally. When the irritability of a distal
point of the alimentary tract becomes greater than the more proximal
points, an antiperistaltic wave is set up causing vomiting. The
myenteric activities are regulated by the autonomic impulses over the
vagus, and by the sympathetic impulses over the splanchnic nerves. The
autonomics contract the longitudinal muscles, dilating and shortening
the tube. They also stimulate secretion of digestive juices and fluids
and mucus and dilate the blood-vessels. The sympathetics contract
the circular fibers and sphincters, narrowing and lengthening the
tube, retarding the food, inhibiting the secretions and constricting
the blood-vessels. The myenteric reflexes can continue after the
vagi and splanchnics are cut. The vagi simply stimulate them and the
splanchnics inhibit them. The pathways are from the coeliac plexus
where the vagi and splanchnics meet with various other plexuses on
the arteries and following the courses of the arterial supply to
the minutest parts of each organ. Each cell is surrounded by nerve
fibers. Visceral-afferent fibers over both vagi and splanchnics convey
impulses to the cord segments and medulla which modify the systemic
blood supply, drawing blood from the head and surface by constricting
their arteries during digestion and filling the abdominal arteries.
If opposite impulses should be received drawing blood away from the
abdominal arteries, digestion would be interfered with. Any lesion or
other condition causing hyperirritability or overstimulation of the
vagus will result in overstimulation of the myenteric nerves, with
vasodilatation, hypersecretion, contraction of the longitudinal coat,
widening and shortening of the digestive tube, sluggish peristalsis but
rapid movement of food through the sphincters, incomplete digestion
and undernourishment. Inhibition of the splanchnic nerves will produce
a like result. The opposite condition would come about as a result of
inhibition of the impulses over the vagus to the myenteric nerves, or
of overstimulation of the splanchnic nerves.
Inhibition of the splanchnic nerves may be secured by extreme flexion
of the spinal column. This raises the cord in the spinal canal,
lengthens it, stretches or draws on the nerve roots and vessels,
squeezes the fluid out of the cord, and inhibits the splanchnics in two
ways, first by a partial anemia or ischemia of the cord, and secondly
by direct traction of the visceral afferent fibers in the posterior and
anterior roots.
Conversely, stimulation of the splanchnic nerves may be secured by
complete extension of the spinal column. This lowers the cord in
the spinal canal, shortens it, releases the strain on the nerve
roots and vessels, flushes the cord with blood, and tones up the
sympathetic impulses in two ways, first by increasing their relative
and absolute nutrition, through richer supply of richer blood, and
secondly by releasing the nerve roots from strain, permitting free
entry of afferent impulses over the posterior roots, and free exit of
visceral-efferent impulses over the anterior roots.
Any lesion, inasmuch as it limits or alters the normal motion in a
joint, produces an exaggeration or diminution of the normal spinal
curves, and more or less lateral curvature. The altered equilibrium
thus produced affects the viscera in three ways: 1. Mechanically, by
pressure, gravity, altered position of ribs, vertebræ, diaphragm, etc.;
2. Reflexly, influence on nerves to and from affected segment; 3.
Directly, by interference with nutrition of nerve cells by hyperemia or
ischemia.
There is always a functional kyphosis in visceroptosis or
splanchnoptosis. The nerves in the cord are inhibited. The skeletal
muscles are hypotonic, allowing the functional kyphosis to occur,
and the viscero-motor nerves are inhibited, allowing the abdominal
viscera to become hypotonic and sag out of place within the abdominal
cavity. The ribs are held up by the cervical fascia, and the abdominal
muscles are held up by the ribs. The hypotonic condition extends to
intercostals and abdominal muscles, with the result that the abdominal
muscles are unable to play their part in maintaining the viscera in
their proper places. The contraction or tonus of the abdominal muscles,
the external and internal oblique, transversalis, rectus abdominis,
diaphragm and levator ani, maintain the viscera firmly in position. It
is only when the muscles of the abdominal wall have lost their tone
that any strain or weight is thrown on the peritoneal and vascular
supports. The inhibition of the restraining sympathetic impulses via
the splanchnic nerves, allows hypersecretion and hypermotility of the
alimentary tubes and further complicates the clinical picture by a
colicky diarrhea or spastic constipation.
There are eight sphincters of circular unstriped muscle in the
alimentary tract. Inhibition of sympathetic supply or increased
autonomic supply causes sphincter insufficiency, overstimulation by
sympathetic impulses or an insufficient supply of balancing autonomic
impulses causes sphincter spasm, stasis, vomiting, fermentation,
putrefaction, auto-intoxication. At each of these sphincters food is
held back and controlled till the proper time has elapsed and the
proper chemical environment is prepared for it in the next portion
of the tract. Normal function of these sphincters is absolutely
essential to normal metabolism and nutrition. The upper esophageal
sphincter controls the entrance to the esophagus; the cardia controls
the entrance to the stomach, the pylorus controls the entrance to
the duodenum, the X-Ray shows a duodenal sphincter that controls the
entrance of food into the jejunum. Here the food enters the long
tract of the jejunum and ileum which measures twenty-five feet when
the longitudinal muscles are relaxed and the circular muscles tonic,
and which a short time later may measure only fifteen feet when the
longitudinal muscles are contracted and the circular are relaxed. This
section ends at the ileo-cecal valve, which controls the entrance
of food into the cecum. There is the mid-colic sphincter about the
junction of the proximal third with the distal two-thirds of the
transverse colon, and the recto-colic sphincter which controls the
passage from the sigmoid to the rectum. The rectum ends in the internal
sphincter ani. There is some evidence of a ninth sphincter, the
mid-gastric at the point where the peristaltic waves of the stomach
begin. Absorption takes place mostly from the ileum and jejunum and it
is worthy of note that four of these sphincters hold the food up on its
way into this part of the tract, and four of them hold it back on its
way out. Any lesion may affect one or other of these sphincters. It
is believed that antiperistalsis from the mid-colic sphincter to the
cecum during digestion is normal permitting more complete absorption of
nourishment. Yet here, after absorption is complete, and at all times
elsewhere in the alimentary tract, peristalsis is normally forward
because the point of highest irritability is at the upper esophageal
sphincter and the irritability decreases as the tract is further from
the esophagus.
When the splanchnics are inhibited and the vagus autonomic impulses are
normal or increased, the intestinal sphincters from the pylorus down
may all be incompetent, so that food passes along too rapidly to be
properly digested and absorbed. This results in undernourishment.
Any lesion anywhere in the body will affect =peristalsis=. It begins
at the lower third of the stomach where it joins the pyloric portion
and goes forward to the internal sphincter ani, being modified in its
course by local conditions. Compensation may be established. Many cases
of diarrhea and constipation are thus to be accounted for. =Diarrhea=
is a symptom due to vasodilatation, hypersecretion and relaxation of
the circular muscles especially at the sphincters. When these three
factors are cleared up by correction of the lesions and hyperextension
of the spine, the diarrhea stops unless some other factor is at
work to irritate the myenteric nerves or to excite the autonomics
or inhibit the splanchnics. Lesions from the sixth dorsal down are
usually accompanied at first by some diarrhea, which afterwards
becomes constipation, through loss of tone in the longitudinal muscles
especially in the distal part of the colon. In these cases, correction
of lesions, and extreme flexion of the lower dorsal and lumbar spine
will give relief while the body is returning to normal.
When gastric digestion begins, simultaneous action is set up in the
ileum. When disease of the cecum, appendix or ascending colon is
present, there is contraction of the ileo-cecal valve causing stasis
of the lower ileum and disturbed or retarded action of stomach and
duodenum. These reactions are brought about by impulses to and from the
myenteric plexus. The sympathetic and autonomic nerves affect the motor
system of the alimentary tract not directly but through the myenteric
or Auerbach’s plexus.
The =external sphincter ani= muscle is supplied by the pudendal
nerve from the third and fourth sacral segments. It is in a state
of tonic contraction, and having no opposing muscles keeps the anal
orifice closed. The autonomic supply to the longitudinal muscles in
the descending colon and rectum is from the second and fourth sacral.
Inhibition here will, therefore relax the longitudinal muscles and
external sphincter and permit free peristalsis in the descending colon
and rectum. Pelvic disturbances may affect these nerves, or pressure
due to visceroptosis, etc. The circular muscles of this section are
supplied from the lumbar cord. They may be affected in any lumbar
lesion, with the end result of spastic constipation by reason of a
shortened markedly distended descending colon, sigmoid and rectum, and
little peristalsis because of inhibition of the circular fibers, and
contraction of the external sphincter ani.
The fundus of the stomach, lying in the left dome of the diaphragm,
always contains a cushion of air which supports the left dome of the
diaphragm, as the convexity of the liver supports the right. Normally
the air is regulated and causes no symptoms. A lesion, usually of the
mid-dorsal or lower dorsal segments may inhibit the circular fibers
and permit distension, which becomes enormous when the pylorus is
obstructed. The shortness of breath, palpitation of the heart, etc.,
accompanying this distension are probably due to pressure on the heart
and lungs from which the stomach is separated only by the diaphragm.
Eighth, ninth and tenth dorsal lesions play a large part in peptic
ulcers by permitting hyperemia, hypersecretion, and lowered vitality
of the mucosa, and pyloric incompetence or spasm, because the pylorus,
pyloric end of the stomach and first part of the duodenum get their
chief sympathetic supply from the ninth and tenth dorsal segments of
the cord. The tenth vertebra is more freely movable than the higher
dorsal joints and is therefore more frequently in lesion, which helps
to account for the greater frequency of duodenal ulcer.
The main sympathetic supply to the appendix seems to be derived from
the eleventh dorsal segment. The appendix has the same motor and
secretory mechanism as the rest of the alimentary tract but is richly
supplied with lymphoid follicles. One of the twigs from the eleventh
dorsal nerve pierces the rectus muscle to supply the skin at McBurney’s
point, thus explaining the great frequency of pain and cutaneous
hyperalgesia at this situation in appendicitis. Lower dorsal and upper
lumbar lesions are unquestionably causes of many cases of appendicitis
and other obscure diseases traceable to appendicitis. Correction of
these lesions has restored the appendix and related structures to
normality in hundreds of cases.
Sensory reflexes are shown in hyperalgesia and pain or tenderness in
the abdominal skin and muscles and the parietal layer of the peritoneum
from the ensiform cartilage to the pubes in an area extending about two
inches on each side of the mid-line, corresponding to the distribution
of the twigs of the lower six thoracic nerves which supply sensation to
this region. =Esophageal= disturbance at the cardia causes pain in the
region supplied with sensation by the fifth and sixth dorsal, near the
ensiform. =Gastric derangement= causes pain midway between the ensiform
and umbilicus, which radiates to the left, in the area supplied by the
eighth dorsal. =Hepatic disturbance= causes pain on the right of the
median line, radiating to the right in the sensory distribution of the
ninth dorsal. =Intestinal pain= is located in the sensory distribution
of the tenth dorsal nerve in an oval area around the umbilicus. Pain
due to =duodenal ulcer= is sharply localized at a point about an inch
or two above and to the right of the umbilicus where twigs of the tenth
dorsal nerve come to the surface. This point corresponds closely to the
normal position of the underlying duodenum, though the duodenum may be
displaced, and the sensitive spot remain at the same point. The pain
from =fundal gastric ulcer= or =carcinoma= is usually localized sharply
about an inch or two to the right of the median line midway between
the ensiform and umbilicus, at the spot where the twigs from the
eighth dorsal nerve pierce the rectus and come to the surface. In the
disease of the =pylorus=, reflex pain is lower; of the =cardiac end=,
higher. The reflex pain at McBurney’s point in =appendicitis= has been
referred to, but it must be borne in mind that pain from disturbance
in the =colon= also shows in the sensory distribution of the eleventh
dorsal nerves midway between the umbilicus and pubes. Pain may also be
referred to areas supplied in the back by the corresponding segments.
These reflex pains can usually be stopped by inhibiting along the spine
corresponding to the sensory area affected. This reduces the impulses
entering the posterior roots and lowers the irritability of the segment.
The =motor reflexes= from gastro-intestinal disturbances result in
muscular contractures of spinal, abdominal and other muscles supplied
by motor nerves arising in the anterior horn of the segment which
innervates the part of the viscus that is affected. Stomach, liver,
gall-bladder, pyloric and duodenal disturbances cause increased tone,
contraction, contracture and rigidity of the rectus muscles above
the umbilicus, for instance, and the other viscera contract it in
lower portions. More important are the extreme contractures of the
musculature of the back which is supplied by the segments which supply
the affected part of the viscus. These contractures produce some
distortion and loss of motion in spinal joints and thereby produce the
same effects as primary lesions, causing widespread disturbance which
persists until the spinal musculature is normalized. In =colic=, the
lumbar segments being involved, there is marked contraction of the
ilio-psoas which causes the characteristic drawing up of the thighs
on the abdomen, while the extreme contraction of the rectus abdominis
draws the thorax down.
Most persistent vomiting may arise reflexly from other organs as
in so-called biliousness, jaundice, pregnancy, brain affections,
appendicitis, onset of acute infectious diseases, alcoholism,
sea-sickness, colic, hernia, intestinal obstruction, migraine,
shock, and anesthesia. Irritation of any sensory branch of the vagus
or of nerves which connect with it in the medulla, or reflexly
from consciousness via the cerebral cortex, as in the case of
nauseating sights, smells, tastes, as well as irritation from any
viscera innervated from the sixth dorsal down, may overstimulate
the corresponding efferent nerves going to parts of the alimentary
tract supplied by that segment, increase its irritability and start
antiperistalsis. Similarly disturbances in almost any viscus may
reflexly disturb the normal balance between sympathetic and vagal
autonomic stimuli resulting in hypersalivation, hyperchlorhydria,
pylorospasm, distension, gastric atony, gastrosulcorrhea,
enterocolitis, spastic constipation, achylia, or colicky diarrhea.
In these cases, the derangement of the viscus reflexly disturbs the
alimentary tract through central nerve connections. Correction of the
primary trouble is followed by removal of the reflex symptoms. In this
connection it is important to note that the visceral reflex symptoms
may arise from irritation of the alimentary tract by improper diet,
poor cooking, or wrong combinations. Carbohydrates digest quicker
than proteins, and these more rapidly than fats. Food is handled by
the fundus in the order in which it was swallowed. If the fats are
swallowed first, the starches may be held up for five or six hours,
subjected to the acid stomach secretions and allowed to ferment causing
distension, which reflexly produces a variety of symptoms.
Mental exertion, strong emotions, heavy physical exertion, interfere
with the function of the alimentary tract and set up disturbances in
the balance of sympathetic and vagal autonomic impulses, through the
nervous reflexes via the cortex, and through the demand for blood,
which impoverishes the abdominal circulation at a time when it needs
all the blood it can get. The ischemia produced in this way has about
the same effect as ischemia produced by a spinal lesion. Conversely,
disturbances of the alimentary tract produce profound changes in
character and personality, by reflexes to the cerebral cortex causing
dullness of perception, in all the senses, poor memory, sluggish
thought, erratic judgment, irritable disposition, fear, worry, lack
of ambition, indecision, lack of energy, vacillation, and finally a
psychosis in which manic depressive symptoms are balanced by paranoiac
symptoms.
The alimentary tract is so intimately bound up with the whole stream of
vital activity, whether vegetative, sensorimotor, or psychic, that any
disturbance of body or mind is likely to affect it in some part, and
conversely any disturbance of the alimentary tract is bound to affect
all the rest of the body and the mind. A satisfactory classification
of its diseases is therefore difficult to make, but the one here
adopted is probably the best for the purpose. The early stages of
gastro-intestinal diseases are often so similar that it is nearly
impossible to differentiate them with certainty; the classification
is therefore based on the clinical picture and pathology of advanced
stages. Fortunately, with the exception of cancer, diseases treated in
the early stages usually clear up when the lesions are corrected, and
the necessary attention given to the other causative factors present.