The large intestine regarded as a syphon : with supplementary notes / by R.W. Leftwich.

  • Leftwich, Ralph Winnington, 1849-1919.
Date:
1902
Catalogue details

Licence: In copyright

Credit: The large intestine regarded as a syphon : with supplementary notes / by R.W. Leftwich. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    By R. W. Leftwich, M.D., London. The accepted view, which attributes the movements of the bowel contents to peristalsis, is absolutely convincing as regards the small intestine—with its free mobility, its thick walls, and its relatively small lumen; but many, like myself, must have felt the same explanation inadequate, when applied to the large intestine, and more particularly to the ascending colon. This portion of the large bowel has the smallest muscular development, though it needs the greatest, for its semiliquid contents have to be pro- pelled against the force of gravity for from twelve to sixteen hours out of the twenty-four, and in diseases accompanied by orthopnoea perhaps for weeks or months continuously. Compared with the small intestine, its walls are not only thin, but they have the extra disadvantage of being sacculated. It has feeble circular muscular fibres, with admittedly weaker peristalsis, a large lumen, and very little mobility. Especially is this latter the case when it is unprovided with a mesentery, which, according to Treves, happens in 74 per cent, of individuals. Further, it contains no valves, though even veins have these. Lastly, the caecum is nearly always found empty. Under all these adverse conditions, it is hard to believe that, in the erect position, its semifluid contents can be propelled by peristalsis, whether assisted or not by volun- tary muscular contraction. On the other hand, if it is merely one limb of a syphon, the difficulty vanishes, for its contents will be exactly balanced by those in the opposite limb. Thus,