In a late book that has attracted much attention a famous surgeon lays great stress on the fact that failure of the nearly twenty-eight feet of small and large human intestine to function properly is the primary cause not only of much ill health but of a very considerable number of organic diseases (dealt with elsewhere.) As he specializes on abdominal surgery his conclusions are based on many observations.
In a paper contributed to the same volume Sir Arthur Keith, of the Royal College of Surgeons, London, one of the highest authorities on the evolution of abdominal organs, says that soon after his appointment as a teacher of anatomy at the London Hospital in 1895, his attention was drawn to the large percentage of dissecting room subjects, particularly females, in which the abdominal organs, were misshapen and displaced downwards. At the same time it was impressed upon him that a special action of the muscular walls of the abdomen is the chief means by which the abdominal organs are maintained in position since the time when we assumed an upright posture. One of these organs that is often displaced is the transverse colon which frequently sags well below the navel and sometimes reaches the floor of the pelvis owing to the load of effete material it is required frequently to carry.
William Russell, ex-president of the Royal College of Physicians, of Edinburgh, observes that the transverse colon always descends with the stomach and is to be found along its lowest border, no matter how low that border may be. The stomach, however, may be normal as to position and yet the transverse colon form a great loop downward .
Arthur F. Hurst, of Guy’s Hospital, London, reports that in a skiagraph (x-ray) study of 15 normal young men in 1908, it was found that in an upright position the lowest part of the transverse colon is almost invariably situated well below the navel, even when the stomach is empty. In the majority of cases constipation associated with falling abdominal organs is due to the weakness of the abdominal and pelvic muscles and the falling of the diaphragm, (the muscular-membranous partition that divides the lung-heart cavity from the abdominal cavity). This condition is frequently worse in the upright position. One of the results is a pull and strain on the ligaments by which the abdominal organs (viscera) are suspended, generally described- by patients as a weight or pressure of a dragging nature. The discomfort is most marked in people of weakened nerves?.
James T. Case 2 examined 30 women students who thought themselves in normal health. In 27 the level of the transverse colon reached well below the navel, (umbilicus), in many of them well down in the true pelvis. In only three was it as high as within an inch below the navel, even with the patient lying down. In but three was the lower border of the stomach up to the same line, with the patient standing. One of these three was short and stout so that both the stomach and transverse colon were higher than usual. One had duodenal ulcer (immediately below the stomach) and a third had gall bladder disease with adhesions. In the other 27 the lower border of the stomach averaged 21/2 to 3 inches below the navel with the patient standing.
Hurst says the characteristic bulging of the lower part of the abdomen and retraction in front of the pit of the stomach (epigastrium) is due mainly to the falling of the small intestine. When stasis occurs in the cecum (beginning of the colon) and ascending colon these parts are constantly full and heavy instead of being empty from about 2 a.m. until 4 hours after breakfast. In such cases they are particularly apt to drop, as are all parts of the colon when similarly weighted, with the symptoms eased on lying down.