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The Vermiform Appendix.

This is the small worm-like appendage to the cecum, which when inflamed gives rise to the trouble known as appendicitis. It is from one to five inches in length, and, despite the assumption that it is an organ that performs no necessary function in the economy of digestion, it finds its purpose and its use in adding stimulus, through its own motion and secretion, to the involuntary contractions and expansions of the colon, those vermicular movements called peristalsis.

"AC-R."--The Colon.

This organ, also known as the large intestine, consists of a tube about five feet in length, designated in the illustration as "AC", the ascending colon, "TC", the transverse colon, "DC", the descending colon, "SF", the sigmoid flexure, "R", the rectum at the extremity of which is the anus.

The colon is the main organ of elimination of the body, and through it the greater part of solid refuse is carried to the rectum to be discharged. When the colon is permitted to become clogged with food waste, the resulting condition is known as constipation, in which state fecal matter accumulates and renders the normally clean bowel a receptacle and retainer of foul, rotting refuse. The sigmoid flexure, "SF", is a device that prevents excessive pressure by the contents of the organ upon the muscles of the rectum, "R". Lying between the descending colon and the rectum it interrupts the straight fall from the transverse colon and it acts as a retaining pouch. The lower opening of the rectum, the anus, is guarded by a strong circular muscle which is under voluntary control.

The intestines as a whole are thus seen to consist of that part of the alimentary canal, which, commencing at the pyloric opening of the stomach, is coiled in the abdominal cavity and which ends at the anus. The several portions of the small intestine are known as the duodenum, the upper section, the jejunum, the middle section, and the ileum, the lower section. The lumen or tubular cavity of the small intestine is larger at its upper end, gradually narrowing as it goes downward.

The muscular coats of the intestines are circular and longitudinal in structure. In the colon the longitudinal fibres are proportionately longer than in the small intestine. Their greater length here permits of the formation of enlargements that often become the seats of fecal accumulation, and it is undoubtedly true that these cavities may contain fecal material that has been in process of gathering for weeks, months, or even years. Its presence and its products cause symptoms of disease to appear that vary from catarrhal inflammation to serious reflex disturbances. Excepting in extreme conditions, while quantities of waste may be held in these enlargements, a passage is necessarily maintained, and the main channel of the bowel still carries off feces. Occasionally a cavity becomes greatly distended with fecal matter, which hardens as its moisture is absorbed, and accumulations such as this have been mistaken for tumors or for malignant growths upon some abdominal organ. Impacted feces may occur in any part of the bowel, but chronic accumulations are discovered more often in the region of the cecum, in the ascending colon, and at or about the point of juncture of the ascending and transverse portions of the bowel, a condition that is to be expected, since in this part of the organ peristalsis works against gravity during the waking moments of the day.

Accumulations in the colon at times become so great that their weight tends to displace portions of the bowel, and several instances have been observed in whom the transverse colon from this cause had descended to the pelvis. In other cases the portion of the organ referred to, thus weighted for long periods, no longer lay normally just beneath the stomach, but occupied a position varying from slight downward displacement to a situation approximately in rear of the umbilicus. Fecal accumulations also vary in density, and they at times are so hard as to be mistaken for gall-stones. And again their mass may be so great as to press upon one or other of the abdominal organs, thus interfering with its functions. In this manner the liver is often compressed and its flow of bile obstructed, while the urinary organs may suffer likewise. In one observed instance, after thorough cleansing of the colon by means of an enema, a loss in weight of ten pounds was noted; and in another fecal matter sufficient to fill a bedroom vessel of common size was taken from the bowel.

When feces are impacted in the colon it is difficult for the small intestine to perform its functions, for, not being able to discharge its waste freely, this organ in turn becomes clogged. Fermentation results, and the stomach is involved, while always the kidneys, the liver, the lungs, and the skin are forced to tasks beyond their capabilities, the two organs last named, in addition to their normal labor, being called upon to assist in the elimination of poisonous products not discharged, as they should be, through the bowels.

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