Page:Civilisation in relation to the abdominal viscera, with remarks on the corset 3.png

1418 THE LANCET,]

influenced by the knowledge of the influence of intestinal stasis on women, and the benefit which these people derive from matrimony. His views on this subject certainly did not meet with encouragement in the United States, partly, I suppose, because of religious or legal objections, and probably to a great extent from the ignorance of the public and even of our profession on the subject of intestinal stasis. I am inclined to think that when women know more about the physiology of life they may exert some influence on legislation. This is more likely to develop, in the first instance, in the United States, where both men and women hold broader views and are less tied by creeds and tradition than they are in the old world.

The mental condition which is brought about by auto-intoxication is most distressing. While it renders the sub­jects miserable, and unable to concentrate their attention on work or pleasure or to control their tempers, it makes them most unpleasant companions. An alcoholic woman may be cheerful under the influence of her drug, but in no circumstance does the toxæmia of intestinal stasis produce other than a depressing influence on the mind and on the body generally. Medical men are very fond of calling this condition neurasthenia. These patients readily become melancholic. They frequently suffer severely from headache, either continuously or at intervals, and they awake in the morning with a headache, feeling they have obtained no rest or advantage from their sleep, and that they are just as tired and exhausted as when they went to bed. The world seems always chill and gloomy to them, quite apart from the intestinal pain and discomfort which they so often experi­ence. My friends have often said to me that they were sure patients would never submit to such a serious opera­tion as removal of the large bowel. They forget that to these sufferers life bas no attraction, and the risk of the operation at least affords them a chance of escaping from it. I do not think that any patient bas expressed to me the slightest anxiety on this score, but has most willingly grasped the opportunity of parting with his other troubles at all costs and at the earliest opportunity.

The patients usually suffer from abdominal symptoms, varying from a colicky pain due to obstruction at a flexure or at the sigmoid, or to a flatulent distension of the stomach or intestine due to decomposition produced by the delay in evacuation of the contents, or to the presence of a pancreatitis or of gall-stones. These conditions have resulted, partly from a direct infection of the pancreatic or biliary ducts by organisms from the small intestine whose level in the small intestine has been materially raised by stasis, and partly from a reduced resisting power to organisms consequent on the auto-intoxication. This infection of the pancreatic and biliary ducts does not appear to take place in such cases of intestinal stasis as arise early in life. I have never seen it in patients in whom loss of flesh has been a marked feature before 20 years of age. Infection of the gall-bladder and later of the pancreas arises in stout patients who develop intestinal stasis at or beyond middle life. It would seem that the loss of flesh and of vigour consequent on the toxæmia of intestinal stasis so affects the mechanics of the gall-bladder as to produce an accumulation of bile in it and in association with the infec­tion of the ducts to determine the formation of stones in it. Here again intestinal stasis is responsible for an inflamma­tion of these structures followed later by a cancerous infection.

I have endeavoured to indicate the importance of the fall of the viscera in the erect posture. Obviously the most effectual means of meeting this condition is by the exercise of a sufficient pressure exerted appropriate]y on the lower abdomen. For a long time women have been in the habit of wearing corsets for the purpose of supporting their dress and of affording attractive outlines to their bodies. The English corset is disastrous in that it exerts a constrict­ing encircling pressure on the abdomen about the lower costal margin and exaggerates the tendency to downward displace­ment of the viscera. The straight-busked French corset is much less harmful, and if skilfully made and applied serves to exert a moderate pressure on the lower abdomen. The corset that is most efficient is one that, while exerting a firm and constant pressure in a backward and upward direction on the abdomen below the umbilicus, leaves the upper portion of the abdomen quite free. Owing to a want of knowledge of the pathology of intes­tinal stasis the corset has not received the attention it deserves, so that by far the most important factor in the treatment of intestinal stasis and of its effects has been left in abeyance. I would strongly urge its therapeutic value on the medical profession as being the most effectual means I know by which the trouble to which I have called attention in these remarks may be avoided or mitigated.
 * Cavendish-square, W.