Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger.

  • Billings, Frank, 1854-1932.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    794/850 (page 772)
    markedly edematous and thickened, and the contents of the sigmoid flex- ure consist of blood and feces. In the other forms of acute occlusion whicli accompany strangulation, namely, internal incarceration and invagination, local meteoris'm either does not occur at all or scarcely develops to sucli an extent as to be of clinico-diagnostic importance. Although it has been already mentioned, the importance of the subject leads me to reiterate that in acute occlusion, if this attack an intestine previously permeable, peristalsis that is distinctly visible and tetanic in- testinal stiffening only occur exceptionally, and never to the extent seen in occlusion which follows a slowly growing stenosis. The reasons for this are obvious: In the first place, there is no muscular hypertrophy of the, intestinal wall in acute occlusion, and the paralysis of the musculature which occurs develops with particular rapidity in the doubly occluded and strangulated intestinal areas in which local meteorism has developed; para- lyzed muscles, of course, do not contract. The extremely rare occurrence of diarrhea in acute occlusion (in in- vagination, incarceration), is deserving of brief mention, since, at first, it may lead to gross errors in diagnosis. This is explained by the hj])o- thetic assumption of a hypersecretion of fluid from the intestinal wall in consequence of paralysis of the mesenteric nerves. Besides this group of symptoms, other symptoms on the part of the circulatory apparatus are noted; these dominate the situation, and impress their stamp upon the afi'ection, the clinical condition closely resembling collapse from other causes. The extent of these phenomena may vary in individual cases; as a rule, however, they are decidedly marked. In regard to their occurrence two views are maintained at the present time: A nervous reflex theory, and an intoxication theory. In my opinion the latter is operative only for certain rare symptoms and cases. On the other hand, the nervous reflex theory readily explains the majority of symptoms which are clinically common and important, and which usually appear at the onset of the affection. I cannot here analyze the reflex theory in detail, but will only remark that in accordance with well-known physiological facts the severe clinical picture is caused by decided irritation of the sensory nerves of the intes- tine and of the peritoneum; that is, of the mesentery, which results with the acute onset of volvulus, incarceration, invagination, obstruction from gall-stones, etc. Occlusion thereby leads to an alteration of cardiac activity and of the entire distribution of the blood, this being brought about by the reflex influence of the cardiac vagus and of the splanchnic nerve. In fact, the majority of the symptoms may be thus explained, particularly those above described and also some rare ones; as, for example, the albu- minuria and cylindruria which are occasionally observed in incarcerated hernia. The idea of the intoxication theory is this, that in the closed in-