The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Edward Martin
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    may determine the incompetency of tlic already weakened muscnlar fibres, the patient perisliing with obstructive symptoms, tympany being well developed. The anxiety which all la])arotomists feel in operations upon excessively fat patients is not because of the mechanical difficulties which the thick abdominal walls and loaded omentum offer, but because it is universally recognized that in these patients symptoms of obstruction are peculiarly prone to occur. Jurgens^ describes a pathological change affecting not only the muscles of the bowel but also the terminal nerve filaments. Henrot^ notes the invasion of the muscularis by certain sclerosed areas. Nepva detected, in a case of fecal obstruction, atrophy of the muscular coat of the bowel. Thibierge^ found in the bowel of the aged suffering from obstinate constipation glandular atrophy, wast- ing of the muscular coat and probably of the intra-parietal nerves, and arterial atheroma. Intestinal paralysis may result then— 1. From a general neurotic or hysterical condition. 2. From local reflex action. .3. From abdominal traumatism, or exposure of the abdominal viscera. 4. From enteritis or peritonitis. 5. From atrophy or fatty degeneration of the muscular coat of the bowel. The form of paralysis associated with distention and septic absorption will be considered later. Prognosis.—This, if the case is recognized early and the general condition is not too profoundly depressed, is, except in post-opera- tive cases, less serious than is the case with any other form of acute obstruction. Since, without the corroborative testimony of an autopsy, it is impossible to say whether or not obstruction has depended upon paralysis, statistics upon this subject cannot be given. There is good reason for believing, however, that many if not the majority of cases of internal strangulation, volvulus, etc., cured by such remedial means as puncture, salines, enemeta, and massage have in reality been cases of paretic obstruction, since it is difficult to conceive how these measures could be of the slightest use were the conditions diagnosed actually present. 1 Berlin. Klin. Wooh., 1881. 2 Union, med., 1878. 3 Thes. de Par., 1884, No. 231.