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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    gut, when gaseous distention completes the paralysis of the par- tially cri])])lcd bowel, and adds to tlic im])er]neal)ility of the canal by the kinking which great inflation generally prcxliices. The symptoms of paralytic obstruction, depending upon degen- erative changes of the muscular layer of the bowc.'l, arc fairly characteristic. The patients are usually advanced in years, and not rarely show atheromatous or fatty change in other ])arts of the body. There is a preceding history of long-contined constipation, and possibly of occasional attacks of temporary obstruction. The acute onset is usually preceded by an unusually long and olistinate constipation, symptoms of obstruction develdj)ing after the taking of an active purge. Pain at times denotes the beginning of acute symptoms; this may be so intense as to suggest internal strangulation. Thibierge states that this pain is due to the mechanical eiFect of stretching upon the intra-parietal bowel nerves. Often pain is not a con- spicuous feature of the attack. Distention is well marked and involves the whole abdomen. At times in the c?ecum and sigmoid flexure the presence of fecal ac- cumulations may be perceived by palpation and percussion. Vomiting is usually well marked; it may become bilious, but not fecal. At times it is entirely absent. Constipation is from the beginning of acute symptoms absolute. Tenderness is usually absent—the temperature remains about normal, the pulse steadily increases in rajyldity and the patient perishes of exhaustion or septic absorption. Treatment.—In this condition death seems to be produced by— 1. The mechanical interference to respiration occasioned by the enormous distention. 2. The exhaustion, consequent upon the cessation of assimilation, the pain, and the constant vomiting. 3. Septic absorption. It is particularly in this class of eases that salines have won their reputation. Administered in the first stage before paralysis is fairly developed they seem to have the power of re-establishing peristalsis, of restoring tone to the muscular coat of the bowel and of sweeping from the intestine the partially digested matter ripe for fermentation and putrefaction. That the paralysis dependent