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

  • Martin, Edward, 1859-1938.
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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    there is obstinate and continued vomiting of all food taken ; this vomited matter is more or less feculent in odor and appearance, depending upon the seat of obstruction and the time which has elapsed since the symptoms developed. There is often violent peristalsis to be detected through the belly walls. There may be much tympany. Symptoms of pain, and straining efforts at defe- cation are common. Death is inevitable if the case is not treated surgically. The immediate cause of the fatal issue is inanition or exhaustion. Perforative peritonitis occurs at times, but is not so common as in acute obstruction of a more advanced age. With such symptoms following hard upon birth, the diagnosis of obstruction from either congenital malformation or internal stran- gulation would be positive, and, as either would demand the same treatment, the differential diagnosis between these two is not abso- lutely essential. Diagnosis.—Since the most common seat of this form of con- genital malformation is about the anus and rectum, a careful search should be made in this region, the finger being carried into the anal aperture, if patulous, in the hope of finding the seat of occlusion. By means of a bougie, exploration can be carried some inches fur- ther than the finger can reach. It must be remembered that, the rectum and anus being normal, the next probable seats of obstruction are at or about the duode- num, the ileocecal valve, or the sigmoid flexure of the colon. In the new-born child the colon is a foot in length, and normally occupies the same anatomical region as in the adult. The sigmoid flexure is ten inches long, and lies mainly in the pelvis. The condition of the colon can readily be made manifest by means of injection of either air, hydrogen, carbonic acid gas, or any unirritating liquid, preferably normal saline solution (.7 per cent.). Neither gas nor liquid should be passed into the bowels by means of a force-pump, or any kind of injecting syringe. If gas is used it should be passed from a bag, and the pressure, not exceeding a pound and a half, should be kept under observa- tion by means of a manometer attached to the supply tube. The best way of introducing water is by means of gravity. The ordinary fountain syringe answers every purpose; the nozzle should