Diseases of the intestines, their special pathology, diagnosis, and treatment : with sections on anatomy and physiology, microscopic and chemic examination of the intestinal contents, secretions, feces and urine intestinal bacteria and parasites; surgery of the intestines; dietetics, diseases of the rectum, etc / by John C. Hemmeter.

  • Hemmeter, John C. (John Conrad), 1863-1931
Date:
1902
Catalogue details

Licence: In copyright

Credit: Diseases of the intestines, their special pathology, diagnosis, and treatment : with sections on anatomy and physiology, microscopic and chemic examination of the intestinal contents, secretions, feces and urine intestinal bacteria and parasites; surgery of the intestines; dietetics, diseases of the rectum, etc / by John C. Hemmeter. Source: Wellcome Collection.

    181/688 (page 177)
    neighborhood of that place in the abdomen whither they go (Naunyn). In acute intestinal occlusion, energetic (tetanic) con- tractions of the intestinal muscles (above the point of occlusion) are not observed, in my experience. These contractions are perceived most frequently and distinctly in chronic intestinal stenosis, and are often felt by the patient himself a considerable time before the complete occlusion of the intestine. There are also peristaltic con- tractions observable in the suprastenotic loop of acute obstruction, but they never reach such a degree of intensity as to deserve the name tetanic, nor do they ever effect a plastic erection of the loop in question. During the palpation of the abdomen one must also be on the lookout for a tumor or a deep-seated resistance. These, however, are frequently lacking in acute intestinal occlusion, and in only a portion of the cases of intussusception can a cylindrical tumor be felt. In carcinomatous stenosis of the intestines an irreg- ular knotty tumor, which is sensitive to pressure, may sometimes be felt. The accumulation of thickened, hardened feces above the stenosis may, however, often simulate the appearance of a malignant tumor. If the examination of the abdomen has given no definite result, a careful digital examination of the various hernial orifices must be made. Besides the more common forms, all the rarer hernias— —lumbar, umbilical, ischiorectal (rupture through the perineum), ischiadic, obturator hernias, etc.—must also be considered. The omission of the examination of the hernial orifices is a great neglect, which may bitterly avenge itself upon the physician. If the orifices of the hernial sacs have been found to be open, a thorough simple and combined exploration by vagina and rectum is imperatively necessary. In the former, one must search for those changes in the position of the uterus which may exert a pressure upon the lower parts of the intestine. One must also look for tumors of the ovaries and of the other pelvic organs which may also act in this manner. Prostatic hypertrophy must be looked for by rectal palpation. Fecal accumulations, strictures, and tumors of the lower section of the rectum may be discovered by such digital examination. If the suspicion is present that the obstruction to the course of the feces is situated in the lower section of the intestines, and if the digital investigation has given normal results, II—12