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
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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.

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    mesentery is not included in the obstruction or constriction. Here the changes are principally dependent on the stagnation of intestinal contents. The first and fundamental question to decide in each case will be, “ Is it a case of strangulation or obturation ? In all strangulations and incarcerations, the forms which we are considering now, the nutrition of the intestine soon suffers as a result of the circulatory disturbance. The incarcerated loop becomes distended and ulti- mately paralyzed. The distention may acquire colossal dimensions ; a single loop of the large intestine, for instance, when distended, apparently fills the entire abdominal cavity and extends up into the dome of the diaphragm. In all strangulations we always have a fixed, distended, and paralyzed intestinal loop. The parts lying above the strangulated portion, the suprastenotic loops, show no distention, or very little, in the first stage. We have already given the causes of strangula- tion, and those of obturation are given in another chapter, yet to fol- low. It is necessary to repeat here that as there are no circulatory disturbances in the mesentery in obturations, the nutrition of the in- testine suffers comparatively little. We do not observe any distended paralyzed loop, and the portions of the intestine above the obstruc- tion are not only free from paralysis, but the peristalsis is distinctly increased. Invaginations occupy an intermediate position ; sometimes they involve the mesentery, and sometimes they do not. Therefore we may have in one case the phenomena of strangulation, and in an- other those of obturation. The most important symptoms may be arranged in the order of their frequency, as follows : (i) Gas and stool retention, (2) pain, (3) vomiting, (4) meteorism, and (5) incarceration shock. There are other symptoms of minor importance; for instance, tumor, fever, singultus, anuria, or diminished excretion of urine, exudations into the abdominal cavity. Retention of Feces and Gas.—This is, in my opinion, the first important symptom in all cases that can be noticed from an early date. It occurred in 84 per cent, of the 500 cases in literature in which any statement concerning this symptom was made at all, as the first deviation from the normal condition. The reason why it