Introduction of a large quantity of water into the intestine in order to diag nose a condition of atony or dilatation recommended. From 1 to pints are necessary in order to produce the splash ing sound in the normal intestine, per ceptible in the neighborhood of the trans verse and descending colon; while only or '/, pint will produce the sound if there is atony or dilatation; and in such a ease it is perceptible first in the sigmoid flexure, then in the transverse colon, and finally in the entire large in testine. Change of position produces a succussion-sound, and dilatation of the sigmoid flexure may be ascertained, which may be beyond the median line. In the same manner displacement of the transverse colon may be determined, and if simple atony only is present the splash ing will be heard in the normal position of the colon, while if there is also dis placement the sound will be heard under the mnbilicus. It is indispensable to evacuate the intestine with a purgative before performing this lavage. In catarrh of the intestine the water will return charged with mucus and false membrane, while if the intestine is normal the water will be clear or will contain only some slight epithelial debris. Boas (Deut. med. Zeit., Jan. 15, '95).
A very characteristic group of symp toms is present in congenital idiopathic dilatation of the colon. Chief among them and the first to appear are two, viz.: constipation and abdominal dis tension. In 22 of the 24 cases published one or both of these was witnessed within three months, and nearly always within a few (lays after birth. Generally it is noticed that within a few days after birth the child tends to be much con stipated. In a few cases several weeks or even as long as three months appear to have elapsed before the trouble with the bowels began. In one patient there was never constipation. In nearly half the cases constipation was the first symp tom noticed, although in most of these distension of the abdomen developed very soon after. In almost all of the remain ing eases the development of constipation and of distension seems to have been simultaneous. J. P. C. Griffith (Amer. Jour. Med. Sciences, Sept., '99).
Etiology.—Dilatation of the colon may arise from a variety of causes, the essential element being invariably an atonic state of the muscular coat of the bowel.
This may result from long-protracted catarrhal conditions, from frecal accumu lation, and from other forms of chronic intestinal obstruction, such as the pres ence of neoplasm, or of a foreign body, or of constriction from without or within, and the like.
Atony of the intestine separated from chronic constipation, which is often only a symptom of the former condition. The atony usually affects the colon, widen is unable to expel the fieces. Tt may be primary, as the result of improper diet, sedentary habits, or a too frequent use of cathartics: or it may be secondary to many disorders, as obesity, disease of the heart, lungs, or liver, typhoid fever and other intestinal diseases, or organic nervous diseases. It is often found in childhood and may be congenital. Frie
denwald (Med. News, Aug. 11, '94).
In cases of marked tyinpanites the distension is practically confined to the large intestine, and it would appear that the obstruction to the escape of flatus is due to the downward pressure of the descending colon and sigmoid flexure upon the upper portion of the rectum, forcing the folds of Houston one upon the other, and bringing about, in this way, what is for the time in effect an impermeable stricture.
The most rational method of relieving this obstruction and liberating the im prisoned gas is the inversion, or partial inversion, of the patient, and removal through the aid of gravitation of the pressure from above, which has con verted the mucous folds referred to into an absolute obstruction.
While the knee-chest position may answer best in cases of extreme dis tension, the placing of the patient upon the side, with elevation of the foot of the bed, will commonly secure relief in cases of moderate distension. Leslie M. Swcetnam (Annals of Surg., Mar., '95).
At times the condition is present from early life and in rare instances it has been thought to be congenital.
Case of a child, 3 V, years of age, male, who from birth was extremely constipated. No action of bowels with out purgatives. For the first year there was no enlargement of abdomen, and the child was in no pain. At the end of the first year gradual and progressive enlargement of the abdomen supervened.
At the age of 3 7, years constipation became alarming, and no flatus was passed. The distension and pain became more marked than ever before, while purgatives and enemata seemed useless.
On admission to the hospital the ab domen was much distended and uni formly enlarged. There were vermicular movements over the lower part of the abdomen, apparently associated with the distended colon. This colon could be felt as an elongated prominence, running obliquely across the abdomen, and vary ing in position from time to time. Move ments were both spontaneous and ex cited by examination. Laparotomy was performed, no stricture found. A second operation in the left inguinal region, in order to empty the colon, met only with partial success, it being impossible to really empty the intestine. Five days later the patient showed signs of perfo rative peritonitis and died. At the au topsy, there was a little recent peri tonitis. "The lower half of the abdomen is occupied by the enormously distended and hypertrophied sigmoid flexure, which lies completely across the abdominal cavity with the concave border looking to the left. The upper half of the loop is the wider and longer, measuring 20 centimetres by S centimetres, while the lower half is 15 centimetres long by 5 centimetres in diameter. . . . There seems to be a thickening of that part of the mesocolon which approximates the two ends of the loop and causes traction on the lower end, thus creating a partial narrowing of the lower portion." The wall of sigmoid and descending colon was much thickened; there was no ulceration. Idiopathic dilatation of the colon is a rare condition.