Cases fall into four categories: (1) the rarest, those undoubtedly of con genital origin, of which the author's case is only the fifth on record; (2) those in which the symptoms come on a few months after birth—these cases are closely allied to the preceding; and (3) those developing some years after birth, but distinct from (4) those only occur ring in adult life. The cause regarded as being purely mechanical. The whole of the colon may be dilated, but the sigmoid flexure is almost invariably af fected, and from this point the dilatation spreads backward to a varying extent of the colon. Treatment has been most unsatisfactory. Purgatives and enemata have little effect, and lead to increased suffering, while massage is dangerous. C. F. Martin (Montreal Med. Jour., Mar., '97).
When dependent upon obstruction, of whatever character, it follows hyper trophy in consequence of the constant efforts at expulsion of the accumulating contents. In some instances no form of obstruction has been discovered, and it may be that in these the condition may have been dependent upon an hypoplasia of the muscular coat of the bowel. The gut may attain enormous proportions and it may extraordinary dis placement and distortion.
Case in which sigmoid flexure formed two large sacs extending across the ab domen. Money (Brit. Med. Jour., Feb' 4, 'SS).
Case of gigantic intestinal divertic ulum seen in a boy aged Li. The ab domen began to swell soon after birth and continued till death, which followed an operation for relief of the condition. It was found at the autopsy that a large diverticulum connected with the rectum. Maas (Centralb. f. Gynak., Apr. 22, '83).
It also becomes the repository for a vast accumulation of faecal matter, and it may, through acute dilatation of the bowel, attend inflammation of the peri toneum or this mechanism lead to a fatal issue of some organ with a peritoneal covering.
Treatment.—The treatment consists in the prevention of the causative con ditions when possible, of their removal when present, and of their effects when these have developed, with a proper regard, of course, for the general state of the patient. Thus, constipation is to be prevented by attention to and regulation of the diet, and to be judiciously cor rected when it exists, though the abuse of purgatives is to be carefully guarded against. Accessible strictures should be dilated, obstructing neoplasms and for eign bodies removed, and constricting bands and confirming adhesion freed. The fecal accumulations are best re moved by enemata of either water, warm or cold, alone, or with the addition of soap-suds, castor-oil, olive-oil, cotton seed oil, or turpentine.
Large quantities of olive-oil, varying from a pint to a quart, in divided doses, have been successful in fiecal ac cumulations. E. W. Mitchell (Cincin nati Lancet-Clinic, Jan. 17, '91).
Massage is capable of effecting good results in suitable cases, and electricity also at times. The diet should be prefer ably concentrated, and food requiring in testinal digestion, or giving rise to a bulky and coarse residue, must be avoided. Of drugs, strychnine is, per haps, the best, conjoined or not with belladonna, in accordance with the pres ence or absence of irritability of the bowel.
Enteroptosis. — Descent of the intes tines from their position is a frequently overlooked condition occurring coinci dently with gastroptosis, nephroptosis, and prolapse of other abdominal organs. It constitutes the disorder termed by Glenard "splanchnoptosis." In rare cases the condition may be congenital. .Pre disposing causes may be relaxation of the abdominal walls from numerous preg nancies or from rapid emaciation; trau matism; improper use of cathartics; and, in addition to these general causes, there must be in every case a relaxation of the ligaments and the mesentery. The con dition, even when extreme, may be with out symptoms, but usually there exist signs of disordered functions, which may affect the general nutrition. The appe tite is generally lessened, and there are sensations of weight and fullness, with acid eructations. In some cases the bowels move daily, but more often con stipation prevails, sometimes alternating with diarrhoea. Excessive flatulence is usual, and not rarely there is mem branous enteritis. As a result of these abnormal conditions there are loss of flesh and a feeling of weariness, and the patient has the appearance of one suffer ing from a wasting disease. Nervous symptoms are marked, with headache, loss of sleep, and other sensations, which might lead to a diagnosis of neurasthe nia or hysteria. The course of the dis ease is chronic. (Boas.) Enteroptosis can be cured in many in stances. Personal plan of treatment is to strap the stomach with strips of ad hesive plaster. Adhesive plaster is pre ferred to the bandage in these cases be cause the patients are thin, and it is difficult to fit a bandage and keep it snugly applied. Irritation of the skin can be overcome by the application of Unna's zinc plaster before putting on the adhesive plaster. Nervous dys pepsia and enteroptosis are thought to be closely allied. It is remarkable how quickly the nervous dyspepsia can be relieved by treatment directed to the cure of the enteroptosis. A. Rose (Med. Record, Jan. 5, 1901).