Treatment. —Whatever measure is re sorted to for the relief of acute intestinal obstruction must be used promptly, but of equal importance is the avoidance of remedies which, though seemingly indi cated, are hurtful. Among these may be classed purgatives. The most active factor in the production of suffering is exaggerated peristalsis; to administer drastic purgatives, etc., but accentuates the torture of the patient, exposes him to early collapse, and increases the chances of rupture. Especially is this a fact when some foreign substance—such as a pin, needle, etc.—has been swal lowed. Under such circumstances, the patient must be given food which will have much solid residuum, such as oat meal, cornmeal, or large quantities of bananas or mas.hed potatoes. The latter is especially useful when sharp bodies have been swallowed. The prolonged constipation preceding the acute attack has usually caused the patient to resort to various measures, which, though in effectual as purgatives, have already in duced partial exhaustion of the intesti nal muscular fibres.
Extreme caution is necessary in the administration of laxatives when an obstruction of the intestine may he the cause of the symptoms. lf the bowels are not moved, an attempt at purgation makes the patient much worse, and too often induces a state of collapse, which renders an operation hopeless; or, if an operation be performed, the bowel is found so distended and paralyzed that it cannot recover its tone. C. P. Gilder sleeve (AIed. 'News, :Mar. 26, 'OS).
Purgatives are absolutely contra-indi cated in all eases of acute obstruction, and are of very limited, exceptional, and temporary advantage in chronic cases. T. F. Prewitt (Jour. Amer. Med. A.ssoc., Apr. 23, '9S).
Physostiginine in doses of from to V„ grain (0.0005 to 0.00075 gramme) for tympanites in different intestinal disorders has given excellent results. The drug is given by mouth three times daily. Von Xoorden (Berliner klin. Wochen., Oct. 21, 1901).
The use of opiates tends, likewise, to reduce the vital activity of the intestinal tissues; morphine should only be used, therefore, when there is severe pain, and just enough should be administered hypodermically to assuag-e the suffering.
Attention called to harmful effect of opium in intestinal obstruction. In case of acute intestinal obstruction, in a vigorous boy of 19 years, due to a fibrous band, the abdomen was opened, the band divided, and the patient did well until the fourth day, when, suddenly, vomit ing and symptoms of obstruction reap peared. Wound was perfectly healthy. In searching for cause of symptoms it was found that patient had received about 5 grains of opium during the four days after operation, contrary to in structions. Castor-oil was administered, in drachm doses every half-hour, until bou els were moved, when symptoms dis appeared and the patient again entered on convalescence. Thiery (Bull. de la
Soc. Anat., Oct., '92).
The distressing vomiting first claims attention. The most satisfactory meas ure is lavage of the stomach. Not only is the vomiting relieved, but all other symptoms, including undue peristalsis, seem to be reduced in intensity, and the patient is advantageously prepared for operative procedures should such be come necessary. Practiced repeatedly,— i.e., every three or four hours,—this measure has alone proved curative in some cases.
The most effective methods 'for the reduction of the obstruction are the use of large water enemata and the insuffla tion of air. The former is to be pre ferred; the quantity of liquid used can easily be gauged, while the pressure can conveniently be regulated by raising or lowering the vessel from which the fluid is obtained. As noted by Jeffreys Wood, before attempting to reduce an intussus ception with water sufficient assistance must be secured. The child is, of neces sity, exposed a great deal during the treatment; so that a hot-water bag to lie on, with cotton-wadding coverings over the legs, are necessary to prevent too much shock. The height at which the funnel or irrigator is held is about four feet. An ordinary red-rubber tube one half to five-eighths inch in diameter, as used for washing out the stomach, may be used.
Among medical measures which may be instituted as precursory to surgical intervention in the event of failure 13igh rectal enemata head the list. These should always Lie given with the patient in the knee-chest position; but, if the patient is too weak to assume this post me. a h it or right lateral semiprone po NN an-wer. The enemata should 14. carried by means of a long, flexible lectal tube as high up as one can sue teed in introducing it. Plain, warm ater; or water and glycerin; or water to which a modicnin of turpentine has been added, the turpentine being emulsi tit41 by shaking up with an egg. may be it-ed. If three or four enemata do not yield results, it is unwise to delay cceli otomy. lt is risky to administer purga tives.
Opiates should be withheld as part of the medical treatment; they should only be given during the time consumed in preparing for operation, to obtund the pain. In the event of failure with the enemata, all observers are agreed that early operation offers the only salvation for the patient. Murphy operates early; McArdle advocates early operation; Broca operates after twenty-four hours; Natinyn also urges early operation and holds that the best results are obtained in the first three days. L. A. Hering Y. Med. Jour., Feb. 9, 1901).