Four cases in which reduction followed rotating of the body round the long axis while the patient was lying down. The untwisting of a volvulus by the rotation a half-turn first to one side then to the other, if it increases the pain in one direc tion and not in the other, suggests the direction of the twist. Rotation in the opposite direction should untwist the vol vulus. G. H. Hunter (Lancet, Aug. 19, '99).
When tympanites is extreme and can not be relieved by tbe means indicated, puncture of the gut through the ab dominal wall is recommended by some authorities. A small aspirator-needle thoroughly asepticized should be used and left in situ until collapse of the gut is manifest.
The use of electricity in addition to the mechanical action of water is advo cated by Mingour and Bergonie. A 2 per-cent. salt solution may be used, the positive pole of a galvanic battery being placed on the abdomen and the negative in the rectum.
Case of a child, aged 5 '/, years, who developed signs and symptoms of in testinal obstruction with fmcal intoxica tion. For seven days purges and ene mata were administered without result, and the patient became wasted and col lapsed, with a weak pulse and a tym panitic abdomen.
Recourse was finally had to electricity. A large indifferent electrode was placed on the abdomen and used as the positive pole. Into the rectum about a pint of salt solution was injected, and a rectal sound 4 '/, inches long, introduced as the negative pole. The current was gradually raised to 20 milliamperes and after three minutes to 23; one or two interruptions having been made, a rush of ftecal matter amounting to about 3 pints, followed, and was succeeded by the immediate recovery of the patient. Min gour and Bergonie (Arch. d'Elect. Med., No. 52, '97).
The use of atropine in large doses, 1/13 grain hypodermically, recommended in intestinal obstruction before deciding on laparotomy. Two cases, one due to paralysis, the other to spastic contraction of the muscular coats, were relieved by the drug alone; in a third cceliotomy became necessary, the intestinal obstruc tion being due to a, parametritic band. Ba tsch (Mtinch. med. Woch., July 3, 1900).
Case in which, when first seen, the patient was in collapse, with extremely tender abdomen, tympanites, and vomit ing. The following evening, after the vomitus bad already become feculent, 1/2 grain of atropine was injected. The ab solute constipation was relieved and the collapse symptoms slowly disappeared.
B. Marcinowski (Miinchener med. Woch., Oct. 23, 1900).
If, after a short, but faithful, trial of the methods indicated, no satisfactory result is reached, the abdomen should be opened. Wiggin states that, as a preparatory treatment in operations for intestinal obstruction, the stomach should be washed out, if there has been much vomiting or abdominal distension, while an intravenous saline injection of three pints will be useful if the patient is suffering from shock. If the site of the obstruction is not located, he recom mends that the incision be made through the right, rectus, between the umbilicus and pubis. If the intestinal coils be greatly distended, the distension should be relieved by aspiration or, if need be, incision. He states that in the after treatment excessive thirst may be al layed by two or three large doses of muth subnitrate, and after the first day the patient may be made more able if allowed to lie on his side. The • ral mien( to give too small of nourishment at too fre ,nt interval,: a sYstem which fatigues .toinach aud is likely to cause irri t Of the organ.
Ile fact. apparently demonstrated by statisti.s. that one-third of the cases re (ov,r as a result of internal treatment, is likely to lead to some disastrous re sult:4_ Statistics tend to show that at least 4000 deaths occur in Germany in a vear from intestinal obstruction. Even under the. most favorable conditions, at least two-thirds of the cases depend ex clusively upon surgical treatment. A. Schreiber (Deutsches Archiv f. klin. Med., Dec. 13, 1900).
In chronic cases—i.e., when the symp toms. are not strongly marked and the obstruction is shown to be incomplete by the occasional passage of small quantities of hecal matter, perhaps mucoid and tinged with blood—the possibility that intussusception is present and that the invag.inated portion will slough off and bring. about recovery should be borne in mind. Still, as correctly emphasized by Erdmann, these cases can never be claimed as true cures, owing to the like lihood of stricture-formation's following the sloughing process, and the fact that they are very prone to be followed by obstruction, demanding at a later day an emergency operation, which is likely to have a more serious aspect than would the question of primary operation for imussusception.