AND OCCLUSIONS OF THE INTESTINE (a) HIRSCHSPHU NG'S DISEASE -CONGENITAL DILATATION OF THE COLON This very interesting condition, the etiology of which is not yet entirely clear, was first described in 1S80, by Hirschsprung, in Copen hagen. He states, in his last publication on the subject, that Ile has seen in all ten such eases. The literature with which I am familiar, pactieularly in the works of Conceal, Goureviteh, Neter, Ibrahim and others, is already rather considerable.
According to the symptomatology of the affection, one must dis tinguish two groups of cases; namely, those which show at birth, or in the first (lays of life, the phenomena of persistent constipation and gaseous dilatation of the abdomen; and, others in which these symp toms begin later, for the most part at the time of weaning, or at the beginning of accessory feeding.
The first group concerns children who are born apparently healthy, in which often after birth no external alteration is noticed, and to which the attention of the attendants is first aroused because of the fact that there is no spontaneous evacuation of the meeonium. The physician, on being called in, convinces himself, by digital examination of the rec tum, that there is no mechanical obstruction in this region. After giving an enema, a small quantity of infant feces is evacuated; the child remains restless, sleeps poorly-, has no spontaneous defecation; and dilatation of the abdomen is added as a new symptom of the malady, the abdomen becomes tense, the skin is coursed by dilated veins, and is at the same time slightly- cedematous. This condition increases visibly; the diaphragm becomes pushed upward, and dyspncea and cyanosis may be present. If a rectal tube is introduced, and water permitted to flow in, the water comes back only in part, and the nieconium is brought out in large quantities first through the introduction of the finger into the rectum and massage of the abdominal wall with the other hand.
The abdomen then sinks and becomes softer, and the condition of the child is improved; again it takes nourishment, the cyanosis disappears; but, after some time, the whole affair is repeated, and so it continues, until, finally, after a varied length of time, death intervenes, brought about, sometimes, by interference of the respiratory organs; sometimes, by insufficient nourishment or also by chronic intoxication, from decom position products taken up in the blood-stream. In this last condition,
coma, convulsions or other meningeal-like symptoms may result.
In contrast to these eases, which represent the true picture of the malady presented by Hirsehsprung, there are other cases in which, after several months of complete health, or at most a slight tendency to costiveness, persistent constipation sets in, for the most part, as already mentioned, influenced by accessory nourishment or by weaning. The dilatation of the abdomen with gas soon follows, and continually increases, so as finally to present the appearance of a so-called balloon belly, which in size and form is not found in any other condition. (See p hot graphs, Figs. 21 and 22, and Plate 49, Figs. 1 and 2). Moreover, the vitality of these patients is much endangered, and, in conse quence of t he marked constipation, uleerat ive processes of the mucous membrane of the large intestine may develop, which lead to abscesses of the submucosa (Hirsch sprung) and likewise can occasion severe cachexia.
The etiology of the affection is different bleach of the two groups just briefly sketched. When the symptoms set in at once at birth, or shortly after it, we must assume 96 its cause a congenital malformation of the colon, which leads to considerable dilatation, eventual] y , also, to hypertrophy of its walls (which, however, is not constant), and so a stasis of the intestinal content with its scquehe is brought about. These are the real cases of congenital dilated colon according to the conception of Ilya.