This evacuation of the intestine must be frequently repeated and assisted by abdominal massage and electricity, in order to accomplish the least palliative result for any- considerable length of time. Massage of the abdomen is best performed by beginning in the right iliac fossa and from there upward and across the abdomen, and then downward in the region of the left inguinal region; and should consist of a progres SiVe kneading of the large intestilie with the fingers and tapping it with the open hands, laid on in rztpid alternation, and in thoroughly shaking the abdomen between the out-spread fingers, and similar procedures, each of which should laet about five minutes, and which should be repeated every- morning at about the same time.
To carry out the faradization, the electrodes am set side by side, and passed along the course of the large intestine; or, the so-called eleetrical lavage (Lenander) can be used, in which, first, the rectum is filled with salt solution and one electrode, covered with India rubber but with its point free, is introduced into the rectum and applied to the rectal mucous membrane, while the other electrode is moved up and clown on the outside. In addition, a tight bandage is applied to the abdomen (Escherich). The administration of the tincture of nux vomica (Levi) and similar mechanical and inedical methods, intended to increase tone can be undertaken together with a moderate diet, which should be as concentrated as possible. These measures may check the malady for a long thne. and produce relatively.* satisfactory results. For a permanent cure of the abnormality, operative procedures have been recommended. The simple production of an artificial anus is rather purposeless, and, so far as I can discover, from the results in the literature, is shortly attended, as a rule, by a fatal termination. The much more rational resection of the intestine, in ease reported by lijorksten (an anastomosis of the colon and rectum NVIIS attempted) had a temporary effect, although the chikl died finally in the effort to close the artifieial anus first made. Kredel operated more successfully, but still further experience must be relied on to indicate with certainty the proper procedure.
(b) INTESTINAL STENOSIS AND ATRESIA There are congenital and acquired forms which will be described separately.
The symptoms of congenital intestinal stenosis and intestinal occlusion are violent vomiting, beginning shortly after birth, fol lowed by distention of the abdomen, and the complete failure to eliminate mcconium per anum. The higher up the stenosis is situated the earlier the vomiting begins. The vomitus consists, at first, of the intestinal contents present, as far as the point of closure, then, also, of the nourishment given, and lastly of bloody.- material which comes from the stomach, the small vessels of which, in the mucosa, are rup tured in consequence of the great, straining. When the stenosis is low down in the lower ileum, or in the large intestine, even fecal matter is passed by the mouth. The degree of distention depends upon the sit uation of the narrowing. The nearer it is to the stomach, the less is the
dilatation, which, if the obstruction is close to the stomach, is limited to the epigastrium, while, in cases where the interference to the passage of the stool lies further down, the abdomen is greatly distended, particu larly in the region of the navel and shows a slight flattening in the flanks (NolVicourt). To these symptoms, disturbances of mieturition are often added; this, either because of the complete stoppage of the resorption of fluids, stops entirely-, or becomes irregular and painful, which is occasioned by- compression of the ureter by the greatly.- dis tended intestine, or must be regarded as a reflex symptom. The great gaseous distention of the abdomen elevates thc diaphragm which again may lead to dyspnoca and cyanosis.
The appearance of the child incliciates the gravity of the affection. The face becomes sharp, the expression is drawn, ond distorted by pain, the tongue dry- and the skin cool [temperatures about 35° C. (05° F.) are very frequent]. Wasting is rapid, and, in this state of collapse, interrupted by tonic spasms or convulsive seizures, death intervenes in a few days (generally in 4-5, seldom El week, exceptionally: longer). As a rule, on examination of the abdomen, no resistance is present, and no tumor is felt. Violent peristaltic movements are visible, under the tense and attenuated abdominal wall, particularly when the ste nosis is placed low down. In such cases gurgling and rumbling is heard and felt. The examination of the rectum, which should never be omit ted, in order not to overlook any- occlusion in the neighborhood of the anus or rectum, shows its complete potency-, even in the case of a, ste nosis situated low down. There may be sonic widening of the ampulla; the palpating finger, however, or the sound rarely conies upon an obstruction. (In single rare instances the obstruction is occasioned by kinked signioid flexure, which is pressed deep in the pelvis anti bulges forward over the rectum--Kuligo, The etiology of congenital intestinal stenosis and occlusion is not always the same. Kreuter has, it is true, made the attempt to explain all the various forms by the history of their development, supported by the fact that the intestinal canal in most vertebrates and in man possesses in early embryonic life a well-developed lumen, which later is covered by epithelium, in order that it may again finally become patent. IIe assumes that in such cases the opening does not take place at all, or only in an incomplete manner when atresia or stenosis takes place. He considers these conditions, therefore, as simple phenomena of retardation, and thinks that the factors emphasized by others as important etiologically, such as inflammation, intussusception, volvulus and the like, are secondary results of the printery processes. This ap pears to me to be a little too schematic, especially as in this way many other findings, such as anomalies of the vessels, obliteration of the blood-channels of the intestine, etc., are not explained.