RUPTURE OF THE INTESTINAL WALLS. C7l 



CHAPTER XLI. 



RUPTURE OF THE INTESTINAL WALLS. 



As a result of these different forms of disturbed intestinal func- 

 tion, whether of impaction from ingesta, distension from gases, 

 or both combined, there is occasionally encountered this lesion 

 of ruptured intestinal walls. This is probably oftener observed 

 affecting the colon than the small bowel, and is more likely to 

 follow the existence of degenerative changes in the muscular 

 and other textures of the tube, whereby the integrity and 

 resisting power of these is impaired, as also their natural peri- 

 staltic action and other activities interfered with, from which, 

 in all probability, has resulted the impaction or excessive 

 t3rmpany where these have severally existed ; the altered 

 textural change in the bowel being thus, in many instances, 

 both the cause of the impaction or distension, and the expla- 

 nation why the rupture should occur in these particular 

 instances and not in all. 



The symptoms which indicate this fatal termination of dis- 

 turbed function are neither uniform nor diagnostic. In some, 

 the occurrence of the lesion seems to be followed by rapid 

 collapse ; in others, it would appear that life may be prolonged 

 for a few days. With one, we may have mitigation of the dis- 

 tressing features previously existing; with another, on the 

 •contrary, all these may suffer aggravation. 



When occurring in association with impaction or unnatural 

 retention of ingesta in the colon, together with considerable 

 distension from gases in the bowels, in which cases we often 

 have restlessness and much straining, the occurrence of the 

 lesion is usually followed by relief in the symptom of restless- 

 ness, and a subsidence of the straining, comparative calm and 

 quietness being the condition succeeding the rupture until 

 death. In all, with the completion of the rupture, I have 

 observed that exhaustion is a feature rapidly developed ; and 

 that although relief from pain seems to have been obtained at 

 once and unexpectedly, there is a haggard, anxious expression 

 of countenance, a frequent and small pulse, steadily becoming 

 more rapid and at last imperceptible, patchy perspiration, short 

 catching respiration, gradually a disinclination and inability to 



