Treatment. 363 



gm.) ; disinfectants are added to these to reduce fermentation 

 (lysol or creolin, 15-20.0 gn\. naplitliol, naplithalin, 10-15 gm.). 

 As long as the contractility of the intestinal loops is not abol- 

 ished, as long as evacuation by it has not become impossible, and 

 as long as intestinal gases are expelled from time to time, 

 eserine (0.08-0.10 gm.) or arecoline (0.06-0.08 gm.) may be used 

 subcutaneously. If, however, parts of the intestine have already 

 lost their contractility (in very severe cases), these drugs are 

 no longer beneficial and may be dangerous (see page 303). Since 

 bloating of the stomach is frequently present simultaneously, the 

 stomach tube should be used. 



If, in spite of these applications, the condition of the patient 

 becomes worse, or if the excessive dilatation of the abdomen 

 bring about great dyspnea, puncture of the intestines must no 

 longer be delayed. This removes the danger of suffocation and 

 reestablishes contractility of the punctured portion of the in- 

 testines and the parts situated between the puncture and stom- 

 ach. In secondary bloating intestinal puncture alone promis.es 

 relief. Puncture of the cecum is usually practiced ; if necessary, 

 however, the colon or the small intestines must he punctured. 



Intestinal puncture is best practiced with a slender trochar 10x15 cm. long. 

 The skin is first properly cleansed, then an incision is made. The trochar is now- 

 introduced into the center of the depression of the right flank with the point directed 

 towards the left elbow. After the escape of gas ceases, the tube is removed or, better 

 still, left in place and closed with a cork, when it may be opened later on to let out 

 more gas which might have again accumulated. If in spite of this puncture the 

 symptoms of bloating persist or if the left flank has been distended more promi- 

 nently from the start, the left flank is punctured. If this is done one must pre- 

 viously ascertain by rectal exploration at which point of the left side the bloated 

 colon is situated, so that one does not puncture the rectum or some loops of small 

 intestines or enter into the free abdominal cavity, in which ease the puncture is 

 without any result whatsoever. 



Puncture of the colon from the rectum (Imminger, Foringer, Jensen, Eeinhardt) 

 appears indicated only in those rare cases, when the left portion of the colon is 

 not lying close to the abdominal wall and when puncture of the cecum does not bring 

 relief. Such a puncture may be made with a large exploratory trochar or an Elsch- 

 ner trochar with a curved canula 40 cm. long or a Eaitsits trochar which is short 

 and can be introduced into the rectum as far as one can reach, and may in this 

 manner reach anterior portions of the intestines. To permit the escape of the gases 

 the short trochar must be connected with a rubber tube. If the free end of the 

 tube is placed below water the evacuation of gas can be easily controlled. 



Intestinal puncture, whether practiced from the flanks or from the rectum, is 

 never harmful in primary bloating, if we use a slender trochar and proceed under 

 aseptic precautions, or at least as cleanly as possible, and if in puncture from the 

 rectum one follows the trochar with the guard. Before puncture from the rectum, 

 the latter should be irrigated several times with disinfectant solutions. In secondary 

 bloating, when the elasticity of the intestinal wall has suifered in consequence of 

 serous or hemorrhagic extravasation, it may occur exceptionally that some intestinal 

 contents get into the abdominal cavity. 



Great restlessness must be counteracted by morphine in- 

 jections (0.3-0.5 gm.) or by rectal injections of chloral hydrate, 

 because reckless rolling may bring about rupture. 



In hogs, dogs and rabbits, kneading or massage of the ab- 

 dominal cavity may be beneficial ; • also chasing the patients 

 around, also repeated cold douches. If the stomach is bloated 

 simultaneously, emetics (see page 291) may be used. If suffoca- 



