Acute Intestinal Indigestion with Impaction. 201 



measures and yet drastic purgatives are full of danger. The free 

 secretion from the vascular small intestines and the active ver- 

 micular movements, lead to the speedy over-distension of the 

 bowel just in front of the obstruction, the current being strong 

 and active all around the contracting gut in contact with the mu- 

 cosa, while a weaker return current sets in in the centre, but is 

 effectually checked and arrested at no great distance in front of 

 the impaction by the strong backward peripheral stream. If 

 therefore the impaction is not broken up, it is inevitable that the 

 gut above must be more and more distended until a rupture ensues. 



Yet in a certain number of cases a moderate dose of aloes or 

 castor oil supplemented by frequent enemata and other measures, 

 succeeds in safely overcoming the obstruction. The solid impact- 

 ed mass is gradually softened and removed, and finally after per- 

 haps three or four days of complete obstruction the fseces begin 

 to pass and recovery ensues. 



With or without the aloes, the hypodermic use of pilocarpin or 

 ■eserine or both will often succeed in obtaining successful 

 peristalsis. Barium chloride while inducing more active per- 

 istalsis is, on that account, somewhat more dangerous. 



Pain may be moderated and fermentation checked by chloral 

 hydrate (^ oz.), or, an anodyne, morphia (2-4 grs.), may be 

 given liypodermrcally. In the absence of these, extract of 

 hyoscyamus or belladonna (2 drs.) may be given by the mouth, 

 and repeated as may be necessary. If tympany is dangerous use 

 the trochar and cannula. Enemata and other accessory measures 

 must not be neglected. 



W. Williams has r&sorted to rectal injections of 2 oz. aloes 

 forced into the rectum by a syringe furnished with a long elastic 

 tube, and repeated when expelled. Brusasco has used copious 

 liquid injections poured into a rectal tube the end of which is raised 

 at least ten feet above the croup, so as to gain the requisite force. 

 Schadrin uses injections of cold water to stimulate the bowels to 

 ■contractions. Injections of oils or mucilaginous matters when they 

 can be carried far enough lubricate the walls and favor the passage 

 of solid matters. Castor oil which acts to a large extent locally is 

 especially applicable. 



Mechanical applications are often valuable. If the obstruction 

 is lodged in the rectum or floating colon it can usually be reached 



