180 



DISEASES OF THE DIGESTIVE APPARATUS. 



time, is the principal indication. The operation is practised in the 

 right flank, in the centre of the triangle formed by the external 

 angle of the ilium, the transverse processes of the lumbar vertebra, 

 and the last rib. The skin should be shaved and disinfected ; we 

 next make a narrow buttonhole by means of the lancet or the 

 fleam, and the puncture is then made by directing the point of the 

 trocar toward the left elbow. After evacuation of the gases, the 

 cutaneous wound is closed with collodion or a piece of court- plaster. 

 It may happen that the left flank is more prominent than the 

 right ; the puncture may then be performed on the left side. 



The puncture through the rectum, recommended long ago by 

 Chabert, Aubry, etc., and quite recently by Foringer, must be 

 rejected, even if the swelling seems localized to those viscera which 

 it is impossible to reach through the cutaneous puncture. In the 

 first place, the operation through the rectum cannot be made under 

 antiseptic precautions; besides, we run the risk of a colo-rectal 

 fistula. 



In cases of tympanites of medium intensity, sulphate of eserine 

 administered by subcutaneous injections (0.1 gramme in 5 to 10 

 grammes of water) has given excellent results ; but when the viscera 

 are much distended, this agent is dangerous ; it may, by its violent 

 action, produce an intestinal rupture. 



Ether clysters (15 to 20 grammes of ether in 1 litre of water) 

 pretty commonly used in France, are also useful in the treatment 

 of flatulent and spasmodic colics (^Cagny, Heu, Zorn). 



It is always of advantage to resort to cold injections, also to cold 

 compresses, massage of the abdomen, etc., in order to induce the 

 evacuation of gas, but it will be wise not to lose too much time 

 with these remedies. Other agents recognized by different authors 

 are of little value. Absorbents are not to be advised ; some of 

 them, like ammonia and liver of sulphur, for instance, increase the 

 quantity of gas by adding ammonia and sulphuric acid ; others, 

 such as lime-water, do not retain their alkaline condition any farther 

 than the stomach. 



Verminous Colics. 



Etiology. We must particularly mention the following intes- 

 tinal parasites which produce colics : Ascaris megalocephala ; Tœnia 

 jplieata, T. mammillana, T. perfoliata ; Spiroptera megastoma ; Sde- 

 rostoma tetraoantha ; Gastrophilus equi^ and Grastrophilus hœmor^ 



