Lavage Of The Bowel

Injections of large amounts of water into the bowel under considerable pressure are also occasionally of benefit, especially in cases of intussusception of the colon or when a foreign body or hardened fecal matter is the cause of the obstruction within the large bowel. According to Treves, it is desirable to use this procedure after anaesthetizing the patient. A considerable quantity of water (varying according to the age of the patient from half a pint to three quarts) is introduced into the bowel by means of an ordinary fountain syringe. The fluid is allowed to remain in the colon for at least ten minutes. While injecting the water it is best to have the patient in such a position that his head is lowered and his pelvis is raised. While the irrigation of the bowels is going on the physician should hold his hand upon the patient's abdomen and in this way notice any change which may occur.

In intussusception when the tumor can be felt the latter will in some instances suddenly disappear, giving way to the pressure of the water. Too great force, however, should never be used, as this may bring on rupture of the bowels. Instead of water, injections of warm olive oil, which were first recommended by Kussmaul and Fleiner, may be used in the same way. Dr. Klubbe 1 has related three cases of cure by means of this method.

Inflation Of The Bowel With Air Or Certain Gases In Cases Of Invagination

Trastour 2 recommended inflation of the bowel with air by means of a common bellows, to which an India-rubber nozzle and rectal tube had been attached. The forcible filling up of the bowel with air is capable of producing the same effect as the injection of water and may free the invaginated portion. Von Ziems-sen 1 has recommended the use of carbonic-acid gas, while Senn2 suggested hydrogen gas. Carbonic-acid gas is best used in the form of "sparklets," as suggested by Dr. A. Rose3 of New York. Care must be taken not to fill up the bowel too quickly and too forcibly.

1 Klubbe: British Medical Journal, November 6th, 1897.

2 Trastour: Bulletin General de Therapie, 1874, p. 107.

Massage

Massage has been recommended by several writers. Its use, however, is not entirely harmless. It can be of benefit only in cases of obstruction by gall stones and fecal matter, but even in these cases extreme care in its use is necessary.

Electricity

Electricity has especially been recommended by Boudet. Among seventy cases of ileus Boudet4 had fifty-three recoveries by this method. The faradic or galvanic current may be used. In the application of the faradic current one metal electrode of cone shape is inserted into the rectum while another large plate electrode is kept over the abdomen for about ten to twenty minutes. In using the galvanic current it is necessary to have a special rectal electrode, which is constructed in such a way that water running through it forms the conductor, so as to avoid burning the mucosa. The other electrode is placed over the abdomen. The negative pole should be inside. The strength of the current should vary from ten to fifteen milliamperes. The duration of the treatment should be twenty to twenty-five minutes.

1 Von Ziemssen Archiv fur klinische Medizin. Bd. 33. Heft 3 and 4.

2 Nic. Senn: "Intestinal Surgery, " Chicago. 1889, p. 244.

3 A. Rose: New York Med. Journal. 1900. i., p. 47.

4 Boudet: Progres Medical, February 7th and 14th. 1885.

Electricity will be of special value in obstruction due to hardened fecal matter or in the paralytic form of ileus, while in incarceration it is rather contraindicated.