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THE INDIAN MEDICAL GAZETTE. [February 1, 1877.

TWO CASES OF OBSTRUCTION OF THE BOWELS AND ITS RESULTS.

By Radha Natjth Roy, Assistant Surgeon, Aligurh. ,1

Case I.?Jummon, a Hindoo male; aged 30, was admitted into the Aligurli dispensary on the 19th August last with the follow- ing history:?The patient about 13 days ago received 30

stripes for a crime of theft, and after the infliction of the

stripes he walked to his house, a distance of 14 miles. He was a great opium-eater and gunja-smoker. On his return home he took about 5 grs. of opium on an empty stomach, and afterwards partook of a hearty meal of bread and dhal. The next day his bowels were constipated and with difficulty he evacuated a small hard lump of faeces. Since then he has had no action from the bowels, though he strained a good deal. He was always accustomed to have his bowels naturally moved twice in the day. Oil the day he was taken ill he vomited twice during the night, but slept soundly For the next five succes- sive days he used native medicines, which had no effect what- ever. He then went to the branch dispensary at Secnndra, where he was treated for six days. The native doctor gave him enemata and a dose of purgative powder. After the

injections two or three lumps of faeces came away, but he suffered from a severe pain in the abdomen. He was then advised to come to Aligurh, where he obtained admission on the 19th (i.e.) on the 12th day of his constipation. On admission I found that his general state of health was

not good. He was of a thin and weakly frame of body; his pulse was small and weak; tongue thickly coated; vomit-

ing was stercoraceous and of yellow colour; abdomen greatly puffed up and distended, its surface uneven, owing to the un- equal elevations of the distended coils of the intestines; percussion note was resonant in the epigastric and hypochon- driac regions, but very dull in the right and left iliac, hypo- gastric and umbilical regions. On palpation, only the distended coils of the intestines could be felt rolling under the fingers. There was no femoral or inguinal hernia. He was ordered a warm bath and castor oil enemata with a long tube. The

injection was retained for five minutes and then voided, mixed with faeces of a yellow colour similar to that vomited. The injection was again repeated four times in the day, but nothing beyond the liquid injected, coloured yellow, was returned. He was also ordered the following pill:?9=. Ext.

colocynth gr, ii, ext. aloes gr. i, calomel gr. i, opium gr. one every 2 hours ; turpentine stupes and a hip bath. The

pain in the abdomen decreased, but vomitang of foetid yellow coloured liquid became incessant; cach time he brought up about 3 or 4 oz. of faecal matter. His pulse began to fail and respiration became laborious; his skin was bathed with a cold clammy perspiration, and he died next morning iD a state of collapse. On making a post-mortew examination it was found that the

omentum had become much injected, thickened, and glued to the surface of the intestines, but it was separated by a little force. A coil of the ilium was found twisted on itself behind the bladder. It was of a deep scarlet colour and adherent to the posterior surface of that viscus. There was a small quan-

tity of serum of yellow colour in the peritonial cavity. The

coils of the small intestines were all matted together by an exu- dation of lymph. The twisted portion was soft and very friable and the whole of the intestines were distended and of a

deep red colour. Case II.?The second case, however, terminated in recovery

and the history is as follows :? The patient, a Hindoo male, named Jugulkissore, aged about

30, was admitted on the 6th of September last. He stated that

from the previous day he was suffering from severe pain in the abdomen which was almost constant near the umbilicus ;

that he took his meals which consisted of some atta and some

vegetables; and that he had passed a few lumps of faeces be- fore admission, but they were very scanty. On admission

he was crying with agony, lying on his back with his legs drawn up; pulse was very small and weak; nails blue ; eyes sunken ; skin perspiring ; tongue moist and clean ; abdomen tense and painful on pressure, especially in the right iliac

region; percussion note of the umbilical 1 and right iliac

regions was very dull, but not so in other regions; vomited several times. The ejected matters consisted of water with

shreds of mucus: no hernia present. He was ordered a cold

water enemata with a long tube, and the followiug pill:?p. Ext. hyoscyam gr. i. ext. aloes gr. ii., calomel gr. iii, opium gr. one pill every third hour.

1th.?The injections were returned almost immediately, and without any faecal matter with them, the pulse has slightly improved; feels a little stronger; skin normal; vomiting not so frequent; no stools; passed urine freely. Pain in the um- bilical and iliac regions is very intense, so much so that he can- not bear the pressure of the fingers ; slept fairly: ordered him to continue the pills and to apply bran poultices. 8th.?Vomited four times yellowish green bile ; no stools;

pain much the same; pulse moderately full; tongue still

thickly coated; skin normal; slept soundly during the greater part of the night. The same remedies were continued. 9th.?Has vomited several times water mixed with bile.

Passed 7 stools during the last 24 hours. The stools were of a fluid consistence and of a yellow colour ; pulse quick and full; skin warm ; tongue moist, but furred; pain in the iliac and umbilical regions is much the same, but other parts of the abdomen are free from uneasiness. Continue pills, with calomel gr. ii in each one, every four hours.

10th.?Vomiting subsided, only thrice; has passed five

liquid yellow-coloured stools ; pain in the iliac and umbilical

regions is better; percussion note is not so dull; pulse full; skin normal. On palpation a small hard lump about the size of an egg can be felt in the right iliac region: ordered one

pill every three hours. From this date his progress was uninterrupted and he was

discharged cured on the 20th September, but the hard lump in the right iliac region, although it had softened down, was still present. Remarks.?Cases of obstruction of the bowels are of fre-

quent occurrence in these Provinces, and the history of each nearly always points to some indigestible substance as the cause. I have invariably found it to follow meals pre- pared from newly cut crops, such as oats, bajra, or from

fruits, such as plums. The obstruction is often mechanical and is rendered more complete by the peristaltic action of the bowels while they endeavour to get rid of the offending matter. These foreign bodies, by their presence, also produce local and sometimes general peritonitis. From increased action, con- sequent on irritation, any portion of the intestine may become twisted on itself and thereby produce a new cause of ob- struction. Injection through a long tube, and the adminis- tration of opium and calomel, is the best method of treat- ment in these cases. In the first case it proved unsuccessful owing to the previous adhesions and matting together of the bowels. So long as peritonitis does not set in and adhesions

have not taken place, the treatment by injection through a long tube, used gently, is the safest one to follow. I have tried

strychnia in these cases, but it has proved useless. In some of habitual constipation I have seen the administration of the drug followed by much benefit, as it acts by increasing the peristaltic movements of the bowels, but in cases such as those above recorded, opium and calomel combined are the most

reliable remedies.