Case of Mechanical Obstruction of the Bowels
Boston Medical and Surgical Journal
The novelty of the following case I hope will be sufficient apology for insertion in your periodical, and at the same time it may institute a more minute search after mechanical causes in constipation than is generally supposed to exist. October 7th.-I was requested to visit a negro man, aged about 25 years, who had been for five days laboring under the ordinary symptoms of epidemic dysentery. Tormina and tenesmos, with scanty discharges of a mucous character, sometimes tinged with blood,
... d with blood, frequent inclination to stool, thirst, loss of appetite, and other symptoms indicating a febrile state of the system. There was no vomiting or nausea throughout the whole course of the disease. These symptoms persisted with little or no abatement until the tenth day of his illness, with entire constipation up to this time, in despite of all our endeavors to produce a discharge from the intestinal canal. Strangury was a symptom in his case which we witnessed in almost all the bad cases of the epidemic of this summer and fall. It was promptly relieved by the warm bath and an anodyne administered about fifteen minutes before entering the bath. We commenced our treatment by the administration of a purgative we are in the habit of using in dysentery-a combination of castor oil, solution of carbonate of potash, tinct. opium and the essence of peppermint-for several days. This seemed to have no effect on the peristaltic action of the bowels, and more active purgatives were substituted, placing our chief reliance on the specification of mercury, in the dose of three grains of calomel united with one grain of opium every three hours. This treatment we concluded to persevere in, whatever other medication might be thought advisable, until ptyalism was induced. Injections of the solution of nitrate of silver were freely used to allay irritability of the lower bowel, and prevent disorganization of the mucous membrane, as the frequent discharges indicated a highly irritated state of that organ, being fluid, of a dark appearance and very offensive odor. Cathartic enemata, warm bath, frictions over the abdomen and cathartic medicines by the mouth had no other perceptible effect than to allay the tormina and tenesinus for a while, and produce loud roarings and flatulence. Obstruction of the bowels from some mechanical cause evidently gave rise to the great distress and sufferings of our patient, for which we sought in vain, until it was deemed necessary to distend them with warm water. This was accordingly attempted on the fifth day of our attendance, but the obstacle which prevented the passage The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on June 25, 2016. For personal use only. No other uses without permission. From the NEJM Archive.