W. Stansfield, Alfred Johnson
1908 The Lancet  
1012 of bowel farther and farther away from the site of obstruc tion. Well-marked peristalsis of small and large intestine was seen showing that whatever may have been the previou: history the obstruction had been present for some time. Th diagnosis of the site of the obstruction when the latter wa: complete with well-marked distension and peristalsis was ii the absence of any palpable tumour impossible. A tumoui in such cases was felt in five cases only. Suppuration or perforative peritonitis
more » ... ccurred in 12 cases In all except one the inflammation was in the peritonea cavity. In this the growth was at the pelvic colon adhereni in the iliac fossa. A large abscess was present in the ilia( fossa behind the peritoneum and tracking upwards towards the lumbar region ; this was traced directly to the growth. There are three ways in which the peritoneum may become infected:-1. An ulcer in the cœcum may perforate. There werE five cases in this series. In three this occurred during the period of complete obstruction. In each the peritonitis was diffused. The growth was in the pelvic colon in two and at the splenic flexure in one of these. In the two cases, although chronic obstruction had been present for some time, it had not terminated acutely. These growths were in the pelvic colon. In both the cascum was much distended, as shown at operation. In one, in addition, a perforation had occurred just above the growth and the abscess had travelled up along the colon and formed a collection of pus under the left diaphragm around the spleen, with infection of the pleura. 2. In six cases the infection occurred through the base of the grorwth. In three of these the peritonitis was diffused. In only one of these three did the perforation occur when the obstruction was complete. In three a ocalised abscess formed around the growth, slowly and nsidiously without any acute onset and not during the period of complete obstruction. In five the growth was in the pelvic colon and one at the splenic flexure. 3. In one case only did perforation of a stercoral ulcer above the growth occur and cause diffuse peritonitis. This occurred in the period of complete obstruction. The growth was in the pelvic colon. In two cases there was an intestinal fistula. In both a growth in the pelvic colon had communicated with the bladder. The occasions when it was feasible to perform a radical operation were comparatively few. In tabular form with contra-indications this is shown as follows :-In only 19 out of 55 cases would it have been possible to remove the growth. Adhesions to surrounding structures were the great barrier. Secondary visceral deposits were once of themselves the only cause. Glands was a possible cause in one case of a growth in the transverse colon and in three of the growths of the pelvic colon would have prevented removal, but there were other contra-indications also present in these three cases. I have considered that in all cases where perforation or localised suppuration has occurred remeval was contra-indicated. It is possible that if some of the cases of perforation of the cæcum had been operated upon before the catastrophe removal might have been per. formed. Results of Operation. 1. Exetsion.-One case of excision of the hepatic flexure is quite recent. One of resection of the transverse colon remained in perfect health for three years. He then developed acute obstruction from adhesions and died. There was not a trace of growth in the abdomen. One case of excision of the splenic flexure is well, six years after. Of eight resections of the pelvic colon only seven can be traced. One recurred in the glands and died nine months after the operation. A second recurred in the glands after the primary operation; these were excised and he was well four years afterwards. The remaining five are well at intervals of ten months, 14 months, 17 months, two years and ten months, and three years. 2. Anastomos'is.-Two cases of growths in the hepatic flexure lived four and 13 months respectively. One case of the transverse colon lived eight months. One case of the splenic flexure (this was associated with local suppuration) lived four months, and the second nine months. Harley-street, W. WE have been impressed by the results obtained by the use of what we believe to be a new modification of the three-phase electrical current in the treatment of & p o u n d ; atony of muscular tissue, either striped or unstriped. The instrument which we have recently clinically tested is known as the Lloyd combination wave apparatus ; it is simple and inexpensive. A four-volt accumulator drives a motor generator with three commutators producing three currents; there is a device of a shunt across the armature for the production of three minor currents. These three major and minor currents, all of sine nature, are led to three ordinary induction coils, from which wires are connected to three-pad electrodes. An electrical brake on the motor and a rheostat render the speed of the contractions well under control. In treatment of atony of the alimentary canal one pad is placed in the lumbar or sacral region and the remaining two on the abdominal wall. The three minor waves seem'to modify the effect of the three major waves as seen in the ordinary three-phase apparatus, and the effect is to produce a painless contraction of the muscles. We have been using this apparatus for nearly a year and the following are notes of a few cases:-CASE I.-A. B., a slight pale lady with a congenitally small liver, never remembered having her bowels opened naturally, her motions always being of a very light colour. She was ordered an aperient strong enough to produce one motion a day and her diet was regulated. The three electrodes were used as described, the apparatus started in a manner to produce slow contraction, and with the two front pads the abdomen was massaged. After a fortnight's daily treatment of 10 to 15 minutes at a time the colour of the motions improved and she required less aperients. Aperients were entirely stopped at the end of three weeks, and the treatment was continued another week. Some three months later there had been no relapse. CASE 2.-C. D., a little girl, aged eight years, pale, weak, and undersized, had not had her bowels opened without assistance since she was six months old. She was treated only 21 times in two months, at the end of which she was taking very little medicine and often doing without, the electric treatment sufficing. CASE 3.-E. P., a middle-aged lady, had suffered with constipation for two years, her abdomen being lax and flabby with a loaded colon. She was treated daily for three weeks, also with gradually decreasing doses of aperients. She was entirely relieved at the end of this time, her spirits and appetite better, her figure much improved, and she was stronger iu every way. , CASE 4.-G. 11. was suffering from severe neuralgia of the fifth nerve. She had been under treatment for some time with the usual remedies and had received no benefit. We placed one pad on the abdomen and
doi:10.1016/s0140-6736(01)60244-7 fatcat:spzbw7skmrcntev3z7uhj5xp7u