The mode of death from acute intestinal strangulation and chronic intestinal obstruction / by Thomas Bryant.

  • Bryant, Thomas, 1828-1914.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The mode of death from acute intestinal strangulation and chronic intestinal obstruction / by Thomas Bryant. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    the practical conclusions which I shall draw will be laid upon patho- logical knowledge, and that what is to bo done to save or prolong life, will be educed from what is known of the changes which tend towards its destruction. I do this, moreover, under the assured conviction that it is by this method alone that the scientific practice of surgical art is to be promoted. And, first of all, with reference to what is commonly called acute intestinal obstruction, but which should be designated in- testinal strangulation, is it true that patients die from the obstruc- tion—that is, from the arrest of the passage of foeces along the intes- tinal tube ? or is it more nearly accurate that the obstruction is merely a symptom of some condition which, if not relieved, must bring about a fatal result; fatal, however, not from obstruction to the passage of freces through the lumen of the bowel, but from changes in the bowel itself and the parts above ? I believe this latter interpretation to be correct, and would adduce as proof the case of acute strangulated hernia relieved by operation or taxis, as the case may be, and in which the symptoms, however severe before its reduction, at once cease on this result being effected ; although, possibly, no action of the bowels may be obtained for two or three weeks subsequently, the want of action not giving rise to any special symptoms. In fact, in this instance, as, in all other cases of acute or a like nature, the symptoms are directly due to the arrest of the circulation of the venous blood through the strangulated bowel, and not to the obstruction to the passage of the intestinal contents. The action of the bowels may, as a clinical symptom, be one of value to prove the patency of the intestinal tract, and to suggest, consequently, the completed removal of the cause of the strangulation ; but it is well to remember that the symptoms excited by a strangulation of the bowel are not due to obstruction alone. It was from a want of appreciation of this fact that the older sur- geons gave purgatives in cases of internal intestinal strangulation, as well as in cases of strangulated hernia after its reduction ; and it is, I believe, from the want of a full appreciation of the bearing of the same fact that, in examples of intestinal strangulation not hernial, practi- tioners seem, even at the present day, to trust too much to physic, and various manipulative and other acts, when there is nothing less than the removal of the strangulating cause from which the slightest good is to be anticipated. To impress this point, allow me to consider briefly the mechanism of what is called strangulation, and to illustrate it as best seen in an example of strangulated hernia—though, whether the case be one of external or internal hernia, of volvulus or twist, or of strangulation by a band, the mechanical results are identical. And here let me say, when interference with the circulation is mentioned, it is to the venous and not to the arterial circulation that reference is made ; and that, by interference to the circulation, is meant obstruction to the passage of venous blood from the parts strangulated to those below, the ob- struction varying from mere slowing of the venous blood-current to complete blood-stasis. In a case of hernia, when reducible, the circu- lation through the displaced knuckle of bowel may not be interfered