Researches on the pathology of the intestinal canal. Part I / by John Abercrombie.

Date:
[1820]
    many cases, to answer better than the more active,—and that the beneficial result sometimes follows the very mildest in very small doses, after the most powerful in immense quantities have been given in vain. I am aw'are of a source of fallacy which is inseparable from such observations, but I conceive they are by no means to be disregarded ; and when we add to them the fact, that a full dose of opium is sometimes followed by the re- sult which we have sought for in vain from the most powerful purgatives, I submit, whether the whole phenomena of the dis- ease do not give considerable probability to the principles which I have proposed. In regard to the use of purgatives, I suspect, that the best practice in general is to give mild medicines in moderate doses, repeated at very short intervals, while, at the same time, w'e keep in view, that the use of purgatives is but a part of the treatment, and that the main object is to remove, if possible, that condition of the canal, as a muscular organ, by which purgatives are prevented from producing their usual ef- fects. Every one,/indeed, must have experienced, that, in re- gard to the use of purgatives, there is a point in the treatment of ileus when he is often brought completely to a stand, when he is convinced that it is in vain to urge them farther, and is led to look around for remedies calculated to act upon some other principle.' Important remedies of this kind are blood- letting, blistering, and the effectual application of cold, either externally^ or by glyster; but, as far as my observation extends, the remedy of most general utility is the tobacco injection. It should be begun with caution ; perhaps for an adult in the quantity of 15 or 20 grains infused in four or six ounces of hot water. Aftey the interval of an hour or two, it may be repeated in a quantity a little larger, until such effects are produced by it, viz. slight giddiness and muscular relaxation, as shew that it is exerting its proper effect upon the system. It may then be repeated at proper intervals a great many times, if the case do not yield. With these precautions I have given it in states of great nausea and exhaustion, with the effect of diminishing' in- stead of increasing them, and, in one case, to a child three years of age, with the happiest result. In oiie of the most severe .and obstinate cases I have had occa.sion to treat, it was repeattcl nearly twenty times with various partial effects, and at leuo'th with complete success, dhe obvious effect of this remedy upon the system, is to produce relaxation of all muscular parts, and tne mode of its operation in ileus is involved in considerable ob- scurity. I have supposed, that, in this disease, the upper pait of the canal ip healthy, sometimes in strong action,—that a part below this is inactive from distention,—aiul that the lower part
    IS healthy and contracted, being kept in that contracted state by its tonic power, and the suspension of the action by which, in the healthy state of the parts, it would have been distended. A certain force is, indeed, acting upon it by the propulsion of matters from the upper part, but this acts with little effect after being communicated through the intermediate portion, which is in the state of an inanimate canal. It is, therefore, unable to overcome the tonic contraction of the lower part, which thus opposes an obstacle to the parts recovering their healthy rela- tions. The same observation applies, if we suppose, that the distended part itself retains some degree of action, though feeble and imperfect. Now, in this state of the parts, could the tonic power of the lower part be for a time considerably diminished, it might perhaps be brought, as it wei'e, more into unison with the other parts,—might be dilated in the natural manner by the weakened force which is acting upon it,—and the parts might thus be enabled to recover their healthy relations. Is this the action of the tobacco injection ?—It is mere conjecture, and I urge it no farther. I add the following case, illustrating the elfect of this remedy in a state w'hich seemed to be nearly hope- less, and exemplifying an important fact to which I have alrea- dy alluded,-—that symptoms resembling those of gangrene may be recovered from. Case 21.—A woman, aged 20, (17th November 1813,) was affect- ed with violent pain in the right side of the abdomen, and obstinate costivencss ; pulse natural; had been ill three days ; used purgative medicine and injections with some relief. 18th.—Pulse 96; urgent vomiting j pain of abdomen violent; was bled and blistered, and purging injections repeated. 19th.—Pulse 120 j no stool; no relief; pain violent over the whole abdomen ; urgent vomiting. Was bled again ; various medicines given without elfect; every thing was vomited. Towards the after- noon, the pain nearly ceased, with collapse of the features, and cold- ness of the surface ; pulse 140, and very weak; vomiting continued ; appeared to be moribund. Wine was now given, about a glass every hour. 'After a few hours, her appearance being improved, the tobac- co injection was given at first in small quantity, and it was repeat- ed several times. It did not increase the sinking, but seemed rather to abate both it and the vomiting; wine continued. 20th.—Pulse im})roved; some scanty evacuations ; tobacco injec- tion given several times with partial effect; vomiting abated; some Epsom salt was retained, and operated ; free from pain ; pulse 96. 21st and 22ci.—Continuetl to improve; pulse 80; bowels kept open by small doses of Epsom salt. From this time continued well. I have already alluded to the effects of blood-letting, and the application of cold. In the state of collapse produced by a full
    the disease give way so suci- denly, that there was „o time to raise the patient out of bed «*se mus" £T°ed'-‘"‘!r‘'"® -"f^^tion, this remedy of to the remarkable effects of coid°lSl"’'‘'";"l r p“:e®“f ”jf 4- S'*-voLVof“th!:zr„at ha?e hadh-ttie.expZenc:. Tut mt^;!: trato' more I have tried in several cases In soZ rif ^ ftct'frottt^”tTet:ST.;;'or:^: which it i« ’ ^ convinced that the pnnciple on Sy of Lo!Z Vorir som'" “ ed, in which "hrfoIctle t ecTTfT^^^ "T ,or dght pounds, was used w&n^ “ of six verisrstdt^f^rot^ ~tTet tS ioT= the 17th day ’ fi>vourably,“as iate as
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