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A SIMPLE APPARATUS FOR GASEOUS DISTENSION OF THE COLON:
1680
T
intestines looked quite healthy. The adrenals were enlarged were visible in any of the sections examined. But the lesion :was and firm and adherent to the surrounding tissues. undoubtedly tuberculous in appearance. The semilunar For the following report and accompanying drawings Iganglia and a portion of the left great spanchnic nerve vere " The right examined microscopically, but there was no evidence of any am indebted to my friend Dr. W. E. Fothergill : and larger body had the usual cocked-hat shape. A piece of pathological ] change in these structures." diaphragm was adherent to one end of it ; also several flakes Manchester. of fat. Its length was 65 cm, its breadth 1.5cm., and its depth 2 c.m. The coverings of fat and connective tissue were closely adherent to the organ, so that no definite A SIMPLE APPARATUS FOR GASEOUS fibrous capsule could be found. Transverse sections did not DISTENSION OF THE COLON: show the usual differentiation into cortical and medullary of tissue. was rather to be comThe seen WITH NOTES OF THREE CASES OF INTUSSUSCEPTION portions organ TREATED BY IT. posed throughout of irregular septa of fibrous tissue which separated masses of light colour and caseous consistency. BY R. A. LUNDIE, M.A , B Sc., M.B , F.R.C.S. EDIN., There were cavities centrally placed in several of these masses. ASSISTANT MEDICAL OFFICER, LONGMORE HOSPITAL, EDINBURGH. The left and smaller body was less regular in shape than its fellow, being thicker and deeper at one end than at the other. It still, however, would be recognisable as a supraIN a case of intussusception that came under my care renal body. Its length was 4 c.m , its breadth 12 c.m., andFsome years ago I tried, among other methods of treatment, its depth 1’5 c.m. Splitting it from end to end, it gave tthe introduction of the contents of a syphon bottle of sodatough resistance to the knife, and a distinctly gritty feeling water through a rectal tube, as recommended by Treves and was recognised in parts, which on subsequent examination ( it others. While did a distension of the colon, The produce were found to be calcareous. structure was altered rapid t this was much less than have would been the as in the other there no cortex or medulla obviously rapid just body, being visible, but irregularly distributed caseating masses of (case had gas alone been used, and when the bowel convarying size separated by fibrous septa. (See F ig. 1 ) ttracted and expelled the mixture of water and gas it returned Microscopical examination.- Slices of both bodies were rnot without discomfort and inconvenience. The latter dishardened and cut by the paraffin method, the celloidin method, and the combined method. The inspection of theseadvantage is also present in the method strongly recomshowed both bodies to be in an exactly similar condition.mended by Von Ziemssen2-viz., introducing in succession As regards the characteristic structure of suprarenal bodies,iinto the rectum solutions of bicarbonate of soda and of the condition was as follows : The capsule was thicker andttartaric acid. In the house where my next case occurred denser than usual, and contained numerous blood-vessels.tthere happened to be a seltzogene. and it struck me that this. could be made to answer my purpose better than an ordinary I found, as I expected, that it was a great improvessyphon. FIG. 3. ment, and showed 3the device to the Edinburgh MedicoChirurgical Society. As I recently had the opportunity of using it in another case I think it well to make it more generally known. ’
An island of unaltered cortex-a
portion of Fig. 2,
a
(Hartnackin.).
The cortical layer was recognisable only in a few places, notably in small islands surrounded by fibrous tissue, which lay round the margin of the organ embedded in the thickened capsule. In these islands were groups or columns of cells lying packed together in the interstices of a delicate fibrous stroma. They had large round nuclei, which stained deeply with hæmalum. The cell outlines were faint. There was no trace of the medullary layer, or of the vessels or Thus within the thickened nerves supplying the organ. capsules all the tissues were altered. In the centre of each of the masses of caseating matter was amorphous debris staining faintly with eosin or picrocarmine (Fig 2, e), around this was more debris, staining more darkly and having scattered through it the nuclei of the cells characteristic of the cortical zone. These nuclei stained deeply with baemalum, and closely resembled those in the islands of normal tissue. Round this band of incompletely destroyed tissue was a layer (Fig. 2, d) in which fairly healthy cells were crowded very closely together, so that their deeply stained nuclei gave under the low power a purple zone round the pink of the debris in the centre. There was, however, no trace of the characteristic arrangement in columns of these cortical cells. Round the whole mass was fibrous tissue (Fig. 2, b) arranged in concentric layers, and enclosing vessels (Fig. 2, c). No giant cells
The illustration renders description almost superfluous. It will be seen that the upper globe only is charged ; I have found the most convenient method of effecting this to use the tartaric acid in large crystals, not in powder, in order that its solution and the consequent evolution of carbonic acid may be somewhat delayed. Pour as umal the charge, first of tartaric acid and then of bicarbonate of soda, into the 2
1 Intestinal Obstruction, p. 444. Deutsches Archiv fur Klinische Medicin, 1883, vol. xxxiii
pp.3 235-245.
Vide Edinburgh
p. 1146.
Médico-Chirurgical Journal, June, 1893, vol. xxxviii
1681 globe of the seltzogene ; after adding a little water quickly withdraw the funnel, introduce the tube, and screw it home as speedily as possible. A piece of plain indiarubber tubing, with a rectal nozzle attached, completes the apparatus. The patient’s lower bowel should be emptied by an ordinary
upper
it intussusception. She died in in the right hypochondrium.
1895 from
malignant tumour origin was not
The exact
n made out. CASE 2.-A delicate woman, thirty-four years of age, was s subject to occasional attacks of abdominal pain. On the of Oct. 31"t, 1892, she experienced sudden violent e evening If this has been pain enema before distension with gas is tried in the abdomen more severe than ever before, but not p done it will be found possible to distend the colon several distinctly d localised. The patient was much collapsed. No times in succession, allowing it time to expel the gas tumour t was made out. Morphia was administered hypodermibefore more is introduced, without disturbance from cally. c On Nov. 1st the pain and vomiting were controlled I have not found it necessary to press oonly by morphia. In the evening irflation gave no relief. escape of fluid. the buttocks together round the tube, or to resort to Some g blood-stained mucus was passed. On Nov. 2od the other means of preventing the escape of the gas, and patient was much in the same condition. In the evening r so of increasing or prolonging the pressure and the itiflation i was repeated There was sudden, sharp, localised distension of the colon. This could easily be done when pain above the pubes, followed by great relief No more I r was required. and rapid recovery followed desirable-e.g., if the method were employed for diagnostic morphia CASE 3 -A boy, aged eleven years, healthy, but not very purposes. Nor have I found it necessary to give chloroform; r when pain is produced, though it may be sharp, it is only robust, on July llth, 1896, after unusual exertion, ate a large momentary. When the tap is opened it will be found that aand hurried meal, and continued to rush about afterwards. the gas escapes and the patient’s abdomen distends veryAt 6 P.M. he was seized with sudden pain on the right side rapidly; a second or two will probably suffice to inflate the cof the abdomen. There was localised tenderness from the colon as much as is required In this rapidity, it seems to 1liver to the right iliac fossa. Repeated vomiting occurred, The symptoms me, lies the chief advantage of the method in the treatment ffollowed each time by temporary relief of intussusception ; strong and even pressure is brought to) (continued after the stomach and bowels were empty. The bear so quickly that the constricting muscular fibres have patient had broken, restless sleep The pulse was quick and probably not time to contract in response to this stimulussmall. The colon was thrice inflated in quick succession on until it has reached its full strength. As a dislocated a 12th, at 2 A.M. There was sharp pain at the time. July shoulder-joint may sometimes be reduced with ease if the:
A Mirror
HOSPITAL
PRACTICE,
present,
B B 3
T
intestines looked quite healthy. The adrenals were enlarged were visible in any of the sections examined. But the lesion :was and firm and adherent to the surrounding tissues. undoubtedly tuberculous in appearance. The semilunar For the following report and accompanying drawings Iganglia and a portion of the left great spanchnic nerve vere " The right examined microscopically, but there was no evidence of any am indebted to my friend Dr. W. E. Fothergill : and larger body had the usual cocked-hat shape. A piece of pathological ] change in these structures." diaphragm was adherent to one end of it ; also several flakes Manchester. of fat. Its length was 65 cm, its breadth 1.5cm., and its depth 2 c.m. The coverings of fat and connective tissue were closely adherent to the organ, so that no definite A SIMPLE APPARATUS FOR GASEOUS fibrous capsule could be found. Transverse sections did not DISTENSION OF THE COLON: show the usual differentiation into cortical and medullary of tissue. was rather to be comThe seen WITH NOTES OF THREE CASES OF INTUSSUSCEPTION portions organ TREATED BY IT. posed throughout of irregular septa of fibrous tissue which separated masses of light colour and caseous consistency. BY R. A. LUNDIE, M.A , B Sc., M.B , F.R.C.S. EDIN., There were cavities centrally placed in several of these masses. ASSISTANT MEDICAL OFFICER, LONGMORE HOSPITAL, EDINBURGH. The left and smaller body was less regular in shape than its fellow, being thicker and deeper at one end than at the other. It still, however, would be recognisable as a supraIN a case of intussusception that came under my care renal body. Its length was 4 c.m , its breadth 12 c.m., andFsome years ago I tried, among other methods of treatment, its depth 1’5 c.m. Splitting it from end to end, it gave tthe introduction of the contents of a syphon bottle of sodatough resistance to the knife, and a distinctly gritty feeling water through a rectal tube, as recommended by Treves and was recognised in parts, which on subsequent examination ( it others. While did a distension of the colon, The produce were found to be calcareous. structure was altered rapid t this was much less than have would been the as in the other there no cortex or medulla obviously rapid just body, being visible, but irregularly distributed caseating masses of (case had gas alone been used, and when the bowel convarying size separated by fibrous septa. (See F ig. 1 ) ttracted and expelled the mixture of water and gas it returned Microscopical examination.- Slices of both bodies were rnot without discomfort and inconvenience. The latter dishardened and cut by the paraffin method, the celloidin method, and the combined method. The inspection of theseadvantage is also present in the method strongly recomshowed both bodies to be in an exactly similar condition.mended by Von Ziemssen2-viz., introducing in succession As regards the characteristic structure of suprarenal bodies,iinto the rectum solutions of bicarbonate of soda and of the condition was as follows : The capsule was thicker andttartaric acid. In the house where my next case occurred denser than usual, and contained numerous blood-vessels.tthere happened to be a seltzogene. and it struck me that this. could be made to answer my purpose better than an ordinary I found, as I expected, that it was a great improvessyphon. FIG. 3. ment, and showed 3the device to the Edinburgh MedicoChirurgical Society. As I recently had the opportunity of using it in another case I think it well to make it more generally known. ’
An island of unaltered cortex-a
portion of Fig. 2,
a
(Hartnackin.).
The cortical layer was recognisable only in a few places, notably in small islands surrounded by fibrous tissue, which lay round the margin of the organ embedded in the thickened capsule. In these islands were groups or columns of cells lying packed together in the interstices of a delicate fibrous stroma. They had large round nuclei, which stained deeply with hæmalum. The cell outlines were faint. There was no trace of the medullary layer, or of the vessels or Thus within the thickened nerves supplying the organ. capsules all the tissues were altered. In the centre of each of the masses of caseating matter was amorphous debris staining faintly with eosin or picrocarmine (Fig 2, e), around this was more debris, staining more darkly and having scattered through it the nuclei of the cells characteristic of the cortical zone. These nuclei stained deeply with baemalum, and closely resembled those in the islands of normal tissue. Round this band of incompletely destroyed tissue was a layer (Fig. 2, d) in which fairly healthy cells were crowded very closely together, so that their deeply stained nuclei gave under the low power a purple zone round the pink of the debris in the centre. There was, however, no trace of the characteristic arrangement in columns of these cortical cells. Round the whole mass was fibrous tissue (Fig. 2, b) arranged in concentric layers, and enclosing vessels (Fig. 2, c). No giant cells
The illustration renders description almost superfluous. It will be seen that the upper globe only is charged ; I have found the most convenient method of effecting this to use the tartaric acid in large crystals, not in powder, in order that its solution and the consequent evolution of carbonic acid may be somewhat delayed. Pour as umal the charge, first of tartaric acid and then of bicarbonate of soda, into the 2
1 Intestinal Obstruction, p. 444. Deutsches Archiv fur Klinische Medicin, 1883, vol. xxxiii
pp.3 235-245.
Vide Edinburgh
p. 1146.
Médico-Chirurgical Journal, June, 1893, vol. xxxviii
1681 globe of the seltzogene ; after adding a little water quickly withdraw the funnel, introduce the tube, and screw it home as speedily as possible. A piece of plain indiarubber tubing, with a rectal nozzle attached, completes the apparatus. The patient’s lower bowel should be emptied by an ordinary
upper
it intussusception. She died in in the right hypochondrium.
1895 from
malignant tumour origin was not
The exact
n made out. CASE 2.-A delicate woman, thirty-four years of age, was s subject to occasional attacks of abdominal pain. On the of Oct. 31"t, 1892, she experienced sudden violent e evening If this has been pain enema before distension with gas is tried in the abdomen more severe than ever before, but not p done it will be found possible to distend the colon several distinctly d localised. The patient was much collapsed. No times in succession, allowing it time to expel the gas tumour t was made out. Morphia was administered hypodermibefore more is introduced, without disturbance from cally. c On Nov. 1st the pain and vomiting were controlled I have not found it necessary to press oonly by morphia. In the evening irflation gave no relief. escape of fluid. the buttocks together round the tube, or to resort to Some g blood-stained mucus was passed. On Nov. 2od the other means of preventing the escape of the gas, and patient was much in the same condition. In the evening r so of increasing or prolonging the pressure and the itiflation i was repeated There was sudden, sharp, localised distension of the colon. This could easily be done when pain above the pubes, followed by great relief No more I r was required. and rapid recovery followed desirable-e.g., if the method were employed for diagnostic morphia CASE 3 -A boy, aged eleven years, healthy, but not very purposes. Nor have I found it necessary to give chloroform; r when pain is produced, though it may be sharp, it is only robust, on July llth, 1896, after unusual exertion, ate a large momentary. When the tap is opened it will be found that aand hurried meal, and continued to rush about afterwards. the gas escapes and the patient’s abdomen distends veryAt 6 P.M. he was seized with sudden pain on the right side rapidly; a second or two will probably suffice to inflate the cof the abdomen. There was localised tenderness from the colon as much as is required In this rapidity, it seems to 1liver to the right iliac fossa. Repeated vomiting occurred, The symptoms me, lies the chief advantage of the method in the treatment ffollowed each time by temporary relief of intussusception ; strong and even pressure is brought to) (continued after the stomach and bowels were empty. The bear so quickly that the constricting muscular fibres have patient had broken, restless sleep The pulse was quick and probably not time to contract in response to this stimulussmall. The colon was thrice inflated in quick succession on until it has reached its full strength. As a dislocated a 12th, at 2 A.M. There was sharp pain at the time. July shoulder-joint may sometimes be reduced with ease if the:
A Mirror
HOSPITAL
PRACTICE,
present,
B B 3