OCR Text |
Show 1711 o1 'rne cause or SLRANGULAIULN. or THE cause or STRANGULATION. flamrnation and of all the consequent evils, has prescribed tin practice of administerin<r stimulating medicines. But were it understood that the cause of death is the violent and inces~ sant efforts of the intestines to relieve themselves from their load of increased secretion, flatus and feces (passed retrO» grade), surgeons would seek to allay this violent commotion, instead of endeavouring, by exciting the bowels, to withdraw the strangulated gut at the expense of direct injury, and an aggravation of every dangerous symptom. Surgeons may put this simple question to themselves: does it not happen that when there is obstruction in circumstances which do not prevent the blood passing to the diseased or obstructed part, where consequently there is not gangrene from deficiency of circulation, yet the patient is carried 01? with the same train of symptoms, and in the same period, and with similar appear~ ances after death, as in what is called strangulated hernia? It is the obstruction of the canal then which kills the patient, not the strangulation and injury to a part of the intestine: "Mews v'ir Min \‘ and the obstruction kills by the violence of inflammation occaa sioned by the accumulation in the upper parts of the canal, and the violent working of the muscular coats of the intes tines. 01' THE CAUSE OF S'IRANCULATION, AND THE QUESTION OF 175 the discharge of feces is to be regarded only as a necessary consequence of such removal ; then I think it is clear, says Mr. Pott, that a power or faculty of stimulating or irritating the muscular coat of the internal canal, ought to be the property of whatever is administered. There seems to me no point ca~ pable of being so clearly established as that in hernia, the intestine is in a very high state of painful excitement and ac~ tion; that purgatives may still increase this, and by a happy cll‘ort as it were, draw the portion of the gut from its stricture; but if they do not succeed in this, that they must increase the inflammation, pain, and action, and accelerate the doom of the patient, cannot be denied. But I have now to give my reason for thinking that the ins testine is very seldom withdrawn from its stricture by the violent excitement of the guts within the belly. Suppose that instead of the uniform and smooth walls of the abdon on, every where presented to the bowels, there should occur a noose prepared by adhesion, or a herniary sac ; and that in , the accidental motions of the intestine, or in consequence of the general pressure of the viscera, a portion of the gut pasces into this cavity or noose. Does an incarcerated or stran- gulated hernia result from this? No, surely; for the next successive efl‘ort in the peristaltic and vermicular motion of the intestine, pulls the portion from its hole. It is as easily SI'ASM IN THE SAC 0R STRICTURE. IT is natural for us to turn to the last publication on the subject of which we treat. Mr. Cowpcre‘s does not appear 1.0 me to have the correct idea of the most frequent cause of strangulation. Most surgeons consider that when the intes~ tine is " so begirt as not to be capable of executing its proper office, the person to whom this happens, maybe said to be in immediate danger." These are the words of Mr. Pott, and his conclusion results from the premises. If the view of exhin biting medicines be to extricate the rrut from its stricture, and " The same causes which produce hernia, render them strangulatcd, 8-52 D 0') withdrawn as introduced. To incarcerate the included gut, the fluid contents of the intestine must be pushed into the ant contained in the hernia, so as to distend it thus: WUNl " |