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the intention; but, instead of a normal peristole, an antiperistaltic action is produced, and the contents and secretions of the intestines are forced into the stomach, which rejects these as well as the ingesta. Nutrition fails; the kidneys yield a scanty secretion; failing depuration burdens the nervous system exhausted by pain; and inflammatory processes are established.

The patient succumbs to the combination of adverse conditions. Then come a post-mortem and a diagnosis.

It was the instruction afforded by two such post-mortems, made by the writer several years ago, which led him to consider with much interest the treatment of cases in which the symptoms of intestinal obstruction occur, and in which, after careful and competent examination first made, no indications can be obtained for surgical procedures.

The opinions formed have been followed in the hospital-service of the writer for several years, where a considerable number of cases, some fatal, more recoveries, have seemed to justify -the fatal equally with the successful cases—the plan of treatment adopted.

It is the object of this paper in a few words to state this treatment, that the limited experience of one observer may be corrected, and so made valuable by many; and that the considerable number of physicians who, as evidenced by the previous treatment of cases admitted to the hospital, adopt a different, and it is believed injurious, course may be induced to reconsider their early treatment of symptoms of intestinal obstruction. No questions of diagnosis will be discussed, because, if the case be surgical, it is not a question of medical treatment at all, and if medical, in a majority of cases, a treatment must be decided upon in advance of a diagnosis; and perhaps the progress of the case will show more of the good or bad effects of the physician's interference than of the real seat and nature of the original trouble. No space will be given to details of cases, because it is believed that the principles involved and the results obtained may be as clearly illustrated and as faithfully rendered by a general statement.

First. -The indications in cases of intestinal obstruction, where the obstruction can not be removed by surgical interference, are: a. To allay pain and intestinal spasm, and to subdue all irregular intestinal muscular action. b. To give rest to the stomach. c. To sustain nutrition, and to maintain the functions of the kidneys, liver, skin, respiration, etc. d. To prevent and limit inflammation. e. To overcome the obstruction.

Second.—TREATMENT.—The last indication, the overcoming of the obstruction (not necessarily its removal, as in cases of growths in the substance of or attached to inner wall of the intestines, inflammatory adhesions, inclusion of the bowels, incomplete hernia, etc., in which the loss of caliber of the intestine, although permanent, permits ordinarily a passage, but at times from congestion, spasm, or other accidental condition, a more or less obstinate obstruction occurs), is first in importance. All direct means of moving the bowels are avoided from the first. No laxatives or purgatives are employed. It is believed that this should be an invariable rule of practice.

Morphine and atropine, in the proportion of twenty of the former to one of the latter, are steadily employed hypodermically; the amount to be determined by the relief from pain afforded. An enema of four ounces of flaxseed tea is administered every two bours, and care is taken that it is retained.

Nutrient enemata of Valentine's extract of beef, with pepsin, or of defibrinated blood, take the place of every third enema of flaxseed tea. Flaxseed poultices are applied to the abdomen.

The horizontal position is strictly maintained, and sleep and quiet are secured. The stomach has nothing forced upon it, and to that extent it is saved the necessity of irregular action.

This plan is steadily pursued, day after day, until pain is relieved, inflammation, if it have supervened, has terminated, and the bowels act spontaneously.

Third.The favorable effects, observed by the writer, of the above treatment, most marked in some cases admitted to hospital, after some days of progress under plans of treatment to which cathartics were admitted, have been :

1. Pain is much more under control and with less medicine. 2. Vomiting is less frequent.

3. Spasm and irregular action are prevented.
4. Strength and nutrition are markedly well supported.

5. The following physiological observations are believed to be established : a. Respiration is fully maintained by the atropine, the patients showing, in this respect, a most striking contrast to those in whom morphine is permitted to produce its usual effect on this important vital act. b. The rectal enemata at once increase the action of the kidneys and the quantity of urine voided. In this, again, it is very interesting to see the clearer intelligence and improved nervous condition of the patient, who before was passing very little water with consequent blood-poisoning. The action of the kidneys is steadily promoted by the liquids thus introduced and absorbed. C. “Intestinal injections of water have a very great influence over the secretion of bile.” See Wood's “Materia Medica and Therapeutics,” Philadelphia, 1880, third edition, p. 448.

6. The writer has observed, in post-mortem examinations, inflammation and general peritonitis, as he believes, excited by the cathartic treatment adopted to overcome obstructions; for he has seen, in several instances, post-mortem examinations where the anatomical causes of obstruction were identical and irremediable, and where the above plan of treatment was followed, and there was an entire absence of inflammation.

Finally, in general, the observations of this treatment have included cases of intestinal obstruction due to occlusion, where only a segment of the wall of the intestine was incarcerated in an obturator hernia, to annular growths (malignant) in the wall of the intestine, to intussusception, to perityphlitis, and to various unrecognized causes. The general vital condition has been apparently better, the progress less exhausting, and the return to evacuations of the bowels, even where large accumulations have been finally passed, has been easy, spontaneous, and natural.

THE MANAGEMENT OF CRIMINAL ABORTION.

By William H. ROBB, M. D., of Montgomery County.

Read Vovember 18, 1884.

In medicine, the expulsion of the ovum before the sixth month of pregnancy is called an abortion; but in law, there is no distinction of this kind, and the term abortion is applied to the expulsion of the contents of the uterus at any time during gestation before its normal completion. Criminal abortion is one procured intentionally, by means either of instruments or irritating medicines, except in instances in which this is necessary to the preservation of the life of the mother or the child. I extract the following paragraph, pertaining to the history of abortion, from the work of Dr. H. R. Storer: "The practice of destroying the fætus in utero, to say nothing of infanticide, history declares to have obtained among all the earlier nations of the world, the Jews alone excepted, and to a very great extent. Aristotle defended it and Plato. It is mentioned by Juvenal, Ovid, Seneca, and Cicero, and is denounced by the earlier Christians. It was common in Europe through the middle ages, and still prevails among the Mohammedans, Chinese, Japanese, Hindoos, and most of the nations of Africa and Polynesia, to such an extent that we may well doubt whether more have ever perished in those countries by plague, by famine, and the sword.” 1 With the many instruments used by the professional abortionist and his willing imitators, all of you who have had even a limited practice must be familiar. To attempt an enumeration of them

1 Storer and IIeard, “ Criminal Abortion," Boston, 1868, page 31.

would be presumptuous on my part. The patent nostrums used by these criminals are almost unlimited in number. For an account of the symptoms as well as the diagnosis of abortion, I refer you to any of our standard works on obstetrics. The symptoms and diagnosis are nearly the same, whether the abortion be accidental or intentional. With propriety I might even refer you

to these able authorities for instruction as to the management of criminal abortion, but for the fact that I hope to present some practical points in its treatment worthy of your consideration. I shall confine my suggestions to the management of cases occurring before the fifth month of gestation. During the later months, these cases are very like those of labor at term. The treatment of criminal abortion may be considered ander four sections:

1. The best means of controlling hæmorrhage.
2. The safest way of removing the entire ovum.
3. The prevention of septicæmia.
4. The restoration of the woman to health.

To control the hæmorrhage, we have both constitutional and local remedies. The constitutional measures from which we expect most good are the use of ergot and digitalis and, indirectly, brandy and ether. For convenience we should prefer the ergot and digitalis in the form of the fluid-extract. To obtain their immediate effects, it is advisable to administer them in full doses hypodermically. In extreme cases, when a repetition of these drugs is indicated, they should be given hypodermically, at least until the patient has considerably rallied. The brandy and ether required should be administered in the same way and at short intervals. To trust to the slow and uncertain action of medicines given by the mouth, would be dangerous and might prove fatal. In the treatment of abortion, we should advise the use of ergot as soon as possible after the patient is seen, either for the purpose of controlling hæmorrhage or to aid the expulsion of the contents of the womb. We should continue its use until the entire ovum is removed and the uterus becomes well contracted. The very feeble and quick pulse, which is often present, will call for the use of digitalis, brandy, and sometimes

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