– Ileus (H. F. Biggar) ,American Institute of Homoeopathy, 1904,
The pathological varieties of neuropathic ileus are the results of intestinal ecclusions of slow origin, caused simply either by accumulation of fecal matter, or by paralysis of the intestine, or diminution of its size in consequence of the presence of foreign bodies, stricture and compression, as follows:
Any interference with the nerves that disturbs the regular contraction of the muscular walls of the intestines, whether from anatonic or adynamic condition or contraction from lead poisoning or paralysis of intestines following operations upon mesentery, or fractures of spine high up in dorsal region followed by intestinal obstruction or tabes and nervous spinal disturbances or interference with the sympathetic produces paralysis of the intestine.
Enervation of intestines may be from reflex causes. A common reflex cause is impaction of hepatic calculi, but intestinal paralysis ceases as soon as the dilatation or diverticulum is formed, while in transit is the time of greatest disturbances, or from ovarian compression of twisted pedicle. Pleurisy of the diaphragmatic layer, and pneumonia are other reflex causes. Peristalsis itself is another cause of reflex action or tyrotoxicon or promaine poisoning.
In local peritonitis associated with appendicitis with perappendicular infection of the streptococcus variety, we have inability to produce bowel movement.
In reflexes post-operative, as in intestinal paralysis (ileus paralyticus) following laparotomies resulting from injury to nerves at the time of the operation.
From cicatrices of ulcers, from fissures, hemorrhoids and ulcers of the rectum.
General peritonitis from staphylococcus infection, with the intestines matted together with lymph (without inflammatory symptoms), when obstruction continues until there is an exfoliation of that membrane. When it is thrown off leaving only the excoriated peritoneum, death soon follows.
Obstruction from bands and adhesions, from Meckel’s Diverticulum the Appendix Veriformis or other abdominal and pelvic organs.
Obstruction from plugging of the lumen of the intestine from tumors, (a) hardening of feces (coprostasis), (b) gall stones, (c) enteroliths, (d) foreign substances introduced into the bowel, and (e) intestinal worms. In obstruction from foreign bodies the writer has found the causes to be peach and cherry stones, an accumulation of seeds of berries, entroliths and in one case the vertebra of a lamb which had been swallowed ten years previously.
Obstruction from occulsion of the mesentery vessels, due to thrombosis or embolism is rarely recognized during life; if the artery is clogged there is usually evidence of cardiac and arterial disease. The plugging of the artery results in the intestine becoming deeply congested and ecchymosed. The symptoms are very vague but generally accompanied with a cardiac or hepatic disease or hernia.
In the beginning of the attack the temperature is generally sub-normal, the face cyanotic and pinched. The local symptom is colic with vomiting, the latter is a very prominent symptom – the passage of bloody stools, or tarry bloody stools, with a carrion odor, which differ from the currant-juice discharges in intussusception.
A case in point which to the writer was unusual, is as follows:
Mr. D., Farmer, age 36, presented himself with his own diagnosis of umbilical hernia caused by lifting a heavy stone. The tumor was just below the umbilicus in the median line and in the decubitus position seemed firm and immovable, but disappeared when standing. It was freely movable only under an anesthetic. The abdomen was opened and a tense, cystic tumor about six inches in diameter was found, not adhered, but between the folds of the iliac mesentery. On attempting to enucleate, the cyst leaked a white fluid resembling milk. A specimen was immediately sent to the laboratory and pronounced to be chyle. Two-thirds of the cyst was removed, the remaining third was stitched to the peritoneum as in cholecystotomy. On the third day, after doing splendidly, he suddenly developed symptoms of obstruction of the bowel. The abdomen was immediately reopened. No obstruction was found but the entire small bowel was greatly oedematous and thickened. At no place was it gangrenous. Bowel movement was established but the patient suddenly died an hour later from thrombosis of the mesenteric vein and thoracic duct. The tumor was situated at about the beginning of the duct or the receptaculum. Before death the characteristic symptoms as above described in occulsion of mesenteric vessels were pronounced.
The writer has relieved intestinal suppression of the neuropathic character by colonic irrigation, external applications and the selected remedy. In March last was summoned to West Virginia to operate for obstruction. Dr. H. F. Biggar, Jr., responded to the call as the writer was then confined to his home with the grippe. The following methods were successfully resorted to by the Doctor without knife:
Mrs. S., age 48, had previously enjoyed general good health and had been actively engaged in church and philanthropic work. Some three hours after eating salads and ices she was taken with sudden pain localized in the left inguinal region; the doctor saw her seventy-two hours after the attack began and found her condition fairly good. Pain more general over the abdomen and tympanitic. Her medical attendants had been unable to produce a passage of the bowels though calomel, saline aperients, caster oil and croton oil had been administered. Under anesthesia a colon tube five feet in length was, after repeated attempts, passed through the sigmoid and four feet into the colon and an enema of, sodium sulphate one ounce, spirits of turpentine two drachms, ox gall one ounce, and water two pints, producing a movement with a small quantity of feces. This result, coming after the colon had been repeatedly flushed, together with the absence of tumor or localized area of dullness led to the diagnosis of suspension of peristalsis of neural origin. The tube was re-inserted and a gallon of olive oil left high in the bowel. Strychnia grains one sixtieth every hour and hot fomentation of turpentine applied to the abdomen. We were gratified after six hours of work when she passed an enormous quantity of fecal matter which contained the indigo which had previously been administered with the castor oil. Careful diet, rest, and abstinence from her mental responsibilities has restored her health.
Other similar cases successfully treated without the knife could be cited by the writer but time will not permit of their history.