– Ileus (H. F. Biggar),American Institute of Homoeopathy, 1904, 60th Session,
Medical and adjuvant treatment have proved of avail in a number of cases of intussusception.
The surgeon should be well versed in therapeutics. Eminent and creditable physicians assert that intestinal occlusions have been relieved by attenuated medicines. In obstruction of the neuropathic type, proper medication is essential for relief. The selection of the remedy will be according to the symptoms. The following have proved satisfactory: Nux Vomica, Belladonna, Bryonia, Colocynth, Opium, Magnesia phos., Alumnia, Thuja-Lycopodium, Hydrastis and others.
No cathartics should be given especially after the diagnosis is made.
Lavage of stomach is beneficial, removing contents of proximal bowel, and for a time stopping the vomiting. Lavage of stomach and colon will keep the bowel clean and perhaps prevent sepsis.
The following are some of the means which have proved beneficial in the reduction of obstruction. Belladonna internally and externally as follows: Apply extract belladonna one drachm, iodine ointment (U. S. P.) one ounce, smear on lint sufficient in size to cover abdomen. Give internally tincture of belladonna sufficient, if necessary, to produce atropism; even giving ten or more minims every hour until the throat becomes dry and the pupils dilated. If necessary add a one grain suppository hourly; a most excellent remedy, according to its physiological action for some forms of intestinal obstruction. The dosage of belladonna should be determined by the effect to be obtained, the drug effect being necessary for the cause of obstruction; when thus relaxed the obstruction yields. In some cases attenuated doses have been sufficient to relieve. There may be criticism upon the dosage suggested, but we must recollect that we have a desperate case in hand and our endeavor should be to save life without an operation if possible. Another application is extract of belladonna and opium each twenty-five grains (25) with one (1) ounce of glycerine triturated thoroughly, and frequently paint the abdomen. Small doses of opium are admissible in cases when obstruction is caused from reflex action, more especially when from diaphragmatic pleurisy or pneumonia. Tabacum 2X internally or rectal enema prepared as follows: One drachm of plug tobacco, or the cured leaf, to a pint of water. Ox gall, glycerine and water, one pint or more. Some obstructions have been relieved by colonic irrigation, the conditions depending upon the impairment of the lumen.
Former Surgeon General M. O. Terry gives the following preparation, stating: “I send you the prescription in regard to obstruction which three of us here have used for more than a quarter of a century:
Number (1) R.:
Atropia gr. 1-60.
Acid sulphuric gtt. 10
Aurantii cort o dr. 1
Magnesia sulph dr. 1
Aqua dest., oz. 1/2 M.
Make up for the number of doses desired. Usually I have a four ounce bottle made up of No. 1, the No. 2 being the same without the atropia.
Sig. Give the above named dose of No. 1 and in urgent cases the No. 2 every three hours. If after 12 hours no dryness is experienced in the mouth No. 1 can be repeated. If such conditions be noticeable do not give for 24 hours. It may take three to five days without a result but your patient will be improving all the time. It has never failed me. Other remedies may be given just the same and high enemas systematically used every 3, 6 or 12 hours, of glycerine, soap and water or sweet oil. If castor and sweet oil can be taken 1/2 oz. of each repeating in 3 or 6 hours I would give the mixture.
Great care must be observed in the use of fluids to overcome the obstruction, if the pressure is too great there is danger of rupturing the bowel, especially if gangrenous.
Intussusception if in the colon may be sometimes relieved by enemata, or inflation by hydrogen gas or air, if inflated with hydrogen gas, two or three gallons may be cautiously introduced.
Colonic irrigation with salt solution (one teaspoonful to the quart) at a temperature of one hundred and fifteen to one hundred and twenty-five degrees using four or five or more gallons at each irrigation.
When using rectal enema have the abdomen methodically kneaded. Enemata may locate the obstruction. If one pint only is retained it is at, or in the sigmoid flexure; a larger quantity indicates the colon.
Enema for emptying the lower bowel alters the relation of abdominal contents and may be made of oat meal gruel with caster oil and turpentine or of ice water.
An enema of ether and alcohol each three drachms and water ten ounces; also olive oil, castor oil and oil of turpentine each two or three ounces.
The best position of the patient for rectal enemata is the knee and chest position, using rectal catheter. The inversion of the patient is a very doubtful procedure. A hot bath may sometimes relax, or the local application of ice.
Nelaton suggested electrolysis.
Snuff to produce sneezing has proven efficacious in overcoming slight obstructions.
Among local relaxtants especially in external hernia, are oil of lobelia, oil hyoscyamus or oil tabacum. Leches have been used successfully. Before attempting reduction of hernia by taxis profound narcosis is admissible. Chloroform narcosis is the best relaxor.
Let the diet be fluid and sustaining and it is better to be given by the rectum.