Clematis
"Liquid Petrolatum" - Gereinigtes Petroleum, Art. G 179 - TEIL 2
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Die englische Originalausgabe - Teil 1, u.a. zwecks Überprüfbarkeit der Übersetzung:
"The non-surgical treatment of intestinal stasis and constipation, also an important announcement regarding liquid petrolatum"
R.H.FERGUSON, M.D. PRESENTED THE UNIVERSITY OF TORONTO BY THE NON-SURGICAL, TREATMENT OF INTESTINAL STASIS AND CONSTIPATION
Compiled by ROBERT H. FERGUSON, M.D., Sc.D.
Also an Important Announcement Regarding Liquid Petrolatum
Published for the Physician and Surgeon by E. R. SQUIBB & SONS, NEW YORK MEDICAL DEPARTMENT MCMXVI Copyright, 1916, by ROBERT H. FERGUSON
(Anmerkung: Dieser Text wurde zwecks besserer Lesbarkeit neu formatiert, Fehler des ursprünlichen Scanvorgangs wurden nicht korrigiert, die Überschriften hier auch in deutsch sind fett hervorgehoben, Quelle:
Full text of "The non-surgical treatment of intestinal stasis and constipation, also an important announcement regarding liquid petrolatum"
Fett hervorgehobene Abschnitte wurden ins Deutsche übersetzt - siehe zweiten Beitrag)
IMPORTANT ANNOUNCEMENT REGARDING LIQUID PETROLATUM
Wichtige Ankündigung bezüglich “Liquid Petrolatum”
For the successful treatment of Intestinal Stasis and Constipation by the methods described in the pages of this handbook, the employment of a mineral oil of correct constitution and highest purity is imperative.
In pursuance of OUT long-established and well-known policy to supply of every product only the best quality for the purpose intended, we have made a thorough and exhaustive study of all American and Russian mineral oils obtainable. After more than three years of such careful investigation and research we are able to announce:
First: There are two distinct types of mineral oil for internal use offered in the market, differing greatly in physical and in chemical properties, namely:
(a) The heavy oils, consisting principally of the naphthene series of hydrocarbons. These heavy oils are derived only from crudes found in California and in certain fields of Russia.
(b) The light oils, consisting chiefly of the methane or paraffin series of hydrocarbons. In this class belong all American mineral oils except certain ones of California.
In short, numerous comparative tests made by us show the Californian heavy oil to differ in essential respects from other American oils and also to be superior to the Russian oils.
We, therefore, have selected this Californian Heavy Oil of high viscosity as the best mineral oil obtainable for the internal treatment of intestinal stasis and constipation, and hereafter shall supply it on all orders. It is refined for us under our control only by the Standard Oil Company of California, which has no connection with any other Standard Oil Company.
ANNOUNCEMENT 5
LIQUID PETROLATUM, SQUIBB
This Liquid Petrolatum Squibb, Heavy (Calif ornian), meets the quality specifications as follows: It is a water-white, odorless, tasteless mineral oil, consisting almost entirely of the naphthene series. It has the high specific gravity* of 0.886 to 0.892 at 15 C. or 0.881 to 0.887 at 25 C. It has an exceptionally high natural viscosity,f a point of paramount import .
* It is claimed that a heavy hydrocarbon oil of high viscosity does not pass as rapidly through the intestine as does an oil of lower gravity and viscosity. This slower passage permits a more even distribution of the oil, a more complete lubrication of the intestinal wall, and possibly a more thorough inhibitive action on bacteria. Furthermore, if a light oil of low viscosity is used there is leakage or dribbling, while under ordinary circumstances no such annoyance is experienced when a heavy oil of high viscosity is employed.
In Judging mineral oils by their physical appearance, it should be borne in mind:
First : That high viscosity does not necessarily mean high specific gravity. The former bears no definite relation to the latter.
Secondly : That apparent high viscosity may not be true viscosity. Certain mineral oils offered in the market with exaggerated claims have apparently a high viscosity, but upon testing show an actual low viscosity. Thus, they are in fact not only low in specific gravity, but also low in viscosity, their appearance to the contrary notwithstanding. For instance, because true viscosity is the chief index of lubricating power.
Furthermore, it is a pure mineral oil free from paraffins, inorganic matter, organic sulphur compounds and injurious hydrocarbons, such as anthracene, phenanthrene, chrysene, phenols, and oxidized acid or basic bodies.
It resists oxidizing agents better than do the oils of the methane, ethylene, and aromatic series. It shows a marked stability against chemical agents in general. It is designated and sold solely under the Squibb label and guaranty. You are respectfully asked to specify it on your prescriptions in order to make sure that this Californian oil of highest viscosity is furnished.
E. R. SQUIBB & SONS. THE NON-SURGICAL TREATMENT OF INTESTINAL STASIS
AND CONSTIPATION Compiled by ROBERT H. FERGUSON M.D., Sc.D.
FOREWORD
This handbook is intended to set forth, in the briefest manner possible, the consensus of opinion of the medical profession concerning the non-surgical aspect of the treatment of intestinal stasis and constipation. It advances no novel ideas, but brings together statements of representative physicians and surgeons.
Concerning certain aspects of the treatment little is said, as, for instance, the orthopaedic the choice of corsets if visceroptosis, etc., exists; the hygienic, since it varies so with temperament, time, and place; also the dietary, which, too, is quite individualistic. Enough, however, is advanced to suggest rational non-surgical treatment, while the accurate and complete bibliography will enable those more deeply interested to consult the original papers. Furthermore, the full and carefully constructed index will give easy access to the whole.
Just here certain matters which involve principles of scientific moment, as well as of every-day practical medical interest, should be noted. All the authors recommend liquid petrolatum as the internal remedy par excellence. However, this product is called by a large number of different names, such as "mineral oil," "paraffin oil," "liquid paraffin," "petroleum oil," "liquid petroleum," "Russian oil," "Russian mineral oil," and many other designations ; but in the United States only one distinctive name is recognized, the name established by the United States Pharmacopoeia. Therefore, the attention of the Medical Profession of the United States is respectfully called to the propriety of adhering strictly to the name official in the United States, which is "Liquid Petrolatum."
In the United States, "paraffin" means the solid wax-like hydrocarbon so commonly used for candles, etc. "Liquid paraffin" is this solid substance either melted or in solution. "Petroleum" and "petroleum oil" signify various forms of more or less crude earth oil, as kerosene, certain lubricating oils, etc.
To use, in the United States, such designations for "liquid petrolatum" is not only confusing and misleading, but is against the effprts of the U. S. P. to establish a definite nomenclature. Consequently, it should be noted that the official name for the hydrocarbon oil intended for internal use is "Liquid Petrolatum, Heavy." In order to avoid confusion in this handbook, the U. S. P. designation has been used instead of the varying names employed by the authors.
Liquid petrolatum is a mineral oil which must be distinguished not only in its chemical composition but also in its physiological action from the oils and fats of vegetable and animal origin. These latter oils are split up, digested, and absorbed in the gastro-intestinal tract, and serve various purposes in the human economy.
Liquid petrolatum undergoes no change in the stomach or intestines. It is not absorbed, and it passes out of the system in the same condition and quantity that it entered. Its primary action is entirely mechanical, merely lubricating the lumen of the gut, and keeping the intestinal contents soft. However, the secondary effects of its action are important, such as the relieving of overworked myenteric ganglia by allowing the intestinal contents to pass easily; the hindering of decomposition by preventing stagnation of the contents of the bowel; its indirect bactericidal action by investing the bacteria so completely as to exclude whatever nutriment is necessary for their propagation; and, because of all this, the permitting of a better digestion and absorption of food than are possible when stasis exists.
The criterion for judging a liquid petrolatum for internal use is bound up with the fact that the primary action of this product is lubrication. High specific gravity is of great value; and of two oils, one heavy and the other light, but alike in other respects, the heavier oil, doubtless, would be the better for use internally.
However, the chief index of lubricating power is viscosity; therefore, a high viscosity ought to be the feature sought first, and specific gravity next; of course, not overlooking purity, which always is essential.
The Londc-n Lancet 1 says, "Since it is admitted that the value of liquid petrolatum taken internally is chiefly that of a lubricant on the contents of the bowel (although incidentally it may also restrict bacterial activities), the viscosity of the oil is probably a more important factor. ... It seems pretty safe to say that the effects would be quite different when, on the one hand, a rapidly flowing oil is used and, on the other, an oil travelling slowly through the digestive tract. . . . Oils which flow more rapidly . . . are less likely to produce that steadiness of lubrication which is physiologically desirable; they frequently produce intestinal pain and they may even escape without lubricating at all. Possibly, also, the disturbing effect on digestion, which sometimes occurs, is due to the employment of an oil of too easy fluidity."
In selecting, then, a suitable hydrocarbon oil for internal administration, it should be borne in mind that choice should be made of a pure liquid petrolatum which has not only a high specific gravity, but also a high natural viscosity; and since, as The Lancet says, "viscosity is affected much more by temperature than is specific gravity," care should be taken that the oil has the desirable high viscosity at body temperature. 1 The Lancet, London, 1915, Oct. 2, p. 762.
CONTENTS - Inhaltsverzeichnis
FOREWORD 9 - Vorwort
I. IMPORTANCE OF INTESTINAL STASIS . 17
Bedeutung der Darm-Stase
II. DEFINITION OF INTESTINAL STASIS . 18
Definition der Darm-Stase
III. REMOTE EFFECTS OF INTESTINAL STASIS 19
Fernere Auswirkungen der Darm-Stase
WATSON'S CLASSIFICATION OF CASES . 22
Watsons Einteilung der Fälle
IV. CAUSE OF THE AUTOINTOXICATION IN INTESTINAL STASIS 24
Ursache der Auto-Intoxikation bei Darm-Stase
V. CONSTIPATION, INTESTINAL STASIS, AND ENTEROPTOSIS 28
Verstopfung, Darm-Stase und Enteroptose
VI. POSSIBILITY OF TREATING INTESTINAL STASIS BY INTERNAL
LUBRICATION 33
Möglichkeiten der Behandlung der Darm-Stase durch innere Schmierung
VII. WIDE-SPREAD EXISTENCE OF INTESTINAL STASIS 42
Weitverbreitetes Bestehen einer Darm-Stase
VIII. NON- SURGICAL TREATMENT OF INTESTINAL STASIS 43
Nicht-Chirurgische Behandlung der Darm-Stase
IX. CONSTIPATION IN INFANTS .... 72
Verstopfung bei Kleinkindern
X. LIQUID PETROLATUM DURING PREGNANCY AND LACTATION 80
“Liquid Petrolatum” während der Schwangerschaft und Stillperiode
XI. LIQUID PETROLATUM FOR THE INSANE . 82
“Liquid Petrolatum” für Geisteskranke
XII. SURGICAL USE OF LIQUID PETROLATUM 83
Chirurgische Verwendung von “Liquid Petrolatum”
(a) As a Prophylactic 83 - als Prophylaxe
(b) For Diagnosticating Surgical from Non-surgical Cases .... 84
Zur diagnostischen Unterscheidung chirurgischer von nicht-chirurgischen Fällen
(c) Intra-abdominally to Prevent Post Operative Stasis (Burrow's Method) 85
Intra-abdominal zur Vermeidung post-operativer Stase (Burrows Methode)
Contra-indications for the Intraabdominal Use of Mineral Oil . 90
Kontraindikationen für die intra-abdominale Verwendung von Mineralöl
(d) To Prevent or Mitigate PostAnaesthetic Nausea and Vomiting 91
Zur Verhütung oder Minderung post-anästhetische Übelkeit und Erbrechen
(e) As a Post-Surgical Laxative . . 92
Als ein post-chirurgisches Abführmittel
INDEX . . 93 - Stichwortregister (entfernt, da durch Scannen unbrauchbar)
The Non-Surgical Treatment of Intestinal Stasis and Constipation
Die nicht-chirurgische Behandlung der Darm-Stase und Verstopfung
I. THE IMPORTANCE OF INTESTINAL STASIS.
Die Bedeutung der Darm-Stase
OcHSNER, 2 of Chicago, calls attention to the fact that "every author of note, from Hippocrates to the present day, who has written a treatise on medicine, has insisted on the importance of preventing an abnormal accumulation of excrement in the large intestine, both as a prophylactic against future, and as a cure for existing, disease."
LANE, S of London, says: " Chronic intestinal stasis, which I believe to be the prime factor in the production of very many diseased conditions, is of enormous importance, and we cannot spend too much time or thought in unravelling the many problems which it presents."
2 Surgery, Gynecology and Obstetrics, 1916, Jan., p. 44.
9 British Medical Journal, 1912, May 4, p. 989. 17
18 TREATMENT OF HOCKEY,* of Portland, Oregon, says: "Careful clinical observation is convincing me, day by day, that the question of intestinal stasis and its consequent morbidity is one of the most important subjects before the medical profession at this time." Accordingly, it is well to ask, What is this important condition?
II. DEFINITION OF INTESTINAL STASIS. 4
Definition der Darm-Stase
No better definition of intestinal stasis has been given than that of him who has done more than any other to call attention to the fact, cause, and pathology of stasis, and has demonstrated its treatment. "Sir W. ARBUTHNOT LANE, whose views, as Ochsner says, 5 have been fully supported by no less famous a scientist than Metchnikoff," 6 says 7 :
"By chronic intestinal stasis I mean
4 Surgery, Gynecology and Obstetrics, 1913, Dec., p. 737.
6 Surgery, Gynecology and Obstetrics, 1916, Jan., p. 44.
8 The Nature of Man, Part III, Chap. X, Eng. trans., p. 248 et seq.
The Prolongation of Life, Part II, Chap. Ill et al.
7 Proceedings of Royal Society of Medicine, London, Vol. VI, Part 1, p. 94; also British Medical Journal, 1912, May 4, p. 989 et al.
such an abnormal delay in the passage of the intestinal contents through a portion or portions of the gastro-intestinal tract as results in the absorption into the circulation of a greater quantity of poisonous or toxic material than can be treated effectually by the organs whose function it is to convert them into products as innocuous as possible to the tissues of the body."
III. REMOTE EFFECTS OF INTESTINAL STASIS.
Fernere Auswirkungen der Darm-Stase
LANE* emphasizes the fact that intestinal stasis means more than "merely the absence of a daily action of the bowels," and that this stasis is important since "any delay in the passage of the contents of this drainage scheme has a threefold result on the organisms found in the intestine. Their multiplication is facilitated, they extend beyond the limits of their normal habitat, and extraneous strains are developed. These organisms may extend along the ducts of the organs which open into the drain pipe, and they or their products, carried into the blood stream, may infect organs which do not directly communicate with the intestine, for example, the kidneys," producing "progressive degenerative changes in every tissue."
In this way, the disturbance caused by "^ intestinal stasis may be, according to! Lane, Bainbridge, and others, most extensive and important, yet apparently remote from any connection with intestinal toxaemia.
For instance, it affects the ductless glands. RowELL 9 in a "Discussion of Alimentary Toxaemia" before the Royal Society of Medicine, London, reported: "In the case of a very athletic young lady of which I have knowledge, who had a large thyroid and some symptoms of chronic intestinal stasis, after a course of liquid petrolatum given freely three times a day for ten days the thyroid had diminished to less than half its former size, and the patient felt perfectly well." 9 Proceedings Royal Society of Medicine, London. Vol. VI, Part 1, p. 197.
LANE IQ operated on a patient for intestinal stasis. He says: "For eight years she had suffered from an enlarged thyroid which projected forward in her neck, and which interfered with respiration. It contained several large adenomata. . . . Within a few days after the operation, it was obvious that the thyroid was diminishing steadily in size, and this diminution continued till, when she left the hospital, it was but little larger than normal. I understand at the present time it is not larger than normal."
"Also the nervous system is markedly affected." Further, 11 there may be "degenerative changes in the breast associated with stasis, which disappear if the drainage scheme be properly dealt with."
10 Proc. Royal Society of Medicine, Vol. VI, Part 1, p. 106.
11 Surgery, Gynecology and Obstetrics, June, 19 13, pp. 600-606;
Proceedings Royal Society Medicine, Vol. VI, Part 1, pp. 96-105 (Lane); p. 197 et al. (Rowell); p. 317 (Clark). The Operative Treatment of Chronic Intestinal Stasis, by Sir W. Arbuthnot Lane, 3d Edition, London, 1915, pp. 53-68.
12 British Medical Journal, 1911, Apr. 22, pp. 913, 914.
LANE considers intestinal stasis to be intimately and causally connected with many cases of appendicitis, 12 rheumatoid arthritis, and tuberculosis. As regards the latter two, LANE IS says: "In my experience, a patient cannot develop either of these diseases (except in the case of tubercle by inoculation) unless the resisting power to the entry of organisms, or, in other words, the vitality of the tissues of the body, has been depreciated by the poisons which circulate through them in chronic intestinal stasis."
Watson's Classification of Cases
WATSON," of Edinburgh, says: "Long-continued observation of many cases of chronic disease, and more especially private cases which I have had the opportunity of investigating by the aid;sof modern methods of diagnosis, has led me to recognize three distinct groups of conditions that arise mainly or entirely from intestinal toxaemia. ... (1) A neurasthenic group. This includes some cases at present regarded as neurotic, and also a sub-group in which the symp toms are mainly mental. (2) Rheumatoid arthritis. (3) A dyspeptic group."
13 British Medical Journal, 1912, May 4, p. 989.
"Edinburgh Medical Journal (N.S.), 1914, February, p. 130;
1914, March, p. 220 et seq.; 1914, April, p. 345 et seq.
"From a therapeutic standpoint, cases of intestinal toxaemia may be roughly classified into three main groups. Group 1 : Cases in which the symptoms are physical signs which are comparatively trivial and which yield readily to simple medical treatment. Group 2: In which the symptoms are more pronounced and are accompanied by marked objective indications of an abnormal state of the digestive tract, but which are amenable to careful and prolonged medical treatment. Group 3: In which the condition of the digestive tract is so abnormal that medical measures fail to relieve; relief being obtainable only by surgical treatment.
"Cases which fall under one or other of these groups are met with very commonly in the every-day practice of the physician, and I am satisfied that they form a large share of the cases which come under the daily observation of the practitioner."
The "keynote of successful treatment is found in the application of antiseptic and aseptic principles, rest, diet, treatment of bowels," etc. . . . "The use of liquid petrolatum is of great value as a mechanical lubricant in many of these cases."
IV. CAUSE OF THE AUTOINTOXICATION IN INTESTINAL STASIS.
It is of use to note how this autointoxication has been accounted for. PAUL G. WooLEY, 15 of Cincinnati, Ohio, states three possibilities, viz.: First, that "during digestion of food-materials, by the normal secretions of the gastrointestinal tract, toxic substances are formed, and that these substances may enter the blood stream and produce serious disorders." Second, that "bacteria resident in the intestinal tract act upon the foodstuffs and produce toxic substances which are absorbed and act as intoxicants." Third, that "the presence of bacteria themselves, which have entered the blood stream from the intestine, is the source of trouble."
15 Journal of Laboratory and Clinical Medicine, 1915, Oct., pp. 47-49.
DixoN 16 says: "It is by no means certain that true toxins are absorbed from the intact mucous membrane of the intestinal canal," and, for proof, calls attention to the fact that snake venom, diphtheria toxin, and tetanus toxin are harmless when taken by the mouth. He adds: "In general, however, I think . . . that alimentary toxaemia is poisoning produced not by 'toxins' . . . but by relatively simple chemical substances, certainly not of a more complex chemical nature than many of the alkaloids we are in the habit of administering. These poisons are a result of digestion or putrefaction of food . . . chiefly proteins."
ROBERT SAUNDBY, I? however, explains absorption of toxins by traumatism, and emphasizes the importance of constipation in autointoxication on account of its causing lesions in the intestinal mucosa.
16 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 129.
17 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 43.
He says: "Simple constipation does not lead to any increase of decomposition in the faeces . . . but it is a not uncommon cause of chronic intestinal catarrh which may go on to ulceration and even perforation, and it is to these inflammatory consequences that must be attributed the varied symptoms which are associated with constipation," and "nothing is more certain than that many symptoms may result from constipation where alterations in the wall of the bowel have taken place. Nor is it inconsistent with this view that thorough emptying of the bowel should be followed by temporary relief of these symptoms, but, at the same time, we should expect that the simple evacuation of the pelvic colon would not effect a cure."
18 Bacterial Activity in the Alimentary Tract The British
Journal of Surgery, Vol. II, No. 8, 1915, April, pp. 608-638 (see p. 609, also pp. 623, 624). The Lancet Clinic, 1915, August 14, p. 154; 1915, August 21, p. 172.
N. MuTCH, 18 London, in his epoch-making work, says: "To put the matter briefly, the upper alimentary tract is specialized for aseptic absorption of food and the colon for the bacterial destruction of residues. It is conceivable that disease may arise from infection of the lumen of the upper alimentary tract, with the generation of poisonous decom- position products; or from infection through the walls of the alimentary canal with discharge of bacterial toxins into the circulation. . . .
" In all likelihood, some of the symptoms experienced in constipation are caused by bacterial toxins generated in the tissues of the alimentary tract or even in distant tissues infected through this channel. Concerning the pathogenesis of these symptoms, there is little accurate evidence available. . . .
"Secondary intestinal infections, in which less usual organisms are in the ileum in addition to those commonly present in intestinal stasis, probably give rise to many symptoms which must be ascribed to the action of bacterial toxins rather than to food-decomposition products."
But what RowELL 19 says should be borne in mind, viz., that "the exact nature of the particular poison in any case is a minor point, so far as diagnosis and treatment are concerned." 19 Proc. Royal Society of Medicine, Vol. VI, Part 1, p. 196.
V. CONSTIPATION, INTESTINAL STASIS, AND ENTEROPTOSIS.
Verstopfung, Darm-Stase und Enteroptose
SAUNDBY 20 calls attention to a very important matter. He says: "Faecal retention is not inconsistent with a daily action of the bowels"; and A. F. HERTZ 21 emphasizes this fact when he says: "It is well known that the frequency of the stools gives no certain evidence as to the existence of intestinal stasis."
20 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 43.
21 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 164.
22 Surgery, Gynecology and Obstetrics, 1913, June, p. 600 et seq.; also The Operative Treatment of Chronic Intestinal Stasis, 1st, 2nd, and 3rd editions (London, 1915).
SIR W. ARBUTHNOT LANE 22 was the first to emphasize the importance of interference with the "drainage scheme" by "obstruction ... at the points of normal fixation and by kinks due to acquired bands." In the dependent loops of intestine which are formed, the intestinal contents stagnate or move on so abnormally slowly that fermentation and putrefaction produce an enormously large bacterial flora, or form toxins which by absorption are distributed more or less extensively throughout the body. It is necessary, however, to bear in mind that the important fact is not that of enteroptosis with or without kinks, but of autointoxication, whether there are constrictions and a falling of the intestines or not.
A. E. ROCKET 23 says: "Ptosis is undoubtedly a cause of stasis in many cases; and stasis, by its interference with nutrition and by its mechanical elongations of the colon, is probably a frequent cause of ptosis. But ptosis is found without stasis, and stasis without ptosis. . . . Many symptoms, both gastric and intestinal, ascribed to ptosis, are symptoms of stasis, and clear up when the stasis is relieved, and do not necessarily clear up when the ptosis is relieved." So also "stasis does not necessarily mean constipation. There are a few cases of marked intestinal autointoxication without constipation." 23 Surgery, Gynecology and Obstetrics, 1913, Dec., p. 737.
J. N. JACKSON, 24 of Kansas City, Mo., says: "I have seen a true toxic condition without any interference with peristalsis."
WILLIAM J. MAYO 25 says that "about 50 per cent, of the fluids and 10 per cent, of the solids" ingested by the human being "are absorbed by this (the first half) of the large intestine. Beyond the splenic flexure, absorption is limited in amount, the bulk of absorbable material placed in the rectum being promptly passed into the proximal colon for absorption.
24 Journal American Medical Association, 1915, Aug. 28, p. 770.
26 American Journal of the Medical Sciences, 1913, Feb., p. 157.
26 New York Medical Record, 1905, Aug. 12, pp. 246-252
British Medical Journal, 1906, Vol. II, p. 238.
"It has been shown by Bond, 26 Cannon, and others that there is a fairly constant antiperistalsis in the large intestine which passes material back toward the csecum. . . . 'Lyle has aptly compared its storage function to the stomach,' but adds that, ' unlike the stomach, which absorbs
but a small amount, the csecum absorbs actively. In some animals there is a sphincter in the ascending colon to hold the material in the csecum. In man, a marked physiological activity is shown at this point, although no colonic sphincter exists.' '
LESLIE 27 says: In intestinal stasis "the pelvic colon and rectum may become greatly elongated (perhaps as much as twice the normal length), sagging along the floor of the true pelvis, and capable of retaining the faecal matter for several days, even though a small piece may be broken off and evacuated daily, thus giving rise to a false impression of bowel regularity. There may even be irritating diarrhea ' the diarrhea of constipation. ' '
** American Practitioner, August, 1913, p. 410.
It is admitted, then, that in many ways during the passage of the contents of the intestine, and at many places en route, bacteria and toxins are produced and may be absorbed with more or less serious results to the individual. Since this is so, the summary of BAiNBRiDGE 28 is well made. He says: "Lane . . . has demonstrated clearly that in health maintenance, the question of prime importance is body drainage the non-absorption of poisons and the elimination of whatever poisonous matter may be produced within the alimentary canal before there has been inaugurated a vicious cycle of events which may be the forerunner of disastrous end results."
- That this importance of 6 'body drainage' ' is not exaggerated is evident from the experiments of CARREL 29 and others at the Rockefeller Institute for Medical Research and at the Laboratories of the New York Lying-in Hospital. 30 These experiments show "that decay is due to an inability of the tissues to eliminate waste products."
28 Maine Medical Journal, 1913, July.
29 Journal American Medical Association, 1911, Jan. 7, pp. 32. 33; 1911, Nov. 11, p. 1611; 1912, Aug. 17, pp. 523-527.
Studies from the Rockefeller Institute, 18, 1914, pp. 344-349. Journal Exp. Med. t 1913, Jan., pp. 14-19. 30 CARREL AND MONTROSE T. BURROWS, Journal American Medical Association, 1910, Oct. 29, p. 1554.
CARREL AND MONTROSE T. BURROWS, Journal Exp. Med., 1911, Vol. XIII. No. 4, pp. 562-570. A. CARREL, Journal Exp. Med. t 1912, Vol. XV. No. 5, pp. 516-528.
Also "that under the conditions and within the limits of the experiments, senility and death are not a necessary, but merely a contingent, phenomenon." It is this removal of general body waste, and particularly the prevention of additions to the effects of normal waste throughout the body consequent upon the absorption by the intestine of toxins formed on account of the hindrance to normal elimination, that is the aim of the treatment of stasis. The result is a renewed and prolonged vitality of general body tissue."
VI. POSSIBILITY OF TREATING INTESTINAL STASIS BY INTERNAL LUBRICATION.
Möglichkeiten der Behandlung von Darm-Stase mittels innerer Schmierung
The question now arises: Can intestinal stasis be treated by non-surgical means, with any assurance of success?
30 A. CARREL, Journal Exp. Med. t 1914, Vol. XX, No. 1, pp. 1-2.
LOSBE AND EBELING, Journal Exp. Med. t 1914, Vol. XIX. No. 6. pp. 593-602.
The answer of both surgeons and physicians is an unequivocal "Yes," provided a proper selection is made of advanced cases, and incipient or mild cases be cared for promptly; also liquid petrolatum is the remedy to be relied upon, and should be tried before deciding on surgical means, provided the product employed is of the required purity, high specific gravity, and high natural viscosity.
LANE 31 says : " We find some difficulty in drawing the line between the cases in which the stasis can be efficiently met by the use of liquid petrolatum and those in which an alteration in the drainage scheme is advisable. In all doubtful cases we give liquid petrolatum a thorough trial before adopting operative procedures."
WILLIAM S. BAiNBRiDGE 32 says: "The 30 LOSEB AND EBELING, Journal Exp. Med. t 1914, Vol. XX, No. 2, pp. 140-148.
A. H. EBELING, Journal Exp. Med., 1913, Vol. XVII, No. 3, pp. 273-285.
A. H. EBELING, Journal Exp. Med., 1914, Vol. XX, No. 2 pp. 130-139.
31 British Medical Journal, May 4, 1912, p. 989
82 New York Medical Journal, 1914, Jan. 24.
vast majority of cases should have been prevented. Hygienic and medical treatment will cure a large proportion of cases if instituted in the beginning. Certainly, nine out of ten, and possibly nineteen out of twenty, of all cases should not reach the stage which calls for surgical intervention."
LANE 33 says: "From the surgeon's point of view, the treatment of chronic intestinal stasis consists in facilitating the passage of material through the several portions of the gastro-intestinal tract. ... In the vast majority of cases, the use of a lubricating material, such as liquid petrolatum, which precedes the passage of food, application of some spring support to the lower abdomen, which tends to keep the viscera up and to control the delay of material in the small intestine and caecum, and the avoidance of the use of such proteid foods as poison the tissues if retained for an abnormally long time in the intestine, are sufficient for the purpose."
33 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 114.
R. MURRAY LESLIE w says: "In the large majority of instances, if the cases are treated at a comparatively early stage, simple remedial measures such as diet modifications, physical exercises, abdominal massage, supporting belts, aperient remedies, and lubricants (such as liquid petrolatum) are usually quite efficacious. . . . Liquid petrolatum ought to be given in large doses (J^ to 1 ounce) two or three times daily."
WILLIAM VAN V. HA YES M says: "Surgery should not be thought of in the great majority of instances, but is indicated in the marked cases failing to respond to persistent competent medical treatment."
A. F. HERTZ 86 says: "In those cases in which the whole of the colon is involved, medical treatment almost invariably succeeds."
34 Proceedings Royal Society of Medicine, London, Vol. VI. Part 1, p. 272. M New York Medical Journal, 1914, Feb. 28, p. 172. **Proc. Roy. Soc. Med., London, Vol. I, Part 6, p. 175.
37 Surgery, Gynecology and Obstetrics, 1913, Dec., p. 428.
ROBERT C. CoFFEY 87 writes: "The large majority of cases of ptosis may be successfully treated and the patient made perfectly comfortable by medical and dietary measures. Surgery should never be considered for the treatment of ptosis per se. Gastric or intestinal stasis not relieved by medical and dietary measures constitutes the only excuse for surgery in this class of cases." ... "I wish to reiterate that only a very small per cent, of ptosis cases as they now come to the doctor are surgical."
W. B. Russ, 88 of San Antonio, Texas, says: "Cases of intestinal stasis, even though infection and toxaemia are present, are primarily not surgical cases; and, if the patients are properly treated, very few need ever become surgical."
REA SMITH, SS> of Los Angeles, California, says: "I wish particularly to endorse the statement of Russ, that most cases of intestinal stasis are medical, and I agree that operation should be reserved for medical failures."
38 Journal American Medical Association, 1915, Aug. 28, p. 769.
w Journal American Medical Association, 1915, Aug. 28, p. 770.
J. H. KELLOGG, 40 of Battle Creek,' Michigan, says he "feels that his experience has demonstrated that by the systematic use of liquid petrolatum, combined with a laxative and antitoxic dietary, a very large proportion of the cases now subjected to short circuiting and other operations might escape surgical interference altogether; certainly a thing greatly to be desired, especially since we do not yet know what may be the remote effects of these operations, while we do know that the immediate results are often far from satisfactory."
N. W. JoNES, 41 Portland, Ore., writes: "No patient should ever be operated upon until a local barrier of surgical degree has been determined as such by the failure of medical measures."
40 New York Medical Journal, 1914, Sept. 12, p. 508.
41 Lancet Clinic, 1915, Dec. 4, p. 495.
Proc. Roy. Soc. Med. t Vol. I, Part 6, p. 9.
W. HALE WHITE 42 believes the general practitioner can prevent intestinal stasis. He told the Royal Society of Medicine, London, that in intestinal stasis "if surgical interference is ever necessary the patient for whom it is necessary is a reproach to her doctors, if she has consulted any in the earlier period of her illness, for the condition never ought to be allowed to advance to the stage which requires surgery."
In this connection, the words of OCHSNER, 43 of Chicago, Illinois, are significant. He says: "During ... 1914 ... the cases operated upon by my colleague . . . and myself . . . represent less than 10 per cent, of all the cases which came under our care during this period for the relief of intestinal stasis, and still the number operated upon contains some cases which should not have been treated surgically." He gives 44 as "contra-indications to surgical treatment" "the class of neurotics whose nervous condition has not been caused by intoxication due to intestinal stasis," also "in all instances where careful and long-continued hygienic, dietetic, and medicinal treatment results in physiological relief." After these cases are ruled out, "only a very small percentage of patients suffering from intestinal stasis will remain who need to be considered from the surgical standpoint."
* 3 Surgery, Gynecology and Obstetrics, 1916, Jan., p. 45.
44 Surgery, Gynecology and Obstetrics, 1916, Jan., pp. 47, 48.
About three years ago, the Royal Society of Medicine in London, England, 45 had "A Discussion on Alimentary Toxaemia: Its Sources, Consequences, and Treatment." The reading of papers and the debate occupied six sessions on as many days in three consecutive months. It was a very exhaustive consideration of intestinal stasis, and commanded the best medical, surgical, and dental talent. The printed part of this discussion fills 380 royal octavo pages. At the closing of the sessions, W. HALE WHITE," in making the summary of all that had been set forth, said: "It is agreed that in the vast majority of cases medical treatment suffices, and what has been said about treatment hi this discussion has come chiefly from the surgeons. ... If the cases that now seem to some to justify surgical treatment had been treated in the first stages by proper medical means, surgical interference would not have been necessary, so that when this is widely appreciated, cases ought never to become so severe that surgical treatment is contemplated, and we may hope one result of this discussion will be that we shall keep the drainage scheme of our patients in sufficiently good order as to render surgical interference unnecessary."
48 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, 1918, March, April, May, pp. 1-380; 46 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 380.
And, similarly, A. J. OcnsNER, 47 after saying that intestinal stasis occurs "in patients who have suffered severely from digestive disturbances during infancy, with severe gaseous distension of the intestines," adds, "it seems as though not only the toxic conditions but that the
cause of these conditions should be met by proper prophylaxis before the support of the intestines and the muscular structure have been permanently injured. It would, consequently, seem proper to credit the pediatrician and the general practitioner with the elimination of a great part of suffering from this cause in the future."
47 Surgery, Gynecology andjObstetrics, 1916. Jan., pp. 46, 47.
VII. THE WIDE-SPREAD EXISTENCE OF INTESTINAL STASIS.
Die weit verbreitete Existenz der Darm-Stase
The existence of intestinal stasis and the condition of alimentary toxaemia are much more common than might seem to be the case on first thought.
N. W. JONES,** of Portland, Oregon, says that "fifty per cent, of all people possess the general asthenic type of build," that "within this type . . . lies . . . the potentiality for general body weakness which determines ... the morbid symptoms attributed to ptosis." "Only when mechanical or toxic symptoms occur ... do patients realize that they are not well." "No patient should ever be operated upon until a local barrier of surgical degree has been determined as such by the failure of ... medical measures." These are orthopsedic, hygienic and dietary, and the internal administration of liquid petrolatum. He says: "When the stasis is severe, and especially when it concerns local ileum or csecum blocking, the patient must be put to bed under control, and the bowel filled as rapidly as possible with a soft vegetable pulp and a variable amount of liquid petrolatum."
48 Lancet Clinic. 1915, Dec. 4, pp. 494-495. '
It is evident that there is a very general belief that intestinal stasis can be treated medicinally. OCHSNER'S 49 experience shows how small a per cent, of cases of intestinal stasis is surgical, and WATSON'S 50 careful observations lead him to say that cases which come under his grouping "are met with very commonly hi the every-day practice of the physician," and he is satisfied that such cases "form a large share of the cases which come under the daily observation of the practitioner."
Fortsetzung im nächsten Beitrag!
Gruß,
Clematis
Damit die Übersetzungen nicht von der Diskussion "verschüttet" werden, bitte ich vorerst darum, die Diskussion im ERSTEN Thread, hier: https://www.symptome.ch/threads/gereinigtes-petroleum-art-g-179.62907/, zu führen.
Die englische Originalausgabe - Teil 1, u.a. zwecks Überprüfbarkeit der Übersetzung:
"The non-surgical treatment of intestinal stasis and constipation, also an important announcement regarding liquid petrolatum"
R.H.FERGUSON, M.D. PRESENTED THE UNIVERSITY OF TORONTO BY THE NON-SURGICAL, TREATMENT OF INTESTINAL STASIS AND CONSTIPATION
Compiled by ROBERT H. FERGUSON, M.D., Sc.D.
Also an Important Announcement Regarding Liquid Petrolatum
Published for the Physician and Surgeon by E. R. SQUIBB & SONS, NEW YORK MEDICAL DEPARTMENT MCMXVI Copyright, 1916, by ROBERT H. FERGUSON
(Anmerkung: Dieser Text wurde zwecks besserer Lesbarkeit neu formatiert, Fehler des ursprünlichen Scanvorgangs wurden nicht korrigiert, die Überschriften hier auch in deutsch sind fett hervorgehoben, Quelle:
Full text of "The non-surgical treatment of intestinal stasis and constipation, also an important announcement regarding liquid petrolatum"
Fett hervorgehobene Abschnitte wurden ins Deutsche übersetzt - siehe zweiten Beitrag)
IMPORTANT ANNOUNCEMENT REGARDING LIQUID PETROLATUM
Wichtige Ankündigung bezüglich “Liquid Petrolatum”
For the successful treatment of Intestinal Stasis and Constipation by the methods described in the pages of this handbook, the employment of a mineral oil of correct constitution and highest purity is imperative.
In pursuance of OUT long-established and well-known policy to supply of every product only the best quality for the purpose intended, we have made a thorough and exhaustive study of all American and Russian mineral oils obtainable. After more than three years of such careful investigation and research we are able to announce:
First: There are two distinct types of mineral oil for internal use offered in the market, differing greatly in physical and in chemical properties, namely:
(a) The heavy oils, consisting principally of the naphthene series of hydrocarbons. These heavy oils are derived only from crudes found in California and in certain fields of Russia.
(b) The light oils, consisting chiefly of the methane or paraffin series of hydrocarbons. In this class belong all American mineral oils except certain ones of California.
In short, numerous comparative tests made by us show the Californian heavy oil to differ in essential respects from other American oils and also to be superior to the Russian oils.
We, therefore, have selected this Californian Heavy Oil of high viscosity as the best mineral oil obtainable for the internal treatment of intestinal stasis and constipation, and hereafter shall supply it on all orders. It is refined for us under our control only by the Standard Oil Company of California, which has no connection with any other Standard Oil Company.
ANNOUNCEMENT 5
LIQUID PETROLATUM, SQUIBB
This Liquid Petrolatum Squibb, Heavy (Calif ornian), meets the quality specifications as follows: It is a water-white, odorless, tasteless mineral oil, consisting almost entirely of the naphthene series. It has the high specific gravity* of 0.886 to 0.892 at 15 C. or 0.881 to 0.887 at 25 C. It has an exceptionally high natural viscosity,f a point of paramount import .
* It is claimed that a heavy hydrocarbon oil of high viscosity does not pass as rapidly through the intestine as does an oil of lower gravity and viscosity. This slower passage permits a more even distribution of the oil, a more complete lubrication of the intestinal wall, and possibly a more thorough inhibitive action on bacteria. Furthermore, if a light oil of low viscosity is used there is leakage or dribbling, while under ordinary circumstances no such annoyance is experienced when a heavy oil of high viscosity is employed.
In Judging mineral oils by their physical appearance, it should be borne in mind:
First : That high viscosity does not necessarily mean high specific gravity. The former bears no definite relation to the latter.
Secondly : That apparent high viscosity may not be true viscosity. Certain mineral oils offered in the market with exaggerated claims have apparently a high viscosity, but upon testing show an actual low viscosity. Thus, they are in fact not only low in specific gravity, but also low in viscosity, their appearance to the contrary notwithstanding. For instance, because true viscosity is the chief index of lubricating power.
Furthermore, it is a pure mineral oil free from paraffins, inorganic matter, organic sulphur compounds and injurious hydrocarbons, such as anthracene, phenanthrene, chrysene, phenols, and oxidized acid or basic bodies.
It resists oxidizing agents better than do the oils of the methane, ethylene, and aromatic series. It shows a marked stability against chemical agents in general. It is designated and sold solely under the Squibb label and guaranty. You are respectfully asked to specify it on your prescriptions in order to make sure that this Californian oil of highest viscosity is furnished.
E. R. SQUIBB & SONS. THE NON-SURGICAL TREATMENT OF INTESTINAL STASIS
AND CONSTIPATION Compiled by ROBERT H. FERGUSON M.D., Sc.D.
FOREWORD
This handbook is intended to set forth, in the briefest manner possible, the consensus of opinion of the medical profession concerning the non-surgical aspect of the treatment of intestinal stasis and constipation. It advances no novel ideas, but brings together statements of representative physicians and surgeons.
Concerning certain aspects of the treatment little is said, as, for instance, the orthopaedic the choice of corsets if visceroptosis, etc., exists; the hygienic, since it varies so with temperament, time, and place; also the dietary, which, too, is quite individualistic. Enough, however, is advanced to suggest rational non-surgical treatment, while the accurate and complete bibliography will enable those more deeply interested to consult the original papers. Furthermore, the full and carefully constructed index will give easy access to the whole.
Just here certain matters which involve principles of scientific moment, as well as of every-day practical medical interest, should be noted. All the authors recommend liquid petrolatum as the internal remedy par excellence. However, this product is called by a large number of different names, such as "mineral oil," "paraffin oil," "liquid paraffin," "petroleum oil," "liquid petroleum," "Russian oil," "Russian mineral oil," and many other designations ; but in the United States only one distinctive name is recognized, the name established by the United States Pharmacopoeia. Therefore, the attention of the Medical Profession of the United States is respectfully called to the propriety of adhering strictly to the name official in the United States, which is "Liquid Petrolatum."
In the United States, "paraffin" means the solid wax-like hydrocarbon so commonly used for candles, etc. "Liquid paraffin" is this solid substance either melted or in solution. "Petroleum" and "petroleum oil" signify various forms of more or less crude earth oil, as kerosene, certain lubricating oils, etc.
To use, in the United States, such designations for "liquid petrolatum" is not only confusing and misleading, but is against the effprts of the U. S. P. to establish a definite nomenclature. Consequently, it should be noted that the official name for the hydrocarbon oil intended for internal use is "Liquid Petrolatum, Heavy." In order to avoid confusion in this handbook, the U. S. P. designation has been used instead of the varying names employed by the authors.
Liquid petrolatum is a mineral oil which must be distinguished not only in its chemical composition but also in its physiological action from the oils and fats of vegetable and animal origin. These latter oils are split up, digested, and absorbed in the gastro-intestinal tract, and serve various purposes in the human economy.
Liquid petrolatum undergoes no change in the stomach or intestines. It is not absorbed, and it passes out of the system in the same condition and quantity that it entered. Its primary action is entirely mechanical, merely lubricating the lumen of the gut, and keeping the intestinal contents soft. However, the secondary effects of its action are important, such as the relieving of overworked myenteric ganglia by allowing the intestinal contents to pass easily; the hindering of decomposition by preventing stagnation of the contents of the bowel; its indirect bactericidal action by investing the bacteria so completely as to exclude whatever nutriment is necessary for their propagation; and, because of all this, the permitting of a better digestion and absorption of food than are possible when stasis exists.
The criterion for judging a liquid petrolatum for internal use is bound up with the fact that the primary action of this product is lubrication. High specific gravity is of great value; and of two oils, one heavy and the other light, but alike in other respects, the heavier oil, doubtless, would be the better for use internally.
However, the chief index of lubricating power is viscosity; therefore, a high viscosity ought to be the feature sought first, and specific gravity next; of course, not overlooking purity, which always is essential.
The Londc-n Lancet 1 says, "Since it is admitted that the value of liquid petrolatum taken internally is chiefly that of a lubricant on the contents of the bowel (although incidentally it may also restrict bacterial activities), the viscosity of the oil is probably a more important factor. ... It seems pretty safe to say that the effects would be quite different when, on the one hand, a rapidly flowing oil is used and, on the other, an oil travelling slowly through the digestive tract. . . . Oils which flow more rapidly . . . are less likely to produce that steadiness of lubrication which is physiologically desirable; they frequently produce intestinal pain and they may even escape without lubricating at all. Possibly, also, the disturbing effect on digestion, which sometimes occurs, is due to the employment of an oil of too easy fluidity."
In selecting, then, a suitable hydrocarbon oil for internal administration, it should be borne in mind that choice should be made of a pure liquid petrolatum which has not only a high specific gravity, but also a high natural viscosity; and since, as The Lancet says, "viscosity is affected much more by temperature than is specific gravity," care should be taken that the oil has the desirable high viscosity at body temperature. 1 The Lancet, London, 1915, Oct. 2, p. 762.
CONTENTS - Inhaltsverzeichnis
FOREWORD 9 - Vorwort
I. IMPORTANCE OF INTESTINAL STASIS . 17
Bedeutung der Darm-Stase
II. DEFINITION OF INTESTINAL STASIS . 18
Definition der Darm-Stase
III. REMOTE EFFECTS OF INTESTINAL STASIS 19
Fernere Auswirkungen der Darm-Stase
WATSON'S CLASSIFICATION OF CASES . 22
Watsons Einteilung der Fälle
IV. CAUSE OF THE AUTOINTOXICATION IN INTESTINAL STASIS 24
Ursache der Auto-Intoxikation bei Darm-Stase
V. CONSTIPATION, INTESTINAL STASIS, AND ENTEROPTOSIS 28
Verstopfung, Darm-Stase und Enteroptose
VI. POSSIBILITY OF TREATING INTESTINAL STASIS BY INTERNAL
LUBRICATION 33
Möglichkeiten der Behandlung der Darm-Stase durch innere Schmierung
VII. WIDE-SPREAD EXISTENCE OF INTESTINAL STASIS 42
Weitverbreitetes Bestehen einer Darm-Stase
VIII. NON- SURGICAL TREATMENT OF INTESTINAL STASIS 43
Nicht-Chirurgische Behandlung der Darm-Stase
IX. CONSTIPATION IN INFANTS .... 72
Verstopfung bei Kleinkindern
X. LIQUID PETROLATUM DURING PREGNANCY AND LACTATION 80
“Liquid Petrolatum” während der Schwangerschaft und Stillperiode
XI. LIQUID PETROLATUM FOR THE INSANE . 82
“Liquid Petrolatum” für Geisteskranke
XII. SURGICAL USE OF LIQUID PETROLATUM 83
Chirurgische Verwendung von “Liquid Petrolatum”
(a) As a Prophylactic 83 - als Prophylaxe
(b) For Diagnosticating Surgical from Non-surgical Cases .... 84
Zur diagnostischen Unterscheidung chirurgischer von nicht-chirurgischen Fällen
(c) Intra-abdominally to Prevent Post Operative Stasis (Burrow's Method) 85
Intra-abdominal zur Vermeidung post-operativer Stase (Burrows Methode)
Contra-indications for the Intraabdominal Use of Mineral Oil . 90
Kontraindikationen für die intra-abdominale Verwendung von Mineralöl
(d) To Prevent or Mitigate PostAnaesthetic Nausea and Vomiting 91
Zur Verhütung oder Minderung post-anästhetische Übelkeit und Erbrechen
(e) As a Post-Surgical Laxative . . 92
Als ein post-chirurgisches Abführmittel
INDEX . . 93 - Stichwortregister (entfernt, da durch Scannen unbrauchbar)
The Non-Surgical Treatment of Intestinal Stasis and Constipation
Die nicht-chirurgische Behandlung der Darm-Stase und Verstopfung
I. THE IMPORTANCE OF INTESTINAL STASIS.
Die Bedeutung der Darm-Stase
OcHSNER, 2 of Chicago, calls attention to the fact that "every author of note, from Hippocrates to the present day, who has written a treatise on medicine, has insisted on the importance of preventing an abnormal accumulation of excrement in the large intestine, both as a prophylactic against future, and as a cure for existing, disease."
LANE, S of London, says: " Chronic intestinal stasis, which I believe to be the prime factor in the production of very many diseased conditions, is of enormous importance, and we cannot spend too much time or thought in unravelling the many problems which it presents."
2 Surgery, Gynecology and Obstetrics, 1916, Jan., p. 44.
9 British Medical Journal, 1912, May 4, p. 989. 17
18 TREATMENT OF HOCKEY,* of Portland, Oregon, says: "Careful clinical observation is convincing me, day by day, that the question of intestinal stasis and its consequent morbidity is one of the most important subjects before the medical profession at this time." Accordingly, it is well to ask, What is this important condition?
II. DEFINITION OF INTESTINAL STASIS. 4
Definition der Darm-Stase
No better definition of intestinal stasis has been given than that of him who has done more than any other to call attention to the fact, cause, and pathology of stasis, and has demonstrated its treatment. "Sir W. ARBUTHNOT LANE, whose views, as Ochsner says, 5 have been fully supported by no less famous a scientist than Metchnikoff," 6 says 7 :
"By chronic intestinal stasis I mean
4 Surgery, Gynecology and Obstetrics, 1913, Dec., p. 737.
6 Surgery, Gynecology and Obstetrics, 1916, Jan., p. 44.
8 The Nature of Man, Part III, Chap. X, Eng. trans., p. 248 et seq.
The Prolongation of Life, Part II, Chap. Ill et al.
7 Proceedings of Royal Society of Medicine, London, Vol. VI, Part 1, p. 94; also British Medical Journal, 1912, May 4, p. 989 et al.
such an abnormal delay in the passage of the intestinal contents through a portion or portions of the gastro-intestinal tract as results in the absorption into the circulation of a greater quantity of poisonous or toxic material than can be treated effectually by the organs whose function it is to convert them into products as innocuous as possible to the tissues of the body."
III. REMOTE EFFECTS OF INTESTINAL STASIS.
Fernere Auswirkungen der Darm-Stase
LANE* emphasizes the fact that intestinal stasis means more than "merely the absence of a daily action of the bowels," and that this stasis is important since "any delay in the passage of the contents of this drainage scheme has a threefold result on the organisms found in the intestine. Their multiplication is facilitated, they extend beyond the limits of their normal habitat, and extraneous strains are developed. These organisms may extend along the ducts of the organs which open into the drain pipe, and they or their products, carried into the blood stream, may infect organs which do not directly communicate with the intestine, for example, the kidneys," producing "progressive degenerative changes in every tissue."
In this way, the disturbance caused by "^ intestinal stasis may be, according to! Lane, Bainbridge, and others, most extensive and important, yet apparently remote from any connection with intestinal toxaemia.
For instance, it affects the ductless glands. RowELL 9 in a "Discussion of Alimentary Toxaemia" before the Royal Society of Medicine, London, reported: "In the case of a very athletic young lady of which I have knowledge, who had a large thyroid and some symptoms of chronic intestinal stasis, after a course of liquid petrolatum given freely three times a day for ten days the thyroid had diminished to less than half its former size, and the patient felt perfectly well." 9 Proceedings Royal Society of Medicine, London. Vol. VI, Part 1, p. 197.
LANE IQ operated on a patient for intestinal stasis. He says: "For eight years she had suffered from an enlarged thyroid which projected forward in her neck, and which interfered with respiration. It contained several large adenomata. . . . Within a few days after the operation, it was obvious that the thyroid was diminishing steadily in size, and this diminution continued till, when she left the hospital, it was but little larger than normal. I understand at the present time it is not larger than normal."
"Also the nervous system is markedly affected." Further, 11 there may be "degenerative changes in the breast associated with stasis, which disappear if the drainage scheme be properly dealt with."
10 Proc. Royal Society of Medicine, Vol. VI, Part 1, p. 106.
11 Surgery, Gynecology and Obstetrics, June, 19 13, pp. 600-606;
Proceedings Royal Society Medicine, Vol. VI, Part 1, pp. 96-105 (Lane); p. 197 et al. (Rowell); p. 317 (Clark). The Operative Treatment of Chronic Intestinal Stasis, by Sir W. Arbuthnot Lane, 3d Edition, London, 1915, pp. 53-68.
12 British Medical Journal, 1911, Apr. 22, pp. 913, 914.
LANE considers intestinal stasis to be intimately and causally connected with many cases of appendicitis, 12 rheumatoid arthritis, and tuberculosis. As regards the latter two, LANE IS says: "In my experience, a patient cannot develop either of these diseases (except in the case of tubercle by inoculation) unless the resisting power to the entry of organisms, or, in other words, the vitality of the tissues of the body, has been depreciated by the poisons which circulate through them in chronic intestinal stasis."
Watson's Classification of Cases
WATSON," of Edinburgh, says: "Long-continued observation of many cases of chronic disease, and more especially private cases which I have had the opportunity of investigating by the aid;sof modern methods of diagnosis, has led me to recognize three distinct groups of conditions that arise mainly or entirely from intestinal toxaemia. ... (1) A neurasthenic group. This includes some cases at present regarded as neurotic, and also a sub-group in which the symp toms are mainly mental. (2) Rheumatoid arthritis. (3) A dyspeptic group."
13 British Medical Journal, 1912, May 4, p. 989.
"Edinburgh Medical Journal (N.S.), 1914, February, p. 130;
1914, March, p. 220 et seq.; 1914, April, p. 345 et seq.
"From a therapeutic standpoint, cases of intestinal toxaemia may be roughly classified into three main groups. Group 1 : Cases in which the symptoms are physical signs which are comparatively trivial and which yield readily to simple medical treatment. Group 2: In which the symptoms are more pronounced and are accompanied by marked objective indications of an abnormal state of the digestive tract, but which are amenable to careful and prolonged medical treatment. Group 3: In which the condition of the digestive tract is so abnormal that medical measures fail to relieve; relief being obtainable only by surgical treatment.
"Cases which fall under one or other of these groups are met with very commonly in the every-day practice of the physician, and I am satisfied that they form a large share of the cases which come under the daily observation of the practitioner."
The "keynote of successful treatment is found in the application of antiseptic and aseptic principles, rest, diet, treatment of bowels," etc. . . . "The use of liquid petrolatum is of great value as a mechanical lubricant in many of these cases."
IV. CAUSE OF THE AUTOINTOXICATION IN INTESTINAL STASIS.
It is of use to note how this autointoxication has been accounted for. PAUL G. WooLEY, 15 of Cincinnati, Ohio, states three possibilities, viz.: First, that "during digestion of food-materials, by the normal secretions of the gastrointestinal tract, toxic substances are formed, and that these substances may enter the blood stream and produce serious disorders." Second, that "bacteria resident in the intestinal tract act upon the foodstuffs and produce toxic substances which are absorbed and act as intoxicants." Third, that "the presence of bacteria themselves, which have entered the blood stream from the intestine, is the source of trouble."
15 Journal of Laboratory and Clinical Medicine, 1915, Oct., pp. 47-49.
DixoN 16 says: "It is by no means certain that true toxins are absorbed from the intact mucous membrane of the intestinal canal," and, for proof, calls attention to the fact that snake venom, diphtheria toxin, and tetanus toxin are harmless when taken by the mouth. He adds: "In general, however, I think . . . that alimentary toxaemia is poisoning produced not by 'toxins' . . . but by relatively simple chemical substances, certainly not of a more complex chemical nature than many of the alkaloids we are in the habit of administering. These poisons are a result of digestion or putrefaction of food . . . chiefly proteins."
ROBERT SAUNDBY, I? however, explains absorption of toxins by traumatism, and emphasizes the importance of constipation in autointoxication on account of its causing lesions in the intestinal mucosa.
16 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 129.
17 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 43.
He says: "Simple constipation does not lead to any increase of decomposition in the faeces . . . but it is a not uncommon cause of chronic intestinal catarrh which may go on to ulceration and even perforation, and it is to these inflammatory consequences that must be attributed the varied symptoms which are associated with constipation," and "nothing is more certain than that many symptoms may result from constipation where alterations in the wall of the bowel have taken place. Nor is it inconsistent with this view that thorough emptying of the bowel should be followed by temporary relief of these symptoms, but, at the same time, we should expect that the simple evacuation of the pelvic colon would not effect a cure."
18 Bacterial Activity in the Alimentary Tract The British
Journal of Surgery, Vol. II, No. 8, 1915, April, pp. 608-638 (see p. 609, also pp. 623, 624). The Lancet Clinic, 1915, August 14, p. 154; 1915, August 21, p. 172.
N. MuTCH, 18 London, in his epoch-making work, says: "To put the matter briefly, the upper alimentary tract is specialized for aseptic absorption of food and the colon for the bacterial destruction of residues. It is conceivable that disease may arise from infection of the lumen of the upper alimentary tract, with the generation of poisonous decom- position products; or from infection through the walls of the alimentary canal with discharge of bacterial toxins into the circulation. . . .
" In all likelihood, some of the symptoms experienced in constipation are caused by bacterial toxins generated in the tissues of the alimentary tract or even in distant tissues infected through this channel. Concerning the pathogenesis of these symptoms, there is little accurate evidence available. . . .
"Secondary intestinal infections, in which less usual organisms are in the ileum in addition to those commonly present in intestinal stasis, probably give rise to many symptoms which must be ascribed to the action of bacterial toxins rather than to food-decomposition products."
But what RowELL 19 says should be borne in mind, viz., that "the exact nature of the particular poison in any case is a minor point, so far as diagnosis and treatment are concerned." 19 Proc. Royal Society of Medicine, Vol. VI, Part 1, p. 196.
V. CONSTIPATION, INTESTINAL STASIS, AND ENTEROPTOSIS.
Verstopfung, Darm-Stase und Enteroptose
SAUNDBY 20 calls attention to a very important matter. He says: "Faecal retention is not inconsistent with a daily action of the bowels"; and A. F. HERTZ 21 emphasizes this fact when he says: "It is well known that the frequency of the stools gives no certain evidence as to the existence of intestinal stasis."
20 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 43.
21 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 164.
22 Surgery, Gynecology and Obstetrics, 1913, June, p. 600 et seq.; also The Operative Treatment of Chronic Intestinal Stasis, 1st, 2nd, and 3rd editions (London, 1915).
SIR W. ARBUTHNOT LANE 22 was the first to emphasize the importance of interference with the "drainage scheme" by "obstruction ... at the points of normal fixation and by kinks due to acquired bands." In the dependent loops of intestine which are formed, the intestinal contents stagnate or move on so abnormally slowly that fermentation and putrefaction produce an enormously large bacterial flora, or form toxins which by absorption are distributed more or less extensively throughout the body. It is necessary, however, to bear in mind that the important fact is not that of enteroptosis with or without kinks, but of autointoxication, whether there are constrictions and a falling of the intestines or not.
A. E. ROCKET 23 says: "Ptosis is undoubtedly a cause of stasis in many cases; and stasis, by its interference with nutrition and by its mechanical elongations of the colon, is probably a frequent cause of ptosis. But ptosis is found without stasis, and stasis without ptosis. . . . Many symptoms, both gastric and intestinal, ascribed to ptosis, are symptoms of stasis, and clear up when the stasis is relieved, and do not necessarily clear up when the ptosis is relieved." So also "stasis does not necessarily mean constipation. There are a few cases of marked intestinal autointoxication without constipation." 23 Surgery, Gynecology and Obstetrics, 1913, Dec., p. 737.
J. N. JACKSON, 24 of Kansas City, Mo., says: "I have seen a true toxic condition without any interference with peristalsis."
WILLIAM J. MAYO 25 says that "about 50 per cent, of the fluids and 10 per cent, of the solids" ingested by the human being "are absorbed by this (the first half) of the large intestine. Beyond the splenic flexure, absorption is limited in amount, the bulk of absorbable material placed in the rectum being promptly passed into the proximal colon for absorption.
24 Journal American Medical Association, 1915, Aug. 28, p. 770.
26 American Journal of the Medical Sciences, 1913, Feb., p. 157.
26 New York Medical Record, 1905, Aug. 12, pp. 246-252
British Medical Journal, 1906, Vol. II, p. 238.
"It has been shown by Bond, 26 Cannon, and others that there is a fairly constant antiperistalsis in the large intestine which passes material back toward the csecum. . . . 'Lyle has aptly compared its storage function to the stomach,' but adds that, ' unlike the stomach, which absorbs
but a small amount, the csecum absorbs actively. In some animals there is a sphincter in the ascending colon to hold the material in the csecum. In man, a marked physiological activity is shown at this point, although no colonic sphincter exists.' '
LESLIE 27 says: In intestinal stasis "the pelvic colon and rectum may become greatly elongated (perhaps as much as twice the normal length), sagging along the floor of the true pelvis, and capable of retaining the faecal matter for several days, even though a small piece may be broken off and evacuated daily, thus giving rise to a false impression of bowel regularity. There may even be irritating diarrhea ' the diarrhea of constipation. ' '
** American Practitioner, August, 1913, p. 410.
It is admitted, then, that in many ways during the passage of the contents of the intestine, and at many places en route, bacteria and toxins are produced and may be absorbed with more or less serious results to the individual. Since this is so, the summary of BAiNBRiDGE 28 is well made. He says: "Lane . . . has demonstrated clearly that in health maintenance, the question of prime importance is body drainage the non-absorption of poisons and the elimination of whatever poisonous matter may be produced within the alimentary canal before there has been inaugurated a vicious cycle of events which may be the forerunner of disastrous end results."
- That this importance of 6 'body drainage' ' is not exaggerated is evident from the experiments of CARREL 29 and others at the Rockefeller Institute for Medical Research and at the Laboratories of the New York Lying-in Hospital. 30 These experiments show "that decay is due to an inability of the tissues to eliminate waste products."
28 Maine Medical Journal, 1913, July.
29 Journal American Medical Association, 1911, Jan. 7, pp. 32. 33; 1911, Nov. 11, p. 1611; 1912, Aug. 17, pp. 523-527.
Studies from the Rockefeller Institute, 18, 1914, pp. 344-349. Journal Exp. Med. t 1913, Jan., pp. 14-19. 30 CARREL AND MONTROSE T. BURROWS, Journal American Medical Association, 1910, Oct. 29, p. 1554.
CARREL AND MONTROSE T. BURROWS, Journal Exp. Med., 1911, Vol. XIII. No. 4, pp. 562-570. A. CARREL, Journal Exp. Med. t 1912, Vol. XV. No. 5, pp. 516-528.
Also "that under the conditions and within the limits of the experiments, senility and death are not a necessary, but merely a contingent, phenomenon." It is this removal of general body waste, and particularly the prevention of additions to the effects of normal waste throughout the body consequent upon the absorption by the intestine of toxins formed on account of the hindrance to normal elimination, that is the aim of the treatment of stasis. The result is a renewed and prolonged vitality of general body tissue."
VI. POSSIBILITY OF TREATING INTESTINAL STASIS BY INTERNAL LUBRICATION.
Möglichkeiten der Behandlung von Darm-Stase mittels innerer Schmierung
The question now arises: Can intestinal stasis be treated by non-surgical means, with any assurance of success?
30 A. CARREL, Journal Exp. Med. t 1914, Vol. XX, No. 1, pp. 1-2.
LOSBE AND EBELING, Journal Exp. Med. t 1914, Vol. XIX. No. 6. pp. 593-602.
The answer of both surgeons and physicians is an unequivocal "Yes," provided a proper selection is made of advanced cases, and incipient or mild cases be cared for promptly; also liquid petrolatum is the remedy to be relied upon, and should be tried before deciding on surgical means, provided the product employed is of the required purity, high specific gravity, and high natural viscosity.
LANE 31 says : " We find some difficulty in drawing the line between the cases in which the stasis can be efficiently met by the use of liquid petrolatum and those in which an alteration in the drainage scheme is advisable. In all doubtful cases we give liquid petrolatum a thorough trial before adopting operative procedures."
WILLIAM S. BAiNBRiDGE 32 says: "The 30 LOSEB AND EBELING, Journal Exp. Med. t 1914, Vol. XX, No. 2, pp. 140-148.
A. H. EBELING, Journal Exp. Med., 1913, Vol. XVII, No. 3, pp. 273-285.
A. H. EBELING, Journal Exp. Med., 1914, Vol. XX, No. 2 pp. 130-139.
31 British Medical Journal, May 4, 1912, p. 989
82 New York Medical Journal, 1914, Jan. 24.
vast majority of cases should have been prevented. Hygienic and medical treatment will cure a large proportion of cases if instituted in the beginning. Certainly, nine out of ten, and possibly nineteen out of twenty, of all cases should not reach the stage which calls for surgical intervention."
LANE 33 says: "From the surgeon's point of view, the treatment of chronic intestinal stasis consists in facilitating the passage of material through the several portions of the gastro-intestinal tract. ... In the vast majority of cases, the use of a lubricating material, such as liquid petrolatum, which precedes the passage of food, application of some spring support to the lower abdomen, which tends to keep the viscera up and to control the delay of material in the small intestine and caecum, and the avoidance of the use of such proteid foods as poison the tissues if retained for an abnormally long time in the intestine, are sufficient for the purpose."
33 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 114.
R. MURRAY LESLIE w says: "In the large majority of instances, if the cases are treated at a comparatively early stage, simple remedial measures such as diet modifications, physical exercises, abdominal massage, supporting belts, aperient remedies, and lubricants (such as liquid petrolatum) are usually quite efficacious. . . . Liquid petrolatum ought to be given in large doses (J^ to 1 ounce) two or three times daily."
WILLIAM VAN V. HA YES M says: "Surgery should not be thought of in the great majority of instances, but is indicated in the marked cases failing to respond to persistent competent medical treatment."
A. F. HERTZ 86 says: "In those cases in which the whole of the colon is involved, medical treatment almost invariably succeeds."
34 Proceedings Royal Society of Medicine, London, Vol. VI. Part 1, p. 272. M New York Medical Journal, 1914, Feb. 28, p. 172. **Proc. Roy. Soc. Med., London, Vol. I, Part 6, p. 175.
37 Surgery, Gynecology and Obstetrics, 1913, Dec., p. 428.
ROBERT C. CoFFEY 87 writes: "The large majority of cases of ptosis may be successfully treated and the patient made perfectly comfortable by medical and dietary measures. Surgery should never be considered for the treatment of ptosis per se. Gastric or intestinal stasis not relieved by medical and dietary measures constitutes the only excuse for surgery in this class of cases." ... "I wish to reiterate that only a very small per cent, of ptosis cases as they now come to the doctor are surgical."
W. B. Russ, 88 of San Antonio, Texas, says: "Cases of intestinal stasis, even though infection and toxaemia are present, are primarily not surgical cases; and, if the patients are properly treated, very few need ever become surgical."
REA SMITH, SS> of Los Angeles, California, says: "I wish particularly to endorse the statement of Russ, that most cases of intestinal stasis are medical, and I agree that operation should be reserved for medical failures."
38 Journal American Medical Association, 1915, Aug. 28, p. 769.
w Journal American Medical Association, 1915, Aug. 28, p. 770.
J. H. KELLOGG, 40 of Battle Creek,' Michigan, says he "feels that his experience has demonstrated that by the systematic use of liquid petrolatum, combined with a laxative and antitoxic dietary, a very large proportion of the cases now subjected to short circuiting and other operations might escape surgical interference altogether; certainly a thing greatly to be desired, especially since we do not yet know what may be the remote effects of these operations, while we do know that the immediate results are often far from satisfactory."
N. W. JoNES, 41 Portland, Ore., writes: "No patient should ever be operated upon until a local barrier of surgical degree has been determined as such by the failure of medical measures."
40 New York Medical Journal, 1914, Sept. 12, p. 508.
41 Lancet Clinic, 1915, Dec. 4, p. 495.
Proc. Roy. Soc. Med. t Vol. I, Part 6, p. 9.
W. HALE WHITE 42 believes the general practitioner can prevent intestinal stasis. He told the Royal Society of Medicine, London, that in intestinal stasis "if surgical interference is ever necessary the patient for whom it is necessary is a reproach to her doctors, if she has consulted any in the earlier period of her illness, for the condition never ought to be allowed to advance to the stage which requires surgery."
In this connection, the words of OCHSNER, 43 of Chicago, Illinois, are significant. He says: "During ... 1914 ... the cases operated upon by my colleague . . . and myself . . . represent less than 10 per cent, of all the cases which came under our care during this period for the relief of intestinal stasis, and still the number operated upon contains some cases which should not have been treated surgically." He gives 44 as "contra-indications to surgical treatment" "the class of neurotics whose nervous condition has not been caused by intoxication due to intestinal stasis," also "in all instances where careful and long-continued hygienic, dietetic, and medicinal treatment results in physiological relief." After these cases are ruled out, "only a very small percentage of patients suffering from intestinal stasis will remain who need to be considered from the surgical standpoint."
* 3 Surgery, Gynecology and Obstetrics, 1916, Jan., p. 45.
44 Surgery, Gynecology and Obstetrics, 1916, Jan., pp. 47, 48.
About three years ago, the Royal Society of Medicine in London, England, 45 had "A Discussion on Alimentary Toxaemia: Its Sources, Consequences, and Treatment." The reading of papers and the debate occupied six sessions on as many days in three consecutive months. It was a very exhaustive consideration of intestinal stasis, and commanded the best medical, surgical, and dental talent. The printed part of this discussion fills 380 royal octavo pages. At the closing of the sessions, W. HALE WHITE," in making the summary of all that had been set forth, said: "It is agreed that in the vast majority of cases medical treatment suffices, and what has been said about treatment hi this discussion has come chiefly from the surgeons. ... If the cases that now seem to some to justify surgical treatment had been treated in the first stages by proper medical means, surgical interference would not have been necessary, so that when this is widely appreciated, cases ought never to become so severe that surgical treatment is contemplated, and we may hope one result of this discussion will be that we shall keep the drainage scheme of our patients in sufficiently good order as to render surgical interference unnecessary."
48 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, 1918, March, April, May, pp. 1-380; 46 Proceedings Royal Society of Medicine, London, Vol. VI, Part 1, p. 380.
And, similarly, A. J. OcnsNER, 47 after saying that intestinal stasis occurs "in patients who have suffered severely from digestive disturbances during infancy, with severe gaseous distension of the intestines," adds, "it seems as though not only the toxic conditions but that the
cause of these conditions should be met by proper prophylaxis before the support of the intestines and the muscular structure have been permanently injured. It would, consequently, seem proper to credit the pediatrician and the general practitioner with the elimination of a great part of suffering from this cause in the future."
47 Surgery, Gynecology andjObstetrics, 1916. Jan., pp. 46, 47.
VII. THE WIDE-SPREAD EXISTENCE OF INTESTINAL STASIS.
Die weit verbreitete Existenz der Darm-Stase
The existence of intestinal stasis and the condition of alimentary toxaemia are much more common than might seem to be the case on first thought.
N. W. JONES,** of Portland, Oregon, says that "fifty per cent, of all people possess the general asthenic type of build," that "within this type . . . lies . . . the potentiality for general body weakness which determines ... the morbid symptoms attributed to ptosis." "Only when mechanical or toxic symptoms occur ... do patients realize that they are not well." "No patient should ever be operated upon until a local barrier of surgical degree has been determined as such by the failure of ... medical measures." These are orthopsedic, hygienic and dietary, and the internal administration of liquid petrolatum. He says: "When the stasis is severe, and especially when it concerns local ileum or csecum blocking, the patient must be put to bed under control, and the bowel filled as rapidly as possible with a soft vegetable pulp and a variable amount of liquid petrolatum."
48 Lancet Clinic. 1915, Dec. 4, pp. 494-495. '
It is evident that there is a very general belief that intestinal stasis can be treated medicinally. OCHSNER'S 49 experience shows how small a per cent, of cases of intestinal stasis is surgical, and WATSON'S 50 careful observations lead him to say that cases which come under his grouping "are met with very commonly hi the every-day practice of the physician," and he is satisfied that such cases "form a large share of the cases which come under the daily observation of the practitioner."
Fortsetzung im nächsten Beitrag!
Gruß,
Clematis
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