Clinical Lecture on Obstinate Constipation and Obstruction of the Bowels
Authors: P. Black
Journal: BMJ (1871)

OBSTINATE constipation" and " obstruction of the bowels" are events which may take place from a great variety of causes.Some of these I shall endeavour to place before you.One of by no means uncommon occurrence consists in an "accumulation of impacted fleces" in the large bowel.This is a form of the complaint which is attended by very little or no danger, and is soon relieved by proper measures.Yet even this may occasion great temporary distress to the patient, and much anxiety to the friends.I will mention a case which occurred in my own prac- tice a good many years ago.I had been in long attendance on a lady, about thirty, for no definite organic disease.She at last got tired of me, and, at the instance of her nurse, a homoeopathic physician, since dead, was called in.After he had been some time in attendance, I was recalled on an emergency of so-called "obstinate constipation" or "obstructed bowels."It seems that her homoeopathic doctor had referred her complaint to an attack of piles; but as he failed to relieve it, the friends became excessively anxious, and a little ashamed, and I was again summoned.I found the lady in a state of considerable suffering, with, however, little or no febrile disturbance, but she had some nausea, and refused all food.Sbe had a desire to go to stool, but the slightest straining effort caused such pain that it was impossible to persevere.Her bowels had been locked up for about ten days.My examination satisfied me that all her dis- tress was caused by hard impacted fteces which bad been allowed to accumulate in the lower bowel, and that the easiest way of relieving her would be by repeated injections of warm water.Some objection was made to this simple and easy treatment, and the late Mr. Aston Key was called in consultation with me.He took the same view of the case, and said that, if this were not done, he should be obliged to scoop out the contents of the bowel with the handle of a spoon.The first alternative was then adopted, and complete relief was obtained, after which I was allowed to withdraw, to be again replaced by the homeeopatbic doctor.This case should perhaps be rather called a case of "constipation" than of "obstruction."Nevertheless, the bowels were locked up for a considerable time, and symptoms were coming on not unlike those which betoken a more serious affection.I will mention another case in which the obstruction seemed to be seated higher up, though this case, also, may be regarded as simply one of " obstinate constipation."Some years ago I was asked to visit a lady resident at Islington.I knew her previously, and, judging from her appearance, had always thought her a very healthy person.I was now told, however, that she was subject to the constant inconvenience, or more than inconvenience, of obstinately constipated bowels, and that she frequently used very large injections of very hot water.The account given me of her attack was this.She had just returned from War- wickshire, whither she had gone to be present at a wedding, and had been absent three days.She had not felt well on leaving home, and would rather not have gone, but was unwilling to disappoint her friends.During the whole time of her absence she felt very unwell, and was seized with sickness on the railway in returning, which sickness had occasionally returned.I saw her in bed with a tranquil countenance; no pain in the abdomen, which bore pressure everywhere.The tongue was slightly furred ; the pulse not affected.She had a cool skin, and had slept tranquilly during a considerable portion of the night.I took a very favourable view of the case; but, knowing that an invincible obstruc- tion will sometimes come on with these mild symptoms, I was deter- mined to use no measures which would have the effect of aggravating the sufferings should this unfortunately be the case.Accordingly, the plan of treatment which 1 adopted was to keep washing out the lower bowels by means of injections, until these came away unchanged, which would be a proof that they had done everything they were capable of effecting.A very large quantity of faecal matter was brought away in this manner, and the patient seemed in a more comfortable state.At last, the in- jection was returned without bringing any ftcal matter along with it.She was now seen by Dr. Burrows in conjunction with myself, and, as some sickness continued, he advised the continuance of the injections, and a draught containing the effervescing citrate of magnesia at inter-