TVHE study of the colon has been somewhat ' neglected in comparison with the intense research on the stomach and gall-bladder. The barium enema has not been used often enough. In routine X-ray examination in the past we have often looked at the twenty-four hour plate, seen the colon more or less filled and gone no further. In many clinics the barium enema has been used in only one-fifth or less of the gastro-intestinal cases.The colon is worthy of investigation not only to detect the deformities of cancer, diverticulitis, or adhesions, but especially in cases of constipation to learn also the form, position and tone, the degree and mode of emptying, the types of peristalsis or segmentation. In this way important anomalies are discovered, one of the most interesting of which is the redundant colon.Several of the members of this Association have recently studied this interesting condition and helped us to understand it. We are greatly indebted to the pioneer work of Mills1, to the clinical studies of Kantor2, to the statistical work of Larimore3, and also to the observations of Bryant4 on the length of the intestine.The ensuing data are based on a series of 43 cases.They show that the redundant colon is riot uncommon, but is very frequently overlooked, and early wrong diagnoses have been the rule. It is associated with, and we believe is the cause of, important abdominal symptoms, such as, colics, constipation, and flatulence. Formerly, it used to be discovered only as an occasional surprise at a surgical operation, and we had a wrong impression of the disease, as surgery discovered only the most severe cases. Now with the frequent use of the Roentgen ray we have a far better idea of its frequency, importance and diagnosis.Description. The redundant colon is one that is too long for its owner, and is loosely attached, falling readily into loops and kinks. This is not a question of absolute length, as Bryant4 has shown that there is considerable normal variation in the length of the colon ; it is simply too long for the individual abdomen. The redundancy may be general ; the whole colon may fit the abdomen badly, every part of it may be a little too long and too loose; or it may be local; there is simply a long sigmoid loop, a double loop at the splenic or hepatic flexure, or a very long transverse colon. Over two-thirds of the important loops are found on the left side of the colon, in the sigmoid, descending colon or splenic flexure. This looping and kinking of the colon may interfere with its function, and cause mild, moderate, or even very severe symptoms, which lead to confusion with other kinds of abdominal disease.For reasons given below under diagnosis, we have not included in our series cases described as hyperrotation of the colon, or over-descent of the cecum, where the hepatic flexure is in the normal position, the right side of the colon long and straight, and the cecum low ( fig. 8) ; nor cases of non-fusion of the cecum (mobile cecum) ( fig. 10).The cause of redundant colon is usually considered to...
Our conclusions from the literature and our own experiments may be summarized as follows: I. Blood for bacteriological examination during life should be taken directly from the veins and in considerable quantity. II. Resorption of toxines is the most important feature in cases of sepsis; pyogenie bacteria invade the general circulation in a rather small proportion even of severe eases, and, as a rule, late in the course of the disease. III. A general infection by the pnenmococcus can be demonstrated occasionally in the late stages of acute lobar pneumonia. IV. The value of blood cultures as a means of diagnosis in obscure cases of sepsis is limited by the fact that invasion of the blood by the specific organism cannot be demonstrated during life in the majority of cases. Positive cultures are very valuable; negative cultures do not exclude local septic infections. V. The detection of specific bacteria in the blood of cases of sepsis and of pneumonia gives a very unfavorable prognosis in most cases. VI. General terminal infections with pyogenic cocci occasionally occur as an immediate cause of death in chronic disease. Local infections processes play this part more frequently. VII. As far as our experiments have shown, invasion of the blood by bacteria during the death agony, with subsequent distribution of the genus to the organs by the circulation, is a rather uncommon occurrence. VIII. Owing to the relative infrequency of agonal invasion, we believe that in the majority of cases where the autopsy is performed promptly after death, the bacteria which are found in the organs succeeded in reaching these organs previously to the death agony, and are associated with the course of the disease. IX. The presence of bacteria in the organs of late autopsies is due in many cases to post-mortem extension from one organ to another, and in some cases to the post-mortem growth of small numbers of genus which were distributed to the organs by means of the circulation.
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