R. A. Cutting

Effect of insulin and glucose on normal and obstructed intestine.

Conclusions From these results, it is suggested that glucose alone should not be used postoperatively and certainly not in the presence of intestinal obstruction, because glucose alone in the majority of instances exerted an inhibiting effect on intestinal activity. Insulin, OS the combination of insulin and glucose produced an increase in intestinal activity. The best results were obtained when insulin preceded the administration of glucose by about one-half hours time. There was no correlation betn-een the intestinal activity and the hlood sugar findings.

Relative Value of Splanchnic and Spinal Analgesia in Treatment of Experimentally Produced lleus

In a previous communication 1 we reported the results of splanchnic analgesia in the treatment of experimental ileus, and concluded that this form of treatment is undoubtedly of great value in reestablishing motility in the intestinal wall. The present communication concerns the relative value of splanchnic analgesia and spinal analgesia. Our results are based upon a series of 70 dogs. In 50 animals novocain splanchnic analgesia was produced, and records of the blood pressure, intestinal motility, and respirations were obtained on the kymographic drum. In most of the cases a single tracing of intestinal motility was obtained, and this from the terminal ileum. In some cases, however, additional tracings were obtained from the duodenum and also from the colon. In 9 animals instead of using novocain an aqueous solution of nicotine was used, as advocated by Rosenstein and KÜhler. 2 Nicotine is apparently an unsatisfactory substance when used in this way, since it increases the blood pressure unduly, and fails to increase the intestinal motility to a satisfactory degree. The range of blood pressure rise in all but 3 animals was greater than 90 mm. of mercury, and, while in 5 cases the tone in the ileum was raised from 10 to 50 mm., as recorded by the writing point on the kymographic drum, the other 4 animals showed insignificant effect on both tone and motility, and in the case of the duodenum and the colon the tone of the intestine was actually decreased. The results of the present investigation, with respect to novocain, show that both the tone and amplitude of intestinal movement are markedly increased in the ileum, the average figure for the tone being an increase of 29.5 mm. and in the amplitude a value of 11.2 mm. The induction of novocain splanchnic analgesia, however, reduces the blood pressure, but not unduly, the average figure being 20 mm. of mercury.

Relative Values of Heat and Cold on Experimentally Produced Peritonitis

Experiments were undertaken to throw light on the controversial question of the relative value of local applications of heat and cold on the course of peritonitis. They are based on 119 animals. Of these, 9 were sacrificed in obtaining cultures. Experimental peritonitis was produced in dogs by the intraperitoneal injection of combined anaerobic and aerobic cultures obtained from animals in which a primary peritonitis occurred as a result of artificially produced obstruction of the cecal appendage. Peritoneal fluid was obtained with hypodermic syringe and needle and inoculated into tubes of meat digest broth, one test tube being incubated under anaerobic and the other under aerobic conditions. The 24 hour cultures of the 2 tubes were then mixed, and equal quantities of the resultant mixture introduced into the peritoneal cavity by hypodermic needles, the skin having previously been shaved and sterilized. The injection was uniformly made into the left lower quadrant at a point approximately midway between the umbilicus and anterior superior spine of the ilium. The animals were then divided into 3 groups. One group was used as control, and received no treatment except the administration of hypodermoclysis. A second group received, in addition to hypodermoclysis, a Leiter coil over the area of injection, through which a continual stream of cold brine flowed. In the third group a similar application to the abdominal wall was made, but hot water was passed through the coil. Observations every 3 hours included rectal temperatures and temperatures of the coil, the latter being obtained by a thermometer inserted between the lower surface of the coil and the abdominal wall. Hemoglobin estimation and leucocyte and differential blood count were made every 24 hours during the survival of the animal.

Treatment of Ileus by Splanchnic Anesthesia. An Experimental Study.

Markowitz and Campbell 1 have shown that spinal anesthesia will relieve paralytic ileus produced in experimental animals. Believing that in these cases inhibitory impulses were transmitted to the intestines by way of the splanchnic and that spinal anesthesia produced a splanchnic block, we decided that spinal anesthesia was dangerous and unnecessary, as the same results could be produced by splanchnic anesthesia by the Kappis technic. Twenty-four dogs were used in this experiment to see if peristalsis could be reestablished in experimentally produced ileus. Upon opening the abdomen of the dog and exposing the intestine there results a physiological ileus. The number of dogs used in this experiment was 14. This type of ileus was easily overcome by splanchnic block with 1% novocain by the Kappis method, producing active peristalsis in the quiescent intestine. The peristaltic waves, after splanchnic anesthesia, were recorded by kymographic tracings. The next experiment was the production of a chemical ileus and the reestablishment of peristalsis in this chemically produced ileus. Five dogs were used in this experiment. The ileus was produced by injecting into the abdominal cavity, through the abdominal wall, iodine and potassium iodide solution. Observations were then made fluoroscopically and radiographically by contrast meal introduced into the gastro-intestinal tract. After the development of the ileus, splanchnic anesthesia was produced. Fluoroscopical and radiographical observations demonstrated the return of peristalsis in the ileus, which readily returned to the normal condition, showing that a chemical ileus could easily be overcome and peristalsis reestablished by splanchnic anesthesia.