Intestinal Obstruction, with Stercoraceous Vomiting, Treated by Large Doses of Opium, Frequently Repeated
Intestinal Obstruction, with Stercoraceous Vomiting, Treated by Large Doses of Opium, Frequently Repeated
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肠梗阻，伴有粪样呕吐，用大剂量鸦片治疗，经常重复
DOI：
10.1136/bmj.2.809.7
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发表时间：
1876
影响因子：
--
通讯作者：
H. Hardwicke
中科院分区：
文献类型：
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作者：
H. Hardwicke
1876年7月1日英国医学杂志。胎盘被取出，没有出血，也没有任何明显的症状，除了持续几天的严重胃痛，大大增加了已经存在的不适和疲惫。在适当补药和清淡滋补食物的治疗下，病人恢复得很好。她仍在该机构工作，身体非常健康。子痫的病因已经有很长一段时间了，甚至现在，仍然是一个很多猜测的主题；而且，尽管近年来著名的医生们已经做了很多工作来确定它们的真正性质，但关于它们的起源和运作方式的理论还需要进一步的说明，才能使它们被最深思熟虑的医学专业人士所接受。因此，毫不奇怪，有些人把假定的原因看作是一种未知的精神或身体潜能的许多影响，通过系统中的印象产生，并获得动态能量，或慢或快地引起抽搐及其病态的伴随。我倾向于相信这一理论有很多道理，而且所引用的案例可以证明某种这样的机构的存在。前兆症状的相对缺失；系统从子宫状态对印象的敏感性；酒精中毒导致神经症的倾向；他所受到的无端虐待，以及病人以前的健康状况，都表明了这一结论。众所周知，在许多癫痫病例中，与身体状态无关的恐惧是令人兴奋的病因。在这种情况下，恐惧对神经系统的影响很可能是导致本已处于不稳定平衡状态的“生命机器”失控的最重要因素。毫无疑问，病人以前的酗酒使她的身体系统容易发生癫痫样的抽搐，这是众所周知的酗酒的结果。目前在这些庇护案件中，有确凿的证据表明，酒精除了其其他有害影响外，足以引起这种癫痫发作。子痫的治疗必须尊重疾病的原因，无论是蛋白尿、尿毒症、水血症还是贫血，并认识到患者的素质和发展。如果可能的话，它必须消除所有道德、精神或身体上的刺激来源，并以成功为目标，而不诉诸经验主义。在上述案例中，氯仿对防止痉挛有很大作用，但它的重要性仅次于水合氯醛，我认为水合氯醛值得强烈推荐。过氯化物铁的酊剂经过相当的试验，发现不适合作为一种特殊的治疗剂。肠子和膀胱都得到了照顾，所有已知的刺激来源，除了子宫，都被切除了。饮食治疗主要包括牛奶和牛肉茶，在病情最严重的时候，病人几乎只靠牛奶和牛肉茶生活。当康复期开始时，要谨慎地使用较强的食物，并继续使用，直到病情好转，可以重新使用普通的收容所饮食。
July I, 1876,] THE BRITISH MEDICAL YOURNAL. placenta was removed, and there was no haemorrhage nor any prominent symptom, save a severe gastric pain which lasted several days, and added greatly to the discomfort and exhaustion already present. Under the administration of suitable tonics and light nourishing food, the patient made a good recovery. She is still in the Institution and enjoys excellent health. The causes of eclampsia have been for a long time, and are even now, a subject of much speculation; and, although much has of late years been done by eminent physicians to ascertain their real nature, the theories promulgated as to their origin and modus operandi require further illustration to make them acceptable to the most thoughtful of the medical profession. It is not surprising, therefore, that some have looked upon the supposed causes as so many effects of an unknown mental or physical potentiality, generating by impression in the system, and having acquired dynamic energy, causing slowly or speedily the convulsions and their morbid accompaniments. I am inclined to believe there is much truth in this theory, and that the case adduced is one that goes to prove the existence of some such agency. The com-parative absence of premonitory svmptoms; the susceptibility of the system from the uterine state to impressions; the predisposition through alcoholismus to neuroses; the unwarranted abuse received, and the previous good health of the patient, all point to this conclusion. Fear, independently of any physical state, is known to be the exciting cause in many cases of epilepsy, and it is probable that in this instance its effect on the nervous system was the most important factor in causing the" machinery of life", already in a state of unstable equilibrium, to run riot. Doubtless, the previous intemperance of the patient had greatly predisposed her system to epileptiform convulsions, which are well known to result from excessive drinking. There are at present in this asylum cases which conclusively prove that alcohol, in addition to its other baneful effects, is potent enough to cause such seizures. The treatment of eclampsia must respect the cause of the disorder, whether it be albuminuria, uroemia, hydraemia, or arremia, and take cognisance of the diathesis and development of the patient. It must remove, if possible, all sources of moral, mental, or physical irritation, and aim at success without resorting to empiricism. In the case described, chloroform did much to ward off the fits but it was second in importance to chloral-hydrate, which I think worthy of the strongest recommendation. The tinctureof the perchloride of iron was fairly tried and found wanting as a special curative agent. The bowels and bladder were attended to, and all known-sources of irritation, except the uterine, removed. The dietetic treatment consisted chiefly of milk and beef-tea, on which the patient almost exclusively lived during the acme of her illness. When conva-lescence commenced, stronger food was cautiously used, and continued until an ameliorated condition justified a recurrence to the ordinary asylum diet.