THE INJECTION OF FLUIDS THROUGH THE ABDOMINAL 
WALLS INTO THE LARGE INTESTINE BY MEANS 
OF THE TROCAR. 
JAMES R. CHADWICK, M.D., of Boston. 
(Read before the N. Y. Obstetrical Society, Nov. 2, 1875.) 
When reporting, recently,1 a case of ovariotomy, in which 
the intestines had been punctured by the aspirator for the relief 
of distressing flatulence, I suggested the feasibility of injecting 
brandy, beef-tea, or other fluids, through the canula into the 
small or large intestine, after the escape of the gas. By this 
means it seemed to me that a patient's strength might be sup- 
ported when nothing could be retained in the stomach, and ab- 
sorption from the rectum was too slow to meet the demands of 
the system. In thisnvay I thought that fluids could be intro- 
duced in considerable quantities into that part of the alimentary 
canal from which they would be most readily absorbed. In 
the same report I raised the question whether peristaltic action 
might not also be excited by the injection of suitable liquids, 
by which means a second and equally important indication 
would be met. 
As the opportunities of testing a new procedure like the 
above must naturally be rare in the practice of one individual, 
I venture to bring before this Society the result of my first ex- 
perience-meagre and unsatisfactory though it be-in the hope 
that others may thus be stimulated to test the value of this 
measure, should the proper emergency arise. 
The case was one of peritonitis following the delivery by 
version of a 9-10 lb. boy, after a labor complicated by the 
presence of four large fibroids in the uterus, and of placenta 
praevia. When the abdominal distention by flatulence became 
so great as seriously to embarrass the respiration, I introduced 
the smallest trocar of my Botin's aspirator through the abdom- 
1 Boston Medical and Surgical Journal, July 22, 1875. 2 
Chadwick : The Injection of Fluids 
inal walls into what appeared to be the transverse colon, or sig- 
moid flexure. A rubber tube was affixed to the canula, and its 
other extremity carried into a basin of water, so that the escape 
of gas could be noted by the steady rise of bubbles from the 
water. After quite an amount of flatus had escaped, but be- 
fore there was any sign of its cessation, I pinched the tube, 
inserted into its end the nozzle of a syringe, and essayed to 
inject beef tea into the intestine. For some reason-probably 
because the minute lumen of the canula became plugged with 
the shreds of tissue which were seen floating in the fluid-the 
attempt utterly failed, though persisted in for quite a while. 
Not wishing to take the time requisite to strain the liquid, be- 
cause of the mental agitation of the patient, I made a solution 
of one part of very choice rye whiskey in three parts of water, 
and proceeded to inject it through the canula into the intestine. 
In this I was successful, but the very first drops of the fluid 
gave the woman so intense a colic-referred to a spot just 
below the point of injection-that I stopped at once for fear 
lest the intestinal wall had dropped off the end of the canula, 
and allowed the whiskey to enter the peritoneal cavity. As 
the pain soon subsided, I injected again with like effect, though 
the pain was less acute, the sensation being rather that of burning. 
Not deeming it right to subject the patient to further suffering, 
I then desisted, having first satisfied myself that the canula had 
not escaped from the intestine by allowing more gas to pass off 
before withdrawing the instrument. Of this fact there was no 
doubt, either in my mind or in that of Dr. A. D. Sinclair, who 
rendered me most efficient assistance. 
In reflecting recently upon the likelihood of such an occur- 
rence as that just referred to, I have gradually been driven to the 
conclusion that this mishap is hardly possible, owing to the ana- 
tomical relations of the peritonaeum. For all practical purposes 
(the openings of the Fallopian tubes may be disregarded), the 
peritonaeum is a closed sack, which, in a state of health, is en- 
tirely empty; consequently we cannot conceive of the opposed 
layers, as represented by the intestinal, visceral, abdominal, etc., 
falling apart, because such a phenomenon would necessitate the 
formation of a vacuum between them. This being contrary to 
nature, the only remaining inference is, that when the gas escapes 
from a coil of intestine, either the subjacent convolutions must through the Abdominal Walls. 
3 
rise to find the space previously occupied by the one that has 
been emptied, or the abdominal walls must contract so as propor- 
tionately to diminish the capacity of the abdominal cavity. In 
either eventuality, the coil evacuated must collapse between 
the abdominal walls and the underlying intestines. The point 
of the canula is not then in danger of emerging into the cavity 
of the peritonaeum, but rather of penetrating the walls of the 
next intestinal coil, provided it is sufficiently sharp. In the 
case under discussion, the canula was blunt and unquestionably 
remained in that portion of the colon into which it was origin- 
ally plunged. 
It will be seen that, in the above remarks, I have assumed 
the absence of gas within the cavity of the peritonaeum; this 
is justified by analogy with the other serous cavities (pleura, 
etc.), and by the silence of all anatomists on this subject. The 
question is an important one, with bearings upon many mooted 
points. For instance, the presence or absence of intestines in 
Douglass' pouch has been often discussed ; if my view, however, 
is correct, this duplicature of the peritonaeum cannot be void, 
and consequently the space commonly assigned to it in the 
illustrations of our text-books must in reality be alternately 
invaded by the uterus, bladder, rectum, and intestines, according 
as one or another of these organs is distended by solid, liquid, 
or gaseous contents. It seems to me not improbable, that the 
normal development of distensible gases within the intestines 
is partly designed to prevent the painful suction that would 
otherwise be exerted upon the walls of the peritoneal cavity- 
notably of 'the abdomen-to fill the vacuum formed by the 
emptying of one or all of the viscera. 
An attempt to obtain corroboration of the views here ex- 
pressed is met at the outset by the serious obstacle, that the 
condition of the peritoneal cavity is completely altered when it 
is opened post-mortem for examination. A reference, however, 
to the superb plates representing sections of frozen cadavera, 
published by Braune, shows in every instance the correctness of 
my conclusions. In Braune's plates, as well as in the numerous 
illustrations taken by him from the works of Le Gendre and 
Pirogoff, no spaces are represented in the peritoneal cavity be- 
tween the uterus, bladder, intestines, etc., and the walls that 4 
Chadwick : The Injection of Fluids 
enclose them. In several of the descriptions it is expressly 
stated that no such spaces existed. 
To return from this digression to the case under discussion, 
one thing is at all events certain, that in peritonitis the intes- 
tines would inevitably be glued to the abdominal walls and to 
each other by the effused lymph, and thus such mishap as was 
feared be prevented. Perhaps this pathologica, condition may 
account for the harmlessness of puncturing he intestines, 
although the contraction of the muscular walls c f the intestine 
would probably suffice to close the minute aperture made by a 
trocar, as is certainly the case with the bladder. 
The woman continued to complain of intermittent lancinat- 
ing pains running down to the groin, and clearly due to peristal- 
tic action. To relieve the suffering, and arrest the action of 
the bowels, which was undesirable in view of the peritoneal in- 
flammation, I administered a quarter of a grain of morphine 
subcutaneously and left the room. In ten minutes I was sum- 
moned by the patient's complaint " that something was about 
to pass from the bowels." Examination with the finger demon- 
strated the presence of two large scybala? in the rectum, which 
had previously been empty, although not even flatus had 
escaped for nearly twelve hours before. The woman died of 
septicaemia two days later. No autopsy was allowed. 
My aim in the above procedure was to introduce nutrient or 
stimulant fluids into the intestine, whence I hoped they would 
be absorbed so as to support the patient's strength, which object 
could not be satisfactorily attained per vias naturales, owing to 
the constant vomiting, and to the fact that enemata could not 
be forced above the lower three inches of the rectum, from 
which very little was likely to be taken up. The constriction 
of the rectum was probably due to the pressure of the large 
group of fibroids contained in the uterus. I entertained the 
hope that, if my patient could be sufficiently nourished, she 
might survive the peritonitis, which did not seem very intense 
or diffuse. In this scheme I was accidentally foiled, but should 
not be deterred from trying the same plan again with properly 
strained beef-tea or a much more dilute alcoholic stimulant. 
As a means of exciting peristaltic action, my procedure was 
eminently successful. The extreme sensitiveness of the intes- 
tinal mucous membrane to the contact of an alcoholic fluid so through the Abdominal Walls. 
5 
dilute as not to produce any appreciable astringent sensation in 
the mouth or rectum, is particularly worthy of note. In lieu 
of any other data, my experience points at alcoholic solutions of 
varying strength as suitable for this purpose. Future experi- 
ments will, I trust, demonstrate that this method is capable of 
being utilized in the treatment of very obstinate cases of intes- 
tinal torpor, faecal impaction, and the like. In the latter condi- 
tion it may perhaps be found, that the hard scybalous masses 
can be softened and broken up by the injection of different 
tin ids into their midst, when enemata and purges have proved 
powerless. 
If this use of the trocar to facilitate the escape of intestinal 
gases is as harmless as is claimed by those who have tried it, I 
see no reason why the intestines should not be repeatedly tapped 
for the injection of fluids in many desperate conditions and 
diseases, when the ordinary resources of medical art have 
failed.