ON AN EXPERIMENTAL DEMONSTRATION OF 
THE VALUE OF GASEOUS ENEMETA IN THE 
DIAGNOSIS OF PERFORATIONS OF THE IN- 
TESTINES, AND THEIR REPAIR BY THE RUB- 
BER RING AND DECALCIFIED BONE PLATE 
METHOD. 
IB Y 
R. Harvey Reed: M. D. 
MANSFILLD, O. 
From Transactions 
Ohio State Medical Society 
1 888. 
Press of 
THE WILLIAMS PUBLISHING CO. 
Cleveland, O. [Reprinted from the Transactions of the Forty-Third Annual Report 
of the Ohio State Medical Society.] 
ON AN EXPERIMENTAL DEMONSTRATION OF 
THE VALUE OF GASEOUS ENEMETA IN THE 
DIAGNOSIS OF PERFORATIONS OF THE IN- 
TESTINES, AND THEIR REPAIR BY THE RUB- 
BER RING AND DECALCIFIED BONE PLATE 
METHOD. 
R. HARVEY REED, M. D., MANSFIELD, OHIO. 
We do not claim any originality for the experiments 
we shall endeavor to show you this afternoon. 
To Professor N. Senn of Milwaukee belongs the honor 
for all the originality pertaining to these experiments ; but 
as we cannot have a Senn in every state to attend our 
meetings, the next best thing we can do is to repeat his 
interesting and important experiments, and by these 
means endeavor to impress on every member present here 
to-day their scientific importance and practical utility. 
The first experiment will consist in etherizing a dog, 
and by rectal injections of hydrogen gas, show you that 
this gas can be passed the entire length of the alimentary 
canal, and be burned at the end of a stomach tube inserted 
into the dog's stomach. 
The second experiment will consist in etherizing an- 
other dog, opening the abdominal walls, and making a 
perforated wound of the intestines, which we will again 
replace in the abdominal cavity, and by rectal injections of 
hydrogen gas we will be enabled to show you that the 2 
INTESTINAL PERFORATION. 
gas will escape at the perforation of the intestine into the 
peritoneal cavity, and from there through a glass tube in- 
serted into the abdominal wound, from which it may be 
readily burned. 
We will then take the same dog and make a resection 
of the intestine, and unite the upper and lower ends of 
the same by the rubber ring method. 
The third experiment will consist in etherizing another 
dog, after which we will shoot him through the abdomen, 
and then by applying the hydrogen gas test, demonstrate 
to you positively whether the bullet perforated the intes- 
tine or not; we will then repair the wounded intestine by 
Professor Senn's decalcified bone plate method. 
By repeated experiments Professor Senn has demon- 
strated that pure hydrogen gas is absolutely harmless 
when injected into the intestinal canal, and he has also 
demonstrated by repeated experiments that it is innoxious 
when brought in contact with the peritoneal cavity. 
By experiments on the cadaver he has demonstrated 
that it requires from eight to ten pounds pressure to the 
square inch to rupture the bowel at its weakest point, 
while it only requires from one-quarter pound to one 
and a half pounds pressure to the square inch to force the 
gas the entire length of the intestinal canal. 
By taking an ordinary gas bag filled with hydrogen gas, 
you will find by the use of the manometer that two hun- 
dred pounds placed on the gas bag will register about three 
pounds on the manometer, which enables us to calculate 
very accurately the amount of pressure we are making on 
the intestinal walls by a given amount of weight on the 
gas bag. 
Then by knowing the amount of pressure it requires to 
rupture the intestine, and the pressure it requires to in- 
flate the entire canal, we have our bearings so firmly 
established as to easily avoid all points of danger from 
over pressure. R. HARVEY REED, M. D. 
3 
Now, gentlemen, here is what my friend, Dr. Baldwin, 
calls a " cur of low degree," which has been etherized. 
I will now ask Dr. Craig to insert the stomach tube 
while I insert this rectal tube attached to the rubber hose 
of the gas bag, on which my assistant, Dr. Barker, is 
sitting. 
The doctor will now turn on the gas, which you will 
notice has already commenced to distend the abdomen, 
and were you all close enough you would soon hear the 
gas pass the ileo-caecal valve, which makes a hissing sound 
as it passes through. 
It will take a moment for the gas to inflate the small 
intestines and stomach, when it will escape from the 
stomach tube. 
If Dr. Larimore will now touch a match to the end of 
the stomach tube, I think you will find the gas escaping 
already. [A match was touched to the end of the tube 
and lit the gas, which burned several inches high.] 
There, gentlemen, is positive proof that the gas has 
passed the entire length of the alimentary canal, notwith- 
standing the theories we have been taught concerning the 
ileo-caecal valve. 
The next step in our experiments will be to take the 
second dog, which I will ask Dr. Larimore and Dr. Hedges 
to etherize for me, after which we will open the abdominal 
cavity, and make a perforated wound of the intestine, and 
demonstrate to you that the hydrogen gas will escape from 
the abdominal wound. 
[At this point Dr. Brundage of Xenia suggested that, 
owing to the lateness of the hour, the rest of the experi- 
ments, excepting the rubber ring operation, be dispensed 
with, as the audience would take it for granted that the 
gas would escape from the wound of the intestine without 
taking the time to actually demonstrate it. Dr. Reed said 
he was ready and willing to do whatever the audience 
preferred in the matter. After some general talk, it was 4 
INTESTINAL PERFORATION. 
decided that the rubber ring experiment should be 
demonstrated on the dog, and that that should close the 
experiments.] 
While the dog is being etherized we will utilize our time 
by describing the ring, which consists of the simplest 
form of ordinary black rubber. 
The one I have here is made from a common rubber 
nipple, which has been cut in segments about half an inch 
in length. These segments were cut lengthwise and re- 
duced in calibre to suit the intestine for which they are in- 
tended. 
The rings are reunited by continuous catgut sutures. 
[Shows different sized rings ready prepared.] 
You will readily observe by having the rings prepared 
in this manner that the catgut sutures, which hold the 
ring together and really make it a ring, will soon become 
absorbed, converting the ring into a straight piece of 
rubber, which will be readily passed per rectum without 
the least danger of obstruction. 
We will now proceed with the operation by opening the 
abdominal cavity along the median line, and, after resect- 
ing some six or eight inches of the ilium, reunite the 
divided ends. 
I will now tie the mesenteric arteries close to the border 
of the section of the ilium to be removed. 
This being done, I will separate the mesentery from 
that portion of the ilium, being careful to keep my in- 
cision between the ligatures and the border of the intestine, 
and thus avoid any hemorrhage. 
Before we proceed any further, we must satisfy our- 
selves positively which is the upper end and which is the 
lower end of the intestine, for in this operation it is 
absolutely necessary to know this, and observe that the 
proper relation of the bowels be carefully maintained in 
uniting them. This is not necessary, however, in the R. HARVEY REED, M. D. 
5 
■decalcified bone plate method, which is a strong argument 
in its favor. 
By examination, I find that this is the upper portion of 
the bowel, around which I will throw this broad rubber 
band, which is simply a piece of rubber such as you 
would use for your pocket diary, which I have cut open, 
and also cut a slit near the one end, which readily enables 
me to pass it around the bowel, and by pushing the end 
through this slit and drawing it tight, prevents all extrav- 
asation without injury to the intestine, and when the 
operation is over, it is easily and quickly removed. 
This narrow rubber band I will place around the lower 
end of the bowel in the same manner as the first, which 
will not only prevent extravasation, but serve as a mark to 
designate between the upper and lower portions of the in- 
testinal tract, the upper one having the broad rubber band 
around it, and the lower one having the narrow band 
around it. 
We are now ready to remove the segment of intestine 
between these rubber bands, which I will now do with the 
scissors. 
The next step in the operation is to insert this rubber 
ring into the upper end of the intestine, so that the lower 
edge of the ring and the cut end of the bowel are just 
even, and fix it there by a continuous catgut suture 
" whipped" over and over, as it were, the two ends. 
Having done this, I will next carry a needle, armed with 
a catgut, through the wall of the intestine and upper end 
of the ring, and out through the lower opening of the 
ring and bowel, and back again and out through the 
upper end of the ring and intestine, about a line from 
where I entered, and by tying the ends of the catgut 
together, I fix the upper end of the ring in the bowels. 
Having thus fixed the rubber ring in the upper end of 
the intestine, we are now ready to invaginate the lower 
end of the bowel, which I will now do with my forceps, 6 
INTESTINAL PERFORATION. 
and turn the serous surface in about half or three-quarters 
of an inch. 
My assistant will now hold the lower end of the bowel 
so as to prevent the return of the invaginated portion, 
while I take my forceps and carefully grasp the upper 
portion of the bowel and rubber ring, and insert them 
into the invaginated portion of the lower end of the 
intestine. 
You will observe that the contraction of the cut end 
of the bowel makes this procedure somewhat difficult, 
owing to the dilatation of the upper end by the rubber 
ring and the reduction of the calibre of the lower end by 
the invagination. 
Having inserted the upper end into the lower, the next 
step is to fix it there by two sutures passed through both 
the upper and lower portions of the intestine and also the 
rubber ring. 
These sutures should be passed one on each side of the 
intestine, as it were, and not on the mesenteric border or 
dorsem of the bowel, so to speak, and should be of catgut, 
and simply carried through both the upper and lower por- 
tion of the bowel and include the rubber ring, and then 
carried out again through the same, say half an inch from 
where you entered, and the two ends of the suture tied 
together. 
Owing to want of time, I will not wait to introduce both, 
of these sutures, as my object is to demonstrate the gen- 
eral principles of the operation rather than the technique;, 
hence I shall only take the time to insert the one suture. 
Having united the two ends of the intestine, the last 
step is to cut off a small piece of the omentum, which we 
will select from the least vascular portion of the omental 
apron, and throw it around the intestinal splice like a 
ferule, and fix it there by two or three catgut sutures 
along the mesenteric border of the intestine. 
Then remove the rubber bands from around the upper R. HARVEY REED, M. D. 
7 
and lower portion of the bowel, and after cleansing the 
peritoneal cavity, close the abdominal wound and the 
operation is complete. 
I will now ask you to take the trouble to come down 
and examine what we have done for yourselves, and if 
any part of the operation has not been made plain, I will 
try to make it so. [The members then came down and 
examined the results of the operation.] 
By this method you will observe that a resection of the 
intestine can be made, performing an enterorrhaphy, as I 
have done to-day, or an ileo-colostomy, or a lateral im- 
plantation operation, with little danger of extravasation, 
the operation being much easier and more rapidly per- 
formed than any of the old methods of uniting the bowel 
by the Czerny-Lembert suture, and with much less 
danger of fecal extravasation. 
By this method you are enabled to bring two broad sur- 
faces of the peritoneum together and fix them there, while 
the rubber ring, by its elasticity, keeps the intestinal walls 
from collapsing, and keeps the upper and lower portions 
of the intestine held firmly together, preventing extravasa- 
tion and facilitating rapid union, which is usually com- 
pleted in from 36 to 48 hours. 
The ferule of omentum not only acts to doubly 
strengthen the splice made in the intestine, but it soon 
becomes firmly adhered to the intestine and prevents ex- 
travasation, should a defect occur at any point in the splice. 
The catgut sutures soon become absorbed, which is 
not until the two ends of the intestine are firmly united, 
when there is no further use for the rubber ring, which is 
passed per rectum as a straight piece of rubber. 
I regret that want of time will prevent my showing you 
the decalcified bone plate operation, for I think time will 
demonstrate it to be the better of the two operations 
when put to the crucial test for the repair of the in- 
testines. 8 
INTESTINAL PERFORATION. 
As already mentioned, in this operation it makes no 
difference in performing an ileo-colostomy whether the 
operator knows which is the upper or lower end of 
the bowel. 
All that is required is to ligate the mesenteric arteries, 
remove the desired portion of the .intestine, invaginate 
both the upper and the lower ends of the bowel and close 
them while invaginated with a continuous catgut suture ; 
then make a slit, say an inch long, in each intestine about 
an inch from the end, on the opposite side of the bowel 
from its mesenteric border ; then by inserting one of the 
decalcified bone plates into each slit [passes fac-similes of 
the decalcified bone plates around],* and fix it there by 
transfixing the sides of the slit with the two sutures 
armed with the needles, and bring the two sutures, not 
armed with the needles, out at the ends of these slits. 
After you have fixed both ends of the intestine alike, 
you have nothing to do but carefully approximate slit to 
slit and tie the lower two sutures together, then each 
of the two end sutures together, and lastly, the 
upper two sutures together, and you will have an artificial 
channel established between the upper and lower ends of 
the intestine, which is firmly braced with these bone 
splints which hold the serous surfaces of the intestine 
firmly against each other until union is complete, when 
the bone splints are digested, and the ligatures are passed 
per rectum, while the continuity of the bowel is estab- 
lished with only a slight "jog in it," as our civil engineers 
would call it. 
In the majority of instances I prefer the decalcified bone 
plate operation, because of its simplicity and efficiency. 
By this operation you can make a resection, or by an 
implantation operation "side track" any desired amount 
*For description of bone plates, see "Some New Operations in Ab- 
dominal Surgery," etc. Columbus Medical Journal, Vol. VI., No. 7, 
page 301. R. HARVEY REED, M. D. 
9 
of the intestinal tract, and allow it to undergo physiological 
atrophy; or, as in a case I saw a few days ago in the 
Milwaukee Hospital, in which there was a cancer of the 
pylorus, where Professor Senn had, by the bone plate 
method, divided the duodenum below the cancer and 
attached the lower portion of the bowel to the greater 
curve of the stomach, the operation proving successful, 
the speaker having seen the patient and talked with her 
during her convalescence. 
Before closing these remarks, allow me to say that my 
friend, Dr. William Mackie of Milwaukee, has just 
written me that on the eve of his return home from the 
meeting of the American Medical Association at Cin- 
cinnati, he was called to a case of gun-shot wound, where 
he had occasion to use the hydrogen gas enemata for 
diagnostic purposes, and found it as reliable in the human 
as in the dog, this being the first case on record in which 
it was used for diagnostic purposes on the human subject.* 
The practical importance of these discoveries made by 
Professor Senn is of such moment to the profession, not 
only from a scientific but a medico-legala aspect, that I 
trust the imperfect attempt I have made here this after- 
noon to reproduce them will at least be sufficient to 
interest you all enough to procure and read for yourselves 
his masterly production on "An Experimental Contri- 
bution to Intestinal Surgery, with Special Reference to 
the Treatment of Intestinal Obstruction," read before the 
Ninth International Medical Congress, and published in 
the Annals of Surgery; also his paper on "Rectal 
Insufflation of Hydrogen Gas an Infallible Test in the 
Diagnosis of Visceral Injury of the Gastro-Intestinal 
Canal in Penetrating Wounds of the Abdomen," read in 
the section of surgery at the Thirty-ninth Annual Meet- 
* Since my return from the State Society, I received the report of Dr. 
Mackie's case in the Medical News, Vol. LIL, No. 23, page 628. 10 
INTESTINAL PERFORATION. 
ing of the American Medical Association,* and after 
reading and studying those wonderful contributions to 
intestinal surgery, you will, if not satisfied with their 
practical value, repeat his experiments for yourselves 
until you are satisfied, and then prepare yourselves with 
the necessary equipments to apply these simple and 
reliable methods for the saving of human life in your own 
practice. 
* Since delivering the above lecture, Professor Senn's paper on " Rectal 
Insufflation of Hydrogen Gas," etc., has been published in The Journal 
of the American Medical Association, Vol. X., No. 25, page 767.