Transcribed from the pdf
Journal of the American Medical Association May 17, 1902 pp. 1304-1305
UNPRECEDENTED CASE OF CONSTIPATION
D. Geib, MD., and J.D. Jones. M.D
Groton, S. D.
This case, reported in the South Dakota State Medical society, June, 1900 and
to the Aberdeen District Medical Society, June, 1900, by Dr. D. Geib, was
further described in a communication to the Aberdeen District Medical Society,
September 1901, by Dr. J.D. Jones and concluded by review of the case to time
of death, January 8, 1902, with autopsy, by Drs. D. Geib and J. D. Jones.
The patient, Mr K, having enjoyed good health previous to the age of 11, began
at that time to be constipated and was treated for three months by Dr. Nicholas
Senn, then of Dodge County Wisconsin, no bowel movement being secured. The
result of cathartics and laxatives was severe pain. The constipation continued
until death. It was a common occurrence for him to go three weeks or as many
months without a movement of the bowels. At the age of 20 he did not have a
movement for three or four months at a time. He consulted a homeopathic
physician, who prescribed for him two drops of croton oil, to be doubled in two
hours, tripled in four and quadrupled in six hours. This produced no result but
after a period of several weeks, his bowels moved again.
For seven years following his bowels were fairly regular. At the age of 29 he
contracted a severe cold and five months and three days passed without an
evacuation. After a few months of regularity, his bowels did not move for six
months and fourteen days. At this time he consulted Dr. Stamm of St Paul,
without immediate benefit, but during the next six months his bowels were
regular. In February, 1900, the constipation returned. The patient had no
movement from June 18, 1900 to June 21, 1901.
During these periods of costiveness he could eat full meals and do a good days
work. His respiration was always normal the urine was normal when he was free
from pain, but highly colored when in pain. The evacuation of his bowels left
him very weak and was greatly troubled with gas so that he had to lie on his
right side to relieve himself and was partially disabled for work.
His abdomen was greatly distended so the liver and the stomach crowded up the
diaphragm and the floating ribs were visibly pushed out. there was tenderness
in the sigmoid flexure, but over the remainder of the abdomen he could bear
He was not troubled with gas when regular. The administration of valerian,
sumbul and asafetida by Dr. Geib gave him considerable relief.
On June 19, 1901, Dr. Jones was called in with Dr. Geib to relieve the patient
from his painful condition. The abdomen was greatly distended. The colon, on
palpation, seemed to be as large as a six-inch stovepipe. From the head of the
sigmoid flexure to the rectum, the bowel seemed to be perfectly straight and
hard. On digital examination the rectum was found filled with a mass of fecal
matter so hard that no impression could be made on it. The anus was dilated and
the mass removed from the rectum with a bone curette and hot water. Further
operation was postponed because of the pain suffered by the patient, and olive
oil enemas were ordered.
June 21, on further attempt to evacuate the bowels, it was found that the olive
oil had softened the hard mass so that about two pounds of feces could be
removed before the patient complained of pain; his weakened condition prevented
further operation. The circumference of the patient at this time at the
ensiform cartilage was 39 in., at the umbilicus, 38.5 in., and at the crest of
the ileum, 39 in.
On arrival at the house on the morning of June 22, the report was received that
he had passed an ordinary pailful of feces since the day previous. There was
much rejoicing in the family. The patient was very weak and sore, so no further
operation was attempted at this time, but the olive oil enemas were ordered
The patient, when next seen, on June 25, was feeling comfortable; the gas had
ceased to trouble him and he had passed about three quarts of feces that
morning. His measurements at this date were, at the ensiform cartilage 34 in.,
umbilicus 33in., and at the crest of the ileum, 30 in.
The enemas were ordered continued, Mr. K. estimated that he had passed about
eight gallons of feces since the beginning of the treatment. On June 29, he was
cheerful and pleased at his progress. The measurements at the ensiform
cartilage were 34 in., umbilicus 30 in., crest of ileum 29 in. From that date
he received massage treatment given by Dr. Geib, twice a week for three weeks,
and improved in strength so that he was able to ride to town and walk about.
One July 8, after his massage he suffered considerable pain for about three
His bowels moved frequently. The contents were described as resembling soft
soap and during this period of discomfort he passed a hard mass about the size
of a ducks egg, containing grape seeds. He had not eaten grapes since the fall
before. After this he had little trouble and gained in strength and weight. The
only treatment then given was massage, iron and strychnia.
The history of the case subsequent to the above report to the Aberdeen District
Medical Society is as follows: Since the treatment in June, 1901, the bowels
regularly; occasionally he was obliged to take an enema, but he was well
nourished and weighed more than he had for years. He was very sensitive to cold
this winter, chilling on the least exposure.
On the second day before his death, which occurred Jan. 8, 1902, he rode to
town, a distance of eight miles. He retired at 11 p.m. apparently as well as
usual, and awoke about 5 a.m. with pain. He arose about 8 a.m. built the fires
and did part of his morning's work. The pain, however, became very intense and
he went to the house and suffered more or less all day. There was a great
desire to evacuate the bowels, but it was impossible. At 2 o'clock the
following morning, he died while sitting on the stool. No medical aid was
The autopsy showed the abdomen greatly distended with gas and fecal matter. On
making an incision along the linear alba, the tension was sufficient to tear
the flesh apart; the omentum was very thin and the colon was brought at once
into view. The position of the colon was as shown in the photograph, save that
the extra loop overlaid the normal colon. The splenic flexure, transverse colon
and descending portion of the extra loop were very much thickened, containing
much more muscular fiber than normal. The parts most distended were the splenic
flexure, the transverse and descending portion of the extra loop, but the whole
colon was much larger than normal.
The most distended portion measured 19 1/4 inches in circumference. The
rectum contained a hard mass of feces shaped like a goose egg, measuring about
4 inches in the shortest diameter and 6 inches its longest. This was pressed
tightly against the sphincter and acted as a valve. The remaining portion of
the colon contained soft feces; the total contents were an ordinary bucketful.
The stomach and small intestines were empty. The diaphragm was crowded up to
the level of the forth rib on the right side; the heart and lungs were both