Abstract OPPORTUNITIES to assess directly the effects of pharmacologic agents on large segments of exposed, intact human colon in the unanesthetized state have been rare. Such studies have been reported by Puestow1 and Weeks,2 and recently a new opportunity to study directly the appearance and function of the colon in four human subjects with fistulas became available. Previous reports have concerned themselves chiefly with motility functions. The present communication is based not only on observations of motility but also on a study of alterations in color, degree of engorgement and fragility of the mucous membrane. SUBJECTS Subject A was a 26 year old mechanic who had had chronic ulcerative colitis for six years. An ileostomy had been performed two years previously. Shortly after the ileostomy there occurred a large prolapse of ascending colon and cecum through an old cecostomy wound. The prolapsed area measured 7 by 2½ inches (18 References 1. Puestow, C. B.: Intestinal Motility of the Dog and Man, Illinois Medical and Dental Monographs , vol. 2, no. 4, Urbana, Ill., University of Illinois Press, 1940. 2. Weeks, D.: Observations of Small and Large Bowel Motility in Man , Gastroenterology 6:185, 1946. 3. Drs. Asher Winkelstein, Ralph Kaufman, Sidney Margolin and Franklin Hollander gave us permission to report these pharmacologic studies performed when one of us (W. J. G.) was an assistant clinical research fellow at Mount Sinai Hospital, New York. 4. Munsell Book of Color , Baltimore, Munsell Color Company, Inc., 1929. 5. Richards, C. W.; Wolf, S., and Wolff, H. G.: The Measurement and Recording of Gastroduodenal Blood Flow in Man by Means of a Thermal Gradiometer , J. Clin. Investigation 21:551, 1942.Crossref 6. Meyer, K., and Hahnel, E.: The Estimation of Lysozyme by a Viscosimetric Method , J. Biol. Chem. 163:723, 1946. 7. Wolf, S.: Effects of Suggestion and Conditioning on the Action of Chemical Agents in Human Subjects—The Pharmacology of Placebos , J. Clin. Investigation 29:100, 1950.Crossref 8. Grace, W. J.; Wolf, S., and Wolff, H. G.: Life Situations, Emotions, and Colonic Function , Gastroenterology 14:93, 1950. 9. Wener, H. E., and Simon, M. A.: The Production of Ulcerative Colitis in Dogs by the Prolonged Administration of Mecolyl , Gastroenterology 12:637, 1949. 10. Goodman, L., and Gilman, A.: The Pharmacological Basis of Therapeutics: A Textbook of Pharmacology, Toxology and Therapeutics for Physicians and Medical Students , New York, The Macmillan Company, 1941. 11. Carmichael, A. E.; Fraser, F. R.; McKelver, D., and Wilkie, D. P. D.: The Therapeutic Action of Progstigmin , Lancet 1:942, 1934.Crossref 12. Wolff, L. H.: The Effect of Certain Parenterally Administered Drugs on the Colon of the Dog . Am. J. Digest. Dis. 6:243, 1939.Crossref 13. Lium, R.: Etiology of Ulcerative Colitis: II. Effect of Induced Muscular Spasm on Colonic Explants in Dogs, with Comment on Relation of Muscular Spasm to Ulcerative Colitis , Arch. Int. Med. 63:210 ( (Feb.) ) 1939.Crossref 14. Riker, W. T., and Wescoe, W. C.: Direct Action on Prostigmine on Skeletal Muscle: Its Relationship to Choline Esters , J. Pharmacol. & Exper., Therap. 88:58, 1946. 15. Grace, W. J.; Holman, C. W.; Wolf, S., and Wolff, H. G.: The Effect of Vagotomy on the Human Colon , Gastroenterology 13:536, 1949. 16. Lyons, R. H.; Mol, G. K.; Weligh, R. B.; Hooblev, S. W.; Campbell, K. N.; Berry, R. L., and Rennick, B. R.: The Effect of Blockade of Autonomic Ganglia in Man with Tetraethyl Ammonium Chloride , Am. J. M. Sc. 213:315, 1947. 17. Posey, E. L.; Brown, H. S., and Bargen, J. A.: The Response of Human Intestinal Motility to Tetraethyl Ammonium Chloride , Gastroenterology 11:83, 1948. 18. Elsom, K. A., and Drossner, J. L.: Intubation Studies of the Human Small Intestine: XVII. The Effect of Atropine and Belladonna on the Motor Activity of the Small Intestine and Colon , Am. J. Digest. Dis. 6:589. 1939. 19. Wolf, S., and Wolff, H. G.: Human Gastric Function: An Experimental Study of Man and His Stomach , ed. 2, New York, Oxford University Press, 1947. 20. Posey, E. L., Jr.; Bargen, J. A.; Dearing, W. H., and Code, C. F.: Effects of Certain So-Called Antispasmodics on Intestinal Motility , Gastroenterology 11:344, 1948. 21. Jackman, R. J., and Bargen, J. A.: The Influence of Certain Antispasmodic Drugs on the Intestine of Man , Surg., Gynec. & Obst. 67:63, 1938. 22. (a) McDonald, A. D., and Settle, H. L.: Action of Posterior Pituitary Principles on the Colon , J. Physiol. 86:8 P, 1936. 23. Hollander, F.: The Insulin Test for the Presence of Intact Nerve Fibers After Vagal Operations for Peptic Ulcer , Gastroenterology 7:607, 1946. 24. Almy, T. P.; Hinkle, L. E.; Berle, B., and Kern, F.: Alteration in Colonic Function in Man Under Stress: II. Experimental Production of Sigmoid Spasm in Patients with Spastic Constipation , Gastroenterology 12:437, 1949. 25. Wolf, S.: The Relation of Gastric Function to Nausea in Man , J. Clin. Investigation 22:877, 1943. 26. Wolf (footnotes 17 and 23).
A.M.A. Archives Surgery – American Medical Association
Published: Dec 1, 1950