There are potentially a number of things that we could describe today as "bowel paralysis". Taking the term at face value, "bowel paralysis" would imply that the bowels of the patient are no longer motile, leading to constipation and bowel obstruction. Perhaps the diagnosis we see today that is most consistent with that definition is gastroparesis, which is a slowing/complete stalling of the intestines.

However, it is important to note, that in early medicine conditions were described by the macro-effects they caused and not necessarily by the specific pathophysiology underlying the condition. For example, the disease consumption was named such because it those afflicted became emaciated and were "consumed" by the disease before they passed. As science progressed, we determined that the "consumption" was actually caused by an underlying tuberculosis infection.

Keeping that in mind,it is likely that your grandmother passed away, at least in part, from a condition that caused her to bowels to function improperly and inhibited the passing of stool.

There are a handful of conditions that can cause actual bowel paralysis (eg gastroparesis). However, we must also consider conditions that could mimic the appearance of bowel paralysis. From an epidemiological and statistics standpoint, there are quite a few more conditions that could look like bowel paralysis that there are those that actually cause paralysis of the gut wall. We must take that a step further and consider that the medical conditions and diseases plaguing us today are considerably different than those from 100 years ago. Additionally, we must consider the differences in diagnostic tests and treatment options afforded to physicians today versus those afforded to doctors a century ago. As I'm sure you've surmised, I don't think there can be one nicely wrapped answer to your question.

If you have any other information about your grandmother's medical history, that would certainly help point myself or any other writer towards a more likely cause. Some questions that might be helpful to answer: How old was your grandmother when she died? What medical problems did she have? Did she have a history of abdominal surgery? Was her death the culmination of a long struggle, or did it occur rather rapidly? Did she have onset of any new symptoms in the months preceding here death? If so, what were they?

If you don't have the answers to those questions, that's okay. I'll detail below what I believe would be the commonest causes of fatal "bowel paralysis" in the setting of the limited medical care one would be able to receive in 1910.

1. Bowel obstruction.

• This is normally caused by a mechanical obstruction of the bowel
• It can be caused by things like abdominal surgeries which leave adhesions that constrict the bowels externally
• It can be caused by things like infection, parasites and cancers that obstruct the lumen of the bowel itself
• It can be caused by an internal hernia
• A bezoar or stool ball

2. Intestinal ischemia

• This is caused when the intestines lose blood flow, which is most often secondary to cardiac thromboembolic phenomenon
• It can be chronic in the setting of significant atherosclerotic disease

3. Toxic Megacolon

• This is where destruction of the muscles and nerves of the colon itself lead to bowel paralysis
• It can be caused by bacteria (eg C. Difficile), toxins and medical conditions (Hirschsprung's disease)

4. Toxins/"medicines"

• Many of the "medicines" used back in the early 1900s we now know were actually quite poisonous; its possible that chronic or acute use of a medicine or tonic led to bowel paralysis
• It's also important to note that medications like opiates (morphine, etc) were available back then, and can most certainly cause constipation. There is a possibility your grandmother was being treated for something else and given opiates for pain. This would give the appearance of "bowel paralysis" and might have been mistaken for the cause of death.

5. Gastroparesis

• This is thought to be secondary to the chronic destruction of the nerve cells in the gut
• Today, this condition is most commonly caused by poorly controlled diabetes; however I would imagine that most people with diabetes in the early 1900s did not live long enough to acquire diabetes-induced gastroparesis
• I suppose that the one could get gastroparesis with the chronic ingestions of small amounts of neurotoxic agents. As stated above, many of the "medications" and tonics used a century ago were actually quite poisonous. I guess it's theoretically possible your grandmother could have acquired gastroparesis after many years of toxic ingestions.

I hope this has helped give you some idea of what could have lead to your grandmother's death. If you're able to answer any of the questions I asked and/or provide me with some additional information about her, I may be able to tailor a more specific answer.

• Jacob