Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.
- Date:
- MDCCCXLIX [1849]
Licence: Public Domain Mark
Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.
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![other papers, with the view of illustrating the present state of medicine in Italy.] 44.—On a peculiar Obstruction of the Bowels. By Daniel Donovan, M.D., of Skibbereen. [Four cases have been seen by the au- thorof an affection so curiousand anoma¬ lous, that we give his own narrative.] Patrick Hanley applied at the Skibbereen Dispensary on the 23d inst. He was then labouring under se¬ vere tenesmus and bearing-down pain; and, to use his own words, “ had a bowel complaint on him for four days, and could pass nothing but red blood.” He further stated that “ he could make no water, and that there was a lump in his seat.” This description of his disease, and the fact that my attention had been di¬ rected to the Subject by my friend Dr Fitzgibbon, who detailed the particulars of two similar cases that occurred in his practice a few days before, led me to make an examination, and I discovered at the orifice of the gut a large solid mass. The parts around the anus were puflfed out, and the sphincter was dis¬ tended to the utmost. It was evident that mechanical means could alone relieve the sufferer; and on using the handle of a pewter spoon for the purpose, a large quantity of consoli¬ dated potato skins, with some portion of the substance of the tubers and coarse Indian meal, was dislodged. The re¬ tention of urine was immediately re¬ moved, and the other symptoms relieved, but recurred, and required for four suc¬ cessive days the same treatment, toge¬ ther with the administration of large enemata of warm water, which assisted in bringing down and breaking up the firm mass that filled the intestine. These concretions are almost entirely formed of potato skins, and are conse¬ quent on the use of diseased tubers, in which the peel and farinaceous substance of the potato are so intimately blended together, that it is impossible to detach the former in the ordinary way ; and large quantities of the skins are conse¬ quently swallowed, and accumulating in the bowels, form the obstructing masses that I have described. It is of much importance that a cor¬ rect diagnosis should be formed in this disease, as, from the similarity of some of the symptoms, it may be confounded with dysentery, and lead to very unavail¬ ing or even mischievous treatment. The straining at stool, the evacuation of blood from the ulcerated lining of the rectum, and the retention of urine that may be mistaken for suppression, are all symptoms which are exhibited by the malignant dysentery that has raged for the last two years, and may lead to an incorrect diagnosis of the disease that I am alluding to; but there is one diag¬ nostic character that, once observed, cannot be mistaken, and which clearly points out the nature of this complaint —I allude to a very peculiar sour smell from the body of the patient, like that exhaled from fermenting potato skins, —a substance used by weavers in the manufacture of coarse linens. When¬ ever this smell is recognized in cases ex¬ hibiting the other symptoms that I have described, an immediate examination of the rectum shonld be made, and mecha¬ nical means should be immediately em¬ ployed to unload the gut, as any other plan of treatment would be perfectly useless. A similar species of obstruction was very common in the autumn of 1846 from the use of boiled wheat.—Dublin Med. Press, Nov. 8, 1848. 45.—Illustrations of the Rcsidts of Pleximetric Percussion. By M. Piorry (Hopital de la Pltiej. [It is well known that M. Piorry in¬ sists strongly on the necessity of accu¬ rate percussion as a means of diagnosis, and in particular on the limitation of organs, by marking out their bounda¬ ries on the surface. The following cases are adduced, in one of his late clinical lectures, as evidence of the suc¬ cessful employment of this method ;—] 1.—A woman, aged sixty four, was seized with stitch in the side, general lassitude, dyspnoea, fever, and difficult expectoration. Five days after the commencement of the symptoms the expectoration was purulent, like that of the last stage of phthisis. One portion of the right lung was marked out as partially dull on percussion, without increased resistance communicated to the percussing finger; here there was crepitant rale, indicating the conges¬ tive stage of pneumonia. Over a se¬ cond portion the percussion was quite dull, the vocal resonance increased, the respiration bronchial, and the resist¬ ance to the finger such as to indicate a perfectly condensed lung. In a third portion the dulness of percussion con¬ tinued, and on auscultation there was](https://iiif.wellcomecollection.org/image/b29348390_0033.jp2/full/800%2C/0/default.jpg)
