Case of internal strangulation of the intestines : with remarks / by George F. Lane.

  • Lane, George F. (George Frederick), 1828?-1856.
Date:
[1851]
Catalogue details

Licence: Public Domain Mark

Credit: Case of internal strangulation of the intestines : with remarks / by George F. Lane. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    vomiting and profuse perspiration. During the attacks, hot bran poultices and fomentations gave most relief, and his recovery on each occasion had been coincident with free action of the bowels. On Saturday, the 21st, after eating his dinner, he complained of a return of the pain, and as his ordinary aperient dose did not take effect, Mr. Burchell was sent for, and further aperient remedies were exhibited. On the following day (Sunday), vomiting supervened, and he complained that the pain had extended itself across the abdomen to the right side, but was not much increased by pressure; the pulse was J 00, slightly jerking, and the tongue furred. Aperient medicines were again administered, but without effect. On the 23rd, the sickness was more constant, and everything taken into the stomach was almost immediately re- jected. In the course of the day the pain in the left iliac region became very severe, occurring in paroxysms at short intervals, and considerably aggravated by each act of vomiting; the pulse re- maining nearly the same. A blister was applied over the seat of pain, calomel arid opium given every four hours, and enemata of castor oil administered. 24th.—One enema brought away a small quantity of faecal matter: the others returned as injected immediately after they were administered: the pain in the left side still formed a prominent subject of complaint, and it was only when pressed that the other parts of the abdomen gave evidence of tenderness. There was no heat of skin or other symptom of pyrexia The calomel and opium were continued, together with hot fomentations to the abdomen, and croton oil was afterwards administered in minim doses every four hours. On tho 2Gth, the whole of the symp- toms were decidedly worse, and tho vomited matters yielded an undoubted faecal odour; hiccup now ensued, toge- ther with rigidity of the muscles of tho lower jaw and of each hand. Mr. Gay saw him at 5 o’clock, p.m., when his condition was as follows :—He was lying on his back, his face deathly pale, with a countenance exprossive of extreme anxiety, and bedewed with perspiration. The breathing and heart’s action wore regular and tranquil. On directing attention to the abdomen, it was found presenting no marked irregularity of surface or enlargement; pressure over the left iliac fossa occasioned intense pain, but over other parts of the abdo- men there appeared little more than slight tenderness. There was dulness on percussion around the umbilicus and over the caecum, but resonance along the course of the colon; no enlarged convolutions of intestines could be detected. Faecal vomiting was frequent, the tongue dryish and coated with a thick fur, tho pulse feeble and thready, but re- gular : attempts were made to pass O’Beirne’s tube, and an oesophageal bougie, but these could not be intro duced further than 6 or 7 inches, and fluids injected by this means returned almost instantly by the side of the tube, nor could the latter be passed further, by taking advantage of the moment of injection for pushing it onward; and when it seemed to have overcome the obstruction, the tube was found to have bent, and its extremity protruded externally. Throughout this attack, tho urine had not materially lessened in quautity. There could be no doubt that intestinal obstruction of a very unyielding nature existed here, and that in the adoption of measures to overcome it, if any pre- sented themselves after due considera- tion, the only chance lay in prompti- tudo. Five days had now elapsed since the setting in of the symptoms, and no relief whatever had been afforded the patient by the ordinary measures em- ployed. The preceding twenty-four hours had witnessed so rapid an increase in the severity of the symptoms, that all were of opinion that the sufferer would speedily fall a victim to his malady, unless some relief was speedily obtained. Crude mercury was not given, since, from the evidence afforded of its effects in similar cases, it was not thought likely to bo of service.* It was desirable to make outas clearly as the preceding symptoms would admit, tho exact nature and seat of the obstruc- tion. The pain referred it to the left iliac region, and tho previous history of the patient led to tho inference that chronic disease of some kind existed in a portion of the intestinal tube or in parts contiguous. Mr. Gay surmised
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