Surgical essays: the result of clinical observations made at Guy's Hospital / [Bransby Blake Cooper].
- Bransby Blake Cooper
- Date:
- 1833
Licence: Public Domain Mark
Credit: Surgical essays: the result of clinical observations made at Guy's Hospital / [Bransby Blake Cooper]. Source: Wellcome Collection.
290/318 page 274
![temperature of the skin preserved, immediately ordered six grains of calomel and a grain and a half of opium, with directions to take an ounce of castor oil two hours after the pill. At 10, p.m.—The medicine had produced no effect upon the bowels; pain of the abdomen increased ; pulse quicker and rather smaller. Bigh- teen ounces of blood were immediately drawn, which produced fainting, but without affording any relief from the pain, four grains more of calo- mel were given, the castor oil desired to be repeated two hours after the calomel, and nine more leeches to be applied to the abdomen. Sep. 6th, 4.m.—The pain unabated ; the bowels had not been relieved; the abdomen had become much distended, but scarcely amounting to tympanites; the vomiting continued. Two grains of calomel and eight of compound colocynth were then given. At 12, m.—The pills had produced no effect; warm water was then injected into the rectum, which was returned without any feculent matter. The pain in the abdomen unabated, indeed, rather increased in urgency, particularly upon pressure; the pulse had become more feeble. A drop of croton oil was now administered. At 5, vp. M.—Bowels not relieved, pain unabated, pulse very feeble, and the feet rather cold. At this period I was sent for, and found him with a very feeble pulse, sunken countenance, and his forehead bedewed with a clammy sweat. I ordered him three grains of solid opium and a castor oi] injection. The opium produced no mitigation of pain, and he died at ten o’clock. . Upon examination after death the jejunum was found to have given way from ulceration, presenting externally a clear determined edge, without any eversion of the mucous membrane, which had, in fact, been destroyed by the ulcerative process. Plate 4, well delineates this dis- tinguishing mark between an opening produced by ulceration and one by laceration. The edges of the ulcer, and consequently the peritoneum, were adherent to the omentum, but not sufficiently to prevent the escape of the contents of the bowel. The peritoneum was much inflamed over its whole surface, but especially on the right side. Both these cases, I should say, deviate from that degree of collapse which usually attends rupture of an intestine; which collapse, however, does not seem to occur immediately upon the infliction of the injury, but at the period when the contents of the bowel makes its way into the peritoneal cavity, the degree of prostration being in proportion to the quantity and probably the quality of the matter extra- vasated.](https://iiif.wellcomecollection.org/image/b22009255_0290.jp2/full/800%2C/0/default.jpg)
