On the simulation of ascites in cases of intestinal obstruction / by E. Markham Skerritt.

  • Skerritt, Edward Markham, 1848-1907.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: On the simulation of ascites in cases of intestinal obstruction / by E. Markham Skerritt. 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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    side, and the left flank was resonant, while there was dulness in the right flank as high as 1 inch in front of the anterior superior iliac spine. There was no supra-pubic dulness. During this day, three doses of 30 minims each of the tincture of belladonna were given, and towards evening the patient began to be delirious and to talk constantly. Next day, March 7, the delirium still continued, and was evidently of a pleasing character. The patient answered questions cheerfully, and said he felt better. The abdomen was certainly more flaccid. Tenderness just above the um- bilicus was complained of. The patient on this day was lying on the left side, and dulness was distinctly marked as far forwards as 2 inches in front of the left anterior superior iliac spine, while the right flank was resonant. At midday the patient was almost pulseless at the wrist, but was still able to move about in bed with apparent ease. The pleasing delirium continued. Soon after, death took place very quietly. Post-mortem.—A knuckle of small intestine, about 5 feet distant from the stomach, was adherent to the left side of the brim of the pelvis, and here a coil about 6 inches long was doubled back upon itself so that the two ends of this portion were applied to each other and closely adherent; between the extremities the included gut was puckered up, and the whole was bound together by adhesions evidently of no. very recent formation, as they were organised into toughish fibrous tissue, which gave way only to considerable force. There was no sharp line of strangulation, but the whole of this portion of the gut was much congested, of a dark claret colour ; it measured about an inch in diameter. Below this point, the intestine was extremely contracted • and above, the gut was greatly distended with liquid faces’ and gas, so that the coils measured from 3 to 3£ inches in diameter. There was no fluid in the peritoneal cavity. Remarks— Before passing to the special subject of this paper, two points in this case call for brief comment • off ]+St* ?nenefiieCtS of the bellad°™. The more severe toxic ettects of belladonna are generally developed in this order •— Delirmm of pleasing character, convulsions, coma, and death. In this case the dose was so large and frequent that the patient apparently passed at once into the stage of in sensibility, and, when the effect of the drug was somewhat going off, seemed to return to the earlier stage of pTea^ig
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