Harveian lectures on the mode of death from acute intestinal strangulation and chronic intestinal obstruction : delivered before the Harveian Society of London, 1884 / by Thomas Bryant.

Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Harveian lectures on the mode of death from acute intestinal strangulation and chronic intestinal obstruction : delivered before the Harveian Society of London, 1884 / by Thomas Bryant. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    lO Case xiv. Intussusception of Ileum; Sloughing ; Acute Peritonitis. —Mary K., aged 49, was admitted into Guy's Hospital on December 31st, 1879, and died on January 9th, 1880. Three months previously she had begun to feel pain in the abdomen, which at the same time commenced to increase in size. Nothing had relieved her. When admitted, she had loss of appetite, but neither nausea nor vomiting. The abdomen was large, and flabby, but not distended. At times she felt great pain, when lumps were felt travelling about the abdomen ; there was also a gurgling of fluid therein. The bowels were acting about five times a day. On January 7th the abdomen was larger, and the pain in it more constant. A streak of blood also appeared in one motion. On January 9th she died. Six hours before death the pain was intense. At the necropsy (17), acute peritonitis was found, with lymph all over the distended intestines. A foot above the ileo-C£ecal valve, the distension suddenly ceased. The lower end of the ileum, the cojcum, and colon, were empty and healthy. At one spot the bowel seemed to be crossed by a band, and to be sloughing ; but, on examin- ation, it was seen that this apparent band was the collar of an intus- susception, and that the receiving layer, at its upper part, was sloughing, and perforated by several holes. The intussuscepted mass was about four inches long ; it was flaccid, free from swelling, but of dark colour, and probably sloughing. Case xv. Intussusception of Heum into Colon; Perforation of the Bowel by Ulceration at the Heck of the Entering Layer ; Peritonitis.— Catherine McL., aged 5 months, was admitted on May 11th, 1874, and died on the 19th, the twelfth day of her illness. She had been well until four days before admission, when she was seized with paina and retching in paroxysms of fifteen minutes. She was quiet dming the intervals. This condition of things lasted for five days, when the pain ceased for a few hours ; but it returned next day. She passed blood jjfir anum on the first .day of her illness, and two days later, but not afterwards. The abdomen was hard on palpation, but resonant; no tumour was to be felt. The bowels were opened three times ; the motions were of a natural colour. On May 19th, she was much worse, and sank, the abdomen being tense. At the necropsy (174), the abdomen was found to be distended ; no lump was to be made out. The peritoneum was pink. Semifluid fseces were spread over the intestines. The transverse and descending colon were distended with the intussuscepted caecum and ileum. The ileum was perforated ; attempts to reduce the intussusception caused complete laceration of the bowel where perforated. In some cases, as in three of the twenty now being noticed, the bowel below the seat of intussusception was ruptui-ed from the inflation employed to assist the return of the invaginated bowel; whUst, in another case, the child collapsed rapidly after inflation. Under all circumstances, therefore, the treatment by inflation is hazardous and dangerous, although success in exceptional cases may be recorded. I have before me the notes of three cases in which this treatment seemed to be successful. In acute cases, it is hardly applicable, since the strangulation of the intussuscepted bowel seems to require as acti'Jp treatment as an acute strangulated congenital hernia. In the more
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