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
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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![Secondly, in relieving the pain caused by the passage of faeces, through the narrowed and probably ulcerated lumen of intestine, and the ineftectual efforts of the bowel above to pass on its contents; Thirdly, in prolonging life, probably for one or two years, and possibly for four or five years, and, at the same time, in saving the patient from a painful and miserable death—that from obstruction ; whilst, at the same time, it leads the patient to his last home in as painless and quiet a way as can be desired. The operation, however, to secure these desirable results, must be undertaken in the state of disease that precedes pernicious obstruction. For, as soon as marked symptoms of obstruction occur, changes, to which attention has been already drawn, have commenced in the bowel above the seat of obstruction, against which the operation of colotomy can have no influence. The operation, moreover, if considered early, that is, before decided obstruction has taken place, may possibly, as demonstrated by me in 1882, in some few cases be super- seded by lumbar colectomy, or the removal of the stricture itself through the lumbar wound ; an advantage which needs no argument to demonstrate it. For full particulars of this operation, I must refer to my paper on lumbar colectomy, published in the Transactions of tlic Royal Medical and Ghirurcjical Society, for 1882 (vol. Ixv, p. 131), I must now proceed to support the second proposition, that lumbar colotomy is valuable as a curative operation in syphilitic and simple ulcerations of the rectum which resist other treatment, as it is in cases of recto-vesical fistula. In my Table ill, I have included twenty cases of colotomy for simple and syphilitic strictures ; five were clearly of a syphilitic origin, several were of the dysenteric type, others may have been of the tubercular variety. In all, the strictures were long and narrow, for diaphragmatic strictures can be treated by simpler means. Seven of these twenty cases died within the month, from either the operation or from its having been postponed too long ; five died within six months ; four survived the operation from one to five and a half years, all dying from causes unconnected with their local trouble ; one, aged 28, from bronchitis at two and a half years ; one, aged 38, from kidney-disease at three years ; one, aged 50, from pneu- monia at three and a half years ; one, aged 70, from ruptured heart at five and a half years after operation. Four other patients were alive when the tables were compiled, in July 1884 ; one seventeen months after the operation, another two and a half years, a third four years after, and in good general health, and a fourth fourteen years after. Of the four patients who were alive when last hoard of, the one who was alive and well seventeen months after the operation was a man, aged 35, who had been operated upon for extensive ulceration of the rectum with obstruction of two years' standing. After the operation, the bowel-symptoms rapidly disappeared, and the ulcers healed, although with contraction. All the motions passed through the lumbar wound. The second case was a man, aged 25, who had had syphilis three years before the operation, and ulceration and stricture of the rectum for two years. The bowel an inch and a half above the [Continued at page SS below the line,]](https://iiif.wellcomecollection.org/image/b21907924_0035.jp2/full/800%2C/0/default.jpg)
