A CASE OF INTESTINAL OBSTRUCTION ARISING FROM INTERNAL STRANGULATION
Authors: J. Hinton
Journal: BMJ (1853)

TiB increasing importance of that class of diseases com- monly styled Intestinal Obstruction, and the large mor- tality which still attends these disorders, must be my excuse for occupying the time of this branch of the Association by the brief detail of a solitary case.Still, as isolated cases may yet contain some facts leading to the more successful treatment of the disease, I would direct attention to the case itself, and to the remarks appended to it.CASE.About six months previous to the fatal attack, W. P., aged 16, a collier, suffered from an attack of consti- pation, attended by serious symptoms of inflammatory action in the ceecal region.These symptoms were relieved by leeches, calomel and opium, etc., the opium being exhi- bited freely.On the night of Monday, October 1st, 1852, having had a slight motion during the evening, he went to bed in perfect health, but was roused during the night by a sudden attack ,of severe pam in the bowels, and almost immediately he Tomited.He took some brandy, without relief; and early in the morning his mother came to my surgery, requesting some aperient medicine, which my assistant gave her.Re- collecting his old attack, I called; and finding that the aperient had not acted, but that the vomiting had rather increased, I ordered it to be immediately discontinued.The boy's appearance was anxious; his tongue was coated, and already becoming dry; and his pulse was quick.The ab- domen was tense, and slightly tender in the coacal region, which appeared, if anything, more prominent than on the opposite side; there was no dulness on percussion, but rather resonance.Mustard poultice, followed by poppy fomentation, was applied to the abdomen.Aud R.-I'ulveris ipecac.compositi gr.x.Hydrargyii cliloridi gr.ij.Ft. pulvis omni horn sumendus.Suniat olei ricinii iij mane.I will not detail the progress of the case.Suffice it to say, that under the plan mentioned, he improved in every respect.The vomiting abated and disappeared; the tongue became moist; but although the oil was not rejected, it did not act.On the following day, I ordered him three grains of solid opium; and, about three hours afterwards, an injection of castor oil, with eight or ten drops of croton oil, was given.This speedily returned, bringing with it a wery large, bulky, feculent motion, giving great relief, which lasted throughout the day.Small doses of opium were continued.During the following day, October 20th, partial motions, less copious, and one containing blood (as reported), fol- lowed the use of injections; but towards evening, pain ,returned slightly, and although he did not vomit, his -countenance was more anxious, and his tongue drier.From this time he gradually became worse.Opium was given -freely whenever he was in pain, and relieved him for a time.!Purgatives were omitted, and the vomiting did not return.Croton oil, tartar emetic, and other injections were em- ployed without avail.The abdomen was more tense; the qguantity of urine passed was scanty.On the fifth day of the attack, seeing that he did not improve, I began seri- ously to think of an operation, and expressed my opinion plainly to the parents, who consented to let me perform aniy operation I chose.The next morning, therefore, I sent for my friend Mr. Scott, of Newport, determining that, if his view of the case in any way coincided with my own, I would hesitate no longer.I found my patient considerably worse on that morning; much weaker; delirious at times; and before Mr. Scott arrived, death terminatedmy hopes.ORIINAL COMMUNCATION8.