Harveian Lectures on the Mode of Death from Acute Intestinal Strangulation and Chronic Intestinal Obstruction
Authors: T. Bryant
Journal: BMJ (1884)

He had an old hernia'on the right side.On August 25th, two days before admission, without any assignable Mause, he was seized with some abdominal pain, purging, and vomit- ing, and these symptoms continued up to his admission, with abdominal distension, and great tenderness, and collapse.His'tulse was 126, and temperature l101 F. On August 28th the seat of the old night hernia was explored; only an old thickened sac was found.He died next day.At the inspection (286) the thoracic viscera were bealthy.There was suppurative peritonitis, with its focus at the right iliac *egion.The intestines were glued together; 'there was pus on both surfaces of the liver.The parts about the cecum were inftrated with iniflamtnatory material and pus.The appendi cmeci was dis- coloured and ulcerated ; the end ofit was not'discovered.:RE*AnRks.-Thiscase was.complicated with the"presence, of an'old r%kht irotal hernia.So, when the man was suddenly seired with severe abddnilnal'pain and vomiting, the-suspicion 'of -the-symptoms being duq to intestinal strangulationwas raised;,and the fact,that,purging was symptom did not do away with the suspicion.ThOe hernia was, there- fore, explored, but with no benefit; only an old thickened sac was found.I am not disposed to find fault with the treatmrit, but con- sider that, upon the whole, eTcal trouble should have been diagnosed.CASE LIV.Perforation of Appendix Cewci: Peritonitis: Pneumonia, following Perforation oj the Diaphrarg.-TomL., aged 12, 'was ad- mitted Augast 18th, and lived until SepteTber 2nd, 1869.He-had been ta;ken ill on August 8th, ten days before admision, with severe abdominal pain and bilious vomiting.The pain continued until the following morning, and recurred four or five times a day.-Ten days Inter he was admitted, with febrile disturbance, abdominal tenderness, and thoracic respiration.On August 21st there wasbasic pneumonia; on the 26th the abdomen was -tumid, with the liver to, be felt down to the umbilicus.'Later on, purging ensued.The boy died on September 2nd.The necropsy (227) revealed general pteumonia, peritonitis, with recent adhesions; a collection of pus in the left iliac fossa, and the recto-vesical pouch, on the under and uppr surface-of the -liver, and 'on the diaphragm, through which was a perforation into the chest.In the right iliac fossa were two soft friable concretions, near the end of the appendix c-eci, *:hich for its last inch was 'ulcerated and destroyed.The colon and rest of the appendix were healthy.r CASE Lv.Inflammation of the Ccecal App4tndi' Sloughitug of its Mitcous Coat: Perforation of its Neck'.: Suppurafive Peritonitis: Double PleuriVy.-T.R., aged 20, admitted on Ju1y '5th, died-qn 'uly 7th, 1875.He had been -healthy, though nevers,iong.Twelve months beforehand Le had had constipation for two days, and abdomi- nal pain, but no vomiting, and had recovered.He -;was quite well'on Jaly 4th, the bowels acdting twice naturally.le ate manyl, cherries avnd awoke at 5 A.. .-on the 5th with sudden violent abdominal pain in the right iliac region.He vomited soon after, and the vomiting thenceforward continued.He was admitted with a tympanitic abdo- men.The urine was high-coloure4 and seanty.On the 6th, the patient had incessant vomiting; ,his temperature was 98.3 Fahr., his pulse 128.pain 1qcame agonisili and he san.1oratose.The posA mnortem examination (271) showed d Aou 1e.pleuts:.,The lunDgs aud heart were healthy.There was pus in the 1g 'ilic, .fossp,an lmnvph between the omentum and codts.pft:6d eWed Mwel 'tie coils of intestines about the crecal aeirdf '46fi 'A fw-C r)