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

STRANGULATION AND TYPilLITIS.iNXhe two lectures it has been my privilege to deliver, attention has been directed to the stibjects of acute intestinal strangulation,acute Mhi chronic intussusceptioni, and chronic intestinal obstruction-; and T,j]4p6 I have not belen too dogmatic in my observations.My desire hlag been to separate, as cleaily as I could, -these three very different pithological as well as clinical conditions; and to demonstrate to you, by pathological facts and clinical data, how patients die from these conditions, in order that I might point out how a fatal result may be warded off or prev-ented.*I have said little about the difficulties of diagnosis, nor how to avoid them; and yet, of all points, these are the most important; since, I take it, it is on account of the uncertainty of diagnosis that our treatnment of these cases has been uncertain, tentative, expectant untisfactory', nd,(I must add) unsuccessful.In the present lecture, I ptopose to consider this subject of diagnosis, and to see if any way of deliTer;ance from the difficulty is to be found.'It is unnecessary to dwell upon the symptoms of an acute intes- .0iii1stra.ngulatiou,since a sudden attack of abdominal pain, aecom- .paniedwith vomiting, attacking a patient previously in apparent good healtlt-the two symptoms being more or less paroxysmal, and asso- ciasted with obstruction-mark its nature.; and they do so, whether or not :twey are complicated with an external hernial swelling.,When .thvlatter condition obtains, a strangulated hernia is readily dia- gnosed; when no such swelling is present to make the special dia- gnosis sure, the symptoms are still enough to indicate the existence of some,internal strangulation, although its special form may be obscure.It istrue, that a sudden perforation of the intestine from ulceration-an acute attack of peritonitis following some cical or periciecal t,rouble-or al acute attack of gall-stones, may simulate to a degree a ease bt acute intestinal strangulation; and yet, I think, on investiga.ti8n, the diagnosis of these two former conditions ought not to be difficult.My observations will consequently chiefly point to these; ,the third, or gall-stonie difficulty, I leave for my medical friends to un- CASE XLIrX.-Alady, aged 67, who had previouslv been perfectly well, was suddeniy seized with intense abdominal pain and vomiting,; and these symptoms rapidly passed on to collapse and death within twelve' hours.After death, a perforating ulcer of the duodenum was found.CASE L. Perf(rrating (ccr of the Duodenum: Peritonitis: Abdomen not distended.Charles R., agred 28,was admitted on July 2nd, 1877.Three weeks previously, after some nausea, he had been attacked with vomitilg in the morning, and had not been well since.He had often suffered from constipation.On June 30th, after having taken a warm h, he was seized with severe pain in the abdomen across the epigqtric region, and with vomiting.After twenty m-inutes the pain ceastd, but returned in half an -hour, and continued until the following afternoon, whleln it ceased entirely.The bowels had acted on the day tefpre he had been talen ill.The vomiting, of greenish -iaterial, had .liucehbeen persistent.On July 2nd, two days after the commence-