Duodenal ulcers in infancy / L. emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Duodenal ulcers in infancy / L. emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/18 (page 9)
    in fat Examination, sl.oweil a iioorly nourislu..! infant of tlie inaras.nic type- weight but o pounds, 7 ounces. Except for tlie presence of a moderate dJree Of tl.rush and erytliema of the buttocks, tlie pl.ysical examinatiou was ne<uUive I lie abdomen was normal; there were no peristaltic waves and no pyloric tumor • heart and lungs normal. - i »>i>k forniula containing fat O.fiO; simar C.OO; protein 1.20 per cent. The child lived eight days after admission, duriii- which time she vomited in all but six times, tivice on the first day. twice on the second day and only twice thereafter. The Aoniiting was not folcible The appetite was good; the child generally took her food well. The bowels moved usually twice a day; for the first three days the stools were yellow, smooth and we 1 digested; afterwards they were yellow and thin, but never fre,|iient and no blood was present. Even from the beginning the prostration was marked’ Ihe temperature was habitually subnormal in spite of artificial heat and the use of a cotton jacket. The loss in weight continued for the first four days after which the child became somewhat edematous. During the last three day.s in the hospital the teni],erature was not above 95 F. Death occurred ,n‘,i'te unexpected y in a condition of collapse. There was no marked abdominal dis- tention and no tenderness was noted. Yccropsy.—Permission to examine the brain was not obtained. The heart and lungs showed nothing of importance. On opening the abdominal cavity the parietal peritoneum and omentum were found much congested and showed numerous small hemorrhages. The peritoneal cavity contained about 70 c.c. of airjid yellow fluid, which after standing deposited a heavy jirecipitate of pus cells. The cause of the peritonitis was found to be a perforatino- duodenal ulcer. It was situated on the posterior wall just below the pylorus. It was circular, about 5 uuni. in diameter and had a typical “punched out” aiuiearanee. Ao signs of repair at its borders. The mucous membrane of the intestine was blood-stained, but no other lesions were present. The stomach was congested but showed no ulcers. Cultures from the ])eritoneal fiui.l showed the strepto- coccus and colon bacillus. Streptococci were also obtained from the heart’s blood and lungs. Microscopical examination of the ulcer was made by Dr. TIartha Wollstciii patho ogist to the hospital. There was no inflammatm-y reaction, but a loss’ of sub.stance which at one point involved all the coats of the intestine The edges of the gap were sloping, not undermined. The walls of the mucosa sub- mucosa and muscular coats forming the edge of the ulcer had undergone nemosis and were converted into a granular, poorly staining layer. The epithelial layer o the mucosa was degenerated or ahsent for some distance beyond the bord’ers f the ulcei; beyond this the duodenal wall was normal. The adherent ])ancreas was also normal. p<im.ieas ^^»odenum; intense jaundice; intestinal hemor- tfiagCj death from marasmus. nistory.--M. K., a male Italian child, 2 months old, was admitte.l to the hospital on account of marked jaundice and progressive loss of weioht The parents were not very intelligent and no detailed previous history could be obtained. It was ascertained, however, that the child was born at full term a ei a noimal labor and had been breast fed up to admission. It had never tlirived. Jaundice was first observed two weeks before and had steadily increased The stools were gray and the urine stained the napkins. The history of the ““''»■«*«> )■ * p'o---. >v,.„ E.xamination on admission .showed a small, wretched looking infant; weioht 5/o pounds. The jaundice was intense, the .skin being of an olive-green hue The sclerae and mucous membranes were also stained with bile. Yothino of importance was mscovered in the head, neck or chest. The