The mode of death from acute intestinal strangulation and chronic intestinal obstruction / by Thomas Bryant.

  • Bryant, Thomas, 1828-1914.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The mode of death from acute intestinal strangulation and chronic intestinal obstruction / by Thomas Bryant. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    in the person of a gentleman aged 51, who had had a right inguinal hernia for twenty-five years, for which he had worn a truss. The hernia had only given him trouble once, six months previously. Three days before I saw him with Dr. AVilkinson of Sydenham, during some violent e.xertion, the hernia partially descended, but it was at once readily reduced. Vomiting soon followed its reduction, with pain on the right of his umbilicus ; and both symptoms became worse. On the third day, the vomiting was ftecal. No hernia could be felt; and there was no fulness at the internal ring, and not even tenderness on deep pressure. His abdomen was fuller than natural; and there was a fixed pain, increased in paroxysms, on the right side of the um- bilicus. No other hernia existed. An exploratory operation was at once suggested, and performed at the site of the old hernia; and, when nothing was found at the part, the excision was extended up- wards along the semilunar line for about two inches. A band was then felt with the finger within the abdomen, which was divided by means of a pair of scissors, and a rapid recovery took place. The patient is now alive, I could add many cases of what is known as displaced hernia, to demonstrate the value of the practice I am encouraging ; for such may rightly be called internal hernia. But surgeons are all agreed upon the necessity of an exploratory abdominal operation in these cases— first to discover, and secondly to relieve, the cause of strangulation. I will now pass on to consider how it is that death results from what is known as intussusception, and by what means life may be saved or prolonged in that condition. I find that in the necropsies of twenty cases, of which I have notes, ten being males, and ten females, death usually occurred from either gangrene of tbe entering and re- turning layers, or perforation by ulceration of the receiving or external gangrene of the intussuscepted portion, as has been already explained in the cases of internal strangulation, being brought about by the obstruction to its venous circulation. When the obstruction is sudden and complete, the symptoms will be acute, as in a case of strangu- lated hernia. When it is slow or incomplete, the symptoms, as well as the pathological changes, will be chronic; and, under the latter circumstances, inflammatory changes will have much to do with the pathology of the affection. Under all circumstances, whether in the acute or chronic form of intussusception, inflammatory changes take place in the outside or receiving layer, from which the pathological records of Guy's Hospital reveal the fact that perforation or ulceration of the bowel occurs. In acute cases of intussusception, therefore, the pathological eye of the clinical physician should see more or less complete blood-stasis of the intussuscepted bowel, with inflammation and ulceration of the outside or receiving layer ; and in the chronic cases the same patho- logical eye should see like changes, but of a more chronic form. In the one, as in the other, the changes are certain, though they may vary, somewhat, in the speed with which they are brought about; but to the surgeon they suggest decision, and not delay. The two yellowing cases illustrate these points.