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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    Syphilis: Acute Peritonitis.—A. H., aged 27, was admitted in May, 1877, and died on May 5tli. At the necropsy (No. 161), there was acute suppurative peritonitis, which had evidently started from the pelvis. The pelvic organs were matted together, and there was much thickening of the pelvic subperitoneal connective tissue. The rec- tum, in its lower six inches, had its coats greatly thickened, and indui-ated, with hypertrophy of its muscular fibres. The lining mem- brane was represented by a smooth cicatricial layer, which was uneven, puckered, and traversed by numerous bands of fibrous tissue. The upper line of the cicatrix was well defined. Two openings led into sinuses lined bj'' membrane, one of which passed towards the right Fallopian tube and bent over the ovary, so that it was at first thought the tract might be the tube. The uterus was virginal; the Fallopian tubes were matted together by inflammatory product. There was no proof of syphilis in the body. The kidneys were soft. To illustrate the view propounded still further, I propose to show how, after colotomy, these non-cancerous ulcerations heal, though it may be with a narrowing, and, possibly, occlusion of the rectum. I shall quote extracts from the report of those contained in Table III, which I shall bring before you (vicZc page 34). Most of these cases came to me for supposed cancer ; but, from their subsequent progress, this diagnosis was evidently wrong. Indeed, the group of cases, taken as a whole, not only demonstrates the fact that extensive simple ulceration of the rectum takes place, and that such leads on to stricture; but that, after colotomy, by which rest to the ulcerating bowel, and the re- moval of sources of irritation, is guaranteed, the most extensive ulcerations rapidly heal. Thus, in one case (2), after colotomy, the bowel was very narrow and thickened for some inches. In Case 3, there was ulcera- tion of the rectum for many inches. In Case 4, the patient, a man aged 65, had had, twelve years previously, a recto-vesical fistula, and passed wind with his urine. This ceased of itself, and he remained well for eleven and a half years ; that is, till six weeks before his ad- mission, when the symptoms returned, associated with rectal obstruc- tion, and the passage of fteces into his bladder. He was relieved by colotomy, but died on the seventeenth day subsequently ; and, after death, there was evidence of old ulceration into the bladder, as indi- cated by a cicatrix and a large recent fistula, the result of a simple ulceration into the bladder. In Case 5, the rectum and colon had evidently been the seat of chronic inflammation ; they were ulcerated and thickened. Indeed, the colon was so friable that it ruptured during the operation. In Case 6, there was a double stricture, and all ulceration had become repaii-ed in the twenty-eight days that fol- lowed the operation. One stricture near the anus was three inches in ength ; a second, narrower, was six inches higher up ; both were cica- tricial, the result of repair after simple ulceration. In Case 8, the bowel had undergone repair, and had contracted during the five months that had elapsed between the operation and death. In Case 9, one of recto-vesical fistula and rectal ulceration; after colotomy, all the ulceration healed, and the fistula remained ; but, as no motion had passed down the bowel beyond the lumbar wound since the oper-