Case of acute haemorrhagic pancreatitis / by A.D. Fripp and J.H. Bryant.

  • Fripp, Alfred Downing, (1865-1930)
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: Case of acute haemorrhagic pancreatitis / by A.D. Fripp and J.H. Bryant. 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.

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    procured some relief, but he did not like fomentations, saying that they increased the pain. An hour later an enema was given but without result. When seen again in the evening it was found that as soon as the effect of the morphia had passed off, the pain had returned, and the point of its maximum intensity was above and to the left of the umbilicus. He had taken some drachm doses of olive oil with live minims of tincture of belladonna in each, and had vomited twice. The pulse and the temperature and the skin were now normal. Mr. Macllwaine, of Redhill, saw him with Dr. Blackler, and suggested the possibility of the diagnosis being acute pan- creatitis of the hasmorrhagic variety. It was determined to give him another injection of morphia and to send him up to Guy’s that night. On the 18th, at 1 a.m., he arrived at the hospital and I saw him. On admission.—Pulse 100. Respiration 24. Tempera- ture 96°. He is a well-developed, rather stout man. The face is congested, and of a somewhat earthy colour. The pain and restlessness are so great that it is difficult to get sensible answers to questions. His low groaning is almost incessant. The pain is chiefly above the umbilicus. The abdomen is somewhat full, but not distended nor hard; it moves fairly with respiration; it is not tender to pressure. The knees are not drawn up except in the acutest paroxysms of pain. There is no abnormal area of resonance or dulness, nor is there any abnormal lump or peristaltic wave to be dis- covered. The tongue is very dry, red, not brown, and not furred. The lips are rather blue. The face is congested, and wears an anxious and exhausted expression. The gums show no blue line. The hands are cold and inclined to be moist, and the fingers are rather bluish under the nails. The pupils are small and do not react well. The knee-jerks and reflexes are normal. Urine 1020, not unduly dark; no albu- men, sugar, or blood. It was not examined for leucin and tyrosin. Micturition.—No history of any abnormality could be ob- tained. The pulse is regular, fairly full, 100 per minute. The respiration and the circulatory system presented nothing abnormal. I had no doubt that the right thing to do was at once to perform an exploratory laparotomy, but I felt considerable doubt whut we should find, as is proved by the clerk’s entry