Report for the year 1897 of the statistical committee, with appendices : (12th year of issue) / Metropolitan Asylums Board.

  • Metropolitan Asylums Board (London, England). Statistical Committee.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Report for the year 1897 of the statistical committee, with appendices : (12th year of issue) / Metropolitan Asylums Board. Source: Wellcome Collection.

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    of the intestinal wall around the perforation, and there was much lymph on the peritoneum. The coil of gut in which the perforation was situated appeared to be nearly empty. The perforation was inverted, and the peritoneal surfaces on each side of it thus brought together were held in position by a few irregular sutures. Then a continuous silk suture was introduced in the longitudinal line of the gut for about two inches, the site of the perforation being in the middle of this line. The peritoneum was very soft and readily tore through. The suturing reduced the calibre of the bowel by about a third. On account of the feebleness of the patient's pulse brandy was now injected subcutaneously. The abdominal cavity was washed out with warm water as thoroughly as her condition allowed, and, a drainage tube being introduced, the wound was stitched up. The operation lasted an hour. After being put back to bed the child soon rallied and began to talk, and to call for bread and butter and something to drink. She was allowed occasional sips of brandy and water, and the nutrient enemata were continued. The patient lived for nearly four days, dying at 6.45 p.rn. on March 14th. She became much more emaciated than before the operation. The pulse, varying in rate from 120 to 160, became more and more feeble. There was vomiting at intervals. Until the 13th she was free from pain, except on two occasions, when it was slight; but on the morning of that day she appeared to be in considerable pain. The abdomen became gradually more distended, but was never excessively so. At 10 a.m. on the 11th, the temperature was 100*6° : afterwards it fell to subnormal, and so remained to the end. One of the stitches at the lower extremity of the abdominal wound gave way on the 14th. A little sero-purulent fluid was from time to time sucked up through the drainage tube, but it was never offensive. The nutrient enemata were retained up to the morning of the 13th. A post-mortem examination was made at 3.30 p.m. on March 16th. There was great wasting. The abdomen was tumid, and discoloured from post-mortem changes. The abdominal wound was gaping at the site of the lower two stitches. There was a little fluid pus in Douglas’s pouch, and thickish layers of purulent lymph on the right side of the pouch, extending to the right iliac fossa, and covering one or two coils of intestine. There was no faecal material present in the peritoneal cavity, and no fetor. There was one marked adhesion of coil to coil, causing a rather sharp kink in the gut, but this was remote from the site of the perforation, which was lying just below and to the right of the umbilicus. On pulling the injured gut up a few soft adhesions gave way, and a few bubbles of gas and a bead of yellow faecal material were seen to escape from a point to one side of the line of suture. This point was subsequently ascertained to be a second perforation occurring in a different ulcer from that in which the first perforation had taken place. The line of suture was about two inches long, running slightly obliquely in the axis of the gut. There was no escape of gas or faeces from the original perforation at any point along the line of suture, A drop of pus welled up from a small hole in the peritoneum, nearly opposite the second perforation on the other side of the line of suture. Very few of the stitches appeared to have cut through the tissues. There was little or no lymph thrown out round the sutures. The gut was markedly constricted, but gas and fluid readily passed through the narrowed portion. On opening the gut there was seen a ridge two inches long, and projecting about a quarter of an inch into the interior of the bowel. It