Clinical Lecture on Convergent Squint

R. Liebreich
1873 BMJ (Clinical Research Edition)  
pulse, 140; temperature, I02 degs. On the eighteenth, the abdomen was again distended, and, though discharges of fluid freces went on during the day, not a particle of air was suffered to escape. The next five days were spent witlhout change; the tension again became frightful, and the sufferings during these weary days were very great, Somrtimes the peristalsis was allowed to have its full swing ; generally it was kept 'within bounds by opiium or belladonna, and a light poultice over the
more » ... tice over the abdomen gave much relief. On the night of the twenty-fourth, chloroform was carefully given, and the colon was again punctured. The cannula was passed well downwards, and then held against the abdominal wall to prevent its slipping, as it had done before. It was retained for some time; much gas escaped, and, as the peristalsis came and went, there were great discharges. The tension was immensely relieved; opium was again injected, and, as before, she slept all through the night. Daring the next day, and the day after, she was feeble, scarcely able to speak. The pulse had fallen to 120; the bowels had been moved Freely by oil, and, soon after, flatus passed in great quantity. Preceding this improvement, there was a profuse diuresis, sixty ounces of urine having been passed within twelve hours. On the twenty-ninth day, the belly was quite flat ; there was no return of distension, and, though reduced nearly to a skeleton, she rapidly gained flesh. Seven weeks after the operation, she returned to Ireland, and remains well. There can be little doubt that the puncture of the intestine saved this patient. It did so by gaining time; for, as already stated, it was pretty certain that a portion of the adherent bowel, which formed the roof of the hbematocele, had become trapped as it fell downwards after evacuation of the fluid. It was hoped, if the patient could only live long enough, that more or less absorption of the connecting lymph would soon take place, and lead to some change of position in the arrangement of the part at fault, that would allow of air to pass along with the solid contents. Fortunately, this happened. The profuse diuresis, which occurred just before the relief, I have seen take place once before in a case of obstruction, whlich terminated favourably.
doi:10.1136/bmj.2.677.716-a fatcat:5nfpourabzbxpmh5djmmlg54ke