A CASE OF INTESTINAL OBSTRUCTION. By Assistant Apotiiy. H. H. M.
Successfully
Judge,
Madras Army,
treated by Morphia and Atropine.
I WAS summoned at 5 P.M. on the 15th May, 1882, by letter see Mrs. J., who had been ill for two or three days On my visit I found the patient complaining of pains of a the transverse colon, and inability to spasmodic character, along retain any nourishment; the vomited matter was said to coninto sist chietly of bile. her previous history elicited Enquiry the statement, that the bowels could not be got to act without the aid of medicine of some kind ; this condition of things having obtained for some time past. An enema taken in the afternoon had the effect of dislodging a few scybalre. There was no pyrexia present; the tongue was clean and moist. A large warm water enema was ordered and effervescing draughts with hydrocyanic acid and spts. of chloroform to check the sickness of stomach; turpentine stupes to abdomen. Fluid nourishment. 16th Afayt 6 A.M.?Passed an indifferent night from colicky pains and incessant vomiting, which is proving harassing ; no action of the bowels.
previously!
to
Ordered, Ol. Ricini
?i
St.
stupes.
Sinapism
to
?i> Tinct. OpiiTTJ^XV, Aquae Menthse Pip.
epigastrium,
ice to suck, continue turpentine
NOON.?Rejected the oil soon after taking it, and has scarceretained anything ; feels dry and thirsty, no fever ; tongue clean and moist, pulse quiet. Examination shewed the abdomen to be quite supple and free from tenderness, except at a spot to left of umbilicus where pressure caused her to wince. No fuU ness of either iliac region. 12
ly
322
THE INDIAN MEDICAL GAZETTE.
To have : Ext. Opii, Ext. Belladonna aagr. X piH every four hours, and a castor oil and warm water enema at 2 p.m. four hours. Linseed meal poultice to abdomen every 6 p.m.?The enema brought away some fecal matter; felt a little relieved after it ; has had a little sleep ; sickness of stomach continues though not so frequent, vomit consisting of bile and fluid nourishment. 11-30 P.M.?Became suddenly faint and low from exhaustion induced by repeated fits of vomiting. Dr. Drake Brockman was called in emergently when the pills were directed to be omitted, and a hypodermic of atropine gr. morphia gr. % was administered ; brandy and ice in small quantities. 17th May, 6 a.m.?Felt easier after the hypodermic, not so sick, no action of the bowels, pulse quiet, 78, abdomen a little fuller evidently from flatus; tongue clean and moist. To have another castor oil and warm water enema. 12 noon.?Some grumous matter came away by enema. Abdomen more full, tympanitic, tender over the spot previously mentioned to left of umbilicus, and also sore on pressure in both iliac regions. Urine examined, high coloured, scanty, no albumen. The long tube was passed per rectum its whole length 2^', and a large warm water castor oil and turpentine enema administered. Hypodermic of morphia and atropine repeated Ice to suck, turpentine and to be continued every six hours. stupes continued, nutrient enemata with brandy and laudanum every two hours. 5-30 p.m.?Has had small snatches of sleep; complains of soreness over the whole abdomen, not affected by pressure. Feeling of sickness continues, though nothing is ejected beyond a little bile, 7-45 p.m.?Administered atrophfe sulph. gr. morphia: X gr- hypodermically. Retains the nutrient enemata well ; is a little restless, with a tendency to faintness and coldness ; pulse of good volume ; skin cool. Omit laudanum from enemata. 18th May, 6 a.m.?Had a comfortable sleep up to 12 last night. At 1 a.m. had a large vomit consisting of dark coloured bile, and another at 5 a.m. of brightly colored bile about 40Z. Bowels acted twice, motions fluid, one containing a piece of feculence dark coloured, about the size of an inch. Skin cool, pulse 75, tongue moist and clean, abdomen supple, less pain and tenderness, pupils normal. Repeated atropine and morphia hypodermically. A plain warm water enema. 12 noon.?Has had a calm morning, slept soundly for two hours, has felt squeamish, but no actual vomit since 5 A.M.
(7 hours).
The enema administered in the morning returned coloured and of feculent odour. Examination of abdomen shews distinct dulness over ascending colon, the rest of the surface gives a clear resonant note ; abdomen full. Administered morphia gr. % ; atropia sulph. gr. s\ hypoder-
mically.
Enemata (nutrient) continued ; ice by mouth. 7-30 p.m.?Passed a dark fluid motion at 6 o'clock, felt much relieved after it ; no sickness of stomach ; feeling much easier in The hypodermic gives her refreshing rest and keeps every way. her calm. Hypodermic repeated, linseed poultice to abdomen, continued enemata. iqth A/ay, 6 a.m.?Passed a comfortable night, having slept well, no sickness of stomach, no pain in abdomen to talk of, feels much better this morning. Bowels moved again during the night, a scanty fluid evacuation ; hypodermic omitted ; ordered some light nourishment by mouth ; enemata every 4 hours. 5 P.M.?Doing well ; quite relieved of all distressing symptoms ; complains only of weakness. Allowed to sit up. 20ih May.?Feeling quite well. Has discontinued enemata, bowels acting normally. Recommended to take the following pill for a fortnight ; Ext. Belladonnce gr. Ye, Ext. Nucis Vomicae gr. X> with Gentian Ext. in one pill every morning early.
Discharged.
[December,
1882.
Successfully
Judge,
Madras Army,
treated by Morphia and Atropine.
I WAS summoned at 5 P.M. on the 15th May, 1882, by letter see Mrs. J., who had been ill for two or three days On my visit I found the patient complaining of pains of a the transverse colon, and inability to spasmodic character, along retain any nourishment; the vomited matter was said to coninto sist chietly of bile. her previous history elicited Enquiry the statement, that the bowels could not be got to act without the aid of medicine of some kind ; this condition of things having obtained for some time past. An enema taken in the afternoon had the effect of dislodging a few scybalre. There was no pyrexia present; the tongue was clean and moist. A large warm water enema was ordered and effervescing draughts with hydrocyanic acid and spts. of chloroform to check the sickness of stomach; turpentine stupes to abdomen. Fluid nourishment. 16th Afayt 6 A.M.?Passed an indifferent night from colicky pains and incessant vomiting, which is proving harassing ; no action of the bowels.
previously!
to
Ordered, Ol. Ricini
?i
St.
stupes.
Sinapism
to
?i> Tinct. OpiiTTJ^XV, Aquae Menthse Pip.
epigastrium,
ice to suck, continue turpentine
NOON.?Rejected the oil soon after taking it, and has scarceretained anything ; feels dry and thirsty, no fever ; tongue clean and moist, pulse quiet. Examination shewed the abdomen to be quite supple and free from tenderness, except at a spot to left of umbilicus where pressure caused her to wince. No fuU ness of either iliac region. 12
ly
322
THE INDIAN MEDICAL GAZETTE.
To have : Ext. Opii, Ext. Belladonna aagr. X piH every four hours, and a castor oil and warm water enema at 2 p.m. four hours. Linseed meal poultice to abdomen every 6 p.m.?The enema brought away some fecal matter; felt a little relieved after it ; has had a little sleep ; sickness of stomach continues though not so frequent, vomit consisting of bile and fluid nourishment. 11-30 P.M.?Became suddenly faint and low from exhaustion induced by repeated fits of vomiting. Dr. Drake Brockman was called in emergently when the pills were directed to be omitted, and a hypodermic of atropine gr. morphia gr. % was administered ; brandy and ice in small quantities. 17th May, 6 a.m.?Felt easier after the hypodermic, not so sick, no action of the bowels, pulse quiet, 78, abdomen a little fuller evidently from flatus; tongue clean and moist. To have another castor oil and warm water enema. 12 noon.?Some grumous matter came away by enema. Abdomen more full, tympanitic, tender over the spot previously mentioned to left of umbilicus, and also sore on pressure in both iliac regions. Urine examined, high coloured, scanty, no albumen. The long tube was passed per rectum its whole length 2^', and a large warm water castor oil and turpentine enema administered. Hypodermic of morphia and atropine repeated Ice to suck, turpentine and to be continued every six hours. stupes continued, nutrient enemata with brandy and laudanum every two hours. 5-30 p.m.?Has had small snatches of sleep; complains of soreness over the whole abdomen, not affected by pressure. Feeling of sickness continues, though nothing is ejected beyond a little bile, 7-45 p.m.?Administered atrophfe sulph. gr. morphia: X gr- hypodermically. Retains the nutrient enemata well ; is a little restless, with a tendency to faintness and coldness ; pulse of good volume ; skin cool. Omit laudanum from enemata. 18th May, 6 a.m.?Had a comfortable sleep up to 12 last night. At 1 a.m. had a large vomit consisting of dark coloured bile, and another at 5 a.m. of brightly colored bile about 40Z. Bowels acted twice, motions fluid, one containing a piece of feculence dark coloured, about the size of an inch. Skin cool, pulse 75, tongue moist and clean, abdomen supple, less pain and tenderness, pupils normal. Repeated atropine and morphia hypodermically. A plain warm water enema. 12 noon.?Has had a calm morning, slept soundly for two hours, has felt squeamish, but no actual vomit since 5 A.M.
(7 hours).
The enema administered in the morning returned coloured and of feculent odour. Examination of abdomen shews distinct dulness over ascending colon, the rest of the surface gives a clear resonant note ; abdomen full. Administered morphia gr. % ; atropia sulph. gr. s\ hypoder-
mically.
Enemata (nutrient) continued ; ice by mouth. 7-30 p.m.?Passed a dark fluid motion at 6 o'clock, felt much relieved after it ; no sickness of stomach ; feeling much easier in The hypodermic gives her refreshing rest and keeps every way. her calm. Hypodermic repeated, linseed poultice to abdomen, continued enemata. iqth A/ay, 6 a.m.?Passed a comfortable night, having slept well, no sickness of stomach, no pain in abdomen to talk of, feels much better this morning. Bowels moved again during the night, a scanty fluid evacuation ; hypodermic omitted ; ordered some light nourishment by mouth ; enemata every 4 hours. 5 P.M.?Doing well ; quite relieved of all distressing symptoms ; complains only of weakness. Allowed to sit up. 20ih May.?Feeling quite well. Has discontinued enemata, bowels acting normally. Recommended to take the following pill for a fortnight ; Ext. Belladonnce gr. Ye, Ext. Nucis Vomicae gr. X> with Gentian Ext. in one pill every morning early.
Discharged.
[December,
1882.
