PATJN'A city dispensary. CASES TREATED IN 1871.
I
By
Sub-Assistant
Surgeon
Mahomed Sudrool IIuq.
PENETRATING AND LACERATED WOUND OF THE ABDOMEN, WITH PROTRUSION OF THE INTESTINE; RECOYKRY. An elderly man, named Hur Lall, aged 60, resident of Fatoolia, was admitted into the hospital on the 19th September, 1871. It was stated that when walking in a field up to hi3 waist in water, he was attacked by a crocodile which seized him by the wall of the abdomen, and commenced to draw him into deep water. He was, however, soon rescued by his friends, and brought to the dispensary about nine hours after the accident. On admission, the'following symptoms were observed:? Skin dry and harsh, its temperature much raised ; tongue dry; thirst urgent; abdomen covered with a dhootee soaked in oil, on removing which a penetrating and lacerated wound about six inches in length was observed, extending from the anterior superior spinous process of the right ilium obliquely forward and inward towards the crest of the pubis, where it turned a little downward: close to this wound there was another of the same length, thus leaving a narrow baud of flesh between tliem.
Juke 1,
1872.]
A MIRROR OF HOSPITAL PRACTICE.
In the course of these wounds, penetration into the cavity of the abdomen occurred at two places, one at the upper corner, and another at the middle ; through the first two knuckles of large intestine had come ont, and from the second about six feet of small intestine, but no omentum: the intestines were highlycongested, their color being dark-red; they felt thick, their temperature being raised, and were covered with a glairy substance, but there was no haemorrhage. Having mv hands well-oiled, I began to reduce the protrusion, in which I succeeded with a little difficulty ; the lips were then brought into apposition, and kept together by interrupted silk sutures : water dressing was applied with a broad bandage, and opium was internally given; he was under treatment for fiftyone days, and discharged perfectly cured on the 9 th Noveinber, 1871. \ J CASES OF IMPERFORATE AJTUS. \
J
Case I.?A healthy full-grown male infant was brought to the dispensary on the 30th March, 1871, at 9 p.m. He had no anus, the skin-between the tuberosities was smooth and continuous, and of natural color. The raphe terminated at the middle of the perineum.? during straining, the skin at the natural position of the anus did not show any sign of swelling, but on pressing the part by the tip of the fingers, a clear A crucial incision about an sense of distention could be felt. inch and a half in length was made, no sign of the rectum was yet discovered excepting some cellular tissue mixed with fat. On further exploration, at a depth of about two inches, a soft bag was felt on introducing the finger, which became distended during the effort of straining, this was taken for the rectum terminating in a closed pouch; with great difficulty it was opened, and instantly meconium was passed: he was discharged cured on the 7th April, 1871. Case II.?A full-grown male infant, forty-eight hours old, was admitted on the 8th July, 1871, for treatment for costiveThe child had had at home several kinds of opening ness. medicine, but with no effect. Externally his anus was well formed : on passing finger into it, I was surprised to find the rectum terminating in a closed bag, lying loosely in the cavity of the pelvis, resembling the mouth of a gravid uterus in the vaginal canal; the distance between it, and the external opening, was nearly three inches. I passed a double-bladed knife holding it under my right index finger, and in this way succeeded in opening the. gut; this was followed by the passage of a large quantity of meconium : the boy was discharged cured on the 24th July, 1871. Case III.?A healthy, full-grown male infant, six hours old, who was born without anus, was brought here on the 19th July On examining the perineum, I to make him an artificial one. found the skin quite continuous, having a circular violet-colored spot at the natural position at the fundament. At first I did I administered a dose of castor not like to interfere with it. oil, and kept him under observation ; about two hours after the physic, I found the skin distended each time; the child made I opened it as usual, upon which a an effort to make stool. large quantity of meconium was ejected; and the child was discharged cured on the 25th July, 1871. In each of these cases the aperture was kept patent by a piece of cork covered with cloth. One of the patients, I have since ascertained, died of some other disease. The two others are living and continue to do well in every respect. Fatna, 3rd March 1872.
133-
I
By
Sub-Assistant
Surgeon
Mahomed Sudrool IIuq.
PENETRATING AND LACERATED WOUND OF THE ABDOMEN, WITH PROTRUSION OF THE INTESTINE; RECOYKRY. An elderly man, named Hur Lall, aged 60, resident of Fatoolia, was admitted into the hospital on the 19th September, 1871. It was stated that when walking in a field up to hi3 waist in water, he was attacked by a crocodile which seized him by the wall of the abdomen, and commenced to draw him into deep water. He was, however, soon rescued by his friends, and brought to the dispensary about nine hours after the accident. On admission, the'following symptoms were observed:? Skin dry and harsh, its temperature much raised ; tongue dry; thirst urgent; abdomen covered with a dhootee soaked in oil, on removing which a penetrating and lacerated wound about six inches in length was observed, extending from the anterior superior spinous process of the right ilium obliquely forward and inward towards the crest of the pubis, where it turned a little downward: close to this wound there was another of the same length, thus leaving a narrow baud of flesh between tliem.
Juke 1,
1872.]
A MIRROR OF HOSPITAL PRACTICE.
In the course of these wounds, penetration into the cavity of the abdomen occurred at two places, one at the upper corner, and another at the middle ; through the first two knuckles of large intestine had come ont, and from the second about six feet of small intestine, but no omentum: the intestines were highlycongested, their color being dark-red; they felt thick, their temperature being raised, and were covered with a glairy substance, but there was no haemorrhage. Having mv hands well-oiled, I began to reduce the protrusion, in which I succeeded with a little difficulty ; the lips were then brought into apposition, and kept together by interrupted silk sutures : water dressing was applied with a broad bandage, and opium was internally given; he was under treatment for fiftyone days, and discharged perfectly cured on the 9 th Noveinber, 1871. \ J CASES OF IMPERFORATE AJTUS. \
J
Case I.?A healthy full-grown male infant was brought to the dispensary on the 30th March, 1871, at 9 p.m. He had no anus, the skin-between the tuberosities was smooth and continuous, and of natural color. The raphe terminated at the middle of the perineum.? during straining, the skin at the natural position of the anus did not show any sign of swelling, but on pressing the part by the tip of the fingers, a clear A crucial incision about an sense of distention could be felt. inch and a half in length was made, no sign of the rectum was yet discovered excepting some cellular tissue mixed with fat. On further exploration, at a depth of about two inches, a soft bag was felt on introducing the finger, which became distended during the effort of straining, this was taken for the rectum terminating in a closed pouch; with great difficulty it was opened, and instantly meconium was passed: he was discharged cured on the 7th April, 1871. Case II.?A full-grown male infant, forty-eight hours old, was admitted on the 8th July, 1871, for treatment for costiveThe child had had at home several kinds of opening ness. medicine, but with no effect. Externally his anus was well formed : on passing finger into it, I was surprised to find the rectum terminating in a closed bag, lying loosely in the cavity of the pelvis, resembling the mouth of a gravid uterus in the vaginal canal; the distance between it, and the external opening, was nearly three inches. I passed a double-bladed knife holding it under my right index finger, and in this way succeeded in opening the. gut; this was followed by the passage of a large quantity of meconium : the boy was discharged cured on the 24th July, 1871. Case III.?A healthy, full-grown male infant, six hours old, who was born without anus, was brought here on the 19th July On examining the perineum, I to make him an artificial one. found the skin quite continuous, having a circular violet-colored spot at the natural position at the fundament. At first I did I administered a dose of castor not like to interfere with it. oil, and kept him under observation ; about two hours after the physic, I found the skin distended each time; the child made I opened it as usual, upon which a an effort to make stool. large quantity of meconium was ejected; and the child was discharged cured on the 25th July, 1871. In each of these cases the aperture was kept patent by a piece of cork covered with cloth. One of the patients, I have since ascertained, died of some other disease. The two others are living and continue to do well in every respect. Fatna, 3rd March 1872.
133-
