deeper and the skin, superficial fascia, and the muscles successively divided. The muscular tissue was divided to A fine layer of tissue was next same extent as the skin.
carried were
the
divided, and the much distended colon
It is came into view. said in books that the colon is recognised by its greenish colour. As it was night we could distinguish no colour, but we felt sure that the glistening distended substance at the bottom of the wound must be the colon. It was drawn forwards and attached to the lips of the wound by four stitches. As soon as the first needle was passed a little gas having a foetid odour came out, and I felt sure that I was on the right track. The gut was opened transversely between the stitches, a large quantity of gas and meconium rushed out and the abdomen lost its distended condition. Very little blood was lost. The baby now cried lustily, and it was removed to a bed. The wound was covered with a piece of muslin soaked in carbolic oil. The father had brought the baby, the mother could not come, as she would have been out-casted had she come out of her lying-in room until some ceremonies were performed. The difficulty of nursing was now felt, and as no dhai could be had, the baby was ordered to have cow's milk and lime water, with a drop of rum, every three hours. At about 9. p. M., a couple of hours after the operation, I saw the baby again, and it was doing well.
COLVIN HOSPITAL, ALLAHABAD. A CASE OF COMPLETE ABSENCE OF
COLOTOMY;
RECTUM;
DEATH.
By Asst.-Surgeon Mohendra Nath Ohdedar. a male child, four clays' old, was brought from a village the Colvin Hospital, Allahabad, at about 6 o'clock on the evening of the 31st March, 1884. The hospital dhai came to me and reported that a baby had arrived in whom the natural I immediately went over passage of defecation was absent. to the hospital and saw it. The face was pinched ; the baby could cry only faintly, the breathing was difficult, the abdomen was very much distended and tympanitic, and the veins on its surface were distinctly marked out. At the perinceum, the skin, at the spot where the anus should be, was of a darkish colour and thrown into wrinThe bones?the coccyx and the tuberosities of the kles. ischia?did not seem to be displaced. When the baby cried no bulging could either be seen or felt at the perinceum. This last circumstance led me to suspect that probably this was not a case of simple closure of the anus, but that the rectum might either be high up or entirely absent. The baby was in great agony, no time was to be lost, and I made up my mind to operate at once. It was placed in the lithotomy position on a table out in the open air, so that I might gel as much light of the setting sun as possible. An incision was made at the perinseum along the mesial line, and the dissection carried deeper, carefully keeping very close to the was frequently introduced to feel for the coccyx. The finger impulse. The dissection was carried to a depth of about an It was inch and-a-half and yet the impulse could not be felt. then clear to me that I had to do with a case of congenital absence of the rectum, and that it was unsafe and even useless to carry the perineal incision any deeper. The opening of the gut higher up was the only course left, and I obtained the father's permission to do it. As, however, it was an operation which no one should attempt single-handed, and I had seen only one such case while a student in college, I thought it necessary to obtain the advice and help of my respected friend He was and colleague, Assistant-Surgeon Kali Dass Nandy. sent for and came over very promptly. He was also of opinion that the opening of the gut higher up was the only course left, and that the baby would die during the course of the night if relief were not immediately given. By this time it was quite dark, and with candle light I commenced the operation of. colotomy on the left side. A transabout an inch and-a-half long was made at the verse incision middle of the space bounded above by the false ribs and below by the crest of the left iliac bone. The dissection was carefully
S-,
to
April 1st.?Doing well; appears more lively; was moved through the artificial anus. April 2nd, 7 a. M ?Child lively ; bowels loose and the stools of a whitish colour like curd. To have more Aqua Calcis, and the wound to be constantly kept clean. 6 p. m.?Stools frequent and whitish ; face pinched. On pressing on the abdomen the child does not cry or becomc restless. Pulse very weak. To have a drop of rum every half
hour. The child gradually got worse and died at 4 o'clock on the morning of April 3rd?57 hours after the operation. Remarks.?The rarity of the operation is my only apology for sending the above notes for publication. The operation of colotomy under any circumstances is a severe one, but in my case the failure of the perinteal incision to reach the rectum was sufficient justification for undertaking this extreme measure. The baby was in great agony, and very probably When it would have died that night had we not given it relief. one fails to reach the gut through the perinccum, he should not let the probable result of colotomy influence his mind, but give the tiny little thing the last chance of life. The death in my case was principally due to diarrhoea. The baby could not assimilate cow's milk, though diluted with water, Pressure on the and the mother could not come to nurse it. child's abdomen did not give it pain, and this leads me to believe that peritonitis did not exercise any material influence on the result.
carried were
the
divided, and the much distended colon
It is came into view. said in books that the colon is recognised by its greenish colour. As it was night we could distinguish no colour, but we felt sure that the glistening distended substance at the bottom of the wound must be the colon. It was drawn forwards and attached to the lips of the wound by four stitches. As soon as the first needle was passed a little gas having a foetid odour came out, and I felt sure that I was on the right track. The gut was opened transversely between the stitches, a large quantity of gas and meconium rushed out and the abdomen lost its distended condition. Very little blood was lost. The baby now cried lustily, and it was removed to a bed. The wound was covered with a piece of muslin soaked in carbolic oil. The father had brought the baby, the mother could not come, as she would have been out-casted had she come out of her lying-in room until some ceremonies were performed. The difficulty of nursing was now felt, and as no dhai could be had, the baby was ordered to have cow's milk and lime water, with a drop of rum, every three hours. At about 9. p. M., a couple of hours after the operation, I saw the baby again, and it was doing well.
COLVIN HOSPITAL, ALLAHABAD. A CASE OF COMPLETE ABSENCE OF
COLOTOMY;
RECTUM;
DEATH.
By Asst.-Surgeon Mohendra Nath Ohdedar. a male child, four clays' old, was brought from a village the Colvin Hospital, Allahabad, at about 6 o'clock on the evening of the 31st March, 1884. The hospital dhai came to me and reported that a baby had arrived in whom the natural I immediately went over passage of defecation was absent. to the hospital and saw it. The face was pinched ; the baby could cry only faintly, the breathing was difficult, the abdomen was very much distended and tympanitic, and the veins on its surface were distinctly marked out. At the perinceum, the skin, at the spot where the anus should be, was of a darkish colour and thrown into wrinThe bones?the coccyx and the tuberosities of the kles. ischia?did not seem to be displaced. When the baby cried no bulging could either be seen or felt at the perinceum. This last circumstance led me to suspect that probably this was not a case of simple closure of the anus, but that the rectum might either be high up or entirely absent. The baby was in great agony, no time was to be lost, and I made up my mind to operate at once. It was placed in the lithotomy position on a table out in the open air, so that I might gel as much light of the setting sun as possible. An incision was made at the perinseum along the mesial line, and the dissection carried deeper, carefully keeping very close to the was frequently introduced to feel for the coccyx. The finger impulse. The dissection was carried to a depth of about an It was inch and-a-half and yet the impulse could not be felt. then clear to me that I had to do with a case of congenital absence of the rectum, and that it was unsafe and even useless to carry the perineal incision any deeper. The opening of the gut higher up was the only course left, and I obtained the father's permission to do it. As, however, it was an operation which no one should attempt single-handed, and I had seen only one such case while a student in college, I thought it necessary to obtain the advice and help of my respected friend He was and colleague, Assistant-Surgeon Kali Dass Nandy. sent for and came over very promptly. He was also of opinion that the opening of the gut higher up was the only course left, and that the baby would die during the course of the night if relief were not immediately given. By this time it was quite dark, and with candle light I commenced the operation of. colotomy on the left side. A transabout an inch and-a-half long was made at the verse incision middle of the space bounded above by the false ribs and below by the crest of the left iliac bone. The dissection was carefully
S-,
to
April 1st.?Doing well; appears more lively; was moved through the artificial anus. April 2nd, 7 a. M ?Child lively ; bowels loose and the stools of a whitish colour like curd. To have more Aqua Calcis, and the wound to be constantly kept clean. 6 p. m.?Stools frequent and whitish ; face pinched. On pressing on the abdomen the child does not cry or becomc restless. Pulse very weak. To have a drop of rum every half
hour. The child gradually got worse and died at 4 o'clock on the morning of April 3rd?57 hours after the operation. Remarks.?The rarity of the operation is my only apology for sending the above notes for publication. The operation of colotomy under any circumstances is a severe one, but in my case the failure of the perinteal incision to reach the rectum was sufficient justification for undertaking this extreme measure. The baby was in great agony, and very probably When it would have died that night had we not given it relief. one fails to reach the gut through the perinccum, he should not let the probable result of colotomy influence his mind, but give the tiny little thing the last chance of life. The death in my case was principally due to diarrhoea. The baby could not assimilate cow's milk, though diluted with water, Pressure on the and the mother could not come to nurse it. child's abdomen did not give it pain, and this leads me to believe that peritonitis did not exercise any material influence on the result.
