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another glyster with Glauber salts; this he retained two hours, and then parted with a portion only without feces; a second calomel pill like the first was repeated. He was washed twice since last night. Nine o'clock P. M.-His vomiting still continues; pulse rather fuller than in the morning; febrile symptoms somewhat increased; the glyster was again repeated with Glauber salts and sweet oil; four leeches were applied to the chest, and the bleeding to be encouraged; the saline mixture to be continued.

Saturday, August 26th, nine o'clock A. M.-He hiccupped much after I left him last night, and was very restless; but after day-light he became more tranquil. The leeches bled well. He still continued to vomit as often as fluids were given him; had not parted with the glyster I gave him last night. He complained a good deal of soreness of the belly, notwithstanding his pulse and other febrile symptoms are much abated. I gave him a table-spoonful of castor-oil, and an injection of Epsom salts, in four ounces of water. In a quarter of an hour he requested to be placed on his chair. He now had a full and copious liquid stool, sitting in this erect position full 20 miOn examining the contents of the motion, it consisted of a quart or more in quantity, principally of gruel, with some few small lumps of feculent matter; these I had washed; they were found to contain several portions of the rind or skin of the apricot. He was much relieved, and highly pleased at having this evacuation, and spoke more in his natural voice. Seven o'clock P. M.-Soon after I left him, he took two or three spoonfuls of boiled milk, which he vomited about twelve at noon. He has not vomited since, and had no more stools. He is in every respect better. The castor oil, with an injection of water-gruel, was repeated; the washing of the body when hot was to be continued.

Sunday, August 27th, ten A. M.-He has had four stools without pain since last night; the two first very copious, and amongst them was discovered more of the rind of the apricot. Breathing is much relieved; pulse and skin nearly natural; he has been washed several times since yesterday, from which he always finds relief and comfort. No vomiting since yesterday noon; slept well. Eight o'clock P. M.-Has had two stools since morning; pulse and heat of skin rather increased. The cold ablution to be repeated.

Monday, August 28th, eleven o'clock A. M.-Four stools since last visit; the first contained a lump of undigested apri cot; the last was slimy and of a dark green colour. The tongue is clean; he has slept well; the fever is much abated; breath

ing natural; no thirst; expressed a wish for some roast mutton, which was not allowed. Nine P. M.-Too many visitors hav→ ing been admitted, his fever was increased this evening. Skin hot; pulse fuller, and somewhat cordy. Two stools since morning, of good consistence. Applied six leeches to the thorax, which bled freely for two hours, during which time the abdomen and chest were fomented, and the legs, arms, and face well washed in cold water, which immediately reduced the heat of skin.

Tuesday, August 29th, ten o'clock A. M.-Much better in every respect. Removed three of the sutures.

Wednesday, August 30th, eleven o'clock A. M.-Free from fever; in every respect doing well; had two stools since yesterday, but of too firm consistence. Removed the remaining sutures this morning; the wounds seem to be nearly closed, except about an inch of that part of the wound nearest the ileum. Some matter was discharged from the abdomen between the stitches. The calomel pill is to be repeated this evening, and the castor oil in the morning.

Thursday, August 31st.-Has had four natural stools since yesterday, of the same consistence. Some pain last night in the abdomen. His father, from mistaken motives, omitted the calomel pill and oil; both were now given him. Tongue clean; skin and pulse quite natural.

Friday, September 1st.-Has had four small stools since yes terday; the last watery; the abdomen fuller than it ought to be. On inquiry I found that his parents had given him more hasty-pudding than was ordered, thinking I did not allow him sufficient nourishment. He is now in much pain, and his fever is increased; pulse quickened, with a catching of his breath; slept well in the beginning of the night. Until last evening had voided his urine freely, and in full quantity; since then it has been very scanty, and passed with much pain. I was now given to understand that he has been subject to a stoppage of his water at times, ever since he was three months old. The wound in the thorax granulates and looks well; that of the abdomen more open since yesterday; the peritoneal coat, however, appears firmly attached its whole length. This wound discharges more white purulent matter than can be accounted for from the size of the wound, yet no opening can be discovered into the cavity of the abdomen; he is much reduced.

Saturday, September 2d. He has had four watery stools, and has passed his urine freely. Pulse and breathing natural; abdomen flaccid; tongue clean; no pain; quite cheerful; wounds

look healthy; the lower one discharges good matter, but in increased quantity.

Sunday, September 3d.-As yesterday.

Monday, September 4th.-Wounds look well and healthy, and discharge freely. The lower portion of the abdomen appearing rather fuller than yesterday, I applied a gentle pressure, when a small quantity of pus spun out of the abdomen, through a small opening that now discovered itself, but not sufficiently large to admit the blunt end of a probe. He is free from fever; bowels open; in good spirits; complains of hunger; allowed a small portion of boiled milk.

Tuesday, September 5th.-Has had but an indifferent and uneasy night; very little sleep until this morning, when he slept for three hours. He appears much worse to-day. The pulse quick and small; complains of great pain in the pit of the stomach; belly distended; tongue rather white; breathing short, with moaning, but no shiverings or sickness; has had three watery stools; he has been more fretful, and passed no urine since last night. Repeat the calomel pill, and foment the abdomen. Nine P. M.-He passed a pint of urine in about an hour after I left him, which appears to contain matter; has had two stools, and passed another worm; he is in less pain. The body, which had become less, has again increased to nearly its former size; he is in better spirits, and amuses himself as usual; skin cooler; pulse quick and full, but not cordy; no thirst. Repeat the fomentation.

. Wednesday, September 6th.-Slept well the whole of last night; has had one copious stool this morning; has very little fever; skin cool; wounds improve, and discharge freely; pulse nearly natural; quite cheerful; passed very little urine; belly not quite so prominent; soft and less painful, yet not easy, especially about the scrobiculus cordis. Ordered parsley-root tea for drink, and beef tea for food.

Thursday, September 7th.-Urine passed more plentifully; belly softer, and less swelled; wound in the abdomen healing fast, and the discharge less in quantity; in every respect improving

Saturday, September 9th.-Somewhat feverish to-day, supposed to be owing to taking too much food yesterday. Repeat the castor oil twice in the week.

Wednesday, September 13th.-Wounds healing fast.

Saturday, September 16th.-Has been allowed these last three days some boiled chicken in small quantities, without any bad consequences following; wounds discharge very little, and are nearly closed; complains of some pain on the slightest pres

VOL. XII. NO, 45.

sure on the fractured rib, but not the least pain in any part of the abdomen. He is now allowed to sit up an hour or two each day. Convalescent.

Wednesday, September 20th.-It is now a month since the accident occurred. The wounds are perfectly healed. He walked across the room with the assistance of a person holding him by one arm. He is of course much emaciated and very weak, not able to put his left leg in a right line forward, but throws it across the other, but sits perfectly upright. In every other respect he is quite restored. Whenever he laughs, when the bandage is removed, the parietes of the abdomen, for about two inches in diameter, where the cicatrix is formed, rises into a round ball. The parietes are extremely thin, so much so, that the peristaltic motion of the intestines has been frequently seen through them. A laced jacket, made in the form of stays, with a pad of linen in the direction of the wound, was this day applied, and recommended to be worn until he recovers the complete power of the abdominal muscles.

Wednesday, September 27th.-Walks perfectly well, and is fast recovering his strength.

It seldom falls to the lot of country surgeons to see such extensive lacerated wounds, and more particularly where the intestines were so completely divided as in the case now related. I noted down, at the bed-side of the patient, the facts relating to this case, in the most simple and accurate manner I was able. It is not necessary for me, in this place, to notice the various methods recommended by different surgeons, for the approxi→ mation of the divided intestine; it is my intention only to report the case as it occurred, and the method employed in the treatment. The intestine was completely separated, and the division extended into the mesentery. Four stitches of the interrupted suture were employed, making use of a small curved needle, with a double silk thread. Firm and sufficient hold was taken, passing the needle through all the coats of the intestine, from without inwards in one portion of gut, and from within outwards in the other. The edges were then brought accurately together, the ligature tied fast, and the silk cut close to the knots. I did not apprehend any danger in this case from the contents of the bowels passing through the wound into the cavi ty of the abdomen, notwithstanding the distance of the stitches. Thinking that they would more easily pass through the open and natural passage, I presumed that every portion of the divided intestine would be equally pressed upon, so as to prevent the escape of any contents; nor had I any fear of its sides adhering for want of being distended by artificial means, judging that the

constant passage of the fecal matter would prevent it. No case can more clearly establish Mr Travers's opinion respecting the superiority of the adhesive tendency of the peritoneal coat, over the remaining parietes of the abdomen, than this. The swelling of the abdomen, no doubt, was owing to an overloaded stomach, the bowels being partly distended with air, and to a retention of his urine. To these combined circumstances do I attribute the opening of the wound, down to the peritoneal coat, which was distinctly seen; therefore, had not the union of this coat been sufficiently firm, the most fatal effects would in all probability have ensued. The omentum being lacerated through its whole length, was no doubt the cause of the matter forming within that cavity. This membrane was returned to its place without any other attempt to approximate its divided edges, than by laying them together. The treatment of this child, it may be observed, was as simple as possible; opiates were strenuously avoided, supposing that they would be highly detrimental in producing costiveness, and in increasing fever. In such cases as the above, the few additional hours of ease and rest are not at all adequate to the mischief produced by them. It may be thought there was an incongruity of practice in using the warm fomentation, and cold ablution at the same time. Water, I apprehend, whether cold or warm, have each the power of reducing febrile heat, and the former had the further effect of relaxing and softening the abdomen; and in this case their effects were strongly marked in relieving almost at once every febrile symptom. It appeared to me that this ablution and fomentation prevented the necessity of repeated general blood-letting. It is probable, had cold water been used to the abdomen instead of the warm fomentation, the same results might have been obtained, and that it might not have been necessary to remove the stitches so early.

This unfortunate boy + is small and delicate; has a mind superior to his situation in life and years. After his fever had abated, he expressed a desire for solid food; but he did not indalge it, and received a denial with great fortitude. It is true, indeed, that he cried a little once or twice on being denied it; and on these occasions his parents gave him more spoon-meat than what I allowed him. These little excesses invariably produced an accession of fever; and he became so sensible of this, that he oftentimes refused taking more although offered to him. I

* Vide Travers on the Intestines.

†Three years ago he fractured the femur of the left thigh.

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