Wound of the Intestines, successfully treated. By Dandridge
B. Hilliard, M. D., of Halifax county, North Carolina.
To the Editor of the Medical Examiner:
Sir,—I beg leave to send you the notes of a case of wounded in-
testine, with recovery. On the 11th May, at 9 o’clock, A. M., I
was called to see a negro slave, belongingto Capt. Hardy Pitts, who
had been stabbed in the left iliac region. On reaching him, I found
that nearly all the small intestine had protruded, on a portion of which
was a transverse cut, three-fourths of an inch in length, with an ac-
companying wound of the mesentery, one of the blood vessels of
W’hich was divided. The injury had been received about an hour
before my arrival, in a conflict with another slave, who inflicted it
with a sharp pointed knife, making an external wound two inches in
length. I immediately administered to him 30 gtt. sul. ether, and then
secured the bleeding vessel, which fortunately had been compressed
by the weight of the protruded mass, by ligature. The wounded in-
testine, which displayed the mucous membrane everted, was closed
with a fine suture needle, by neatly drawing together the outer edges
without puncturing the mucous membrane, by this means approxi-
mating its edges, so that when the threads should be disengaged
from the outer coat of the bowel by suppuration, the inner coat
would be healed, thereby leaving no orifice through which matter
could escape. The ends were cut off close, and the whole returned
into the cavity of the abdomen. The external wound was then
closed by stitches, sufficiently to retain the bowels, leaving a small
orifice through which the blood might escape, which I favored by
laying the patient in a favorable position, and preventing the
bowels from plugging it up by the introduction of a finger. After
which I ordered him thirty drops of laudanum, to be repeated every
hour till composed. Three o’clock in the evening, complained of
much nausea and restlessness; ordered him 20 drops sul. ether and
15 drops laudanum, after which he took some gruel, appeared more
composed, and slept during the night, On the morning of the
12th, there was much restlessness ; pulse 100 ; abdomen slightly
tympanitic ; ordered mucilaginous drinks ; a cold corn meal poul-
tice, with slippery elm, over which was poured an ounce of lauda-
num, and the whole of the abdomen covered over with it, with
orders to renew it every fifteen minutes, and to give 30 drops sweet
spts. nitre every hour till the fever abated. Two hours after, pulse
80, soft and compressible ; ordered 35 drops laudanum. Slept
tolerably well that night.
13th. In the morning expressed himself more comfortable; 4
o’clock in the evening complained of nausea ; pulse 120 ; abdomen
tympanitic and tender ; much thirst; ordered 20 drops ether and
30 drops spts. nitre every half hour, to be followed by 35 drops
laudanum ; and an opium plaster around the umbilicus ; the cold
mush poultice applied as before, and renewed every fifteen min-
utes. In a few hours the pulse fell to 70, and the patient ex-
pressed himself comfortable. 14th. Some fever, which was soon
subdued by the same prescription. On the 15th, 16th, and 17th,
continued the same treatment, so far as the indications demanded
it. On the 18th, ordered an injection of 12 oz. slippery elm tea,
to be repeated in three hours. 19th. 12 oz. corn-meal gruel, 3 oz.
castor oil, and 60 drops laudanum, by injection, which produced a
copious evacuation, the first he had had since the accident. Three
weeks after, the patient resumed his labors on the farm, and at this
time (Dec. 3) is perfectly sound and healthy. Had I allowed the
ends of the sutures to depend externally, where they would have
been partially confined, the peristaltic motion of the bowel would
have caused the stitches to tear out. My thanks are due to my
highly valued friend, Dr. Thomas Arrington, of Nash county, for
the efficient services rendered me in this case.