Ulceration of the Ccecum,—Hemorrhage,—Death.	By H. A.
Ramsay, M. D., Raysville, Georgia.
On the 1st ult. I was called to see Emanuel, belonging to Mr.
0-----, of this vicinity. The patient was a stout, robust man,
aetat. 24. He had been complaining of some slight pain in his
bowels and lumbar portion of the spine for several weeks, together
with some perversion of his appetite ; not sufficient, however, to
prevent him from being about, and attending to light work. On
the 1st he grew suddenly worse, and was obliged to go to his bed.
When sent for I found him rather restless, pulse soft and volu-
minous, but not increased in action; skin warm and comfortable,
with the exception of his hands, which were cool; tongue soft,
sides white,middle red; pressure upon the epigastric region and the
abdomen generally produced some evidence of tenderness; he said,
however, that he felt no pain, yet at the same time he was giving
vent to constant groans and sighs. I was induced to think he
certainly felt pain, from his complaining so constantly, but he
positively denied the existence of any, although repeatedly inter-
rogated by myself and Dr. Collins, who saw him subsequently.
The patient said he had had regular alvine evacuations daily; he
was rational, and without mental disturbance at any time; his
spine exhibited no tenderness on pressure; his stomach was not
disturbed by nausea, nor was his urinary secretion in the least
deranged. This is all the information that could be elicited by
Dr. Collins and myself, although we examined him very minutely.
We prescribed calomel in repeated doses during the night, sina-
pisms, and an opiate to calm his restlessness, and emollient poul-
tices to the abdomen. At 2 o’clock at night the mercurial pro-
duced a green biliary evacuation, shortly after which he had a
copious discharge of clotted blood ; but few minutes had elapsed
ere another took place. These continued to increase greatly, and
alarmed those watching. I was called immediately, and found
the man weltering in his blood, pulseless, rolling from side to
side of his bed, moaning but rational, and declaring that he felt
no pain. I examined the rectum and found the blood running
almost in a stream. Seeing he would die in a few moments,
unless relieved, I plugged the rectum, gave him freely of brandy,
applied mustard plasters, and ordered a laudanum enema—having
despatched a boy for a syringe, but ere he returned the patient
had sunk.
Two hours after death, in the presence of Dr. Collins and
several gentlemen, I made an autopsy. The stomach exhibited
no disease. The spleen was corrugated. The liver contained
some dark grumous blood, but looked natural and healthy. The
intestinal tube did not exhibit any marked signs of disease,
excepting in the coecum, where it was ulcerated for nearly two
inches, the ulceration presenting a dark greenish color, like
mouldy cheese ; near the middle of the ulcer there was exposed
the mouth of an artery, the coats of which had evidently been
destroyed, thus producing the haemorrhage. The calibre of the
bowel was very much diminished ; the appendix vermiformis was
smooth and indurated; and about the point of ulceration the
mesentery presented some marks of purulent deposition. We did
not examine the brain; the bladder was sound; there was some
effusion into the pericardium; the lungs w?ere healthy.
The patient died in less than three hours from the time the
haemorrhage began.
How long could this ulcer have existed before his death ?