Case LXXXIX.
William Spoull, æt. 23, baker. Admitted on the 22d day of fever: no pain or tenderness of abdomen; tongue red and dry; bowels loose; no pain of chest; some cough; no pain of head; some of limbs and back; mind distinct; little sleep; very deaf; pulse 102.
25th. Tongue much furred and fissured; four stools; cough the same; pulse 108.
26th. Four stools, mixed with blood; respiration hurried.
27th. Tongue more clean, slightly aphthous; three stools without blood; respiration less hurried; pulse 104.
29th. Severe pain of abdomen, from which he had hitherto been quite free, came on during the night; at present it continues very severe, is much increased on pressure; abdomen swollen and tense; four stools without blood; pulse 112, sharp.
30th. Pain of abdomen not so severe, but still excited by full pressure; vomited a large quantity of bilious fluid; two stools, dark and slimy; respiration hurried; countenance sharp and anxious; pulse 124, small. Died two hours after visit.
Abdomen. The mucous membrane, both of the small and large intestines, in general highly inflamed; the lower third of the ilium, the cæcum and the colon were full of ulcers, one of which, in the ilium, had perforated through all the coats of the intestine, and formed, near the ileo-cæcal valve, a large circular opening, of the size of a crown piece, through which the contents of the bowel had escaped into the cavity of the peritoneum; this cavity contained a large quantity of sero-purulent fluid, mixed with feculent matter; the convolutions of the intestines were glued together and their peritoneal coat every where highly inflamed; the spleen, liver, and pancreas were sound. Head. The brain and its membranes were healthy. Thorax. Viscera healthy.
The attentive student of the important and instructive cases included under this section will have perceived that, in the order in which they stand, they exhibit a complete series of changes in the intestines from the slightest vascularity to the most intense inflammation; and from mere elevation and inequality of the mucous membrane, in consequence of adventitious deposit beneath it, or from the simple and most superficial abrasion of its surface, to the most extensive and deep ulceration, on to the ultimate perforation of all the coats of the bowel.