ETAWAH SUDDER DISPENSARY. Case of obstruction of the bowels.

By Assistant-Surgeon Nil Rattan Bannerjee, Etawah.

Bhagi, a Hindoo male, aged about 40 years, came to the hospi- tal for treatment on the and September, 1882. His abdomen was highly tympanitic and sounded like a drum. His face was

anxious, and he was crying from the painful distension of his

abdomen. His pulse was tolerably well, tongue moist and slightly coated, breathing difficult, and he was unable to walk erect.

On enquiry, the patient'said that he was not moved for 12 days, and had'taken little food in the meantime. He had attacks of constipation of a milder type about 8 or 10

times before, but used to be relieved in 3 or 4 days at the out- side. He did not notice the passage of scybalse ever before, but said he had diarrhoea almost every time after such attacks. This time it commenced similarly, and he tried all sorts of na- tive remedies, but without effect. He had no vomiting, hiccup, or any uneasiness of that sort.

Treatment.?On admission, an enema of hot water and soap was given and repeated after 4 hours, but only a small portion of the enema fluid returned. Fomentations of turpentine, and milk diet were ordered ; opium 1 gr., twice in the night given to procure sleep. 3rd September.?Slept very little last night, enema continued,

and given three times in the course of the whole day. Croton oil was rubbed on the abdomen, but no effect on the bowels was produced.

4th September.?Bowels not moved, had no sleep, calomel 10 grs. given internally, followed in the evening by an enema ; the fluid not discharged, the patient could not expel the liquid by his own efforts. 5th September.?Had no sleep last night, bowels not moved,

castor oil 2 ozs. given to assist the calomel out of the system, but when no effect was produced till midday the long tube of the stomach pump was cautiously inserted to the extent of 24 inches, filling the tube with water previous to insertion, to avoid entrance of air. The tube met with little obstruction, and with some manipulation was easily introduced. A large quantity of offen- sive gas was expelled through the tube, and the tympanites disappeared. Hot water and turpentine were injected through the tube, and the returning liquid was thick, offensive, and contained soluble feculent matter. When withdrawn, the sides of the tube were coated with slimy feces. The patient continued well for the whole day, and took some milk only.

6th September.?The tympanites returned during the night. An injection by the long tube was again given, a portion of scy- bafe blocked the tube, but none was felt by the finger in the rec- um, a mixture of Tinct. belladonna, 7I^X,^'Wr- strychinse

Aquae gi m. Haust, three times a day was ordered. The

pulse continues well. yth September.?Injected twice by the long tube with tinct.

of assafoetida and turpentine in tepid water. The patient is

better, scybafe blocked up the opening of the tube, but cannot

be reached. Mixture continued; slept in the night for six hours. 8th September. ?Injected twice as above, the patient has not

regained the power of passing out the injection by his own efforts, pulse getting weak. Stimulants given with the mixture and quinine 2 grs., twice a day ordered. Slept well.

gth September.?Cannot pass his motions. Injection given twice as before, doing well, pulse improving, mixture continued, slept well.

10th September.?Morning, passed a large quantity of hard scybalse and had two usual motions by his own efforts also.

Better, took food well. nth September.?Continues better, had two ordinary mo-

tions, no uneasiness, feels very hungry. 12th. September.?Discharged, cured, from the hospital.