Perforation of a Gastric Ulcer; Recovery.

Abstract

THE following are the notes of a case which I attended whilst doing work for Mr. Routh of Sibford-Ferris.The patient, aged fifty years, had been a healthy, active man all his life and could not remember ever lying up for illness ; but for a month preceding the present attack he had Itad vague symptoms of gastritis, such as a little pain after food and occasionally slight sickness. He had never vomited .any blood, and having enjoyed such good health all his life he was unwilling to accept much in the way of .advice or treatment. On July 14th he had his dinner as usual at one o'clock, consisting of a mixed diet of meat, &c., and afterwards returned to his work out of doors. He was lifting barrels about, when at four o'clock he was suddenly seized with a violent pain in the 'epigastrium which was so severe as to render him helpless ; he was put to bed and poultices were applied to the abdomen. He brought up a quantity of green, bile-stained vomit, but was only sick this once. As I was visiting in another direction when sent for I did not see him 'till nine o'clock that evening. Then I found him pale and i sweating, with the pulse somewhat quickened and the temperature slightly raised. The epigastrium and right hypochondrium were the seat of great pain and tenderness, especially a small area a little below the tip of the ninth rib. The whole abdomen was very rigid. At no time was anything of the nature of a tumour to be felt. He had passed urine without much difficulty, and his bowels had been slightly moved. Suspecting the real nature of the case I ordered that he should have nothing by the mouth and should continue the hot fomentations. I saw him early next morning, when he said that he had slept -fairly well and was feeling less collapsed, but the pain and tenderness remained ; his temperature was 99° F. and the ,pulse was 72. At 8.30 P.M. the temperature was' 101°, the pulse 72, full and soft, and the tongue was a good deal coated and dry. He had had two or three teaspoonfuls of weak milk in the afternoon, by my direction, as a test. His bowels had been again moved; as I have mentioned there was no further vomiting. The abdominal wall was less rigid and the pain less severe, but diffused over the whole abdomen ; the very tender area remained, but now the important sign of resonance over the liver area was present, and I felt pretty confident of the diagnosis. Thinking that an operation would probably be the only means of saving the patient's life, I consulted Dr. George Findlay of Brailegïj on the matter, -and he kindly came over to see him, By this time it was midnight and the patient, feeling better, being hardly persuaded that the matter was serious, we decided to wait till the morning, and even then to postpone operation so long as the improvement was maintained. I may say that the improvement did steadily continue, the pulse remained good but dropped to about 60 per minute, the pyrexia subsided, and at the end of five days from the onset the resonance over the liver had disappeared, and the pain...