ILEUS DUE TO VASCULAR OBSTRUCTION. 447 W. R. C., aged thirty-five years, married, capitalist, weight about zoo pounds, for nearly two years, at intervals varying from four to six weeks, has been suffering, especially after over-indul gence in eating and drinking, from uncomfortable feeling in the epigastrium, and at times this sensation extended all over the abdominal cavity, slight nausea always accompanied, but no vomiting and no fever. These supposed attacks of indigestion I was often called to treat, and was able to relieve, by antiseptic laxatives and dieting, in the course of two or three days.
April 4, 1897, I was called to see the patient, and found him complaining from pain in the region of the stomach, had slight nausea, some tympanitis, but no fever, no vomiting, no soreness on manipulations. The usual treatment was given, but the symp toms remained about the same for three days ; on the 7th he stated that the pain was extending all over the abdomen, and also to his back in the lumbar region. He seemed to believe it to be rheu matic, and attributed it to sleeping with the window open.
April ii feels about the same ; he is up and around the room ; his bowels have moved well, and contained no blood.. Tempera ture normal.
April 12, bowels moved again, no fever, no vomiting; an ex amination of urine on this date was negative, the pain in the ab domen and in the back along the spine somewhat severer. He was given a hot bath, a light massage, and the back painted with tinct ure of iodine. Towards night he was very restless, so that it was necessary to give him morphia hypodermically.
April 13, consultation with Dr. Frank Billings ; patient had no fever, no pain on deep pressure over the abdomen or the back ; he seems to feel better, bowels had moved early in the day, and the movement was natural and contained no blood. The case was diagnosed as rheumatic pains in the back and walls of the ab domen ; sodium salicylate, acetate of potash, and colchicum ordered. During the night, however, the pain returned, and was so severe as to require subcutaneous injection of morphia ; under the influence of the latter he had a comparatively fair night.
April 14, at io A.M., the pain returned and was felt mostly in the abdomen ; it grew worse towards noon ; one-quarter grain of morphia sulphate with of a grain of atropia were given, and repeated three times during the afternoon, with only temporary relief. The pain was continuous, but more or less paroxysmal, due, undoubtedly, to exhaustion of the nerve centres for a time. There was no vomiting, no straining at stools, no discharge of bloody mucus. Dr. Billings was summoned again, and later on Dr. L. L. McArthur, and, while the preparations for an operation were taking place, the patient had to be given chloroform to ease his suffering. The operation was performed at 8.3o P.M. The whole of the small intestines were gangrenous as well as the ascending and transverse colon. The condition was due to occlu sion of the superior mesenteric artery. Patient expired on the table. No adhesions, bands, torsions, nor internal herniae found.