[FS/2/2/2/1/6]
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Case 12, No 131
[Annotated ‘Calculus’ and ‘3 days’]
1887
18th June
Calculus
This horse was admitted with colic at 4pm, this day, but refused morning food & found lying down at mid-day, brought in from billet & a diffusible stimulant & ultimately a five drachm solution of aloes administered. At 7 p.m. I saw the case, patient not in acute pain but persistent, cold water enemeta & hot fomentations to belly ordered. At 10 p.m. no relief from pain & worse pulse, smaller, respiration quick, pain intense, some blood had come from anus, I made a rectal examination, found a rupture in the roof of the rectum about a foot or so from the anus. The rupture was through the mucous coat, but not through the muscular coat. There was haemorrhage from the place which appears about 2 in. long. The patient strained, on examination which on this discovery was at once discontinued. I was in hopes that the rupture was posterior to the peritoneum but such turned out not to be the case. The line of treatment followed was to subdue pain & allay inflammation, so with this object I gave extract Indian Hemp & hot fomentations to the belly. These gave relief & were continued.
19th June.
7 a.m. Still in dull pain, gave 1oz
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hemp every hour until relieved, continued hot fomentations.
No action of the bowels, but some gas & fluids passed. The pulse is smaller, but the patient wonderfully lively and plucky.
12.30 Noon. The pain ceased, remained quiet all the afternoon, no passage.
7 pm. Still in slight pain, again, pulse about 90 & very small, repeated hot fomentations which gave relief. Walked about outside of his own accord & drank freely, there being no action of the bowels. Ol. lini Oj was given.
20th June.
Nothing but sheer pluck is keeping him alive, there are a few intestinal murmurs, the right colon dull on percussion, central sounds of fluids, no action of bowels, abdomen rather tymphanic, pulse smaller, size eye more infected, little or no pain, the hemp has stupified[sic] him, received an intravenous injection eserine, which was followed by a slight colic which soon passed off.
He remained standing, sinking slowly but making a tremendous fight for life.
21st June. Died at 5 a.m.
Autopsy abdomen tymphanic a little pus like fluid ran out on opening the cavity. The large intestines were completely collapsed, the 2nd & 3rd portions of the colon were slightly
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twisted from distension & rolling, a large knuckle of the single colon was found opposite the pelvic cavity, with much peritoneal infection on tracing this out to the anus, a calculus was found about 5” diameter, 18” from the anus & posterior to this a rupture through all the coats of the rectum, the edge of the rupture which occurred on the attached border of the intestine was ragged & discoloured the m[ucous]. m[embrane]. of the intestines much engorged. The stomach was full of liquid & contained a quantity of hemp. lungs much congested, heart large & fatty, liver fatty. The calculus was not weighed as it was kept in situ as a specimen.
Discharged, Died.
[Annotated ‘For some time before death ingesta dribbled from nostril. On P.M.E. the Omentum Major was found to have large haemorraghic spots in it.
[Transcription by Claudia Watts, KCL History, April 2019]
