An Account of a Very Remarkable Case of a Boy, Who, Notwithstanding That a Considerable Part of His Intestines Were Forced out by the Fall of a Cart upon Him, and Afterwards Cut off, Recovered, and Continues Well

XXXVII. An Account of a very remarkable Case of a Boy, who, notwithstanding that a considerable Part of his Intestines were forced out by the Fall of a Cart upon him, and afterwards cut off, recovered, and continues well. Read June 12, 1755. On the third of January 1755, I was called to John, the son of Lancelot Watts (a day-labourer, living at Brunsted), a servant-boy to Mr. Pile, a farmer at Westwick, near North-Walsham, Norfolk, aged thirteen years. He was overturned in a cart, and thrown flat on his face, with the round, or edge of one side of the cart, (bottom upwards) whelmed across his loins, the upper part of the body lying beyond the wheel at right angles. In this helpless condition he continued some time, and was found with a very large portion of the intestines forced out at the anus, with part of the mesentery (and some loose pieces of fat, which I took to be part of the omentum), hanging down below the hams double, like the reins of a bridle, very much distended and inflamed. He had a continual nausea, and violent reachings to vomit, and threw up every thing he took. The pain of the stomach and bowels was exquisite, attended with convulsions; his pulse low and quick; and frequently he fell into cold sweats. After using an emollient and spirituous fomentation, I reduced the parts, though to no purpose: the vomiting immediately returned, and forced them out again. Next day the fever increased, the nausea and reachings to vomit continued, the parts parts appeared livid and black, with all signs of a mortification. On the third day the mortification increasing, I cut off the intestine, with the mesentery, close to the anus. He had had no stool from the time of the accident, but soon after the operation there was a very large discharge of blackish and extremely offensive faeces, which continued several days, lessening by degrees. He soon grew easy, and the nausea and vomiting abated. I gave him Tinct. Cort. Peruv. simpl. twice a day; and, as he complained at times of griping pains, he took now and then Tinct. Rhubarb. vinof. and has recovered a good state of health. For some time he had six or seven, or more stools in a day; at present commonly three or four, all loose, which come soon after eating; and frequently he is obliged to hurry out to ease himself, during his meals. I have three times lately tried, if I could discover a passage through the coats of the rectum, with my finger, and I think I have always felt an opening, just above the sphincter, towards the spine; the circumference of which was full, and protuberated, seemingly as large as my finger, the lower edge of which was harder than the rest: he complained of pain, when I pressed the upper part. The intestine cut off measured fifty seven inches, by a string applied to the outer surface. On the 7th of May the boy came walking from Brunsted to North-Walsham (seven miles), and dined with me, was perfectly well, and walked back again that afternoon. North-Walsham, Norfolk, May 28, 1755. John Nedham. Witness, E. Brooke, Surgeon. XXXVIII.