Remarks on the Treatment of Burns and Scalds.

Abstract

J. J., of tender age, quick intellect, slight conformation, and delicate constitution, became gradually ailing with symptoms of mesenteric disease. The abdomen was swollen and painful, he lost flesh, and his general health declined. On this account he was placed under the care of eminent medical men in London, who senit him for a time to the sea-side; the disease, never. theless, steadily though slowly advanced, and whilst the enlargement and tenderness of the abdomen increased, the rest of the body became attenuated. At length the quantity of the alvine discharges, which were of a palewhite colour, was observed to decrease, and as the quiantity became less and less, an abscess was discovered to be forming externally on the right side of the abdomen, below the umbilicus. When it broke the feecal smell of the discharge at once proved that it came from the cavity of the intestine, and very soon afterwards a calculus, of a whitish colour, and about the size of a nutmeg, was four,d on the poultice. This abscess was succeeded by another more posteriorly; and through these openings several more calculi, of nearly the same size and colour, were from time to tinle expelled with the fecal matter. The expulsion of these concretions gave some lhope of recovery, and every effort to effect it was redoubled, btut no improvement took place. All the stools continued to pass throuigh the abdominal openings, he became colour-less and atrophied, the peritoneum infiltr-ated, his lower extremities anasarcous, and he gradually sank from exhaustion. On examirning the abdominal viscera, the omenta and peritoneum were found stuidded with a nmultitude of small tubercles; and tihe mesentery, from the quantitv and size of the tuibercular masses it contained, was like a net bag full of white marbles. The external openings communicated with the cavity of the coecum, which lhad become the seat of an abscess, extending almost as high as the transverse arch of the colon. The involved portion of the gut was fixed by peritoneal adhesions superiorly to the acute margin of the large lobe of the liver, laterally to the omentum majus and small intestines, and inferiorly to the fundus of the bladder. The cavity of the ccecumn at its inferior extremity was freely open to the ileum; but its superior part was so blocked up bv a fungoid growth that it would scarcely allow of the small end of a blow-pipe being passed into the transverse arch of the colon. The internal surface of the bowel presented a mass of chronic and irregular granulations of a dark red colour, some of which were elevated into nipple-like processes. The same dark colour pervaded the villous coat of the intestinal canal at either end of the disease, and that of the ileumr, close to the ileo-coecal valve, was extensively ulcerated. The rationale of this interesting case may be summed up in the following order:-Debility of constitution; tubercular diathesis; tubercles of the mesentery more actively developed; atrophy; softening of the tubercular matter in the villous coat of the coecum; superflcial ulceration of the same, extended and kept open by the irritation of fecal matter; granulations shooting up, and by degrees obstructiug the passage of the colon; formation of concretions by the gradual deposit of the phosphates upon indigestible nuclei, namely,orange pips, apple pips, &c., which were found in their centres; and lastly, ulcerations through the abdominal parietes, to expel the calculi, and serve as an outlet for the feces. [To be continued.]