"In December laft, a fever seized the inhabitants of the weftern country, nearly all at once. You would scarcely fee one in a hundred free from it. It was called by the physicians, the influenza; but it had every appearance of the remitting bilious fever, or break-bone fever, described in your first volume. The pulfe was full and foft, but not quick. Thofe who were attacked, had sickness at the stomach, great oppreffion about the heart and precordia, a depreffion of spirits, violent pain in the head and bones; and in fact, no part was exempt.

"Bleeding had little or no effect; but a bilious cathartic never failed of entirely removing the difeafe, as foon as one motion was obtained, and in some cases even before it procured a paffage."

Account of an extraordinary Cure of a Wound of the Intestines.

THE following account of an extraordinary recovery from a

wound of the inteftines, was fent me fome years ago by relation in London, to whom it was given by a friend; but no information was afforded as to the author, or by what means the paper came into his hands.-As however the author has adverted to his connection with the Radcliffe infirmary, I have concluded it might be useful to publish the cafe, as its truth may be perhaps established, by this meafure. Editor.

*

IN the evening of the 26th of September, 1775, I was called' in great hafte, to James Langford, a young man in the twenty-first year of his age, who had been maliciously stabbed

The Radcliffe Infirmary is in Oxford, and was erected by the trustees of Dr. Radcliffe's benefactions.—It was begun in 1759, and opened for the reception of patients in 1770, See Medical and Phyfical Journal, vol. 8. page

126.

with a knife, in the left fide of his belly. The wound was between two and three inches in length, running from the left os ilium obliquely upwards towards the navel. I found him lying on the floor, weltering in his blood, with a large portion of his intestines forced through the wound; and I learnt, from the unfortunate youth himself, that, as foon as the wound was inflicted, the bowels began to appear; and, by the time I got to him, which could not exceed ten minutes, I verily believe, that the full half of the intestinal tube was protruded through the opening. This I attributed, in fome measure, to the fulness of the stomach; for, immediately before the accident happened, he had eaten a very hearty fupper. The wound at first bled freely; but the hemorrhage was foon restrained by the preffure of the prolapfed inteftines, which were, to a great degree, diftended with air; and from this circumstance I was flattered with the best hopes that they had escaped the affaffin's knife; but, to my great difappointment, it proved other wife, as will appear most evidently from the fequel of this narrative. Examining his pulfe, I found it was exceedingly low, quick, and interrupted; his fkin was all over cold and clammy, and he laboured under great langour, anxiety, and pain about the præcordia. He likewife complained of a disagreeable tingling and numbness of the whole thigh, leg, and foot, of the fide wounded; and acquainted me, that he dropped on the floor, in confequence of the inability of the limb to fupport him, and not from any faintinefs, as might have been reasonably expected, from the loss of blood, or through fear, to which, indeed, he seemed an utter ftranger. I ordered him to be conveyed to his bed in an horizontal posture, left the raifing of the body might encourage a farther descent of the parts which still remained in the abdomen; and a fomentation of port wine, with warm water, to be got ready immediately, out of which a double flannel fhould be wrung, and applied directly to the prolapfed inteftines, and renewed occafionally, to prevent them from getting too

dry, as well as to preferve, as much as poffible, their natural heat. The reduction of the difplaced bowels was begun, with laying the patient's legs over an affistant's shoulders, who was defired to kneel upon the bed for that purpose, with his back towards him, and then the legs were brought forward as far as to the hams. By these means, the lower parts of the body were elevated, and, in confequence, the weight of the bowels falling back towards the cheft, counteracted their further protrusion. While the patient continued in this pofition, I endeavoured, with my hands, to force the guts back into their proper place; but foon found, from the quantity of them protruded, together with their great inflation, that a larger, or more extended presfure than my own hands could afford me, was neceffary; and not thinking it prudent to employ any of the by-standers in fo hazardous a task, left, by their inexperience they might handle the bowels too roughly, I fent for two of my fellow-labourers in the care of the Radcliffe infirmary, to my affiftance. As foom as they came, the reduction was again attempted; one of us directing that portion of the bowel which was laft protruded, while the two others made a gentle, regular, and circumfcribed preffure from all fides towards the opening. But this endeavour not fucceeding, convinced us, that it would be much fafer to enlarge the wound, to facilitate the return of the prolapfed parts, than hazard the neceffity of handling them too much, or exposing them too long to the circumambient air, either of which would, in all probability, have proved fatal. This being done accordingly, by continuing the wound in the fame direction upwards, about two inches, the expofed bowels were eafily and foon returned into the abdomen. We then brought the edges of the wound together, and kept them by the future called gaftroraphia, leaving a proper opening in the most depending part of it, for the discharge of the blood or matter which might be collected in the cavity; and afterwards it was dressed in the ufual way, lightly, and almost fuperficially, with an anodyne poultice over all.

The regimen enjoined him, with refpect to diet, was only gruel, panada or fago; with barley water or thin gruel to drink; and the medicines were the following:

В Mannæ

Ol: Amygd. D. ana 3fs.

Aq: Alexit. fimp.

zi.

Nucis mofchat. 3i.-M. ft. hauftus quam

primum fumendus et quartâ quâque horâ repetendus donec alvus refponderit.

Tinct. Thebaic. gt. xl.-ft. enema quovis tem

pore infundendum fi dolor abdominis urgeat.

27th. Vifiting him early the next morning, I found the night had been spent in great reftleffnefs and inquietude, notwithstanding the clyfter had been thrown up according to the direction. He was exceeding low; his fkin felt still cold and clammy; his pulfe weak and fluttering; he complained of frequent chills, and an oppreffive tightnefs of his belly, though the wound had discharged confiderably a thin, ferous humour, which had wetted the bandage quite through. Nor was the tenfion of the abdomen, at this time, fufficient to account for the oppreffive pain he complained of; from whence I concluded it to be fpafmodic.

The dreffings were removed; and I defired my apprentice to foment the part with an infufion of the emollient flowers, for a full hour, and to take particular care that the stupes were applied of a very moderate warmth; often having obferved, that this manner of applying them, when an inflammation was either to be refolved or prevented, was more effectual than when the heat has been greater. This obfervation, upon a little reflection, will be found agreeable to reafon; for as great heat proves an aftringent, on the contrary, a moderate and VOL. I. Q q

kindly warmth relaxes, and, by promoting a free perspiration of the parts to which it is applied, fooner effects the end propofed. The wound was dreffed as before, with the addition of two ounces of the fpecies procataplafmate de cymino to the poultice; and, as the draughts he had taken had not produced any motion of the bowels, it was thought proper to inject the underwritten clyfter, as foon as it could be prepared:

Mel. Solutiv. ana 3fs.-ft. enema.

This, in about half an hour, occafioned a very copious difcharge of faces, together with a good deal of blood; fome of it congealed into lumps, the reft fluid. This circumftance did not fail to alarm my apprehenfions of the imminent danger of the lad's fituation, as it was no longer to be doubted, but that the bowels were wounded in fome part of them; but what part, ftill remained a matter of conjecture. When the clyfter had done operating, he took this draught:

B Sperm. Ceti, (Mucilag. Gum. Arab. Solut.) i.

Aq. Alexit. Simp.

Ol. Amygd. D.

gifs.

Syr. de Meconio. ana. zij.

Tinct. Thebaic. guttas x.-M. ft. haust.

Late this evening the fomentation and dreffings were again renewed, and directions given, that he should take one of the draughts, with manna, oil, &c. as first prescribed, at three o'clock in the morning; and to repeat them regularly every fourth hour, till they had had their defired effect.

28th. He had got but little fleep in the night, though he had Jain fomething quieter, with fhort, but interrupted slumbers intervening. His pulfe, and all the other fymptoms, were much in the fame state as yesterday, excepting a general foreness of the abdomen, of which, at this time, he made great complaint,