All’s well that ends well

An Account of a very remarkable Case of a Boy, who, notwithstanding that a considerable Part of his Intestines was forced out by the Fall of a Cart upon him, and afterwards cut off, recovered, and continued wellA grisly tale, but one with a happy ending: John Nedham wrote to the Philosophical Transactions in 1756 with news of a road traffic accident and its consequences:

On the 3d of January 1755, Mr. N. was called to 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 13 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 Mr. N. took to be part of the omentum, hanging down below the hams, double, like the reins of a bridle, very much distended and inflamed.

‘Like the reins of a bridle’ is a curiously vivid (and unpleasant) simile. Unsurprisingly, the boy was not well.

He had a continual nausea, and violent retchings 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, Mr. N. reduced the parts, though to no purpose; the vomiting immediately returned, and forced them out again. Next day the fever increased, the nausea and retchings to vomit continued, the parts appeared livid and black, with all the signs of a mortification. On the 3d day the mortification increasing, he cut off the intestine, with the mesentery, close to the anus, being 57 inches in length.

Five feet of gut is a lot to lose; it sounds as if the boy lost his entire large intestine.

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 became easy, and the nausea and vomiting abated. Mr. N. gave him tinct. cort. Peruv. simpl. twice a day; and, as he complained at times of griping pains, he took now and then tinct. rhabarb. vinos, and had recovered a good state of health.

‘tinct. cort. peruv. simpl.’ is a tincture of Peruvian bark (bark of the Cinchona tree), whose active ingredient is quinine.  It would at least have brought the boy’s temperature down.  ‘tinc. rhabarb. vinos’ is a tincture of rhubarb in wine.

For some time he had 6 or 7, or more stools in a day; afterwards commonly 3 or 4, all loose, which come soon after eating; and frequently he was obliged to hurry out to ease himself, during his meals.

But good news: for once, a case ends well.

On the 7th of May the boy walked from Brunsted to North-Walsham, 7 miles, was perfectly well, and walked back again that afternoon.

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