494 
PERFORATION OF THE DUODENUM BY BOTS. 
custom. I should also remark, that she had been for some time 
labouring under a catarrhal attack, but was convalescent. 
As she was in good condition I bled her to a considerable 
extent, at least 14 lb, and ordered her to be kept on a low 
diet, consisting of bran mashes and a little gruel, with clysters 
to be thrown up occasionally; and to take every eight hours, until 
the costiveness was relieved, oleum lini J v b magnes. sulphat. 
^iv, digitalis 3ss, mixed together in a quart of warm water. 
On my arrival on the 17th, I found that no material altera¬ 
tion had taken place, and the pulse still sixty. I abstracted 
six quarts of blood, when a visible alteration occurred; she 
appeared much relieved, and her pulse in an hour fell to forty- 
five. As she remained costive, I continued the medicine, See. as 
before, and had her extremities hand-rubbed and bandaged. 
On the morning of the 18th, about five o'clock, the servant 
came to inform me, that at ten the night before she was taken 
(to use his description) in a dreadful state, continually lying 
down and suddenly springing up remarkably quickly, and, that 
which to me appeared surprising, she would not allow a light to be 
brought near her. She continued in this state for an hour, 
when she fell as if she had been shot; stretched out her feet and 
legs straight and stiff, the fore feet being firmly fixed against 
the wall. In this situation she remained until seven, p. m., when 
death terminated her sufferings. On my visiting her, I found 
her as described by the groom, apparently as if she was in a 
dead sleep ; moderately warm all over; breathing laborious; 
pulse about 40, but not so strong as yesterday. It was literally 
impossible to arouse her; in fact, she appeared to be in a com¬ 
pletely comatose state. I applied a blister over the os frontis, the 
temples, and the occiput, and gave rather strong stimulants with 
a solution of aloes, ordering them to be repeated every six hours : 
on my arrival about seven in the evening, I found her dead. 
On opening the cavity of the abdomen, the first thing that 
attracted my notice was the great size of the stomach, which was 
remarkably distended with food. The intestines appeared 
healthy, with the exception of a small portion of the duodenum, 
rather more than six inches from the pyloric orifice of the stomach, 
which was considerably inflamed. On examining it more mi¬ 
nutely, I discovered that near the centre there was a hole through 
which I could easily introduce my finger, and that the surround¬ 
ing parts were in a highly gangrenous state. On laying it open, 
I found a great number of bots, at least 250, firmly adhering 
to the duodenum ; and so close were they to each other, as com¬ 
pletely to obstruct the passage of the faeces. On inspecting the 
cavity of the abdomen, 1 found four of these (in this instance) 
