The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Edward Martin
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    probable that it is their products, and not tliemselves, which are responsible for the train of symptoms described. It will be recognized at once that a great number of individual cases present a combination of the symptoms of the different con- ditions described, rather than the typical course of either diffuse, or spreading peritonitis, or abdominal septicaemia. This is because these conditions may complicate each other. Thus given, a case of acute purulent peritonitis, or the S])reading form of this inflamma- tion, complicated, as it frequently is, with obstruction, if tlie bowel contains large quantities of putrescent matter, fermentation and gas formation are exceedingly rapid, the ptomaines are absorbed in large quantities, and in place of pain and fever the toxic symptoms may prevail. The characteristic features of abdominal septicaemia may mark the case, the normal or subnormal temperature and the absence of pain and tenderness often conveying a belief in amelio- ration in the condition of the patient which the weak, running pulse should at once dispel. At times there is not only absence of pain and tenderness, but there may be no sign of tympanitic distention, though the abdomi- nal cavity may be full of pus. These cases are marked by the character of the pulse and by a peculiar board-like hardness of the abdominal muscles. This latter sign is, however, not always present. To account for this w^ant of tympany, no other expla- nation is needed than absence in the alimentary canal of ferment- able substances, or presence of certain chemical agencies which pre- vent this fermentation. It is probable that the same paralysis of the intestinal walls exists as in other cases, but that there is not present the, at times, enormous pneumatic pressure developed by the decomposition of organic bodies. The septic absorption in these cases would come from the pus in the peritoneal cavity rather than from the bowel contents. The violence of the symptoms is by no means commensurate with the septic matter inclosed within the peritoneum. Sims, Baudens, and many others have observed that death resulted when only an ounce or two of non-offensive, blood-stained serum was found in the abdominal cavity. Musser^ records the successful issue of a case from which three gallons of bloody, purulent fluid were withdrawn by means of a canula. 1 University Med. Mag., vol. 1, p. 273.