Page images
PDF
EPUB
[merged small][graphic][graphic]
[merged small][graphic][graphic][merged small][merged small][merged small][merged small]

GEO. F. SHEARS, M. D. H. V. HALBERT, M. D.

C. GURNEE FELLOWS, M. D.
Jos. P. COBB, M. D.

E.S. BAILEY, M. D.

VOLUME XXV

JANUARY-DECEMBER

1904

ERA PUBLISHING COMPANY

CHICAGO

CH. GATCHELL, M. D., EDITOR

Vol. XXV.

CHICAGO, JANUARY, 1904

No. 1

PROFESSOR OF SURGERY IN HAHNEMANN MEDICAL COL

LEGE AND HOSPITAL, CHICAGO.

ORIGINAL ARTICLES abdominal viscus is ruptured, no external

wound being present?

The answer to this question may be RUPTURE OF ABDOMINAL VISCERA

facilitated by briefly reviewing the sympWITHOUT EXTERNAL WOUND.*

toms of shock which may be present BY GEO. F. SHEARS, M. D.,

without rupture of any viscus. From a

standard surgery (Park) we copy the folWere the surgeon compelled to deal lowing symptoms: “Pallor of the skin solely with the best method of treatment and visible mucous membrane, with corof rupture of certain abdominal organs it

responding coldness of the same; dilated might be a difficult task, but, his line of

pupil, retracting slowly to light; irregu: action being clear, it would not involve

larity of the heart's action, with weak the mental perturbation or necessitate the

circulation, or thready imperceptible careful judgment that is demanded in pulse; irregular respiration; breathing the question, Is there in this case, in

both very irregular in rate and depth; which no external wound is present, a

mental apathy; loss of voluntary muscle rupture of an abdominal viscus?

movement; impairment of superficial senThere are cases in which this question sibilities; occasional nausea and vomiting, is answered with no difficulty whatever,

or, in exceptional cases, of erethistic type; and others in which its answer is attended

restlessness, with irregular pulse and diwith the greatest uncertainty, and can not

lated pupils." be positively stated until an exploratory

How do these symptoms compare with cæliotomy has been made.

those present in cases in which an operaBetween these two extremes are many

tion or post mortem has determined the cases in which a close and careful analy

actual lesion, and what symptoms are to sis of all symptoms present may enable

be relied upon as indicating the necessity one to avoid the ruinous policy of delay

for operation ? when rupture has actually taken place,

Let me quote a few cases as best illusand the equally dangerous policy of ac

trating the method of arriving at a contion when rupture has not taken place.

clusion: For, safeguard it as 'we may, the open

CASE I. RUPTURE of the KIDNEY. A ing of the abdominal cavity unnecessar

little girl, aged twelve years, was run over ily is neither conducive to the present or by express wagon. Immediately after the future comfort of the patient. Neither is accident the child was pulseless; pale ; it a stimulant to the bruised, shocked or cold sweat; no external sign of injury. injured, when unnecessary. It does not In one half-hour the pulse went up to add to the balance in the favor of recov- 120; temperature subnormal; abdomen ery, but may of itself be the straw to turn then sensitive, rigid, more on the right the fatal balance.

side than on the left. Passed bloody What symptoms are present when an urine. Diagnosis of ruptured kidney.

Lumbar incision was made on the right * Paper read at the meeting of the Clinical Society of Hahnemann Hospital,

side. Found rent in the peritoneum, and

146113

« PreviousContinue »