On penetrating gunshot wounds of the abdomen : an experimental study and clinical review / by Aug. Schachner.

  • Schachner, August, 1865-1941.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On penetrating gunshot wounds of the abdomen : an experimental study and clinical review / by Aug. Schachner. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    pital it was found tliat a ball of a .32 calibre had entered the left hy- pochondriac region, passing downward, backward and inward, lodg- ing itself against the body of a lumbar vertebra, and in its transit half severing the descending colon and a lumbar artery near its origin, com- pletely filling the cavity with blood. Notwitstanding an operation upon entrance by the visiting surgeon, the man sank 12 hours there- after from haemorrhage. Prominent among the local symptoms are vomiting, pain, abdominal distension, with or without loss of the area of he- patic dulness, the escape of blood, bile or faeces from the ex- ternal wound, and in wounds of the kidney or bladder, bloody urine. The vomit may or may not contain blood, and if the latter, it generally indicates a perforation of the stomach, but the same may also result from a non-penetrating wound of this organ. The pain is variable, and often severe, and local- ized in character. Abdominal distension with loss of the area of hepatic dulness indicates the escape of gases into the peri- toneal cavity. Tympanitis without such indicates an accumu- lation within the intestinal cavity, and may occur in the ab- sence of a lesion. When unmistakable escape of bile or faeces occurs externally, it is a positive proof of a wound of the liver or intestines. With the exception of a few drops, haemor- rhage from the external wound seldom occurs. Bloody stools, or haemorrhage within the rectum, may also occur in perforations as well as partial divisions and contusions of the intestines, and when its occurrence is rapid it points to injury of the large intestines. Unless the case'be one that tends to an uneventful recovery, the secondary symptoms worthy of note are generally those of peritonitis, septicaemia, or pyaemia, the symptoms of which are already too common to require repetition here. Occa- sionally, however, an intoxication is met with to which Vechere has given the name of intestino-peritoneal septicae- mia, and for a review of the latter I refer to the article by Stimson1 on the same subject. The author's language of the review is borrowed here at length. 'New York Medical Journal, 1889. Vol. II.