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

  • Martin, Edward, 1859-1938.
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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    It is well known tliat nearly all cases of obstruction terminating fatally are complicated by peritonitis, even though no perforation can be demonstrated; the distended and congested bowel wall allowing free passage of septic irritating matter. This peritonitis, not due to perforation, is at first a progressive fibro-purulent form, though it may be suddenly converted to a diffuse form. Intestino-peritoneal Septicemia. — Under this heading Verchere describes an abdominal affection characterized by consti- tutional symptoms, with locally marked mefeorism. Death occurs, usually, between the eighth and twelfth day ; rarely befi^re the sixth day. At the autopsy a small quantity of sero-sanguinolent fluid is found in the peritoneal cavity; this is at times fetid, but no adhesions, no signs of peritonitis are observed. It was for this condition that Marion Sims, who described it accurately and assigned the causative role to septic absorption, ad- vised abdominal section. Barnard and St. Laurent have also clearly described the condition, as has Jobert under the heading A Latent Form of Peritonitis, of which Meteorism is the most Characteristic Symptom. The cause for the constitutional symptoms of this form of ab- dominal trouble, which is commonly termed peritonitis, is probably filtration and absorption of the septic products of decomposition within the bowel. Symjjfoms of acute peritonitis.—AYliere inflammation is due to perforation the onset is usually sudden, and is characterized by in- tense pain with symptoms of collapse; this latter condition may rapidly become more marked, and the patient may perish in the course of a few hours. Commonly, the pain is shortly followed by abdominal distention and tenderness. The respirations are entirely thoracic, the diaphragm being either paralyzed by extensive inflammation or not acting on account of pain. The pulse is commonly rapid and wanting in power; during the height of the inflammation it may be hard and small, the so-called wiry pulse. There is obstinate vomiting of thin, bile-stained matter, and the bowels are confined.