11 tli March 1892 with the following wounds supposed to have been inflicted by thieves at
night.
Injuries.
wound (incised) with clean dorso-lumbar left the edges region of back, inches long and 2 transverse in direction inches wide, gaping, semilunar in shape with the the lower, and on separaupper flap overhanging ting the lips of the wound, a wide gap was seen, through which the upper extremity of the left, kidney could be felt, and the inner surface of the spleen with its vessels, &c? entering the hilum distinctly seen moving synchronously with the action of the diaphragm during respiration. 2. Penetrating wound (incised) situated in the right lumbar region of back above the crest of ilium, 2? inches in length, oblique in direction, and leading with the abdominal cavity in the direction of the false pelvis, as was ascertained by means of a probe. There was no protrusion of the bowels or any of the viscera through the above wounds. Incised wound of the right cheek over the 3. light superior maxillary and malar bonea extending down to the periosteum of the bones, and of this shape? 1.
Penetrating
on
the?right
I was sent for nearly twelve hours after the wouuds had been inflicted, and although there had been some hemorrhage previous to my arrival, yet it was insignificant compared with the gravity of the injuries. The patient was conscious when I saw him; but his friends stated that soon after the receipt of the injuries he became unconscious. The wounds were washed with perchloride of mercury lotion 1 in 5000 (warm), and after thorough cleansing the edges were brought into perfect coaptation with silver wire sutures. Iodoform sprinkled freely over the wounds, and carbolic oil (1 in 40) dressing with a piece of lint saturated in it, and a mercurial veil over this, and over all cotton wool and
bandage
applied.
R
Pil opii. gr.i given immediately>nd to be repeated ...
To be
PENETRATING WOUNDS OF THE ABDOMINAL CAVITY--TREATMENT?RECOVERY. By
Surgeon-Capt.
G. H.
FINK,
i.m.s.
Maeiamad, aged 20 years, Mahometan male was admitted into the Bijuor Hospital on the
Diet.?Milk
only.
11th 12th 13th
Temperature. March?E.?99'2?F. ?
?
M.?99?F. E.-99-4?F. M.?98-4?F. E.?98?F.
at bed time.
176
INDIAN MEDICAL GAZETTE.
14th March.?The wounds
tiseptically Patient
as
were
dressed
an-
before.
doing
very well. silver wire sutures removed. Union by first intention has taken place. No discharge or signs of inflammation 1 C)th
March.?The
present.
Dressed
as before. Patient doing well. The patient was kept in
for a longer and period, being police dangerous in character from its anatomical situation and depth of penetration into the abdominal cavity?with wound of the peritoneum which is such an important structure in the human body and plays such a grave part in case3 where it is wounded. The patient made a perfect recovery, and was discharged from hospital after the lapse of a month as cured.
hospital
case
a
which is one of exceedinto consideration all the circumstances connected with it and the delay in its treatment antiseptically, makes one ask the questions: are wounds of the peritoneum equally dangerous in the various situations of the abdominal cavity ? It seems to me that those of the portions peritoneum which lie anteriorly and laterally are more prone to take on severe inflammatory action when wounded owing to the abdominal breathing, which brings into action certain muscles which aid the act, and also to the lack of support and a certain degree of pressure aud disturbance through the vermicular con-, tractions of the intestinal tract. In the posterior portions the peritoneum has firmer support in the strong and powerful muscles of the back, and iu the dorsal decubitus it is not subjected to the disturbance that the anterior and lateral portions are in the act of respiration, which act in man is abdominal more than thoracic. Moreover, the diaphragm in its action, while descending tends to push the organs downwards and somewhat forwards, and hence disturbs the anterior portion of the peritoneum for more than the posterior, and one can understand that wounds anteriorly are subject to greater disturbances iu the act of healing than those situated posteriorly or postero-laterally. I have not had experience of abdominal wounds, penetrating in their nature, to be in a position to offer an opiniou as to their relative dangers in their various situations; but it is one worthy our attention and investigation, iu order that the least inflammable parts be chosen for operation of the various diseases which the organs are subject to. Again, another question arises with reference to the question of Peritonitis, viz., that some individuals are more prone to it than One could of course naturally conclude others. from the experience of those who have given Remarks.?This
ing interest, taking
case
[June
1892.
their attention to the subject of inflammation alone?no matter in what portion of the body it happens to occur?how, in one case, it takes on a kindly action and heals with scarcely any disturbance; whilst in others it takes on an angry erysipelatous character and threatens life seriously and often proves fatal. The result depends so much upon the mode of life and habits of the individual, and upon his temperament largely. The case in point was a man who was thin and spare and very anaemic. Judging by analogy, I should think that it is these unhappy individuals, if so they can be termed, who are after all happiest in serious matters where inflammation would be expected, in another class of individuals, of a plethoric habit to extinguish life. I have been able frequently to predict in eye cases after the operation for cataract, whether the individual is likely to suffer from severe, medium or no conjunctivitis at all by simply the appearance of his conjunctiva before operation ; and in most cases my predictions have been true, particularly in the cases where no
conjunctivitis
was
expected.
T'sey
are
usually
who are almost, bloodless, nearly chlorotic in their tint, and after the lapse of four days after operation, no sign of conjunctivitis is present, and the line of union after linear extraction with or without iridectomy, is scarcely It is in such cases visible to the naked eye. that wounds seem to heal more kindly than in the florid, healthy and plethoric patients. Such being the case, is it not an advantage in a severe operation, such as ovariotomy or other major operations to operate on your anaemic patient, rather than feed him up and dose him with tincture of steel and other tonics ?
patients