Reviews of the literature of 32 cases collected, 22 of which are intra- and 10 extra- peritoneal. Of the intraperi toneal cases 10 recovered. Of the extra peritoneal ones 7 recovered. Sch!anger (Archly f. kiln. Chin, 13. 43, '92).
As a result of surgical intervention, the mortality from traumatic rupti.re of the bladder has, during the past fifteen years, been reduced from 90 to about 54 per cent. Of IS cases of extraperitoneal rupture treated by operation, 10 ended in recovery and S in death. Of 34 patients in whom the peritoneal covering of the bladder had been involved in the injury, 14 recovered after operation and 20 died. Sieu• (Archives Gen. de Med., Feb., Mar., '94).
Treatment.—SHOCK.—Shock or col lapse, though unreliable as a sign of severe injury to the abdominal viscera, is, nevertheless, an alarming condition, especially if the temperature is subnor mal and the breath is shallow, and it should at once receive attention. The patient is placed in bed with the head low, and a free supply of pure air in slued, supplemented with oxygen if ticable. Hot-water bottles are placed around him and he is covered with blankets previously warmed, if possible, or wrung out of hot water.
Two main elements have to be borne in mind in this class of cases: (1) that the state of shock is due to a direct com motion of the sympathetic system with probable inhibition of the heart's action, and (2) the possibility of an internal lesion which may involve death by ex sanguination or the outpour into the peritoneal cavity of gastric or intestinal fluids. While the first condition calls for stimulants adapted to sustain the flagging heart and restore the action of the vasomotor, the agents employed should not be administered by the mouth, since, in case of rupture of the stomach, the duodenum, or jejunum, a portion, at least, of the fluid may be added to those that may have found their way into the peritoneal cavity.
Rectal and subcutaneous injections should, therefore, be resorted to.
If no remedy be at hand, subcuta neous injections of 1 drachm of whisky or brandy may be employed, and re peated every five or six minutes until reaction occurs. A turpentine stupe or a fresh mustard poultice (not plaster) over the xiphoid cartilage, and a rectal injection composed of a tablespoonful of turpentine, a raw egg, and a teacup ful of warm water, sometimes act with surprising rapidity. Hypodermic injec tions of ether, or, better still, tincture of digitalis with/ 120 grain of atropine, repeated in fifteen minutes, arc nec essary to sustain cardiac action. After the second dose the digitalis may be injected alone several times more. These measures are greatly assisted by galvanic stimulation of the phrcnie nerve, the negative pole, moistened in a solution of chloride of ammonium, being applied to the neck in the depression immediately in front of the sterno-mas told muscle, and the positive over the epigastrium.
These means are sometimes inefficient and hypodermoclysis should be per formed. If a fatal issue seems inevitable, saline transfusion is indicated.
When the case is not very urgent, and the operator can act with deliberation, hypodermoclysis should be performed. When the symptoms are alarming and life is about to ebb, saline transfusion is indicated. T. L. Rhoads (Then. Gaz., Oct. 15, '97).
Administration cf morphine indicated in cases of great shock after injury. Use of drug should not be continued, one or two hypodermics usually being sufficient. McBurney (Med. Record, Apr. 23, '95).