It is generally believed that sub normal temperature is always present when there is hitraperitoneal Immor rhage. Cases showing that there may be, on the contrary, a marked elevation of temperature. Reynier and Quenu (Soc. de Chir., Dec., '95).
Case in which there was an elevation of temperature of F. five hours after receipt of injury. Vautrin (La Med. Mod., Feb. 15, '9G).
In abdominal injuries due to blunt force the symptoms are referable to the abdominal wall and cavity, or both. Pain may be severe or slight. As an early symptom vomiting is dis tension may be slow or rapid, rigidity develops later, shock may or may not be present. The temperature and pu:se, par ticularly the latter, are considered of great importance. Opium, even in small doses, renders the diagnosis of such in juries difficult, and should never be ad ministered early. After an abdominal injury, if there is tenderness, accelera tion of the pulse tending to increase ever so slightly, together with abdominal dis tension and a rise in temperature, the diagnosis of a grave injury is made abso lute. In most cases but a few hours of close observation are required to estab lish the diagnosis. In such cases explora tory laparotomy should be performed at once unless the condition is so desperate that aniusthesia means certain death. R. S. Fowler (Y. Y. Med. Jour., Aug. 19, '99).
IItematemesis may assist in establish ing the diagnosis of lesion in the stom ach or the upper portion of the intestinal tract, while the presence of blood in the stools may do the same as regards lesions of the intestines as a whole, in cluding the colon. But, in itself, this symptom is, by no means, characteristic, since a violent strain may cause sudden engorgement of pharyngeal, gastric, rec tal, or lllemorrhoidal vessels and then, several days after the accident, blood rupture ensue. Even when present, streaks in vomited matter or stools are not always indicative of an alarming COD di t ion.
Blood in the urine is a more reliable sign of lesion in the urinary tract, espe cially the kidney and bladder. Anuria is also indicative of lesions in these or gans; but, as shock frequently arrests the flow of urine, it is only valuable as a symptom after all symptoms of shock have passed.
'hemorrhage into the orbits and from the ears are occasionally met with when the concussion has been very severe. This symptom does not necessarily in dicate that the injury is an unusually dangerous one.
A few hours after the accident the pain usually becomes reduced; the pa tient may be more quiet and, perhaps, somnolent, the pulse remains in its former condition. This period lasts between twelve and twenty-four hours. If at the end of this time there be no complication, a visceral lesion is probably not present. If, on the con trary, the symptoms gradually increase in intensity, the likelihood of grave in jury is very great.
In the light of present knowledge, however, the practitioner should not de lay active procedures until the patient's life becomes compromised by permitting the mechanical injury produced to start an infectious process. when the manner in which the injury was inflicted and the force applied tend to suggest serious in ternal lesion.
Diagnosis.—The diagnosis should pri marily be based upon the history of the accident, the manner in which the jury occurred, the shape of the body, or bodies, by means of which the trauma tism was inflicted, and the degree of cussive force applied, and, secondarily, upon the symptoms present.
Lesions of the Intestinal Tract.—Ya lions theories have been advanced as to the manner in which rupture of the intestine is brought about, but experi ments have shown that squeezing of the gut between the compressed abdominal wall and the vertebral column is the main mechanical factor brought into action. Crushing against the ilium is rarely produced. Another, although rare, cause of rupture is the presence, in the intestinal tract, of liquid or liquid material, the sudden circum scribed pressure exerted upon the gut causing it to burst, through overdisten sion. The small intestine is the seat of lesion in 75 per cent. of the cases of rupture in the course of the intestinal canal. Hence the importance of care fully ascertaining in each ease the direc tion from which the percussive force came, the intensity of that force, and the relative position of the organs between the site of pressure and the spinal column.