Statistics of 1lS cases published since 1878, 50 of which were fatal. In 14 of these the fatal result was due to primary, continuous, and secondary hremorrhages combined with shock. while suppuration, including peritonitis. caused death in 16 cases. W. W. Keen (Annals of Surg., Aug., '96).
Case of boy run over by heavy wagon, resulting in fracture of right lower ribs; symptoms of internal hiemorrhage pointed to right kidney. When abdo men was opened, spleen bad been com pletely severed from remainder of organ and forced to right side of abdomen. Right kidney was so badly crushed that it had to be removed. Remnant of spleen removed. Boy died in twenty four hours. At autopsy it was found that left kidney had been torn completely through. Robert Abbe (Med. Record, Apr. 23, '9S).
Injuries to the ureter in addition to the general symptoms of shock, which may subside within a few hours, are characterized by the appearance of little blood in the urine and perhaps only an occasional clot. If no lesion of an ab dominal organ accompanies rupture of the ureter, no very great symptoms will be manifested. Transient hmmaturia should not be overlooked, especially with persistent pain in the side. C. L. Scudder (Boston Med. and Surg. Jour., May 2, 1901).
Prognosis. — Death almost invariably attended rupture of the intestinal tract prior to the introduction of exploratory abdominal section, and prompt resort to active surgical procedues, when neces sary, is indicated.
Chavasse has collected thirty-six. cases of kicks in the abdomen by horses, thirty-five of which died. A man who has been kicked in the abdomen by a horse has one chance out of three of dying. More than one-half of personal cases saved, thanks to intervention, although it is true that some cases were opened which might have recovered spontaneously. The laparotomy did no harm. Intervention should be practiced when there are sharp, local pains and rapid elevation of temperature. Kir misson (La France M6d., No. 14, '95).
Three hundred and seven cases of con tusions of the abdomen, from the kick of a horse, treated without operation, found in literature; 215 recovered and 92 died. Of 36 cases in which operation was practiced, 26 died and 12 recovered, and in only 3 of these could operation have been considered as imperatively necessary. As soon as a patient is kicked
in the abdomen by a horse, he should be taken to a hospital, a careful history of the accident taken down, and the pa tient treated expectantly. He should be placed in bed, heat applied, pain relieved, and should be given no food; every half hour the temperature and respiration should be recorded, with a note of the general condition and the local symp toms. The moment that peritoneal reac tion or general infection is evident the abdomen should be opened. Seven eases personally witnessed in which recovery occurred without. operation. Nimier (Arch. de Mod. et de Pharm. Mil., Mar., '9S).
Where abdominal contents are rupt ured 00 per cent. of cases die. Early operation favored. John T. Rogers (Jour. Amer. Med. Assoc., July 9, '98).
As to the liver, as late as 186-1 wounds of this organ were considered as practi cally hopeless in every instance. While a very small proportion of these cases recover without surgical interference, as is shown by the scars occasionally found in the hepatic parenchyma, the fact re mains that an exploratory laparotomy, permitting the surgeon to quickly arrest the loss of blood in case of hoemorrhage and to rid the peritoneal cavity of ac cumulated extraneous fluids, has greatly reduced the mortality. The prognosis becomes much more unfavorable when peritonitis has set in, but a fatal issue may sometimes be averted, even in ad vanced cases of this complication, by surgical intervention.
Case in a girl, aged 9, who, four days after receiving a kick, came under treat ment, with well-marked peritonitis. On the fifty-second day abdominal section; adhesions found everywhere. Neverthe less almost steady recovery. A year afterward the child seen and in perfect health. Greiffenhagen (St. Petersburg med. Woeh., Apr. 25, '92).
The same remarks apply to rupture of the gall-bladder.
Case of rupture of the gall-bladder duo to a blow upon the abdomen. Three weeks after the accident laparotomy was performed with the removal of three quarts of brownish fluid contain ing numerous blood-clots. Convalescence slow, but complete. Thomas (Deutsche med. Woch., July 14, '92).